1994: Judith A. Beto, PhD, RD
Beneficial Nutrition Program Through International Alliance (Nutrition Foundation of India) With ADA or ICDA
I would like to propose an alliance between the International Committee of Dietetic Associations and the American Dietetic Association with the Nutrition Foundation of India. I have been fortunate to be an invited visitor on three occasions to various areas of India. I always return from each visit with a renewed sense of appreciation for the field I have chosen and the profound need for nutrition intervention in India.
Background
By the turn of the century, it is estimated that India’s population will reach one billion people. Nutrition problems in India are vast. As a developing country, India suffers from uniform access to basic support services: lack of safe drinking water and sanitation systems along with insufficient supply and distribution of food. Major cities are linked by airline services but the cost is far beyond the reach of the average citizen. Instead, the population travels by extensive rail systems that require numerous stops and layovers to reach destinations. The access to medical care and preventive health services is developing slowly. Such care is available in large cities where government teaching hospitals exist.
Tracking of disease incidence and mortality is lacking. Hindu customs practiced by a large portion of the population require cremation by sunset and very few, if any, deaths are recorded. Public health is of concern but is shadowed by the bureaucracy and sheer number of patrons that require service. Poverty is a way of life. Yet many survive, despite the odds, to attenpt to maintain a lifestyle that is interfaced with lack of adequate food, nutrients, and safe drinking water.
Personal Awareness
I have been privileged to visit India on three occasions as an invited professional guest. In 1987, I was part of a volunteer health care faculty organized by the Medical Council of India to share information on renal disease. In 1992, I was a session chairperson on nutrition at the fifth Asian Pacific Congress of Nephrology held in New Delhi. During this visit, I was an invited lecturer at the Childs Trust Hospital in Madras. In 1993, I returned to give a statistical lecture at the Postgraduate Institute of Medicine in Chandigarh. These visits have given me an opportunity over time to assess and evaluate the types of nutrition intervention that may be most effective.
Varsha Kalidasan, PhD, RD, is a dietitian from Madras that I have developed a professional exchange with over these years. Her interest, originally in renal disease, was balanced by an international exchange fellowship in Boston several years ago. While on the staff of Childs Trust Hospital in Madras, she developed a nutrition component for one of the few well baby clinics in India. This private hospital, founded in 1979, receives support from the International Lions and Rotary Clubs. It offers extensive services, regardless of income, to a large portion of the pediatric population in Madras. The medical equipment and staff expertise is greater than most centers in India. The impact on children in this area has been remarkable. Childs Trust has been used as a WHO site for model vaccination programs. Currently, Dr. Kalidasan directs a hospital nutrition service in another facility in Madras and has been instrumental in sharing India’s efforts towards nutrition with me.
India’s Current Nutritional Efforts
India has several centers of nutrition interest. The Nutrition Society of India, a professional organization, holds annual academic sessions to share information and research. The National Institute of Nutrition at Hyderabad publishes periodic editions of Nutritive Value of Indian Foods. This center also trains many of the dietitians in India. Their education level is closer to our equivalent of a diet technician, currently appropriate for the level of intervention possible. Most hospitals are large open wards with minimal staff. The family is often expected to visit and be responsible for part of the care of the patient. Food service is very informal and bulk oriented in composition. Therapeutic diets are difficult to enforce within the hospital and almost impossible to enforce as an outpatient due to lack of specialty foods and economic issues.
Nutrition Foundation of India
The most valuable nutrition information dissemination is compiled by the Nutrition Foundation of India. This multidimensional organization is headed by C. Gopalan, PhD, a noted nutrition scientist.
Publications: The Nutrition Foundation of India publishes an impressive quarterly newsletter updating interested professionals on ongoing activities within the country. Topics noted in 1993 included:
Child Care in India—Emerging Challenges
Tumeric: A Potential Anti-Cancer Agent
Integrated Child Development Services (ICDS): An Assessment
Efficacy of Megadose of Vitamin A
Prevalence of Diabetes in Indians
Publications are routinely compiled that are invaluable resources to a very literate professional society. Some representative publications include:
Special Publication 5: Women and Nutrition in India, edited by C. Gopalan and S. Kaur. Highlights studies of nutrient requirements and RDA of girls and women, women and the health system, pattern of growth and development of Indian girls compared to adult Indian women, demographic consequences of low status of women in an Indian society, socio-economic and socio-cultural influences on nutritional status and women’s roles.
