Public nutrition from an approach to a discipline: concern's nutrition case studies in complex emergencies

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue--through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC--that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.