Paper No.

: 16 Applied Anthropology
Module : 10 Public health Nutrition

Development Team

Principal Investigator Prof. Anup Kumar Kapoor

Department of Anthropology, University of Delhi

Dr. Rashmi Sinha

Paper Coordinator
Faculty of Anthropology, School of Social Sciences,
IGNOU, Delhi

Ms. Shumayla & Dr. Meenal Dhall

Content Writer Department of Anthropology, University of Delhi

Dr. Satwanti Kapoor (Retd Professor)

Content Reviewer
Department of Anthropology, University of Delhi
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 Description of Module

Subject Name Anthropology

Paper Name Applied Anthropology

Module Name/Title Public health Nutrition

Module Id 10

Contents:
1. Introduction
2. Public Health Nutrition
3. Difference between Public Health Nutrition and Community Nutrition
4. Malnutrition
4.1 Type of Malnutrition
i. Macronutrient Deficiency (Undernutrition)
a. Marasmus
b. Kwashiorkor
c. Marasmic Kwashiorkor
ii. Overnutrition
iii. Micronutrient Malnutrition
a. Iodine Deficiency Disorder (IDD)
b. Vitamin A Deficiency (VAD)
c. Iron Deficiency Anemia
d. Other Micronutrient Deficiency
5. Policy and Public Health Nutrition
5.1 National Nutrition Policy
6. Direct or short term Interventions
7. Indirect or long term Interventions

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 8. Importance of Public Health Nutrition
Summary

Learning Objective:
 To study public health nutrition and its components.

1. Introduction
Public health can be defined as the science and art of preventing disease, promoting health, efficiency
and prolonging life through organized community efforts, so as to enable each citizen to realize his/her
birthright to live healthy (Winslow, 1920), this has been viewed as the scientific diagnosis and
treatment of the community. In this regard community as a whole instead of an individual, is seen as a
patient. When focus shifted from an individual to community, processes and patterns begin to emerge
and combine to form unified whole (Keegan, 2005) with this approach, the focus is the community’s
strength and resilience instead of risks and diseases. Strengths of community may be psychological,
physiological, spiritual or social. They include factors like education, support systems, knowledge,
copying skills, communication skills, fitness, nutrition, self-care skills, etc. (Goodman, 1996).
Nutrition is an input to and foundation for both health and development. Health and nutrition are the
two things which should go hand in hand. Proper nutrition is the key to healthy body. Scientifically it
can be believed that nutrition guides the individual on the aspect and correlation of diet and health.
Healthy people are stronger and are more productive to create opportunities to progressively break the
cycles of both poverty and hunger in a sustainable way. Better nutrition is the leading entry point to
end poverty and is a milestone in achieving better quality of life.
The negative consequences of problems related to nutrition are malnutrition and chronic health
conditions like obesity, diabetes mellitus, cardiovascular disease and cancer (Dyer, 2004; Beaudry et
al., 2004). In addition, such conditions add significant burden to the world’s morbidity, mortality and
incapacity, despite the remarkable amount of biological knowledge accrued over the years (Beaudry et
al., 2004). WHO estimated that the prevention of the major nutrition-related health risk factors (poor
dietary habits, inactivity, cigarette smoking and alcohol use etc) could decipher into an advantage of 5
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 years of disability free life expectancy. A public health nutrition and a community health nutrition
approach will make it possible to reverse the course of major nutrition problems (CDC, 2007).

