Editor’s note

We have sent this letter, together with Professor Waterlow’s letter, to the heads of the departments of Nutrition and of Child and Adolescent Health and Development at WHO, with a request for their comment.

The New Nutrition Science

So what is new

Madam

Roger Hughes rightly says that the discipline of public health nutrition needs definition⁽Reference Hughes¹⁾. Mark Lawrence and Tony Worsley agree⁽Reference Lawrence and Worsley²⁾.

However, in my opinion current definitions stick public health nutrition up a gum tree. Its teachers and practitioners generally seem content to identify the discipline as a branch of clinical nutrition. In a parallel process, public health is now usually seen as a branch of medical science. Taken together, these mind-sets make public health nutrition a rather trivial discipline – in the metaphor, not a tree but a twig. Or, to alter the metaphor, the medical sciences build palaces within which the public health sciences are allocated leaky wings, while public health nutritionists are stuck in out-houses. These images correspond to the relative amounts of cash and other resources currently available to medical researchers, in contrast with public health professionals.

The new nutrition science stands up out of this cultural cringe. It identifies clinical nutrition and public health nutrition as branches of nutrition seen as a whole, which has social (including political), economic and environmental as well as biological dimensions⁽³⁾. It does not identify health with the treatment or prevention of disease. This new vision is at the same time a return to the ancient tradition of dietetics, the natural philosophy which – in common with classic public health – was, as from the later 19th century ce, expropriated and subjugated by what are now the dominant conventional medical sciences⁽Reference Cannon^4, Reference Latour⁵⁾.

It may be tempting to acquiesce in a caste system within which public health nutritionists are the street-sweepers and scavengers. In response, not for the first time, I offer the challenge of Rudolf Virchow in 1848: ‘It is no longer a question of treating the patient with drugs or by the regulation of food, clothing or housing… With one million people, palliatives will no longer do… We must begin to promote the advancement of the entire population’⁽Reference Virchow⁶⁾.

The New Nutrition Science project was launched in 2005 at the International Congress on Nutrition in Durban. Colleagues now presenting and developing the project are – as I am – constantly told by young professionals that the vision of the new nutrition, including its environmental dimension, resonates with the reasons why they have chosen nutrition as their profession⁽Reference Candelas, Nymoen, Patterson and Scholtens⁷⁾.