Scope of public health nutrition in India

The National Food Security Act, 2013, mandates food and nutrition entitlements for children, pregnant women and breastfeeding mothers with maternity support.

The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992, and the Amendment Act, 2003, provide a strong policy framework for protecting, supporting, and promoting nutrition interventions—especially during periods of greatest vulnerability for children and women.

The National Nutrition Policy, 1993, complemented by other policies, such as the National Health Policy, 2002 and the National Policy for Children, 2013, provides a strong foundation for addressing immediate and underlying determinants of undernutrition through both direct and indirect interventions.

The Twelfth Five Year Plan reinforced the commitment to prevent and reduce child undernutrition (underweight prevalence in children 0–3 years), as one of its core monitorable targets, binding multiple sectors and states to collective action.

In spite of framing strong policies, Indian population still faces numerous challenges which have not seen significant improvements in many years. The prevalence of undernourishment amongst women is as high as 31.6% in Jharkhand State. While under-five stunting at 37.9%, compares to the developing country average of 25%, nearly 21% of children under-five show wasting, which is more than twice the developing country average of 8.9%; and 51.4% of women in reproductive age have anaemia.

Daunting are the crisis which India still goes through, consisting of high undernutrition prevalence, growing incidence of non-communicable diseases, high population densities, vulnerable migrant labour and daily wage earners, low status of women, low participation rates and lower wages of women in the labour force, and poor health infrastructure,[2] making Public Health Nutrition important to be lifted up in terms of developmental priority of government and stakeholders in the field.

India has a long road ahead to fight most of the challenges that the population is posed against in terms of right nutrition and health. Some measures could be by strengthening food supply chains, empowering women and SHGs working towards spreading awareness and providing resources to the unreachable population.[2] Another collective measure that has been initiated long back and is still being observed in various regions of the world is National Nutrition Week, with few common objectives:

-To check the problems of Nutrition in the communities.

-Evaluate appropriate techniques for preventing and combating nutritional problems through extensive research.

-Conduct operational research to plan and implement national nutrition programs.

-Monitor the nutrition and nutritional status of the country.

-Educate people about health and nutrition through orientation training.[1]

REFERENCES:

1. //www.solutionweb.in/national-nutrition-week/
2. Lele, Uma & Bansal, Sangeeta & Meenakshi, J.. (2020). Health and Nutrition of India's Labour Force and COVID-19 Challenges. Economic and political weekly. LV. 13-16. //www.researchgate.net/publication/341670761_Health_and_Nutrition_of_Indi a's_Labour_Force_and_COVID-19_Challenges

Scope of Public Health Nutrition in India

Public Health Nutrition is a critical domain being looked into by the major educational institutes in India. With the advent of malnutrition in undernutrition and obesity, it is imperative to strike a balance and “educate” one and all about the same. The Government has initiated different programmes and schemes to address the issue. The institutes have introduced many courses to educate the medical fraternity about the importance of Public Health Nutrition.

A critical shortage of public health workers has been identified. There are just 3587 dieticians per 100,000 Indians, according to their estimates. The demand, on the other hand, is immense. Nutrition is jointly owned by the Ministry of Women and Child Development (WCD) and the Ministry of Health and Family Welfare in the program/policy domain (MoHFW). Ministry of Women, Children and Families, Ministry of Health and Family Welfare, Ministry of Agriculture, Planning Commission, Research Organizations, Government Nutrition Programs such as the Integrated Child Development Scheme (ICDS), Mid-day Meal Program (MDM), and women and child health schemes are all potential employers for trained public health nutritionists. ^[1]

A situational analysis conducted in 2011 across different institutes in India highlighted the gap between the nutrition initiatives and the education imparted to the stakeholders. An urgent need was there to undertake various educational programmes to address this issue. Initially, the subject, “Nutrition”, had been taught under the specialisation Home Science. With time, the different policymakers, legislators and decision-makers have realised the importance of Public Health Nutrition education to define and specify pathways and use epidemiological methods to address malnutrition. It combines comprehensive and collaborative actions, ecological in viewpoint and intersectoral in breadth, based on public health principles, including environmental, educational, economic, technical, and legislative approaches. The need for this field to be recognised – in which academics and practitioners come together to understand better, share, and multiply their efforts to study and battle nutrition-related illnesses in India – is urgent. ^[2]

Reference

1. Khandelwal S, Kurpad A. Nurturing public health nutrition education in India. European journal of clinical nutrition. 2014 May;68(5):539-40.

