Advancing the Health of the Population Through Public Health Nutrition Practice

1. Advancing the Health of the PopulationThrough Public Health Nutrition Practice A Message from the Pan Canadian Task Force on Public Health Nutrition Practice 2010-2011

2. Background The Pan Canadian Task Force on Public Health Nutrition Practice was formed in early 2006 to provide strategic guidance and expert advice on enhancing public health nutrition practice in Canada. It comprises leaders in public health nutrition and organization liaisons from across Canada. The work of the Task Force was funded by the Public Health Agency of Canada and administered by Dietitians of Canada.

3. Background The Task Force’s work is part of a large collection of pan Canadian activitiesthat are strengthening the public health system to better respond to current and emerging issues. The Task Force has been guided by: • Core Competencies for Public Health in Canada: Release 1.0 Building the Public Health Workforce for the 21st Century First Ministers’ Meeting on the Future of Health Care 2004

4. Background To date, the Task Force’s work includes: a literature review; key informant interviews; a situational analysis; a discussion document; a report on the consultation process that engaged more than 300 public health and dietetic practitioners, educators and managers; recommendations for action; examples of dietitians providing leadership in public health nutrition practice. Available at: www.dietitians.ca/publichealthnutrition

5. Results: A national definitionof public health nutrition practice As a result of this comprehensive research and consultation, the Task Force identified a national definition to shape the future direction of public health nutrition practice. Purpose of today’s presentation: • introduce you to this definition; • demonstrate how consistent use will strengthen public health AND nutrition practice, and improve the health of the population.

6. Results: A national definitionof public health nutrition practice The Task Force has identified the following national definition of public health nutrition practice: • Public health nutrition practice requires the leadership of dietitians with expertise in nutrition, food systems and related public health sciences. • Public health nutrition practice encompasses the assessment, promotion, protection and enhancement of health and the prevention of nutrition-related diseases. • Using population health and health promotion approaches, strategies focus on the interactions among the determinants of health, food security and nutritional and overall health.

7. Improving the health of the population There are many key public health issues related to food and/or nutrition, including: • chronic disease and obesity; • food insecurity; • childhood and maternal health. Public health nutrition professionals at various levels of influence are providing leadership in practice to address these challenges. On the following slides are examples of these professionals in action.

8. Improving the health of the population Chronic disease and obesity • According to the World Health Organization (WHO), chronic diseases account for a projected 89% of all deaths in Canada in 2005. • In 2004, 23% of adult Canadians were considered obese and 36% overweight. Prevalence of overweight in Canada is expected to increase. • Many provinces and territories have responded by establishing healthy eating and active living strategies. The cost: WHO estimates a loss of USD $9 billion (over 10 years starting in 2005) from premature deaths due to heart disease, stroke and diabetes. WHO Fact Sheet: Facing the Facts: The Impact of Chronic Disease in Canada Statistics Canada, Nutrition: Findings from the Canadian Community Health Survey (CCHS), Issue No. 1

9. Improving the health of the population Promoting healthy choices As a Junior Nutritionist at Health Canada, Joëlleprovides support for a report by the Sodium Working Group, which will recommend a national strategy for optimizing sodium intake. Melinda, a Public Health Dietitian at Toronto Public Health, works on a diabetes prevention project targeting two priority communities. She provides customized education in nutrition, physical activity and diabetes prevention, plus food skills and cooking sessions. As Program Advisor for the Office of the Chief Medical Officer of Health in New Brunswick, Suzanneis actively involved with provincial policy. She has analyzed federal recommendations on trans fat and identified implications for food produced in N.B. or served in restaurants. She will advise the Deputy Minister on the implications of the federal Sodium Working Group report.

