A demographic profile of Canadian public health nutritionists

The purpose of this study was to obtain a comprehensive demographic profile of public health nutritionists employed in provincial and municipal/regional departments of health in Canada in 1988. One hundred and fifty three (78%) of all eligible Canadian public health nutritionists responded to a mailed questionnaire. Almost all (98%) respondents were female, with a mean age of 35.8 +/- 7.2 years. Most nutritionists (83%) worked full time, and had been employed in public health for a mean of six years and nine months. Seventy percent of respondents had worked in another profession(s) or other area(s) of nutrition prior to entering public health. Although 65% were members of the management team or represented by a nutritionist on the management team, 25% of nutritionists were not regarded as members of senior management in their health agency. While the majority of nutritionists in Ontario (84%) had completed a graduate degree, this was the case for the minority of respondents from British Columbia (35%), the Prairies (32%), Quebec (33%), and Atlantic Canada (27%).     

Predictors of effectiveness among public health nutritionists

This study investigated how public health nutrition directors and practitioners each rated the effectiveness of their professional performance. We examined the specific factors which were predictive of each set of effectiveness ratings. Eleven directors supplied the names and addresses of 226 practitioners, each of whom was mailed a questionnaire. The response rate to the mailing was 84 per cent. Director ratings of practitioners were not significantly related to the self-ratings. Results of multiple regression analysis revealed that the directors had based their evaluation on more "external" criteria, such as age, being a Registered Dietitian, and possessing an extroverted personality. In contrast, the nutritionists' self-ratings were based on more introspective qualities, including self-perceived innovativeness, and the number of competencies which they felt they were currently performing well. The roles of work environment, nature of supervision, and type of educational preparation need to be assessed in future research.     

Preparing public health nutritionists to meet the future

Public health nutrition personnel have been defined as those specialized nutrition professionals and paraprofessionals who provide nutrition services through agencies whose mandate is health protection and promotion, disease prevention, and/or primary care to people in the community. Educators preparing graduate level nutritionists for future demands of federal, state, and local public health programs must read the scientific, technological, and societal trends, including changes in demographics, health delivery systems, communications technologies, and consumer demands. As research more clearly defines the role of nutrition and diet in human health, nutritionists should be educated to monitor trends and be proactive in seeking emerging opportunities. It is nutritionists' responsibility to assure that scientific findings in nutrition, dietetics, and food science are considered in policy formulation as well as in the technical input into agency and community programs. The nutritionist who understands the changing values and life-styles of diverse populations uses acceptable techniques to motivate any necessary behavior changes. To be effective in the community, he/she uses community assessment, epidemiological, and program planning skills basic to public health practice. In the current climate of cost containment, the public health nutritionist will successfully compete for dwindling funds by managing programs with skill and documenting cost benefits and cost-effectiveness.     

Identification and evaluation of competencies of public health nutritionists.

The Delphi Technique was used to elicit a number of essential competencies expected of the "entry-level" public health nutritionist from members of Graduate Faculties of Programs in Public Health Nutrition. Questionnaires composed of "competency statements" were constructed from these responses and sent to practitioners in public health nutrition. The questionnaire requested evaluation of the "necessity" of each competency. Responses served as the basis for "factor analysis" procedures, employed to obtain clusters of competency functions expected of the nutritionist. From the 109 competency items originally identified, 17 competency scales were derived from the factor analysis. A ranking from both faculties and practitioners revealed that both groups highly rated competencies to communicate, to counsel and deal with clients/patients, and to interpret scientific data in "lay language." Less important in the ranking were competencies which dealt with administrative abilities, program planning, legislative activism, and consumer advocacy. These findings have cimplications for the practitioner in public health nutrition as well as for academic groups who must plan and evaluate curricula in public health nutrition and in other fields of public health.     

Survey of nutritionists in state and local public health agencies

A spring 1985 survey of 50 state and four territorial public health nutrition directors identified 2,931 budgeted positions for public health nutritionists--1,128 in state agencies and 1,803 in local health departments. To achieve the recommended staffing ratio of one public health nutritionist per 50,000 population, an estimated 1,827 more public health nutritionists are needed nationwide with more needed in some states than in others. About half of the state personnel systems require registration or registration eligibility to assure expertise of public health nutrition personnel; about one-third also require graduate training in public health for leadership, planning, and policymaking positions. Sixty-two percent of the funding for state and local health agency nutritionist positions is from the Special Supplemental Food Program for Women, Infants, and Children (WIC). When that is added to the 11% of funds from the Maternal and Child Health Block Grant, 73% of the public health nutritionist positions are federally supported to serve women of childbearing age, infants, and children. That leaves the remaining state and local funding sources and the federal Prevention Block Grant (2%) to pay salaries of nutritionists to serve the general public, including men, postmenopausal women, and the elderly.     

