Federal Overview for Public Health Nutrition

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Federal Overview for Public Health Nutrition
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Some Major Nutrition Players

• USDA
• Food and Nutrition Service
• Center for Nutrition Policy and Promotion
• Food Safety and Inspection Service (FSIS)
• Department of Health and Human Services
• CDC
• HRSA
• FDA
• NCI
• Office of Disease Prevention and Health Promotion
• EPA agency responds directly to president

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• USDA Mission Enhance the quality of life for the
  American people by supporting production of
  agriculture
• ensuring a safe, affordable, nutritious, and
  accessible food supply
• caring for agricultural, forest, and range lands
  
• supporting sound development of rural
  communities
• providing economic opportunities for farm and
  rural residents
• expanding global markets for agricultural and
  forest products and services
• and working to reduce hunger in America and
  throughout the world.
• USDA Vision A healthy and productive Nation in
  harmony with the land.

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Food and Nutrition Service (FNS)

• works to increase food security and reduce hunger
  by providing children and low-income people with
  access to food, a healthy diet, and nutrition
  education in a manner that supports U.S.
  agriculture and inspires public confidence in the
  Nation's domestic nutrition assistance programs.
• FNS nutrition assistance programs represent about
  half of USDA's budget.

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FNS Programs

• Food Stamp Program
• Child Nutrition Programs
• Special Supplemental Nutrition Program for Women,
  Infants, and Children (WIC).
• Commodities to low-income Americans.
• Monitoring of the eating habits of program
  participants

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Center for Nutrition Policy and Promotion (CNPP)

• develops and promotes science-based dietary
  guidance and economic information for consumers
  and professionals in health, education, industry,
  and media

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Center for Nutrition Policy and Promotion (CNPP)

• Partner with HHS for Dietary Guidelines
• Healthy Eating Index
• Nutrient Content of the Food Supply
• Food Guide Pyramid
• Thrifty Food Plan

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Thrifty Food Plan

• Last revised 1999
• Establishes menus and market basket costs for a
  minimal cost healthful diet
• All menus meet Dietary Guidelines for Americans,
  the Recommended Dietary Allowances, and the
  serving recommendations of the Food Guide
  Pyramid.
• Used as the basis for food stamp allocation
  decisions, and to determine the federal poverty
  level

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Federal Poverty Guidelines

• Poverty thresholds were originally derived in
  1963-1964,using
• U.S. Department of Agriculture food budgets
  designed for families under economic stress
• Data about what portion of their income
  families spent on food
• The current thresholds were originally developed
  as the cost of a minimum diet times three
• If total family income is less than the threshold
  appropriate for that family, the family is in
  poverty

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2004 HHS Poverty Guidelines
Size ofFamily Unit 48 ContiguousStates and D.C. Alaska Hawaii
1 9,310 11,630 10,700
2 12,490 15,610 14,360
3 15,670 19,590 18,020
4 18,850 23,570 21,680
5 22,030 27,550 25,340
6 25,210 31,530 29,000
7 28,390 35,510 32,660
8 31,570 39,490 36,320
For each additional person, add  3,180  3,980  3,660
SOURCE  Federal Register, Vol. 69, No. 30,
February 13, 2004, pp. 7336-7338.
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Food Research Action Committee (FRAC) on the
Thrifty Food Plan

• USDA research shows that only 12 percent of low
  income households who spend at the Thrifty Food
  Plan level get their recommended dietary
  allowances for 11 key nutrients.

http//www.frac.org/html/federal_food_programs/pro
grams/fsp_faq.html
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FRAC on the Thrifty Food Plan, cont.

• The Thrifty Food Plan contains a number of
  assumptions which may not be accurate for many
  food stamp recipients. For example, purchasing
  foods for a nutritious diet requires adequate
  food preparation facilities, extensive time for
  food preparation, an in-depth knowledge about
  nutrition and inexpensive transportation to
  warehouse-type grocery stores or supermarkets.

