Community Nutrition
HNU 365
Dr. Laurie Wadsworth
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
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
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
Course Evaluation
Assignment
Value
Lab Assignment #1
5%
Lab Assignment # 2
5%
Mid-term Exam
20%
Final Project Report
10%
Project Tool
15%
Community Project Fair
10%
Final Exam
35%
Educational Tool
Public Health Educators’
Participation in Teams
Participated in average of 4
teams
3 of these were interorganizational
40% respondents participated
in 5 or more
Curricula should reflect
collaborative work
Lovelace, et al., 2009, Health Promot Pract 10
(3), 428-435
“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
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
Review for Lecture
Stepping it up: Moving the
Focus from Health Care in
Canada to a Healthier
Canada
Health Council of Canada
http://www.healthcouncilcana
da.ca
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)
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)
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)
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)
Shared themes…
Shared geographical location
Shared needs
Shared interest
Sense of belonging
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).
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
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
Organizations involved
in community
nutrition…
Voluntary
Agencies
Food Aid
Social
Programs
Services
Self-help
Day
Public
Groups
Care,
Health Fitness
Schools
Centres
Agency
Agricultu
Work
ral
Site
Extension
Food
Health
Industry
Care
Providers
(Obert, 1986 in Davis,
1989)
Key Actions for
Successful Nutrition
Programming
Program Design
-goals, population
-planning
Service Delivery
-Assess needs, tailor services
-Sustainability
Program monitoring
& Evaluation
-Collect data
-Conduct evaluations
Indicators of Change
Social & economic trends
↑ ethnic diversity
↑ Women in global workforce
↑ older adults
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
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
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
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
Demographic Transition
Theory
Population Pyramids
Developed & Developing
Nations
by age and sex
1960
2000
2040
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
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
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
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
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
TC Douglas
Monique Bégin
Canada Health Act
(1984)
Five Principles for continued
federal funding
Public Administration
Comprehensiveness
Universality
Portability
Accessibility
Future of Health Care
in Canada
 Canadians favour system
 Publicly funded
 Comprehensive
 Pessimistic about sustainability
 Increasing privatization
 Calls for substantial reforms
 Consensus remains elusive
Health Care Costs in
Canada (1994)
40%
35%
Hospital
MDs
30%
Rx Drugs
Public Hlth
25%
20%
15%
10%
5%
0%
Home Care
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
Commission on the Future
of Health Care in Canada:
Roy Romanow
Macleans, 2003
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
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
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
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
NS DHAs
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
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/He
althyEatingNovaS
cotia2005.pdf
Total Diet Approach
 Evidence supports behaviouroriented 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
Eating Well with
Canada’s Food Guide
Eating Well with Canada's
Food Guide
First Nations, Inuit & Métis
USDA Food Guide
Pyramid
USDA Food Guide
Pyramid
Mexico
Sweden
UK
China