Introduction to Public Health Nutrition

1. Introduction to Public Health Nutrition January 2010 Nutrition 531

2. What is Health?

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

4. What is Public Health?

5. Mission of Public Health “…to fulfill society’s interest in assuring conditions in which people can be healthy.” IOM. Future of Public Health.

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

7. 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

8. Public Health Practice Compared to Clinical Nutrition Practice

9. Core Functions of Public Health

11. Assessment • Assess the problems and needs of the population • Monitor the health of populations • Assess and monitor the determinants of population health

12. Policy Development • Develop policies, programs and activities that address health outcomes and the determinants of those outcomes

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

14. 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

16. What About Nutrition?

17. 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.

18. Leading Causes of Death, 1900 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

19. Leading Causes of Death, 1997 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

21. Ecological Approaches to Public Health Nutrition

22. The Socio-Ecological Model

23. WORK/ INTERNATIONAL NATIONAL/ COMMUNITY LOCALITY INDIVIDUAL POPULATION SCHOOL/ FACTORS REGIONAL HOME Leisure Activity/ Facilities Public Transport Transport Globalization of markets S Energy Expenditure Urbanization Public Safety I Labor T Y O % OBESE OR UNDERWT Health Care Infections Health P R Development Worksite Food & Activity E V Social security Sanitation Food intake : Nutrient density A L Media & Culture E Media programs & advertising System Family & Home N Manufactured/ Imported Food E Education Media School Food & Activity Food & Nutrition Agriculture/ Gardens/ Local markets National perspective Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org Societal policies and processes influencing the population prevalence of obesity

24. Part of the Social Network from the Framingham Heart Study with Information about Body-Mass Index According to Year Christakis N and Fowler J. N Engl J Med 2007;357:370-379

25. How are the functions of Public Health performed?

26. 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

27. 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 healthproblems

28. 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

29. Brief History of Public Health Nutrition

30. 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.”

32. “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.”

34. “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.”