//www.nature.com/articles/ejcn201442

2. Khandelwal S, Dayal R, Jha M, Zodpey S, Reddy KS. Mapping of nutrition teaching and training initiatives in India: the need for Public Health Nutrition. Public health nutrition. 2012 Nov;15(11):2020-5.

//www.cambridge.org/core/journals/public-health-nutrition/article/mapping-of-nutrition-teaching-and-training-initiatives-in-india-the-need-for-public-health-nutrition/F1E5E5734F6DB3A66B825F8AE426B59B

Other Interesting Reads

1. Ramakrishnan U, Lowe A, Vir S, Kumar S, Mohanraj R, Chaturvedi A, Noznesky EA, Martorell R, Mason JB. Public health interventions, barriers, and opportunities for improving maternal nutrition in India. Food and nutrition bulletin. 2012 Jun;33(2_suppl1): S71-92.

//journals.sagepub.com/doi/abs/10.1177/15648265120332s105

2. Scrimshaw NS. The new paradigm of public health nutrition. American Journal of Public Health. 1995 May;85(5):622-4.

//ajph.aphapublications.org/doi/pdf/10.2105/AJPH.85.5.622

@chandrima-chatterjee Absolutely there is a need to recognize nutrition education, update the existing curriculum, and fill the gaps in the competencies required by the workforce to combat the nutritional problems in India. The need for Informatics in nutrition education is one area that should strengthen. We need to make evidence-based decisions and modify the policies according to timely analyses of the humungous volume of data. Incorporating informatics in nutrition can aid professionals in understanding, communicating, and effectively handling the data to achieve nutrition-based SDGs target. 

Interesting read: 

1. This paper talks about nutrition competencies needed across the health care professional from different disciplines. It provides insightful recommendations on how to prepare health care professionals to address nutrition-related conditions. (Kris-Etherton PM, Akabas SR, Bales CW, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr. 2014;99(5 Suppl):1153S-66S. doi:10.3945/ajcn.113.073502)
2. Joshi A, Gaba A, Thakur S, Grover A. Need and Importance of Nutrition Informatics in India: A Perspective. Nutrients. 2021 May 27;13(6):1836. doi: 10.3390/nu13061836. PMID: 34072133; PMCID: PMC8230128.

With an aim to decrease malnutrition, India has implemented several nutrition interventions in the last half century, including the National Food Security Act 2013, National Institute of Public Cooperation and Child Development (NIPCCD), Integrated Child Development Services (ICDS), and Midday Meal Scheme. Apart from this, the Government of India launched several other schemes to nurture women and children's health, including the POSHAN Abhiyaan, Anganwadi Service Scheme, and the Pradhan Mantri Matru Vandana Yojana under ICDS. Despite strong constitutional and legislative policy, plans, programme commitments and institutions being put in place to prevent nutritional issues, India still remains burdened with challenges of undernutrition[1]. India is home to almost one-third of all the world's stunted children and half the world's wasted children [2]. The nutrition scenario has remained discouragingly stagnant, with extremely slow rates of improvement. For last couple of years, economic slowdown and stagnation in wages, the growing food- security amongst poor households, inequality in access to diverse diets, and insufficient investments in welfare programmes, has led India to an alarming situation [1].

We should also note that because of the COVID-19 nationwide lockdown, Mid- Day Meal scheme has faced massive challenge. The COVID-19 pandemic has both marginalized women from accessing primary care as well as severely affected the nutritional intake of adolescent girls and women. Nutritional and dietary inadequacies and restrictions during a pandemic put many of the already malnourished girls at higher risk of developing or increasing micronutrient deficiencies and other forms of undernutrition. Their challenges are worsening with the shutdown of educational institutions, restricting their access to mid- day meal and weekly iron and folic acid tablets [3].

Public health nutrition is multi-dimensional and Government should priorities some key areas:

1. Food Systems: Strong regulatory and policy frameworks to support healthier diets for all should be put into place. Bio- fortification  which is one of the cost- effective solutions to provide the desired levels of nutrients should be encouraged, which can in turn have a measurable impact on nutritional status. Measures to ensure effective implementation and integration into policies, and access to food needs to be prioritized.

