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Unformatted text preview: Community Nutrition GCH 421 Chapters 6 and 2 The process of policy making Let’s look at some examples of nutrition policy Let’s issues on pages 164-165. issues With a partner, tackle 3 of these – just jot down With your thoughts, we’ll come back to this your Policy – A course of action chosen by public Policy authorities to address a given problem. authorities Problem – “ Substantial discrepancy between what Problem is and what should be” is Policy making – Process by which authorities Policy decide which actions to take to address a problem or a set of problems, and it can be viewed as a cycle. cycle. Problem definition and agenda setting Convince people the problem exists Agenda setting – process in which people concerned about at issue Agenda work to bring the issue to the attention of the general public. (this can be difficult) can The issue must also get onto the institutional agenda (lobbying to The policy subgovernments). policy Formulation of alternatives Most creative phase where possible solutions are addressed. In the U.S. policies are formulated by legislative, executive, and In judicial branches at federal, state, and local levels. judicial Policy adoption Policy tools are developed here. (regulations, tax breaks, fines). The tools are welded to agencies so that they will be implemented. In the U.S. government, 2 departments are most related to nutrition In policy: DHHS and USDA. policy: The policy cycle DHHS and USDA DHHS NIH NLM FDA CDC Medicare and Medicaid USDA Food and Nutrition Service Center for Nutrition Policy and Promotion Policy implementation After the best solution has been developed and the tools After are developed, the policy is modified to fit the needs, resources, and wants of the implementing agency and the intended clientele. the Policy evaluation The purpose is to determine whether a program is The achieving its stated goals and reaching its intended audience, what the program is actually accomplishing and who is benefiting. (evaluating programs often start during the agenda setting stage) during Policy termination Can occur for many reasons.. Problem has changed, did Can not work, no political support, etc.. not Legitimating Policy How to implement the policy. Legitimacy is – “the belief on the part of citizens Legitimacy that the current government represents a proper form of government and a willingness on the part of those citizens to accept the decrees of that government as legal and authoritative” government So it can be “mainly in the mind” Example includes the FDA’s health claim policy – Example see p 173 Table 6-1 see The legislative and regulatory process Laws and regulations Laws are often vague. Ex. The WIC program was Laws authorized in 1972 and did not stipulate anything regarding nutritional risk (mostly costs of program). regarding The administrative units will use their judgments to The interpret laws. interpret How an idea becomes law See fig 6-4 p 175, to see how a bill becomes law. See After the law is passed and enacted it is reviewed by the After appropriate agency which is responsible for issuing guidelines for how the law will be regulated. The agency then issues “proposed regulations” which are reviewed during a comment period by experts. reviewed How a bill Becomes a law The Federal Budget process The Language of the budget Budget – President’s financial plan for the federal Budget government. government. Receipts or revenue – Amounts the government expects Receipts to raise through taxes and fees. to Budget authority – Amounts that government agencies Budget are allowed to spend in implementing their programs allowed Budget outlays – Amounts actually paid out by Budget actually government agencies government Entitlements – Programs that require the payment of Entitlements require benefits to all eligible people as established by law benefits Discretionary spending – Remainder of the federal Discretionary budget that can be spent in various areas: defense, nutrition, etc.. nutrition Principles of Federal Budgeting Let’s look at the Federal Budget Cycle for Let’s 2009. p 178 2009. Appropriation – The authority to spend Appropriation money. It can cover several years. money. The political process Takes time and is not perfect. Let’s read the bottom of page 179 to see how Let’s legislation was formed concerning food adulteration, misbranding, and false advertising. adulteration, Federal Food Drug and Cosmetic Act, 1938, FDR In December 2000, and amended in 2005, In legislation was signed by President Clinton that included a provision for creating a new Medicare MNT (medical nutrition therapy) benefit for MNT (medical patients with diabetes or kidney disease. patients Current legislation and emerging policy issues Current Legislation State licensure laws Bioterrorism and Food Safety Emerging issues Aging Child nutrition Tackling overweight and obesity with a Tackling comprehensive approach. comprehensive Factors that play a role in obesity • Lack of physical activity • Readily available high calorie foods Current legislation and emerging policy issues In 2002, the Improved Nutrition and Physical Activity In bill (IMPACT) was introduced. bill Training of health professionals to diagnose, treat, Training and prevent obesity. and Funding for states to conduct weight management Funding activities (bike paths) activities Increase funding for CDC’s school health program Fund research to look at effects of nutrition Fund assistance programs assistance Request that the Agency for Healthcare research and Request quality complete a report on the effectiveness and safety of popular weight loss programs and publicize results. results. Dietary Reference Intakes – New DRI’s will affect labeling and Dietary recommendations. recommendations. Labeling of Dietary Fats – Trans fatty acids and essential fatty acids. Biotechnology – Genetically engineered and modified crops and Biotechnology foods. foods. Complementary and alternative medicine – Need to conduct more Complementary studies studies Functional foods and Nutraceuticals in the mainstream Functional Medical foods (enteral foods) Medical The growing dietary and herbal supplement markets – In 1994, The Congress passed the Dietary Supplement and Health Education Act (DSHEA), which restricted FDA authority over any product labeled a “supplement”, so long as the product made no claim to affect a disease. But the products can say it “supports”, “promotes”, or “maintains” health. “maintains” Other legislation Let’s look on page 189, for “writing effective letters”. Go back and re-visit the issues on p 164-165. Pick one issue Write a letter to your legislator with your present Write concern concern Indicate which department/agency you believe should Indicate have jurisdiction have Indicate to your legislator that you want him/her to Indicate bring this to their attention bring Present alternatives to your position Suggest funding resources Suggest how you will evaluate the program Write either as an individual or a group Last points Chapter 2: Assessing Community Resources Doing a community needs assessment can