Public Nutrition and Health Chapter Notes | Home Science for Class 12 - Humanities/Arts PDF Download

Introduction

• Good nutrition is the foundation and cornerstone of health, as studied in Class XI under basic concepts of nutrition, health, physical fitness, and wellness.
• Public health refers to collective actions taken by society to protect and promote the health of entire populations.
• Public health nutrition focuses on preventing both undernutrition and overnutrition to maintain optimal nutritional status for populations.

Significance

• Malnutrition is a critical issue, underlying at least 50% of deaths in children under five years of age.
• Nutrition-related problems in India are alarming:
• Approximately one-fifth of infants are born with low birth weight (less than 2.5 kg), which can adversely affect growth, development, and adult life, potentially leading to child mortality.
• Widespread growth retardation exists among preschoolers from socio-economically disadvantaged families, with nearly half suffering from mild to moderate undernutrition.
• A large proportion of children and adults experience micronutrient deficiencies, known as hidden hunger, particularly in iron, zinc, vitamin A, vitamin C, vitamin D, iodine, folic acid, and vitamin B12.
• Uncontrolled nutritional problems can impair physical growth, leading to smaller adult stature, and affect mental and cognitive development, reducing productivity and quality of life.
• Malnutrition results in significant economic costs, with productivity losses estimated at over 10% of lifetime earnings for individuals and 2-3% of the nation’s gross domestic product.
• Addressing malnutrition can drive India’s economic growth and national development.
• While undernutrition is predominant, overnutrition is increasing due to changes in dietary patterns and lifestyles.
• Lifestyle changes include increased sedentariness, reliance on faster transportation, reduced walking, and less physical activity, with children in large cities playing fewer outdoor games.
• Dietary patterns have become less healthy, with increased consumption of processed foods, fast foods, snacks, and western-style foods (e.g., burgers, pizzas, biscuits, chocolates, cakes, pastries, soft drinks) and Indian foods like mithais and samosas, which are high in energy, sugar, fat, and salt, and low in nutrients and fiber.
• Intake of whole grains, pulses, vegetables, and fruits has decreased, contributing to undesirable weight gain, overweight, obesity, and non-communicable diseases such as hypertension, heart disease, diabetes, cancer, and arthritis.
• Non-communicable diseases impact physical health, quality of life, and increase financial burdens.
• India faces a “double burden of malnutrition,” with coexistence of undernutrition and overnutrition.
• While communicable diseases like smallpox have been controlled, newer diseases like HIV/AIDS and persistent ones like tuberculosis, hepatitis, and malaria are increasing in prevalence.
• Communicable diseases have worse outcomes for undernourished individuals or those with compromised immunity due to obesity, diabetes, or HIV/AIDS.
• These challenges require a trained cadre of public health professionals, including public health nutritionists, to address treatment, control, and prevention.

Basic Concepts

• Public health nutrition is a field focused on promoting good health by preventing nutrition-related illnesses and problems in populations through government policies and programs.
• It employs large-scale, organized, multidisciplinary approaches to address issues affecting large groups, necessitating collective action.
• The field is multidisciplinary, grounded in biological and social sciences, and differs from clinical nutrition and dietetics by targeting community and vulnerable group issues.
• Public nutrition integrates knowledge from nutritional, biological, behavioral, social, and managerial sciences.
• It is described as the art and science of promoting health, preventing diseases, and prolonging life through organized societal efforts.
• A community is a group sharing common characteristics, such as language, lifestyle, or health problems.
• Public nutrition professionals promote good nutrition and prevent nutritional problems by identifying issues, understanding their causes, and planning, implementing, and evaluating strategies.
• Nutritional problems are linked to multiple interacting factors at various levels, including:
• Economic factors, such as availability of financial resources.
• Agricultural policies affecting food production and prices.
• Availability and access to health care facilities and services.
• Government policies, political will, and socio-cultural factors.
• Poverty is often the underlying cause, exacerbated by lack of access to basic amenities like toilets in rural households, leading to poor sanitation, loss of work days, and economic losses.
• A significant proportion of the population lacks safe drinking water, resulting in work days lost to waterborne diseases.

