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National Perspective on Micronutrient Deficiencies and Their Impact on Health and Productivity

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Title: National Perspective on Micronutrient Deficiencies and Their Impact on Health and Productivity


1
National Perspective on Micronutrient
Deficiencies and Their Impact on Health and
Productivity
Dr. Chandrakant S Pandav
  • Professor Head, Centre for Community Medicine,
  • All India Institute of Medical Sciences,

Regional Coordinator International Council for
Control of Iodine Deficiency disorders (South
Asia)
New Delhi, India
2
Contributors
  • Dr. Kapil Yadav
  • Senior Program Officer, ICCIDD, c/o CCM, AIIMS,
    New Delhi
  • Dr. P. Stalin
  • Junior Resident, CCM, AIIMS, New Delhi
  • Dr. Ravi Upadhyay
  • Junior Resident, CCM, AIIMS, New Delhi

3
Outline
  • Take Home Messages
  • Nutrition A link between food health
  • Micronutrients Public health importance
  • Micronutrient Deficiencies
  • Burden
  • Health consequences
  • Impact on productivity
  • Copenhagen Consensus
  • Take Home Messages

4
Take Home Messages
  • Micronutrient deficiencies
  • Public Health Problem
  • Burden is heavy
  • Health consequences
  • Serious irreversible
  • Productivity loss Significant

5
The Millennium Development Goals
  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat HIV/AIDS, malaria and other diseases
  • Ensure environmental sustainability
  • Build a global partnership for development

6
Need for Equity Focus
  • To leave the poorest and marginalized
  • Strategically short-sighted
  • With resources depleted,
  • Political will exhausted and
  • A public that has moved on
  • By 2015, it will be a big challenge to reach the
    most deprived

7
The doctor of the future will no longer treat
the human frame with drugs, but rather will cure
and prevent disease with nutrition.
- Thomas Edison (1847 1931), American
Inventor, Scientist Businessman
8
  • However much a mother may love her children, but
    impossible for her to provide quality child care
    if she herself is poor, illiterate, anemic
    and unhealthy.
  • Dr. V. Ramalingaswami (1921 - 2001), Director
    (AIIMS) Director General (ICMR)

9
Main factors for good health and quality of life
  • Genetics
  • Nutrition
  • Mental well being
  • Physical activity and exercise
  • Avoidance of toxicants i.e. tobacco, alcoholic
    consumption and drug abuses
  • Environment physical, biological, chemical,
    social, economic political

10
Nutrition is a link between food and health
  • Agriculture
  • Food supply
  • Service
  • Promotion
  • Protection
  • Treatment
  • Nutrient needs
  • Dietary intakes
  • Nutrition wellbeing
  • Nutrition literacy
  • Free from food borne illness
  • Good health
  • Food quality
  • Food safety

Food Security
Food and Nutrition Education
Food Culture
Ultimate Goals
Nutrition Security and wellbeing for All
11
Food and Nutrition Challenges
  • Continuing and persistent undernutrition
  • Undernourished (Protein and energy deficiency) in
    children and adults
  • Micronutrient deficiencies of iron, iodine, vit.
    A and others
  • Overnutrition and diet related diseases
  • Overweight obesity
  • Diabetes mellitus, high blood lipids,
  • High blood pressure
  • Cardio-vascular diseases
  • Cancers
  • Food safety and quality

12
Food and Nutrition Challenges
  • The pandemic of hunger and obesity, both are
    increasing
  • FAO estimated in 2009 that
  • over 1,000 million people were
  • undernourished.
  • Paradoxically, WHO estimated that
  • 1,600 million adults are overweight
  • and 400 million are obese.

13
Macro-nutrients Proximate principles, Sources of
energy body building
14
Micronutrient Must be provided in food enable
the body to use other nutrients
15
The Known 51 Essential Nutrients for Sustaining
Human Life
Numerous other beneficial substances in foods
are also known to contribute to good health.
16
Micronutrients Public Health Importance
  • Iron
  • Vitamin A
  • Iodine
  • Zinc
  • Folic Acid

17
India
  • Burden of Micronutrient Deficiencies
  • Health Consequences of
    Micronutrient Deficiencies
  • Impact of Micronutrient Deficiencies
    on Productivity

18
The Ugly Face of Hidden Hunger
Folic Acid Deficiency
Iron Deficiency
Vitamin A Deficiency
Zinc Deficiency
Iodine Deficiency
19
Anemia in women (15-49 yrs)
Urban poor 59
Urban rich 49
Rural 57
3/4th of young children, ½ of women
1/4th of married men are
anemic (NFHS 3, 2005 06)
20
Bitots spot 0.6
Night Blindness 0.2
Preschool children (NNMB 2006)
21
Goitre 70 million
Mild neurological deficits 6.6 million
Cretins 2.2 million
Burden of IDD (National Iodine Deficiency
Disorders Control Programme, Annual Report
(2009-10) M/o Health FW, Govt. of India, New
Delhi.)
22
Non-iodized salt
Iodized salt
Proportion of households with adequately iodized
salt 51 (NFHS 3, 2005-06)
23
Burden of zinc deficiency No data
24
Burden of Folic Acid Deficiency 2,00,000 babies
born with neural tube defects per year
25
India
  • Burden of Micronutrient Deficiencies
  • Health Consequences of
    Micronutrient Deficiencies
  • Impact of Micronutrient Deficiencies
    on Productivity

