Community Nutrition Mid-Term Flashcards
What influences policy makers?
- Laws
- Regulations
- Policies
What are the changing social and economic trends?
- More immigrants;
- Aging populations;
- Rising costs, changing consumer expectations, increased competition, and greater cultural diversity;
- Downsizing, mergers, cross training, and managed health care
What is a Community?
–A group of people located in a particular space who have shared values and interact within a social system •People •Location in space •Social interaction •Shared values
What is Community/Public Health Nutrition?
-Discipline that strives to prevent diseases and to improve the health, nutrition, and well-being of individuals and groups within communities
Who are the People?
Those who are served by and benefit from community nutrition programs
What is a Policy?
-Course of action chosen by public authorities to address a given problem;
-What governments and organizations intend to accomplish through their laws, regulations, and programs
EX: Dietary Guidelines for Americans
What are the Dietary Guidelines of Americans?
- 2010;
- the cornerstone of Federal nutrition policy and nutrition education activities;
- Issued and updated every 5 years by the Department of Agriculture (USDA) and the Department of Health and Human Services (HHS).
What are the main points of the DGA?
- Intended for Americans ages 2 years and over, including those at increased risk of chronic disease;
- Focused on foods and beverages that help achieve and maintain a healthy weight, promote health, and prevent disease;
- 7th edition released since 1980 and remain the current edition until the 2015 Dietary Guidelines for Americans are released.
What is MyPlate?
- Tool used to INTERPRET the Dietary Guidelines;
- Build a healthy plate;
- Cut back on foods high in solid fats, added sugars, and salt;
- Eat the right amount of calories for you;
- Be physically active your way
What are Programs?
Instruments used by community nutritionists to seek behavior changes that improve nutritional status and health
What is Public Health?
- Organized effort by society to →
- Protect, promote, restore the health of people through the application of science, practical skills, and collective action
What is the WHO definition of “Health”?
“state of complete physical, mental, and social well-being, not merely the absence of disease”
→ Focus is on OVERALL well-being and health, not just about the foods and what is being eaten
What are the Populations by stages of disease continuum?
- Well Population = Primary Prevention;
- At Risk = Secondary Prevention/Early Detection;
- Established Disease AND Controlled Chronic Disease = Disease Management and Tertiary Prevention
What is the goal between Primary and Secondary Prevention?
- Between Well and At-Risk;
- PREVENT disease incidence
What is the goal between Secondary and Established Disease?
- Between At-Risk and Diseased;
- Prevent PROGRESSION
What is the goal between Established Disease and Controlled Chronic Disease?
- Both Disease Management and Tertiary Prevention;
- REDUCE complication or disability
What is included in Primary Prevention?
- SCREENING;
- Individual = (Promote breastfeeding, 5-to-9 a-day campaign, Food safety training)
- Community = (Health fairs promoting low-salt cooking, Walking trails in local parks)
- System = (State requirement for daily PE)
What is included in Secondary Prevention?
- DETECTION;
- Individual = (Screening of individual patients by physicians, Early diagnosis, counseling, medical nutrition therapy)
- Community = Cholesterol screening at local grocery store, Osteoporosis check at local health fair)
- System = (Insurance company reimbursement for weight loss)
What is included in Disease Management and Tertiary Prevention?
- TREAT and REHABILITATE:
- Individual = (Diabetes management, Medical nutrition therapy and rehab services after a heart attack)
- Community= (Offering special diets in community feeding programs)
- System = (Legislation mandating special diets be provided in federal nutrition programs)
What is Healthy People 2010?
-National Health agenda for the current decade;
-22 Nutrition and Weight Status Objectives;
-Benchmarks and monitored progress over time in order to =
Encourage collaborations across sectors.;
-Guide individuals toward making informed health decisions;
-Measure the impact of prevention activities
Who is the Community Nutritionist?
Identifies the need of the community and puts into place a program or service designed to meet that need.
What is an Entrepreneur?
- One who undertakes the risk of a business or enterprise;
- Enterpriser
- Innovator
- Initiator
- Promoter
- Coordinator
- Must have creativity and innovation
What are the Leading Indicators of Change in Public Health?
- An aging population;
- Generational diversity;
- Increasing demands for nutrition and health care services;
- Increased ethnic diversity;
- Challenges of the twenty-first-century lifestyle;
- Increasing awareness of environmental nutrition issues;
- Global Environmental Challenges for Public Health
What is a Policy?
The course of action chosen by public authorities to address a given problem;
- Anything that you feel is important and that you lobby for;
- Public policy is out profession;
- Knowing that there’s an issue that needs to be changed
What is the PURPOSE of a Policy?