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Cooperative State Research Education and
Extension Service (CSRES)
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CSREES Families, 4-H, and Nutrition

• Youth development
• Expanded food and nutrition program (EFNEP)
• Children, youth and families at risk
• CSREES partners with state land grant
  institutions and local counties

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Department of Health and Human Services
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National Cancer Institute 5 A Day for Better
Health

• The national Program gives Americans a simple,
  positive message - eat 5 or more servings of
  fruits and vegetables every day for better
  health. The program is jointly sponsored by the
  National Cancer Institute in the U.S. Department
  of Health and Human Services and the Produce for
  Better Health Foundation, a nonprofit consumer
  education foundation representing the fruit and
  vegetable industry. The National Cancer Institute
  funds behavior change and communications research
  to determine strategies that are effective to
  increase fruit and vegetable consumption.

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NIH

• Many institutes include nutrition-related
  research portfolios
• National Heart Lung and Blood Institute (NHLBI)
• National Institute on Aging (NIA)
• National Institute of Diabetes Digestive
  Kidney Diseases (NIDDK)
• National Institute of Child Health and Human
  Development (NICHD)
• National Institute of Environmental Health
  Sciences (NIEHS)
• John E. Fogarty International Center (FIC)
• National Center for Complimentary and Alternative
  Medicine (NCCAM)

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HRSA

• Diverse Agency
• Direct Services
• Supporting health care infrastructure
• Community and Migrant Health Services
• Health Centers
• Expanding
• Maternal and Child Health
• Block Grants to States
• Discretionary Grants

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CORE PUBLIC HEALTH SERVICES DELIVERED BY
MCH AGENCIES
Maternal Child Health Bureau
DIRECT HEALTH CARE SERVICES (GAP
FILLING) Examples Basic Health Services and
Health Services for CSHCN
MCH
EPSDT
CHC
SCHIP
ENABLING SERVICES Examples Transportation,
Translation, Outreach, Respite Care, Health
Education, Family Support Services, Purchase
of Health Insurance, Case Management,
Coordination with Medicaid, WIC and Education
POPULATION--BASED SERVICES Examples Newborn
Screening, Lead Screening, Immunization, Sudden
Infant Death Counseling, Oral Health, Injury
Prevention, Nutrition and Outreach/Public
Education
INFRASTRUCTURE BUILDING SERVICES Examples Needs
Assessment, Evaluation, Planning, Policy
Development, Coordination, Quality Assurance,
Standards Development, Monitoring, Training,
Applied Research, Systems of Care and
Information Systems
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Centers for Disease Control Mission

• To promote health and quality of life by
  preventing and controlling disease, injury, and
  disability

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Centers for Disease Control 11 Centers,
Institutes, and Offices

• Epidemiology Program Office
• National Center for Chronic Disease Prevention
  and Health Promotion
• National Center for Environmental Health
• Office of Genetics and Disease Prevention
• National Center for Health Statistics
• National Center for HIV, STD, and TB Prevention
• National Center for Infectious Diseases
• National Center for Injury Prevention and Control
  
• National Immunization Program
• National Institute for Occupational Safety and
  Health
• Public Health Practice Program Office

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National Center for Chronic Disease Prevention
and Health Promotion

• Vision Enabling all people in an increasingly
  diverse society to lead long healthy, satisfying
  lives.

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National Center for Chronic Disease Prevention
and Health Promotion

• Mission
• To prevent death and disability from chronic
  diseases
• To promote maternal, infant, and adolescent
  health.
• To promote healthy personal behaviors.
• To accomplish these goals in partnership with
  health and education agencies, major voluntary
  associations, the private sector, and other
  federal agencies.

