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Abstract: Using the Norwegian nutrition policy as a basis, the book presents an analysis of nutrition policies by assessing the extent of policy implementation by citing factors helpful to or impeding progress, and by deriving ways to support policy development in other interested countries. The Norwegian nutrition policy deals with health and diet, agricultural self-sufficiency, rural development and environmental conservation, and world food security.
Micronutrient deficiencies are common across the developing world and have major effects on the health outcomes of its population. Although this is well understood, many countries find it difficult to bring about policy change in this regard. This paper uses micronutrient policies designed and implemented in Malawi as a case study to shed light on the barriers and gaps faced by developing countries for similar programs and policies. To understand the drivers of policy change, this paper uses the kaleidoscope model to trace the policy processes of three major micronutrients—iodine, vitamin A, and iron. Using a select set of policy process tools, as well as field interviews with key informants who were part of Malawi’s micronutrient policy process, the authors test a set of hypotheses on 16 variables that drive policy change in the micronutrient policy sphere. Results indicate that much of the agenda setting for micronutrient policies and programs was triggered by external events that focused on the elimination of micronutrient deficiencies as part of the global development agenda. These events include the International Conference on Nutrition, the Millennium Development Goals, and, more recently, Scaling up Nutrition. The design of micronutrient policies and program interventions in Malawi was adopted by locally mandated ministries and institutions, in collaboration with development partners who provided both financial and technical support at the design stage. The adoption of micronutrient policies and intervention programs was driven primarily by external funding, particularly through supplementation programs related to vitamin A and iron. Adoption of fortification standards for vitamin A has been going on for more than a decade due to continuous resistance from the private sector, which faces additional costs and needs greater technical expertise. The biofortification method of micronutrient interventions for iron and vitamin A is externally driven and relatively new in Malawi. Although this method is widely accepted by policy makers, no concrete strategy has been developed for its design, adoption, and implementation. Further, supplementation and fortification programs continue to face implementation challenges due to poor physical infrastructure and monitoring systems. However, the national institutional architecture required for agenda setting, design, adoption, implementation, evaluation, and review to address micronutrient deficiencies is in place in Malawi. The system needs continued support from development partners for effective functioning at all levels. The use of various tools for the policy change part of the kaleidoscope model indicate that policy change is a dynamic process; over time, changes in the nature and composition of the members of policy and institutional architecture can result in different policy outcomes. The Malawi case study demonstrates two things. First, local leadership is crucial in keeping micronutrient deficiencies on the policy-making agenda, and second, it matters where coordinating power is placed in the policy hierarchy. This paper finds that, even with policy champions, adopted policies will face implementation challenges unless they are supported with adequate resources and are systematically followed through to final execution and delivery.
The book revisits the causes of persisting under nutrition in India, but moves away from the usual focus on women and children to a broader view of the entire population. It estimates the economic losses resulting from ignoring under nutrition in the adult working population and questions the current narrow focus of nutrition interventions, suggesting that a family-based approach may provide quicker results and long-term sustainability. It compares the best and worst performing states in the country to glean learnings from both successes and failures and emphasizes the need to hand over the ownership of nutrition outcomes from the state to the community and family for more sustainable results. The book is organized in three sections: Part 1 details the nutrition status of the population, regional variations in nutrition outcomes and government response in terms of interventions. Part 2 reviews issues and concerns like gender discrimination, poor child nutrition status, ineffective implementation of government programmes in the field and the possible impacts of emerging issues like climate change. Part 3 seeks solutions from both international and country experiences.
This volume offers the most comprehensive coverage on fetal programming. Chapters are written by authors of international and national standing, leaders in the field and trendsetters. The clinical relevance of the current research is emphasized in each chapter, which also contains key points, key words, and concise summaries for ease of learning. Fetal programming affects conditions in the immediate postnatal period, as well as in later life and adulthood. These conditions include cardiovascular disease, frank hypertension, stroke, dyslipidemia, coagulopathy, increased insulin resistance-metabolic syndrome, type-2 diabetes, leukemia, testicular cancer, prostate cancer, breast cancer, polycystic ovary syndrome, precocious puberty, impaired immune function, renal disease, lung disease, and osteoporosis. Neuropathologies, behavioral and mental deficiencies, schizophrenia, and depression have also been reported in adults who were exposed to nutritional inadequacies in utero. Diet, Nutrition and Fetal Programming provides an overview on the effects of fetal programming on disease, and comprehensive looks at maternal nutrition factors and fetal programming effects on brain and behavior, and physiology and disease. It also provides an in depth look at specific nutrient restrictions and supplements on physiology and disease, the effects of maternal disease on fetal programming, mechanisms of programming, and a special section on the international aspects and policies on fetal programming.