Course: International Nutrition
Presents major nutritional problems that influence the health, survival, and developmental capacity of populations in developing societies. Covers approaches implemented at the household, community, national, and international levels to improve nutritional status. Explores the degree to which malnutrition can be prevented or reduced prior to achieving full economic development through targeted public and private sector interventions that address the causes of malnutrition.
The purpose of this course is to familiarize and engage the student in (a) major existing or emerging issues in international nutrition that influence the health, survival, and development capacity of people living in developing societies and, (b) various direct and indirect approaches to improving nutritional well-being of populations. One basic premise in the course is that large segments, indeed the majority of people in most developing (low income) countries remain food insecure and nutritionally deprived with respect to both energy-yielding macronutrients (notably protein and fat) and essential micronutrients. Their survival from childhood through adulthood is threatened and their quality of life suffers because of undernutrition, the severity of which ranges from chronic food insufficiency to famine. Infants, young children and women of reproductive age are considered most at-risk of the consequences of undernutrition, which include infection and complications during pregnancy. Although advances in socio-economic and development status tend to reduce undernutrition, the course explores interventions that can selectively and progressively reach those in need and affordably reduce food and nutritional insecurity, and enhance the public's health prior to achieving substantial gain in economic development.
A second reality of malnutrition in developing countries is a rising tide of obesity affecting certain regions of the world (eg, Latin America, Northern Africa and East Asia) and, within most low income countries in certain population segments. These populations are experiencing a "nutrition transition," that may be giving rise, in part, to an increasing trend in non-communicable disease as cause of death.
One can conceptualize a "continuum" of nutritional status on which populations lie, ranging from severe undernutrition and milder degrees of deprivation, to "normal" status, to being mildly overweight through to obesity. A given population may exhibit greater nutritional stress at either extreme. Societies where both under- and overnutrition coexist as public health problems are said to be experiencing a "dual burden" of malnutrition. Where a population lies on the continuum can be thought to evoke different individual, household, community, national, and international responses. Preventive responses are often modified by socio-economic, infrastructural, cultural, civil, and political considerations. Thus, nutritional problems of public health importance in developing countries have complex and, usually, long-acting causes. Adequate solutions to these causes (a) often require action across multiple sectors of society, (b) should be evidence-based and (c) pursued in the context of national policy and resources.
Most of the attention in this course addresses the burden and consequences of undernutrition, including protein-energy malnutrition and micronutrient deficiencies, their causes, epidemiology and approaches to prevention at various levels of society. Several "emerging" or special topics will be also be addressed, including the "nutrition transition" toward obesity, nutritional interactions in HIV/AIDS affected populations, nutrition and reproductive health, and the epidemiology of famine.
There are no formal prerequisites for taking the course. However, students are expected to be familiar with basic principles of nutrition, study about the types and causes of malnutrition, and be or become familiar with resource constraints typically facing developing countries. Students are strongly encouraged to broaden their reading in these areas during the term in order to participate in an informed way in class discussions, especially in areas of assessment and intervention, and to write an authoritative paper on nutritional problems and programs within a selected country.
The primary text for this course is:
West KP Jr, Caballero B, Black RE. Nutrition. In: Merson MH, Black RE, Mills AJ (eds). International Public Health: Diseases, Programs, Systems, and Policies. Sudbury, MA: Jones and Bartlett Publishers, 2nd edition, (in press) 2005.
Allen L, Gillespie S. What works? A review of the efficacy and effectiveness of nutrition interventions. ACC/SCN Nutrition Policy Paper no.19, ADB Nutrition and Development Series No. 5. Manila: Asian Development Bank, 2001.
Supplementary readings will be handed out throughout the course or assigned from websites.
The course will focus on a discrete number of international nutrition issues. A lecture will be given on each topic by a course instructor or guest speaker. Students will be given either power point handouts or lecture outlines. Lecture material will be available on the course website. Supplementary readings will also be on reserve, and can be signed out overnight, for those wanting to enhance their reading about nutritional topics.
Each lecture will be ~1 hour in length, leaving hopefully ample time (~20-25 minutes) for discussion based on the contents of the lecture, required readings and other enrichening experiences students bring into the course. At the end of each class, we will try to summarize and emphasize important points related to the topic. Most of the time students may be called upon to provide this summary.
> Summary of Major Assignments
TERM PAPER: COUNTRY SITUATIONAL ANALYSIS
Acting as "consultants" to a Minister of Health, students will be expected to write a brief (6-page, double-spaced), critical paper on nutritional problems within an assigned country (described elsewhere). Students will be asked to submit the names of four developing countries in order of preference. Countries will be assigned on the 3rd day of class. Course faculty will present a summary of term papers on the last day of class.
There are no quizzes, no mid-term and no final examination. Numerical grades will be based on the following:
Term paper 70%
Quality (vs frequency) of class participation 20%
Class attendance 10%
Numerical grades will be calculated and, based on the curve of their distribution, letter grades (A,B,C,D, or F) will be assigned.