Considerations for the Health System for addressing the Double Burden of Malnutrition

The potential costs to individuals and society at large of managing and treating the consequences of the double burden of malnutrition appear prohibitive. Public health has been defined as "the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society" (Acheson, 1988). The evidence indicates that a fully engaged public health scenario is the most cost effective way to achieve greater health for the population. Where this has been adopted in practice substantial health gains have been achieved at relatively modest cost. The challenge is the necessary initial investment of resource and effort; the ongoing monitoring and evaluation to identify and address problems or issues at an early stage; and the assurance of appropriate health literacy to enable each person to accept appropriate responsibility for their health within a health system that assures appropriate support and care within a tiered system of delivery. All opportunities for health/ill-health devolve around appropriate nutrition at every age. Poor nutrition can be considered to be a failure of the social system, expressed as ill-health and medical problems in the most vulnerable. Appropriate nutrition embraces physical activity, potable water and clean air as well as an adequate and balanced intake of food. Poor nutrition is most often a consequence of stresses imposed by the environment either directly or indirectly, be they associated with infection or social structure. A clear understanding of the mechanistic basis of any disorder directly informs individual and population approaches to ameliorating the challenge at every level of biological and social organization. The opportunity to use big data to establish the underlying principles that determine these relationships and how their application might vary from one context to another is fundamental to enabling the organization of the health system to securely address the double burden of malnutrition at manageable cost. (author)