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estimated 250 million preschool children alone are vitamin A deficient, with a substan-
tial proportion of pregnant women in at-risk areas equally being suspected of suffering
from vitamin A deficiency (WHO 2011d). For calcium, vitamin D, the B vitamins, and
folate, low intakes can also be common (Allen et al. 2006). However, for many micronu-
trients, reliable prevalence data are not available, which makes substantiating the occur-
rence of vitamin and mineral deficiencies difficult (Borwankar et al. 2007).
Summing up these figures gives a total of at least 7 billion cases of people suffering
from one form of malnutrition or another (Figure 6.1); in at least 5 billion cases this
includes a micronutrient deficiency. Therefore, because not all of the entire human pop-
ulation is affected by malnutrition, many individuals must suffer from multiple nutri-
tion problems. What these headcount figures do not show, though, is how severe the
suffering is in each case—for instance, being iodine deficient is not necessarily compa-
rable to being vitamin A deficient.
To address the issue of how different health outcomes can be quantified and com-
pared, in the 1990s the World Bank and the World Health Organization introduced
a summary measure for population health called “disability-adjusted life years,” or
DALYs (World Bank 1993; Murray and Lopez 1996). One DALY can be thought of as
one “healthy” year of life that is lost due to mortality or morbidity. Each year of life lost
due to premature death is counted as one DALY, and each year lived with a disease or
injury is counted as a fraction of one DALY, depending on the severity of the condition.2
The sum of DALYs across all health outcomes and across the entire population can be
thought of as a measure of the overall gap between current health status and an ideal
situation where everybody lives to an advanced age, free of disease and disability. This
gap is also called the “burden of disease” (WHO 2011b).
Undernourishment
Overweight
Iodine deciency
Zinc deciency
Iron deciency
Selenium deciency
Di�erence to highest estimate
Lowest estimate
Vitamin A deciency
0.0
0.5
1.0
1.5
2.0
Figure  6.1 Billion people suffering from malnutrition worldwide.
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