Community Nutrition and Health

These two terms cannot really be defined separately since problems of nutrition and health co-exist in  the community where one  influences the other. Therefore, general definitions have been provided followed by an elaboration of the concept of community nutrition. 

Community  health 

Community  health is concerned with the  health problems among different groups of population. Such concern with health problems of population groups lead inevitably to a broad  range of interests i,e, from the cause, prevention and control of diseases, nutritional or otherwise. Thus community  health includes both identification of nutritional and health problems  and causes and prevention as well as control of diseases. You might be aware of many of ehc health  problems. Aren't you! Can  you suggest a few? Yes, jaundice, diarrhw, ulcer etc.. and nutritional problems like anaemia, night blindness, etc. are a few examples. 

Now let us understand community nutrition. 

Community  nutrition 

Community nutrition is the study of assessing food and nutrition situation in terms of identification of fwd and.nutrition prob!ems, causative  factors and possible  solutions both  for  prevention and cure of the problems. 

Now  you must have realized why community nutrition and health cannot be looked at separately and how they are interlinked with one another. Nutritional problems of a community are indicated by the nutritional status of the  different  groups of people in the community. The nutritional status of population groups in a particular community is influenced by a variety of factors. The manifestations of undernutrition and malnutrition vary in  type and  degree from community to community  through differences in food availability and consumption patterns. A population group may survive  for sometime on a marginally inadequate diet, but may be more prone to disease and less efficient both physically and mentally. 

Food consumption is influenced by a variety of factors, many of which will be discussed in the next unit.

Nutritional  Surveillance is another term which can be substituted  for community nutrition. It could be said to describe the process of attempting to  estimate the number of individuals in a population who are  either suffering from  inadequate  nutrition in terms of type and degree. It should further be concerned with identifying the reasons for any  malnutrition which  may be discovered, and which individuals in a community are most vulnerable to its effects. Corrective and preventive  measures can then be determined and steps taken to implement suitable action plans. 

From this explanation, it is clear that, nutritional surveillance or community nutrition consists of three distinct components.  They are: 

1. Community Diagnosis 
2. Developing an Action Plan 
3. Evaluation of Action 

Let us  discuss each of the  component separately. 

1.  Community Diagnosis 

Reading through  the unit, you  must have got familiar with the community and certain general issues related to community. You know/and can identify the common diseases in the  community particularly those related to nutritional problems.  Next, how to identity these problems? In order to identify these nutritional  problems you need to learn about different assessment methods like dietary survey, clinical method, anthropocentric measurement and biochemical analysis. You may recall  reading about these methods in course I, block 6, unit 25. Using  that knowledge, try to identify how many people and which groups of people are suffering with  what problems in a community? This gives you the information on who are the vulnerable groups of the community and what are the problems  with which they are suffering? 

Remember that the community must take part in all these discussions for which  you have acquired the skill in the previous unit. You must also coordinate with other agencies in the community for obtaining the above information. 

Now  you are ready  to concentrate upon the identification of factors which cause nutrition and health problems to occur. It is important  to remember that food, nutrition and health problems are combined to diagnose the causative factors. These three problems are interlinked and the root causative factors may be common and interrelated with one .another. Let us understand this with an example. If  diarrhoea presently occur among a group of children in a community due to improper source of drinking water it might  lead to malabsorption of nutrients in  the body. As a result, any nutritional deficiency like anaemia or night blindness might set in. Poor dietary situation might further aggravate the condition. Thus the-problem is initially health and then lead to nutritional later. The root causative factor may be common to more than one of the three problems. 

Some of the causative factors a&  educational, social,'economic, cultural, agricultural. health, etc. These factors are detailed here for your  understanding. 

Educational 

Lack of awareness among people about foods and nutrition, child care, hygiene and sanitation and their relation to nutritional health status. 

Social

Living conditions are unhygienic, over crowded and insanitary. Mothers  and children overburdened with work in the farm and at home. 

Economic 

Poor agricultural yield and low economic conditions. 

Cultural 

Undesirable traditions or religious beliefs which affect diet, attitudes towards practices such  as child spacing and so on. 

Agricultural 

Nonavailability of certain foods. 

Health 

Lack of awareness about safe drinking water source, common illness, malnutrition. 

This is not the full kt of factors involved? You, alone may not be able to collect detailed  information on all these items. Information on these issues is always available from people within the community, other community workers and various agencies. Chart 1 shows some common topics and likely sources of information. 

Common topics and likely source of information.

