Community Nutrition l What is community nutrition? What is health? l CN and trends in healthcare l Risk reduction and disease prevention

Definitions l Nutrition = l Community = “unified body of individuals with common characteristics or interests who live in a particular area”

What is Community Nutrition? l Community Nutrition (CN) strives to improve the health and well-being of individuals and groups within the community l Three arenas: l Involves socioeconomic, political, cultural, and psychological aspects of food…

CN vs. Public Health l CN draws on dietetics and public health »public vs private l Public Health = societal efforts to promote/restore people’s health »1900s: »now:

Ten Leading Causes of Death in the U.S. (1900) RankCause of death Pneumonia/influenza Tuberculosis Diarrhea and enteritis Heart disease Stroke Liver disease Accidents Cancer Diphtheria Meningitis Causes in which diet plays a part Causes in which alcohol plays a part

Ten Leading Causes of Death in the U.S. (2000) RankCause of death Heart disease Cancer Stroke Lung diseases Accidents Diabetes Pneumonia/influenza Alzheimer’s disease Kidney disease Septicemia Causes in which diet plays a part Causes in which alcohol plays a part

What is Health? l Absence of _____________ l State of:

Components of a Healthful Lifestyle

ClinicalMedical Community nutrition interfaces with the realities of the health care system Trends in Nutrition/Healthcare

Reality Prevention is more effective, but… prevention efforts are _______________ Outcomes can also be hard to_______

Health Insurance l Fee-for-Service (private) »traditional individual or group l Managed care (private) »group, usually employer-based l Public (Medicare and Medicaid) »low SES »aged, blind, disabled »are entitlement programs l Uninsured »working poor, seasonal workers »uninsurable

U.S. Healthcare: Insurance Coverage Insured: (number; %) Uninsured: (White/Black) million; 84.8% 10.7% / 19.5% million; 84.4% 11.1% / 19.5% Sources: Census Bureau, CDC (NCHS); August 2004

U.S. Healthcare: Insurance Coverage Insured: (number; %) Uninsured: (White/Black/Hispanic) million; 84.8% 10.7% / 19.5% 2006?? million; 85.2% 10.5% / 16% 2008?? million; 85.3%10.4% / 16% / 31% Sources: Census Bureau, CDC (NCHS); Accessed September 2009 Heyman KM, Barnes PM, Schiller JS. Early release of selected estimates based on data from the 2008 National Health Interview Survey. National Center for Health Statistics. June Available from

Trends in the Healthcare System l Increase in managed care: HMOs, PPOs l Increased costs l (Trend in jobs: part-time)

Health Continuum

Risks and Disease Prevention l Risk = l Risk assessment =

Who is at Risk? l Individuals »referral »ill l Groups »risk factors l Population » known problems l Depends on people and hazards considered

U.S. Health Disparities: IMR (per 1000 live births) 2005 Life expectancy (male/female in years) 2007 Poverty (% of population) White / % Black / % Hispanic % Total / % Sources: Census Bureau, CDC (NCHS); Accessed September 2009; Health: United States, 2008; National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007; Income, Poverty, and Health Insurance Coverage in the United States: 2007

U.S. Health Disparities ~1998 IMR (per 1000 live births) Life expectancy (years) Poverty (% of population) Whites 7.3 ~ % Blacks 17.6 ~ %

Healthy People 2010 l Mission = creating healthy people in healthy communities l 2 Goals: »increase the quality of life and years of healthy life »eliminate health disparities