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Advanced training in food and nutrition: Disciplinary, interdisciplinary, and problem-oriented approaches

Limitations of disciplinary and interdisciplinary approaches
Pragmatic limitations
Epistemological limitations and instrumental limitations
Normative limitations
The problem-oriented approach
Elements of a problem-oriented training programme

David L. Pelletier

David Pelletier is affiliated with the Division of Nutritional Sciences at Cornell University in Ithaca, New York, USA.


The development of effective and sustainable solutions to food and nutrition problems is known to require knowledge from many disciplines and the involvement of multiple sectors within a country. For this reason, interdisciplinary knowledge and intersectoral action have come to be recognized as important strategies. Disciplinary and interdisciplinary knowledge is essential for characterizing the prevalence, distribution, causes, and consequences of food and nutrition problems, and for developing and testing potential interventions. However, this paper maintains that disciplinary and interdisciplinary knowledge is insufficient for generating effective and sustainable solutions. The paper identifies four limitations inherent in this approach (pragmatic, epistemological, instrumental, and normative) and argues that a problem-oriented, participatory approach is required to overcome these limitations at all administrative levels from community through national policy. This approach draws upon knowledge from diverse disciplines in the search for solutions, but also integrates it with situation-specific knowledge concerning causes, feasibility, and distributional consequences of alternative solutions, and social interests and values held by the interested and affected parties. Although these are amenable to analysis through well-established methods of planning and social sciences, these methods are still subject to the four limitations noted above. This perspective is used in the second half of this paper to identify the key characteristics of effective practitioners and the key elements of advanced training programmes.


The UNU/IUNS Workshop represents an important opportunity for the international nutrition community to redefine the types of training required to solve food and nutrition problems. Given the central role of universities and training centres in developed and developing countries, it is particularly appropriate that the UNU and the IUNS have co-sponsored this event and that representatives from many of these institutions have committed themselves to this task.

This paper has an unusually broad scope. It includes all phases from the development of policy goals to their implementation and evaluation. This encompasses a wide variety of organizational settings (ministries, international and bilateral agencies, non-governmental organizations, universities, training centres, research centres, industry) and potentially multiple administrative levels from international, regional, and national to provincial and district. It might focus on the training needs of staff responsible for direct nutrition policies and programmes (i.e., those actions with nutritional improvement as their central objective) as well as those staff responsible for policies and programmes that affect nutrition positively or negatively in the course of pursuing other objectives (e.g., health, economic, and agricultural development). At the policy level, it might include skills for choosing, designing, and implementing diverse policy instruments (e.g., fortification, supplementation, education, public health intervention, or food, economic, and agricultural development), and at the programme level it might include skills for managing vertical programmes as well as fostering community-based approaches. Finally, it might include those responsible for doing problem-oriented research, planning, and policy analysis, as well as those responsible for day-to-day implementation and management.

Recognizing that other portions of this Workshop will examine the specific training needs for different cadres of professionals (e.g., in the context of the training pyramids), the primary purpose of this paper is to provide an overall framework for rethinking our approaches to training. Specifically, the paper suggests that the key challenge is to create a feasible problem-oriented approach to training that takes advantage of the tremendous breadth and depth of discipline-generated knowledge but overcomes the fragmentation of knowledge, skills, and perspectives that is associated with the discipline-based approach. The problem-oriented approach, as defined here, differs from the discipline-based approach in practical, epistemological, instrumental, and political terms. As described below, interdisciplinary approaches, which are often advocated for overcoming the limitations of the disciplinary approach, are problematic in their own right and do not overcome the most fundamental limitations.

Limitations of disciplinary and interdisciplinary approaches

Figure 1 lists disciplines with knowledge relevant to addressing food and nutrition problems. As shown, the many disciplines can be grouped into roughly five or six clusters that share much in common. What is not shown, but is widely appreciated, is that each of the disciplines contains a number of subdisciplines and bodies of prerequisite knowledge. For instance, the biological side of nutritional sciences could include intermediary metabolism; the biochemistry of vitamins, minerals, and macronutrients; the physiology of digestion, transport, storage, and utilization in health and disease; growth, development, and nutritional requirements throughout the life cycle; and the biology of nutritional assessment in the individual. The prerequisite bodies of knowledge often include several semesters of general and organic chemistry, biochemistry, cell biology, genetics, and physiology. Similar subdivisions and prerequisites can be enumerated for each of the disciplines shown here.

