1. Assuring the Implementation of Effective Public Health Strategies for Nutrition

2. Objectives Students will be able to:
Describe the characteristics of public health approaches to assuring nutritional health
Apply basic constructs of systems thinking to a public health nutrition concern

3. Leading Nutrition Concerns
Obesity
Sustainability
Food Security

4. Effective Strategies to Address these Concerns require:
Transdisciplinary research base
Population-heath focus
Grounding in fundamental social and economic determinants of health
Intersectoral engagement

5. Systems Thinking
the only way to fully understand why a complex problem occurs and persists is to understand the part in relation to the whole (O'Connor & McDermott, The Art of Systems Thinking: Essential Skills for Creativity and Problem-Solving)
Traditional scientific approach = isolating small parts of the system
Systems thinking = taking many interactions into account

6. Systems thinking is needed for problems that are:
Complex problems that involve helping many actors see the "big picture" and not just their part of it
Recurring problems or those that have been made worse by past attempts to fix them
Issues where an action affects (or is affected by) the environment surrounding the issue, either the natural environment or the competitive environment
Problems whose solutions are not obvious

7. Ecological Framework for Influences on What People Eat

8. 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

9. 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

10. Assuring Functions of Public Health
IOM 1994
Proposed by Aday
Enforce laws and regulations that protect health and ensure safety
Design model legislation to promote population health-centered programs within and across sectors
Link people to needed personal health services and assure the provision of health care when otherwise unavailable
Collaborate to develop and finance an integrated continuum of primary prevention, treatment, and long-term care programs and services in the community.
Aday, LA. Reinventing Public Health

11. Assuring Functions of Public Health
IOM 1994
Proposed by Aday
Assure a competent public health and personal heath care workforce
Train pubic health, planning and development professionals in the population-based health approach
Evaluate effectiveness, accessibility, and quality of personal and population-based public health services
Evaluate public health and intersectoral initiatives in terms of their population health impact.
Aday, LA. Reinventing Public Health

12. Serving All Functions IOM 1994 Proposed by Aday
Research for new insights and innovative solutions to health problems
Design and conduct transdisciplinary research to address fundamental determinants of population health
Aday, LA. Reinventing Public Health

13. Responsibilities of Schools of Public Health
Educate educators, practitioners and researchers – prepare leaders
Transdisciplinary research
Contribute to policy
Work with other professional schools to assure quality public health content
Assure access to lifelong learning for practitioners
Actively engage in communities
Who Will Keep the Public Healthy? IOM 2002.

14. An Intersectoral Approach to Public Health
IOM. The Future of the Public’s Health, 2002

15. Key Components of the Food Sector
Production
Farming, gardening, aquaculture, wild foods
Transformation
Processing, packaging, labeling, marketing
Distribution
Transportation, wholesaling, warehousing
Access
Retail, food safety, food security
Consumption
Purchasing, preparing, preserving, eating
Resource & Waste Mgmt.
Disposal, recycling
Muller, Tagtow, Roberts, MacDougall. J Hunger Envir Nutr. 2009/

16. CONSUMPTION-ORIENTED FOOD SUPPLY CHAIN ANALYSIS
describe the steps in the chain from farm to fork;
describe the organizational, financial, technological, and policy characteristics of the processes and actors in each step of the chain
identify the organizational, financial, technological, and policy incentives and disincentives within the chain
analyze how incentives and disincentives affect the food environment: food availability, prices, and marketing;
identify how these incentives could be leveraged to better align the food supply chain with healthy diets
Example: Coca-Cola supply chain.
Hawkes, J Hunger Envir Nutr. 2009

18. Assuring conditions for access to adequate and appropriate food
Emerging Model for an Intersectoral Approach to Public Health Nutrition
Communities
Institutions
Media
NGOs
Assuring conditions for access to adequate and appropriate food
Govt.: public health, agriculture, education, environment
Business
Food System Sectors
Academia

19. Determinants of Individual Food Choice
Proximal & Immediate
Taste
Cost
Convenience
Proximity
Overarching Influencers
Marketing
Cultural norms
For some specific individuals: health concerns and health literacy

20. Identify possible strategies to improve the behavior
Pick a specific food-based behavior that needs to be improved in a specific population
How is this behavior linked to obesity, food security & sustainability?
Develop a graphic to describe the system that currently influences the specific behavior
Identify possible strategies to improve the behavior
Identify a role for at least 5 of these sectors:
Govt. public health (fed, state, local)
Govt. agriculture
Communities
Institutions (worksites, schools, faith institutions, etc)
Health care
Employers
Media
Academia
Food system actors