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Division of Nutrition and Physical Activity
Purpose

• provides science-based activities for children
  and adults that address the role of nutrition and
  physical activity in health promotion and the
  prevention and control of chronic diseases

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Division of Nutrition and Physical Activity
Scope

• Epidemiology
• Applied research
• Public health policy
• Surveillance
• Community interventions,
• Evaluation
• Communications

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Sample of CDC Nutrition and Physical Activity
Projects

• Surgeon Generals report on Physical Activity in
  1996.
• Funding of 24 Prevention Research Centers
• Funding 16 states to provide coordinated school
  based programs for nutrition and physical
  activity
• Creation of Healthy Schools Indices
• Expansion of National Breast and Cervical Cancer
  Early Detection Program to include dietary and
  physical activity interventions
• Promotion of Active Community Environments

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Future Activities for DNPA

• CDC considers it a priority that people be
  afforded opportunities to pursue and maintain
  good health through such avenues as safe walking
  and cycling trails low-fat, high-fruit-and-vegeta
  ble menu selections in restaurants, schools, and
  worksite cafeterias and physical activity
  programs in schools, worksites, and community
  gathering places.

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Office of Disease Prevention and Health Promotion,

• Works to strengthen the disease prevention and
  health promotion priorities of the Department
  within the collaborative framework of the HHS
  agencies.
• Collaborated with USDA on Dietary Guidelines

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Working Together.
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Dietary Guidelines 2000 A

• Aim for Fitness
• Aim for a healthy weight.
• Be physically active each day.

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Dietary Guidelines 2000 B

• Build a Healthy Base.
• Let the Pyramid guide your food choices.
• Choose a variety of grains daily, especially
  whole grains.
• Chose a variety of fruits and vegetables daily.
• Keep food safe to eat.

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Dietary Guidelines 2000 C

• Choose Sensibly.
• Choose a diet that is low in saturated fat and
  cholesterol and moderate in total fat.
• Choose beverages and foods to moderate your
  intake of sugars.
• Choose and prepare foods with less salt.
• If you drink alcoholic beverages, do so in
  moderation.

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Revision of Dietary Guidelines

• Advisory Group for 2005 revision convened August
  2003.
• Items that were proposed in letter from OMB
• Trans fatty acids, n 3 fatty acids
• Focus on obesity?

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The Fun Begins 2003

• "There are a number of nominees that have very
  close ties to the food industry that might lead
  them to make recommendations that are weaker than
  they should be based on the science,"
• "The answer is devoting our energies to
  strengthening programs that teach people to
  follow the guidelines...and help to reshape the
  food environment to make it easier for people to
  eat well," Margo Wootan, CSPI.
• Fitzgerald (R-Ill) proposed having guidelines
  come only from DHHS. USDA should not be giving
  dietary advice, considering its "main mission is
  to promote the sale of agricultural products."

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Methods for Dietary Guideline Development

• Committee selected by Secretaries of HHS and USDA
  
• Initial subcommittees on nutrient adequacy,
  carbohydrates, fats, fluid and electrolytes,
  energy, ethanol, and food safety
• Later subcomittees on crosscutting macronutrient
  issues and fruits and vegetables, grains, milk,
  and milk products

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Research Questions

• Each committee drafted relevant research
  questions
• Systematic review of the scientific literature
  peer reviewed articles, DRIs, Agency for
  Healthcare Research and Quality report on omega-3
  fatty acids and the World Health Organization
  International Agency for Research on Cancer
  (IARC) report on the relation between fruit and
  vegetable intake and cancer
• Conclusive statements were drafted and reviewed

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USE OF THE USDA FOOD INTAKE PATTERN AND SPECIAL
ANALYSES

• Establish nutritional goals based on DRIs
• Establish energy levels by activity, gender, age
  (12 categories)
• Assign nutritional goals to each specific food
  intake pattern.
• Assigning a nutrient content to each food group
  and subgroup.
• Determining the daily intake amounts for each
  food group or subgroup.

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August 2005 The Report is Published

• Nine recommendations
• Highlights of specific recommendations
• New guidelines scheduled to be released January
  2005.

