Chytanya Kompala is currently completing a Hilton Prize Coalition Fellowship with PATH, a global health and innovation NGO based in Seattle, WA. Chytanya holds a Master of Science in Public Health degree in Nutrition from the Johns Hopkins Bloomberg School of Public Health.
In this blog post, Chytanya writes about her experience working with PATH’s Nutrition Innovation team to explore the effects of tobacco use during pregnancy on childhood stunting. She is also currently drafting a policy brief to highlight interventions that could help to reduce chronic undernutrition.
Stepping Out of the Silo: Advocating for Interdisciplinary Approaches to Undernutrition
By Chytanya Kompala
Global nutrition is my passion. In graduate school, I was trained to think about nutrition problems in the developing world from a certain perspective. My training came from nutritionists and did not emphasize collaboration with sectors outside of nutrition. My peers have been nutritionists. All of my previous work experiences have been completely focused on nutrition. As a global health nutritionist and researcher, I was eager to work with the Nutrition Innovation team at PATH and gain an insider’s perspective into one of the most reputable global health NGOs in the world. When I started my fellowship in February 2017, I was expecting something similar to my previous nutrition-centric experiences. I was anticipating joining a team that worked similarly to other organizations in this field. I was expecting to rely on my existing knowledge of nutrition. Instead, I had an entirely different experience. I found myself learning so much about new topics from a team with diverse backgrounds and next-generation ideas.
The issue of chronic undernutrition (technically known as stunting) has been at the center of my fellowship research. Chronic undernutrition among children under age five is one of the largest burdens of malnutrition and is an unavoidable topic in the developing world.
Early this spring, I attended a presentation at PATH’s headquarters by Roger Thurow, a senior fellow at the Chicago Council on Global Affairs and the author of The First 1,000 Days. “Stunted children have a life sentence to under-performance and under-achievement,” he said. As Thurow described, stunting during childhood impacts a child for the rest of his or her life. Long-term consequences of stunting include reduced educational attainment, impaired cognitive function and development, poor economic productivity, and even an increased likelihood of having stunted children. Stunting is an intergenerational condition that hinders the growth and development of individuals, families, communities, and even countries.
The Lancet 2013 Series on Maternal and Child Nutrition was a seminal set of papers that acted to coalesce the nutrition and development communities around a set of proven, “nutrition-specific” interventions to address stunting. They estimated that scaling up 10 nutrition interventions to 90 percent coverage would reduce stunting by about 20 percent. While this finding gave the community renewed focus, it also highlighted how much we still do not know about the complex determinants of stunting. What about the remaining 80 percent?
One of the aims of PATH’s Nutrition Innovation team is to help answer that question. During my six months at PATH, I worked on two projects: an ongoing systematic review and meta-analysis on the effects of tobacco use during pregnancy and its association with stunting, and drafting a corresponding policy brief on “nutrition-sensitive” risk factors that may be contributing to stunting—those that were not highlighted in The Lancet 2013 Series.
I never thought that my research would be focused on tobacco use. At first, I was skeptical about researching this topic. I have no background or experience working on tobacco, and I was unsure about how relevant tobacco would be to stunting. But through our meta-analysis, my eyes have been opened to the idea that much more cross-sectoral research still needs to be done to explore the intersection and overlap between different health and development issues and nutrition outcomes.
Working on the Nutrition Innovation team at PATH has taught me an invaluable lesson about the interdisciplinary nature of global health and nutrition. Too often, people try to do great work in silos. Echoing this message at PATH’s 40th anniversary celebration in May, a diverse panel of innovators and young leaders discussed the importance of making connections across sectors to solve the world’s problems. By working collaboratively and moving away from the “business as usual” mindset, we can achieve greater impact. Thinking about stunting outside of the “nutrition-specific” lens enables us to better understand the complex and broad, sweeping determinants of the problem. Our research on tobacco is just one example of this.
We are currently in the process of drafting our policy brief with the aim of broadening the conversation about stunting to address issues beyond the nutrition interventions highlighted in The Lancet. We are exploring sound evidence on additional determinants of stunting, such as household air pollution, tobacco use, hygiene and sanitation, education, and delaying the first birth and birth spacing.
Part of our message is to advocate for more interdisciplinary approaches among people working in different sectors—to encourage researchers, program implementers and policymakers to expand their approach to include cross-sector indicators in their research and programs. Many health and development studies and programs do not include stunting as an outcome of interest, even when evidence indicates that there may well be an effect. We hope our work can help guide the conversation out of the box and lead to new, creative, and interdisciplinary approaches to end undernutrition around the world.
I am grateful for this fellowship and exposure to the great work of the Nutrition Innovation team at PATH. My time here has greatly expanded and shaped my perceptions and approach to thinking about global nutrition.