Special Publication 8: Profiles of Undernutrition and Underdevelopment: Studies of Poor Communities in Seven Regions of the Country. Funded by the Ford Foundation. Presents studies of tribal, urban slum, and rural areas concerning nutritional status of children and adults.
Special Publication 9: Towards Better Nutrition—Problems and Policies, edited by C. Gopalan, 44 authors. Covers areas of community health and nutrition problems, women and child nutrition, foods and diets, energy metabolism, vitamin A, national nutrition programs, and nutrition and diseases.
Recognized Information Source: The Nutrition Foundation of India is an excellent clearinghouse of information. The publications are well written, professionally produced, and peer-reviewed. The Foundation appears to be well aware of the political ramifications within the country and has succeeded in surviving despite changing health agendas and funding. Culture is an essential part of food behavior. India has a rich and diverse culture that represents a wide array of health practices and beliefs. The Nutrition Foundation recognizes this diversity and strives to provide information and research within the culture.
Grassroots Approach: An alliance with the Nutrition Foundation of India would continue to reinforce that information needs to be disseminated from a recognized organization within the culture. Because of India’s vast numbers, the most practical and simple project can have a profound effect on millions of individuals. These projects need to be designed and implemented with a community-based approach. The Foundation has recognized that the most successful programs to date have not been large-scale projects from the national government but rather have been those programs adapted locally that emphasize community involvement and delivery.
Communication Feasibility: English is the only common language and is spoken widely. Most, if not all, publications are in English. The alliance would be realistic. India continues to follow the formal British traditions of written protocol and committee format that would interface well with organization communication. Widespread telephone communication is not currently available in all areas, so the written publication format is the most logical basis for all communication.
History of Self-Evaluation: The Foundation uses problem-solving and critical thinking when evaluating existing programs. India is a country where resources are precious and very little is wasted. Manpower and efforts are treated the same. Extensive work has already been done in recognizing problems with inadequate performances and results in current nutrition efforts. Future alliances will benefit from this groundwork and assure resources are directed for maximum efficacy.
Proposed Alliance Priorities
I would suggest the following proposed activities to establish a beneficial nutrition program through an international alliance with the Nutrition Foundation of India and the ADA or ICDA:
1. Establish a publication exchange. The quarterly bulletin of the Nutrition Foundation of India could be abstracted in the Journal of the American Dietetic Association. The Journal of the American Dietetic Association and Perspectives in Applied Nutrition would be invaluable resources for research and education. Special publications of both organizations could be exchanged for similar purposes.
2. Share dietetic education criteria and standards. The current dietetic and nutrition education in India differs from the United States. As the complexity of the nutrition delivery system grows, the expertise and numbers of leaders in nutrition will need to continue as well. Experts within the country and within the culture will be challenged in the next century to provide nutrition parameters for a changing population. Poverty and malnutrition will continue to exist, but the rising numbers in the middle class will potentially bring “westernized” problems. In the United States, the CADI Study (Coronary Artery Disease in Indians) has shown strong evidence of insulin resistance, unique lipid profile, and links to dietary habits and sedentary lifestyle.
3. Develop a faculty exchange program. Nutrition experts from each country could benefit from an exchange of ideas face-to-face. Annual programs from both organizations could be videotaped and shared. Travel grants based on established criteria could be offered. Fulbright scholarships, already existing in the United States, could be encouraged to include a nutrition priority. The ultimate goal would be an opportunity to provide teaching and research information that could be used to train community educators in India that in turn would deliver the knowledge and services on a community level.
4. Share existing nutrition databases. The large Indian population in the United States is difficult to include in research protocols because of a lack of a nutrition database that provides accurate information on cultural foods. There are existing publications and databases in India that could be merged and adapted for use. Computer technology centers are rapidly growing in India and would benefit from selected information from existing American databases.
5. Support evolvement of existing nutrition education materials and programs. Many of the literacy and language problems found in the vast expanse of India are present in some areas of our own country. Techniques of simple communication with carefully selected messages could be shared. The use of television and satellite communication will grow and require new media skills that are already present in our country.
Summary
I believe an alliance with the Nutrition Foundation of India would clearly meet the criteria set “to work toward raising the nutrition health of the world community.” The Foundation has put priority of work on nutrition in women and children that interfaces well with the research agenda of the American Dietetic Association. I have been privileged to share a tiny part of my expertise with this country and have found even the smallest contribution can make a difference. It would be an honor to assist in the formation of an alliance which would take tiny dreams and propel them into significant action.