14/09/2015

Learning Outcomes
NUTD 3107 & 9226 By the end of the session, you will be able to:
Public Health and Community Nutrition
1. Discuss guiding principles for program
implementation
Program Implementation 2. Describe a community development approach to
program implementation
Theoretical and practical elements 3. Discuss an example of a community development
approach
Dr. Kaye Mehta
kaye.mehta@flinders.edu.au
4. Discuss nutrition education within the context of
broad social determinants

 Building Healthy
Theoretical elements of program Program Public Policy
implementation should
implementation be guided by the  Creating Supportive
Environments
Ottawa Charter for
Health Promotion  Developing Personal
Guiding principles for working with Knowledge and Skills
communities
 Strengthening
to promote health community Action
and  Re-orienting Services
to Health
build capacity
World Health Organisation, 1986

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Structure and agency

Understand social determinants of health
• Acknowledging and addressing structure (social
• Imposing nutrition education without determinants)
understanding social determinants • AND
Can: • Respecting and encouraging agency (personal
• reinforce inequity power to act)
• Building capacity for agency
• exacerbate guilt and anxiety
• Improving health literacy about the food system
• fail to achieve nutritional change (structure) and nutrition (agency)
Talbot & Verrinder, 2014, Chapter 2
Talbot & Verrinder 2014; Baum 2008

Communicating values Working with community

Imposing top-down interventions communicates: • Seeking community views
• power and expert status of professionals • Listening with empathy and compassion
• community deficits • Collaborating with community to find solutions
• victim blaming • Sharing knowledge and skills with community
• disrespect for community knowledge and • Working alongside community as partners or co-
expertise facilitators
Imposing top-down interventions invites: • Builds community capacity
• lack of trust • This is community development approach
Talbot & Verrinder 2014; Hughes & Margetts 2011
• resistance

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Community development and empowerment

‘Community control and power’ are central to practice of
Social Determinants of Health
health promotion (WHO 1986)
Empowerment approaches counteract inequity,
marginalisation, victimisation, isolation and disempowerment

Community development approach

•Encouraging community participation
•Fostering local leadership
•Enhancing community capacity
•Increasing community control
Addresses ‘Strengthening community action’ in Ottawa
Charter for Health Promotion (WHO 1986)

Labonte R, 1999

Community development approach Foodie and community member

Community Foodies SA on a Supermarket tour

• Peer education program

• Training in basic nutrition, program development
and community work principles
• supported by dietitians and other heath or
community professionals to
• work with communities to promote healthy eating
http://www.communityfoodies.com
•

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Foodies and participants showing off

Foodies at Clarendon Community
food. Cooking group for people with
Fair disabilites

Community development as a practice Foodies from around the state get together
paradigm once a year to celebrate
• Holistic view of health
• Addressing social determinants and inequity
• Tackling isolation, marginalisation,
disempowerment as health determinants
• Connecting people, building self-esteem,
empowering
• Community settings as sites for community
connection
Labonte and Laverack 2001; Talbot & Verrinder 2040

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Foodies engaging minority groups Health literacy

• “Successful nutrition education in the community involves learning
to manage change in people’s eating behaviours and the forces
that shape it”. (Frankle & Owen 1993, p.255)

• “Nutrition education must acknowledge the links between food

choice and the social, cultural and psychological influences
impacting on individuals”. (Hehir 1993, p.75)

• Education for empowerment (rather than compliance) (Kickbusch

2001)

• Achieving nutrition and health literacy through social as well as

biological focus on food; learning about the food system
(structure) and nutrition (agency)

Traditional dietetic practice Practical elements of program implementation

Bio-medical vs social

Medical Behavioural Socio-environmental • Strategy planning and delivery

Treatment of dietetic‐ Education for  behaviour Addressing social  • Process and impact evaluation
related health  change; improving illness   determinants of illness 
problems risk factors; educating for  and health • Managing budget and resources
health • Managing risk
Traditional dietetic practice
• Reporting and communicating with stakeholders
• Advocacy for improvements
Downstream Upstream • Research
Hughes & Margetts, Chp 15
Illness Treatment, Rehab, Prevention, Health promotion

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Governance
• Supports project, resolves conflict, advocates
Summary
• Contributes to capacity building Nutrition programs should be guided by:
• Social determinants of health
Structure • Primary Health Care principles
• Advisory committee, management committee or steering • Ottawa Charter for Health Promotion
committee • Community development principles
• Involving stakeholders including community
• Requires shared vision, clear roles and responsibilities- Nutrition education should not lose sight of social
terms of reference determinants
• Regular meetings and communication
Hughes & Margetts, Chp 15
Attend to practical matters of program implementation
including governance

Useful References
• Labonte R and Laverack G, 2001, Capacity building in health
promotion, Part 1: for whom? And for what purpose?, Critical Public
Health, 11,2, 111-127
• Kickbusch, I. (2001). Health literacy: addressing the health and
education divide. Health Promotion International 16(3): 289 -297.
• Frankle, R. and Owen, A. (1993) “Nutrition in the Community The Art
of Delivering Services” 3rd edn. Chapter 10 Managing Change with
Nutrition Education.
• Hehir, A. 1993, ‘Nutrition education: a review of strategies’,
Australian Journal of Nutrition & Dietetics, vol 50 (2), pp 75 – 78.
• Worsley, T 2008 Nutrition Promotion Theories and methods,
systems and settings. Allen & Unwin NSW.
• Talbot & Verrinder 2014, Promoting Health, The Primary Health
Care Approach 5th edition. Elsevier.