For the final assessment in this course, your task is to explore a public health nutrition issue. This task brings together the core elements of the course in understanding the public health significance of nutrition problems at different stages of the lifespan.

Imagine that you have just started working for a health department in a particular country/state/region. You have been asked to critically review the scientific literature discussing a nutrition issue of significance in that region. For this activity, your task is to have a detailed exploration of nutrition issues of significance in a particular age group, identifying clearly the social and geographic contexts. Your review should describe and/or assess a community or public health nutrition problem in the chosen population, and should relate to a single country or region or population context that you have direct knowledge of, or have read widely about. You are required to consider a life course perspective in completing the task.

For this task, first choose a country or region. This may have been one that you have lived in, worked in, or have a special interest in. What would you consider is the primary nutrition- related health issue in this country/region? You may choose your topic from the list below:

- Outcomes of malnutrition during pregnancy (mother/infant)
- Stunting, wasting etc., during infancy
- Adolescent/school age nutrition issues
o Iron deficiency anaemia in adolescent girls
o Consumption of junk food
- Micronutrient deficiencies
o IDA
o Vit A deficiency
o Iodine deficiency
- Poor fruit and vegetable consumption
- Nutrition-related overweight, obesity or metabolic and cardiovascular diseases
- Nutrition issues in the elderly Please clarify your choice of topic with me.
Consider the following while describing your problem:

1. What is the problem? What is the key nutrition problem that is being discussed? (do not state this in terms of inadequate health service, or of causal or contributing factor e.g. poverty)

2. Where does the problem exist? (Country/region)
a. Define the geographic area that you are describing.
b. Describe your population and its characteristics (SES, religion and food culture, age group etc.)

3. Prevalence and distribution of the problem

4. What is the extent of the problem?

a. Who is (most likely to be) affected? Is the problem changing over time? How? What data is available to describe the distribution of this problem in the population? What does it tell us? What is the global prevalence for this nutrition problem? What data is available to describe the relative extent of this problem in comparable or contrasting regional or national populations?

b. What indicators were used? How is this problem detected/measured in a population? (What sort of clinical/functional/anthropometric measurements are used?) Are there particular low tech or low cost tools that might be considered useful for nutritional assessment in a field/community setting?

5. Why is this problem important?

a. You need to be able to state clearly why this nutrition problem should matter from a public health point of view. Why should politician or public health policy makers pay attention to this problem? Specifically what is your argument for investment in public health nutrition programs or policies? What are the implications of the problem? You might like to consider both short and long term implications of inaction for - Individual health, earning &/or caring capability, Quality of Life - Future health expenditure, and/or - Human rights

6. What are the causes of this problem? Determinant analysis

a. Conceptual maps can be a useful way of visually displaying factors influencing the problem (both barriers and facilitators of positive change). Typically there is some consideration of proximal, intermediate and distal influences. Conceptual maps are a useful aid to thinking ecologically.

b. What role does the [nutrient/dietary pattern/nutrition behaviour] play in human health? - Are there dietary factors that need to be explained? (e.g. what are the dietary source of a particular nutrient; particular factors inhibiting absorption, etc., are there any sociocultural issues that hinder consumption) What are the immediate contributing factors? Are there behaviours that need to be explained? What conditions or factors promote these immediate contributing factors? What social or commercial determinants have contributed to the problem?

7. Media
a. Stories about actual communities or households affected by this problem are extremely useful in putting a human face to the problem. Find an example of a media article that incorporates a description of the ‘human face' of this problem. Comment on how the author of the piece (a) perceives the problem and (b) what approach does the response fall under?