To fashion strategies for solving public problems.
What is Policy Making?
- Process by which authorities decide which actions to take to address a problem or set of problems;
- “If dietetics is your practice, politics is your business” –Academy of Nutrition and Dietetics
What is required for a nutrition concern to become a policy?
- Scientific basis and program evaluation;
- Supportive political climate
What are some Nutrition-Related Policies?
-Dietary Guidelines for Americans 2010
-National Policies Formulated by the US Congress
oFederal Food, Drug, and Cosmetic Act
oNutrition Labeling and Education Act
oDietary Supplement Health Education Act
What are the Steps of Policy Making?
- Define the problem and set the agenda
- Formulate alternatives or policy formulation
- Adopt the policy
- Implement the policy
- Evaluate the policy
- Terminate the policy
What is involved in Defining the Problem and Setting the Agenda (Step 1)?
- Problem is defined → You want to make it public knowledge;
- Problem is brought to the attention of the policy makers;
- Issue is put on the agenda for consideration;
- Build widespread public interest (Media!)
What is involved in the Formulation of Alternatives (Step 2)?
- Discussion of possible solutions to a problem;
- Policy Formulated at the…
- National (federal), state, and local levels by the;
- Legislative, executive, and judicial branches of government
What is involved in Policy Adoption?
- Select tools or instruments to achieve a given policy;
- Tools are wielded by federal, state, and municipal departments and agencies that are responsible for implementing policy
What are the TOOLS for policy adoption?
- Regulations
- Cash grants
- Loans
- Tax breaks
- Certification
- Fines
- Price controls
- Quotas
- Public promotion
- Public investment
- Government-sponsored programs
Who are the Administrative Agencies Responsible for Nutrition Policy Implementation at the FEDERAL LEVEL?
- DHHS – Department of Health and Human Services;
- USDA
What is the role of the DHHS?
- Protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves;
- Over 300 programs: health research, preventing outbreaks of infectious disease, ensuring food and drug safety, providing financial assistance to low income and older Americans (CDC, NIH, FDA)
What is the role of the USDA?
-Provide leadership on food, agriculture, natural resources, and related issues
What is involved in Policy Implementation?
- Process of putting a policy into ACTION;
- “Just do it.”
- Millions of policies on state, local, and federal levels working w private organizations and interest groups to carry out government policy
- ‘BUGS’
What are BUGS?
-Bridging Urban Society = Helps create greening projects such as organic gardens on unused, littered, vacant lots
What is involved in Policy Evaluation?
-Evaluation process begins as soon as the agenda is set; Is it working?;
Determines…
-If the program is ACHIEVING its stated goals,
-if the program is REACHING the intended audience;
-if the program is ACCOMPLISHING what it intended to accomplish, and who is benefiting from the program
What are the reasons for Policy Termination?
- Public need was met
- Nature of the problem changed
- No longer mandated by the government
- Policy lost public support
- Private agency relieved the need
- Political system or sub-government ceased to function
- Too costly
WHO is involved in making policies?
- Everyone is involved in policy making but typically it is thought of as something accomplished by elected officials;
- Administrators, executives, committees w/I an organization, bureaucrats, community nutritionist..(those working directly with people);
- Even those people who volunteer at a food bank. -These people are the ones that get it going.
How are Laws and regulations related?
- Laws tend to be vague and broad in scope;
- Administrative agencies interpret the law and provide detailed regulations or rules
What are Law Makers?
ARE NOT POLICY makers → It would take the public out of the policy making.
What are Legislators?
-Legislators ARE LAW MAKERS. “representation democracy.” We can now put the public back into the argument.
What re Judges?
NEITHER policy or law makers
How do Policies related to Laws?
- Implement the law and make them real. And we all make public policies happen;
- They’re the TOOLS of our gov’t.
What is a Budget?
- Provided funds to enforce the laws and regulations;
- Notes income and expenditure and describes intentions for future spending intended to control and shape activities of government agencies
What is involved in a Federal Budget?
- Receipts or Revenue
- Budget authority
- Budget outlays
- Mandatory spending
- Discretionary Spending
What is Receipt or Revenue?
-Amount govt expects to raise through taxes/fees.
What is Budget Authority?
-Amount govt agencies are allowed to spend in implementing their program
What is Budget Outlay?
-Amounts paid out by govt agencies
What is Mandatory Spending?
-Entitlements = Programs that require the payment of benefits to all eligible people as established by law (i.e. SNAP)
What is Discretionary Spending?
- Budget choices that can be made after money is allocated to the entitlement programs (i.e. WIC);
- In the program’s discretion on how they spend the money.;
- They have to be able to account for all spendings
What is the Federal Budget Year?
