Community nutrition

Lecture 1 – video

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What does community nutrition mean to me?

Community

- Sharing an environment – place, intent, beliefs, resources, needs, preferences, risks, skills

Community nutrition vs. public health

- Often considered the same- PH nutrition = community-based programs conducted by govt.- CN = encompasses any program whose target is the community whether it is federally funded or

sponsored by a private group o Nutritionists are largely employed in the public sector for non-profit and profit

- Differences are subtle

Goals of CN

- Improve the nutrition, health, and QOL of people in community- Who benefits?

o People in the communityo Policy – course of action set by public authorities to address a problem

Accomplish through laws, regulations, and programs o Programs – a way to meet nutritional and health needs of a group

Approach

- Assessment- Policy- Programs

Assessment – epidemiology

- Assess and monitor the health of communitieso Collect, analyze, and spread info about health of communities o Surveys, statistics, and observation

- identifying health problem and evaluate the services in the area- Research

o Study, interpret, and apply findings to nutrition problems- Look at a few factors

o Individual lifestyle factors

o Living, working, and social conditionso Community conditions

Community, environmental, and socioeconomical conditionso Background conditions

National policies and cultural characteristics

Policy

- Work w/ communities to inform, educate, and empower- Support community health efforts- Examples include food labeling, school food, FARM bill

Programs

- Based upon assessment and policy- Develop programs to meet needs of communities

o Disease control and preventiono Manage nutrition careo Ways to increase food access

What is health?

- WHO = “the state of complete physical, mental, and social well-being, not merely the absence of disease”

Factors that determine health (assessment)

- Maslov’s hierarchy of needs: Basic needs of food, clothing, and shelter- Access to services- Empowerment- Socio-economic status- Community and social support- Environment

Social determinats of health (assessment)

- Environmental factorso Accesso Education and access to infoo Xportationo Housingo Build environmental-safetyo Food system

o Air and water quality

Relationship of food to health (ASSESSMENT)

- Food supply affected by certain thingso Environment, agriculture, economy, policy food production food supply

- Food intakeo Availabilityo Income/priceo Sociocultureo Demographicso Educationo Environmentknowledge and attitudefood preference and intake

- Nutrient useo Community lifeo Age, sex, raceo Geneticso Activityo Medicationso Infection/DZnutritional statusnutrient intake

Leading causes of disease

- 4 out of top 10 causes have a nutrition component: heart disease, stroke, diabetes, cancer

HEALTHY PEOPLE 2020 (Policy)

- MAJOR GOALSo High-quality, longer lives free of preventable disease, disability, injury, and premature

deatho Achieve equity, eliminate disparities across economic groupso Create environments that promote good health for all and quality of life and healthy

behaviors across all life stageso REVIEW WEBSITE

Healthy people 2020 TOPICS, things that are relevant to us

o Nutrition and weight status 22 objectives

Improve school food, access to food, eliminate low food insecurity, decrease anemia, lower saturated fat intake

o Physical activity o Access to healthcare

PROGRAMS

- Putting objectives into practice

Community nutrition issues

- Federal nutrition guidelines- Food safety- Monitoring nutrition (NHANES)- Hunger/food insecurity- Childhood obesity

Some policies that address nutritional health…

- Dietary guidelines (Nestle’s Food Politics)- FARM Bill

o Food stamps, FMNP, Organic Food Standard- Child Nutrition Act

o School food standards, WIC, CACFP (Child and Adult Care Food Program like HeadStart)- Food safety

o Food Safety Modernization Act- Older Americans Act

o Health promotion and in-home services for older people - Ryan White Act

o Largest federally funded program for those with HIV/AIDs and their families- Center for Science in the Public Interest (CSPI)

o Updates on policies

ROLE…

- Aware of social and economic trends are always changing - Ethnically diverse population - More women in workforce- Educational level of workface increasing- Population continues to age- Smaller world, internet- All of the objectives of HP 2020

Opportunities in community nutrition

- Federal programso WIC, Head Start, Team Nutrition, Let’s Move

- State programs (NY)o HPNAP

o Eat well Play Hard- City based programs

o NYCDOMH- Private

o City Harvesto Worksite Wellnesso Food pantries and soup kitchens

How do we affect change?

- Policy- ‘tipping point’- Design programs that motivate communities to change

LECTURE 2 – 9/12

Epidemiology and Assessment

What is assessment?

“Systematic collection, assembly, analysis, and dissemination of info about the health of a community”

Monitoring must be ongoing. Have new policies and programs that were created to address problem been successful?

Epidemiology evaluates distribution of disease and factors that determine it. Surveillance monitors changes and trends.

