Everything but the kitchen zinc

Examining the role of micronutrients in malnutrition

Individuals as varied as political and economic leaders, undergraduate students, and community-based service providers are increasingly recognizing the value in understanding global health challenges and their solutions. Yet, the term global health continues to be defined, as many people seek to understand how we can effectively collaborate across cultures, disciplines, languages, and sometimes wide-ranging differences in resources and training, to solve challenges and ensure equitable health. These obstacles are substantial, but the opportunities to self-educate and to become the impetus of progressive change are greater. One such opportunity was the 2011 Global Health Conference which took place this year in Montreal.

This three-day conference focused on advancing health equity in the 21st century. It attracted leading global health leaders, practitioners, faculty, and students, who engaged with world renowned keynote speakers, invited guest speakers and lecturers, and partook in the break-out conference sessions, symposia, plenary panels, and oral presentations that the conference embraced.   Hosted by the Global Health Education Consortium, the Consortium of Universities for Global Health, and the Canadian Society for International Health, this conference was an exciting way to showcase and shape global health research, education, and advocacy with individuals from a vast spectrum of backgrounds, interests, and stages of training that make global health the dynamic field that it is.

The Sunday break-out session on the Global Burden of Disease included an eye-opening talk entitled “Infant Mortality and Micronutirition” which focused on zinc. The deficiency of this micronutrient is the greatest in the developing world.

The first speaker, Doctor Robert Black, spoke of the unmet potential of micronutrients and how zinc supplementation has great impacts on infant mortality. In fact, The World Health Organization estimates that the global burden of mortality attributable to zinc deficiency is 750,000 deaths annually. This deficiency is most commonly found in individuals living in Southeast Asia and Sub-Saharan Africa. Dr. Black revealed that time after time, studies show that zinc supplementation can decrease mortality by 15-30 per cent in infants 6 to 35 months old.  Furthermore, 178 million children suffer from stunted growth, and zinc supplementation has a positive effect on such anthropometric measures. Zinc supplementation also curbs infectious disease rates. One study in India showed that zinc supplementation reduced the incidence of diarrhea by at least 20 per cent; when zinc is given as a treatment of diarrhea during an acute bout, it decreases future prevalence of diarrhea by 34 per cent.

Black was followed by Doctor C. Larson, a McGill Medical Graduate specializing in paediatrics and public health. Zinc, he explained, is an important mineral in a large number of biological functions; it supports normal growth and development, promotes wound healing, enhances taste and mood, and is essential for cellular metabolism and immune function. Dietary sources of zinc include oysters, meats, beans, and nuts. He spoke of international efforts to scale-up zinc treatment in an effort to curtail the insidious effects of childhood diarrhea. So far, international efforts have achieved 10 per cent coverage of supplementation in rural areas. He claims the greatest challenge is that such initiatives must have sustainability and it is difficult to distribute resources to the mouths of those who are most in need without creating disparity.

“There is this idea of marketing, which we as health care professionals don’t understand nearly as much as we should, and which is the key for success in large-scale initiatives that involve supply and demand,” he said.

Specifically, the problem with zinc supplemention is demand. Most people are not educated on the importance of zinc. A few years ago, supply was also a barrier, since only France was producing zinc supplements. Currently, Zambia and India are as well.

Doctor S. Horton stepped up to the microphone next to speak about the economics behind micronutrients. She discussed the Copenhagen Consensus, which she describes as the “olympics for economists.” Occurring every four years, it is a meeting where ten of the most eminent economists in the world meet to answer the question of how to best advance global welfare, assuming there was 65 billion dollars at disposal over a four year period. The last meeting in 2008 – which included five Nobel laureates – concluded that micronutrient supplementation for children, specifically vitamin A and zinc, would have the most impact. According to Horton, the international community is making an effort to prioritize these interventions and implement changes as part of a broader international policy effort. Such efforts are funded with increasing contributions by the international private sector, the domestic private sector, domestic governments, and most importantly, by international donors.

Doctor Mark Fryars, vice president of the Micronutrient Initiative wrapped up the session by talking about the need of strengthening inter-country capacity to scale-up micronutrient interventions.  He started his powerful presentation with a quote by Richard Kohl: “start with the end in mind.”  Scaling up is not simply about “coverage or about products,” he said. “It is very much about impact. There has to be a constant and major focus on those truly in need.”

One of the conditions that is implicit in this issue is that sustainability is vital and that coverage needs to encompass those truly in need, and not just those in reach. He discussed the important capacities and capabilities needed to implement a scale-up program. The road for such projects seems clear cut: scientific evidence shows proof of concept, which leads to a scaling-up process which allows for long-term sustainability.  In practice, however, it is not so straightforward. In essence, political commitment, distribution, proper uptake and utilization, affordable prices, the right people, adequate providers, promotion, business processes for engaging conversations between providers and consumers, and finally, complexity and diversity of partnerships are all crucial factors. He particularly stressed the need for secure partnerships. The making of which is, in and of itself, “a discipline, a skill, a science even,” requiring a wide array of interdisciplinary efforts and collaborations.

Zinc supplementation, then, in areas that have a high rate of deficiency has positive, significant benefits in reducing mortality and improving quality of life, yet the path to up-scaling is complex and takes time. It is vital that amidst the process of up-scaling we not lose sight of the ultimate goal – which should focus on positive global impacts and humanitarian-centered interventions.