Federal Overview for Public Health Nutrition

Some Major Nutrition Players: USDA Food and Nutrition Service Center for Nutrition Policy and Promotion Food Safety and Inspection Service (FSIS) Department of Health and Human Services CDC HRSA FDA NCI Office of Disease Prevention and Health Promotion EPA – agency responds directly to president

USDA Mission: Enhance the quality of life for the American people by supporting production of agriculture: ensuring a safe, affordable, nutritious, and accessible food supply caring for agricultural, forest, and range lands supporting sound development of rural communities providing economic opportunities for farm and rural residents expanding global markets for agricultural and forest products and services and working to reduce hunger in America and throughout the world. USDA Vision: A healthy and productive Nation in harmony with the land.

Food and Nutrition Service (FNS) works to increase food security and reduce hunger by providing children and low-income people with access to food, a healthy diet, and nutrition education in a manner that supports U.S. agriculture and inspires public confidence in the Nation's domestic nutrition assistance programs. FNS nutrition assistance programs represent about half of USDA's budget.

FNS Programs Food Stamp Program Child Nutrition Programs Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Commodities to low-income Americans. Monitoring of the eating habits of program participants

Center for Nutrition Policy and Promotion (CNPP) develops and promotes science-based dietary guidance and economic information for consumers and professionals in health, education, industry, and media

Center for Nutrition Policy and Promotion (CNPP) Partner with HHS for Dietary Guidelines Healthy Eating Index Nutrient Content of the Food Supply Food Guide Pyramid Thrifty Food Plan

Last revised 1999 Establishes menus and market basket costs for a minimal cost healthful diet All menus meet Dietary Guidelines for Americans, the Recommended Dietary Allowances, and the serving recommendations of the Food Guide Pyramid. Used as the basis for food stamp allocation decisions, and to determine the federal poverty level

Federal Poverty Guidelines Poverty thresholds were originally derived in ,using: – U.S. Department of Agriculture food budgets designed for families under economic stress – Data about what portion of their income families spent on food The current thresholds were originally developed as the cost of a minimum diet times three If total family income is less than the threshold appropriate for that family, the family is in poverty

2004 HHS Poverty Guidelines Size of Family Unit 48 Contiguous States and D.C.AlaskaHawaii 1$ 9,310 $11,63 0 $10, ,49015,61014, ,67019,59018, ,85023,57021, ,03027,55025, ,21031,53029, ,39035,51032, ,57039,49036,320 For each additional person, add 3,180 3,980 3,660 SOURCE: Federal Register, Vol. 69, No. 30, February 13, 2004, pp

Food Research Action Committee (FRAC) on the Thrifty Food Plan “USDA research shows that only 12 percent of low income households who spend at the Thrifty Food Plan level get their recommended dietary allowances for 11 key nutrients.” s/fsp_faq.html

FRAC on the Thrifty Food Plan, cont. The Thrifty Food Plan contains a number of assumptions which may not be accurate for many food stamp recipients. For example, purchasing foods for a nutritious diet requires adequate food preparation facilities, extensive time for food preparation, an in-depth knowledge about nutrition and inexpensive transportation to warehouse-type grocery stores or supermarkets.

Cooperative State Research Education and Extension Service (CSRES)

CSREES: Families, 4-H, and Nutrition Youth development Expanded food and nutrition program (EFNEP) Children, youth and families at risk CSREES partners with state land grant institutions and local counties

Department of Health and Human Services

National Cancer Institute: 5 A Day for Better Health The national Program gives Americans a simple, positive message - eat 5 or more servings of fruits and vegetables every day for better health. The program is jointly sponsored by the National Cancer Institute in the U.S. Department of Health and Human Services and the Produce for Better Health Foundation, a nonprofit consumer education foundation representing the fruit and vegetable industry. The National Cancer Institute funds behavior change and communications research to determine strategies that are effective to increase fruit and vegetable consumption.

