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CHAPTER 3(CONTD..)

PUBLIC NUTRITION AND HEALTH

STRATEGIES /INTERVENTIONS TO TACKLE NUTRITIONAL PROBLEMS:

Need of the hour is to adopt multidisciplinary approach to tackle the health problems in our country. In 1993 Government of India adopted the National Nutrition Policy (NNP). This was framed by the Dept of Woman and Child Development. 

NNP advocates,  Comprehensive,  Integrated and Inter-sectoral strategy for alleviating the multi-faceted problem of malnutrition and achieving the optimal state for the people.

DIRECT SHORT TERM STRATEGIES:

a. Integrated Child Development Scheme (ICDS) to cover all vulnerable children in the age group of 0-6 years and all pregnant and lactating mothers.

b. fortification of essential foods . eg iodized salt.

c. production and popularization of low cost nutritious foods from indigenous and locally available raw material.

d. control of micronutrient deficiencies among the vulnerable group. Like deficiency of iron, iodine, vitamin A, folic acid among the pregnant ladies, lactating mothers and adolescent girls.

INDIRECT LONG TERM STRATEGIES:

a. Ensuring food security by improving the availability of foods.

b. Improving the dietary pattern by ensuring the availability of nutritionally rich foods.

c. Alleviation of poverty among the rural and urban poor by

v  generating employment opportunities

v  public distribution system.

v  Health and family welfare

v  Prevention of food adulteration

v  Involvement of media

v  Basic nutrition and knowledge

v  Effective monitoring of the nutrition programmes.

v  Improvement in the status of women.

v  Implementing of land reforms

v  Education, literacy and community participation

 Strategies for combating the public nutrition problems can be broadly classified into two groups:

A. Diet or food strategies

B. Nutrient-based approach or medicinal approach

A. DIET OR FOOD STRATEGIES:

These are preventive and comprehensive strategies that use food as a tool to overcome nutritional deficiencies.

They help in preventing micronutrient deficiencies because they increase the availability and consumption of the micronutrient rich foods.

ADVANTAGES:

This strategy is sustainable and has long term benefits.

It is cost effective

Can be adapted to various cultural and dietary traditions

Does not carry any risk of overdose or toxicity.

IMPORTANT FOOD BASED APPROACHES:

Dietary diversification and modification

Horticulture interventions such as kitchen gardening, health and nutrition education and food fortification.

B.NUTRIENT BASED OR MEDICINAL APPROACH:

Nutrient supplements are given to vulnerable groups (those who have the deficiency and those who are at risk).

Supplementation programmes are expensive.

They have the problem of adequate coverage of  population.

Key target groups are different for various nutrients.

NUTRIENT SUPPLEMENTATION:

Appropriate for- Therapeutic treatment and for prevention of deficiencies in a specific target group.

Advantages – timely and sustainable

Disadvantages – costly than other measures and has a narrow scope of coverage.

  

FORTIFICATION:

Appropriate – prevention

Advantages – is highly cost effective, has a wide coverage  is sustainable.

Disadvantages – requires participation of food industry, does not create and awareness among the population, does not lead to long term dietary changes.

DIETARY DIVERSIFICATION:

Appropriate – prevention

Advantages – highly cost effective, wide coverage sustainability, provides many micro nutrients  simultaneously, improves food security.

Disadvantages – requires changes in eating behavior, requires economic development to be feasible, requires change in agricultural policies.

NUTRITION PROGRAMMES IN OUR COUNTRY

1. ICDS: it is an outreach programme for early childhood care and development.

2. Nutrient Deficiency Control Programmes such as National Prophylaxis programme for prevention of blindness (Vitamin A), National Anaemia control programme, National Iodine Deficiency Disorder Control Programme.

3. Food Supplementation programme – MID DAY MEAL PROGRAMME

4. Food security programmes such as Public Distribution system, Antodaya Anna Yojana, Annapurna Scheme, National Food for Work Programme

5. Self employment and wage employment schemes. These are  SOCIAL SAFETY NET PROGRAMMES.

HEALTH CARE:

Health is a fundamental human right.

It is responsibility of the Government to provide adequate health care to the citizens.

Health care is medical care, multitude of services to promote, maintain, monitor,restore health.

In India, health care is provided at three levels – primary, secondary and tertiary.

Primary level – it is the first level of contact with the individual, family and community with the health system.  In India this is provided through the network of PHCs (Primary Health Centres)

                      

Secondary level – It is the second level of contact and services are provided through the district hospitals and community health centres.  These centres are the first referral level.

Tertiary level – It is the third level of contact. It is the highest level of health care. It deals with more complex health problems. This is provided through medical college hospitals, regional hospitals, specialized hospitals and All-India Institutes.

SCOPE :

ROLE OF PUBLIC NUTRITIONIST:

The public nutritionist is eminently suited to participate in all the strategies of health promotion and prevention.

KEY AREAS:

v  Nutritional science,

v  Nutritional needs  in health

v  Diseases throughout the life cycle

v  Nutritional assessment

v  Nutritional care

v  Food science and art

v  Educational methods

v  Use of mass media

v  Programme management

Public nutritionists work in the following areas:

1. Outreach programmes undertaken by hospitals for the prevention, promotion and education of masses.

2. As a part of ICDS at different levels on the basis of qualification and experience.

3. As consultant, advisors at Government level in the policy making committees. 

4. In all developmental programmes of the Government, voluntary organizations and international organizations such as UNICEF, UNESCO, WHO, GAIN, USAID, IFPRI and micronutrient programme etc.

5. Can be a part of the organizations thata take up large scale feeding programmes for young children, school children, adolescents, pregnant and lactating mothers, elderly and challenged individuals.

6. Nutritionists or school health counselors in the school health programme

7. Teaching and research

8. Entrepreneurship

9. Industry as a part of corporate social responsibility and welfare activities.

10. Developer of communication material and educational packages for training purposes.

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APARNA SHARMA 

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