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Public health is a linked system of federal, state and local (city and county) health departments, operated by the government and given the authority and responsibility to monitor and protect the public’s health.
The mission of public health is "to assure conditions in which people can be healthy" (Institute of Medicine, The Future of Public Health).
Since nutrition is an essential aspect of the conditions in which people can be healthy, public health nutrition is part of the public health system
Community nutrition efforts involve a wide range of programs that provide increased access to food resources, nutrition information and education, and health-related care. They also include efforts to change behavior and environments and to initiate policy.
The term community nutrition is often used to reflect the wide range of delivery settings and sponsoring organizations for nutrition-related programs and services. Community nutrition services tend to be directed to individuals and groups in the community.
The term public health nutrition has historically been used for the responsibilities carried out by health departments at local, state and federal levels. The programs offered by public health agencies are usually directed to communities, organizations and systems and have as their goal health promotion and disease prevention.
Additionally, public health nutrition is often involved in policy development. In practice the terms public health nutrition and community nutrition tend to be used interchangeably.
Adequate food and balanced nutrient intake are basic necessities for life, health and well being. Nutrition affects health from conception to old age. Adequate nutrition is especially important in periods of rapid growth and development. Poor nutrition during pregnancy, infancy, childhood and adolescence can mean stunted physical, mental and social development with lifelong consequences. Chronic dietary deficiency, excess or imbalance predisposes individuals to or aggravates a spectrum of disease conditions, and ultimately affect the quality and length of life.
Coronary heart disease, some types of cancer, stroke, non-insulin dependent diabetes (type 2 diabetes), and atherosclerosis are associated with dietary factors. Dietary excesses and imbalances contribute to the development of these diseases.
Currently attention is focused on total caloric intake; amount and type of fat; vitamins such as folic acid and the antioxidants of vitamins A, C and E; minerals such as calcium; and other nutritive substances such as fiber and flavonoids.
Overweight and obesity which are estimated to affect over a third of the population is also an important contributing factor for disease and disability.
The health of mothers and infants has historically been a focus of public health and public health nutrition. Balanced diet and appropriate weight gain have received attention in the past.
Now attention is also directed to preconceptual concerns such as folic acid intake and its association with neural tube defects. Recent research links factors in the fetal environment to risk for adult diseases including diabetes and cancer.
Breastfeeding for the first year of life is recommended because of its many benefits to infants and their mothers.
Childhood is a time when food preferences and habits are shaped.
Childhood nutrition affects growth and development, immune status, and social and cognitive ability. The nutritional intake of children with special health care needs also requires close scrutiny. Low calcium intake of girls and young women sets the stage for osteoporosis in later years.
Some subgroups of the population, including people with low incomes, some racial and ethnic minority groups, and people with disabilities (defined as functional impairments) experience a disproportionate amount of preventable illness and premature death. Nutrition is an important contributing factor.
Some groups, especially those who are economically disadvantaged or isolated, experience periodic or chronic hunger (also called food insecurity) resulting in undernutrition.
Reaching these groups with accessible, culturally-relevant, nutrition programs and services presents aspecial challenge to public health agencies and all community nutrition providers.
Targeting vulnerable subgroups and designing programs to meet their special needs is a strategy used by public health to attempt to reduce disparities in nutritional status and health among population subgroups.
Nutrition behavior (including food selection, preparation and consumption) is the product of culture, education, economics, food availability, social strata, family position and health status. Nutritional status depends on all those factors plus biological and genetic factors.
Guiding all members of the population toward more healthful food choices and optimum nutritional health is a great challenge. And doing so early enough to prevent the development of disease is a goal of public health nutrition.
Meeting this challenge requires the use of multiple, reinforcing behavior change strategies, including food and nutrition information and education.
Other strategies include:
— structuring the environment to enable positive food choices (e.g., juice machines replace pop machines)
— modifying food ingredients and preparation techniques to reduce fat content
— improving the availability of foods such as fruits and vegetables, and
— enacting legislation and regulation (such as required nutrition labels on food packages).
These indirect, environmental strategies complement the direct, individualized nutrition education and counseling provided in health care and other settings.
For more information see: Behavior Change Theary at a Glance
A wide ranging network of providers (including organizations, professionals and volunteers) help assure that needed community nutrition programs and services are available to the population and targeted subgroups.
The combined efforts of many providers are necessary to meet the challenge of assuring optimum nutrition for all. A range of providers also enables nutrition programs to be more closely tailored to the needs and interests of the target population or subgroup so programs are easily accessible and culturally-relevant to their users.
A part of the coordinating role of the public health departments is to assure necessary and appropriate nutrition services are available and duplication is avoided.
[Insert Figure 1 Network of community nutrition organizations]