2. Nutrition finance: Nutrition inequalities exist across states as well as within communities. Therefore, decisions on resource allocation should be informed by data through evidence- based and cost- effective solutions.

3. Health systems: The Government should roll out nutrition services within health services by developing cost effective nutrition care plans, and should invest in human resources for access to quality nutrition care.

4. Community- driven initiatives, The Village Health, Sanitation and Nutrition Day(VHSND) and Community- based Management of Acute Malnutrition model need to be strengthened.

5. Comprehensive approach that will address the different sectors and dimensions of nutrition is crucial [1].

6. Importance of Public health nutrition training:

Reforms in education and the employment sector are needed. Nutrition education should span the entire spectrum from dietetics to research and teaching. Interdisciplinary education that highlights how nutrition fits into broader issues of medicine, agriculture, economics, and policy should be encouraged and incorporated in the existing nutrition curriculum. A diverse array of different aspects of nutrition from maternal- child health to micronutrient deficiencies could allow students to appreciate the link between different sectors and gear up to public health challenges in holistic manner. Nutrition research should be raised in status and made attractive to bright young investigators. India's nutritional research output is disproportionately low, considering its large population and its huge dual nutritional challenges and public health concerns. Investment in nutrition policy research in India could help to guide appropriate modifications in policy strategy and programs for tackling the existing and emerging nutrition problem [4].

Strategies that can be used to combat public health nutrition problems-

(a) Diet or food based strategies - some important food based approaches include dietary diversification and modification, horticulture interventions e.g., home gardening, nutrition and health education, food fortification. Advantage of this strategy is that it is sustainable and will have long- term benefits.

(b) Nutrient- based or medicinal approach: Short term strategy particularly used for Vitamin A, iron and folic acid in India. Supplementation programmes are often expensive and there may be problems of coverage.

It should be remembered that the long- term goal should be to shift from supplementation towards food- based approaches.

References:

[1] //www.theigc.org/blog/nutrition-in-india-a-look-at-the-policy-initiatives-investments-and-outcome-indicators/&source=gmail&ust=1630525847093000&usg=AFQjCNGGNHTmMoOGlyLUlWOdXC_amIwp9 Q"> //www.theigc.org/blog/nutrition-in-india-a-look-at-the-policy-initiatives-investments-and-outcome-indicators/

[2] //www.google.com/amp/s/www.aljazeera.com/amp/news/2018/11/29/one-third-of-worlds-stunted-children-live-in-india-report&source=gmail&ust=1630525847042000&usg=AFQjCNFnA3pR8cEKPXSUrqeF6ErJxJgPG w"> //www.google.com/amp/s/www.aljazeera.com/amp/news/2018/11/29/one-third-of-worlds-stunted-children-live-in-india-report

[3] //nutritionintl.org/news/all-blog-posts/covid-19-will-worsen-the-already-abysmal-state-of-nutrition-among-women/&source=gmail&ust=1630525847024000&usg=AFQjCNFb_AuvF5yWqO4HRpVa1j9dQRN1d g"> //nutritionintl.org/news/all-blog-posts/covid-19-will-worsen-the-already-abysmal-state-of-nutrition-among-women/

[4] Khandelwal S, Siegel KR, Narayan KMV. Nutrition Research in India: Underweight, Stunted, or Wasted?. Global Heart. 2013;8(2):131–7. DOI:  //doi.org/10.1016/j.gheart.2013.05.003

World Health Organization global nutrition targets has 6 malnutrition indicators to be accomplished by year 2025. Similarly, UN Sustainable Development Goals (SDGs) has established its target to eradicate malnutrition by 2030.UN has declared the years 2016-2025 as Decade of action on Nutrition for reducing malnutrition across the world

The  article "The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990–2017" analyzed  the burden of child and maternal malnutrition. It was found that since 1990 the burden has reduced but malnutrition is still a risk factor for deaths in children under five years of age. Although various policy and schemes have been launched  such as the Integrated Child Development Scheme 1975, the National Nutrition Policy 1993, the Mid Day Meal Scheme for school children 1995, and the National Food Security Act 2013 but still  lots of efforts are required to reach the global targets. Furthermore, to address micro and macro nutrients deficiency in adolescents and young women instead of single intervention, integrated interventions will be more effective.