FIG. 1. Selected disciplines relevant to nutrition problem-solving

I. Nutrition and public health

A. Nutritional sciences

1. Biological aspects
2. Behavioural aspects

B. Public health
C. Epidemiology, demography, and statistics

II. Economics and public policy analysis

A. Policy analysis
B. Economics

1. Macroeconomics
2. Microeconomics

a. Production
b. Consumption
c. Markets

3. Resource economics

III. Agricultural and food sciences

A. Agricultural sciences
B. Food sciences

IV. Social sciences

A. Sociology
B. Anthropology
C. Community behaviour and development
D. Educational and behavioural psychology
E. Political sciences

V. Planning, management, and evaluation

A. Programme planning
B. Programme evaluation
C. Public administration/management
D. Development planning and administration
E. Organizational behaviour and development

VI. Adult education, communication, and negotiation

Compiling a list of relevant disciplines, and even elaborating upon the variety of subdisciplines included within each, is relatively straightforward. The difficulty lies in determining whether, how, and what type of knowledge from various disciplines can be brought to bear in addressing food and nutrition problems, and the role of advanced training in that process. As the next sections will show, there are four types of limitations inherent in the discipline-based approach: pragmatic, epistemological, instrumental, and political.

Pragmatic limitations

The pragmatic limitation arises from the facts that (1) most university courses are oriented around disciplinary specialities; (2) many graduate-level, science-based courses require prior course work (e.g., chemistry and calculus); (3) most courses are designed around a semester system; and (4) only one or two years are available for course work in most master’s degree programmes, with an additional year typically available for Ph.D. course work. This structure fosters the training of specialists but impedes multi- or interdisciplinary training.

This problem reflects the high degree of specialization that characterizes modern scientific disciplines [1]. Specialization has proceeded to such an extent that it even impedes communication and understanding among subdisciplines. One consequence is the fragmentation of knowledge. A second is the creation of distinctive world-views among specialists, including the manner in which food and nutrition “problems” and “solutions” are conceived and defined. Related to that is a belief in the superiority of one’s own conception of problems and desirable solutions. Finally, in a parallel fashion, particular conceptions of problems and desirable solutions become institutionalized within governments and non-governmental organizations and perpetuated by political processes [2-4]. All of these consequences of specialization create difficulties in addressing food and nutrition problems, because few food and nutrition problems are amenable to specialized solutions, and the formation of interdisciplinary approaches is usually impeded by a low level of communication, understanding, and/or tolerance across professions.

The training pyramid discussed at this Workshop acknowledges the need for functional specialization in addressing food and nutrition problems. Thus, we can anticipate from the outset that senior policy makers, researchers, planners, trainers, and implementers will each require some unique knowledge, skills, and attitudes. This functional specialization is further enhanced by recognizing the existence of sectoral specialities within practice settings, such as economics, agriculture, health, and education. What remains, however, is to define the core sets of knowledge, skills, and attitudes required by each functional specialist, as well as the overlapping (interdisciplinary) core to be shared by all such specialists. As suggested below, these core areas cannot be defined in the abstract; instead, they should be defined in relation to the types of food and nutrition problems commonly faced by practitioners, which, by their nature, require interdisciplinary knowledge and skills.

Epistemological limitations and instrumental limitations

In discussing the fragmented nature of discipline-based knowledge, Easton and Schelling [1] noted that three solutions have been proposed: interdisciplinary training of individuals, use of multidisciplinary teams, and search for a “general theory” (the latter referring to a theory that might at least unite the social sciences). They noted that none of these has proved particularly effective, in part because of the pragmatic limitations described above. In most cases, the knowledge, theories, and perspectives from one or two disciplines tend to dominate those from other disciplines, and little real integration actually occurs.

A more fundamental issue, however, is that all disciplinary and interdisciplinary approaches suffer from the same bias, namely, the implicit notion that the critical knowledge for solving social problems resides in the disciplines and can be brought to bear on these problems through the efforts of scientific analysis by professionals. As noted in a wide range of social science literature, and as illustrated below, this perspective underestimates the importance of several other categories of knowledge - non-disciplinary knowledge - necessary for addressing social problems [5-10]. This is the epistemological limitation.