2. Public Health Nutrition

Public health Nutrition in simple language can be defined as the promotion of good health by primarily
preventing nutrition-related illness in a population. It is about applying knowledge to solve nutrition
related health problems. Applied nutrition professionals accentuate that “nutrition is just not a
discipline to study but rather it’s a problem to be solved”. Hence solving nutrition problems requires a
multidisciplinary approach. The knowledge base supporting public health nutritionist is developed over
the years and built on a foundation of physiology, biology, biochemistry, basic national sciences and a
wider understanding of social anthropology to understand the dietary pattern of different community
across the world. It notes the importance of scientific research into the basic mechanisms of nutrient
metabolism to assert that nutrition problems in both developed and developing countries cannot be
solved in the laboratory or clinic alone.
The limitations to populations achieving nutritional health fall in the social, cultural, economic and
behavioural dominions in the form of lack to access of food, appropriate distribution among or within
households and maladaptive health and food practices. Public health nutrition advances the knowledge
regarding role of nutrition in disease prevention and in promoting health and applies this knowledge to
plan, manage, deliver and evaluate the nutrition services and programs. Henceforth, the knowledge and
skills require to tackle these constraints are quite different from those of laboratory and clinics. They
require a different approach and training from that associated with the science of nutrition. Public
health nutrition was developed in the United States in response to some societal events and changes to
following situations (Frank-Spohrer, 1996; Kaufman, 2007)
 Infant mortality
 Epidemics of communicable diseases
 Malnutrition
 Access to healthcare
 Economic depression, wars and civil rights
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  Chronic diseases (obesity, diabetes mellitus, heart disease, cancer, osteoporosis, hypertension,
and cancer)
 Behavior-related/ lifestyle problems (inactivity, poor dietary practices, alcohol abuse and
cigarette smoking)
 Aging of the population
 Poverty and immigration
 Poor hygiene and sanitation
The major functions of public health nutrition are
1. The assessment and monitoring of the health and nutritional status of communities and
populations at risk to identify health problems and priorities
2. To assure that all populations have access to appropriate and cost-effective care, including
health and nutrition promotion and diseases prevention services, and evaluation of the
effectiveness of that care
3. The formulation of public policies designed to solve identified local and national health and
nutrition problems.

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 3. Difference between Public Health Nutrition and Community Nutrition
The term “community nutrition” is often used to reflect wide range of delivery settings and sponsoring
organizations for nutrition related services and programmes. The community nutrition services directed
to individuals and groups in communities and not community as a whole. On the other hand, the term “
public health nutrition” has used in terms of responsibilities carried out by health departments at local,
state and federal levels. The programmes offered by public health agencies are directed to
organizations, communities and systems and have their goal health promotion and disease prevention.
Moreover, public health nutrition is often involved in policy making.
Community nutrition efforts involve a wide range of programs which provide increased access to food
resources, nutrition education and information and health related care. They also includes efforts to
change behaviour and environments and to initiate policy. While public health nutritionists work in
health improvement, with groups or communities to promote health, well-being and reduce
inequalities. The role might involve working with low income groups, pregnant women and
communities requiring specific health interventions related to nutrition. These activities could have
developed from surveys or policy development initiatives, which are also the responsibility of public
health nutritionists. In practice the terms public health nutrition and community nutrition tend to be
used interchangeably.

4. Nutritional Epidemiology
Epidemiology is an addition of three Greek word i.e epi, demos and logos. Epi means upon, on or over,
demos means people or populace and logos mean study. It is commonly referred as the fundamental
science of public health. Epidemiology basically is:
1. A quantitative basic science built on a working knowledge of probability, statistics and sound
research methods,
2. A method of casual reasoning based on developing and testing hypothesis pertaining to
occurrence and prevention of morbidity and mortality, and

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 3. A tool for public health action to promote and protect the public’s health based on science,
casual reasoning and a dose of practical common sense (Cates, 1982).
Specifically nutrition epidemiology investigate the role of food and nutrition in human disease. The
main aim of this type of research is to explain the cause of disease, like cardiovascular disease or
cancer, so that public health messages are based on sound scientific evidence. Nutritional
epidemiology is an area of epidemiology that involves research to:
a) Examine the role of nutrition in the etiology of disease
b) Monitor the nutritional status of populations
c) Develop and evaluate interventions to achieve and maintain healthful eating patterns among
populations
d) Examine the relationship and synergy between nutrition and physical activity in health and
disease.

