Health and Promotion Policies and Promotion - Essay Example

Health and Promotion – Policies and Promotion Debbie Whitmore Academia-Research, Inc. May 22, 2005 I. Introduction II. of Project III. Program Achievements and Potential Goals IV. How Project Initiatives fit into National and International Policies/Programmes V. Methods of Project Evaluation VI. Beattie Model VII. Conclusions The country of China has seen significant improvements in their nutritional status over the last twenty years. However, a number of micronutrient deficiencies remain prevalent within various physiological units and age groups (2002). This report will focus on the iron deficiency anaemia problem in China and the country’s plan to reduce it by the introduction of a programme that has created and supplied an iron fortified soy sauce. The type of iron that is being used to fortify the soy sauce is called sodium iron ethylenediaminetetraacetic acid or NaFeEDTA. NafeEDTA is considered to be the most suitable form of iron because of its chemical stability and its effectiveness in foods that may need to be stored for lengthy period of times (Hurrell 2001). Also, NaFeEDTA does not change the taste or colour of the sauce. Soy sauce is consumed by roughly seventy percent of the Chinese population, which makes it an excellent food choice (2002). NaFeEDTA fortified soy sauce was first placed on the Chinese markets in 2002. As of 2003, the fortification programme has been funded by the Global Alliance for Improved Nutrition, also known as GAIN (2005). The Global Alliance for Improved Nutrition implemented a five year programme in the year 2004 that would develop a countrywide plan to manufacture, market, educate and supply the iron fortified soy sauce to China. ‘The goals of the programme include: annual yield of iron-fortified soy sauce in the amount of one million and eight hundred thousand tons, which accounts for thirty to fifty percent of the total soy sauce production in China; proper quality control system is to be established in all of the iron fortified soy sauce producers; the programme is to cover three hundred and sixty million Chinese residents, including one hundred and twenty-nine in high risk populations; and the reduction of the prevalence of anemia by thirty percent in the high risk populations (2005).’ GAIN’s nutritional plan also includes a programme to make the problem of iron deficiency known to the population. The alliance hopes to increase awareness in the urban areas by eighty percent and seventy percent in the rural areas (CDC 2005). An extensive monitoring system has been set in place so that any improvements achieved by the alliance will be heard by the public. An educationally based programme has been put in place that will ensure the public is aware of the existence of the new product and the benefits of its use. Only a select group of soy sauce producers are chosen to manufacture the NaFeEDTA fortified soy sauce. The producers undergo extensive training, regulation and regular governmental inspections in order to be able to provide the nutritious product to the public. This type of monitoring process is advantageous for the public, but inevitably it produces a higher priced product. This will make it a less affordable and therefore less accessible product to those living in the poorer rural areas. On the other hand, China has used social marketing to introduce and make the product known to the consumer. The manufacturing of the fortified sauce is done voluntarily and so is its purchase. The implementation of a fortification programme is a vast and expensive undertaking. In order to be successful, such a programme requires the cooperation of consumers, governmental agencies and private corporations. For these reasons, it may be worth reviewing the importance of a diet that includes a satisfactory amount of iron and the status of the iron deficiency in China. ‘Iron deficiency anemia can be one of the most severe nutritional deficiencies in the world (CDC 2002).’ Young children and women of reproductive age are the most susceptible for this deficiency. ‘Iron deficiency anemia or IDA can lead to a decrease in learning abilities, cognitive development and work capacities for individuals and an entire country (CDC 2002).’ Studies have shown that poor iron levels in individuals have been shown to reduce intelligence quotient levels by as much as five to seven points (UNICEF 2003). The problems that iron deficiencies cause increase as children get older. This form of nutritional deficit could lead to economic devastation for a country in the long run. It is not difficult to understand the reasons China would want to prevent IDA from becoming a long standing or widespread problem. Currently, the iron intake of the Chinese population as a whole is sufficient. ‘In 2000, IDA was found in 12.3% of children under the age of five in urban areas and was found at 26.7% in the rural areas (WHO 2002).’ Iron Deficiency Anemia is the most common nutritional problem in China and plants do not provide enough iron supplements for the body. It is deemed by the Asian country as being an appropriate time to prevent any difficult and perhaps irreversible issues that can be related to a large percentage of a population suffering from the lack of proper nutritional supplements (Shian 2005). China’s fortification plan fits into the goals set by the international community as a whole. In 1990, the World Summit of Children recognized the problem of micronutrient deficiencies and made a pact along with other developing countries to develop programmes to decrease or eliminate these deficits by the year 2000. China joined this commitment two years later than most countries (Mason 2003). Since it has not been diligent in starting its programme, the country is undoubtedly behind in its efforts when compared with the rest of the developed countries. Other international organizations, such as UNICEF, have made providing people with the necessary micronutrients through food fortification programmes a priority also. The battle against iron deficiency is more difficult because no country, including China, has