Read here : //www.thelancet.com/journals/lanchi/article/PIIS2352-4642(19)30273-1/fulltext

Public health nutrition is an important determinant of health. There are a number of factors such as low level of education, diseases or infections, inadequate nutrient intake, early and multiple pregnancies, poverty, gender inequality, caste and racial discrimination, contribute to poor nutrition in India. While malnutrition is seen throughout the life cycle, it is most acute during childhood, adolescence, pregnancy, and lactation. Although the nutrition related policies are documented and interventions are in place but child malnutrition and maternal under-nutrition persist as severe public health problems.

A national strategy focused on digital health, nutrition, and other high-impact interventions has dramatically improved health outcomes across India-but more work remains to be done. There are various interventions that can be used to combat public nutrition problems. They are broadly classified as:

1. a) Diet or food-based strategies: Fortification(fortifying food with nutrients) and Dietary Diversification with a wide coverage (universal), consisting all micronutrients and improving food security.
2. b) Nutrient-based approach or medicinal approach: Nutrient Supplementation (timely and sustained) with a specific nutrient for a specific age group.

Listing out all the Nutrition programmes operating in our country:

1. ICDS: It is an outreach programme for early childhood care and development, covering pregnant and nursing mothers and infants and young children upto 6 years.
2. Nutrient Deficiency Control programmes, namely, National Prophylaxis Programme for Prevention of Blindness due to Vitamin A deficiency, National Nutritional Anemia Prophylaxis programme, National Iodine Deficiency Disorder Control Programme.
3. Food Supplementation Programmes like the Mid-Day Meal Programme.
4. Food Security Programmes, namely, Public Distribution System, Antodaya Anna Yojana, Annapurna Scheme, National Food for Work Programme.
5. Self-employment and wage employment schemes. Self-employment and wage employment are social safety net programmes.

Also,

To participate in all the strategies of health promotion and prevention, public health nutritionist can play a major role. Therefore,

• As a  part  of  outreach  programmes  undertaken  by  hospitals  for  prevention and promotion and education.
• Public health nutritionists or school health counsellors in school health programmes.
• As a part of the national Integrated Child Development Services, at different levels based on qualifications and expertise.
• In all developmental programmes of government, voluntary organisations, NGOs and international organisations like UNICEF, USAID, GAIN,  Nutrition  International,  TATA  Trust,  IFPRI  and  others are numerous other national and regional organisations.
• At the  government  level  as  consultants,  advisors,  or  in  policy  making committees.
• They can  be  involved  with  organisations  who  undertake  large  scale feeding programmes for various target groups such as young children,  school  children,  adolescents,  pregnant  and  lactating  mothers, elderly, challenged individuals.
• They can  be  involved  with  corporate  CSR  programmes  dealing  with food and nutrition security to vulnerable groups.

References:

1. //niti.gov.in/planningcommission.gov.in/docs/reports/genrep/bkpap2020/26_bg2020.pdf
2. //ncert.nic.in/textbook/pdf/lehe103.pdf.
3. Ramakrishnan U, Lowe A, Vir S, Kumar S, Mohanraj R, Chaturvedi A, Noznesky EA, Martorell R, Mason JB. Public health interventions, barriers, and opportunities for improving maternal nutrition in India. Food and nutrition bulletin. 2012 Jun;33(2_suppl1): S71-92. //journals.sagepub.com/doi/abs/10.1177/15648265120332s105

Scope of public health nutrition in India 🇮🇳:

          ☆ Nutrition- impact determinant of health. 

           ☆ The changing health scenarios globally has increased the challenges for public nutritionist. 

            ☆ It causes knowledge and research on nutrition problems and controlling these intervention it extend beyond public health field.

            ☆ Eg:  As a part of national integrated Child development services at different levels based on qualification and expertise. 

PUBLIC HEALTH AND NUTRITION IN INDIA

Malnutrition is the underlying cause of at least 50 per cent deaths of children under five years of age. The statistics for nutrition-related problems in our country reveal an alarming situation:
1) Almost one-fifth of the infants born in India are low birth weight babies i.e., they weigh less than 2500g or 2.5kg. Low birth weight may have adverse effects throughout their growing years and may have adverse implications even in adult life. Low birth weight may even lead to child mortality.
2) There is widespread prevalence of growth retardation among preschoolers (from socio-economically disadvantaged families) and almost half the children suffer from mild and moderate under nutrition.
3) A large proportion of children (and adults) suffers from micronutrient deficiencies in varying degrees of severity also known as hidden
hunger. The micronutrients of most concern are iron, zinc, vitamin A, vitamin D, iodine, folic acid and B12.