5. Malnutrition
Public health nutrition is concerned with improving nutrition in populations in both poor and
industrialized countries linking with community nutrition and other complementary disciplines. Human
beings require balanced diet to live, thrive and survive and to carry out daily activities.
Malnutrition is the most widespread condition affecting health of communities worldwide specially
affecting the health of children. It can be defined as a pathological condition resulting from a relative
or absolute deficiency or excess of one or more of the essential nutrients. The consequences of
malnutrition include stunted mental and physical growth, disability and even death. According to
WHO 49% of the 10.7 million deaths of under-five children annually in developing countries are
attributed to malnutrition. From nutritional point, the condition can be classified into three categories
as shown in the following figure:

Malnutrition

Macronutrient Micronutrient
Deficiency malnutrition
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Over-nutrition

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 5.1 Type of Malnutrition
i) Macronutrient Deficiency (Undernutrition)
Undernutrition occurs when the demands of the body for one or more nutrients are not met. This can be
either due to inadequate dietary intake of the nutrients and/or due to the non-availability of these
nutrients in the body because of frequent infections or other metabolic causes. Undernutrition resulting
from the deficiency of energy (total calories) and/or proteins is commonly known as Protein Energy
Malnutrition (PEM). PEM affects all the segments of populations like children, adult males and
females.
PEM is a spectrum conditions ranging from growth failure to explicit marasmus or kwashiorkor. Also
large number of children suffer from sub clinical forms of PEM, which are measured in terms of
underweight, stunting (short stature) and wasting (thinness). According to WHO, currently 149.6
million children under the age of five, i.e. 26.7% of the total children population of the world of this
age are still malnourished.
a) Marasmus
Marasmus is one of the 3 forms of serious PEM. It is common among children below the age of 2
years. It is primarily caused due to deficiency in calories and energy. The principal characteristics of
marasmus are severe growth retardation, extreme emaciation, old man’s face and loose and hanging
skinfolds over arms and buttocks. For the given age of children will be generally 60% below the
normal standard of growth. Frequent diarrheal episodes leading to dehydration and micronutrient
deficiency of Vitamin A, iron and B-complex are common.
b) Kwashiorkor
Children suffering from kwashiorkor mainly have severe protein deficiency. Kwashiorkor is an African
word meaning, “a disease of the displaced child”, who is deprived of adequate nutrition.It is found
commonly among children of age 1-3 years, when they are completely weaned. The three major
manifestations of Kwashiorkor are oedema (swelling of feet), growth failure and mental changes in
addition, there may be changes in hair and skin associated with it.
c) Marasmic Kwashiorkor

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 When malnourished children exhibit the features of both marasmus and kwashiorkor such changes
could occur during the transition from one form of severe PEM to another. These children may have
extreme wasting of different degrees (representing marasmus) and also oedema (representing
kwashiorkor). These children may also manifest diarrhoea very often and some hair changes.
Sign of Kwashiorkor
Sign of Marasmic Kwashiorkar
Sign of Marasmus
 Oedema
 Extreme muscle wasting
 Extreme muscle wasting  Underweight (<80%of
 Loose and hanging skinfold
 Loose and hanging skinfold normal weight for age)
 Old man’s face
 Old man’s face  Moon face
  Absolute weakness
 Absolute weakness Hair and skin changes
 Oedema

Source Link: http://www.biologydiscussion.com/nutrition/nutritional-problems/nutritional-

problems-due-to-deficiency-disorders-with-diagram/52393
ii) Overnutrition
Overnutrition is the form of malnutrition in which nutrients are oversupplied relative to the amounts
required for normal growth, development and metabolism. In rapidly industrializing and industrialized
countries, a massive global epidemic of obesity is emerging in children, adolescents and adults which
is a form of overnutrition. More than half of the adult population is affected in some countries, with

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 consequent increasing death rates from obesity related problems like heart disease, stroke,
hypertension, and diabetes.
The term overnutrition can refer to obesity and overweight which can be attributed due to general
overeating of foods high in calorie as well as oversupply of a specific nutrient or categories of
nutrients, such as mineral or vitamin poisoning due to excessive intake of dietary supplements, or
nutritional imbalances caused by various fat diets. Risk of overnutrition is also increased by being
more than 20% overweight, consuming a diet high in fat and salt.