Instrumental limitation is closely related to epistemological limitation. It refers to the ability to motivate the relevant groups to take various actions required for improving nutrition. As typically practised, technocratic planning tends to have an exaggerated view of the role of technical or scientific knowledge in social problem-solving, and it underestimates the degree to which the motives, intentions, resources, and behaviour of significant groups are the ultimate determinants of progress in solving many problems [11-13]. In most cases, the success of intervention efforts depends upon the ability to anticipate the behaviour of significant groups and to gain their compliance with, acceptance of, and support for, the intervention. Although some interventions are able to do this in a seamless way (e.g., those that provide economic incentives for change in a desired direction), many others are not able to do so (e.g., those requiring more active involvement of the significant groups, such as natural resource management, maintenance of health or community infrastructure, and compliance with difficult-to-enforce laws, regulations, or programmes). As elaborated below, interventions based solely on discipline-based knowledge and technocratic planning generally suffer from inadequate knowledge of these factors (epistemological), and they are generally unable to elicit such cooperation, acceptance, or behavioural change (instrumental). Although the examples given below relate to household and community behaviour, the same principles apply to other social entities, such as organizations, firms, and interest groups, that may be affected by government actions.

One way to appreciate the limitations of discipline-based (i.e., narrowly defined) solutions to social problems is to consider the conflict they produce at individual, household, or community levels in their implementation. This conflict is illustrated in the case of the use of women’s time. The cumulative impact on women’s time or household time is seldom taken into account when separate interventions are initiated for child care, child-feeding, preventive health services, agricultural intensification, income generation, natural resource conservation, and so on. In addition to time conflicts, there are conflicts or constraints imposed on households by such factors as knowledge, risk aversion, quantity or quality of land or other capital, social norms or obligations, and so on. Women and households, as well as communities, can be expected to reconcile these conflicts according to their own preferences, resources, constraints, and decision-making autonomy.

A discipline- or sectoral-based approach generally assumes that these conflicts do not exist, or that they will be reconciled in a way that is favourable to the intervention. On occasion, attempts are made to identify them beforehand through ex ante surveys or reconnaissance. One example is the introduction of improved varieties of crops on the assumptions that any increased labour demands will be met, that the product will meet the local requirements for taste, storage, and processing, and that consumption patterns can be influenced in the “positive” direction through education. Another well-known example is the implicit assumption that women and households have the resources and ability to implement the recommendations from a prescriptive nutrition education programme. Additional examples are the assumptions that improved latrines will be used after they are built, that improved water sources will be maintained by the users and will reduce diarrhoeal diseases, and that prenatal iron supplements will be used as prescribed. Each of these interventions generally implies an entire chain of assumptions in order to be effective under real-world conditions. If one or more of these assumptions are invalid, the result may be a waste of financial and organizational resources for the external agent, an unsustainable effort and “development distraction” in the community, or both. These failed assumptions impose enormous opportunity costs and are widely documented in the development literature and experience [10,14]. They reflect a knowledge gap on the part of the project planners - one that cannot be satisfactorily filled through traditional planning methods - compounded by the naive assumption that the community will attach the same importance and priority to each vertical solution as do its external proponents.

FIG. 2. Categories of knowledge required for effective problem-solving

Another weakness of a discipline-driven approach (i.e., specialized solutions to complex problems) is that they may be deemed “successful” from a narrow perspective but create unanticipated consequences in other domains [15]. These unanticipated consequences can be positive or negative. Again using the example of improved crop varieties, a programme may be considered successful if it increases aggregate crop production in a community or country over a period of years. Indeed, this is often the basis upon which projects and project staff are evaluated. Some of the unforeseen and uncompensated consequences might include increased demands for women’s time in weeding or processing, less time spent on child care, concentration of income, land, and power in the hands of men or among the village elite, soil degradation, and so on. One of the challenges when trying to improve nutrition is to minimize the negative externalities of development efforts (on nutrition) in diverse sectors, while seeking to enhance the positive externalities (on nutrition) whenever possible. These are viewed as potentially stronger and more sustainable approaches to improving nutrition, relative to the more direct (vertical) nutrition programmes that have been emphasized in the past, such as supplementary feeding and nutrition education [16]. They require different forms of training, experience, and practice.

