Introduction to Public Health Nutrition January 2011 Nutrition 531 What is Health? Health A state of complete physical, mental, and social well-being, not merely the absence of disease. WHO What is Public Health? Mission of Public Health “…to fulfill society’s interest in assuring conditions in which people can be healthy.” IOM. Future of Public Health. Population Health Improving Everyone’s Quality of Life: Group Health Foundation, 2001 Population Health • Considers a broad set of options for improving and sustaining health • Highlights role of social and economic forces in combination with biological and environmental factors • Results in benefits to all Public Health Practice Compared to Clinical Nutrition Practice Public Health Clinical Nutrition Practice Practice Focus Prevention Disease treatment Target Populations Individuals Setting States & Clinics & Communities Hospitals Strategies Multiple, Counseling and Reinforcing education Core Functions of Public Health Assessment • Assess the problems and needs of the population • Monitor the health of populations • Assess and monitor the determinants of population health Policy Development • Develop policies, programs and activities that address health outcomes and the determinants of those outcomes Assurance • Assure the implementation of effective strategies by providing or monitoring policies, activities, and services. What About Nutrition? Mission of Public Health Nutrition • To assure conditions in which people have access to adequate and appropriate food. • To assure conditions in which people can achieve optimal nutritional health. Leading Causes of Death, 1900 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997. Leading Causes of Death, 1997 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997. 10 Essential Public Health Services: Public Health Functions Steering Committee - State and Local • Monitor Health Status to identify community health problems • Diagnose and investigate health problems • Inform, educate, and empower people about health issues • Mobilize community partnerships to identify and solve health problems • Develop policies and plans that support individual and community health efforts • Enforce laws and regulations that protect health and ensure safety • Link people to needed personal health services and assure the provision of health care when otherwise unavailable • Assure a competent public health and personal heath care workforce • Evaluate effectiveness, accessibility, and quality of personal and population-based public health services • Research for new insights and innovative solutions to health problems Brief History of Public Health Nutrition Achievements in Public Health, 1900- 1999: Safer and Healthier Foods (MMWR ) • “During the early 20th century, contaminated food, milk, and water caused many foodborne infections, including typhoid fever, tuberculosis, botulism, and scarlet fever.” • “Once the sources and characteristics of foodborne diseases were identified--long before vaccines or antibiotics--they could be controlled by handwashing, sanitation, refrigeration, pasteurization, and pesticide application. Healthier animal care, feeding, and processing also improved food supply safety.” • “The discovery of essential nutrients and their roles in disease prevention has been instrumental in almost eliminating nutritional deficiency diseases such as goiter, rickets, and pellagra in the United States.” • “During 1922-1927, with the implementation of a statewide prevention program, the goiter rate in Michigan fell from 38.6% to 9.0 %.” • “In 1921, rickets was considered the most common nutritional disease of children, affecting approximately 75% of infants in New York City.” 1917 USDA issues dietary recommendations (5 food groups) 1924 Iodine added to salt 1920s Maternal and Infancy act – state health departments employ nutritionists 1930s Federal gov’t. establishes food relief, nutrition education, school feeding, food consumption survey. 1940s 25% of draftees had present/past malnutrition; National Nutrition Conference for Defense: first RDA, War Order Number One: enrich wheat flour with vitamins and iron 1949 Framingham 1968 Hunger USA 1969 White House Conference on Food, Nutrition, and Health 70s “McGovern committee”, Preschool survey, 10 State Nutrition Survey, Food Stamp legislation, Child Nutrition Act – WIC, EFNEP,NET, nutrition labeling 1979 Surgeon General’s Report: Healthy People 1980 First Dietary Guidelines for Americans 1988 Surgeon General’s Report on Nutrition and Health 1990 National Nutrition Monitoring and Related Research Act 1997 First DRIs Last Decade: Strong Emphasis on Policy & Environmental Change Healthy People 2020 • Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. • Overarching Goals 1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.