In an exclusive interview, Judd Walson, Chair and Professor, Department of International Health at Johns Hopkins Bloomberg School of Public Health, speaks with ETHealthworld’s Rashmi Mabiyan Kaur about the multi-dimensional nature of addressing undernutrition in developing countries.
The conversation highlights how undernutrition extends beyond food to factors such as infection control, poverty alleviation, and hygiene. It also emphasizes the importance of innovations like probiotics and the pivotal role of breastfeeding in shaping a healthy microbiome. Edited excerpts:
How important is nutrition in addressing health challenges, particularly in developing countries?
Nutrition is a critical factor in health, especially in countries where child mortality and undernutrition among mothers remain high. Often, we equate nutrition with diet and food, but undernutrition is about much more than that—it involves measuring growth markers like weight, height, and arm circumference. These low measurements can stem from several factors beyond dietary insufficiency, such as repeated infections, lack of dietary diversity, and broader issues like poverty and hygiene.
Addressing undernutrition requires tackling all these factors. This includes reducing infection risks through immunization, treating recurring diarrheal episodes with ORS (oral rehydration salts), and alleviating poverty. Exciting new interventions, like probiotics, are emerging. Probiotics could help repair the disrupted microbiome in children exposed to pathogens or hospital environments, supporting growth and reducing mortality. Breastfeeding is another essential aspect as it fosters a healthy microbiome, but for cases where breastfeeding isn’t an option, we must innovate ways to replicate its benefits.What role does antimicrobial resistance (AMR) play in child health, and how can we combat it?
AMR is a growing concern for child health in countries like India, where antibiotics are accessed both formally and informally. This widespread usage creates pressure on bacteria to develop resistance. Antimicrobial stewardship is critical—ensuring the right antibiotics are used at the right time for the right diseases.
Hygiene in healthcare settings is also key since hospitals can be breeding grounds for AMR. Engineering better facilities to prevent the spread of resistant bacteria is necessary. Vaccines, particularly those that reduce bacterial carriage, are promising tools to fight AMR. By addressing hygiene, stewardship, and vaccine innovations, we can mitigate AMR’s impact.
How do you see epidemiology evolving to address child and adolescent health challenges in resource-limited settings?
Epidemiology has always been the foundation of understanding diseases—tracing their causes, spread, and patterns. It has now evolved to focus on measuring intervention impacts and scaling those interventions effectively. New tools like large data sets and implementation science are being used to refine health interventions in real-world settings.
In resource-limited settings, the challenge lies in applying these tools to deliver accessible, high-quality healthcare. By understanding both disease patterns and intervention dynamics, epidemiology remains critical in improving child and adolescent health globally.
Despite advancements, why do maternal and child mortality persist, and what can be done?
We already have 90 per cent of the tools needed to reduce maternal and child deaths. High-income countries with robust health systems demonstrate how low mortality levels are achievable. However, the gap lies in delivery—not innovation.
The focus should be on ensuring high-quality healthcare, empowering women, and addressing poverty. Innovations like microbiome research and digital health technologies can provide incremental benefits. Still, fundamental issues—poverty alleviation, community empowerment, and systemic health system improvements—are the true game-changers.
How has the COVID-19 pandemic influenced global health priorities, particularly for children?
COVID-19 was both a technical success and a diplomatic failure. Vaccines were developed and delivered in record time, but global inequities in vaccine distribution highlighted weaknesses in public health diplomacy. For children, the pandemic underscored the importance of immunization and community engagement in health interventions.
We also learned that technical solutions must be coupled with communication and collaboration with communities. Vaccine hesitancy, for instance, is less about knowledge gaps and more about trust and agency. Fundamentally, a lot of the hesitancy around vaccines is about decision-making, capacity, and being able to control one’s future and one’s access to healthcare. Also, vaccines are one thing that we sometimes push on populations without enough community engagement and awareness. Strengthening partnerships with communities will be vital for preparedness for future outbreaks.
Often, health issues aren’t due to a lack of knowledge but the inability to act. Could you elaborate?
Many people know what’s healthy—such as washing hands or eating fresh vegetables—but lack the means to act on that knowledge. For instance, people in food deserts may only have access to junk food, even if they know it’s unhealthy. Likewise, many believe that the way to get people to involved in sanitation practices is to teach them that they should wash their hands. In most households, people know they should wash their hands. This is not the problem. The real problem is that they can’t do it for various reasons, such as lack of access to clean water or soap in this case.
Similarly, in nutrition, poverty and accessibility are significant barriers. Programs often focus on educating people without ensuring they have the resources to implement those learnings. Effective interventions must couple knowledge with access and agency, enabling people to make healthier choices.