Based on these and other examples from the literature and development experience, figure 2 identifies five categories of knowledge necessary for addressing most social problems, assuming that these problems are sufficiently important to warrant public (i.e., government) attention. This figure illustrates the epistemological reason why discipline-based interventions are unlikely to succeed, that is, because they fail to integrate important categories of non-disciplinary knowledge. A recent report from the National Research Council (NRC) identifies this as one of the reasons why the “translation of scientific knowledge model” is not an appropriate model for intervening in social problems [17]. In its place, the report calls for the direct participation of “interested and affected parties,” or their legitimate representatives, in all phases of the problem characterization and planning process, in order to gain access to these non-disciplinary categories of information. The report refers to this as the “substantive” utility of a participatory approach.

FIG. 3. Translational and participatory models of planning

In addition to the substantive advantages, the NRC report identifies “instrumental” advantages of a participatory approach to social problems. Simply stated, this refers to the increased likelihood that various interested and affected parties will accept and/or support an intervention when they have meaning-fully participated in the planning and decision-making process (fig. 3). This results in part from the better-quality information available for planning and decision-making, in part because the interests and values of various parties have been negotiated into the design of the intervention, and in part because of the mutual educational process that takes place through the participatory process. This enhanced likelihood of “acceptance” is similar to the concepts of “community ownership.” By definition, interventions based on discipline-based knowledge suffer from instrumental limitations, because such knowledge is only accessible to professionals or experts. The privileged character of this knowledge, if it is the sole or dominant basis for planning and decision-making, effectively excludes the other interested and affected parties from meaningful participation [17].

Normative limitations

The normative limitation of a science-dominated approach to addressing social problems, including disciplinary and interdisciplinary versions, arises from the fact that the costs and benefits of problems and alternative solutions are differentially distributed across various groups in society. Decisions about how these costs and benefits should be distributed are ultimately based on normative (i.e., value-based) considerations, not scientific analysis. Scientific or technical analysis can help characterize the distributional aspects in order to assist decision-making, but the ultimate decisions require normative judgement.

A substantial literature has developed that is critical of the tendency for technically driven “policy analysis” to fail to reveal these normative dimensions, and of the failure to link these analyses with decision-making processes appropriate for making normative judgements [e.g., refs. 8, 9, 18]. Although countries with established democracies, such as the United States, have formal procedures for political deliberation at the legislative stage, for seeking appropriate balance on scientific advisory bodies, and for eliciting public comment at the implementation stage, these are recognized to have a variety of limitations from an operational and a normative perspective [19]. The situation is even more imbalanced in many developing countries. For these reasons, the recent report from the NRC, with the US situation in mind, has recommended the use of formal participatory processes from the earliest stages of framing the problem through implementation [17]. The recommendations are explicit about the need to integrate analysis (technical) as well as deliberation (reflecting interests and values) throughout the process. It notes that this participatory process will facilitate not only “getting the science right” but also “getting the right science” in attempting to resolve social problems.

The problem-oriented approach

Key characteristics

Given these limitations of disciplinary and interdisciplinary approaches, which basically follow the deeply entrenched “linear translation of scientific knowledge” model, the problem-oriented approach is an attractive alternative. Drawing upon the NRC report [17], this approach has several key features:

» It considers a wide variety of potential outcomes and consequences.

» It recognizes the paramount importance of how problems are formulated, and the normative, substantive, and instrumental benefits of obtaining the participation of all interested and affected parties in the problem-formulation process. This approach is opposed to having the problem defined by professionals or technical experts.

» It is explicitly iterative in nature, rather than a linear planning and decision-making process. This implies that traditional scientific properties, such as prediction and precision, should not be expected in all stages of the planning process. Instead, emphasis is placed on creating a participatory process that will allow the relevant information on interests, values, obstacles, and consequences to surface so that they can be incorporated into the analysis.

» It requires an interplay between two distinct but complementary processes: analysis and deliberation. Analysis refers to the use of scientific methods for acquiring knowledge. Deliberation refers to the methods by which people build understanding, reveal their interests and values, or reach consensus through discussion, reflection, persuasion, and other forms of communication.

» It requires appropriate representation, involvement, or participation of the interested and affected parties.

