Rethinking Nutrition Monitoring

Article excerpt

Nutrition monitoring has been used to analyze the nutrition problems of nations and communities for more than twenty years. But researchers have found that the data are rarely used effectively. A new approach to the process may provide better results.

Nutrition-related problems cut across all classes, races, and socioeconomic groups. For the very poor, the issue frequently is simply getting enough to eat. The resulting undernourishment can lead to impaired physical growth, slowed intellectual development, and depleted energy levels. For the poor and the more affluent, the issue may be adopting the wrong diets, consuming foods high in fats and sugars and not eating enough fruits and vegetables. Such diets can result in obesity and related health risks such as hypertension, heart disease, and cancer.

Some problems are specific to mothers and children. Inappropriate weight gain during pregnancy can pose health risks to both mother and child. A low breast-feeding rate means many children are denied the nutrition benefits and immunity to diseases provided by breast milk.

"For years, planners, practitioners, and researchers have used nutrition monitoring to assess the problems of various populations in developed and developing countries with the goal of stimulating decision making at the national level," says David Pelletier, an associate professor in the Division of Nutritional Sciences. Pelletier has been involved in nutrition surveillance, or "monitoring," since coming to Cornell in 1984. The strategy had first been developed ten years earlier following the world food crisis of 1974.

"During the food crisis, international donors and bilaterals like AID wanted to have up-to-date information on the nutrition situation around the world and in individual countries," he says. "Cornell was identified as a center of excellence to develop the field and implement it in specific countries. We also have been active domestically with national nutrition monitoring, and New York has been one of the more active states at the community level."

One New York State effort, the Community-Based Nutrition Monitoring (CBNM) Project, was begun in 1989 to document the extent of nutrition-related problems and services in several New York counties. A collaborative effort between the New York State Department of Health and the Division of Nutritional Sciences, the project operated as a pilot program in three counties from 1989 to 1992. Widespread interest allowed it to expand to thirteen counties in 1993. It didn't take long, however, for the community practitioners to suspect that the link between data and action was weak.

"The ultimate purpose of the project was to support decisions and actions related to nutrition services, programs, and policies," says Pelletier. "But what we learned was that turning the data into action was difficult. It turns out that if your goal is to find uses for your data, it's very much like putting the cart before the horse. This has been the case both in developing countries as well as in the community programs here at home."

For better or worse, this approach had been used for years in monitoring projects because, at least on the surface, it made sense. Pelletier says it arose out of an epidemiologic and public health paradigm that suggests that if problems are documented, finding solutions will logically follow.

"It was a rational decision-making model, and it made sense to academics and people who follow the rational model," he says. "But the way decision making actually happens in communities and in countries is quite different. People simultaneously focus on problems, their potential solutions, and their connections to their own political agendas or organizational agendas."

As an example of the type of problem people would run into using this model, Pelletier points to the practice of nutritionists collecting data on the heights and weights of schoolchildren. …