Nutrition Promotion

Theories and methods, systems and settings

Tony Worsley

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000246681
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Affluenza in developed societies is damaging our health, leading to increasing rates of obesity, diabetes and other metabolic disorders. Growth in individual food consumption is also threatening ecological sustainability. More than ever before, dieticians, nutritionists, and other health professionals need to promote healthy eating to the general public. Nutrition Promotion sets nutrition education firmly in a public health context, showing that nutrition promotion is most effective when targeted to particular population groups. Tony Worsley presents the history, theory and methods of nutrition promotion, and provides practical applications in a variety of settings and age groups.Drawing on international theory and research, and with international case studies and examples, Nutrition Promotion is an essential text for students and professionals in nutrition studies and dietetics, health promotion and public health programs.'Finally we have a book on nutrition promotion from a public health perspective that integrates food systems, theoretical health behavior change models, evaluation methods, applications across settings and sectors, and provides practical examples from different countries.' - Professor Mary Story, School of Public Health, University of Minnesota 'A timely and considered book. It follows in that great tradition of public health nutrition by providing a basis for analysis, but takes it a step further by helping the reader make the transition to action.' - Martin Caraher, Reader in Food and Health Policy, City University London

1
Introduction

The Aims of Nutrition Promotion

Introduction

For aeons, humans have passed on their knowledge and skills concerning food production and preparation from parent to child. For example, hunter-gatherer societies had extensive botanical knowledge, particularly about the safety of plant foods, which they taught their children (Diamond 1997). As society passed through agricultural and industrial phases, the relevance of these folkways and the role of the family in food education were weakened. Towards the end of the nineteenth century in North America and Western Europe, nutrition science began to develop, encouraged by public-minded individuals and capitalist and military interests who were concerned, for a variety of reasons, about the widespread malnutrition experienced by the working classes. Educators found that malnourished children undertaking compulsory primary education were too malnourished to learn, employers reported low productivity and widespread injuries among manual labourers, and during World War I the military had to reject many conscripts because of severe nutritional deficiencies. So, for these and other reasons — some humane and others less so — the emerging science of nutrition was used to remedy and prevent widespread undernutrition. Nutrition promotion and communication, then, have been around for a long time as both academic and public health disciplines.

The ways in which nutrition science has been promoted and the emphases which have been applied during the past century have varied according to prevailing social and political conditions. For example, in the early twentieth century in industrialised countries, protein-energy malnutrition was a widespread problem so nutritionists responded by promoting diets which contained large amounts of energy and saturated fats. Today, in the midst of an obesity epidemic, such a strategy seems bizarre. Nutrition promotion is very dependent upon the prevailing social, economic and epidemiological orthodoxies. Major differences exist between societies which are in different phases of economic transition. Rich, post-industrialised societies suffer from the effects of excessive energy and salt consumption, leading to noncommunicable diseases like heart disease, cancers and non-insulin-dependent diabetes, and obesity. Economically poorer societies suffer from a wider range of diseases such as infectious and parasitic diseases, as well as non-communicable diseases. These different economic and disease 'climates' require different types of nutrition and health-promotion responses.

The nature of public health

Nutrition promotion and communication are part of public health. This means that they are more concerned with the prevention and amelioration of diseases among populations than with the treatment of sick individuals. While nutrition promotion often takes place in clinical settings (like doctors' offices), it does not Hocus on the treatment of individual patients. That is the important work of clinical nutritionists and dietitians. Instead, nutrition promoters also work with groups of apparently well people, or with individuals who have major influence over the population (e.g. newspaper editors, urban planners, government departments) or who control the content and distribution of the food supply (such as food manufacturers, food retailers and regulatory authorities). (Of course, many dietitians and clinicians often promote nutrition — but nutrition promotion goes beyond the confines of the clinic and includes the efforts of many people in addition to clinicians.)

Nutrition promoters focus on populations of people. While the term 'population can refer to all the humans living in the world or in a country, typically public health workers attend to more specifically defined sub-populations such as men and women, children, young people, the elderly, low-income groups, and so on. The "four pillars of public health and sociology' are gender, age, ethnicity and socioeconomic status because these factors have major influence on health and society, and have to be taken into account in most forms of health promotion.

Various demographic criteria are used to define these sub-populations such as sex (male or female) and age (e.g. people over 60 years of age). Socioeconomic status is a key criterion. People from low socioeconomic status backgrounds tend to be more obese and have worse health than those from higher status strata, so they may require different health and nutrition promotion strategies. Indicators of socioeconomic status include education (e.g. tertiary educated versus nontertiary educated), income (e.g. those in the top 25 per cent of income earners) and occupation. Employment status (e.g. employed full time, part time, unemployed), and ethnicity (e.g. Indigenous and/or speakers ol a minority language) are also important demographic factors.

