Transcript National Perspective on Micronutrient Deficiencies and Their Impact

National Perspective on
Micronutrient Deficiencies and
Their Impact on
Health and Productivity
Dr. Chandrakant S Pandav
Professor & Head,
Regional Coordinator
Centre for Community Medicine,
International Council for Control of
All India Institute of Medical Sciences, Iodine Deficiency disorders (South Asia)
New Delhi, India
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
Outline
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•
•
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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
Take Home Messages
Micronutrient deficiencies
 Public Health Problem
 Burden is heavy
 Health consequences
 Serious & irreversible
 Productivity loss – Significant
The Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower
women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Build a global partnership for development
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
“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
“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)
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
Nutrition is a link between food and health
• Agriculture
• Food supply
• Service
•
•
Food
Food quality
Food safety
Nutrition
•
•
•
•
Health
• Promotion
• Protection
• Treatment
Nutrient needs
• Free from food
Dietary intakes
borne illness
Nutrition wellbeing • Good health
Nutrition literacy
Food Security
Food and Nutrition Education
Food Culture
Ultimate Goals:
Nutrition Security and wellbeing for All
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
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Overweight & obesity
Diabetes mellitus, high blood lipids,
High blood pressure
Cardio-vascular diseases
Cancers
• Food safety and quality
Food and Nutrition Challenges
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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.
Macro-nutrients
Proximate principles, Sources of energy & body building
Micronutrient
Must be provided in food
& enable the body to use other nutrients
The Known 51 Essential Nutrients for Sustaining Human Life*
Air, Water &
Energy
(3)
Protein
(amino acids)
(9)
Lipids-Fat
(fatty acids)
(2)
Oxygen
Water
Carbohydrates
Histidine
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Linoleic acid
Linolenic acid
MacroMinerals
(7)
Na
K
Ca
Mg
S
P
Cl
Trace
Elements
(17)
Vitamins
Fe
Zn
Cu
Mn
I
F
Se
Mo
Co (in B12)
B
Ni
Cr
V
Si
As
Li
Sn
A
D
E
K
C (Ascorbic acid)
B1 (Thiamin)
B2 (Riboflavin)
B3 (Niacin)
B5 (Pantothenic acid)
B6 (Pyroxidine)
B7/H (Biotin)
B9 (Folic acid, folacin)
B12 (Cobalamin)
(13)
*Numerous other beneficial substances in foods are also known to contribute to good health.
Micronutrients:
Public Health Importance
• Iron
• Vitamin – A
• Iodine
• Zinc
• Folic Acid
India
• Burden of Micronutrient Deficiencies
• Health Consequences of
Micronutrient Deficiencies
• Impact of Micronutrient Deficiencies
on Productivity
The Ugly Face of
“Hidden Hunger”
Iron Deficiency
Vitamin A Deficiency Iodine Deficiency
Folic Acid Deficiency
Zinc Deficiency
Anemia in women
(15-49 yrs)
Urban rich
49%
Urban poor
Rural
59%
57%
3/4th of young children, ½ of women &
1/4th of married men are anemic
(NFHS 3, 2005 – 06)
Bitot’s spot
Night
Blindness
0.6%
0.2%
Preschool children
(NNMB 2006)
Goitre
70 million
Mild
neurological
deficits
Cretins
2.2 million
6.6 million
Burden of IDD
(National Iodine Deficiency Disorders Control Programme,
Annual Report (2009-10) M/o Health & FW, Govt. of India, New Delhi.)
Non-iodized salt
Iodized salt
Proportion of households with adequately
iodized salt – 51%
(NFHS 3, 2005-06)
Burden of zinc deficiency
No data
Burden of Folic Acid Deficiency
2,00,000 babies born with neural tube defects per year
India
• Burden of Micronutrient Deficiencies
• Health Consequences of
Micronutrient Deficiencies
• Impact of Micronutrient Deficiencies
on Productivity
Impact of Micronutrient
Deficiencies on Health
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Iron
Vitamin A
Iodine
Zinc
Folic Acid
Iron deficiency
Nutritional anemia: Indirect Cause of Maternal Mortality (20%),
Cognitive impairment & decreased immunity
Vitamin A deficiency
Xerophtalmia, infections & growth failure
Iodine Deficiency
Decreased IQ, mild neurological deficits, cretinism, goitre
stillbirths & neonatal deaths
Zinc Deficiency
Low birth weight, preterm deliveries, spontaneous abortions
& congenital malformations
Folic Acid Deficiency
Neural tube defects, Megaloblastic Anemia
India
• Burden of Micronutrient Deficiencies
• Health Consequences of
Micronutrient Deficiencies
• Impact of Micronutrient Deficiencies
on Productivity
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
……….?
