Introduction to Public Health Nutrition

What is Health?

Health

A state of complete physical, mental, and social well-being, not merely the absence of disease.

WHO

What is Public Health?

Mission of Public Health

“…to fulfill society’s interest in assuring conditions in which people can be healthy.”

IOM. Future of Public Health.

Population Health

Improving Everyone’s Quality of Life: Group Health Foundation, 2001

Population Health

• Considers a broad set of options for improving and sustaining health

• Highlights role of social and economic forces in combination with biological and environmental factors

• Results in benefits to all

Public Health Practice Compared to Clinical Nutrition Practice

  Public Health Practice

Clinical Nutrition Practice

Focus Prevention Disease treatment

Target Populations Individuals

Setting States & Communities

Clinics & Hospitals

Strategies Multiple, Reinforcing

Counseling and education

Core Functions of Public Health

Assessment

• Assess the problems and needs of the population

• Monitor the health of populations • Assess and monitor the determinants of

population health

Policy Development

• Develop policies, programs and activities that address health outcomes and the determinants of those outcomes

Assurance

• Assure the implementation of effective strategies by providing or monitoring policies, activities, and services.

The Future of the Public’s Health in the 21st Century, IOM, November, 2002

Areas of action and change:– Adopting a focus on population health that

includes multiple determinants of health– Strengthening the public health infrastructure– Building partnerships– Developing systems of accountability– Emphasizing evidence– Improving communication

What About Nutrition?

Mission of Public Health Nutrition

• To assure conditions in which people have access to adequate and appropriate food.

• To assure conditions in which people can achieve optimal nutritional health.

Leading Causes of Death, 1900

Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

Leading Causes of Death, 1997

Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

Ecological Approaches to Public Health Nutrition

The Socio-Ecological Model

FACTORSINTERNATIONAL

Development

Globalizationof

markets

SchoolFood &Activity

WORK/SCHOOL/

HOME

Infections

Labor

Worksite Food & Activity

LeisureActivity/Facilities

Agriculture/Gardens/

Local markets

COMMUNITYLOCALITY

Health Care

System

PublicSafety

PublicTransport

Manufactured/Imported

Food

Sanitation

NATIONAL/REGIONAL

Food & Nutrition

Urbanization

Education

Health O

SITY

PREVALEN

E

INDIVIDUAL

EnergyExpenditure

Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org

POPULATION

%

OBESE

OR

UNDERWT

Social security

Media

Transport

Family &Home

NationalNationalperspectiveperspective

Media &Culture

Food intake :

Nutrient density

Media programs

& advertising

Societal policies and processes influencing the population prevalence of obesity

Christakis N and Fowler J. N Engl J Med 2007;357:370-379

Part of the Social Network from the Framingham Heart Study with Information about Body-Mass Index According to Year

How are the functions of Public Health performed?

10 Essential Public Health Services: Public Health Functions Steering Committee - State and Local • Monitor Health Status to identify community health

problems• Diagnose and investigate health problems• Inform, educate, and empower people about health issues• Mobilize community partnerships to identify and solve

health problems• Develop policies and plans that support individual and

community health efforts• Enforce laws and regulations that protect health and

ensure safety

• Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Assure a competent public health and personal heath care workforce

• Evaluate effectiveness, accessibility, and quality of personal and population-based public health services

• Research for new insights and innovative solutions to health problems

Public Health Nutritionists: Guidelines for Comprehensive Programs to Promote Healthy Eating

and Physical Activity (CDC, ASTDPHN)

• Leadership: create vision, convene partners

• Planning/Management: structure, planning, communication, funding

• Coordination: integration of nutrition efforts across programs at the national, state, and local level – consistent messages

Brief History of Public Health Nutrition

Achievements in Public Health, 1900-1999: Safer and Healthier Foods (MMWR )

• “During the early 20th century, contaminated food, milk, and water caused many foodborne infections, including typhoid fever, tuberculosis, botulism, and scarlet fever.”

• “Once the sources and characteristics of foodborne diseases were identified--long before vaccines or antibiotics--they could be controlled by handwashing, sanitation, refrigeration, pasteurization, and pesticide application. Healthier animal care, feeding, and processing also improved food supply safety.”

• “The discovery of essential nutrients and their roles in disease prevention has been instrumental in almost eliminating nutritional deficiency diseases such as goiter, rickets, and pellagra in the United States.”

• “During 1922-1927, with the implementation of a statewide prevention program, the goiter rate in Michigan fell from 38.6% to 9.0 %.”

• “In 1921, rickets was considered the most common nutritional disease of children, affecting approximately 75% of infants in New York City.”

1917 USDA issues dietary recommendations (5 foodgroups)

1924 Iodine added to salt

1920s Maternal and Infancy act – state healthdepartments employ nutritionists

1930s Federal gov’t. establishes food relief, nutritioneducation, school feeding, food consumptionsurvey.

1940s 25% of draftees had present/past malnutrition;National Nutrition Conference for Defense: firstRDA, War Order Number One: enrich wheatflour with vitamins and iron

1949 Framingham

1968 Hunger USA

1969 White House Conference on Food, Nutrition,and Health

70s “McGovern committee”, Preschool survey, 10State Nutrition Survey, Food Stamp legislation,Child Nutrition Act – WIC, EFNEP,NET,nutrition labeling

1979 Surgeon General’s Report: Healthy People

1980 First Dietary Guidelines for Americans

1988 Surgeon General’s Report on Nutrition andHealth

1990 National Nutrition Monitoring and RelatedResearch Act

1997 First DRIs