» The level and type of effort required for problem-solving are situation specific.

Of particular importance for our purposes is this report’s conclusion that the type of scientific knowledge and analysis required for a given policy decision cannot be fully specified in the absence of a participatory, deliberative process that includes the interests and perspectives of the affected parties. In effect, this represents an acknowledgement that the form and direction of scientific research and analysis should be decided in close interaction with representatives from the real-world institutions, communities, and population groups that may be affected by a given decision. It also acknowledges that these other, non-scientific participants possess knowledge and information that is essential for effective policy formulation and implementation. Although this message has been repeated many times in the critical social science literature, this report is one of the first, if not the first, authoritative statements to this effect by the science establishment itself.

Knowledge required for a problem-oriented approach

As noted above, the knowledge required for solving nutrition problems can vary widely, depending on a variety of situational factors. However, the above discussion also suggests some generic categories of knowledge and skills relevant to a problem-oriented approach. As summarized in figure 2, these are the following:

» knowledge about the problem: its prevalence, distribution, and biological and behavioural causes;

» knowledge about the range of potential interventions and their strengths and limitations under various circumstances;

» knowledge about the political and institutional conditions that set boundaries on the range of potential actions, and the ability to function effectively within political and institutional environments;

» knowledge about local conditions - ecological, social, and economic - that may influence the adoption and effectiveness of various interventions; this includes, but is not limited to, the interests and perspectives of a variety of interested and affected parties;

» knowledge that will help anticipate the ecological, social, and economic consequences of alternative interventions; again, this includes, but is not limited to, the interests and perspectives of a variety of interested and affected parties;

» technical knowledge from whichever scientific disciplines are relevant, based on the biological and behavioural nature of the problem and the ecological, social, and economic assessment described above;

» the ability to manage and monitor the effects of the intervention - including the direct and indirect effects, and the anticipated and unanticipated ones - and to make adjustments accordingly;

» the ability to integrate the knowledge, interests, and perspectives from all of the above, usually requiring an interactive or participatory process.

One of the striking characteristics of this list is that disciplinary knowledge is implied in several categories but is subordinate to these problem-oriented categories. The common alternative, as shown in figure 1, is to describe the range of relevant disciplines, such as nutritional sciences, epidemiology, economics, agronomy, management sciences, and so forth. That approach is convenient because it is compatible with the traditional structure of university departments, but it fails to emphasize the role of integration, which is fundamental to a problem orientation. Integration of knowledge and skills is so central to a problem orientation that it is worth stating it as an axiom that can guide the design of training programmes:

The key to an effective practitioner is the ability to seek out and integrate knowledge from diverse sources, being guided by the particular characteristics of a given problem and the ecological, social, economic, political, and institutional context within which it occurs.

Some of this integration must occur across disciplines, which explains the common emphasis on a multi- or interdisciplinary approach. However, as the previous discussion reveals, it is equally important to integrate the above categories of contextual knowledge very early in the process. This is not automatically accomplished by adopting a multi- or interdisciplinary approach, because the latter could be done by involving professionals from a range of disciplines, whereas the integration of contextual knowledge should be accomplished through the direct involvement of representatives of “interested and affected parties” whenever possible and appropriate. The latter requirement is based on the normative, substantive, and instrumental benefits of such participation, as revealed by experience in developed and developing countries and the corresponding scientific literature.

The central importance of integrative skills has important implications for the design of training programmes. In particular, integrative skills are most readily developed through real-world experience. Most current practitioners have developed these skills - to varying degrees of effectiveness - through repeated problem-oriented experience during the course of their professional lives rather than as part of formal education. One of the obvious disadvantages of this approach is that professionals are provided little or no formal guidance on how to seek out and integrate knowledge, which is the primary challenge they face in the real world. The major challenge now is to develop training programmes that are problem oriented and that provide repeated experience in seeking out and integrating knowledge from diverse sources in the course of problem-solving.

The remainder of this paper illustrates some concrete actions that could be initiated as a result of this Workshop, which are consistent with the above axiom and with the acquisition and integration of knowledge from the categories described above.

Elements of a problem-oriented training programme

Core principles

It is useful to begin by articulating some core principles of how nutrition-related specialists might be trained in the future and the roles to be played by developed- and developing-country universities and training centres, donors, and other development partners. For the remainder of this paper, the following elements are assumed:

» The long-term goal is to have most training centred in developing countries (national or regional universities and centres) and driven by their own types of problems and country conditions.

