Module 3 Sociopolitical Context, Global Nutrition, Socioeconomic Position Flashcards
Health Equity
The attainment of the highest level of health for all people. Requires valuing everyone equally and addressing inequalities and injustices in the world and within the healthcare system.
Governance
Society’s organizational structure, is comprised of economic, political, and social institutions. Operate across all levels, from household to community, to country.
Branches of Government
Legislative, Executive, Judicial
Legislative Branch
House & Senate - Has many committees. In the Senate, every member has a say across committees. In the House, there’s respect for committees
Major Committees in Legislative Branch
Finance (S), Health, Education, Labor, and Pensions (S), Energy and Commerce (H), Ways and Means (H), Education and Labor (H)
Nutrition in Congress
Agriculture (FDA, USDA), Armed Services, Judiciary, Transportation
Executive Branch
President & VP- Hold multiple departments. Driven by campaign promises, health, and economic priorities, judicial actions, etc.
Departments in Executive
Department of Health and Human Services
Department of Agriculture
Food and Nutrition Policies
Food prices, taxation, labor regulation
Food assistance programs
Food production
Purchasing, actions, labeling, and food retail standards
Food prices and adjustments
Farm to institute programs
Breastfeeding support
Food Policy and Taxes
About 40 states have some form of tax mechanism for soft drinks, candy, and snacks
Higher tax on foods that are worse (3.4%)
SNAP purchases are tax exempt
SNAP being tax-exempt
Good/bad because does not impact food choices
People mad about this because taxes are supposed to raise funds for social programs so it defeats the purpose
Farm Bill
Multiple year act of congress dealing with support of farming, food assistance, agricultural trade, and rural development
Goal of Farm Bill
Give money to farmers who grow crops that are easily converted into energy dense foods
Help farmers get a good and fair income
Food assistance safety net for income-eligible recipients
What percent of cropland is used for fruits and veg
4%
What size farms get more subsidies
Large farms
How many cents on the dollar go to nonfarm activities
81 cents of the dollar
Relationship between farm quantity and size
Number of farms have decreased but the average farm size has increased
How many nutrition assistance programs does the USDA have?
16
How many people does SNAP feed?
40 million
How many people are food insecure globally?
820 million
What were the early stages of food assistance programs?
Government wanted to give out as much inexpensive food as possible
Dont call it a third-world country call it
Global south (formerly developing country)
Hunger
An uncomfortable physical sensation caused by insufficient consumption. Can become chronic
Food Security
Having access to sufficient, safe, and nutritious food all the time. Access to their food preferences for an active and healthy life
Undernutrition
The result of insufficient food intake; can also result from an unsanitary environment that exposes children to repeated infections leading to poor absorption or utilization of the nutrients consumed. Wasting, underweight, nutrient deficient. (More common in the past for low-income countries)
Wasting
Low weight for height. Shocks to poverty or health
What does wasting indicate
Indicative of acute malnourishment.
Stunting
Low height for age. Disease or infection. Recovery hard. Can cause health problems, birth problems, brain problems stemming from poverty, poor conditions, or undernutrition.
What is stunting indicative of
Indicative of chronic malnourishment.
Underweight
Low weight for age
Underweight Indication
No indication it is due to wasting or stunting
First 100 Days of Eating
Most important to be nutritious to not have physical effects of undernutrition that can last a lifetime
Micronutrient Deficiencies
Anemia, Iodine, Vitamin A, Zinc
Anemia Deficiency
Iron, Folate, B12: Fatigue, weakness, associated with developmental deficits
Iodine Deficiency
Can lead to abnormalities during pregnancy and stillbirth. Can cause mental impairments
Vitamin A
Blindness. Increase risk of death from disease and infections
Zinc
Can increase death from diseases and infections
Types of Interventions for Global Nutrition
Social and Behavioral Change (SBC)
Nutrition-specific interventions
Agricultural Interventions
Social Safety Net Programs
Social and Behavioral Change (SBC)
Group education and support groups
Mass media
Community mobilization (events, health days etc.)
