Who will sit on the hot seat ?

Who will sit on the hot seat ?

The issue of public health nutrition is increasingly gaining importance. However, sometimes I get confused and tend to think that public health nutrition is perhaps one of the easiest topics in the world. The reason lies for such apprehension of mine is the wide spread perception of this topic as an “easy” subject; because anyone, irrespective of the educational background or work experience can be an “expert” in it. This is fairly the case in many developing countries. In the developing countries, the key governmental positions for public nutrition are commonly filled by the non-nutritionist medical doctors who are either a practicing medicine specialists or a pediatrician or a general physician or even against all odds, a hardcore anatomist who had spent most of their career in teaching the structure of human body to the medical student. For a medical doctor, public health nutrition perhaps is the most neglected topic in the MBBS academic curriculum. Being a medical doctor turned public health nutrition specialist, I am aware of the positioning of the nutritional topics in the undergrad medical curriculum of Bangladesh and perhaps other similar settings. The world of nutrition in the medical syllabus of many developing countries highlights mostly just two medical conditions- “Marasmus” and “Kwashiorkor”- the two forms of severe acute malnutrition (SAM). Among the nutritional topics, these two are commonly featured in the MBBS exam questions and all the students make a good preparation. Unfortunately, this is the only topic to study nutrition for many of the nascent doctors! That’s all about the public health nutrition in a 5 year long ( 6 years if the one year internship is considered) MBBS training which is arguably regarded as one of the most challenging graduate courses in the world. No wonder, I have heard some of my nutritionist colleagues making joke of the medical doctors in the field of nutrition by dubbing them “two-page educated nutritionist”.

In reality, public health nutrition is much more than studying just a few topics of SAM. It encompasses food, food intake, macronutrients, micronutrients, dietary assessment, concept of average requirement (EAR), recommended requirement (RDA), highest harmless intake (UL), fortification, supplementation, assessment of nutritional status in population, science and art of policy making and advocacy and many other technical issues.  It hinges upon the social science, statistical science, epidemiology, research methodology, health economics, developmental economy, dealing with statistical software etc. It is truly an area of specialisation with the similar amount of complexity and multi-faceted skills, as required to do specialisation in any medical disciplines. Similar to specialisation in other areas, following the academic training, professional work and the accrued experience can develop a seasoned public nutrition expert over time.

Nutritional science and practices are in the dynamic process of development and refinement which necessitates the nutritional professional must be vigilant and updated on the latest developments. Therefore, just placing a child specialist or medicine specialist in a key position of public nutrition specialist or manager is a no brainer in speculating the potential untoward implication for public nutrition. That person might be a great clinical doctor but she would be unable to do justice for the requirement of the expertise as a public nutrition professional. Unfortunately, this has been happening in many developing counties in the government and the private sectors.

This has been happening despite there is no apparent lack of the trained nutrition graduates who are ready to join the public nutritional positions. The scenario is not different in the NGO sector. I have seen some major non-government organisations in Bangladesh working solely with the nutritional programmes did not have a trained nutritionist among the staff members. This is a sheer failure of human resource management in the countries where the burden of malnutrition is heavy and complex and which only can be dealt efficiently by trained expert nutritionists. To operate an engineering department, engineers are deployed; to treat patient in hospitals doctors are employed. Then why not the nutritionists be deployed in the key public health nutrition positions?  One reason for this is our predominant perception that nutrition is a trivial subject, and as such it does not require a specialist. The other reason is the issues and complexities surrounding the health system which makes entry of specialist nutritionist in the key positions difficult.  Lack of the right personnel in the key positions has been certainly impeding the progress of the nutritional emancipation in the developing countries. The more the governments, the public and the private organisations will look into this, the better will be the prospect for successful and efficient containment of malnutrition.

Sabuktagin Rahman
Public Health, School of Medicine,
Griffith University, QLD

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