Introduction to

Public Health Nutrition

What is Health?
Health
A state of complete physical, mental, and
social well-being, not merely the
absence of disease.
WHO
What is Public Health?
Mission of Public Health
to fulfill societys interest in assuring
conditions in which people can be
healthy.
IOM. Future of Public Health.
Population Health
Improving Everyones Quality of Life: Group Health
Foundation, 2001
Population Health
Considers a broad set of options for
improving and sustaining health
Highlights role of social and economic
forces in combination with biological
and environmental factors
Results in benefits to all
Public Health Practice Compared to
Clinical Nutrition Practice

Public Health
Practice
Clinical Nutrition
Practice

Focus

Prevention


Disease treatment
Target Populations

Individuals
Setting States &
Communities
Clinics &
Hospitals
Strategies Multiple,
Reinforcing
Counseling and
education
Core Functions of Public Health
Assessment
Assess the problems and needs of the
population
Monitor the health of populations
Assess and monitor the determinants of
population health
Policy Development
Develop policies, programs and
activities that address health outcomes
and the determinants of those outcomes
Assurance
Assure the implementation of effective
strategies by providing or monitoring
policies, activities, and services.
The Future of the Publics Health in the
21
st
Century, IOM, November, 2002
Areas of action and change:
Adopting a focus on population health that
includes multiple determinants of health
Strengthening the public health infrastructure
Building partnerships
Developing systems of accountability
Emphasizing evidence
Improving communication
What About Nutrition?
Mission of Public Health Nutrition
To assure conditions in which people
have access to adequate and
appropriate food.
To assure conditions in which people
can achieve optimal nutritional health.
Leading Causes of Death, 1900
Centers for Disease Control and Prevention, National Center
for Health Statistics. National Vital Statistics System and
unpublished data. 1997.

Leading Causes of Death, 1997
Centers for Disease Control and Prevention, National Center for
Health Statistics. National Vital Statistics System and
unpublished data. 1997.
Ecological Approaches to
Public Health Nutrition
The Socio-Ecological Model
FACTORS
INTERNATIONAL
Development
Globalization
of
markets
School
Food &
Activity
WORK/
SCHOOL/
HOME
Infections
Labor
Worksite
Food &
Activity
Leisure
Activity/
Facilities
Agriculture/
Gardens/
Local markets
COMMUNITY
LOCALITY
Health
Care
System
Public
Safety
Public
Transport
Manufactured/
Imported
Food
Sanitation
NATIONAL/
REGIONAL
Food &
Nutrition

Urbanization
Education
Health
O
S
I
T
Y
P
R
E
V
A
L
E
N
E
INDIVIDUAL
Energy
Expenditure
Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org
POPULATION
%
OBESE
OR
UNDER
WT
Social security
Media
Transport
Family &
Home
National
perspective
Media &
Culture
Food
intake :
Nutrient
density
Media
programs
& advertising
Societal policies and processes influencing the population prevalence
of obesity
Christakis N and Fowler J. N Engl J Med 2007;357:370-379
Part of the Social Network from the Framingham Heart Study with Information about Body-Mass
Index According to Year
How are the functions of
Public Health performed?
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
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
Public Health Nutritionists: Guidelines for
Comprehensive Programs to Promote Healthy Eating
and Physical Activity (CDC, ASTDPHN)
Leadership: create vision, convene
partners
Planning/Management: structure,
planning, communication, funding
Coordination: integration of nutrition
efforts across programs at the national,
state, and local level consistent
messages
Brief History of Public Health
Nutrition
Achievements in Public Health, 1900-
1999: Safer and Healthier Foods (MMWR )
During the early 20th century, contaminated food,
milk, and water caused many foodborne infections,
including typhoid fever, tuberculosis, botulism, and
scarlet fever.
Once the sources and characteristics of foodborne
diseases were identified--long before vaccines or
antibiotics--they could be controlled by handwashing,
sanitation, refrigeration, pasteurization, and pesticide
application. Healthier animal care, feeding, and
processing also improved food supply safety.
The discovery of essential nutrients and
their roles in disease prevention has
been instrumental in almost eliminating
nutritional deficiency diseases such as
goiter, rickets, and pellagra in the United
States.

During 1922-1927, with the
implementation of a statewide prevention
program, the goiter rate in Michigan fell
from 38.6% to 9.0 %.
In 1921, rickets was considered the
most common nutritional disease of
children, affecting approximately 75% of
infants in New York City.
1917 USDA issues dietary recommendations (5 food
groups)
1924 Iodine added to salt
1920s Maternal and Infancy act state health
departments employ nutritionists
1930s Federal govt. establishes food relief, nutrition
education, school feeding, food consumption
survey.
1940s 25% of draftees had present/past malnutrition;
National Nutrition Conference for Defense: first
RDA, War Order Number One: enrich wheat
flour with vitamins and iron
1949 Framingham
1968 Hunger USA
1969 White House Conference on Food, Nutrition,
and Health
70s McGovern committee, Preschool survey, 10
State Nutrition Survey, Food Stamp legislation,
Child Nutrition Act WIC, EFNEP,NET,
nutrition labeling
1979 Surgeon Generals Report: Healthy People
1980 First Dietary Guidelines for Americans
1988 Surgeon Generals Report on Nutrition and
Health
1990 National Nutrition Monitoring and Related
Research Act
1997 First DRIs