10. Improving the health of the population Food insecurity Access to safe and nutritious food is a basic right for all citizens, yet many lack this access and experience food insecurity. • 8.8% of the population — more than 2.7 million — experience household food insecurity. • 2.4% of Canadians are assisted by a food bank. • 37% of the people who turn to food banks are children. The cost: Current levels of poverty in Canada have been estimated to cost the equivalent of $24.4 billion a year. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) Food Banks Canada, HungerCount 2009

11. Improving the health of the population • Supporting for food security Laura, the Traditional Diet Coordinator at the Yukon Hospital Corporation, has partnered with others to introduce a community gardens initiative, develop a traditional foods resource and a train-the-trainer tool for diabetes prevention and advocate for improved food security in the Yukon. As the sole regional nutritionist for Labrador North, Sarahparticipates in a number of local, regional and provincial working groups addressing the issue of food security in the region by considering social determinants such as education, income and social support. Liseworks at Agence de la santé et des services sociaux de Montréal, where she oversees 17 initiatives that advocate for policies and programs that enhance health, improve nutrition and address social inequalities.

12. Improving the health of the population Childhood and maternal health • In 2005, only 17% of mothers breastfed exclusively for at least 6 months. The likelihood rises with age, post-secondary education and in urban locations. • Among 21 similarly developed nations, Canada ranks 12th, on average, across six dimensions of child well-being. The cost: The earliest years are pivotal to growth and development. Children from families with lower income and lower levels of education generally have poorer overall health. Statistics Canada, Health Reports, March 2005, Breastfeeding practices The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2008

13. Improving the health of the population Enhancing childhood and maternal health A Public Health Dietitian in Kingston, Ontario, Stephanieplans and implements healthy eating programs for pregnant women, infants and young children. She also works with community groups on feeding workshops and breastfeeding promotion initiatives. Twylaoversees a multidisciplinary team with the Health Promotion Department in Saskatoon Health Region responsible for breastfeeding, infant and preschool nutrition, food security and healthy living initiatives. In her work, she references the WHO Baby Friendly Initiative. As the Provincial Nutritionist in B.C., Lisaworks across government ministriesand with key stakeholders to implement programs and policies that build healthy food environments. For example, through a partnership between agriculture, education and health, her team established a fruit and vegetable program that reaches all school children in the province.

14. A national definition of practice The Task Force has identified the following national definition of public health nutrition practice: • Public health nutrition practice requires the leadership of dietitians with expertise in nutrition, food systems and related public health sciences. • Public health nutrition practice encompasses the assessment, promotion, protection and enhancement of health and the prevention of nutrition-related diseases. • Using population health and health promotion approaches, strategies focus on the interactions among the determinants of health, food security and nutritional and overall health.

15. Call to action Work is already under way as a result of the new definition of practice. • The Partnership for Dietetic Education and Practice (PDEP) is collaborating on the creation of Integrated Competencies for Dietetic Education and Practice. • These competencies will form the foundation for future dietetic education, practical training and regulation of dietitians. • The competencies will help to ensure that new graduates entering the field are consistently prepared to meet the public health challenges ahead. • PDEP will need the support of employers and policy makers to realize the potential of the new Competencies. (Specific examples will follow.) More information available at: www.pdep.ca

16. Call to action Through today’s presentation, the Task Force is asking that policy makers and employers: • Adopt and promote the definition to strengthen public health and nutrition practice. • Use the definition to develop public health and nutrition programs, services and research, educational resources and in human resource planning. You can find more detailed case studies, showing how public health nutritionists across Canada are working within the definition at various levels, at:Public Health Nutrition Practice Scenarios: A Workforce Development and Professional Practice Tool. (www.dietitians.ca/publichealthnutrition)

17. Call to action Other ways that policy makers and employers can support public health nutrition practice: • Provide all dietetic students and interns with public health experiences in their education and practical training. • Identify, promote and support advanced level public health nutrition practice. • Present opportunities for public health nutrition staff to strengthen their practice, for greater consistency nationally and within the public health nutrition workforce. • For a full list of the Task Force recommendations, with commentary, see: Strengthening Public Health Nutrition Practice in Canada: Recommendations for Action (www.dietitians.ca/publichealthnutrition)

18. Summary • Strong public health nutrition practice is critical to protecting and enhancing the health of the population. • In many areas, as our examples have shown, this is already happening. • The definition of public health nutrition practice is a policy tool that will help increase consistency in practice and improve the health of the population.

19. More information Please refer to the accompanying handout for a summary of today’s discussion and follow-up resources. This presentation and the work of the Task Force are available at www.dietitians.ca/publichealthnutrition

20. More information Questions?

21. Thank you for your time and interest