If these problems are not controlled in time, they will not only affect physical growth which may lead to smaller body stature in adulthood, but
may also affect mental and cognitive development. All of these, in turn, can have negative impact on productivity and quality of life. The costs of
malnutrition are very high. Experts have estimated that productivity losses are more than 10 per cent of lifetime earnings for individuals and 2-3
percent of gross domestic product for the nation

India mostly faces the problem of under nutrition; however, the problem of over nutrition is also on the rise. Gradually, over the years, large numbers of persons have altered their dietary patterns and lifestyles. With respect to lifestyle, people have become more sedentary, relying on
faster means of transportation, walking less and doing less amount of physical activity. In large cities, even children do not play enough outdoor
games. Food choices have become less ‘healthy’ because of excessive consumption of processed foods and fast foods At the same time, intake
of whole grains, pulses, vegetables and fruits has reduced. All these lead to undesirable/inappropriate weight gain, overweight and obesity and
ultimately lead to diseases such as hypertension, heart disease, diabetes, cancer, arthritis, among others. These diseases are non-communicable
and take their toll not only on the physical health but also on quality of life, adding to the financial burden.

Thus India is said to face ‘the double burden of malnutrition’ i.e. , coexistence of both under nutrition and over nutrition There is a tremendous need for a trained cadre of public health professionals including public health nutritionists, to address and solve these problems through using large scale, organized and multidisciplinary approaches to solve the problems that affect the population i.e., large number of people for whom
group action is necessary because the professionals are required to address problems of the community /public specially the vulnerable groups.

@kamalpreet  nice insight.

First, investing more in health and recognizing disease prevention and health promotion as the topmost priority. Consequently, government health expenditure on health should increase from 1.3% of GDP at present to at least 2.5% before the end of 13^th Five-Year Plan (2013-19). Presently, India has one of the lowest allocations to health among all countries of the world as percentage of GDP. As a result of such a low investment in health and due to high out-of-pocket expenditure (85.6% which according to the World Bank is among the highest in the world), nearly 60 million people are pushed further into poverty and into the poverty trap from that they are unable to escape.

Of the total health budget allocation for health, at least 80% of the fund should be earmarked for disease prevention, health promotion, and improving the quality of health services at the primary care level. The new health policy should lay stress on the concept of health as the people's right and make it mandatory to protect health budget at all times including the time of financial crisis. Based on the national health policy, each states should develop a state health policy and drive innovation in program implementation and finding solutions to its health problems.

Second, health system should be strengthened to improve the process of service delivery. In order to make the health services responsive to the need of the community, it is necessary to improve the functioning of the existing government health infrastructure. This can be done in three steps as follows: First, the assessment of existing public health system and facilities, bringing improvements based on the findings of the assessment including augmented human and material resources, and monitoring their performance and fixing accountability in a systematic manner, by setting targets and trying to achieve them through a comprehensive and integrated approach, with full involvement of the community. Improved access to government health services, which are used primarily by the poor and the disadvantaged sections of the society, will go a long way in achieving better health outcomes.

For efficient and effective delivery of services, an efficient public-health workforce is key. India has one of the lowest density of health workforce; with density of physicians (7 per 10 000 population) and nurses (17.1 per 10 000 population) as against the global average of 13.9 and 28.6 respectively (World Health Statistics, 2015). The nurses-to-physicians ratio in India is about 0.6:1, as against the nurses-to-physicians ratio of 3:1 in some of the developed countries. The issue is very serious, particularly in the rural areas, as most doctors and hospital beds are concentrated in urban areas catering to only 20% of the India's population. Public health planners should make all efforts to fill vacant posts through efficient recruitments, and build skill of the existing staff through training activities and by creating enabling environment including adequate facilities for health workers to stay in rural areas. To enhance skill training activities, health can leverage with and benefit from the national skill development mission launched by the Prime Minister in August 2015.