NIH Many institutes include nutrition-related research portfolios: National Heart Lung and Blood Institute (NHLBI) National Institute on Aging (NIA) National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) National Institute of Child Health and Human Development (NICHD) National Institute of Environmental Health Sciences (NIEHS) John E. Fogarty International Center (FIC) National Center for Complimentary and Alternative Medicine (NCCAM)

HRSA Diverse Agency –Direct Services –Supporting health care infrastructure Community and Migrant Health Services Health Centers Expanding Maternal and Child Health Block Grants to States Discretionary Grants

DIRECT HEALTH CARE SERVICES (GAP FILLING) Examples: Basic Health Services and Health Services for CSHCN ENABLING SERVICES Examples: Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, Coordination with Medicaid, WIC and Education POPULATION--BASED SERVICES Examples: Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Counseling, Oral Health, Injury Prevention, Nutrition and Outreach/Public Education INFRASTRUCTURE BUILDING SERVICES Examples: Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care and Information Systems CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES MCHEPSDTCHCSCHIP Maternal Child Health Bureau

Centers for Disease Control: Mission To promote health and quality of life by preventing and controlling disease, injury, and disability

Centers for Disease Control: 11 Centers, Institutes, and Offices Epidemiology Program Office National Center for Chronic Disease Prevention and Health Promotion National Center for Environmental Health Office of Genetics and Disease Prevention National Center for Health Statistics National Center for HIV, STD, and TB Prevention National Center for Infectious Diseases National Center for Injury Prevention and Control National Immunization Program National Institute for Occupational Safety and Health Public Health Practice Program Office

National Center for Chronic Disease Prevention and Health Promotion Vision: Enabling all people in an increasingly diverse society to lead long healthy, satisfying lives.

National Center for Chronic Disease Prevention and Health Promotion Mission: –To prevent death and disability from chronic diseases –To promote maternal, infant, and adolescent health. – To promote healthy personal behaviors. –To accomplish these goals in partnership with health and education agencies, major voluntary associations, the private sector, and other federal agencies.

Division of Nutrition and Physical Activity: Purpose provides science-based activities for children and adults that address the role of nutrition and physical activity in health promotion and the prevention and control of chronic diseases

Division of Nutrition and Physical Activity: Scope Epidemiology Applied research Public health policy Surveillance Community interventions, Evaluation Communications

Sample of CDC Nutrition and Physical Activity Projects Surgeon General’s report on Physical Activity in Funding of 24 Prevention Research Centers Funding 16 states to provide coordinated school based programs for nutrition and physical activity Creation of Healthy Schools Indices Expansion of National Breast and Cervical Cancer Early Detection Program to include dietary and physical activity interventions Promotion of Active Community Environments

Future Activities for DNPA “CDC considers it a priority that people be afforded opportunities to pursue and maintain good health through such avenues as safe walking and cycling trails; low-fat, high-fruit-and- vegetable menu selections in restaurants, schools, and worksite cafeterias; and physical activity programs in schools, worksites, and community gathering places.”

Office of Disease Prevention and Health Promotion, Works to strengthen the disease prevention and health promotion priorities of the Department within the collaborative framework of the HHS agencies. Collaborated with USDA on Dietary Guidelines

Working Together….

Dietary Guidelines 2000: A Aim for Fitness  Aim for a healthy weight.  Be physically active each day.

Dietary Guidelines 2000: B Build a Healthy Base….  Let the Pyramid guide your food choices.  Choose a variety of grains daily, especially whole grains.  Chose a variety of fruits and vegetables daily.  Keep food safe to eat.

Dietary Guidelines 2000: C Choose Sensibly….  Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.  Choose beverages and foods to moderate your intake of sugars.  Choose and prepare foods with less salt.  If you drink alcoholic beverages, do so in moderation.

Revision of Dietary Guidelines Advisory Group for 2005 revision convened August Items that were proposed in letter from OMB: –Trans fatty acids, n 3 fatty acids Focus on obesity?

The Fun Begins: 2003 "There are a number of nominees that have very close ties to the food industry that might lead them to make recommendations that are weaker than they should be based on the science," "The answer is devoting our energies to strengthening programs that teach people to follow the guidelines...and help to reshape the food environment to make it easier for people to eat well," Margo Wootan, CSPI. Fitzgerald (R-Ill) proposed having guidelines come only from DHHS. USDA should not be giving dietary advice, considering its "main mission is to promote the sale of agricultural products."