» Developing-country universities would provide high-end expertise in specific disciplines, act as partners in developing a problem-oriented approach to training, assist in capacity-building of national and regional centres, and play supportive roles in problem-oriented research and training over time.

» One goal is to train cadres of problem-oriented nutrition specialists who will be professionally identified as such, while a second and equally important goal is to sensitize a variety of other specialists to the nature of nutrition problems, the nature of their solutions, and the “new development paradigm,” in which the integration of knowledge and participatory processes is central and relevant to all development problems.

» Most of the training will focus on knowledge and skills required for effective practice; the “research skills” to be developed under this programme will emphasize the process of seeking out and integrating knowledge from diverse sources in the course of solving specific problems. This can take many forms, depending upon the contextual factors.

The latter point deserves elaboration. Because of the distinct skills required and a desire to maintain a clear problem orientation, it is proposed that the “integrative research” being discussed here should be distinguished from “decontextualized,” discipline-based research. It is recognized and expected that the latter type of research should continue and that it provides valuable technical knowledge about nutrition problems and potential solutions, but in most cases it is not feasible to develop the skills required for this type of research while simultaneously developing practice-oriented skills. Although there is some overlap in the skill sets required for practitioners and discipline-based researchers, the overlapping skills differ greatly in the level of sophistication required (e.g., the ability to appreciate the implications of econometric or laboratory analyses does not require the same technical sophistication as that required for conducting such analyses). Moreover, the breadth of knowledge and skills required for effective practice in most cases precludes developing a high level of discipline-based expertise in a single discipline.

It is recognized that, as documented in the Pew-sponsored research, employers attach a high value to specialization. It is proposed that in the case of nutrition, such specialization should take the form of a problem-oriented nutrition specialist rather than a discipline-based specialist.

The following sections describe some concrete actions that could be taken in the next few years to develop a problem-oriented research programme.

Development of a training programme

A problem-oriented training programme can be conceptualized as having two main components: (1) a content component, in which core knowledge from several disciplines is assimilated, and (2) a skills component, involving practice-oriented methods from several disciplines, as well as the skills for acquiring and integrating knowledge from diverse sources in the course of problem-solving.

The content component

Defining and creating access to core disciplinary knowledge for nutrition specialists

It is relatively straightforward to create a list of disciplines relevant to solving nutrition problems. Figure 1 illustrates such a list. It is far more difficult to identify the core concepts, facts, and principles from each discipline that should be part of the basic knowledge set of an effective nutrition problem solver, recognizing the breadth of knowledge and skills such practitioners require and the time constraints inherent in formal training programmes. The usual approach in discipline-oriented universities, that of recommending a long list of courses from different departments, does not address this need and, as noted earlier, does not address the difficult task of integration. The difficulty in defining the core content areas from various disciplines arises in part because specialists in those disciplines have difficulty deciding what not to include, and in part from the fact that the “relevant knowledge” depends on the problem and its context. Thus, the following activities are proposed:

Activity 1: Develop a series of detailed case studies, covering a range of common food- and nutrition-related problems, that can be analysed to reveal the knowledge, assumptions, and methods used at different stages. These integrated, practice-based details are usually inaccessible to researchers, educators, and students, thereby perpetuating the discipline-based approach to training. The case studies would serve two purposes: to be used as such in training programmes, and to guide the identification of core content areas (see below).

Activity 2: Using the above case studies as a guide, identify the core content areas and core methods in various disciplines that should form the basic knowledge set of nutrition specialists. Relevant disciplines may include, but not be limited to, those shown in figure 1. After these core content areas have been identified, an integrated textbook or series of textbooks should be developed for use in developing- country training centres and universities. A modular approach would be desirable to facilitate the tailoring of these materials for different courses and audiences.

Several country case studies and programme-specific case studies already have been published that might serve as a starting point for these two activities (e.g., Zimbabwe [20], Costa Rica [21], Thailand [22], Tanzania [23], and Malawi [24]). However, the existing documents and experiences have yet to be analysed along the lines being suggested here, to identify the core knowledge, assumptions, methods, and skills.

