Federal Overview for Public Health Nutrition

Some Major Nutrition Players:• USDA

• Food and Nutrition Service

• Center for Nutrition Policy and Promotion

• Food Safety and Inspection Service (FSIS)

• Department of Health and Human Services• CDC

• HRSA

• FDA

• NCI

• Office of Disease Prevention and Health Promotion

• EPA – agency responds directly to president

USDA Mission: Enhance the quality of life for the American people by supporting production of agriculture: • ensuring a safe, affordable, nutritious, and accessible food supply • caring for agricultural, forest, and range lands • supporting sound development of rural communities • providing economic opportunities for farm and rural residents • expanding global markets for agricultural and forest products and services • and working to reduce hunger in America and throughout the world.

USDA Vision: A healthy and productive Nation in harmony with the land.

Food and Nutrition Service (FNS)

• works to increase food security and reduce hunger by providing children and low-income people with access to food, a healthy diet, and nutrition education in a manner that supports U.S. agriculture and inspires public confidence in the Nation's domestic nutrition assistance programs.

• FNS nutrition assistance programs represent about half of USDA's budget.

FNS Programs

• Food Stamp Program

• Child Nutrition Programs

• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

• Commodities to low-income Americans.

• Monitoring of the eating habits of program participants

Center for Nutrition Policy and Promotion (CNPP)

• develops and promotes science-based dietary guidance and economic information for consumers and professionals in health, education, industry, and media

Center for Nutrition Policy and Promotion (CNPP)

• Partner with HHS for Dietary Guidelines

• Healthy Eating Index

• Nutrient Content of the Food Supply

• Food Guide Pyramid

• Thrifty Food Plan

Thrifty Food Plan

• Last revised 1999• Establishes menus and market basket costs for a

minimal cost healthful diet• All menus meet Dietary Guidelines for

Americans, the Recommended Dietary Allowances, and the serving recommendations of the Food Guide Pyramid.

• Used as the basis for food stamp allocation decisions, and to determine the federal poverty level

Federal Poverty Level

• Poverty thresholds were originally derived in 1963-1964,using:– U.S. Department of Agriculture food budgets

designed for families under economic stress– Data about what portion of their income

families spent on food

• If total family income is less than the threshold appropriate for that family, the family is in poverty

Cooperative State Research Education and Extension Service

(CSRES)

CSREES: Families, 4-H, and Nutrition

• Youth development

• Expanded food and nutrition program (EFNEP)

• Children, youth and families at risk

• CSREES partners with state land grant institutions and local counties

Department of Health and Human Services

National Cancer Institute: 5 A Day for

Better Health • The national Program gives Americans a simple,

positive message - eat 5 or more servings of fruits and vegetables every day for better health. The program is jointly sponsored by the National Cancer Institute in the U.S. Department of Health and Human Services and the Produce for Better Health Foundation, a nonprofit consumer education foundation representing the fruit and vegetable industry. The National Cancer Institute funds behavior change and communications research to determine strategies that are effective to increase fruit and vegetable consumption.

NIHMany institutes include nutrition-related

research portfolios:• National Heart Lung and Blood Institute (NHLBI)• National Institute on Aging (NIA) • National Institute of Diabetes & Digestive &

Kidney Diseases (NIDDK) • National Institute of Child Health and Human

Development (NICHD)• National Institute of Environmental Health

Sciences (NIEHS)• John E. Fogarty International Center (FIC)• National Center for Complimentary and

Alternative Medicine (NCCAM)

HRSA

• Diverse Agency– Direct Services

– Supporting health care infrastructure

• Community and Migrant Health Services• Health Centers

• Expanding

• Maternal and Child Health• Block Grants to States

• Discretionary Grants

DIRECT

HEALTH CARE

SERVICES

(GAP FILLING)

Examples:

Basic Health Services and Health Services for CSHCN

ENABLING SERVICES

Examples:

Transportation, Translation, Outreach, Respite Care,Health Education, Family Support Services, Purchase ofHealth Insurance, Case Management, Coordination with

Medicaid, WIC and Education

POPULATION--BASED SERVICES

Examples:

Newborn Screening, Lead Screening, Immunization, Sudden Infant DeathCounseling, Oral Health, Injury Prevention, Nutrition and Outreach/Public Education

INFRASTRUCTURE BUILDING SERVICES

Examples:

Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research,

Systems of Care and Information Systems

CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES

MCH

EPSDT

CHC SCHIP

Maternal

Child

Health

Bureau

Centers for Disease Control: Mission

• To promote health and quality of life by preventing and controlling disease, injury, and disability

Centers for Disease Control: 11 Centers, Institutes, and Offices

Epidemiology Program Office National Center for Chronic Disease Prevention and Health Promotion

National Center for Environmental Health

Office of Genetics and Disease Prevention

National Center for Health Statistics

National Center for HIV, STD, and TB Prevention

National Center for Infectious Diseases

National Center for Injury Prevention and Control

National Immunization Program

National Institute for Occupational Safety and Health

Public Health Practice Program Office

National Center for Chronic Disease Prevention and Health Promotion

• Vision: Enabling all people in an increasingly diverse society to lead long healthy, satisfying lives.

