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

2. Definitions l Nutrition = science of food and its use by the body l Community = “unified body of individuals with common characteristics or interests who live in a particular area” »people »location »social interaction »shared values

3. 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: »people (diverse) »policy (course of action) »programs (instruments to change behavior) l Involves socioeconomic, political, cultural, and psychological aspects of food…

4. CN vs. Public Health l CN draws on dietetics and public health »public vs private »governmental control l Public Health = societal efforts to promote/restore people’s health »1900s: sanitation, communicable diseases »now: chronic diseases

5. Ten Leading Causes of Death in the U.S. (1900) RankCause of death 1 2 3 4 5 6 7 8 9 10 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

6. Ten Leading Causes of Death in the U.S. (2000) RankCause of death 1 2 3 4 5 6 7 8 9 10 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

7. What is Health? l Absence of disease l State of physical, emotional, mental, social, spiritual well- being

8. Components of a Healthful Lifestyle lElE lElE l No _________ behaviors l _________ management l Adequate ___________

9. Clinical Community Medical Prevention Community nutrition interfaces with the realities of the health care system Trends in Nutrition/Healthcare

10. Reality Prevention is more effective, but… prevention efforts are rarely reimbursed!! Outcomes can also be hard to prove

11. Reality Prevention is more effective, but… prevention efforts are rarely reimbursed!! Outcomes can also be hard to prove (Brainstorm measurable outcomes of nutrition intervention)

12. 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

13. U.S. Healthcare: Insurance Coverage Insured: % Uninsured: (White/Black) 200284.8% 10.7% / 19.5% 200685.2% 10.5% / 16% 200785.5%10.6% / 15.3% 200984.6%15.1% / 22.2% 201084%11.5% / 18.7% (30.3% Hispanic) Sources: Census Bureau, CDC (NCHS); September 2008; August 2011 Cohen RA, Martinez ME, Ward BW. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2009, 2010, 2011. National Center for Health Statistics. June 2010 and 2011. Available from: http://www.cdc.gov/nchs/nhis.htm. http://www.cdc.gov/nchs/nhis.htm

14. U.S. Healthcare: Insurance Coverage Insured: (number; %) Uninsured: (White/Black) 2002 242.4 million; 84.8% 10.7% / 19.5% 2003243.3 million; 84.4% 11.1% / 19.5% Sources: Census Bureau, CDC (NCHS); August 2004

15. Trends in the Healthcare System l Increase in managed care: HMOs, PPOs l Increased costs »technology is $ »aging of population »consumer demands »liability coverage »education costs »unhealthy lifestyles l (Trend in jobs: part-time)

16. Health Continuum

17. Who is at Risk? (and how do you know?) l Individuals »referral »ill l Groups »risk factors l Population » known problems l Depends on people and hazards considered

18. U.S. Healthcare: Insurance Coverage Insured: % Uninsured: (White/Black) RegionUninsured for part of past yearUninsured for more than a year Northeast 13.5%7.2% Midwest16.6%8.1% South22.8%13.5% West21.5%12.4% Cohen RA, Martinez ME, Ward BW. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2009. National Center for Health Statistics. June 2010. Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201006.pdf

19. Risks and Disease Prevention l Risk = expected annual mortality / hazard l Risk assessment = determining extent of the hazard / identifying who faces the hazard

20. 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

21. Healthy People 2020 l Vision = a society in which people live long, healthy lives l Overarching Goals = l Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. l Achieve health equity, eliminate disparities, and improve the health of all groups. l Create social and physical environments that promote good health for all. l Promote quality of life, healthy development, and healthy behaviors across all life stages.

22. U.S. Health Disparities: 2002-2008 2002 / 2009 IMR (per 1000 live births) 2001/2005/2007 Life expectancy (years) 2005 / 2008 Poverty (% of population) Whites 5.9 / 5.3 77.7 / 78.3 / 78.4 8.3% / 8.6% Blacks 13.9 / 12.7 72.2 / 73.2 / 73.6 24.9% / 24.7% Sources: Census Bureau, CDC (NCHS); September 2007 http://www.cdc.gov/nchs/data/hus/hus10.pdf#002http://www.cdc.gov/nchs/data/hus/hus10.pdf#002, August 2011

23. U.S. Health Disparities ~1998 IMR (per 1000 live births) Life expectancy (years) Poverty (% of population) Whites 7.3 ~75 11.6% Blacks 17.6 ~65 33.3%