‘Bridging the knowledge gap against access to nutrition and health equity’ – ET HealthWorld

In a special interview, Judd WalsonChair and Professor, Department of International Health at Johns Hopkins Bloomberg School of Public Healthtalks to ETHealthworld’s Rashmi Mabiyan Kaur about the many ways to tackle malnutrition in developing countries.

The discussion highlights how malnutrition goes beyond food to things like infection control, poverty reduction and sanitation. It also highlights the importance of new approaches such as probiotics and the important role of breastfeeding in creating a healthy microbiome. Excerpts:

How important is nutrition to address health problems, especially in developing countries?
Good nutrition is a key factor in good health, especially in countries where child mortality and maternal malnutrition are still high. Often, we equate nutrition with food and diet, but malnutrition is about much more than that—including measuring growth markers like weight, height, and arm circumference. These low rates can be attributed to a number of factors beyond food insecurity, such as frequent infections, lack of food diversity, and broader issues such as poverty and sanitation.

Addressing malnutrition requires addressing all of these factors. This includes reducing the risks of infection through vaccination, treating diarrhea with ORS (oral rehydration salts), and reducing poverty. New and exciting applications, such as probiotics, are emerging. Probiotics can help repair damaged microbes in children exposed to pathogens or hospital environments, supporting growth and reducing death. Breastfeeding is another important factor as it promotes a healthy microbiome, but in cases where breastfeeding is not an option, we must develop new ways to maximize its benefits.What role does antimicrobial resistance (AMR) have in a child’s life, and how can we fight it?
AMR is a growing child health concern in countries like India, where antibiotics are available both formally and informally. This widespread use puts pressure on bacteria to develop resistance. Antibiotics are important—ensuring that the right antibiotics are used at the right time for the right infections.

Hygiene in healthcare settings is also important as hospitals can be breeding grounds for AMR. Engineering better facilities to prevent the spread of resistant bacteria is needed. Vaccines, especially those that limit the flow of bacteria, are promising tools to combat AMR. By addressing hygiene, management, and vaccination improvements, we can reduce the effects of AMR.

How do you see epidemiology changing to address child and adolescent health issues in resource-poor settings?
Epidemiology has long been the basis for understanding diseases—in terms of their causes, prevalence, and patterns. It has now shifted to focus on measuring the impacts of interventions and scaling up those interventions effectively. New tools such as big data and implementation science are being used to improve health practices in real-world settings.

In resource-poor areas, the challenge is to use these resources to provide accessible, high-quality health services. By understanding the mechanisms of disease and the power of intervention, epidemiology remains important in improving the health of children and adolescents worldwide.

Despite progress, why do maternal and child deaths continue, and what can be done?
We already have 90 percent of the resources needed to reduce maternal and child mortality. High-income countries with strong health systems show low mortality rates. However, the gap is in delivery—not in innovation.

The focus should be on ensuring quality health care, empowering women, and addressing poverty. Innovations such as microbiome research and digital health technology can provide incremental benefits. However, the core issues—poverty reduction, community empowerment, and health system improvement—are the real game changers.

How has the COVID-19 pandemic affected the world’s priorities, especially for children?
COVID-19 has been a technical success and a diplomatic failure. Vaccines were developed and delivered in record time, but global inequities in vaccine distribution highlighted the weaknesses of public health advocacy. For children, this epidemic has highlighted the importance of vaccination and community involvement in health issues.

We have also learned that technical solutions must be combined with communication and collaboration with the community. Vaccination hesitancy, for example, is less about knowledge gaps and more about trust and representation. In fact, much of the reluctance about vaccinations is about decision-making, competence, and being able to control one’s future and one’s access to health care. Also, vaccines are another thing that we sometimes force on people without enough social interaction and awareness. Strengthening community relations will be important for future disease preparedness.

Most of the time, health issues are not caused by a lack of knowledge but by a failure to act. Can you explain?
Most people know what’s good—like washing their hands or eating fresh vegetables—but they don’t have a way to apply that knowledge. For example, people in food deserts may find junk food, even though they know it is unhealthy. Similarly, many believe that the way to get people involved in sanitation is to teach them to wash their hands. In most households, people know that they should wash their hands. This is not a problem. The real problem is that they cannot do it for various reasons, such as the lack of clean water or soap in this case.

Similarly, in nutrition, poverty and access are major barriers. Programs often focus on teaching people without ensuring that they have the tools to implement those lessons. Effective interventions must link knowledge and access to behaviour, helping people make informed choices.