These two activities should be conducted by multi-disciplinary teams from developed and developing countries, including those with intimate knowledge of the case studies, those with first-hand experience in food and nutrition problem-solving, those with expertise in relevant disciplines, and those with talents in developing problem-oriented educational materials. The case studies, textbooks, and other materials should be actively promoted for use in universities and training centres in developed and developing countries.

Sensitizing and educating other specialists in core aspects of nutrition

In addition to ensuring that nutrition specialists have access to the relevant multidisciplinary knowledge, it is important that other professionals be sensitized to and educated in selected aspects of nutrition problems. This is widely recognized but has been difficult to implement, in part because most specialists in other disciplines (instructors and students alike) do not regard nutrition as a priority. The case of nutrition in medical schools is well known, but the phenomenon is not limited to that speciality.

This same problem occurs not only at the university level in the United States, but also at primary and secondary levels, where it has long been difficult to incorporate nutrition education as a separate subject within existing curricula. It is being creatively addressed in some schools by incorporating nutrition-related examples into the curricula of other subjects, such as social studies, science, and mathematics, so that students acquire a “passive” understanding of nutrition in the course of studying these other subjects. This model may be useful in our case as well, so the following activity is suggested as one way to meet this need:

Activity 3: Develop nutrition-oriented modules that could be used as companion materials in existing courses in a range of disciplines, such as those shown in figure 1. These modules (which might consist of case studies plus selected background on the nutrition problem) should be written in the language and concepts of each of the disciplines, rather than the language and concepts of nutrition, in order to make them attractive and relevant for use in such courses. Thus, university students majoring in agricultural economics might develop a more well-rounded understanding of the production-consumption linkages or the potential nutritional effects of commercialization by using such a module, in contrast to a narrower focus on the production and marketing aspects. Similarly, in the portion of a course in public administration that deals with cross-sectoral coordination and participatory development, the instructor might find useful a nutrition module based on the UNICEF conceptual framework and Triple A Cycle.

To be effective, these modules would need to be created by a small, multidisciplinary team involving nutrition specialists and specialists from the other discipline(s) familiar with the nature of materials already in use or needed in these other disciplines. Strategies would also be needed to promote the use of these materials by instructors in these other disciplines and to make the materials accessible to developing countries. One important step in this direction would be to foster the development of such interdisciplinary courses in the universities of developed countries, where many of the future developing-country lecturers receive their advanced training.

The problem-solving component

The use of case studies and problem-oriented textbooks in discipline-based courses would help develop problem-solving skills, but is unlikely to be sufficient by itself. A sound training programme should also provide opportunities for students to learn and apply problem-solving skills through actual experience. Some examples of how such examples might be incorporated into developed-country universities are provided below, on the assumption that such universities will continue to train future lecturers in developing countries and that they should model this problem-oriented approach. It is assumed that analogous experiential training methods could be developed even more readily in developing countries, given the proximity to government offices and communities that could generate field and internship opportunities, and that some portion of this Workshop will focus on these in-country aspects.

Activity 4: Simultaneous with the acquisition of core discipline-based knowledge, students should be presented with a range of “problems” that are typical for their speciality and should be assisted in solving them. Thus, realistic problem sets need to be developed that can be readily used in these training programmes in developed and developing countries. Examples of realistic problems are illustrated in figure 4. Solving these problems will require that the student clarify the objectives of the programme or policy, identify the relevant situational factors, identify the key questions or concerns that require attention, identify the range of interested and affected parties that should participate, and seek out and integrate the relevant discipline-based knowledge required to solve the problem. There are obvious advantages to having students develop these skills in a university environment, where they have access to a range of discipline-based knowledge, expert faculty, and overall mentoring. They also have the opportunity to interact with their peers and to see how their peers approach the same or similar problems. One disadvantage is that they do not have access to the full range of interested and affected parties involved in various problems and solutions, and thus they could not fully assess the relevant situational factors.