Nutrition-specific interventions
Maternal Nutrition
- Increased energy and protein intake during pregnancy and lactation
- Micronutrient fortification
Breastfeeding practices
- Early Initiation (Breastfeeding immediately after birth)
Complementary feeding practices
- Feeding a diverse diet of ingredients
- Feeding during illness
Agricultural Interventions
Primary occupation for many of the poor in rural areas (80%)
Increase household availability and access (food security)
Social Safety Net Programs
Give cash transfers to low-income households: can especially help women and the malnourished
Conditional Cash Transfers
Can only use the cash for certain purposes
- Most target women to improve women’s empowerment
- Also school feeding programs
Unconditional Transfers
Given cash or in-kind
Early Child Development in Nutrition (ECD)
Link between stunting and poor brain growth and development (psychosocial stimulation)
Water, Sanitation, and Hygiene (WASH) & Nutrition
Unsafe water and poor sanitation can cause infection/diseases/worms which leads to malnutrition
Women Empowerment
Women do a large percentage of agricultural work, but face economic constraints
Women often lack decision-making power and face time constraints
Intimate Partner Violence
- > 30% of women in sub-Saharan Africa experience IPV
- Can restrict decision-making and affect nutrition
Careers in Global Nutrition:
Research
Health Professional
UN, Government, NGO’s, Academia
Socioeconomic position
Social and economic factors that influence health. Materials and other resources are unequally distributed. An interplay between policies, social stratification (income, years of education, race, gender), and the position of individuals (social resources, assets)
Social Stratification
A society’s hierarchy and rank system (separation of members based on certain characteristics)
Low SES Food Intake
Legumes, Pasta/cereal/rice, POTATOES, White bread, Deli meat/fatty meat/ fried meat, Canned/fried fish, EGGS, Whole milk, ANIMAL FATS fats, Beer, Sugar
High SES Food Intake
Whole wheat, Fresh foods, Frozen foods, Juices, Lean meat, Seafood, Wine/alcohol, Low-fat dairy, Cheese, Candy, Pastries
Both SES Food Intake
Vegetable Fats
Low SES and Energy/Nutrient Intake
Caloric, Carbs, Fats
High SES and Energy/Nutrient Intake
Proteins, Fiber, Vitamin C, Folate, B Carotene, Calcium, Iron
Race
social construct that was built upon the assumption that there are biological differences between the races
Ethnicity
More complex. Based on ancestry, language, culture, geography, traditions etc
Structural Racism
When society fosters racial discrimination through its system such as employment, earnings, benefits, health care, criminal justice etc.
Personal, interpersonal, INSTITUTIONAL, cultural
Gender
Socially constructed characteristics of women and men
Systems of Thinking
Mental framing and thinking to analyze how something is connected and the links between different factors. Understanding how it works holistically. A systems component may act differently when assessed individually compared to when operating in the system (the part and the whole mentality)
Food System
The pathway of growing food to disposing of it once consumed. Crop/animal/seafood production, workers, climate change, food distribution, food processing/labeling/marketing, food waste, hunger, food policy. If one thing goes awry in the system, it can throw off the entire system (baby food shortage)
Other systems relating to food
environmental, governmental, cultural, health care systems etc.
Consumer Subsystem
Focuses on the household as a unit which acquires food, transforms them into meals and eats them. Household can be one person or a large kinship.
Where people are getting their food
Informal: Markets, Vendors, Kiosks
Formal: Restaurants, food stores, social programs
Other: Homes (home gardens), schools, retail markets
Food store alternatives: vending machines, soup kitchens, food pantries, farmers markets
Food Availability v Food Affordability (Boston Ex)
More corner stores where the average income is lower. More grocery stores in places of higher average income. Food is also slightly cheaper in lower income areas.
Food Swamp
Area clustered with fast-food
Material Circumstances
What are your resources and availability that allow you to have food or not
Access to healthcare, built environment, economic stability, food and water access, living and working conditions, transportation
Access to Insurance
1/10 people in the US don’t have health insurance. People without insurance are less likely to have a primary care provider or afford the medical services they need.