The information related to nutrition and  health problems in  the community, their causative factors is collected along with the members, leaders  and  workers in  the community. 

Community diagnosis, therefore, help identify the problem. After identification of the problem, suitable plan of action needs to  be formulated for the problem. Next  section discusses the second dimension i.e., Action plan of nutrition surveillance. 

2.  Developing an Action Plane

Information collected with the help of community will  help to identify chief problems and suggest causes for the problem. Thus it helps us understand  some of the problems and  needs of the people in the community and  help to plan suitable actions to overcome these problems. 

The chief problems like food shortages, malnutrition and anaemia and.the factors involved, can be identified through this process. After collecting this information, we could meet with the people and discuss it. Meeting and discussions with individuals or groups are useful for helping people look closely at the reasons for problems.  They  need to understand why problems do or do not occur so that they will  be able to choose  the best actions to take to solve their problems. People in the  community, other community workers and health staff  are examples of some of these people with whom we will discuss the problems. 

The aim of these discussions is to learn as much as possible about  the problems how they are regarded by each group, the  number of people who have  these problems, the behaviour that causes the problems, possible reasons for this behaviour, other causes of the problems, what solutions are possible, what are the best solutions, how these solutions will fit into people's  lives,  the advantages and disadvantages of each solution and so on. 

Suggesting causes for food  and nutrition problems 

There are many reasons why food and nutrition problems occur and it is important to ay and identify the most important causes, some of which may be: 

• not enough  food for everyone but especially  for young children 
• too little money to buy food 
• no jobs 
• not enough education 
• bad roads and no transportation to take crops to the  market 
• Not enough clean, safe water 
• infections and diseases in children 
• poor families with ton many children. 

You would notice often  nutrition problems are caused by bad practices such as: 

• poor handling and storage of food 
• unsanitary disposal of rubbish and human waste 
• improper  weaning practices 

You need to work with  the community in finding out possible  causes for the problems as well as possible reasons  for the bad practices which cause problems. 

Bised on the causes, an action plan can be developed. Let us learn how to do it. 

 Developing a Plan of Action 

It is evident  that problems often have several causes. Hence, the community must decide on different actions to take in solving them. Deciding on which actions to take  will depend on the kind of problem, its causes and  the reasons behind the behaviours which cause it Working out an action plan  will  involve: 

• understanding and stating clearly what you want  to achieve 
• deciding on the activities and materials you will need 
• identifying  the people you will need 
• giving jobs  or tasks to people 
• putting the whole plan into a time frame which shows when the activities will start and  end. 

To ensure that the  action plan is effective. evaluation is necessary. How do we evaluate? The next section presents a discussion on  the third important dimension of nutritional surveillance i.e..  evaluation of action plan. 

3.  Evaluation of Action 

Evaluation should be  based  on the views of every one who  was involved in planning and in carrying out the activities. We may carry out evaluation either verbally or in writing.  However, we should write down the results carefully so that we have a record of what happened. Our notes will also help us  plan and carry out future programmes more effectively. 

Evaluation  must be done: 

• from different points of  view (e.g. the community worker. community members other community workers people from outside) 
• clearly and frankly, and 
• completely giving both strong and weak points. 

Why evaluate? 

If at the beginning of a plan or activity, we have a clear idea of what we want evaluation will  help us find out if  we have  succeeded. For example, if we wanted to fewer children becoming malnourished, we need to know at the beginning what are the bad practices which help malnutrition to occur, also other causes.  The plan of action to be followed will be aimed at changing  these practices and correcting the other  causes. Evaluating the results will show whether the bad practices which cause malnutrition are fewer and if there are more of the right behaviours  which keep people healthy. Remember, it may take some time for the results of an activity to show. depending on he kind of health or nutrition problem  which is being dealt with. Evaluation is also important because: 

• we can find out which actions will gain results and which will not 
• we can avoid  repeating  mistakes and  help others to avoid the mistakes we have made 
• we can save time and money by not carrying on with unsuccessful activities 
• we can gain satisfaction by showing results 

Asking questions like what  things went well? Why did they go well? What new behaviours have people learned? How can they  use these behaviours to solve other problems?-will  help us  and  the community evaluate and  learn from a plan or activity. If the results were not what we expected, we should try to find out why? 

Answering the following questions will help us and the community to plan better activities and programmes to improve the  status of community nutrition. 

• Were there any problems in carrying out the activity? 
• Did each person involved know what to do? 
• Could each person do what he had to do? 
• Did each person do what he had to do? 
• How did he do it? 
• Were the right kinds of activities chosen?