Third, focusing on evidence, excellence, and equity. An evidence-based policy-making requires data on disease burden and the associated determinants. Focus should be on strengthening a widespread research and innovation culture through out the country and generating homegrown data, obtained through surveillance, research, and monitoring and evaluation (M&E), so that these data can be used for policy and strategy development, priority setting, and evaluating the impact.

Emphasizing on excellence is crucial to ensure quality in service provision and in program planning and implementation, especially to ensure that health services are responsive to the needs of the community and are provided efficiently and effectively.

Reference:

Public Health Challenges in India: Seizing the Opportunities (nih.gov)

Almost one-fifth of the infants born in India are low birth weight babies i.e., they weigh less than 2500g or 2.5kg. Low birth weight
may have antagonistic ramifications even in grown-up life. Low birth weight may indeed, even lead to youngster mortality. There is far and wide predominance of development impediment among preschoolers (from socio-monetarily hindered families) and nearly a large portion of the youngsters experience the ill effects of gentle and moderate under nourishment. An enormous extent of youngsters (and grown-ups) experiences micronutrient inadequacies in changing levels of seriousness otherwise called stowed away hunger. The micronutrients of most concern are iron, zinc, nutrient A, nutrient D, iodine, folic corrosive and B12. In the event that these issues are not controlled on schedule, they won't just effect actual development which might prompt more modest body height in adulthood, yet may likewise influence mental and intellectual turn of events. These, thus, can contrarily affect usefulness and personal satisfaction. The expenses of hunger are exceptionally high. Specialists have assessed that efficiency misfortunes are more than 10% of lifetime profit for people and 2-3 percent of GDP for the country. This obviously shows that on the off chance that we tackle lack of healthy sustenance, we can assist India with creating, develop financially also, become an amazing country. India for the most part deals with the issue of under nourishment; nonetheless, the issue of over nourishment is additionally on the ascent. Continuously, throughout the long term, huge quantities of people have modified their dietary examples and ways of life. Concerning way of life, individuals have become more inactive, depending on quicker method for transportation, strolling less and doing less measure of actual work. In huge urban areas, even kids don't play enough open air games. All the while dietary examples have become less 'fortifying'. Food decisions have become less 'solid' in light of the fact that prepared food varieties.

Any expert in the field of public nourishment needs to advance great nourishment and/or to forestall dietary issues, for which it is significant to recognize the issue and its size , see how and why these issues happen and afterward plan procedures and activities to carry out them what's more, assess their effect.

In any general public, healthful issues are connected to food as well as to assortment of connecting/interrelated variables at different levels. While neediness is frequently the basic reason, the circumstance turns out to be more awful when a generous extent of families don't approach essential conveniences. Rustic families have less admittance to latrines. Helpless disinfection brings about loss of work days and further financial misfortune. Further, significant extent of the populace doesn't have safe drinking water. Working days are lost every year because of water borne infections.

There are various strategies that can be used to combat public nutrition
problems. They are broadly classified as:
a) Diet or food-based strategies. 

b) Nutrient-based approach or medicinal approach
Diet or food-based strategies: They are preventive and comprehensive strategies that use food as a tool to overcome nutritional deficiencies. They
can play an important role in preventing micronutrient deficiencies by increasing the availability and consumption of micronutrient-rich foods.
One of the important advantages of this strategy is that it is sustainable
and will have long-term benefits. Other benefits are that they are cost effective, can be adapted to different cultural and dietary traditions and very importantly they do not carry risk of overdose or toxicity which may happen in case of nutrient–based / medicinal approach. Some important
food-based approaches include dietary diversification and modification, horticulture interventions e.g., home gardening, nutrition and health
education, food fortification.
Nutrient-based or medicinal approach : In this approach nutrient supplements are given to vulnerable groups i.e., those who are at risk
of deficiency and those who have deficiency. It is a short term strategy particularly used for vitamin A, iron and folic acid in India. Supplementation
programmes are often expensive and there may be problems of coverage.

A public health intervention is an organized effort to those specific behaviors and habits that can improve physical ,mental and emotional health. These interventions can also reframe the perspective of unhealthy habits to change the way people think about those behaviors like vaccination ,motor vehicle safety, safer workplaces ,control of infectious diseases, safer and healthier foods, recognition of tobacco use as a health hazard and the strengthen the public health nutrition in india.

