教學大綱

本頁翻譯進度 燈號說明

審定：無 翻譯：王建偉(簡介並寄信) 編輯：馬景文(簡介並寄信) （編註：輔助教室 編輯所設置自學書院網站設有本課程的輔助教室，內容包括部份閱讀文章的翻譯本，中文文獻連結，和自學者論壇。）

課程描述

提出發展中社會那些影響健康、生存以及人口發展能力的主要營養問題。所涉及的內容是在家庭、社區、國家以及國際社會的層面上改善人口營養狀況的方法。通過有目的針對營養不良諸多因素的公共以及私人部門的干預，來探討預防或者減少營養不良可能達到的程度，以達到全面經濟發展。

課程宗旨

本課程的目的是讓學生熟悉並關注：(a) 在國際營養方面，影響發展中社會人民的健康、生存以及發展能力的現有或浮現的主要議題； (b)各種能夠提高人口良好營養狀況的直接和間接方法。本課程一個基本前提是，在絕大多數發展中國家（低收入），大多數人民依然是食物匱乏和缺乏營養：無論是提供能量的宏量營養素（尤其是蛋白質和脂肪），還是必需的微量營養素。從兒童時期到成年，他們的生存時刻受到威脅，生活品質也因為營養不良而備受影響，其嚴重程度從長期糧食短缺到饑荒。嬰兒、兒童以及育齡婦女是營養不良後果的高危人群，這些後果包括傳染病以及懷孕期的各種併發症。儘管社會經濟以及發展狀況進步會減少營養不良情況，本課程旨在探索一些干預措施，能夠有選擇、逐步接觸有需求的人群，在能力可負擔的情況下改善糧食和營養匱乏，增強公眾健康，再獲取經濟發展的實質成果。

「肥胖症」浪潮是發展中國家的第二個營養不良的現狀，影響著世界某些地區，比如拉丁美洲、北非以及東亞地區，還有絕大部分低收入國家的某些人群。這些人群正經歷「營養過渡」，這可能導致非傳染性疾病死亡增高的趨勢。

人群的營養狀態可概念化為「序列」：嚴重營養不良、輕度營養缺乏、營養正常、輕度超重以及肥胖。某些人群可能在序列兩端承受較大的營養壓力。營養缺乏和營養過剩，共存於一些社會的公共健康問題，這現像可稱為社會經歷營養不良的「雙重負擔」。處於這序列的人群，會激發不同的個人、家庭、社會、國家以及國際的種種反應。預防性反應常常因社會經濟，基礎設施、文化、民間以及政治的考慮而修正。因此，發展中國家具公共健康重要性的營養問題是複雜和一般存在長期的成因。充分解決這些成因：(a) 要採取涉及社會眾多部門的行動；(b)以事實根據為基礎；(c)緊隨國家政策以及資源狀況。

本課程重點關注營養不良的負擔和後果，包括蛋白質能量營養不良和微量營養素缺乏，以及兩者的問題成因，流行病學以及社會不同層面的預防方法。另外還會涉及一些浮現或特殊問題，比如「營養過渡」走向肥胖，愛滋病人群的營養相互作用，營養和生殖健康，以及饑荒的流行病學。

先修課程

本課程沒有正規的先修課程。但學員要熟悉營養的基本原則，學習營養不良的類型和原因，熟悉或學會發展中國家一般面對的資源局限。強烈建議學員在本學期擴大這領域的閱讀，特別是有關評估和干預，才可以有準備參加課堂討論，並就所選國家的營養問題和計劃撰寫權威論文。

相關閱讀資料

課程的主要教科書有：

West KP Jr, Caballero B, Black RE. 〈營養(Nutrition)〉，於 Merson MH, Black RE, Mills AJ 編輯《國際公共健康：疾病、計劃、系統與政策(International Pubic Health: Diseases, Programs, Systems, and Policies)》。Sudbury, MA: Jones and Bartlett Publishers, 第二版（有存書），2005年。

Allen L, Gillespie S.《什麼會起作用？營養干預的效果與效力評論(What works? A review of the efficacy and effectiveness of nutrition interventions)》，馬尼拉：亞洲發展銀行，亞洲發展銀行營養及發展系列第5號，ACC/SCN營養政策文件第19號。2001年。

補充閱讀材料將在課堂分發或通過網路指派。

課程要求

本課程重點講述一些零碎的國際營養問題。每節課講述一個課題，由課程講師或客座講者講授。學員會拿到幻燈片講義或課堂內容大綱。課程網站上提供課堂材料。學員打算進一步閱讀營養題目，可以借閱預留的補充材料，第二天歸還。

每節課大約1小時，希望有充分時間（20~25分鐘）就課程內容，必讀材料以及學員帶來的其他充實體驗進行討論。 每一節課最後總結和強調課題相關的重點。很多時是點名學員主持總結。

> 主要作業總結

期末論文：國家形勢分析

要求學生以衛生部長「顧問」的身份，就某一指定國家（另有描述）的營養問題，撰寫一份簡短（6頁，雙倍行距）的評論文章。學生按自己喜好順序提交四個發展中國家的名字。在第三課上佈置要研究的國家。導師將在課程最後一天總結學期論文。

評分規則

課程不設測驗，沒有期中考試和期末考試。評分按照以下標準：

期末論文 70%
課堂參與情況（重品質，而不是發言次數） 20%
出勤率 10%

計算得分，根據分佈曲線分別給出A、B、C、D或F總成績等級。

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Course Description

Presents major nutritional problems that influence the health, survival, and developmental capacity of populations in developing societies. Covers approaches implemented at the household, community, national, and international levels to improve nutritional status. Explores the degree to which malnutrition can be prevented or reduced prior to achieving full economic development through targeted public and private sector interventions that address the causes of malnutrition.