iii) Micronutrient Malnutrition

Micronutrient malnutrition refers to a group of conditions caused by the deficiency of essential
vitamins and minerals. Micronutrient malnutrition are also referred as ‘hidden hunger’ since the
deficiencies are often sub-clinical and are not easily identified. The micronutrient malnutrition not only
lead to severe illnesses, entailing long and costly treatment, but also influence physical and mental
development, psychic behavior and susceptibility to infections. Commonly, PEM and micronutrient
malnutrition occur together. In India and in most of the developing countries the major micronutrients
are:
a) Iodine Deficiency Disorder (IDD)
Iodine deficiency disorders (IDD) constitute single greatest cause of preventable brain damage during
pregnancy and early childhood, and of retarded psychomotor development in children of young age. It
has remains a major threat to health and development of populations worldwide, but particularly
among pregnant women and preschool children in low-income countries. Till recently, iodine
deficiency was equated with goiter but IDD also results in stillbirth, and miscarriages, but most
devastating toll involves deaf-mutism, mental retardation and impaired educability.
In 1999 according to WHO, IDD was identified as one of the most significant public health problem in
130 countries, affecting approximately 740 million people, or total 13% of the world’s population. The
most affected regions, in increasing order of magnitude, are the Americas (5%). Western Pacific (8%),
South-East Asia (12%), Europe (15%), Africa (20%), and Eastern Mediterranean (32%). Even though
remarkable measurable progress has been achieved in eliminating IDD, still it is estimated that over 16
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 million cretins and nearly 50 million others are still affected by some degrees of iodine deficiency-
related brain damage. 1/3rd of the total world population is estimated to be at risk of IDD.
b) Vitamin A Deficiency (VAD)
Vitamin A deficiency is a major controllable nutritional problem in developing countries and the most
vulnerable are preschool children and pregnant women. In children, vitamin A deficiency is the leading
cause of the preventable severe visual impairment and blindness. Approximately 250 000 to 500 000
VAD children become blind every year, and within a year about half of them die. In addition, VAD
decreases the immunity to infection, so the risk of severe illness and the death from common childhood
infections like diarrhoeal diseases and measles, significantly increases.
Pregnant women often experience deficiency symptoms like night blindness in VAD-prevalent
countries,, that continue till the early period of lactation. Surveys of National Nutrition Monitoring
Bureau (NNMB) and Indian Council of Medical Research (ICMR) reveal that 0.7% of preschool
children and 0.3% adults have Bitot’s spot although its contribution to total blindness has come down
significantly during last 4 decades. Also global data indicates that among children under 5 years of age
affected by VAD, some 3 million have ocular lesions of xerophthalmia and 100-140 million present
only sub-clinical manifestations, yet live with a greater risk of mortality and of developing infections.
c) Iron Deficiency (Anemia)
Iron deficiency is one of the world’s most widespread nutritional disorder, distressing both
industrialized and developing countries. Iron deficiency is considered to be the main cause of anemia.
In developing countries, risk of anemia is deteriorated by the fact that deficiency of iron is associated
with some other micronutrient deficiencies (folic acid, vitamins A and B12), chronic infections such as
HIV and the parasitic infestations like malaria and hookworm. In the poorest populations, usual diet is
monotonous and also based on cereals only which contain high levels of absorption inhibitors and are
low in iron. In such cases, stores of iron are characteristically low, especially in young children and
pregnant women.
It has profound negative effects on the development and health of human. In infants and young
children, iron deficiency results in decreased physical activity levels, scholastic achievement, and
impaired psychomotor development, coordination. In adults of both sexes, it reduces work capacity and
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 also decreases resistance to fatigue. Iron deficiency leads to anemia in pregnant women which is
associated with an increased risk of fetal morbidity and mortality, maternal mortality and morbidity,
and intrauterine growth retardation.
Worldwide, anemia affects around 2000 million people, or about a third of the world’s total population,
while iron deficiency may affect over twice as many. Overall, 52% of pregnant women are anemic and
39% of preschool children, of whom more than 90% are from developing countries. In addition to this,
many school-aged children are also anemic, Thus, Iron deficiency and anemia affect all age groups,
therefore the far reaching impact of anemia presents a true major hurdle in national development.
d) Other Micronutrient Deficiencies
Folate deficiency: It causes widespread megaloblastic anemia in pregnancy and often compounds
already existing iron deficiency anemia. Folate deficiency is also associated with elevated plasma
homocysteine levels and is thus recognized as an independent risk factor for coronary heart disease and
stroke. It is also associated with the occurrence of neural tube defects (anencephaly and spina bifida) in
high-risk population groups across the world including in Europe, the Middle East and China.
Zinc deficiency: It causes growth retardation or failure, diarrhea, immune deficiencies, skin and eye
lesions, delayed sexual maturation, and behavioral changes. Zinc is involved in over 200 enzyme
reactions, and has a critical role to play in the structure and functioning of bio-membranes, and in
stabilizing DNA, RNA and ribosomal structures. Zinc supplementation of malnourished infants and
growth-retarded young children has resulted in improved growth.
Calcium deficiency and osteoporosis: Inadequate dietary calcium intake is associated with a number of
common, chronic medical disorders worldwide, including osteoporosis, osteoarthritis, cardiovascular
disease (hypertension and stroke), diabetes, dyslipidaemias, hypertensive disorders of pregnancy,
obesity and cancer of the colon.

