|Food and Nutrition Bulletin Volume 18, Number 2, 1997 (UNU Food and Nutrition Bulletin, 1997, 118 pages)|
|"Public nutrition": The need for cross-disciplinary breadth in the education of applied nutrition professionals|
It is widely quoted among applied nutrition professionals that "nutrition is not a discipline to be studied; it is a problem to be solved." If this is true, then by definition, solving nutrition problems requires multidisciplinary cooperation. The study of nutrition crosses boundaries from the most basic of laboratory sciences to an understanding of global economic and political interactions among nations. It takes nothing away from the importance of scientific research into the basic mechanisms of nutrient metabolism to assert that nutrition problems in developing countries (any more than in the developed world) cannot be solved in the laboratory or clinic alone. The constraints to populations achieving nutritional health fall in the economic, social, cultural, and behavioural realms: in the lack of access to food, its inappropriate distribution among and within households, and maladaptive food and health practices. The skills and knowledge needed to help address these constraints are quite different from those of the laboratory scientist or the medical practitioner. They require a different kind of training from that associated with the science of nutrition.
This paper addresses the appropriate education and training of applied nutrition professionals, specifically those planning to work in the realm of food and nutrition policy and programmes in developing countries. In a 1996 letter to The American Journal of Clinical Nutrition, Mason and others suggested the name "public nutrition" to define a new field encompassing the range of factors known to influence nutrition in populations, including diet and health; social, cultural, and behavioural factors; and the economic and political context . The suggestion was based on the perception that the field already exists de facto, but that its recognition as a legitimate field of study would allow education and professional development to be more explicitly focused on its objectives. Like public health, public nutrition would focus on problem-solving in a real-world setting, making it, by definition, an applied field of study whose success is measured in terms of effectiveness in improving nutritional conditions.
The recognition that nutrition solutions often lie outside the domain of "nutrition" per se is not new. In the 1970s, the popular concept of multisectoral nutrition planning was based on that understanding. It was discredited [2, 3] not because the analysis was wrong, but because the proposed solution did not take account of political and structural barriers to the implementation of large multisectoral responses. More recent approaches have been based on the assumption that nutrition problems will be solved by incorporating nutrition concerns into a wide variety of disciplines as they are translated into action , for example, when consumption issues are integrated into agriculture policies. This approach is correct if it can be made to work, but it is dangerous because nutrition then risks being the responsibility of no one. Putting nutrition under the rubric of health tends to medicalize the field, while putting it under agriculture may marginalize it. Public nutrition has a distinct identity, incorporating the relevant aspects of the variety of disciplines that bear on the nutrition problem, as well as incorporating scientific advances in the understanding of nutritional problems.