Nutritional Problems in India:

Protein-Energy Malnutrition (PEM):

• PEM is prevalent globally, more so in developing countries than industrialized ones.
• It results from inadequate intake of macronutrients (energy and protein) relative to requirements.
• Children are at greatest risk, but PEM also affects adults, particularly the elderly, and those with diseases like tuberculosis or AIDS.
• PEM is assessed using anthropometric measurements (weight, height, head-chest circumference).
• Underweight is defined as body weight inadequate for age.
• Stunting is inadequate height for age, indicating short stature.
• Wasting is inadequate weight relative to height.
• Severe undernutrition due to food and energy deficiency is called marasmus.
• Protein deficiency causes kwashiorkor.

Micronutrient Deficiencies:

• Diets deficient in energy and protein are likely to lack micronutrients (minerals and vitamins), termed “hidden hunger.”
• Deficiencies of iron, vitamin A, iodine, and zinc are major public health concerns, with growing concerns about vitamin B12, folic acid, calcium, vitamin D, and riboflavin deficiencies.

Iron-Deficiency Anemia (IDA):

• IDA is the most common nutritional disorder globally, affecting both developed and developing countries.
• Vulnerable groups include women of childbearing age, adolescent girls, pregnant women, and school-age children.
• IDA occurs when hemoglobin production is reduced, leading to low blood hemoglobin levels.
• Symptoms depend on the rate of hemoglobin decline, including shortness of breath, fatigue, and lethargy during physical exertion.
• Manifestations include general pallor, paleness of conjunctiva, tongue, nail beds, and soft palate.
• In children, IDA adversely affects cognitive functions like attention span, memory, and concentration.

Vitamin A Deficiency (VAD):

• Vitamin A is essential for healthy epithelium, normal vision, growth, and immunity.
• VAD causes night blindness, progressing to complete blindness without intervention, and reduces resistance to infections, affecting growth.
• A vicious cycle exists between VAD and infections, with deficiency increasing susceptibility and infections increasing vitamin A losses.
• VAD is the most common cause of childhood blindness.

Iodine Deficiency Disorders (IDD):

• Iodine is necessary for normal mental and physical growth and development.
• IDD is an ecological issue due to iodine-deficient soil, prevalent in regions like the Himalayan belt (Jammu and Kashmir to Arunachal Pradesh), Andhra Pradesh, Karnataka, Kerala, Maharashtra, and Madhya Pradesh.
• IDD encompasses a spectrum of disabling conditions from fetal life to adulthood due to inadequate iodine intake.
• Insufficient iodine leads to reduced thyroid hormone production by the thyroid gland.
• Goitre (enlarged thyroid) is the most common manifestation in adults.
• In children, IDD manifests as cretinism.
• Iodine deficiency during pregnancy causes mental retardation and congenital abnormalities in the fetus, which are irreversible.
• IDD affects about 13% of the world’s population, with 30% at risk.

Strategies/Interventions to Tackle Nutritional Problems:

• A multi-disciplinary approach is needed, as emphasized by former Prime Minister Dr. Manmohan Singh, who called malnutrition a “national shame” and urged its eradication within five years.
• The government has implemented significant efforts, including POSHAN Abhiyaan (PM’s Overarching Scheme for Holistic Nutrition), launched in March 2018 in Jhunjhunu, Rajasthan.
• POSHAN Abhiyaan targets stunting, undernutrition, anemia (in young children, women, and adolescent girls), and low birth weight.
• It monitors and reviews the implementation of nutrition schemes, scaling interventions to all districts by 2022 (315 districts in year one, 235 in year two, and remaining in year three).
• The Ministry of Women and Child Development implements POSHAN Abhiyaan, using a robust multi-ministerial convergence mechanism to create synergy.

Direct Short-Term Interventions:

• Integrated Child Development Services (ICDS) covers vulnerable children aged 0-6 years and pregnant and lactating mothers.
• Fortification of essential foods, such as iodized salt.
• Production and popularization of low-cost nutritious foods from indigenous, locally available raw materials, involving women.
• Control of micronutrient deficiencies (iron, vitamin A, folic acid, iodine) among vulnerable groups (children, pregnant women, nursing mothers) through supplementation, free tablets, and other measures.

Indirect Policy Instruments (Long-Term Strategies):

• Ensuring food security by improving food availability.
• Improving dietary patterns by ensuring availability of nutritionally rich foods.
• Poverty alleviation for rural and urban poor through employment generation schemes, public distribution systems, land reforms, health and family welfare improvements, prevention of food adulteration, media involvement, basic nutrition education, monitoring of nutrition programs, improving women’s status, promoting education and literacy, and encouraging community participation.

