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© Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION PART I Overview of the Public Health Nutrition Landscape 47602_CH01_5165.indd 1 8/13/08 1:48:04 PM © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION 47602_CH01_5165.indd 2 8/13/08 1:48:04 PM © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION CHAPTER Community Nutrition and Public Health 1 CHAPTER OUTLINE • Introduction • The Concept of Community • Public Health and Nutrition • The Relationship Between Eating Behaviors and Chronic Diseases • Reducing Risk Through Prevention • Health Promotion • Knowledge and Skills of Public Health and Community Nutritionists • Places of Employment for Public Health and Community Nutritionists • Preventive Nutrition LEARNING OBJECTIVES • Define public health and community nutrition. • Discuss the relationship between diet and diseases. • List current nutrition- and diet-related public health problems. • Explain primary, secondary, and tertiary prevention. • Outline the educational requirements, practice settings, roles, and responsibilities of community and public health nutritionists. • Define the terms Registered Dietitian (RD) and public health nutrition. Introduction ists can participate in nutrition and healthcare planning, they must be Community nutrition is a modern and comprehensive profession that knowledgeable about the concept of community as client. includes, but is not limited to, public health nutrition, dietetics/nutri- tion education, and medical nutrition therapy.1 Community nutrition The Concept of Community deals with a variety of food and nutrition issues related to individuals, The concept of community varies widely. The World Health Organi- families, and special groups that have a common link such as place of zation (WHO) defines community as “a social group determined by residence, language, culture, or health issues.2 There is an increasing geographic boundaries and/or common values and interests.”5 Com- need to focus on community in health promotion and disease pre- munity members know and interact with one another; function within vention because behavior is highly influenced by the environment in a particular social structure; and show and create norms, values, and which people live. Local values, norms, and behavior patterns have social institutions.6 Suburbs and other areas surrounding the legal lim- a significant effect on shaping an individual’s attitudes and behav- its of a city are also an integral part of that city’s total community. iors.3,4 The increasing movement toward using a community approach A second definition of community is demographic and involves requires community nutritionists to become more visible and vocal viewing the community as a subgroup of the population, such as peo- leaders of community health. However, before community nutrition- ple of a particular age, gender, social class, or race.8 A community can 47602_CH01_5165.indd 3 8/13/08 1:48:04 PM © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION 4 PART I Overview of the Public Health Nutrition Landscape also be defined on the basis of a common interest or goal. A collection These professionals establish links with other professionals involved of people, even if they are scattered geographically, can have a com- in a wide range of education and human services, such as childcare agen- mon interest that binds its members. This is called a common-interest cies; social work agencies; services to older persons; high schools; col- community.9 Many successful prevention and health promotion efforts, leges and universities; and community-based epidemiological research. including improved services and increased community awareness of specific problems, have resulted Public Health and Nutrition from the work of common-inter- Public health is defined as “the science and art of preventing disease, community nutrition an area est communities. The following prolonging life, and promoting health and efficiency through organized of nutrition that addresses the are some examples of common- community efforts, so organizing these benefits as to enable every citi- entire range of food and nutrition interest communities:9 zen to realize his/her birthright of health and longevity.”11 It has been issues related to preventing viewed as the scientific diagnosis and treatment of the community. In disease and improving the health ● Members of a national pro- this vision, the community, instead of the individual, is seen as the of individuals, families, and the fessional organization (e.g., community. American Dietetic Associ- patient. When the focus is on the community, patterns and processes 12 ation, American Medical begin to emerge and combine to form a unified whole. Using this ap- health promotion the process Association, Federation of proach avoids focusing on risks and diseases; instead, the focus is on of enabling people to increase American Societies for Ex- the community’s strengths and resilience. Community strengths can control of and improve their perimental Biology, African be physiological, psychological, social, or spiritual. They include such health. American Career Women, factors as education, coping skills, support systems, knowledge, com- National Association of munication skills, nutrition, coherent belief systems, fitness, ability to nutritionist a professional with develop a supportive environment, and self-care skills.3 academic credentials in nutrition; Asian American Profes- sionals, American Public Increasing nutrition knowledge can reduce medical care costs and may also be a registered dietitian. 13–16 Health Association) improve the quality of life. The negative consequences of nutri- tion-related problems include malnutrition and chronic health con- community a group of ● Members of churches ditions such as obesity, cardiovascular disease, cancer, and diabetes people who share a common ● Disabled individuals scat- 17,18 geographical location, values, tered throughout a large city mellitus. In addition, these conditions contribute significantly to culture, or languages. the world’s burden of morbidity, incapacity, and mortality, despite the ● Individuals with specific health condition (e.g., dia- tremendous amount of biological knowledge accumulated over the primary prevention activities 18 betes, hypertension, breast years. The WHO estimated that prevention of the major nutrition- designed to prevent a problem or cancer, mental illness) related risk factors (cigarette smoking, inactivity, poor dietary habits, disease before it occurs. and alcohol abuse) could translate into a gain of 5 years of disability- ● Teenage mothers free life expectancy. secondary prevention activities ● Homebound elderly persons A community and public health nutrition approach will make it pos- related to early diagnosis and Community nutrition and 21,22 treatment, including screening for sible to reverse the course of major nutrition problems. Dietetic dietetics professionals are also diseases. professionals can take the lead in prevention programming because members of a community and their training as counselors and educators provides skills that make tertiary prevention designing are public health agency profes- them important members of a public health profession. activities to treat a disease state sionals who provide nutrition Public health nutrition was developed in the United States in re- or injury and to prevent it from services that emphasize com- sponse to societal events and changes to the following situations:1,23,24 further progression. munity health promotion and disease prevention. They deal ● Infant mortality public health the science and art with the needs of individuals ● Access to healthcare of preventing disease, prolonging through primary, secondary, ● Epidemics of communicable disease life, developing policy, and and tertiary preventions (which ● Poor hygiene and sanitation promoting health and efficiency will be discussed in more detail ● Malnutrition through organized community later in this chapter). ● Agriculture and food production (in response to changes in food effort. production) ● Primary prevention in- ● Economic depression, wars, and civil rights public health nutrition volves designing activities ● Aging of the population focuses on the community and to prevent a problem or ● Behavior-related problems/lifestyle (poor dietary practices, alco- society as a whole and aims at disease before it occurs. optimal nutrition and health hol abuse, inactivity, and cigarette smoking) ● Secondary prevention in- status. Public health nutritionist ● Chronic diseases (obesity, heart disease, diabetes mellitus, men- volves planning activities positions require dietetic tal health, cancer, osteoporosis, and hypertension) related to early diagnosis registration by Commission ● Poverty and immigration and treatment, including on Dietetic Registration status ● Preschool/after-school child care and school-based meals and a graduate-level science screening for diseases. degree that includes study ● Tertiary prevention con- of environmental sciences, sists of designing activities The Relationship Between Eating Behaviors and health promotion, and disease to treat a disease state or Chronic Diseases prevention programs. injury and to prevent it As evidenced by an introductory review of literature and research in from progressing further.10 the area of eating behavior and chronic disease, the relationship between 47602_CH01_5165.indd 4 8/13/08 1:48:04 PM © Jones and Bartlett Publishers,
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