Community Nutrition

1. Community Nutrition HNU 365 Dr. Laurie Wadsworth

2. Text Book • Community Nutrition: An entrepreneurial approach, 5th Edition. Boyle & Holben, 2010 • Web site with chapter summaries, quizzes and Power Point slides • Chapters with case studies, summary points, glossary, programs in action

3. Entrepreneurship in Health Promotion • Opportunities expected to expand in future • Skills used with marketing, management, & other business skills • Design, implementation, evaluation of programs Eddy, & Stellefson, 2009, Health Promot Pract, 10 (3), 333-341

4. Rules of Engagement • Responsibility for own learning & contribution • Openness – open to new ideas & opinions • Participation – at own comfort level • Experimentation – experiment with thinking & sharing • Sensitivity – listen for intent

5. Course Evaluation

6. Educational Tool

7. Public Health Educators’ Participation in Teams • Participated in average of 4 teams • 3 of these were inter-organizational • 40% respondents participated in 5 or more • Curricula should reflect collaborative work Lovelace, et al., 2009, Health Promot Pract 10 (3), 428-435

8. “Apart from hermits, people live and work in groups . . So if you have it in mind to influence the way in which life goes on, you will not do it solely by trying to influence people-as-individuals, you will have also to think of people-in-groups.” J. Yukdin & JC McKenzie Changing Food Habits

9. Weeks 1 & 2 • Introduction and course overview • The ‘who’, ‘what’ and ’how’ of community nutrition • Weeks 3 & 4 • Public Health, Health Promotion, and Population Health

10. Review for Lecture • Stepping it up: Moving the Focus from Health Care in Canada to a Healthier Canada • Health Council of Canada • http://www.healthcouncilcanada.ca

11. Social Science Key to Restoring Health • “The puzzles of better health promotion and disease prevention may be approached more rapidly and effectively through intensified social science research, rather than by awaiting the expected evolution of gene-based explanations and interventions based on future genetic discoveries.” • Floyd Bloom, President Am. Assoc. for the Advancement of Science (2003)

12. Community is… • “a group of people who share a common culture, identify themselves as a group, and usually live within a defined geographical area” (WHO, 1985) • “a body of people living near one or another and in social relationship; a body of people with a faith, profession or way of life in common; common ownership; a sharing” (Webster’s Encyclopedic Dictionary, 1988)

13. Community is… • “a group of inhabitants living in a somewhat localized area under the same general regulation and having common norms, values and organization” (Green and Ottoson, 1994) • “a group of people residing in specific geographical area who have common values, cultural patterns and social problems, together with an awareness of belonging to a group that causes them to interact more intensely with one another than they would with outsiders in a similar context” (Agudelo, 1983 in Jewkes, 1996)

14. Community is… • “is whatever one wishes it to be; but it is always (1) more than one person, (2) sharing, (3) commonalities” (Community Building Resources, Roberts, 1997) • “when a group has the power to decide what is a problem, the power to decide how to solve the problem, and the power to become an active part of implementing the solution (McKnight and de Toqueville in Roberts, 1997)

15. Shared themes… • Shared geographical location • Shared needs • Shared interest • Sense of belonging

16. Health is… • The absence of disease or illness • A state of complete physical, mental and social well-being and not merely the absence of disease and infirmity (WHO, 1974) • The ability to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment; a resource for everyday life, not the objective of living; a positive concept emphasizing social and personal resources, as well as physical capacities.” (WHO, 1986).

17. Community Nutrition… • Emerged as an important component of health and social programs in the early 1940s.” (WHO, 1986). • Aims to prevent problems related both to food insufficiencies and excesses, and to promote well-being through a secure and safe food supply and healthful eating habits

18. Community Nutrition • Focus includes people, policies & programs • Policy • action chosen by decision makers to address specific problem • Through laws, regulations, programs • Programs • Instruments used to seek behaviour changes that improve nutritional well being

19. Organizations involved in community nutrition… Support from Federal and Provincial Governments and the Private Sector Voluntary Agencies Food Aid Programs Social Services Self-help Groups Public Health Agency Day Care, Schools Fitness Centres Agricultural Extension Work Site Food Industry Health Care Providers (Obert, 1986 in Davis, 1989)

20. Key Actions for Successful Nutrition Programming

21. Indicators of Change • Social & economic trends • ↑ ethnic diversity • ↑ Women in global workforce • ↑ older adults

22. Future Trends • Change, innovation, creativity, entrepreneurship • Global social change •  smaller world • Internet links people around the world • ↑ connectedness of human beings •  challenges for community nutritionists

23. Nutrition Trends:Baby-Boom Generation • 82% report being very knowledgeable about food and nutrition • 75% report good to excellent eating habits & health status • Average 2 snacks per day • 82% use vitamin & other supplements Tracking Nutrition Trends 2008, Canadian Council of Food and Nutrition

24. Nutrition Trends:Baby-Boom Generation • Meal most often eaten away from home • Lunch (12%); breakfast (9%); dinner (7%) • 71% get dietary info from dietitians • Labels (71%); Internet (52%); print materials (47%); health professionals (43%) • Nutritional content leads food choice • Whole grains (86%); protein (80%); calories (79%); total fat (78%) Tracking Nutrition Trends 2008, Canadian Council of Food and Nutrition

