title: Challenges and Opportunities in Scaling-Up Nutrition in Healthcare.
abstract: Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity, type 2 diabetes mellitus and hypertension. An increase in ageing populations also has meant increased interest in nutrition-related chronic diseases. In many middle-income countries, there has been an increase in the double burden of malnutrition with undernourished children and overweight/obese parents and adolescents. In low-income countries, an increased evidence base has allowed scaling-up of interventions to address under-nutrition, both nutrition-specific and nutrition-sensitive interventions. Immediate barriers (institutional, structural and biological) and longer-term barriers (staffing shortages where most needed and environmental impacts on health) are discussed. Significant barriers remain for the near universal access to healthcare, especially for those who are socio-economically disadvantaged, geographically isolated, living in war zones or where environmental damage has taken place. However, these barriers are increasingly being recognized, and efforts are being made to address them. The paper aims to take a broad view that identifies and then comments on the many social, political and scientific factors affecting the achievement of improved nutrition through healthcare.
authors.affiliation: The Boden Institute of Obesity, Nutrition, Exercise &#38; Eating Disorders, Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia. ian.darnton-hill@sydney.edu.au.|Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 021111, USA. ian.darnton-hill@sydney.edu.au.
authors.forename: Ian
authors.initials: I
authors.lastname: Darnton-Hill
authors.affiliation: Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand. samir.samman@otago.ac.nz.|Discipline of Nutrition and Metabolism, School of Molecular Bioscience, University of Sydney, Sydney, NSW 2006, Australia. samir.samman@otago.ac.nz.
authors.forename: Samir
authors.initials: S
authors.lastname: Samman
keywords: access; capacity; environment; healthcare; low- and middle-income countries