Understanding the sociopolitical and epidemiological dimensions of malnutrition in Viet Nam.
Lapping, Karin.
2017-04-14T13:36:46.471Z
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Abstract: Globally, 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 both nat... read moreionally 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 level.
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 - ID:
- jh344460d
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