Nutrition and Public Health Dr Julie Frier Consultant Public Health Plymouth City Council

Nutrition and Public Health Food related problems and food safety issues that affect the health of the population Inequalities Variations in opportunity for health through nutrition Food supply Food security: Sustainability, quality, safety, climate Food Poverty: deprivation, affordability, availability and accessibility Consumption Health problems related to the excessive intake of quantity of the habitual diet- energy dense, high fat, high sugar, high salt, Health problems related to the inadequate quantity and quality of the habitual diet- low fibre, micronutrients

Health Consequences Morbidity Premature death Dental decay 70,000 lives saved each year if population diet matched nutritional guidelines on fruit and vegetables, saturated fat, added sugar and salt intake. (Food Matters 2008) Morbidity Dental decay Excess weight / Obesity Type II diabetes Cardiovascular disease Cancer Iron deficient anaemia Poor bone health Mental health and wellbeing Food poisoning / infection

Nutrition and Public Health The purpose of public health in Plymouth is to “improve and protect Plymouth’s health and wellbeing, and improve the health of the poorest fastest.” Key contribution will be access to good nutrition for all

Position in Plymouth

Health inequalities in Plymouth

Poverty & food poverty 10 million people and 3 million children live in poverty 11,700 children living in poverty in Plymouth Food Poverty can be defined as the inability to access healthy affordable food whether due to lack of income, transport issues or lack of knowledge or skills around how to cook food. In UK the poorer people are, the worst their diet Plymouth Foodbank reporting a 40% increase in those receiving food (over 4,000 people)

Poverty and deprivation in Plymouth Child poverty distribution in Plymouth Source: Her Majesty’s Revenues and Customs, 2009

Dental decay

Excess weight / obesity Adults: Male adult obesity 22% Female adult obesity 24% Estimated that obesity rates will double by 2050. (Plymouth interim report 2012) Children: 4-5 years: 9.4% obese 10-11 years: 19.6% obese Trend for 10-11 years is upwards Marked inequalities

Excess weight trends for children aged 4-5 years in Plymouth

Excess weight trends for children aged 10-11 years in Plymouth

Population diet deficiencies Measure   Recommended Actual Fruit / Vegetables 5 a day 31% adults at 4.1 portions 11% boys at 3.0 portions 8% girls at 2.8 portions Saturated fat No more than 11% of food energy 12.7 % of food energy Non Milk Extrinsic Sugars Above in all age groups and for 11-18 years was 15.3% Non-starch polysaccharides 18g a day Population mean below this (13.3-13.8g) Vitamins Reference Nutrient Intake Close to or above (not Vitamin D) (about 1 in 5 had 25-OHD concentration below lower threshold for Vitamin D adequacy Vitamin A / riboflavin 11-18 years 13% below for Vitamin A 21% girls below for Riboflavin Iron 5.6% of girls aged 11-18 years and 3.3% women aged 19-64 years had evidence of iron deficient anaemia National Diet and Nutrition Survey

What influences these problems

Food related problems that affect the health: influences Socio-economic, cultural and environmental factors that influence our living conditions: the food chain, accessibility to shops and outlets, housing situation- facilities to cook and eat, poverty, education approach and level Social and community networks: food culture, social norms, informal learning: cooking & food skills Individual lifestyle factors: knowledge and skills for cooking, individual taste and preference Variation in these =Inequalities in opportunity for health through good nutrition

Solutions- multifaceted and everybody's business Public health approach to the food system Aim: Affordable and nutritious food for all Combat inequality in access to health through food Increase food security Reduce food poverty Ensure equity of access and availability for all especially the most vulnerable Identify and remove barriers to healthy food Strengthen food culture for health Increased available information food, diet and health Foster knowledge and skills of food and nutrition -Cooking skills, growing skills and social value of food Focus on maternal and childhood nutritional health Promote healthy choices to combat chronic disease and obesity

Any questions…