Public health nutrition and food policy

Food in its many manifestations allows us to explore the global control of health and to examine the ways in which food choice is moulded by many interests. The global food market is controlled by a small number of companies who operate a system that delivers 'cheap' food to the countries of the developed world. This 'cheap' food comes at a price, which externalises costs to the nation state in terms of health consequences (diabetes, coronary heart disease and other food-related diseases) and to the environment in terms of pollution and the associated clean-up strategies. Food policy has not to any great extent dealt with these issues, opting instead for an approach based on nutrition, food choice and biomedical health. Ignoring wider elements of the food system including issues of ecology and sustainability constrains a broader understanding within public health nutrition. Here we argue that public health nutrition, through the medium of health promotion, needs to address these wider issues of who controls the food supply, and thus the influences on the food chain and the food choices of the individual and communities. Such an upstream approach to food policy (one that has been learned from work on tobacco) is necessary if we are seriously to influence food choice.     

A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition

BACKGROUND: The role played by lay knowledge in understanding health inequalities has received increased interest recently. Very little is known, however, about how lay knowledge of food and health varies across social class. The present exploratory study compared and contrasted ways in which people from different social backgrounds draw on and use different forms of lay knowledge about food and health. METHOD: Parents from 40 families were recruited from two socio-economically different suburbs (20 families from each suburb). In-depth interviews were conducted with the mother and father in each family to examine lay knowledge about food and health. All interviews were transcribed and coded for specific themes. Responses from each suburb were compared and contrasted. RESULTS: Different forms of lay knowledge about food and health were noted, especially concerning children's eating habits. Parents in the high-income suburb were more likely to discuss food and health in technical terms informed by contemporary nutritional or medical priorities. Parents in the low-income suburb did not share this discourse, but instead were more likely to discuss food in terms related to children's outward appearance or functional capacity. CONCLUSIONS AND IMPLICATIONS: The research highlights differences in lay knowledge about food and health across social class. It emphasises the need for public health nutrition policy-makers and practitioners to pay attention to lay knowledge on its own terms, rather than attempting to educate from predetermined assumptions, principles and standards.     

Delivering multidisciplinary public health in action - the Cardiff food strategy case study

BACKGROUND: There is an increasing awareness that the provision of healthy food relies on the co-ordinated efforts of a number of diverse disciplines, not merely those traditionally linked with food. This paper documents the development of a food and health strategy, commissioned by the health alliance for the city of Cardiff, and focuses on the areas of sustainability, education and training as well as nutrition, food provision and food safety. OBJECTIVE: The aim of the strategy was to increase the uptake of a healthy, safe and sustainable diet for all those living in Cardiff. METHOD: The methodology included a rapid appraisal of food initiatives operating within the city, establishing a food and health strategy working group and the production of strategy documentation. Multi-agency collaboration and consultation were key components of the approach. RESULTS: As the strategy developed, seven action areas became apparent, including education and training, public sector procurement and rewarding excellence. These action areas were incorporated into seven 'action tables', which constitute the core of the strategy. The food and health strategy document was ratified by the Local Health Alliance board in August 2004. But, far greater benefits were realised as a consequence of setting up the strategy working group. Long before the document was written, the strategy process was operating as 'multidisciplinary public health in action'. CONCLUSION: The network that comprised the food and health strategy working group was already able to commence delivery of a more integrated approach to food and health within Cardiff.     

Soil,food security and human health: a review

Direct effects of soil or its constituents on human health are through its ingestion, inhalation or absorption. The soil contains many infectious organisms that may enter the human body through these pathways, but it also provides organisms on which our earliest antibiotics are based. Indirect effects of soil arise from the quantity and quality of food that humans consume. Trace elements can have both beneficial and toxic effects on humans, especially where the range for optimal intake is narrow. We focus on four trace elements (iodine, iron, selenium and zinc) whose deficiencies have substantial effects on human health. As the world's population increases issues of food security become more pressing, as does the need to sustain soil fertility and minimize its degradation. Lack of adequate food and food of poor nutritional quality lead to differing degrees of under‐nutrition, which in turn causes ill health. Soil and land are finite resources and agricultural land is under severe competition from other uses. Relationships between soil and health are often difficult to extricate because of the many confounding factors present. Nevertheless, recent scientific understanding of soil processes and factors that affect human health are enabling greater insight into the effects of soil on our health. Multidisciplinary research that includes soil science, agronomy, agricultural sustainability, toxicology, epidemiology and the medical sciences will facilitate the discovery of new antibiotics, a greater understanding of how materials added to soil used for food production affect health and deciphering of the complex relationships between soil and human health.     

Competencies for effective public health nutrition practice: a developing consensus

OBJECTIVES: To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice. DESIGN: A modified Delphi study involving three rounds of questionnaires. SUBJECTS: A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia. RESULTS: Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. CONCLUSIONS: There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.     

Indigenous peoples' food systems for health: finding interventions that work

This is a short report of a 'safari' held in conjunction with the International Congress of Nutrition in September 2005, in Futululu, St. Lucia, South Africa. Participants were several members of the International Union of Nutritional Sciences Task Force on Indigenous Peoples' Food Systems and Nutrition, other interested scientists and members of the Kwa Zulu indigenous community. The paper describes the rationale for and contributions towards understanding what might be successful interventions that would resonate among indigenous communities in many areas of the world. A summary of possible evaluation strategies of such interventions is also given.     

Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK

OBJECTIVE: To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women. DESIGN: Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand. RESULTS: Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available. CONCLUSIONS: Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.     

Workforce development in South Africa with a focus on public health nutrition

OBJECTIVES: The present paper aims to review and report on the current and predicted future public health nutrition workforce in South Africa. Additionally, it examines ways in which the Department of Health (DOH) is striving to meet the increasing burden of nutrition-related diseases in South Africa. METHODS: The primary sources of data used for the review were reports from the Census office, South African health reviews, mortality and morbidity statistics, and documents from the Health Professions Council of South Africa. RESULTS: There are fewer than 2000 registered dietitians in South Africa and fewer than 600 of them work in the public health sector. Furthermore, professional nurses - who are the backbone of the primary health-care system and deliver the rudiments of basic nutritional care - are not being trained in sufficient numbers to meet population growth; in 2004 there was only one nurse per 4000 persons. This situation is aggravated by the growing burden of conditions associated with both overnutrition and undernutrition, as well as the enormous demands of the HIV/AIDS epidemic. The DOH is striving to meet these increasing needs by means of the Integrated Nutrition Programme as well as a National Human Resources Plan which includes numerous strategies to improve the quantity and quality of health professionals' training, including dietitians and nutritionists. This plan includes the objective of increasing the public health nutrition workforce to more than 250 newly trained dietitians and nutritionists per annum by 2010.