6. Policy and Public Health Nutrition

Nutrition is a multi-sectorial issue and needs to be tackled at various levels. Nutrition affects
development as much as development affects nutrition. It is therefore, important to tackle the problem

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 of nutrition both through direct nutrition intervention for especially vulnerable groups as well as
through various development policy instruments, which will create conditions for improved nutrition.
6.1 National Nutrition Policy
Till the end of IV plan, India's main emphasis was on aggregate growth of economy and reliance was
placed on the filtration effects of growth. In the continuing phase of poverty and malnutrition. an
alternative strategy for the development comprising a frontal attack on the poverty, unemployment and
malnutrition became the national priority from the beginning of V plan. This shift in the strategy has
given rise to number of interventions which increases the purchasing power of poor, to improve
provision of basic services to poor and to devise a security system for the poor through which the most
vulnerable sections (viz. women and children) can be protected.
Of the two major problems of macro and micro-nutritional deficiencies that the women, mother and
children suffer from, while the former are manifested through chronic energy deficiency (CED), the
latter are reflected in Vitamin A, iron, and iodine deficiencies. The strategies adopted on the ninth plan
include- screening of pregnant women and lactating mothers for CED; identifying women with weight
below 40 kg and providing adequate antenatal, intrapartum and neo-natal care under the RCH
programme and ensuring they receive food supplementation through the Integrated Child Development
Services (ICDS) Scheme. The ICDS, launched in 1975, provides supplementary feeding to bridge the
nutritional gaps that exist in respect of children below 6 years and expectant and nursing mothers.
In addition to this, since 2000-01, Government of India has been providing additional central assistance
to states which are under nutrition component of Pradhan Mantri Gramodaya Yojana (PMGY) in an
effort to prevent children to be under-nutrition in the age group of 6-24 months. Supplementary
nutrition is also given to around 105 million school-going children under National Programme of
Nutritional Support to Primary Education (popularly known as Mid-Day Meal).

7. Direct or short term Interventions

(I) Nutrition Intervention for Vulnerable Groups:
a) Expanding the safety net for women and children: The universal Immunization Programme, Oral
Rehydration Therapy and the Integrated Child Development Schemes (ICDS) have had a considerable
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 impact on child survival and extreme forms of malnutrition to reduce incidence of severe and moderate
malnutrition by the year 2000 A.D.
b) With the objective or reducing the incidence of severe and moderate malnutrition by half by the year
2000. Improving monitoring between the age group 0 to 3 year in particular with closer involvement of
the mothers, is the main intervention. Mothers needs to play more active part in the growth monitoring
and should own the process as overall nutrition managements of the child is done by mother at home.
c) Reaching to the adolescent girls as the main target- The government recent initiative of including the
adolescent girls within the ambit of ICDS should be intensified so that they are made ready for a safe
motherhood, their nutritional status is improved and they are given some skill upgradation training in
home-based skills and covered by non-formal education, particularly related to health and nutrition
education.
D) Ensuring better coverage and care to expectant women- supplement nutrition should be included
from 1st trimester in order to achieve the targeted 10% incidence of low birth weight by 2000, and
should also continue during the major period of lactation, at least for the first 1 years after pregnancy.
(II) Fortification of Essential Foods: essential food items consumption should be fortified with
appropriate nutrients which are not available for direct like salt with iodine. The process of fortification
needs to be inexpensive and decentralized.
(III) Popularization of Low Cost Nutritious Foods: Low-cost nutritious foods available locally should
be popularized and the production should be increased. Involvement of women in such activities
should be encouraged.
(IV) Control of Micro Nutrient Deficiencies amongst Vulnerable Groups: Through various intensified
programs deficiency of iron, folic acid, iodine and Vitamin A among children, young girls and
pregnant and lactating women are covered under vulnerable groups. It is important to further intensify
these programs as prophylaxis programs at present do not cover all the vulnerable groups.

