Community Nutrition

HNU 365

Dr. Laurie Wadsworth

Text Book

Community Nutrition: An entrepreneurial approach, 5th Edition. Boyle & Holben, 2010

Web site with chapter summaries, quizzes and Power Point slides

Chapters with case studies, summary points, glossary, programs in action

Entrepreneurship in Health Promotion

Opportunities expected to expand in future

Skills used with marketing, management, & other business skillsDesign, implementation,

evaluation of programs

Eddy, & Stellefson, 2009, Health Promot Pract, 10 (3), 333-341

Rules of Engagement

Responsibility for own learning & contribution

Openness – open to new ideas & opinions

Participation – at own comfort level

Experimentation – experiment with thinking & sharing

Sensitivity – listen for intent

Course Evaluation

Assignment Value

Lab Assignment #1 5 %

Lab Assignment # 2 5%

Mid-term Exam 20%

Final Project Report 10%

Project Tool 15%

Community Project Fair 10%

Final Exam 35%

Educational Tool

Public Health Educators’ Participation in Teams

Participated in average of 4 teams3 of these were inter-

organizational40% respondents participated

in 5 or more

Curricula should reflect collaborative work

Lovelace, et al., 2009, Health Promot Pract 10 (3), 428-435

“Apart from hermits, people live and work in groups . . So if you have it in mind to influence the way in which life goes on, you will not do it solely by trying to influence people-as-individuals, you will have also to think of people-in-groups.”

J. Yukdin & JC McKenzie

Changing Food Habits

Weeks 1 & 2

Introduction and course overview

The ‘who’, ‘what’ and ’how’ of community nutrition

Weeks 3 & 4Public Health, Health

Promotion, and Population Health

Review for Lecture

Stepping it up: Moving the Focus from Health Care in Canada to a Healthier CanadaHealth Council of Canada

http://www.healthcouncilcanada.ca

Social Science Key to Restoring Health

“The puzzles of better health promotion and disease prevention may be approached more rapidly and effectively through intensified social science research, rather than by awaiting the expected evolution of gene-based explanations and interventions based on future genetic discoveries.”

• Floyd Bloom, President Am. Assoc. for the Advancement of Science (2003)

“a group of people who share a common culture, identify themselves as a group, and usually live within a defined geographical area” (WHO, 1985)

“a body of people living near one or another and in social relationship; a body of people with a faith, profession or way of life in common; common ownership; a sharing” (Webster’s Encyclopedic Dictionary, 1988)

Community is…

“a group of inhabitants living in a somewhat localized area under the same general regulation and having common norms, values and organization” (Green and Ottoson, 1994)

“a group of people residing in specific geographical area who have common values, cultural patterns and social problems, together with an awareness of belonging to a group that causes them to interact more intensely with one another than they would with outsiders in a similar context” (Agudelo, 1983 in Jewkes, 1996)

Community is…

“is whatever one wishes it to be; but it is always (1) more than one person, (2) sharing, (3) commonalities” (Community Building Resources, Roberts, 1997)

“when a group has the power to decide what is a problem, the power to decide how to solve the problem, and the power to become an active part of implementing the solution (McKnight and de Toqueville in Roberts, 1997)

Community is…

Shared geographical location

Shared needs

Shared interest

Sense of belonging

Shared themes…

The absence of disease or illness

A state of complete physical, mental and social well-being and not merely the absence of disease and infirmity (WHO, 1974)

The ability to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment; a resource for everyday life, not the objective of living; a positive concept emphasizing social and personal resources, as well as physical capacities.” (WHO, 1986).

Health is…

Emerged as an important component of health and social programs in the early 1940s.” (WHO, 1986).

Aims to prevent problems related both to food insufficiencies and excesses, and to promote well-being through a secure and safe food supply and healthful eating habits

Community Nutrition…

Community Nutrition

Focus includes people, policies & programs

Policy action chosen by decision

makers to address specific problem

Through laws, regulations, programs

ProgramsInstruments used to seek

behaviour changes that improve nutritional well being

Public Health Agency

Organizations involved in community nutrition…

(Obert, 1986 in Davis, 1989)

Social Services

Day Care,

SchoolsAgricultu

ral Extension

Food Industry

Health Care

Providers

Fitness Centres

Work Site

Self-help Groups

Voluntary Agencies

Food Aid Programs

Key Actions for Successful Nutrition Programming

Service Delivery-Assess needs, tailor services

-Sustainability

Program monitoring& Evaluation-Collect data

-Conduct evaluations

Program Design-goals, population

-planning

Indicators of Change

Social & economic trends↑ ethnic diversity↑ Women in global workforce↑ older adults

Future Trends

Change, innovation, creativity, entrepreneurship

Global social change smaller world

Internet links people around the world

↑ connectedness of human beings challenges for community

nutritionists

Nutrition Trends:Baby-Boom Generation

82% report being very knowledgeable about food and nutrition

75% report good to excellent eating habits & health status

Average 2 snacks per day82% use vitamin & other

supplementsTracking Nutrition Trends 2008, Canadian Council of Food and Nutrition

Nutrition Trends:Baby-Boom Generation

Meal most often eaten away from home Lunch (12%); breakfast (9%);

dinner (7%)71% get dietary info from

dietitiansLabels (71%); Internet (52%);

print materials (47%); health professionals (43%)

Nutritional content leads food choiceWhole grains (86%); protein

(80%); calories (79%); total fat (78%)

Tracking Nutrition Trends 2008, Canadian Council of Food and Nutrition

Life Expectancy

“Some Canadians live their lives in excellent health with one of the highest life expectancies in the world . . . Others spend their life in poor health, with a life expectance similar to some third world countries. We cannot correct this inequity through the health care delivery system itself, regardless of the expenditure we devote to it.”