- Begins October 1st;
- Ends September 30th
- U.S. fiscal year is named for the year in which it ends Oct 1, 2012 - Sept 30, 2013 = FY 2013
What is initiates political process?
- Contacting your congressman or congresswomen (U.S.)
- Contacting your legislature member (Louisiana)
What are some emerging political issues?
- State Licensure laws
- Bioterrorism and food safety
- Biotechnology
- Complementary and alternative medicine
- Functional foods and neutraceuticals
- Herbal and dietary supplements
- Human genome project
What are the ways to influence the Political Process?
-Become directly involved;
-Join an interest group;
-Work to influence the political process;
Take political ACTION =
-Write effective letters or e-mail messages – p. 196-197
-Make effective telephone calls
-Email
-Media
What are the National Nutrition Issues?:
- Obesity;
- Hunger;
- Malnutrition;
- Food safety;
- Food labeling;
- Food fortification;
- Nutrition research
What is National Nutrition Policy?
A set of nationwide guidelines that specify how the nutritional needs of the population will be met;
-NO one federal nutrition policy office responsible for overall policy
What areas policy areas does nutrition policy cross?
- Agriculture
- Exports
- Imports
- Commerce
- Foreign relations
- Public health
- National defense
How does the US Nutrition Policy manifest itself?
- Food assistance program rules and requirements
- National food and nutrition objectives (Healthy People 2020: Nutrition and Weight Status)
- Regulations to safeguard the food supply and safe handling of food → Food safety must always be monitored!
- Dietary guidance systems → Must always meet guidelines for all individuals involved and served
- Monitoring and surveillance program directives and mandates
- Food labeling legislation
What are the areas of Nutrition Policy?
- Monitoring;
- Research;
- Policy Making
What is involved in National Nutrition Monitoring?
- Screening = Identify individuals AT RISK;
- Assessment = Measurement of indicators of dietary and nutrition-related health status;
- Monitoring = Assessment of dietary or nutritional status at intermittent times → Over time;
- Surveillance = CONTINUOUS collection of nutritional assessment data, especially on high-risk populations
What is the National Nutrition Monitoring and Related Research Program?
- Measures the health and nutritional status, food consumption, dietary knowledge, and attitude about diet and health of the U.S. population;
- Measure food consumption and the quality of the food supply
Who are the PRIMARY Federal Sponsors of the National Nutrition Monitoring and Research Program?
- U.S. Department of Health and Human Services (DHHS);
- U.S. Department of Agriculture (USDA)
What are the major components of the National Nutrition Monitoring and Research program?
- Nutritional status and nutrition-related health measurements;
- Food and nutrient consumption;
- Knowledge, attitudes, and behavior assessments;
- Food composition and nutrient databases;
- Food-supply determinants
What is “What We Eat in America (WWEIA)”?
- NHANES is a national food survey conducted as a partnership between the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Agriculture (USDA);
- USDA’s Continuing Survey of Food Intakes by Individuals (CSFII) and HHS’ NHANES;
- Combined in 2002;
- DHHS = gathering information and doing the monitoring;
- USDA = development and analysis of the program
What is the 2008 Farm Bill?
-Nutrition Monitoring =
“Requires Secretaries of Agriculture and Health and Human Services to jointly monitor, conduct research on, and disseminate to the public information on diet, nutrition, physical activity, and related issues.”
What are the Mission areas of the USDA?
- Farm and Foreign Agricultural Services
- Food, Nutrition and Consumer Sciences
- Food Safety
- Marketing and Regulatory Programs
- Natural Resources and Environment
- Research, Education, and Economics
- Rural Development
What are some uses of National Nutrition Monitoring Data?
- Health planning
- Program management and evaluation
- Timely warning and intervention efforts to prevent acute food shortages
- Directions for research activities
- Used to make policy decisions regarding food assistance programs, nutrition labeling, nutritional recommendations, and education.
What are the Nutrition INTAKE Standards?
- Dietary Reference Intakes (DRIs)
- Dietary recommendations of other countries and groups
What are the Dietary Guidance Systems?
- Dietary Guidelines with MyPlate food plan
What are the DRIs?
- Estimated Average Requirement (EAR)
- Recommended Dietary Allowance (RDA)
- Adequate Intake (AI)
- Estimated Energy Requirement (EER)
- Acceptable Macronutrient Distribution Range (AMDR)
- Tolerable Upper Intake Level (UL)
What is the World Health Organizations view on health?
Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social services
What is lacking with health care policy?
- Needs to be a national obsession;
- Lack of interrelationship between the science behind successful diets and the public putting them to use;
- Health care for all citizens
Why is there a lack of PREVENTATIVE care?