be Doing analogous to taking the “best photo” of your community. What would you take from GMU? community. To determine the needs of Hispanics in the To community, a community nutritionist will ask many questions: many Ex: How many experience hunger? Do they have a higher unemployment rate? Community Needs Assessment The process of evaluating the health and nutritional The status of the community, determining what the community’s health and nutrition needs are, and identifying places where those needs are not being met. met. It involves systematically collecting, analyzing, It and making available information about the health status and nutritional status of the community or some subgroup of it. some Health status – The condition of a population’s or Health individual’s health, including estimates of its quality of life and physical and psychosocial functioning. functioning Community Needs Assessment Nutritional status – The condition of a population’s Nutritional or individual’s health as influenced by the intake and utilization of nutrients and nonnutrients. and There are large scale assessments requiring lots of There money and people, but most focus on subgroups of a community. community. Target Population The goal of a community needs assessment The is to find out as much as you can about a target population. target Target population – The population that is Target the focus of an assessment, a study, or, an intervention. intervention. Steps in Conducting a Community Needs Assessment Define the nutritional problem Set the parameters of the assessment Collect the data About the community About the background conditions About individuals who represent the target About population population Analyze and interpret the data Share the findings of the assessment Set priorities Choose a plan of action Define the Nutritional Problem Examples of problems: Infants at nutritional risk (not participating in Infants WIC) WIC) Obesity in adults (has increased nationwide) Low birth weight infants (has increased Low nationwide) nationwide) Inadequate food intake of immigrant adults Poor quality of diets of high school students Each statement on the problem states the target Each population and age groups. population Most of these problems are identified from Most previous studies. previous Set the parameters of the assessment These set the direction for the assessment. Define “Community” The scope of the community must be specified. Determine the purpose of the needs assessment Determine purpose May have one or more purposes such as: Identify groups within the community who are Identify nutritionally at risk at Identify the community’s or target population’s most Identify critical nutritional needs and set priorities among set them them Identify factors that contribute to a nutritional Identify factors problem within the community or target population problem Determine whether existing resources and programs Determine resources meet the community’s or target population’s nutritional needs nutritional Provide baseline information for developing Provide action plans to address the community’s or target population’s nutritional needs and for evaluating the program. evaluating Plan actions to improve the community’s or Plan target population’s nutritional status. target Tailor a program to a specific population. Define the target population – Choice is influenced Define by initial perception about the nutrition problem. by Set Goals and objectives for the needs assessment Set Goals – Broad statements of what the activity or program is expected to accomplish program Objectives – Statements of outcomes and activities needed to reach goal. Objectives describe a measurable outcome – increase, measurable reduce, begin, etc.. reduce, Specify the types of data needed These data depend on the goals and objectives of These the assessment. Data may be found in the literature or you may have to collect it. literature Collect data about the community Qualitative data – interviews with key informants Quantitative data – Can be collected or from databases Types of data to collect Community characteristics • Community organizational power and structure • Demographic trends and data • Community health • Existing community services and programs Environmental characteristics • Access to medical clinics • Food availability Socioeconomic characteristics Collect Data Sources of data about the community Collect data about background conditions Collect data about target population Analyze and Interpret Data Requires first collating data collected about the Requires community itself and collecting background conditions that might influence that data (ex.. In Nicaragua potable water!) Nicaragua Data from the assessment are then used to Data “diagnose” the community… these include 4 steps: “diagnose” Interpret the state of health of the target Interpret population within the community population Interpret the pattern of health care services and Interpret programs designed to reach the target population programs Analyze and Interpret Data Interpret the relationship between the target Interpret population’s health status and health care in the community community Summarize the evidence linking the target Summarize population’s major nutritional problems to their environment environment Summary might give how severe situation is, its Summary scope, and cost of intervening vs not. scope, Share the findings of the assessment Share with agencies and organizations not Share directly involved. directly Set Prioritiesto obtain the best health Important to set goals Important outcome. outcome. Health outcomes = The effect of an intervention on Health the health and well being of an individual or population. population. Community priorities, preferences, and concerns Community should be given priority. should Higher priority should be given to common Higher problems more than rare ones. problems Higher priority should be given to serious Higher problems than to less serious problems. problems Set Priorities The health problems of mothers and children that The can easily be prevented should have a higher priority than those that are more difficult to prevent. prevent. Higher priority should be given to health problems Higher whose frequencies are increasing over time than to those whose frequencies are declining or remaining static. static. Look at Healthy People 2010 to help target Look problems. problems. Choose a plan of action Many options here: Share key findings Change public policy Organize a workshop or conference Alter an existing program Develop a new program to address the problem Advocate changes in legislation or public Advocate policy (advocacy = to build support for an idea, cause, or change) cause, Together, with a partner, respond to Together, questions 2 – 5 p 64 under “Summary Questions” Questions” Write down notes and be prepared to Write present this to the class present ...
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This note was uploaded on 01/12/2011 for the course GCH 421 taught by Professor Berkow,s during the Spring '08 term at George Mason.

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