COMPONENTS OF
ECONOMIC EVALUATION
RESOURCES
CONSUMED
Cost
HEALTH CARE
PROGRAM
HEALTH
IMPROVEMENT
Consequences
Cost
Direct
Capital
- (Land, Building, Equipment)
Operating - ( Staff, Overheads)
Indirect
Production loss - (Patients, caregivers)
Transportation
Boarding & lodging
Intangible
Pain
Suffering
Grief
Consequences
Physical functioning
Mortality
Morbidity
Disability
Resources use
Cost averted by health care system in the
form of treatment.
Productivity loss averted.
Social & emotional
functioning
Pain
Suffering
Grief
Changes in quality of life
Friends
Family
COST OF MALNUTRITION – 3 Scenarios
Programme
No Programme
(no resource
allocation)
Existing
programme
(Resource
allocation)
Effective
programme
(100%)
Health consequences
Identification,
Measurement &
Valuation of health
consequences
Due to malnutrition very Mortality
high
Morbidity
Disability
Decrease in prevalence Cost averted by health
of malnutrition
care system in the form
of treatment.
Productivity loss
averted.
Minimal malnutrition
Pain, Suffering, Grief
QOL: family & friends
Calculating Costs: contd..
Productivity lossa 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
HR&D: GOI, Administrative staff college of India, Hyderabad. Dec, 1997.
Productivity loss due to different
deficiency disorders:- Assumptions*
Nutrient
Deficiency
disorder
Iron
Anemia
20%
Iodine
Mild iodine
deficiency
5%
Cretinism
50%
Partial blindness
25%
Total blindness
50%
Vitamin A
Assumed
productivity
loss%
Source: *Assumptions made by Judith McGuire et al National strategy to reduce childhood malnutrition: Final Report; Min of
HR&D:GOI, Administrative staff college of India, Hyderabad. Dec, 1997.
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.
Source:National strategy to reduce childhood malnutrition: Final Report; Min of HR&D:GOI,
Administrative staff college of India, Hyderabad. Dec, 1997.
Assumptions used for analysis
Parameter
Productive life expectancy
Unit
Years
Average annual wage for adult Rs.
Average rate of employment
%
Scenario
Low
Moderate
High
15.6
20
25
3500
5000
7500
75
80
85
National Strategy to reduce childhood malnutrition: Final report; Ministry of Human Resource Development:
Government of India, Administrative staff college of India, Hyderabad. December 1997
Estimated annual
productivity losses (2010)
Nutritional
deficiency
Low
scenario
Rs. Billion
Moderate
scenario
Rs. Billion
High
scenario
Rs. Billion
Iron
305.8
468.2
750.0
Vitamin A
16.4
31.9
63.64
Iodine
69.2
108.1
156.8
National Strategy to reduce childhood malnutrition: Final report; Ministry of Human Resource Development:
Government of India, Administrative staff college of India, Hyderabad. December 1997
Total Annual productivity losses approximately
Rs. 1000 billion (High Scenario)
Micronutrient Initiative:
India Micronutrient National Investment Plan
L Lavialette & et al
Nutrient Category
Vitamin A
Iron and Folic Acid
Iodine
Zinc
Multiple
Management
Total
Yearly Additional Cost
(Rs. in Billion)
4.6
35.9
3.8
2.6
11.0
0.8
58.8
Imagine you had $75bn to
donate to worthwhile causes.
What would you do, and
where should we start?
Copenhagen Consensus : 10 Challenges
1. Air Pollution
2. Conflicts
3. Diseases
4. Education
5. Global Warming
6. Malnutrition and Hunger
7. Sanitation and Water
8. Subsidies and Trade Barriers
9. Terrorism
10. Women and Development
Expert panel
Economists : 8
Challenge Paper
Authors : 3
10 Challenges
Costs and benefits analysis
Rank Listing
Solutions for challenges
Policy Makers
Decision Making on Money Spending
Perspective Paper
Authors : 2
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
Take Home Messages
Micronutrient deficiencies
 Public Health Problem
 Burden is heavy
 Health consequences
 Serious & irreversible
 Productivity loss – Significant
The Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower
women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Build a global partnership for development
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
" 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
Thank You
Seven Challenges in Nutrition
1. Getting nutrition first on the top priority of the
policy makers and keeping it there?
2. Doing the right things
3. Not doing the wrong things
4. Acting on scale
5. Reaching those in need
6. Data based decision making
7. Strengthening operational and strategic capacities
Source: Lancet series on Maternal and Child Under-nutrition 4
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: M&E, R&D, Capacity Building (CB)