Access to Economic Stability
1/10 people are poor meaning they struggle to afford healthy foods, health care, or housing. People with steady employment are less likely to live in poverty and more likely to be healthy. Poor health can affect the ability to work. Policies for career counseling and child care can support people in finding and keeping steady jobs. Policies that also give food, housing and healthcare also can reduce poverty and improve health.
Neighborhoods and Material Circumstances
If there is violence or unsafe air/water it can hinder food access. Can also impact physical health.Racial and ethnic minorities and people with low-income are more likely to live in worse neighborhoods. (Example: Delmar Boulevard in Missouri)
Access to Transportation
High-quality public transit infrastructure is important to facilitate food access. Some people need to take the bus to get food but if transit is unreliable they cant. They also have to limit how much food they can get since you’re taking it on transit. Smaller stores within walking distance are best so someone without a car can make multiple quick trips. There are other opportunities like farm-to-institutions, shuttle services, delivery services etc.
Health
State of complete physical, mental and social well-being; not just about disease. Subjective and personal but can also be in a state of flux. Does not indicate the worth of a person.
Body Mass Index (BMI) Purpose
Toll to indicate current and future health.
Body Mass Index (BMI) History
Developed in the 1800’s by Astronomer Adolphe Quetelet. Based on French and Scottish men of the 1800’s. Ancel Keys (physician) collected heights and weight from predominantly white nations in the 1970’s so it doesn’t really reflect women or POC
Problem with BMI
It is quick, cheap and easy. It is also a very old tool that is culturally inappropriate. Inaccurate for those with higher amounts of muscle mass and does not reflect overall health. Inaccuratly measures body fat but overall still used today
BMI Equation
BMI = [Weight in Kg/ Height in m]^2.
BMI Scoring
<18.5 is underweight; 18.5-24.9 is normal; 25-29.9 is overweight; obese is >30
Regulation of Body Weight Balance
Energy Intake v Energy Expenditure
T/F: If everyone ate the same, we would all look the same
False
Obesity Epidemic Explanation
Food Quality, Human metabolic changes, Intergenerational influences, Medication, Lifestyle, Mental disorders
Obesity Chronic Condition Label
2012, AMA classified obesity as chronic disease. Obesity causes many chronic diseases so it should be labeled a disease in its own right.
Weight Loss as a “Cure All”
Little research on the long-term benefits of weight loss. Study found that the probability of an obese persona acheiving ans mainting a 5% weight reduction is ⅛ for men and 1/7 for women (clearly very hard!)
Minnesota Starvation Diet
1944, 36 men. The first 3 months they got 3,200 calories a day, the next 6 months they got 1,570 a day and the next 3 months got 2000-3000 a day. Then an 8 week unrestricted period. Resulted in psychological and physical effects of starving themselves and then slowly adding more calories. Some dropped out because it was too hard.
Consequences of Intentional Weight Loss
Weight cycling, hypertension (high blood pressure), high triglycerides, insulin resistance (type 2 diabetes) and weight gain.
What is a weight bias
Stigma and shame will motivate people to lose weight. People are responsible for their own weight and fail to lose it because of poor self-discipline or lack of willpower
Why does a weight bias exist
Because of our society and culture. Society values thinness and allows the media to portray obese individuals in a biased and negative way.
The effects of weight bias
Weight stigma, shame, negative body image, unsafe weight loss methods, depression, anxiety, eating disorders, poor physical health, and weight gain
Effects of dieting on physical health
Higher blood pressure, type 2 diabetes, metabolic syndrome
Bias in the healthcare system
Patients feel like their doctors are rude or make assumptions about them because of their weight. Feel ashamed that they didn’t lose weight or ignore their medical concerns if they are always attributed to their weight.
Stigmatizing language around weight
Obesity is latin for “to overeat.” People seem to prefer fat, bigger bodied, or higher weight etc.
Weight Stigma and cycling can independently increase risk for chronic diseases T/F?
True
Socio Ecological Factors in Childhood Obesity
Culture, Country, Community, Clan, Child, Cell
What do we do now regarding weight
Understand that health is more than weight and food is more than nutrition
Understand that diet is more than an individual choice
Develop health practices that build on cultural values around food and eating
Respect and appreciate different body shapes
Focus on the whole person as an individual
Focus on improving health behaviors
Fight against weight discrimination/stigma/bias
What is HAES
Health at every size
What does HAES do?
