Community Nutrition Week 1 Community nutrition is the branch of nutrition that addresses the entire range of food and nutrition issues related to individuals, families and special needs groups living in a defined geographical area. Community nutrition is a discipline that strives to prevent disease and to improve the health, nutrition and well-being of individuals and groups within communities. Founded on the Sciences of Epidemiology- branch of medicine which deals with the incidence, distribution and possible control of diseases and other factors relating to health. Food Nutrition Human Behaviour Community- a grouping of people who reside in a specific locality and who interact or connect through a definite social structure to fulfil a wide range of daily needs. It has four components: People, Location, Social Interaction and Shared Values. Communities are segmented around: particular disease, wellness and risk factors. People Individuals who benefit from the community nutrition programs and services. A community nutritionist identifies a group of people with an unmet need, gathers information about the socioeconomic background, geographic location, religion, ethnicity, cultural food patterns and then develops a program tailored to the needs of them. Policy This is a course of action chosen by public authorities to address a given problem. Policy is what governments and organizations intend to accomplish through their laws, regulations and programs. Programs These are instruments that are used by community nutritionists to seek behaviour changes that improve nutritional status and health. The tend to vary. They may target small groups or larger groups. Role of Community Nutritionist Identifies a group of people with an unmet need Gathers information Develops programs tailored to the needs of the group Works along with other practitioners to help consumers achieve and maintain behaviour change Public Health Can be defined as an effort organized by society to protect, promote and restore people’s health through the application of science, practical skills and collective actions. Assure conditions in which people can be healthy Public Health Nutrition is community-based program conducted by a government agency whereas community nutrition encompasses any nutrition program whose target is the community. Concept of Health Health is a state characterized by anatomic integrity; ability to perform personally valued family , work and community roles; ability to deal with physical, biological and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death. Factors influencing health: biological, lifestyle, living, working and social conditions, community conditions. Health promotion focuses on changing human behaviour by encouraging people to eat healthful diets, be active, get regular rest, strengthen social networks and achieve a balance among family, work and play. Intervention is a health promotion activity aimed at changing the behaviour of a target audience. Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. Health-related quality of life encompasses those aspects of overall quality of life that can be clearly shown to affect health- either physical or mental. CDC defines HRQOL as an individual’s or group’s perceived physical and mental health over time. On the individual level, HRQOL includes physical and mental health perceptions and their correlates including health risks and conditions, functional status, social support and socioeconomic status. On the community level, HRQOL includes community-levl resources, conditions, policies, and practices that influence a population’s health perceptions and functional status. Types of Prevention Efforts Well Population At Risk Established Disease Controlled Chronic Disease Primary Prevention Secondary Prevention/ Early Disease Management and Tertiary Detection Prevention Promote healthy Screening Treatment and acute Continuing care behaviours and Periodic health examinations care Maintenance environments across Early intervention Complications mgmt. Rehabilitation the lifespan Control risk factors Self mgmt Self- mgmt Health Promotion Health Promotion Health Promotion Create supportive environments Health Promotion Primary prevention Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include: legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases. Secondary prevention Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent longterm problems. Examples include: regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes suitably modified work so injured or ill workers can return safely to their jobs. Tertiary prevention Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible. Action Model to Achieve Healthy People 2020 Overarching Goals The Action Model to Achieve Healthy People 2020 Goal shows a feedback loop of intervention, assessment and dissemination that would enable achievement of Healthy People 2020 overarching goals. It is adapted from an Institute of Medicine (IOM) model that illustrates the determinants and ecological nature of health across the life course.1 Interventions, such as policies, programs and information, affect the determinants of health at multiple levels (e.g., individual; social, family and community; living and working conditions; and broad social, economic, cultural, health and environmental conditions) to improve outcomes. Results of such interventions are demonstrated through assessment, monitoring and evaluation. Through dissemination of evidence-based and best practices, these findings feedback to intervention planning to enable the identification of effective prevention strategies in the future. The built environment includes all of the physical parts of where we live and work. It influences a person’s level of PA. For example: inaccessible sidewalk and bicycle paths contribute to sedentary habits. These lead to poor health outcomes such as obesity, CVD, diabetes and some type of cancer. Discuss the build environment and its impact on walking for