Reassessing strategies for improving health

Strategies should include nutrition

EDITOR—That the call for reassessing health outcomes by Evans et al is limited to a disease model as linked to millennium development goals 4, 5, and 6 alone is surprising.1 The World Health Organization listed child underweight as the leading risk factor contributing to the global burden of disease2; and Pelletier et al have clearly shown that malnutrition underlies over 55% of all mortality in under 5s in developing countries.3 These results, which indicate that mild to moderate malnutrition is associated with higher mortality and that an epidemiological synergism exists between malnutrition and morbidity, have been substantiated by several other studies.

So long as the global community continues to aim to tackle health as a disease model divorced from nutrition, as Evans et al propose, it will continue to fail in achieving the millennium development goals. Malnutrition represents the non-income aspects of poverty and a malnourished population cannot aspire to achieve the health goals without also dealing with nutrition. Furthermore, many nutrition interventions that can be made mainstream through the health sector are among the most cost effective best-buys in development as assessed by the Copenhagen consensus and others.4 5 Any future efforts at achieving the millennium development goals must incorporate these nutrition interventions.