• A Healthy, Productive Canada: A determinant of health approach, Senate of Canada, 2009

Demographic Transition Theory

Population PyramidsDeveloped & Developing Nationsby age and sex

1960

2000

2040

Evidence-based Public Health Approaches

Essential to changing public health outcomes

Requires skills to review evidence & to choose most workable strategy for problem defined

Baker, et al., 2009, Health Promot Pract, 10, 342-348

Evidence-based Public Health Approaches

Skills neededCommunity assessmentQuantifying issueDevelop problem statementDetermine what is known from

literaturePrioritizing program & policy

issuesDevelop & implement action

planEvaluate program or policy

Baker, et al., 2009, Health Promot Pract, 10, 342-348

Strengthening Public Health Nutrition Practice in Canada

Public health nutrition requires the leadership of dietitians with expertise in nutrition, food systems & related public health sciences.

Public health nutrition practice encompasses the assessment, promotion, protection & enhancement of health & the prevention of nutrition related disease.

Using population health & health promotion approaches, strategies focus on the interactions among the determinants of heath, food security, & nutritional & overall health.

Pan Canadian Task Force on Public Health Nutrition Practice, 2009

Strengthening Public Health Nutrition Practice in Canada

All dietetic students and/or interns are exposed to public health philosophies and/or environment in their preparatory education and/or practical training based on the updated dietetic competencies.

Dietetic competencies are updates to provide a foundation for desired public health practicePan Canadian Task Force on Public Health Nutrition Practice, 2009

Core Competencies for Public Health

Visitwww.corecompetencies.ca

Learn about development of competencies in Canada

Find links to projects, tools and resources to support public health practice

Build your portfolio by listing competencies you have used

Test your knowledge of core competencies

TC Douglas

Monique Bégin

Canada Health Act (1984)

Five Principles for continued federal fundingPublic AdministrationComprehensivenessUniversalityPortabilityAccessibility

Future of Health Care in Canada

Canadians favour systemPublicly fundedComprehensive

Pessimistic about sustainability

Increasing privatization

Calls for substantial reformsConsensus remains elusive

Health Care Costs in Canada (1994)

0%

5%

10%

15%

20%

25%

30%

35%

40%

Hospital

MDs

Rx Drugs

Public Hlth

Home Care

Health Care Costs in Canada (2004)

$130 B on health/year= over $10,000 per household

Only ~2.1% goes to public healthFor every $100 spent on health

care in Canada, $2.10 goes into public health

For every 100 people working on the health outcome problems, only 2 work on the public health prevention side

Commission on the Future of Health Care in Canada: Roy Romanow

Macleans, 2003

Wellbeing

Institute of Wellbeing adopted this working definition:“The presence of the highest

possible quality of life in its full breadth of expression, focused on but not necessarily exclusive to: good living standards, robust health, a sustainable environment, vital communities, an educated populace, balanced time use, high levels of civic participation, and access to and participation in dynamic arts, culture & recreation.”

Institute of Wellbeing, 2009

Canadian Index of Wellbeing

CIW – www.ciw.caa new method for measuring

Canadian quality of lifeGoes beyond economic indicators

(i.e., GDP)Measures 8 interconnected areas

of wellbeingStandard of living -- Education Health -- Way we

use our timeVitality of communities state of arts, culture, recreation,

environment

Bringing it together

“If we want Canadians to be the healthiest people in the world . . . We have to cure ‘hardening of the categories’ which has over the years drastically compartmentalized many of the policy and programmatic tools that must be brought together to move us along the health outcome continuum.”

• Roy Romanow, Keynote remarks at inaugural meeting of the Health Council of Canada, 2004

Pan-Canadian Health Living Strategy

FPT ministers of health endorsed strategy in 2005

In 2010 endorsed 2 new initiativesCreating a healthier Canada:

Making prevention a priorityCurbing Childhood Obesity: A

federal, provincial, & territorial framework for action to promote healthy weights

NS DHAs

Health Objectives

To protect & promote health of all people

Challenge is to translate goal into actionMany physical, social, biological,

behavioral health determinantsChanging human behaviour

Nations differ in formulation of health objectives & strategies for behaviour change

Community Nutrition:Key Documents

Nutrition for Health: an agenda for action

The Nova Scotia agenda for action

Eating Well with Canada’s Food Guide

Healthy Eating Nova Scotia 2005 http://

www.gov.ns.ca/ohp/repPub/HealthyEatingNovaScotia2005.pdf

Total Diet Approach

Evidence supports behaviour-oriented food & nutrition programs That help learners adopt total diet

approach• Sustainable

• Fits individual preferences

Some concern expressedMay be perceived as permitting

unlimited inclusion of low-nt dense products

• ADA Position paper – Total Diet approach to communicating food and nutrition information, 2007

Eating Well with Canada’s Food Guide

Eating Well with Canada's Food GuideFirst Nations, Inuit & Métis

USDA Food Guide Pyramid

USDA Food Guide Pyramid

Mexico

Sweden

UK

China