Community Nutrition

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Community Nutrition

What is community nutrition? What is health?

CN and trends in healthcare

Risk reduction and disease prevention

Definitions

Nutrition =

science of food and its use by the body

Community = “unified body of individuals with common characteristics or interests who live in a particular area”» people» location» social interaction» shared values

What is Community Nutrition?

Community Nutrition (CN) strives to improve the health and well-being of individuals and groups within the community

Three arenas:» people (diverse)» policy (course of action)» programs (instruments to change behavior)

Involves socioeconomic,

political, cultural, and psychological aspects of food…

CN vs. Public Health

CN draws on dietetics and public health» public vs private» governmental control

Public Health = societal efforts to promote/restore people’s health» 1900s: sanitation, communicable diseases

» now: chronic diseases

Ten Leading Causes of Death in the U.S. (1900)

Rank Cause of death

1

2

3

4

5

6

7

8

9

10

Pneumonia/influenza

Tuberculosis

Diarrhea and enteritis

Heart disease

Stroke

Liver disease

Accidents

Cancer

Diphtheria

Meningitis

Causes in which diet plays a part

Causes in which alcohol plays a part

Ten Leading Causes of Death in the U.S. (2000)

Rank Cause of death

1

2

3

4

5

6

7

8

9

10

Heart disease

Cancer

Stroke

Lung diseases

Accidents

Diabetes

Pneumonia/influenza

Alzheimer’s disease

Kidney disease

Septicemia

Causes in which diet plays a part

Causes in which alcohol plays a part

What is Health?

Absence of disease

State of physical, emotional, mental, social, spiritual well-being

Components of a Healthful Lifestyle

Eating

Exercise No addictive behaviors

» Smoking» Drugs / Alcohol» Eating disorders

Stress management

Adequate sleep

Clinical

Community

Medical

Prevention

Community nutrition interfaces with the realities of

the health care system

Trends in Nutrition/Healthcare

Reality

Prevention is more effective, but…prevention efforts are rarely

reimbursed!!

Outcomes can also be hard to prove

Reality

Prevention is more effective, but…prevention efforts are rarely

reimbursed!!

Outcomes can also be hard to prove

(Brainstorm measurable outcomes of nutrition intervention)

Health Insurance

Fee-for-Service (private)» traditional individual or group

Managed care (private)» group, usually employer-based

Public (Medicare and Medicaid)» low SES» aged, blind, disabled» are entitlement programs

Uninsured» working poor, seasonal workers» uninsurable

U.S. Healthcare: Insurance Coverage

Insured:(number; %)

Uninsured:(White/Black)

2002

242.4 million; 84.8%

10.7% / 19.5%

2003 243.3 million; 84.4%

11.1% / 19.5%

Sources: Census Bureau, CDC (NCHS); August 2004

U.S. Healthcare: Insurance Coverage

Insured: % Uninsured: (White/Black)

2002

84.8%

10.7% / 19.5%

2006 85.2%

10.5% / 16%

2007 85.5% 10.6% / 15.3%

2009 84.6% 15.1% / 22.2%

Sources: Census Bureau, CDC (NCHS); September 2008Cohen RA, Martinez ME, Ward BW. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2009. National Center for Health Statistics. June 2010. Available from: http://www.cdc.gov/nchs/nhis.htm.

Trends in the Healthcare System

Increase in managed care: HMOs, PPOs Increased costs

» technology is $» aging of population» consumer demands» liability coverage» education costs» unhealthy lifestyles

(Trend in jobs: part-time)

Health Continuum

Who is at Risk?(and how do you know?)

Individuals» referral» ill

Groups» risk factors

Population» known

problems

Depends on people and hazards considered

U.S. Healthcare: Insurance Coverage

Insured: % Uninsured: (White/Black)

Region Uninsured for part of past year Uninsured for more than a year

Northeast 

13.5% 7.2%

Midwest 16.6% 8.1%

South 22.8% 13.5%

West 21.5% 12.4%

Cohen RA, Martinez ME, Ward BW. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2009. National Center for Health Statistics. June 2010. Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201006.pdf

Risks and Disease Prevention

Risk = expected annual mortality / hazard

Risk assessment = determining extent of the hazard / identifying who faces the hazard

Healthy People 2010

Mission = creating healthy people in healthy communities

2 Goals:» increase the quality of life and years of

healthy life» eliminate health disparities

U.S. Health Disparities: 2005

1995-2002

IMR

(per 1000 live births)

2001/2005Life expectancy

(years)

2005

Poverty

(% of population)

Whites

5.9

77.7 / 78.3

8.3%

Blacks 13.9

72.2 / 73.2 24.9%

Sources: Census Bureau, CDC (NCHS); September 2007

U.S. Health Disparities ~1998

IMR

(per 1000 live births)

Life expectancy(years)

Poverty

(% of population)

Whites

7.3

~75

11.6%

Blacks 17.6

~65 33.3%