Productivity improvement and job satisfaction among public health nutritionists.

A workshop for public health nutritionists which scrutinized ways to improve productivity and job satisfaction is reported. Participants believed that productivity could be improved most by improving the execution of tasks, followed by better planning of programs, office management, and skills in group education, and by delegation of non-professional activities to lesser-trained personnel. Job satisfaction of public health nutritionists could be increased by reducing stress and discomfort and promoting feelings of personal effectiveness and efficiency through role clarification and by management training. There is a large potential for greater productivity in the profession. Realization of this potential will contribute measurably to the cost-effectiveness of nutritional services.     

Development of professional competence in public health nurses]

PURPOSE: Significant changes that are occurring in the community health care system, require that public health nurses who work for local governments to not only provide direct care but also to coordinate health care teams and participate in policy making. The purpose of this study is to investigate the current system of developing professional competence in public health nurses, and to consider ways to improve it. METHOD: The subjects, randomly chosen, were 100 chief public health nurses and 298 staff nurses in Hokkaido. Sixty-four chief nurses, 44 beginner nurses, 87 proficient nurses and 88 expert nurses responded. The data were collected with a self-administered questionnaire which necessitated the subjects to make a self evaluation of their practical competence and circumstances of its development. RESULT: Self evaluated competence, in making accurate assessments of individual needs and initiating direct care, developed with their experiences in the job, and was generally high. However, the questionnaire showed that self evaluation of their work and ability to do theoretical analysis and research was low and did not progress in conjunction with the length of work experience. Policy making experience was limited and policy making competence was evaluated as low, but there was an expectation that this competence would develop in time. Almost all of the respondents expected their professional competence to progress to higher levels. In particular, beginner nurses wanted to gain practical care competence; proficient and expert nurses wanted to develop their powers of theoretical analysis and do more research, while chief nurses were keen to gain competence in the area of policy making. The respondents reported that they sometimes attended academic conferences, but hardly did any research. CONCLUSION: Low self-evaluation of public health nurses reflect a basic immaturity as a profession. They need to establish their profession and to increase their self-evaluated competencies as their careers develop. These findings showed the importance of establishing a system of continuing education that will cultivate competence in various aspects of their job and also motivate self study. These findings also reveal the importance of collaboration between the university as a vehicle for theoretical work and research and the work place as the embodiment of practical application.     

What can public health nutritionists do to curb the epidemic of nutrition-related noncommunicable disease?

As a result of the rapid shift in dietary and activity patterns, the world is facing a pandemic of obesity. This new global pandemic is rapidly becoming a problem of the poor. Extensive work has been undertaken to document the changes in weight and, to a much lesser extent, in diet, energy expenditures, and activity patterns. Broad-based creative public health actions are needed to offset these larger forces that promote energy imbalance, poor diets, and reduced physical activity. Inaction will result in an acceleration of morbidity, disability, and deaths from major nutrition-related noncommunicable diseases – primarily in developing countries.     

Strategic planning: public health nutritionists strengthen their capacity to function in a changing environment

In 1987, the public health nutritionists who work in Ontario's 42 health units and the Ministry of Health, initiated a province-wide strategic planning process. That same year, three major reports received by the Ontario Ministry of Health proposed new directions for health services. This article briefly describes the strategic planning process used by the nutritionists and presents the resulting "Strategic Plan for Nutrition in Public Health." It also reviews the three reports and illustrates how they support the priorities established by the nutritionists under four major themes: data needs and data collection; economic/environmental issues; program/service issues; and professional issues. The relevance and significance of the parallels among the reports and strategic plan are explored.     

Pneumococcal immunization and public health: the Canadian experience

Pneumococcal vaccine has been poorly used in Canada, despite strong recommendations for its use by the Canadian National Advisory Committee on Immunization. In a recent survey of health officials, however, seven of the 12 Canadian provinces and territories were found to either have a programme for all persons >65 years of age or were planning to implement one within the next year. Factors that have contributed to this increased interest include: better data on disease incidence and preventable illness from population-based surveillance; data on emerging resistance of Streptococcus pneumoniae in Canada to penicillin and other antimicrobials; implementation of vaccine programmes for the elderly by public health officials in Ontario, Nova Scotia and British Columbia; completion of a cost-benefit study of pneumococcal vaccine for Canada; and increased attention to pneumococcal vaccination at national immunization meetings and in the medical literature. Increased availability of vaccine and competitive pricing are also making programmes for the elderly more feasible and affordable. A national meeting entitled ‘Preventing Pneumococcal Disease: A Canadian Consensus Conference’ was held in February 1998 to further build on this growing interest.