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Conclusive Statements

• Specific needs for many Americans re vitamin A,
  C, E, Ca, K, fiber, magnesium, Specific groups
  iron, Folic acid, B12, vitamin D.
• Energy most Americans need to reduce energy
• Fats
• saturated as low as possible
• trans lt 1
• weekly fish, other EPA/DHA may be beneficial (too
  little evidence)

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Statements, cont.

• Carbohydrate
• 45-65
• 14 g fiber per 1000 kcal
• Reduced sugar may be helpful in weight control,
  combined with reduced frequency of starch,
  helpful in oral health
• Selected Foods fruits, vegetables, whole
  grains, milk important

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Statements, cont.

• Salt
• many persons benefit from reductions
• increase potassium
• decrease salt used by food industry in processing
• Alcohol
• Sensibly in moderation
• Abstention is an important option
• Avoid with driving, breastfeeding

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Statements, cont.

• Food safety
• Clean hands, food, surfaces
• Separate raw cooked food
• Cook and chill at safe temperatures
• Vulnerable populations avoid high risk foods

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Statements, cont.

• Physical activity
• Adults 30 minutes of at least moderate on most
  days provides benefits, more provides greater
  benefits
• Children at least 60 minutes is recommended.

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9 KEY MESSAGESTRANSLATING SCIENTIFIC FINDINGS
INTO DIETARY AND PHYSICAL ACTIVITY GUIDANCE

• Consume a variety of foods within and among the
  basic food groups while staying within energy
  needs.
• Control calorie intake to manage body weight.
• Be physically active every day.
• Increase daily intake of fruits and vegetables,
  whole grains, and nonfat or low-fat milk and milk
  products.
• Choose fats wisely for good health.

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Key Messages, cont.

• Choose carbohydrates wisely for good health.
• Choose and prepare foods with little salt.
• If you drink alcoholic beverages, do so in
  moderation.
• Keep food safe to eat.

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Food Safety Objectives from Healthy People 2010

• 10-1 Foodborne infections
• 10-2 Outbreaks of foodborne infections
• 10-3 Antimicrobial resistance of Salmonella
  species
• 10-4 Food allergy deaths
• 10-5 Consumer food safety practices
• 10-6 Safe food preparation practices in retail
  establishments
• 10-7 Organophosphate pesticide exposure

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Food Safety A Team Approachhttp//vm.cfsan.fda.g
ov/lrd/foodteam.htmlCDC

• FDA
• CDC
• USDA
• Cooperative Extension Service
• National Agricultural Library USDA/FDA
  Foodborne Illness Education Information Center
• EPA
• U.S. Department of Commerce National Oceanic
  and Atmospheric Administration

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Food Safety Team, Cont..

• U.S. Department of the Treasury Bureau of
  Alcohol, Tobacco and Firearms
• U.S. Customs Service
• U.S. Department of Justice
• Federal Trade Commission
• State and Local Governments

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Food Safety and Inspection Service (FSIS)

• sets standards for food safety and inspects meat,
  poultry, and egg products produced domestically
  and imported

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FDA

• FDA's mission is to promote and protect the
  public health by helping safe and effective
  products reach the market in a timely way, and
  monitoring products for continued safety after
  they are in use.

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• FDA safeguards the nation's food supply by making
  sure that all ingredients used in foods are safe,
  and that food is free of contaminants -- like
  disease-causing organisms, chemicals, or other
  harmful substances.
• The agency must approve new food additives before
  they can be used in foods. FDA also monitors the
  safety of dietary supplements and the content of
  infant formulas and medical foods.
• Meat and poultry products, however, are regulated
  by the USDA.

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EPA Food and Water Safety

• Establishes safe drinking water standards
  Regulates toxic substances and wastes to prevent
  their entry into the environment and food chain
• Assists states in monitoring quality of drinking
  water and finding ways to prevent contamination
  of drinking water
• Determines safety of new pesticides, sets
  tolerance levels for pesticide residues in foods,
  and publishes directions on safe use of
  pesticides