Social movement organization that focuses on health enhancement, weight inclusivity, eating for well-being, and respectful care.
Results of HAES Interventions
Improves health behaviors, physical activity, and diet quality, Improvements in total cholesterol and LDL cholesterol, Potential improvements in blood pressure, No body weight changes observed, Much more research is needed
Intuitive Eating
Eating when you are hungry and stopping when you are full– Reject the diet mentality, Honor your hunger, Make peace with food, Discover the satisfaction factor, Cope with your emotions and kindness, Respect your body, Movement-feel the difference, Honor your health-gentle nutrition
Hunger
Individual-level physiological manifestation
Hormone that makes you hungry
Ghrelin
Hormone that tells you youre full
Leptin
Food Insecurity
Not an individual-level condition like hunger is. Considers economic and social factors. Not everyone who experiences food insecurity experiences hunger.
Food Security
Consistent access to enough food for an active, healthy life (acc to USDA)
4 Pillars of Food Security
Availability
Accessibility
Utilization
Stability
Four Types of Food Security
High food security
Marginal food security
Low food security
Very low food security
High Food security
No problems accessing adequate food consistently
Marginal food security
Some problems accessing food but intake was not reduced
Low food security
Reduction in quality and quantity of food (Food insecurity without hunger)
Very low food security
Disruption of eating patterns and lack of intake due to low resources (Food insecurity with hunger)
Food Insecurity Key Statistics
10.2% of households experience food insecurity. Most food insecure people are those whose income falls 185% below the poverty line (also black, hispanic, children, and single women households)
Risk Factors in Experiencing Food Insecurity
Socioeconomic factors like income and employment. Limited food availability can lead to lower diet quality, chronic disease, and poor mental health
Covid 19 Impact of Food Insecurity
Prevalence of food insecurity not super different during covid. Black and Hispanic people had more insecurity. Average insecurity stayed the same and white people had less insecurity.
Nutritional Security
Having equitable and stable availability, access, affordability, and utilization of foods that promote well-being and prevent disease (Food security + health). Moves the nation towards health equity where not only is everyone eating but now everyone can have healthy foods. Just because everyone is eating doesn’t mean the quality is the same and the outcomes are the same
Food Banks
collects and stores food to eventually supply other community food programs
Food Pantry
Where food is personally distributed to individuals/families
SNAP
supplemental nutrition assistance program
Purpose of SNAP
Provide benefits through an electronic benefits system (EBT) to be used to purchase food items later. Has sub-initiatives that help certain groups like families. In 2021, 41 million people participated
WIC
SNAP for Women, Infants and Children (up to 5)
WIC Purpose
Also provides health care support and referrals to women, infants, and children with limited resources. In 2021, over 6 million people participated
NSLP
National School Lunch Program
National School Lunch Program purpose
Provide free or low-cost nutritious meals to children of low-income families. In 2019, 29.6 million children participated
Innovative Ways to Increase Food Access
Community gardens
Produce prescription
Mobile markets or pantries
Online grocery services
National Strategy on Hunger, Nutrition and Health
In Sept 2022, Biden Admin created playbook to end hunger and increase healthy eating and physical activity by 2030 → 5 pillars
5 pillars of National Strategy on Hunger, Nutrition and Health
- Improving food access and affordability
- Integrating nutrition and medical health
- Empowering all consumers to make healthy choices
- Supporting physical activity for all
- Enhancing nutrition and food security research
Improving food access and affordability
Expand access to free school meals and summer EBT to children
Make it easier for people to get assistance
Support efforts of cultural and healthy foods for Native Americans
Integrating nutrition and medical health
Expand medicare recipients access to “food is medicine” interventions
Medicare covering obesity counseling
Screen for food insecurity in health care systems
Promoting diverse healthcare workforce that includes nutritionists
Empowering all consumers to make healthy choices
Labeling food as healthy should align with its actual health
Making nutrition info easily available when shopping alone
