By KABIR NAJEEB B.Pharm, M.P.H.

1. Economics of Health
Programmes for Nutrition and
Diet.

2. PROBLEMS ASSOCIATED WITH
NUTRITION:
MALNUTRITION is lack of proper nutrition caused
by any of these below:
1. IMBALANCED NUTRITION: this is a situation
where by the body is unable to absorb certain
nutrients or result of a poor diet. Depending on
the nutrients that are short or in excess supply,
imbalances create unpleasant side effects that
could lead to serious diseases, too much protein
can stress the kidney, less of it can cause
anemia.

3. 2. OVERNUTRITION: this is a situation where by
intake of nutrients exceeds the normal limit
required by the body for a normal growth,
development and metabolism. This can lead
to obesity i.e. over weight which can thus
increase other health issues like high blood
pressure which can lead to stroke, high
cholesterol, high blood sugar and heart
disease.

4. 3. UNDERNUTRITION: this is a situation where
by people do not eat enough nutrients to
cover their needs for energy and growth or to
maintain healthy immune system. Diseases
like kwashiorkor, marasmus, goitre, rickets,
scurvy are associated with undernutrition.

5. Introduction:
The aim of this presentation is to discuss the role of nutrition
and its impact in reducing the public health burden through
the following:
1. Alleviating undernutrition and micronutrient deficiencies
2. Promoting healthy choice of conventional foods
3. Enhancing the use of functional foods for health
improvement and disease risk reduction

6. • A further goal is to improve awareness among
health professionals, authorities and decision
makers and to look at long-term sustainable
approaches to enhance health, including the
adoption of nutritional strategies.
• Attaining this goal may require re-organisation
of healthcare expenditure models to generate
policy-relevant evidence for the
implementation of initiatives.

7. 1. Alleviating undernutrition and micronutrient
deficiencies: Despite strategies employed to
tackle micronutrient malnutrition, limited
progress has been achieved in the developing
countries.
• Of global concern are deficiencies in iron,
vitamin A, zinc, folate, and iodine.
• Below is a table/chart showing number of
people at risk and global prevalence of
micronutrients in WHO regions:

10. • Four main strategies can be used to overcome
micronutrient deficiencies:
• dietary diversification/modification
• food fortification
• supplementation with vitamin and minerals
• global public health and disease control
measures.

11. • Dietary diversification/modification
interventions are probably the most
sustainable strategies to address causes of
deficiency, but permanent solutions are still
required in controlling micronutrient
malnutrition at both research and public
health levels.

12. • Evidence shows that the most cost-effective
approaches to address symptoms of
micronutrient malnutrition are targeted
supplementation and/or fortification
(boosting or enhancing) with iron, iodine, zinc,
folic acid, vitamin A, and multimicronutrients,
provided that households have access to
primary health care.
• The most conventional and widely practiced
strategies used to address micronutrient
malnutrition according to WHO are
supplementation and food fortification.

13. • However, these strategies do not address the
primary cause of poor micronutrient status,
inadequate dietary intake because of food
insecurity, and may not be the most
acceptable, accessible, or appropriate
strategies for rural and/or ultra-poor
households incase of developing countries like
India and other South Asian countries
• Moreover, allocated funds are earmarked for
high-profile diseases, thus further neglecting
macro and micro nutritional programs.

14. • Provision of life saving foods to desperately
poor and sick is not a long-term solution
• Funds should be allocated to make these
communities develop their own food and
become self-sufficient
• In addition, the structural and social
determinants are also affecting human health.
These include availability of basic human
needs, such as shelter/ housing, water and
sanitation, quality education, gender, social
and racial equality.

15. 2.Promoting healthy choice of
conventional foods:
• The WHO definition of health is ‘a state of
complete physical, mental and social well-
being and not merely the absence of disease
and infirmity’.
• Diet plays a critical role in the prevention of ill
health: cancers can be caused either by
inadequacy of nutrients or overindulgence
and half of cancers occur in developing
countries.

16. • Premature death due to NCD (non
communicable disease) is a significant issue
that has a huge impact on productivity, and
has recently been discussed by the United
Nations General Assembly in September 2011
• Cancer, diabetes, heart disease and lung
disease kill 36 million people worldwide every
year, making up 63 % of global deaths
• Prevention strategies involving dietary and
lifestyle changes have been proposed to
address this global health problem.