Nutrition is an important determinant
of health, it plays a major role in individual life and improving quality of life as well.Malnutrition remains a major challenge for public health and for social and economic development of India.
The factors related to nutritional problems range from economic factors (availability of financial resources), agricultural policy (production, pricing of food stuffs), health care services, their availability and access to the government policies, political will and socio-cultural factors.
The objectivie of public health nutrition is to prevent both
undernutrition and overnutrition and to maintain optimal nutritional
status among the people of the nation.
The problem of malnutrition may also affect mental and cognitive development. Which in turn, can have negative impact on productivity.
Malnutrition alone is responsible for appx. 50 per cent deaths of
children under five years of age.

Nutritional Problems in India:
Protein- Energy Malnutrition(PEM)- marasmus and kwshiorkor,
Micronutrient deficiencies-Iron-deficiency anemia (IDA,Vitamin A deficiency (VAD): i) Iodine deficiency disorders (IDDs)
There is a need to adopt a multi-disciplinary approach to address the problem.
The statistics for nutrition based
problems in our country raises an alarming situation:
1.Almost one-fifth of the infants born in India are low birth weight and may even lead to child mortality.
2. Prevalence of growth retardation among pre- schoolers (from socio-economically disadvantaged families) and almost
half the children suffer from mild and moderate under nutrition.
3.A large proportion of children and adults suffers from micronutrient deficiencies in varying degrees of severity also known as hidden hunger. The micronutrients of most concern are iron, zinc, vitamin A,
vitamin D, iodine, folic acid and B12.
Challenges and public health interventions to strengthen the public health nutrition in india:-

A lack of adequately trained public health professionals and Nutritionists means that It is much more challenging to address the issue.

Due to resource constraints, in LMIC like INDIA
the most realistic way is to optimise the use of available resources and existing Infrastructure.
The first step to do this is to assess the current landscape of public health
nutrition (PHN) education in India. Based on a situation analysis and recent findings from
qualitative studies undertaken by the Transform Nutrition capacity building team,
there is a tremendous need for a trained cadre of public health professionals including public health nutritionists, to address and solve these problems. Let us first acquaint ourselves with what is public health nutrition.
Public Health Foundation of India (PHFI), briefly summarises recommendations for the
role of higher education in tackling malnutrition in India

Refrences
//www.google.com/url?sa=t&source=web&rct=j&url=//www.researchgate.net/publication/290568962_The_importance_of_nutrition_in_Public_Health%23:~:text%3DPublic%2520Health%2520Nutrition%2520is%2520the,discipline%2520of%2520Public%2520Health%2520Nutrition.&ved=2ahUKEwi34dyYquPyAhU6H7cAHQQrC_YQFnoECAQQBQ&usg=AOvVaw1RBiInXaN7zCuXDKD7xAEx

(S. Khandelwal et al.
Publisher
Transform Nutrition
www.transformnutrition.org/).

//www.google.com/url?sa=t&source=web&rct=j&url=//ncert.nic.in/textbook/pdf/lehe102.pdf&ved=2ahUKEwiiqamAq-PyAhXZQ30KHSX_CFoQFnoECAMQAQ&usg=AOvVaw1vmUvUhO0nw-KCUqCzjgOn

Challenges and intervention for public health nutrition in India

Malnutrition tops the table as a major challenge for public health nutrition in India

Talking about the challenges to eradicate malnutrition(a major public health concern in developing nations and low income countries) certain factors play a major roll particularly in India.. they are,

• Faulty child feeding practices due to illiteracy
• Dietary inadequate due to low income
• Large families
• Scams in government programs

Coming to the interventions

Many developed nations like United States, United Kingdom, WHO and some private non-profit organizations plays a significant roll to improve public health nutrition in India

For example: USA ‘s -USAID( US AGENCY FOR INTERNATIONAL DEVELOPMENT)

UK’s -DFID  (DEPARTMENT FOR INTERNATIONAL DEVELOPMENT)

According to DFID:

India is one of the fastest growing major economies and is projected to become the world’s third largest economy by 2030. The UK is the largest G20 investor in India, while India invests more in the UK than in the rest of the EU combined. India is crucial for co-operation in international bodies like the United Nations, World Bank and World Trade Organisation. The UK and India share common values on rights and freedoms, and together can be a force for good on global issues. 

Reference: 

//assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/913355/India-Profile.pdf