Global Health and Nutrition: spotlight on Mexico

1. Division of Nutritional Sciences Global Health and Nutrition:spotlight on Mexico Rebecca Stoltzfus Program in International Nutrition Cornell University

2. Lecture Outline • Global Health • Millenium development goals • Global Nutrition • Health perspective • Economic perspective • Nutrition interventions • Mexico’s nutrition and health

3. Which causes the greatest amount of death and disability? Pneumonia HIV/AIDS Diarrhea Malaria Maternal mortality (death related to pregnancy or child birth)

4. % Ischaemic heart disease 12.2 Cerebrovascular disease 9.7 Lower respiratory infections 7.1 COPD 5.1 Diarrhoeal diseases 3.7 HIV/AIDS 3.5 Tuberculosis 2.5 Trachea, bronchus, lung cancers 2.3 Road traffic accidents 2.2 Prematurity, low birth weight 2.0 % Lower respiratory infections 6.2 Diarrhoeal diseases 4.8 Depression 4.3 Ischaemic heart disease 4.1 HIV/AIDS 3.8 Cerebrovascular disease 3.1 Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma 2.7 Road traffic accidents 2.7 Neonatal infections and other 2.7 Leading Causes of Mortality and Burden of Diseaseworld, 2004 Mortality DALYs

5. Burden of Disease by Type of Cause

6. Four critical challenges at the beginning of the 21st century • High levels and rapid growth of noncommunicable diseases in developing countries (the epidemiologic transition) • The still unchecked HIV/AIDS pandemic • Possible influenza pandemic • Persistence of high but preventable mortality and disability from malaria, TB, diarrhea & pneumonia; from malnutrition; and for both mothers and babies, from childbirth Dean Jamison, DCP2 Summary Chapter 1

7. http://www.youtube.com/watch?v=vddX4n30sXY

8. Health-related MDG’s

9. Why nutrition matters: MAL • Three main arguments: • Because malnutrition causes disease and death • Because malnutrition is a barrier to economic development • Because it is unethical

10. 1. The health argument • Lancet Nutrition Series (2008) • www.GlobalNutritionSeries.org • (and in our resources folder)

11. Therapeutic feeding center in Zway Ethiopia. David Blumenfeld. www.blumenfeld.com

12. Stunting: Invisible Malnutrition 105 cm 125 cm 100 cm • 30% increase in risk of death from infectious disease • 10% decrease in lifetime earnings • 7 month delay in starting school • 0.7 years loss of schooling • Increased risk of NCD’s in later life 7 years 7 years 4 years

13. Infection-malnutrition Interaction

14. Effect of Whooping Cough on the Growth of a Guatemala Highland Village Child Well nourished reference 39 wks Source: Mata LJ. The Children of Santa Maria Cauque: A Prospective Study of Health and Growth. MIT Press, Cambridge, MA

18. Suboptimal breastfeeding increases the risk of malnutrition and illness • What is optimal? • Exclusive breastfeeding for 6 months • Continued breastfeeding for at least 1 year Promotion of exclusive breastfeeding could save more child lives than any other known health intervention.

20. 2. The economic argument World Bank: Repositioning Nutrition www.worldbank.org/nutrition The Copenhagen Consensus www.copenhagenconsensus.com

21. www.worldbank.org/nutrition

28. Will achieve nutrition MDG 1 Before 2015 2035 2065 World Bank. Repositioning Nutrition. 2007

29. Five of the top 10 recommended interventions are nutrition interventions

30. Direct and indirect drivers of child undernutrition Child Nutrition Food/nutrient intake Immediate causes Health Access to food Maternal and child-care practices Water/ Sanitation health services Underlying causes at household/ family level INSTITUTIONS Basic causes at societal level POLITICAL & IDEOLOGICAL FRAMEWORK ECONOMIC STRUCTURE RESOURCES ENVIRONMENT, TECHNOLOGY, PEOPLE Source: Adapted from UNICEF 1990

31. Short and long routes to improving child nutrition SHORT ROUTES Interventions Child Nutrition Breastfeeding Complementary feeding Vitamin A Zinc Hygiene Food/nutrient intake Immediate causes Health Access to food Maternal and child-care practices Water/ Sanitation health services Underlying causes at household/ family level LONG ROUTES Agriculture Poverty Reduction Education Health Systems Strengthening Income generation INSTITUTIONS Basic causes at societal level POLITICAL & IDEOLOGICAL FRAMEWORK ECONOMIC STRUCTURE RESOURCES ENVIRONMENT, TECHNOLOGY, PEOPLE Source: Adapted from UNICEF 1990

35. Rivera JA et al., SaludPublica de Mexico 2009

36. Rivera JA et al., SaludPublica de Mexico 2009

37. Rivera JA et al., Nutr Reviews 2004

38. WHO Global Health Risks 2009

43. Figure 7. Changes in effective coverage between 2000 and 2005–06 for 11 interventions and composite measure, with 95% CISBA=skilled birth attendance. ANC=antenatal care. BCG=vaccine for tuberculosis. DPT3=three doses of diphtheria toxoid, tetanus toxoid, and pertussis vaccine. SDPN=serviced delivered to premature neonates. ARI=acute respiratory infections. Pap=cervical cancer screening with Pap smear.

44. Figure 8. Absolute changes in composite coverage between 2000 and 2005–06, by state

45. A counterpoint . . . . .

47. Millions Saved: Proven successes in global health Center for Global Development http://www.cgdev.org/section/initiatives/_active/millionssaved/studies/case_9/