transport. Week 2 Assessing Community Resources A community needs assessment is the process of evaluating the health and nutritional status of the community, determining what the community’s health and nutritional status are, and identifying places where those needs are not met. Health status is the condition of a population’s or individual’s health, including estimates of quality of life and physical and psychosocial functioning. Nutritional status is the condition of a population’s or individual’s health as influenced by intake and utilization of nutrients and non-nutrients. Quality of life (CDC) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. The dimensions of QoL include: Material living conditions Productive or main activity Health Education Leisure and social interactions Governance and basic rights Natural and living environment Overall experience of life Health-related Quality of Life Encompasses those aspects of overall quality of life that can be clearly shown to affect health- either physical or mental. Valid indicators of unmet needs and intervention. More powerful predictor of mortality and morbidity than many objective measures of health. Steps in Conducting a Community Needs Assessment 1. Define the nutritional problem The community nutritionist develops a concise statement of the problem of concern. The problem statement should indicate who is affected by the problem, how many people experience the problem and the impact of the problem on the general health or nutritional status. 2. Set the parameters of the assessment The parameters set the direction for the assessment. Specify the scope of the community. The purpose of the NA should be determined. The target population should also be defined. Overall goals and objectives of the population? Specify the types of data needed. 3. Collect data Qualitative & Quantitative data. Community characteristics (demographic data and trends, community health, existing programs). Environmental characteristics and socioeconomic characteristics (income of families, number of families receiving public assistance etc). 4. Analyze and Interpret Collect data, merge with community and background data and form a report. It involves an analysis and examination of the data collected about the population or nutritional problem. Community diagnosis involves: Interpreting state of health of target population Interpreting pattern of health care services and programs designed to reach the target population Interpreting relationship between the target populations health status and that of the community. Summarizing the evidence linking target population’s nutritional problems to their environment 5. Share the findings The info obtained is useful to agencies and organizations that were not directly involved in it. The data must be shared with other groups and shareholders. It is cost-effective and prevents duplication efforts. It promotes cooperation among organizations and agencies. Enlarges the sphere of awareness about the problem. 6. Set Priorities There are several needs and nutritional problems, but which ones require immediate attention. The community nutritionist must decide which ones to address. This is done by determining which health outcome is most important. This is the effect of an intervention on the health and well-being of an individual or population. Possible criteria for prioritization of public health problems: Magnitude of problem Potential effectiveness of the interventions Potential availability of resources Organizational priorities and comparative advantage 7. Choose a plan of action Share key findings. Use key findings to change public policy Organize a workshop or conference to obtain more input form the community and target population about the nutritional problem. Alter an existing program to address the problem more effectively Develop a new program to address the problem Focus groups •What is a focus group? •How are focus groups different from regular "groups"? •Why are focus groups used? •When should you use a focus group? •How do you run a focus group? Lecture 3- Assessing the Target Population’s Nutritional Status When assessing the nutritional status you must first come up with a plan. This helps to direct you and helps you figure out what questions to ask. 1. Review the purpose, goals and objectives of the NA 2. Develop a set of questions related to the target populations nutritional problem, how it developed and factors which influence it. 3. Choose a method for obtaining answers to the questions. Types of Data to Collect About the Target Population Individual Lifestyle Factors- relates to the target population’s lifestyle and diet (how does it interact with the problem). The community nutritionist asks questions such as “What effect does this particular lifestyle choice have on the target population?” “How can this behaviour be changed?” Understanding Food Choices- nutritional status is directly influenced by nutrient intake and utilization and indirectly by food supply and other factors. Factors Impacting Nutrient Utilization- activity level, smoking status, dietary supplement use, drug-nutrient interaction and physiological status affect nutrient utilization. Food Supply & Food Availability Income and Food Prices Sociocultural Factors Food Preferences, Cognitions and Attitudes The Social Ecological Framework Emphasizes the connection between people and their environment. It includes factors such as: Individual Factors- sociodemographic factors which influenc an individual’s food intake. In order to change one’s knowledge, attitudes beliefs and behaviours these factors should be addressed. Environmental settings- people make decisions about food and physical activity according to their environment. Sectors of influence- communities are influenced by government and its program, policies, public health, and health care systems. Focuses on the sectors whih determine accessibility to healthy food and opportunities to be healthy. Social and cultural norms and values