Course Objectives

The purpose of this course is to familiarize and engage the student in (a) major existing or emerging issues in international nutrition that influence the health, survival, and development capacity of people living in developing societies and, (b) various direct and indirect approaches to improving nutritional well-being of populations. One basic premise in the course is that large segments, indeed the majority of people in most developing (low income) countries remain food insecure and nutritionally deprived with respect to both energy-yielding macronutrients (notably protein and fat) and essential micronutrients. Their survival from childhood through adulthood is threatened and their quality of life suffers because of undernutrition, the severity of which ranges from chronic food insufficiency to famine. Infants, young children and women of reproductive age are considered most at-risk of the consequences of undernutrition, which include infection and complications during pregnancy. Although advances in socio-economic and development status tend to reduce undernutrition, the course explores interventions that can selectively and progressively reach those in need and affordably reduce food and nutritional insecurity, and enhance the public's health prior to achieving substantial gain in economic development.

A second reality of malnutrition in developing countries is a rising tide of obesity affecting certain regions of the world (eg, Latin America, Northern Africa and East Asia) and, within most low income countries in certain population segments. These populations are experiencing a "nutrition transition," that may be giving rise, in part, to an increasing trend in non-communicable disease as cause of death.

One can conceptualize a "continuum" of nutritional status on which populations lie, ranging from severe undernutrition and milder degrees of deprivation, to "normal" status, to being mildly overweight through to obesity. A given population may exhibit greater nutritional stress at either extreme. Societies where both under- and overnutrition coexist as public health problems are said to be experiencing a "dual burden" of malnutrition. Where a population lies on the continuum can be thought to evoke different individual, household, community, national, and international responses. Preventive responses are often modified by socio-economic, infrastructural, cultural, civil, and political considerations. Thus, nutritional problems of public health importance in developing countries have complex and, usually, long-acting causes. Adequate solutions to these causes (a) often require action across multiple sectors of society, (b) should be evidence-based and (c) pursued in the context of national policy and resources.

Most of the attention in this course addresses the burden and consequences of undernutrition, including protein-energy malnutrition and micronutrient deficiencies, their causes, epidemiology and approaches to prevention at various levels of society. Several "emerging" or special topics will be also be addressed, including the "nutrition transition" toward obesity, nutritional interactions in HIV/AIDS affected populations, nutrition and reproductive health, and the epidemiology of famine.

Prerequisites

There are no formal prerequisites for taking the course. However, students are expected to be familiar with basic principles of nutrition, study about the types and causes of malnutrition, and be or become familiar with resource constraints typically facing developing countries. Students are strongly encouraged to broaden their reading in these areas during the term in order to participate in an informed way in class discussions, especially in areas of assessment and intervention, and to write an authoritative paper on nutritional problems and programs within a selected country.

Readings

The primary text for this course is:

West KP Jr, Caballero B, Black RE. Nutrition. In: Merson MH, Black RE, Mills AJ (eds). International Pubic Health: Diseases, Programs, Systems, and Policies. Sudbury, MA: Jones and Bartlett Publishers, 2nd edition, (in press) 2005.

Allen L, Gillespie S. What works? A review of the efficacy and effectiveness of nutrition interventions. ACC/SCN Nutrition Policy Paper no.19, ADB Nutrition and Development Series No. 5. Manila: Asian Development Bank, 2001.

Supplementary readings will be handed out throughout the course or assigned from websites.

Course Requirements

The course will focus on a discrete number of international nutrition issues. A lecture will be given on each topic by a course instructor or guest speaker. Students will be given either power point handouts or lecture outlines. Lecture material will be available on the course website. Supplementary readings will also be on reserve, and can be signed out overnight, for those wanting to enhance their reading about nutritional topics.

Each lecture will be ~1 hour in length, leaving hopefully ample time (~20-25 minutes) for discussion based on the contents of the lecture, required readings and other enrichening experiences students bring into the course. At the end of each class, we will try to summarize and emphasize important points related to the topic. Most of the time students may be called upon to provide this summary.

> Summary of Major Assignments

TERM PAPER: COUNTRY SITUATIONAL ANALYSIS

Acting as "consultants" to a Minister of Health, students will be expected to write a brief (6-page, double-spaced), critical paper on nutritional problems within an assigned country (described elsewhere). Students will be asked to submit the names of four developing countries in order of preference. Countries will be assigned on the 3rd day of class. Course faculty will present a summary of term papers on the last day of class.

Grading Policy

There are no quizzes, no mid-term and no final examination. Numerical grades will be based on the following:

Term paper 70%
Quality (vs frequency) of class participation 20%
Class attendance 10%

Numerical grades will be calculated and, based on the curve of their distribution, letter grades (A,B,C,D, or F) will be assigned.