25. Life Expectancy • “Some Canadians live their lives in excellent health with one of the highest life expectancies in the world . . . Others spend their life in poor health, with a life expectance similar to some third world countries. We cannot correct this inequity through the health care delivery system itself, regardless of the expenditure we devote to it.” • A Healthy, Productive Canada: A determinant of health approach, Senate of Canada, 2009

26. Demographic Transition Theory

27. Population PyramidsDeveloped & Developing Nationsby age and sex 1960 2000 2040

28. Evidence-based Public Health Approaches • Essential to changing public health outcomes • Requires skills to review evidence & to choose most workable strategy for problem defined Baker, et al., 2009, Health Promot Pract, 10, 342-348

29. Evidence-based Public Health Approaches • Skills needed • Community assessment • Quantifying issue • Develop problem statement • Determine what is known from literature • Prioritizing program & policy issues • Develop & implement action plan • Evaluate program or policy Baker, et al., 2009, Health Promot Pract, 10, 342-348

30. Strengthening Public Health Nutrition Practice in Canada • Public health nutrition requires the leadership of dietitians with expertise in nutrition, food systems & related public health sciences. • Public health nutrition practice encompasses the assessment, promotion, protection & enhancement of health & the prevention of nutrition related disease. • Using population health & health promotion approaches, strategies focus on the interactions among the determinants of heath, food security, & nutritional & overall health. Pan Canadian Task Force on Public Health Nutrition Practice, 2009

31. Strengthening Public Health Nutrition Practice in Canada • All dietetic students and/or interns are exposed to public health philosophies and/or environment in their preparatory education and/or practical training based on the updated dietetic competencies. • Dietetic competencies are updates to provide a foundation for desired public health practice Pan Canadian Task Force on Public Health Nutrition Practice, 2009

32. Core Competencies for Public Health • Visit • www.corecompetencies.ca • Learn about development of competencies in Canada • Find links to projects, tools and resources to support public health practice • Build your portfolio by listing competencies you have used • Test your knowledge of core competencies

33. TC Douglas

34. Monique Bégin

35. Canada Health Act (1984) • Five Principles for continued federal funding • Public Administration • Comprehensiveness • Universality • Portability • Accessibility

36. Future of Health Care in Canada • Canadians favour system • Publicly funded • Comprehensive • Pessimistic about sustainability • Increasing privatization • Calls for substantial reforms • Consensus remains elusive

37. Health Care Costs in Canada (1994)

38. Health Care Costs in Canada (2004) • $130 B on health/year • = over $10,000 per household • Only ~2.1% goes to public health • For every $100 spent on health care in Canada, $2.10 goes into public health • For every 100 people working on the health outcome problems, only 2 work on the public health prevention side

39. Commission on the Future of Health Care in Canada: Roy Romanow Macleans, 2003

40. Wellbeing • Institute of Wellbeing adopted this working definition: • “The presence of the highest possible quality of life in its full breadth of expression, focused on but not necessarily exclusive to: good living standards, robust health, a sustainable environment, vital communities, an educated populace, balanced time use, high levels of civic participation, and access to and participation in dynamic arts, culture & recreation.” Institute of Wellbeing, 2009

41. Canadian Index of Wellbeing • CIW – www.ciw.ca • a new method for measuring Canadian quality of life • Goes beyond economic indicators (i.e., GDP) • Measures 8 interconnected areas of wellbeing • Standard of living -- Education • Health -- Way we use our time • Vitality of communities • state of arts, culture, recreation, environment

42. Bringing it together • “If we want Canadians to be the healthiest people in the world . . . We have to cure ‘hardening of the categories’ which has over the years drastically compartmentalized many of the policy and programmatic tools that must be brought together to move us along the health outcome continuum.” • Roy Romanow, Keynote remarks at inaugural meeting of the Health Council of Canada, 2004

44. Pan-Canadian Health Living Strategy • FPT ministers of health endorsed strategy in 2005 • In 2010 endorsed 2 new initiatives • Creating a healthier Canada: Making prevention a priority • Curbing Childhood Obesity: A federal, provincial, & territorial framework for action to promote healthy weights

45. NS DHAs

46. Health Objectives • To protect & promote health of all people • Challenge is to translate goal into action • Many physical, social, biological, behavioral health determinants • Changing human behaviour • Nations differ in formulation of health objectives & strategies for behaviour change

47. Community Nutrition:Key Documents • Nutrition for Health: an agenda for action • The Nova Scotia agenda for action • Eating Well with Canada’s Food Guide • Healthy Eating Nova Scotia 2005 • http://www.gov.ns.ca/ohp/repPub/HealthyEatingNovaScotia2005.pdf

48. Total Diet Approach • Evidence supports behaviour-oriented food & nutrition programs • That help learners adopt total diet approach • Sustainable • Fits individual preferences • Some concern expressed • May be perceived as permitting unlimited inclusion of low-nt dense products • ADA Position paper – Total Diet approach to communicating food and nutrition information, 2007

49. Eating Well with Canada’s Food Guide

50. Eating Well with Canada's Food GuideFirst Nations, Inuit & Métis