Monitoring –

- Surveys generate statistics that form monitoring- Statistics provide info on where we stand as individuals and communities- Observation provides realistic assessment- Indicate trends and challenges- Determine where communities have deficiencies or excesses or food and nutrients

Federal monitoring – NHANES

- Study of nutrition and its relationship to health- Measures nutritional status of population and changes- Became continual survey in 1999- 2000 – NHANES (DHHS) and CFSII (USDA) merged and became NFNS

CSFII – Continuing Survey of Food intake

Monitoring by USDA

- Agricultural Research Service (ARS) – conducts research on health, QOL, prevention of disease and promotion of nutritious food

o North Dakota, Houston, Maryland, Boston, Cali, Arkansas- NAL – Nutrient Data Lab- ERS – Economic Research Service

BFRSS – States Survey

- Ongoing telephone interviews to track health conditions and risk behaviors by state

Epidemiology

- Study of occurrence, determinants, and distribution of health and disease among a defined group of people

- Assumes…o Disease does not occur randomlyo Disease has identifiable causes that can be altered to prevent diseases

- Steers public health policy making

Epidemiology in community health

- Epi and demographic measures are used to study health conditionso Outbreaks of food poisoningo Conditions common to people suffering from chronic diseaseso Diseases related to nutrient deficiencieso Diseases caused by environmental conditions

Descriptive measures in epi

- Distributiono People affectedo Place and time of occurrence

- Determinantso Host factors – age, nutrition status, physiological study which determine individuals risk

factorso Environment – living conditions, job, location and other things that influence exposure

to agent

Basic concepts: RISK

- Likelihood of an event occurringo Probability that those without a disease who are exposed to risk factors will acquire the

disease at some point

- Relative risk – comparison of the risk of some health related even in two groupso Gender, age, exposure

Basic concepts: RATE

- Basic measurement of disease occurrence and identification of high risk groupso Relates cases or events to a population baseo Morbidity rate - # of people living with a diseaseo Mortality rate - # of people dyingo Birth date, disease rate, obesity rate, all kinds of rates

Basic concepts: INCIDENCE RATE

- The number of new cases over a given period of time

Basic concepts: PREVALENCE RATE

- The number of people with a current disease at any given time

Basic concepts: DEMOGRAPHICS

- Measures a population by recording births, deaths, age, and other vitals- Demos that affect health:

o Age, gender, SES, ethnic, education

Epidemiological methods

- Observation- Counting cases- Relating cases to population at risk- Making comparisons- Hypothesis

Epidemiological process

- Define problemidentify causeinterpret results

Epi studies

- Seek to explain distrubition of health and illness with human populations- Knowledge of causes of diseases come from epi studies that compare population groups or

individuals- By relating differences in circumstances and behavior to difference in the incidence of disease,

associations that may be causal are identified

Limitations of epi

- Observed associations may be due to chance- May be due to faulty study design- Might be biological that we may not know about

Nutritional epi

- Study of nutritional determinants of DZ in humans- Explores what people eat and for how long- HISTORY

o Hippocrates – observed relationship b/t food and choiceso James Lind – scurvy could be treated and prevented with limes, lemons, orangeso Joseph Goldberger – pellagra could be prevented by increasing the amount of animal

products in dietso Long-term ongoing studies

- LIMITATIONSo Multiple causes of diseaseo Long latent periodso Not easily reversibleo Complex nature of dieto Lack of practical methods to measure dieto Difficult to get accurate info

Types of studies

- Descriptiveo Ecological

examines rate of dz based on exposure/relationshipo Cross sectionalo Case controlo Cohort

- Interventiono Randomized control study

Assessment methods

- Food surveys- 24-hour recall- Food record/food diary- FFQ

Diabetes epidemic: a case study

- Tpe 2 – accounts for 90-95% of all cases- Total prevalence of DM in US, 2005

o Total: 20.8 million—7% of population- Total prevalence of DM in US, 2010

o Total: 25.8—8.3% of population

Community Food Assessment

“Comprehensive picture of the way a community grows, processes, distributes, and consumes its food. Mapping and assessing the food-related assets allows community members to mobilize their unique capacities to revitalize their food system”

Example: East Harem

- Foods stores- Farmer’s markets- CSA

Why conduct a CFA?

- Emphasis is placed on objective data-based

Who conducts?

- People who work and live in community- Diverse group of professions and others in the community with interest in CFS

o Reps from CBO’so Health, education, and nutrition providerso Food retailers and manufacturerso Community memberso Community farmerso Local officials

What info do you need?