Strategies to Combat Public Nutrition Problems:

Diet or Food-Based Strategies:

• Preventive and comprehensive, using food to address nutritional deficiencies.
• Effective in preventing micronutrient deficiencies by increasing availability and consumption of micronutrient-rich foods.
• Sustainable with long-term benefits, cost-effective, adaptable to cultural and dietary traditions, and free from overdose or toxicity risks.
• Approaches include dietary diversification and modification, horticulture interventions (e.g., home gardening), nutrition and health education, and food fortification.

Nutrient-Based or Medicinal Approach:

• Involves providing nutrient supplements to at-risk or deficient vulnerable groups, particularly for vitamin A, iron, and folic acid in India.
• A short-term strategy, often expensive, with challenges in coverage.
• Target groups vary by nutrient.
• The long-term goal is to shift from supplementation to food-based approaches.

Comparison of Interventions:

Nutrient Supplementation (Medicinal):

• Suitable for therapeutic treatment and prevention programs for specific nutrients and target groups.
• Advantages: Timely and sustainable.
• Challenges: More costly, narrow scope of coverage.

Fortification (Food-Based):

• Suitable for universal prevention.
• Advantages: Highly cost-effective, wide coverage, sustainable.
• Challenges: Requires research, food industry participation, does not raise awareness about nutrition importance, and does not lead to long-term dietary or behavioral changes.

Dietary Diversification (Food-Based):

• Suitable for universal prevention.
• Advantages: Highly cost-effective, wide coverage, sustainable, provides multiple micronutrients simultaneously, improves food security.
• Challenges: Requires changes in eating behavior, economic development, and agricultural policy changes.

Nutrition Programs in India:

1. Integrated Child Development Services (ICDS): An outreach program for early childhood care and development, targeting pregnant and nursing mothers and children up to 6 years.
2. Nutrient Deficiency Control Programs:
3. National Prophylaxis Programme for Prevention of Blindness due to Vitamin A Deficiency.
4. National Nutritional Anemia Prophylaxis Programme.
5. National Iodine Deficiency Disorder Control Programme.
6. Food Supplementation Programmes: Mid-Day Meal Programme.
7. Food Security Programmes:
8. Public Distribution System.
9. Antodaya Anna Yojana.
10. Annapurna Scheme.
11. National Food for Work Programme.
12. Self-Employment and Wage Employment Schemes: Social safety net programs.

Health Care:

1. Health is a fundamental human right, and the government is responsible for providing adequate health care.
2. Health care includes services to promote, maintain, monitor, or restore health, beyond just medical care.
3. In India, health care is provided at three levels:
4. Primary Level: First contact with the health system, provided through primary health centers (PHCs).
5. Secondary Level: Addresses complex health problems through district hospitals and community health centers, which serve as the first referral level.
6. Tertiary Level: The highest level, handling complex issues at medical college hospitals, regional hospitals, specialized hospitals, and All-India Institutes of Medical Sciences.

SCOPE

• Well-trained public nutritionists, also called community nutritionists, are equipped to participate in health promotion and prevention strategies.
• Key areas of expertise include nutritional science, nutritional needs across the life cycle, nutritional assessment, nutritional care, food science, educational methods, mass media, communication, and program management.

Work Areas for Community Nutritionists:

• Participating in hospital outreach programs for prevention, promotion, and education.
• Working at various levels in the national Integrated Child Development Services (ICDS), based on qualifications and expertise.
• Serving as consultants, advisors, or members of policy-making committees at the government level.
• Engaging in developmental programs of government, voluntary organizations, NGOs, and international organizations like UNICEF, USAID, GAIN, Nutrition International, TATA Trust, IFPRI, and other national and regional organizations.
• Involved in large-scale feeding programs for target groups such as young children, school children, adolescents, pregnant and lactating mothers, elderly, and challenged individuals.
• Acting as nutritionists or school health counselors in school health programs.
• Participating in corporate CSR programs addressing food and nutrition security for vulnerable groups.
• Opportunities exist in teaching, research, and entrepreneurship, developing communication materials and educational packages for those with adequate training.

Career Avenues:

• Community nutritionist in Preventive and Social Medicine (PSM) departments of hospitals.
• Nutrition programs of the government, such as ICDS and the Food and Nutrition Board.
• Nutritionists in voluntary organizations (regional, national, international).
• Consultants.
• Nutritionists or counselors for schools, industries, etc.
• Teaching and academics.
• Research.