Methods for Dietary Guideline Development Committee selected by Secretaries of HHS and USDA Initial subcommittees on nutrient adequacy, carbohydrates, fats, fluid and electrolytes, energy, ethanol, and food safety; Later subcomittees on crosscutting macronutrient issues and fruits and vegetables, grains, milk, and milk products

Research Questions Each committee drafted relevant research questions Systematic review of the scientific literature: peer reviewed articles, DRIs, Agency for Healthcare Research and Quality report on omega-3 fatty acids and the World Health Organization International Agency for Research on Cancer (IARC) report on the relation between fruit and vegetable intake and cancer Conclusive statements were drafted and reviewed

USE OF THE USDA FOOD INTAKE PATTERN AND SPECIAL ANALYSES 1.Establish nutritional goals based on DRIs 2.Establish energy levels by activity, gender, age (12 categories) 3. Assign nutritional goals to each specific food intake pattern. 4.Assigning a nutrient content to each food group and subgroup. 5.Determining the daily intake amounts for each food group or subgroup.

August 2005: The Report is Published Nine recommendations Highlights of specific recommendations New guidelines scheduled to be released January 2005.

Conclusive Statements Specific needs for many Americans re: vitamin A, C, E, Ca, K, fiber, magnesium, Specific groups: iron, Folic acid, B12, vitamin D. Energy: most Americans need to reduce energy Fats: –saturated as low as possible –trans < 1% –weekly fish, other EPA/DHA may be beneficial (too little evidence)

Statements, cont. Carbohydrate: 45-65% 14 g fiber per 1000 kcal Reduced sugar – may be helpful in weight control, combined with reduced frequency of starch, helpful in oral health Selected Foods: fruits, vegetables, whole grains, milk important

Statements, cont. Salt: –many persons benefit from reductions – increase potassium –decrease salt used by food industry in processing Alcohol –Sensibly & in moderation –Abstention is an important option –Avoid with driving, breastfeeding

Statements, cont. Food safety –Clean: hands, food, surfaces –Separate raw & cooked food –Cook and chill at safe temperatures –Vulnerable populations avoid high risk foods

Statements, cont. Physical activity: Adults: 30 minutes of at least moderate on most days provides benefits, more provides greater benefits Children: at least 60 minutes is recommended.

9 KEY MESSAGES—TRANSLATING SCIENTIFIC FINDINGS INTO DIETARY AND PHYSICAL ACTIVITY GUIDANCE Consume a variety of foods within and among the basic food groups while staying within energy needs. Control calorie intake to manage body weight. Be physically active every day. Increase daily intake of fruits and vegetables, whole grains, and nonfat or low-fat milk and milk products. Choose fats wisely for good health.

Key Messages, cont. Choose carbohydrates wisely for good health. Choose and prepare foods with little salt. If you drink alcoholic beverages, do so in moderation. Keep food safe to eat.

Food Safety Objectives from Healthy People Foodborne infections 10-2Outbreaks of foodborne infections 10-3Antimicrobial resistance of Salmonella species 10-4Food allergy deaths 10-5Consumer food safety practices 10-6Safe food preparation practices in retail establishments 10-7Organophosphate pesticide exposure

Food Safety: A Team Approach FDA CDC USDA Cooperative Extension Service National Agricultural Library: USDA/FDA Foodborne Illness Education Information Center EPA U.S. Department of Commerce: National Oceanic and Atmospheric Administration

Food Safety Team, Cont.. U.S. Department of the Treasury: Bureau of Alcohol, Tobacco and Firearms U.S. Customs Service U.S. Department of Justice Federal Trade Commission State and Local Governments

Food Safety and Inspection Service (FSIS) sets standards for food safety and inspects meat, poultry, and egg products produced domestically and imported

FDA FDA's mission is to promote and protect the public health by helping safe and effective products reach the market in a timely way, and monitoring products for continued safety after they are in use.

FDA safeguards the nation's food supply by making sure that all ingredients used in foods are safe, and that food is free of contaminants -- like disease-causing organisms, chemicals, or other harmful substances. The agency must approve new food additives before they can be used in foods. FDA also monitors the safety of dietary supplements and the content of infant formulas and medical foods. Meat and poultry products, however, are regulated by the USDA.

EPA: Food and Water Safety Establishes safe drinking water standards Regulates toxic substances and wastes to prevent their entry into the environment and food chain Assists states in monitoring quality of drinking water and finding ways to prevent contamination of drinking water Determines safety of new pesticides, sets tolerance levels for pesticide residues in foods, and publishes directions on safe use of pesticides