Life stage is another important concept. For example, pregnant women have quite different nutrition and health needs than non-pregnant women of similar age. Similarly, growing children have quite different nutritional needs from adults.

Public health programs can be conducted at several levels in society and in different ways. Table 1.1 shows how the public health continuum might be applied to nutrition promotion. It should be clear from the examples that many different groups of people and professions can be involved: parents, teachers, home economists, dietitians, nurses, GPs, gardeners, greengrocers and many others. All of them can promote healthy food and nutrition in some way.

TABLE 1.1 THE PUBLIC HEALTH CONTINUUM

Public health programs at the community on regional level	Community development	Group work	Disease prevention prevention and health promotion with individuals and families
For example: Local food policy Changing suppliers of foods Healthy workplace policy	For example: Local community groups become a lobbying force (e.g. against promotion of obesogenic food to children) Lay outreach workers Community involved in food-mapping activities (e.g. about access to nutritious foods)	For example: Health education activities such as cooking classes Community food gardening groups	For example: Work with individuals in their own home to advise on skills such as cooking and budgeting Advice in clinic from GP or dietitian 'Healthy Start' programs for mothers and infants

Source: Caraher, M. 2007, personal communication.

Marginalisation

A major preoccupation ol present-day public health is marginalisation. Groups of people often live at the margins of mainstream society and may experience several disadvantages which prevent them from accessing the resources required for optimal health. Financially poor people, people with major physical and mental disabilities, people with little education, new migrants or refugees, people from minority ethnic or language groups and many retired people can often be marginalised in that they may find it difficult to gain access to a healthy diet or to other health resources such as employment, housing, safety and health services. Marginalised groups, then, are often a key locus of nutrition and health promotion.

This interest in marginalised groups is derived from a distinctive set of public health values and beliefs. Public health, as the name implies, is about the promotion of the public good in the health arena. It assumes that society is made up not only of individuals and their families and friends, but also institutions like health services, community organisations and business coalitions. This is a controversial viewpoint which is certainly not shared by everyone in neo-liberal 'individualist' societies. It proposes that, in addition to individuals' interests and goals, we should also pursue community goals in which everyone has a stake. These include the protection of the environment and the care of children, sick and infirm people. Consequently, it proposes that government and good governance are important lor the maintenance of the population's health and well-being.

Associated with this idea ol the public good are some important values (or guiding principles) which public health workers use to judge the outcomes of their efforts. These are outlined below.

Equity

This is the belief that everyone in society should be given access to sufficient resources which they need to attain optimal health. It is not the same as 'equality', which often means we treat everyone in the same way (e.g. everyone receives identical levels of health care). Instead, equity recognises that people are not all the same, that some have greater needs than others and that they should have as much help from society as they require. It is much easier for well-oil people to gain access to health resources like medical care, and so attain good health, than it is for poor people. Equity suggests that poorer, less well-resourced people should receive more help from the community than their better-off peers.

There is much debate in many countries about the desirability and affordabilily of equity goals. Some societies are more willing to remedy social inequalities than others. In addition, right- and left-wing politicians differ not only in their acceptance ol the equity principle but also in the ways they believe equity may be achieved. For example, conservative thinkers see small business as an excellent way to spread wealth around the community, thus increasing equity, while left-wing proponents see greater roles for the state (e.g. through taxation policies which redistribute wealth).

Efficacy

This is related to concepts of efficiency and effectiveness. Resources for public health and nutrition promotion are usually very limited, so it is important that they be expended in ways that bring about the most positive outcomes for particular population groups. An efficacious nutrition promotion program is one that spends resources in ways that achieve optimal outcomes with little wasted money and time (i.e. more 'bang for the buck'). Of course, such efficacy needs to be balanced with long-term outcomes. The US Women Infants and Children (WIC) programs gam $10 for every $1 invested, but the gains occur ten or more years later! Efficacy is often thought of as quick wins', and we can lose sight of the value ol long-term investment as opposed to immediate costs. The danger here is that we may have an inverse care law (Caraher 2007, personal communication). We might r...

Table of contents

• Cover
• About the author
• Title
• Copyright
• Contents
• Figures and tables
• Preface
• 1 Introduction: The aims of nutrition promotion
• 2 Nutrition promotion in the food system
• 3 Food consumers
• 4 Nutrition problems and solutions
• 5 Theories and dietary change: Individual-level theories
• 6 Theories and dietary change: Environmental models
• 7 Change methods: Designs and evaluation
• 8 Community nutrition promotion programs
• 9 Nutrition promotion for children and young adults
• 10 Nutrition promotion at worksites
• 11 Hospital and health service-based programs
• 12 Nutrition promotion in the retail sector
• 13 Nutrition communication in the media
• References
• Index