Understanding the sociopolitical and epidemiological dimensions of malnutrition in Viet Nam.
progress in reducing malnutrition is slow, remains uneven, and is not always sustained.
The deleterious short-term and long-term impacts of malnutrition are well documented.
There is unprecedented global recognition and consensus that it is necessary to scale up
efforts to address malnutrition. Examining the sociopolitical and epidemiological
dimensions of malnutrition bot... read moreh nationally and sub-nationally is essential to inform
effective action. Little research in nutrition has been undertaken to understand the
sociopolitical factors and processes that determine national policy formulation and
subsequent actions at the sub-national level. The biological, epidemiological, and
implementation dimensions of nutrition policy and the programming that flows from it has
been researched extensively, however, there is limited investigation of the determinants
of malnutrition in a country and how they differ over time and space. The rapidly
changing country of Viet Nam provides a rich setting in which to examine the
epidemiological and sociopolitical dimensions of malnutrition in part because Viet Nam
should be doing better than it is with regards to reducing stunting. Viet Nam is also a
context where the translation of national policy directives into action on the ground is
challenged by a relatively new process of decentralization of planning and action. This
dissertation is comprised of three analyses. Using a participant-observer, change-agent
model, the first analysis sought to understand why and how the national nutrition agenda
moved forward between 2006 and 2008, years when the lead researcher lived in Viet Nam.
Findings showed that rapid nutrition policy advancement was possible if purposeful,
contextually sensitive, strategies are used where favorable conditions exist, or can be
created. The second analysis examined how the provincial planning process for nutrition
occurred in eight provinces. A qualitative case-study methodology was used and concluded
that there was little variation in the process across provinces. The main barriers to
effective planning were: 1) a top down approach, 2) limited human capacity at
sub-national levels, and 3) difficulty in integrating multiple sectors. The third
analysis investigated whether the relative importance of the determinants of height-
for-age (HAZ) in Viet Nam changed over a ten year period and if the determinants of HAZ
differ depending upon location in the country. Using regression techniques, the 1997 and
2006 Viet Nam Living Standards Surveys were analyzed. Analyses revealed that the
relationships between the determinants and HAZ changed over time and in 2006 differed by
region. The dissertation examined the continuum of issues related to national
agenda-setting for nutrition, the translation of national agendas and plans into
provincial actions, and the relevance of differences of determinants across regions and
over time for program planning and prioritization of actions. Findings indicated that
policy advancement is possible in a short amount of time, that the sociopolitical
dimensions may influence the success or failure of efforts, and contextually relevant
action at the sub-national level is needed. These findings are particularly important
for countries that are challenged to make the right policy choices at the national level
and to translate these into effective action at the sub-national
Thesis (Ph.D.)--Tufts University, 2012.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Patrick Webb.
Committee: Edward Frongillo, and Jennifer Coates.
Keyword: Nutrition.read less