8. Indirect or long term Interventions

1. Food Security- In order to ensure aggregate food security, a per capita availability of
215kg/person/year of food grains needs to be attained. This requires production of 250 million
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 tons of food grains per year by 2000 and buffer stocks of 30-35 million tons in order to guard
against emergencies, such as flood and drought.
2. Improvement of dietary patterns through production and demonstration-Improving the dietary
pattern by promoting the production and increasing the per capita availability of nutritionally rich
foods.
3. Policies for effecting income transfers so as to improve the entitlement package of rural and urban
poor.
a. Improving the purchase power.
b. Public distribution system.
4. Land Reforms: the vulnerability of the landless and the landed poor could be reduced by
implementing land reform measures. Tenure reforms as well as implementation of ceiling laws is
included in it.
5. Health and Family Welfare- This is the major aspect of programmes as health and family welfare
programmes are inseparable. “Health for all by 2000” program includes the increased health and
immunization facilities to all.
6. Basic health and nutrition knowledge- concepts of nutrition and health should be effectively
integrated into the school curricula and in nutrition programs. Nutrition and health education is
also important in context of over nutrition.
7. Prevention of food adulteration must be strengthened by gearing up the enforcement machinery.
8. Nutrition surveillance is another important yet weak area requiring immediate attention.
9. Monitoring of Nutrition Programmes and of Nutrition education and demonstration by the food
and nutrition board, though all its 67 centers and fields units, should be continued. The transfer of
food and nutrition board of the department of women and child development has been approved by
the Prime Minister.
10. Research into various aspects of nutrition, both on the consumption side as well as the supply side,
is another essential aspect of the strategy. Research must accurately identify those who are
suffering from various degrees of malnutrition. Research should enable selection of new variety of
food with high nutrition value which can be within the purchasing power of the poor.
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 11. Equal remuneration includes the wages of the women should be at par with the wages of the men
in order to improve women’s economic status. This needs social efforts to improve the
effectiveness of programmes related to women.
12. Communication through established media is one of the most important strategies to be adopted
for the effective implementation of the nutrition policy. The department of Women and Child
Development will have a well-established, permanent communications division, with adequate
staff and fund support. The existing facilities in the song and drama division and the directorate of
advertising and visual publicity (DAVP) in the Ministry of Information and Broadcasting could
help in a big way to improve nutrition and health education.
13. Minimum Wage Administration which is closely related to the market is the need to ensure an
effective minimum wage administration to ensure its strict enforcement and timely revision and
linking it with price rise through a suitable nutrition formula. Excessive loss of energy during the
working seasons has serious nutritional implications. The legislation should also take care of this
problem.
14. Education and literacy of women is found to be an important key determinant for better nutrition
status.
15. Improvement of the status of women is the most effective way to implement nutrition with
mainstream activities in agriculture, health, education and rural development is to focus on
improving the status of women, particularly the economic status.

