Population Research Centre, University of Groningen, Groningen, The Netherlands,
Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
Ann Nutr Metab. 2019;75(2):123-126. doi: 10.1159/000503670. Epub 2019 Nov 19.
There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one's goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain. Summary and key Messages: In the past 5 years, the International Union of Nutritional Sciences Task Force "Towards a multi-dimensional index for child growth and development" has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child's agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point.
公共卫生领域越来越意识到，要应对营养不良的双重负担，就需要采取多种方法来解决其多维根源，而不仅仅是主要关注生物医学领域。目前的营养不良框架，如儿基会概念框架和 2013 年《柳叶刀》系列，对于理解营养不良的决定因素和制定适当的干预措施非常有帮助。然而，这些框架未能明确解决能动性问题，即追求目标的能力。阿玛蒂亚·森最初提出的能力方法将能动性纳入因果链中。总结和关键信息：在过去的 5 年里，国际营养科学联合会“儿童生长发育多维指数”专题工作组制定了儿童生长的能力框架，并应用该框架进行了实证研究。工作组讨论了进一步发展该方法所需的条件，并解释了该方法对国际组织和政策制定者的附加值。我们建议开发一个优势指数，作为儿童能动性的替代指标。我们假设，这样一个指数将解释儿童营养不平等研究中很大一部分差异，因此呼吁采取行动来改善这一重点。