- Reimbursement for preventive services provided by the present health care system is LIMITED:
- Increased encouragement of preventative care;
- Dietetics gets little reimbursement;
- Affordable Care Act of 2010 attempts to address
How much of the population has Private Insurance?
~ 65% of the nonelderly population;
- 92% of private coverage w/ employers;
- Indemnity or Traditional fee-for-service plans (~8%) → USED to be the majority;
- Group contract insurance (~92%)
How much of the population has government insurance?
~27.8% of the population;
- Federal (Medicare, Medicaid, Military Health Care)
- State/Federal partnership (State Children’s Health Insurance Program SCHIP)
What is Private Indemnity or Traditional fee-for-service plans?
- Charges a fee for EACH SERVICE rendered;
- Provided by BOTH commercial insurance companies and not-for-profit organizations such as Blue Cross and Blue Shield and independent employee health plans
What is Private Managed Health Care Insurance?
- Prepaid group practice plans that offer health care services through groups of practitioners;
- Health Maintenance Organization (HMOs) → Set group of providers
- Preferred Provider Organization (PPOs) → A little more flexibility with choosing physician
- Point of Service Plan (POSs) → Much more traditional; More choice and more expensive
Who are providers of government or public insurance?
- Medicare
- Medicaid
- SCHIP → LACHIP in Louisiana
- Workers compensation
- Medical care for US military veterans (VA System)
- Public Health Service and Indian Health Service
- Department of Defense Military Health Services (TRICARE)
- Department of Justice Federal Bureau of Prisons;
- *Physicians decide which plans to APPLY for and must meet requirements of that plan to be accept as a qualified provider
What is Medicare?
(> 43 million enrolled);
- Based on age; People ages 65 and older or the disabled
- Administered by the Centers for Medicare and Medicaid Services (CMS) which is an agency in the DHHS
What is Part A of Medicare?
- Hospitalization insurance;
- Inpatient charges reimbursed according to a prospective payment system (PPS) known as diagnostic-related groups (DRG’s)
What is Part B of Medicare?
- Medical insurance;
- Optional medical insurance;
- Financed through premiums paid by enrollees and contributions from federal funds;
- Supplemental medical insurance benefits
What is Medicaid?
(> 47 million);
Based on lower socioeconomic status;
Federal/state funded and state administered;
Entitlement program to provide medical benefits for certain LOW-INCOME persons
What is LaCHIP?
- Partnership between the federal government and Louisiana to provide health coverage for children from birth until age 19 years;
- Program for qualifying families which provides total health care for the children;
- East Baton Rouge Parish → 11,592
- State Total → 123,070
What is LaMOMS?
- Expansion of Medicaid coverage;
- Provides health benefits for low-income pregnant women who qualify
Who are the Uninsured population in the US?
2009 50.7 million nonelderly people were uninsured (16.7%);
- Working poor
- Small business who can’t afford;
- Self-employed, part-time employees, seasonal workers
- Early retirees
- Young adults are most likely to be uninsured.
- People in the south and west are more likely to be uninsured than those in the northeast and Midwest.
- Most uninsured are in families with at least one full time worker.
- Hispanics have the highest rates of uninsured, but the largest share of the uninsured by far is white Americans.
What is Maslow’s Hierarchy of Needs?
- Physiological
- Safety
- Belonging/Love
- Esteem
- Self-Actualization
What areas need to be addressed for health care reform to provide everyone affordable health care?
- Cost
- Quality
- Access
How is Cost Containment for health care reform implemented?
- Movement away from traditional fee-for-service plans to HMOs, PPOs, & POSs;
- Cost shifting & self-insured health plans;
- Payers are actively setting reimbursement restrictions and limitations → People who pay the providers and give them reimbursements and establish how many visits or meetings are allowed
- People are not allowed total access to health care due to growing expense;
- Copayments
What is the Prospective Payment System (PPS)?
- Cost containment;
- Federal government implemented as a result of the 1983 Social Security Amendments;
- Based on knowing the amount of payment in advance;
- Cost are PRESET
What is a Diagnostic Related Groups? (DRGs)
-System of classifying hospital admissions for Medicare reimbursement;
~10,000 possible reasons for hospital admission
-23 major categories divided into 490 DRGs
What is the benefit of preventative care through optimal nutrition?
- Optimal nutrition is cost effective;
- Preventive = good nutrition → good health → less illness → less cost;
- good nutrition → improved patient outcome → reduced recovery time → reduced cost
What is Nutrition Intervention?
- Increase in knowledge, skills, and motivation;
- Changes in food habits;
- Altered risk factors;
- Positive outcomes;
- Decreased health costs