17. • A WHO report of the Southeast Asia region
suggested that at least 80 % of cases of
premature heart disease, stroke and type 2
diabetes and 40 % of cancers could be prevented
through lifestyle changes, including a healthy
diet, regular physical exercise and avoiding
tobacco products
• Furthermore, in the Southeast Asia region, a 2 %
annual reduction in deaths due to chronic disease
was shown to be capable of saving over 8 million
lives in the next 10 years, of which over 5 million
people would be aged < 70 years.

18. • In India alone, a similar reduction would also
result in an economic gain of US$15 billion
over the next 10 years
• A recent cost analysis from Harvard University
suggests that unless present health trends are
reversed, the five common NCD – cancer,
diabetes, heart disease, lung disease and
mental health problems – will cost the world
US$47 trillion in treatment costs and lost
wages over the next 20 years.
• Below is a chart showing death causes:

20. 3.Enhancing the use of functional
foods for health improvement and
disease risk reduction:
• The term functional foods was first introduced
in Japan in the mid-1980s and refers to
processed foods containing ingredients that
aid specific bodily functions in addition to
being nutritious
• To date, Japan is the only country that has
formulated a specific regulatory approval
process for functional foods. Known as Foods
for Specified Health Use (FOSHU).

21. • These foods are eligible to bear a seal of
approval from the Japanese Ministry of Health
and Welfare (Arai, 1996)
• Currently, 100 products are licensed as
FOSHU foods in Japan
• In the United States, the functional foods
category is not recognized legally. Irrespective
of this, many organizations have proposed
definitions for this new and emerging area of
the food and nutrition sciences.

22. • The Institute of Medicine’s Food and Nutrition
Board (IOM/FNB, 1994) defined functional foods
as “any food or food ingredient that may provide
a health benefit beyond the traditional nutrients
it contains.”
• Functional Foods From Plant Sources:
Overwhelming evidence from epidemiological, in
vivo, in vitro, and clinical trial data indicates that a
plant-based diet can reduce the risk of chronic
disease, particularly cancer.

23. • In 1992, a review of 200 epidemiological studies
(Block et al., 1992) showed that cancer risk in
people consuming diets high in fruits and
vegetables was only one-half that in those
consuming few of these foods
• It is now clear that there are components in a
plant-based diet other than traditional nutrients
that can reduce cancer risk
• Steinmetz and Potter (1991a) identified more
than a dozen classes of these biologically active
plant chemicals, now known as “phytochemicals.”

24. • Functional foods from plants include:
• Oats: can reduce total and low density
lipoprotein (LDL) cholesterol, thereby reducing
the risk of coronary heart disease (CHD)
• Tomatoes: contains lycopene, the primary
carotenoid found in it has a role in cancer risk
reduction
• Garlic: health benefits of garlic are numerous,
including cancer chemopreventive, antibiotic,
antihypertensive, and cholesterol-lowering
properties.

25. • Tea: A more recent review suggests that
benefits from tea consumption are restricted
to high intakes in high-risk populations
(Kohlmeier et al., 1997a). This hypothesis
supports the recent finding that the
consumption of five or more cups of green tea
per day is associated with decreased
recurrence of stage I and II breast cancer in
Japanese women.

26. Functional Foods From Animal Sources:
• Although the vast number of naturally
occurring health-enhancing substances are of
plant origin, there are a number of
physiologically-active components in animal
products that deserve attention for their
potential role in optimal health
These foods includes:
• Fish: Omega-3 (n-3)fatty acids are an essential
class of polyunsaturated fatty acids (PUFAs)
derived primarily from fish oil.

27. • Diary products:
There is no doubt that dairy products are
functional foods. They are one of the best
sources of calcium, an essential nutrient which
can prevent osteoporosis and possibly colon
cancer
• Beef: An anticarcinogenic fatty acid known as
conjugated linoleic acid (CLA) was first isolated
from grilled beef in 1987 (Ha et al., 1987).
More recently, CLA has been investigated for
its ability to change body composition,
suggesting a role as a weight reduction agent.