done extensive studies on it and all studies recorded are no more than 10 years old (UNICEF 2003). Although IDA is considered the world’s top ten problems, most of the public and politicians have not experienced the devastating effects that IDA can have, therefore there have not been as many advances against the disease as could be. China’s plan is based solely on surveys and studies that are based solely on children and women of child rearing age. Part of the problem that GAIN has to battle with in order to overcome this problem is the public’s perception that iron deficiency is only a problem that women need to be careful of. GAIN will need to be more aware of this issue during the remainder of its public marketing campaign. This is unfortunate in that this programme may only assist that particular group in its quest of increasing the country’s iron consumption. China’s fortification plan is set up to be monitored by the Centre for Disease control and the Ministry of Health. The fact that these two organizations that have assisted in developing the programme will train, monitor and train the producers of the product will allow for a greater control of the project to ensure that it is carried out properly. To this date, China has been very successful in carrying out its programmes, even with the areas of improvement mentioned. China even plans on extending its iron fortification programme by developing fortified flour. The introduction of the fortified flour product indicates that China has continued to look for consumer trends in order to battle the problem. This type of insight is imperative to be triumphant. In addressing any micronutrient deficiency, fortification seems to be the most effective. ‘Fortification has the advantage of requiring relatively less change in consumer behaviours and food habits than other interventions, although this approach does not mean that nutrition education and social marketing can be ignored (Hill 2001).’ China has realized this and firmly integrated those two features in its programme. Additionally, all successful fortification programmes have monitoring and evaluation plans as a part of the goals. The monitoring and evaluation portion of all projects tends to be one of the most expensive aspects of it and more countries are attempting to decrease these costs by finding both private and public organizations that can work together. Examples of those in the public sector that need to be a part of this movement would be the politicians committing to the project. Those that need to participate from the public sector would be those in the medical profession, as they need to assist in the education process of the public. The monitoring phase will have to include overseeing the manufacturers of the fortified sauce to make sure that correct iron amounts are used. Too little NAFeEDTA could render the sauce ineffective and too much could cause other health problems for users of the product. Per the Centre of Disease Control, China’s plan includes this type of monitoring system. Another aspect of a successful fortification programme is one that makes the fortified product stand out from the other products that are not. China meets this criterion by having the soy sauce bottles that are fortified clearly labelled for consumers to see. The Beattie model’s approach to promoting healthy solutions for people is broken down into four approaches: health persuasion, personal counselling, community development and legislative action for health (1991). Health persuasion is when the public is made aware of preventive medical steps that can be taken in order to take control of their health. Personal counselling is when people are given one-on-one counselling sessions that would inform them about health solutions. Personal counselling usually happens when certain groups are targeted. Community development involves allowing groups of people to meet their needs with the education provided to them. Lastly, legislative action is when the government gets involved in order to protect the health of its citizens. The Chinese NaFeEDTA fortification plan for soy sauce appears to address three of those issues. Through its social marketing and education programmes, the health persuasion and community development are addressed. The fact that the government agencies such as the Centre for Disease control are an active part of this movement means that Chinese has moved towards a legislative action for health. This can be enhanced with the support of the politicians. This century has brought a shift away from the idea that one person is responsible for his own health. It has become apparent that when a nation is healthy, its economic situation, lifestyles, development and strength has improves. This has moved many health issues, such as the iron deficiency anaemia, problem from a more isolated hospital care to community prevention (1998). China’s NaFeEDTA fortification programme has done just that. If China continues to review and revise its programme based on consumer trends and needs, it could prove to be more successful that it has set out to be. Undoubtedly, it has a difficult road ahead but China is one country that is aware of the benefits of such a successful programme and has proven that iron deficiency is problem that it wants to confront. REFERENCE LIST Office of Food Administration 2005, Chinese Centre for Disease Control & Prevention, viewed 21 May 2005, www.cdc-ffo.cn/en/QuaM1.asp. Hill, I. 2001, Fortification strategies to meet micronutrient needs: success and failures, US Food and Drug Administration, viewed 20 May 2005, http://saturn.bids.ac.uk. Improving Micronutrients Deficiency Through Food Fortification in China 2005, viewed 20 May 2005, http://china.ilsi.org/index.cfm?pubentityid=303. Project Idea 2003, viewed 21 May 2005, www.micronutrient.org/idpas/pdf/SCN%20Feedback/project_IDEA.pdf. China 2002, Nutrition Overview, viewed 21 May 2005 www.wpro.who.int/NR/rdonlyres/. Deol, S 2005, China Fortified Soy Sauce Project, viewed 21 May 2005, www.ilsi.org/events/actslist.cfm?pubactivityid=87. 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