Supporting physical activity for all
Connecting more people to parks
Increasing awareness of the importance of physical activity
Enhancing nutrition and food security research
Bolster research funding
Research intersections of nutrition such as climate change, race, and food security with nutrition
What is climate change
Long term change in the average weather patterns
Effects Earths local, regional, and global climates
Climate
Long-term regional average of temperature, humidity, rainfall over long periods of time
Weather
Atmospheric conditions that occur locally over short periods of time (wind, snow, rain)
Greenhouse Gas effect
gas trapped in the atmosphere (CO2, CH4, N2O, F gasses)
CO2 in nutrition
fossil fuel use (the largest greenhouse gas)
Methane in nutrition
agriculture, waste management, energy use
N20 in nutrition
agriculture (fertilizer), fossil fuel
F-gasses in nutrition
refrigeration
Greenhouse gasses by sector
Agriculture, forestry, electrical and heat production industry, transportation, buildings
How greenhouse gasses work
Solar radiation enters the atmosphere. The atmosphere tries to release it to balance energy but CO2 traps it so it goes more towards earth. The maintain equilibrium, radiation is added so average temperature of earth elevates
How much have global temps risen
2.12 degrees
Which country emits the most greenhouse gasses
China
IPCC
International Panel on Climate Change
What does the International Panel on Climate Change do and what did they report?
Body governed by the UN responsible for advancing knowledge
Three working groups of the IPCC: The physical science basis, Impacts, adaptation and vulnerability, Mitigation of climate change
Report: Earth will cross the 1.5 C threshold by 2040. 5 shared socioeconomic pathways. More extreme weather ahead and more drought.
How does climate change impact nutrition
Climate change affects food production and food production effects climate change
Climate change can compound nutritional health problems
Global Syndemic
Three pandemics (obesity, undernutrition, and climate change)
Crop Yield and Climate Change
Loss of biodiversity, changes in pests and diseases that can impact crops, extreme weather events impact crop yields, heat impacts produce which raises prices when it’s hard to grow crops
Nutritional Value of Foods and Climate change
Rising CO2 decreases protein content in certain staple crops (wheat, rice, barley). Can also decrease Ca, Zn, Fe, and Mg
Avocado decreased by 40% in Ca.
Coffee production impacted by temp so its been harder to grow and pests have also been a problem
Potatoes depend on rainfall which will become unsuitable by 2050
Vanilla impacted by temperature, heat waves, droughts so prices increasing a lot
Suitable Food System (SFS)
Food system that delivers food security and nutrition for all in such a way that the economic (it is profitable), social (broad-based benefits), and environmental (positive impact on environment) bases to generate food security and nutrition for future generations are not compromised
Why we nee sustainable diets
Food production is among the largest drivers of climate change (contributes to chemical pollution, freshwater use, GHG emission). Relies on a functioning environment so climate needs to be good but it makes it worse. By eating foods that do not increase climate change we are bettering our world
What makes food sustainable?
Not having a lot of travel miles, food storage, processing, waste, packaging, water and land use, greenhouse gasses emitted
Foods to limit for climate change purposes
eat, fish, animal products (beef is number one)
Ultra-processed foods (animals are confined and fed on same crops; also contributes to biodiversity loss)
Foods to increase in a sustainable diet
Grains, in-season fruits and veg, soy products, nuts, beans, peas
Sustainable proteins
beans, peas, lentils soybeans, wheat proteins, seeds, insects
What is the EAT-Lancet Planetary Health Diet
trying to feed world population within planetary boundaries. Diet: Plant-based, low animals, unsaturated fats, limited refined grains
Considered a “reference diet”, gives ranges of suggested amounts of food, tries to reduce chronic disease risk (lowers risk of CVD, diabetes, cancer, obesity, death). Highest range is for whole grains (you should eat the most), lowest is for eggs and animal meat
How many deaths could be avoided with the EAT-Lancet diet?
11.1 million a year
Climate friendly labeling
It will have an Eco letter score which tells you by the color how good something is for the environment
What can people do for the climate and nutrition
Adopt a plant-based diet and other lifestyle choices with the climate in mind. Advocate for policies