28. GOVERNMENT PROGRAMS ON DIET AND NUTRITIONS:
Many programs have been taken by the government to
address the burden of malnutrition worldwide. Some of the
initiatives taken by government on international and national
level are discussed below:
1. The Commodity Supplemental Food Program (CSFP) works to
improve the health of low-income elderly persons at least 60
years of age by supplementing their diets with nutritious
USDA Foods. Women, infants, and children who were certified
and receiving CSFP benefits as of February 6, 2014, can
continue to receive assistance until they are no longer eligible
under the program rules in effect on February 6, 2014.
Through CSFP, USDA distributes both food and administrative
funds to participating States and Indian Tribal Organizations.

29. 2. CHILD AND ADULT CARE FOOD PROGRAMS (CAFP):
• USDA’s Child and Adult Care Food Program plays a vital role in
improving the quality of day care and making it more
affordable for many low-income families
• Each day, 2.6 million children receive nutritious meals and
snacks through CACFP. The program also provides meals and
snacks to 74,000 adults who receive care in nonresidential
adult day care centers
• CACFP reaches even further to provide meals to children
residing in homeless shelters, and snacks and suppers to
youths participating in eligible afterschool care programs.

30. 3. NATIONAL SCHOOL LUNCH PROGRAM (NSLP):
School districts and independent schools that
choose to take part in the lunch program get cash
subsidies and donated commodities from the
USDA for each meal they serve
In return, they must serve lunches that meet
Federal requirements, and they must offer free or
reduced price lunches to eligible children
School food authorities can also be reimbursed for
snacks served to children through age 18 in
afterschool educational or enrichment program.

31. INDIAN GOVERNMENT PROGRAMS ON DIET AND NUTRITION:
The Government has accorded high priority to the issue of
undernutrition and is implementing several programmes of
different Ministries/Departments through State
Government/UT Administration, which have the potential to
improve the current nutritional situation in India.
Some of these programs are as follows:
1. Target group : Pregnant and Lactating Mothers
Scheme: Integrated Child Development Scheme (ICDS)
AIM: Supplementary nutrition, counseling on diet, rest and
breastfeeding, health and nutrition education.

32. Scheme: Indira Gandhi Matritva Sahyog Yojana (IGMSY)
AIM: Conditional Maternity Benefit.
Scheme: Reproductive Child Health RCH-II,
National Rural Health Mission (NRHM),
Janani Suraksha Yojana (JSY)
AIM: Antenatal care, counselling, iron supplementation,
immunization, transportation for institutional delivery,
institutional delivery, cash benefit, postnatal care, counselling
for breast feeding and spacing of children etc.

33. 2. Target group : Children (0-3 years)
• Scheme: Integrated Child Development Scheme (ICDS)
• AIM: Supplementary nutrition, growth monitoring,
counselling health education of mothers on child care,
promotion of infant and young child feeding, home based
counselling for early childhood stimulation, referral and follow
up of undernourished and sick children.
• Scheme: Rajiv Gandhi National Creche Scheme
• AIM: Support for the care of children of working mothers.

34. 3. Target group : Children (3-6 years)
• Scheme: Integrated Child Development Scheme (ICDS)
• AIM: Non-formal preschool education, growth monitoring,
supplementary nutrition, referral, health education and
counselling for care givers.
• Scheme: National Rural Drinking Water Programme
(NRDWP)
• AIM: Availability of safe drinking water.

35. 4. Target group: School going children (6-14 years)
Scheme: Mid-Day Meals (MDM)
AIM: Hot cooked meal to children attending school.
CONCLUSIONS: Health economics plays important role
in identifying ways by which the government can
make cost effective policies towards allocating
resources to tackle the issues related to diet and
nutrition as a global challenge facing every nation on
the earth.

36. REFERENCES:
1. WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of
Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva:
WHO; 2003. pp. 1–149. WHO Technical Report Series no. 916
2. ACC/SCN (United Nations Administrative Committee on Coordination/Sub-
Committee on Nutrition). 1989. Update on the World Nutrition Situation:
Recent Trends in Nutrition in 33 Countries. Geneva: ACC/SCN.

37. THANKS
• PRESENTED BY: KABIR NAJEEB
MPH/DPSRU/2017