National Center for Chronic Disease Prevention and Health Promotion

• Mission:– To prevent death and disability from chronic

diseases– To promote maternal, infant, and adolescent

health. – To promote healthy personal behaviors. – To accomplish these goals in partnership with

health and education agencies, major voluntary associations, the private sector, and other federal agencies.

Division of Nutrition and Physical Activity: Purpose

• provides science-based activities for children and adults that address the role of nutrition and physical activity in health promotion and the prevention and control of chronic diseases

Division of Nutrition and Physical Activity: Scope

• Epidemiology

• Applied research

• Public health policy

• Surveillance

• Community interventions,

• Evaluation

• Communications

Sample of CDC Nutrition and Physical Activity Projects

• Surgeon General’s report on Physical Activity in 1996.

• Funding of 24 Prevention Research Centers• Funding 16 states to provide coordinated school

based programs for nutrition and physical activity• Creation of Healthy Schools Indices• Expansion of National Breast and Cervical Cancer

Early Detection Program to include dietary and physical activity interventions

• Promotion of Active Community Environments

Future Activities for DNPA

• “CDC considers it a priority that people be afforded opportunities to pursue and maintain good health through such avenues as safe walking and cycling trails; low-fat, high-fruit-and-vegetable menu selections in restaurants, schools, and worksite cafeterias; and physical activity programs in schools, worksites, and community gathering places.”

Office of Disease Prevention and Health Promotion,

• Works to strengthen the disease prevention and health promotion priorities of the Department within the collaborative framework of the HHS agencies.

• Collaborated with USDA on Dietary Guidelines

Working Together….

Dietary Guidelines 2000: A

• Aim for Fitness Aim for a healthy weight. Be physically active each day.

Dietary Guidelines 2000: B

• Build a Healthy Base…. Let the Pyramid guide your food choices. Choose a variety of grains daily, especially

whole grains. Chose a variety of fruits and vegetables daily. Keep food safe to eat.

Dietary Guidelines 2000: C

• Choose Sensibly…. Choose a diet that is low in saturated fat and

cholesterol and moderate in total fat. Choose beverages and foods to moderate your

intake of sugars. Choose and prepare foods with less salt. If you drink alcoholic beverages, do so in

moderation.

Revision of Dietary Guidelines

• Advisory Group for 2005 revision convened August 2003.

• Items that were proposed in letter from OMB:– Trans fatty acids, n 3 fatty acids

• Focus on obesity?

The Fun Begins:

• "There are a number of nominees that have very close ties to the food industry that might lead them to make recommendations that are weaker than they should be based on the science,"

• "The answer is devoting our energies to strengthening programs that teach people to follow the guidelines...and help to reshape the food environment to make it easier for people to eat well," Margo Wootan, CSPI.

• Fitzgerald (R-Ill) proposed having guidelines come only from DHHS. USDA should not be giving dietary advice, considering its "main mission is to promote the sale of agricultural products."

Food Safety Objectives from Healthy People 2010

• 10-1 Foodborne infections• 10-2 Outbreaks of foodborne infections• 10-3 Antimicrobial resistance of Salmonella

species• 10-4 Food allergy deaths• 10-5 Consumer food safety practices• 10-6 Safe food preparation practices in retail

establishments

• 10-7 Organophosphate pesticide exposure

Food Safety: A Team Approachhttp://vm.cfsan.fda.gov/~lrd/foodteam.html#CDC

• FDA• CDC• USDA• Cooperative Extension Service• National Agricultural Library: USDA/FDA

Foodborne Illness Education Information Center • EPA• U.S. Department of Commerce: National Oceanic

and Atmospheric Administration

Food Safety Team, Cont..

• U.S. Department of the Treasury: Bureau of Alcohol, Tobacco and Firearms

• U.S. Customs Service• U.S. Department of Justice• Federal Trade Commission• State and Local Governments

Food Safety and Inspection Service (FSIS)

• sets standards for food safety and inspects meat, poultry, and egg products produced domestically and imported

FDA

• FDA's mission is to promote and protect the public health by helping safe and effective products reach the market in a timely way, and monitoring products for continued safety after they are in use.

• FDA safeguards the nation's food supply by making sure that all ingredients used in foods are safe, and that food is free of contaminants -- like disease-causing organisms, chemicals, or other harmful substances.

• The agency must approve new food additives before they can be used in foods. FDA also monitors the safety of dietary supplements and the content of infant formulas and medical foods.

• Meat and poultry products, however, are regulated by the USDA.

EPA: Food and Water Safety

• Establishes safe drinking water standards Regulates toxic substances and wastes to prevent their entry into the environment and food chain

• Assists states in monitoring quality of drinking water and finding ways to prevent contamination of drinking water

• Determines safety of new pesticides, sets tolerance levels for pesticide residues in foods, and publishes directions on safe use of pesticides