26
Impact of Micronutrient Deficiencies on Health
  • Iron
  • Vitamin A
  • Iodine
  • Zinc
  • Folic Acid

27
Iron deficiency Nutritional anemia Indirect
Cause of Maternal Mortality (20), Cognitive
impairment decreased immunity
28
Vitamin A deficiency Xerophtalmia, infections
growth failure
29
Iodine Deficiency Decreased IQ, mild neurological
deficits, cretinism, goitre stillbirths
neonatal deaths
30
Zinc Deficiency Low birth weight, preterm
deliveries, spontaneous abortions
congenital malformations
31
Folic Acid Deficiency Neural tube defects,
Megaloblastic Anemia
32
India
  • Burden of Micronutrient Deficiencies
  • Health Consequences of
    Micronutrient Deficiencies
  • Impact of Micronutrient Deficiencies
    on Productivity

33
(No Transcript)
34
JOB INTERVIEW
Question How much is 2G 3G
? MATHEMATICIAN 2G 3G 5G ACCOUNTANT
2G 3G 5G ..On an average 5G
..Give or take 10 ECONOMIST .?
35
COMPONENTS OF ECONOMIC EVALUATION
RESOURCES CONSUMED
HEALTH IMPROVEMENT
HEALTH CARE PROGRAM
Cost
Consequences
36
Cost
37
Consequences
38
COST OF MALNUTRITION 3 Scenarios
39
Calculating Costs contd..
  • Productivity loss-
  • a proxy to cost of health
    consequences.
  • To measure productivity loss 3 parameters
  • Productive life expectancy.
  • Average annual wage for an adult.
  • Average rate of employment.

Source National strategy to reduce childhood
malnutrition Final Report Min of HRD GOI,
Administrative staff college of India, Hyderabad.
Dec, 1997.
40
Productivity loss due to different deficiency
disorders- Assumptions
Source Assumptions made by Judith McGuire et al
National strategy to reduce childhood
malnutrition Final Report Min of HRDGOI,
Administrative staff college of India, Hyderabad.
Dec, 1997.
41
Estimating the Annual Productivity loss
  • Annual Productivity loss
  • (n p w e) (d pe
    w e)
  • n No. of adults suffering from deficiency
    disorder
  • P Productivity loss due to the disorder.
  • w annual wage
  • e employment rate.
  • d death due to disorder
  • pe productive life expectancy.

SourceNational strategy to reduce childhood
malnutrition Final Report Min of HRDGOI,
Administrative staff college of India, Hyderabad.
Dec, 1997.
42
Assumptions used for analysis
National Strategy to reduce childhood
malnutrition Final report Ministry of Human
Resource Development Government of India,
Administrative staff college of India, Hyderabad.
December 1997
43
Estimated annualproductivity losses (2010)
National Strategy to reduce childhood
malnutrition Final report Ministry of Human
Resource Development Government of India,
Administrative staff college of India, Hyderabad.
December 1997
44
Total Annual productivity losses approximately
Rs. 1000 billion (High Scenario)
45
Micronutrient InitiativeIndia Micronutrient
National Investment PlanL Lavialette et al
46
Imagine you had 75bn to donate to worthwhile
causes. What would you do, and where should we
start?
47
Copenhagen Consensus 10 Challenges
  • Air Pollution 
  • Conflicts 
  • Diseases 
  • Education
  • Global Warming
  • Malnutrition and Hunger 
  • Sanitation and Water 
  • Subsidies and Trade Barriers 
  • Terrorism 
  • Women and Development

48
Expert panel Economists 8
Challenge Paper Authors 3
Perspective Paper Authors 2
10 Challenges
Costs and benefits analysis
Rank Listing Solutions for challenges
Policy Makers
Decision Making on Money Spending
49
10 Challenges
30 Solutions
Ranking list 4 solutions related to Malnutrition
in first 10 priorities 1. Micronutrient
supplements for children (vitamin A and zinc) 3.
Micronutrient fortification (iron and salt
iodization) 5. Bio-fortification 9.
Community-based nutrition promotion
50
Take Home Messages
  • Micronutrient deficiencies
  • Public Health Problem
  • Burden is heavy
  • Health consequences
  • Serious irreversible
  • Productivity loss Significant

51
The Millennium Development Goals
  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat HIV/AIDS, malaria and other diseases
  • Ensure environmental sustainability
  • Build a global partnership for development

52
Need for Equity Focus
  • To leave the poorest and marginalized
  • Strategically short-sighted
  • With resources depleted,
  • Political will exhausted and
  • A public that has moved on
  • By 2015, it will be a big challenge to reach the
    most deprived

53
" We ourselves sometimes feel that what we do is
just a drop in the ocean, But the ocean would be
less because of that missing drop. - Mother
Teresa
54
Thank You
55
Seven Challenges in Nutrition
  • Getting nutrition first on the top priority of
    the policy makers and keeping it there?
  • Doing the right things
  • Not doing the wrong things
  • Acting on scale
  • Reaching those in need
  • Data based decision making
  • Strengthening operational and strategic capacities

Source Lancet series on Maternal and Child
Under-nutrition 4
56
Strategies/Actions to Prevent and Control of
Malnutrition
  • Supplementation with micronutrients/food
  • Food fortification
  • Food regulation
  • Food and Nutrition education/communication
  • Right to food (and nutrition)
  • Food based approach ensuring food
    security/consumption of safe and nutritious food
  • Public health measures basic services,
    immunization, sanitation, water supply, deworming
  • Community based (integrated) approaches
  • Others ME, RD, Capacity Building (CB)
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