9. Importance of Public Health Nutrition

Nutrition is crossroads of all the sectors such as health, agriculture and transport. Nutrition is an input
into development. There is evidence that public health and nutrition interventions are essential for
speeding poverty reduction, have high benefit cost-ratios and can improve nutrition much faster than
reliance on economic growth alone (World Bank Report, 2006). Knowledge of public health nutrition
is important for the following reasons:
1) Adequate nutrition for all is the goal: Adequate food and balanced nutrient intakes are basic
necessities for life, health and well-being. Nutrition affects health from conception to old age.
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 Adequate nutrition is especially important in periods of rapid growth and development. Poor nutrition
during pregnancy, infancy, childhood and adolescence can result in stunted physical, mental and social
development with lifelong consequences. Chronic dietary deficiency, excess or imbalance predispose
individuals to or aggravate a spectrum of disease conditions and ultimately affect the quality of life and
longevity.
2) Dietary factors are associated with five of the ten leading causes of death: Coronary heart
disease, certain types of cancers, stroke, non-insulin dependent diabetes (type-2 diabetes) and
atherosclerosis are associated with dietary factors. Dietary excesses and imbalances contribute to the
development of these diseases. Currently, attention is focused on total caloric intake, amount and type
of fat, vitamins such as folic acid and the antioxidants of Vitamins A, C and E, minerals such as
calcium and other nutritive substances such as fiber and flavonoids. Overweight and obesity which are
estimated to affect over a third of the population is also an important contributing factor for diseases
and disability.
3) Maternal and child nutrition set the stage for life: The health of mothers and infants has
historically been a focus of public health and public health nutrition. Balanced diet and appropriate
weight gain have received attention in the past. Now attention is also directed to pre-conceptual
concerns such as folic acid intake and its association with neural tube defects. Recent research links
factors in the fetal environment to risk for recommended because of its many benefits to infants and
their mothers. Childhood is a time when food preferences and habits are shaped. Childhood nutrition
affects growth and development, immune status and social and cognitive ability. The nutritional intake
of children with special health care needs also requires also scrutiny. Low calcium intake of girls and
young women sets the stage for osteoporosis in later years.
4) Vulnerable subgroups are at a high risk for nutritional problems: Some subgroups of the
population, including people with low incomes, some racial and ethnic minority groups, and people
with disabilities (defined as functional impairments) experience a disproportionate amount of
preventable illness and premature death. Nutrition is an important contributing factor. Some groups,
especially those who are economically disadvantaged or isolated, experience periodic or chronic
hunger (also called food insecurity) resulting in under nutrition. Reaching these groups with accessible,
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 culturally relevant nutrition programmes and services presents a special challenge to public health
agencies and all community nutrition providers. Targeting vulnerable subgroups and designing
programmes to meet their special needs is a strategy used by public health to attempt to reduce
disparities in nutritional status and health among population subgroups.
5) Behavior change is challenging: Nutrition behavior (including food selection, preparation and
consumption) is the product of culture, education, economics, food availability, social strata, family
position and health status. Nutritional status depends on all those factors plus biological and genetic
factors. Guiding all members of the population towards more healthful food choices and optimum
nutritional health is a great challenge. And doing so early enough to prevent the development of
disease is one of the goals of public health nutrition. Meeting this challenge requires the use of
multiple, reinforcing behavior change strategies, including food and nutrition information and
education.

Summary
Globally, poor nutrition is one of the leading cause of morbidity and mortality. Public health nutrition
is concerned with improving nutrition in populations in both poor and industrialized countries linking
with community nutrition and other complementary disciplines. The increasing knowledge about
nutrition can help in reducing the medical care costs and also to improve quality of life. The chronic
and acute undernutrition and obesity and other nutrient deficiencies is intimidating half of the world’s
population. To have improved and significant effect of nutrition status on individual combined effort
from both community and population is required. Public health approach to the prevention understood
that reduction of the risk for individuals with an average risk profile might be negligible or small.
Though, individuals with high-risk need special attention by primary, secondary and tertiary
preventions. Moreover, the risk may not eliminated for the peoples genetically inclined a particular
disease. But, good primary prevention strategies could help in reducing the severity of disease. The
limitations to populations achieving nutritional health fall in the social, cultural, economic and
behavioral dominions in the form of lack to access of food, appropriate distribution among or within
households and maladaptive health and food practices. Public health nutrition is an important sector as
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 it is essential for speeding poverty reduction, have high benefit cost-ratios and can improve nutrition
much faster than reliance on economic growth alone. But the limitations to populations in achieving
the nutritional health is affected by the social, cultural, economic and behavioural dominions in the
form of lack to access of food, appropriate distribution among or within households and maladaptive
health and food practices. It is important to tackle the problem of nutrition both through direct nutrition
intervention for especially vulnerable groups as well as through various development policy
instruments, which will create conditions for improved nutrition.

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