Public Health Nutrition March 28, 2006 Nutrition 531

What is Health?

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

Prerequisites for Health - WHO Freedom from the fear of war Equal opportunity for all peoples Satisfaction of basic needs food clean water and sanitation decent housing education Right to find meaningful work and perform a useful role in society

Determinants of Health

What is Public Health?

Public Health... ”P ublic health…is the combination of sciences, skills and beliefs that is directed to the maintenance and improvement of the health of all people through collective or social actions... Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population.” Source: Last M. A Dictionary of Epidemiology. Oxford; 1988.

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

Core Functions of Public Health

Assessment Assess the problems and needs of the population Monitor the health of populations and related systems of care.

Policy Development Develop policies, programs and activities that address the highest priority problems and needs

Assurance Assure the implementation of effective strategies by providing or monitoring activities and services.

The Future of the Public’s Health in the 21 st 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

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

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

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.

“Unhealthy diet and lack of physical activity account for at least 300,000 deaths each year and increase a person’s risk for many chronic diseases.” CDC. Actual Causes of Death

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 National Vital Statistics System and unpublished data

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 National Vital Statistics System and unpublished data

Source: Centers for Disease Control and Prevention. Health-related quality of life: prevalence data. National Center for Chronic Disease Prevention and Health Promotion, Accessed March 21 at.

Multiple focal points & levels (individual, population-based, organizational, and societal) Includes both policies and programs Addresses factors close at hand as well as remote influences What defines a “public health” approach?

Ecological Approaches to Public Health Nutrition

Societal policies and processes influencing the population prevalence of obesity

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 Practice Compared to Clinical Nutrition Practice Public Health Practice Clinical Nutrition Practice FocusPreventionDisease treatment TargetPopulationsIndividuals SettingStates & Communities Clinics & Hospitals StrategiesMultiple, Reinforcing Counseling and education

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

Goals for 531

Students will demonstrate the ability to gather appropriate information about community and population based nutrition programs and resources. Existing Public Health Nutrition Efforts on Local, State, and National Level - Public policy development -Legislative advocacy -Food, nutrition, and food safety laws/regulations and policies -Application of management principles to public health nutrition programs and services -Nutrition programs in the community ADA Competencies

Students will demonstrate the ability to conduct the full process of community based program planning and evaluation including assessment; setting priorities, goals, and objectives; program implementation and monitoring; and evaluation. Public Health Nutrition Program Planning & Implementation - Cultural competency for nutrition program development -Issues of access to food and food security -Application of management principles to public health nutrition programs and services -Application of social marketing principles to health and nutrition programs ADA Competencies

Brief History of Public Health Nutrition

Achievements in Public Health, : 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 , 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.”