Nutrition is integrated in every aspect of primary health care and is thus part of the means of achieving universal health coverage. Nutrition is implicated in multisectoral policy and action, it serves the engaged people and communities which are so central to primary health care, and, of course, is part of the integrated health services that combine clinical services and essential public health functions.
Nutrition is so essential to health, in fact, that PHC providers are already carrying out nutrition actions without thinking of them as separate interventions. One example is the cutting of the umbilical cord at birth. WHO recommends that the cord be clamped no sooner than one minute after birth, because during this time nutrients continue to flow to the baby. We don’t necessarily think of cord clamping as a nutrition intervention, but it can have very important nutrition implications, primarily providing an increased iron reserve in the first six months of life, which can have consequences for the child’s mental development.
Another example of an intervention which is not necessarily seen as a nutrition intervention is antenatal care. Women often see pregnancy as simply a normal part of their lives and not necessarily a reason to seek medical care. But seeing a medical professional during pregnancy – and the WHO has recently changed its recommendations to eight visits, or one per month – can be the opportunity to provide nutrition interventions to prevent anemia or address other symptoms and risks during pregnancy.
But it is important to remember that nutrition is a key intervention not only during pregnancy and birth, but throughout the life-course. To this end, WHO has recently published its revised Essential Nutrition Actions. This report addresses how nutrition is integrated in all aspects of PHC, whether it be health promotion, prevention, therapeutic or curative, rehabilitative and palliative.
Malnutrition is now seen as a continuum which includes a broad spectrum from undernutrition to excessive nutrition and obesity, as well as micronutrient deficiency. All of these elements form part of dietary risk, which is responsible for 11.3 million deaths a year. In fact, 45% of mortality in children under 5 is attributable to malnutrition. Poor nutrition reduces immunity, increases susceptibility to disease, impairs physical and mental development, and reduces productivity.
In contrast, good nutrition, or optimal nutrition, is the intake of food considered in relation to the body’s dietary needs. It is obtained through a balanced diet combined with regular physical activity and is a cornerstone of our health and well-being. All too often, people – and even health professionals – do not recognize the role of nutrition until something goes wrong.
As health care providers, we don’t need to be waiting until people become patients. PHC practitioners are involved in maintaining the status of health and well-being of all the population. PHC providers will increasingly be called upon to speak to questions of nutrition, both at the individual level, and, more importantly, at the community or policy level. So whether it is advising a pregnant woman on her daily nutritional needs or working with local government on healthy meals for schoolchildren, health care providers will be called upon to provide leadership with regards to nutrition. These actions and interventions will not necessarily happen only within clinical settings, and they will require a health-in-all-policies approach.
“The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” – Thomas Edison, 1903