- Geographic boundaries - Understand problem of food security - Federal food assistance programs- Amount of access to food- Policies available

Basic components of CFA

- Profile of community- Profile of food resources- Assessment of food security- Assessment of accessibility

- Assessment of availability- Assessment of community food production - History/culture of local food system and eco trends - Food consumption habits- Prevalence, adequacy of funding- Prevalence of diet related health concerns- Nutrition education in schools- Size of emergency food programs

What does neighborhood need for healthy eating?

- Access, quality, variety, prices, transportation, education

9/19 – LECTURE 3 – NUTRITION AND PUBLIC POLICY

Policy – guidelines to address the problem

Public policy—course of action chosen by public authorities to guide decisions and actions

- What govts intent to do thru laws, regulations, and programs

Policy-making

- Process by which you make a bill

National Nutrition Policy

YES NOHP2020 There is no federal nutrition officeNational guidelines exist

- Hunger, malnutritionFragmented between

- DHHS (FDA, CDC, NCHS, NIH)- USDA (ARS, HNIS)

Conflict b/t USDA goals between agribusiness and promotion of good nutrition (FARM)

Who makes nutrition policy?

- Reps, lobbyists, experts

“Nutrition policy”

Policies that are concerned with physical and economic access to food….

Bills

- All bills regarding revenue must be drafted in the HoR

- In NYCo No two houses, just a City Councilmayorsigns, law

Policy development and assessment

1990 – Organic Food Production Act

2002 – adopted

Under the farm bill

A little history…

1919—Scientist created synthetic nitrogen (ammonium nitrate) to create bombs, but it is useful for fertilizerAfter WWII—there was a surplus of synthetic nitrogen and pesticides (Monsanto)Today—4 lbs of pesticide per person per year, export 500 million pounds

Organics: from idea to policy

“Agenda setting, problem”

Rodale—1940sRachel Carson—“Silent Spring”, end of 1962, 40 bills regulating pesticide useEPA founded in 1970

“Alternative solutions”

- 1970s organic—an attempt to define alternative to industrial style of agriculture- Struggle to ID organic standards- 3rd party agencies

o Minnesota Organic Growers and Buyers Associationo Organic cert

Why a policy

- More demand of organic food so agribusiness could no longer ignore - Sen Patrick Leahy (VT) chair of Senate Ag Committee

“Policy Adoption”

- 1990 Organic Foods Production Acto Establish national standardso Assure consumers that organically produced foods meet these standardso Facilitate interstate commerce

- Dec 1997—draft of new standards released for public comment o Allowed for use of sewage sludge, irradiation and GMO

o In 6 months, 275k respondedo 1998, omit sludge, etc.

“Policy implementation”

- Dec 21 2000—publication of final rules, 554 pages- Into affect, April 21, 2001- October 2002—label first seen on shelves

“Policy implementation: problems”

- Can an organic Twinkie be certified? - Small farmers are not using standard - Cost of produce vs. processed food

Can policy change behavior?

- Policy that might change behavioro Nutrition labelingo Decrease marketing of junk food to childreno Improved school foodo Promote food and vegetableso NLEA of 1990

NYS Nutrition Policy – New York State

- 6/10 leading causes of death linked to poor dieto Programs

WIC Farmer’s market nutrition program Child and Adult Care Food Program (CACFP) Commodity Supplemental Food Program Creating Healthy Places to Live, Work, and Play Eat Well Play Hard (EWPH) Hunger Prevention and Nutrition Assistance Program (HPNAP) Just Say Yes to Fruits and Vegetables (JSY) Growing Up Healthy Hotline

NYCDOHMH – New York City Department of Health and Mental Health

Federal Programs

- Food safetyo Food Safety Modernization Act

- Food content

o Labelingo Organic

- Childhood nutrition o Childhood Obesity Act

History of Food safety

1906—Pure Food and Drugs Act1927—FDA created1938—Food Drug and Cosmetic Act

Amendments to 1938 FDCA

Child Nutrition Act

1946—National School Lunch Act1966—Becomes Child Nutrition Act1968—CACFP and Summer Food Program started1972—WIC began1980s—FMNP started as pilot in 10 states1996—School food must follow DG2002—FFVP began as pilot under FARM Bill 2004—School Wellness Policy began

Hunger-Free Act of 2012

- National School Lunch Program- School Breakfast Program- Summer Food Service Program- Child and Adult Care Food Program- Special Supplemental Nutrition Program for Women and Children

FARM Bill—first started to help poor farmers and people

FARM Bill Nutrition Program

- SNAP- SNAP-ED

NYC PROGRAMS

- Stellar Farmer’s Markets- Trans Fat- Green Carts

NYS PROGRAMS

- Eat Well Play Hard- HPNAP (Hunger Prevention Nutrition Assistance Program)

FEDERAL PROGRAMS

- SNAP- NSLB- NSBP- CACFP (Child and Adult Care Food Program)