FIG. 4. Examples of problem sets for developing policy and programme skills

I. Programme level

A. Multifaceted problems

1. Analysing nutrition situations and identifying feasible and effective intervention strategies
2. Design of a school feeding programme
3. Design of a community day-care programme
4. Design of a community-based nutrition information system
5. Design of a social marketing programme

B. Bounded problems

1. Deciding the size and composition of rations in emergency feeding situations
2. Analysing anthropometric indicators
3. Designing a logistics system for vitamin A capsule supplies
4. Training health workers in growth monitoring

II. Policy level

A. Multifaceted problems

1. Analysing nutrition situations and identifying feasible and effective intervention strategies
2. Identifying a suitable vehicle for fortification or subsidy
3. Incorporating nutrition into a commercialization policy
4. Designing a comprehensive breastfeeding promotion policy
5. Designing a nutrition advocacy strategy
6. Establishing national nutrition research priorities

B. Bounded problems

1. Designing and analysing a national nutrition survey
2. Estimating national dietary energy requirements
3. Evaluating targeting and coverage of programmes

Activity 5: In an effort to make the problem sets most realistic, it may be possible to use modern communications technology to link students at developed-country universities with in-country staff facing real-world problems in programme or policy design, implementation, or evaluation. This might take the form of an e-mail list serve or fax-based network in which in-country staff pose problems or questions, some of which are selected by students in developed-country universities as semester projects. From that point on, the two parties could communicate about relevant situational factors, views and interests of various interested and affected parties, technical considerations, discipline-based knowledge, and so forth. The student in residence would be responsible for seeking out the relevant information from the university environment, integrating it across disciplines and with the relevant local situational factors, and ultimately formulating a response to the problem in “real time,” thereby simulating actual working conditions. Such an arrangement would not only benefit the student and the training programme, it would also benefit the in-country staff and organizations facing these real-world problems. Over time, such a system would generate a rich assortment of problems (and responses) for use as case-study material with other students. The accumulated record also could be analysed to identify common themes or issues deserving more detailed analysis, research, or expert deliberation, thereby helping to guide university- and donor-sponsored research topics.

Activity 6: A logical complement to the above activities is for M.S. and Ph.D. thesis research to be of a problem-solving variety rather than a discipline-based variety. To a large extent, students from developing countries often conduct problem-oriented thesis research in their own countries. However, upon analysing and writing up their results, many students are confronted with a need to frame their research from a theoretical perspective or show how their work has contributed to discipline-based theory. The search for a contribution to theory may be appropriate if the relevant theories relate to social action, community or organizational psychology, political science, or similar fields. However, in many cases students may not have taken course work in such fields. This situation highlights the need to develop a field along the lines of “public nutrition,” so that students can frame and justify their thesis work in terms of its contribution to this fundamentally problem-oriented field, and be properly prepared for doing so before they conduct their fieldwork. It is unclear which specific actions should be taken to foster the development of this field, but this is a subject worth discussing further at this Workshop and in subsequent forums.

Activity 7: Finally, recognizing the importance of real-world experience for developing problem-solving skills, it would be highly desirable for students trained along these lines to have postgraduate internships as consultants for donor agencies or in donor-supported consulting firms. In the course of one to two years, they could undertake several consulting assignments in various countries or act as members of consulting teams. In addition to rounding out the formal training of these professionals, this would add to the pool of qualified international nutrition consultants, notably to the pool of consultants with a detailed understanding of regional or subregional situational factors.


As is often the case, the mismatch between discipline-based training and the actual needs of problem-oriented practitioners has been recognized by practitioners for some time. As revealed by the US literature on health promotion [25] and public health more broadly [26], this situation is not limited to developing countries. The mismatch is perhaps most apparent for those working at the community level or for those attempting to design effective community-based programmes. For them, the complexity and interrelated nature of problems, and the necessity of involving local institutions or other “interested and affected parties,” are clearly revealed in their everyday practice. For those working at high administrative levels, the sectoral orientation of organizations and the distinctive way in which each defines the character of nutrition problems and solutions more closely parallel the discipline-based orientation of universities. They and their counterparts in universities and training centres are encouraged by their professional training, the organization of their institutions, and the prevailing incentive systems to follow the path of specialization and to minimize the interaction with “interested and affected parties,” who, as commonly perceived, tend to complicate the task of policy and programme planning and place constraints on the autonomy of the planner. This paper has sought to identify the inherent limitations of such an approach, reveal that a problem-oriented and participatory approach is as relevant at the national policy level as it is at the community level, and suggest just a few of the strategies and activities that might help develop and establish a problem-oriented approach in training institutions.


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