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.     

Comparing nutrition programs conducted by public health and Cooperative Extension personnel

We surveyed 218 county extension agents, 75 state extension specialists, 163 public health nutritionists, and 87 public health administrators in 16 states to compare the nutrition program characteristics of extension personnel with public health personnel. Public health personnel were most strongly influenced by funding regulations--more than 80% of public health nutritionists cited infant/preschool nutrition and nutrition for pregnant/lactating women as program topics. About half of the extension agents listed food preservation and preparation as the dominant topics provided. Public health personnel most frequently designed programs for pregnant and lactating women and low-income clientele; 91% of the nutritionists ranked one-to-one counseling as one of their three most important delivery methods. Extension personnel designed programs more often for homemakers/adults and youth and ranked a combination of group and media delivery methods as most important. Public health personnel use anthropometric measures and food intake records to evaluate their programs; extension personnel use written questionnaires and program records. More than 50% of the nutritionists ranked improving the health of their clients as one of the three most important impacts of their programs; more than 50% of the extension agents ranked increasing knowledge and improving skills as their most important impacts.     

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%).     

Nutrition services in state and local public health agencies: how do we measure up in 1987?

In 1987, a second biennial mail survey of public health nutritionists in 54 state official public health agencies identified 2,048 budgeted positions compared with 2,931 in 1985, a 30% loss in the state and local health agencies. To achieve the recommended staffing ratio of one public health nutritionist per 50,000 population for policy, program planning, and program management, an estimated 2,812 more nutritionists are needed for a total of 4,850, or a 60% increase. The number of state personnel systems requiring graduate public health training decreased from 19 to 6, while the number requiring R.D./registration eligibility increased from 24 to 33. Fifty-five percent of positions for public health nutritionists are funded from the Special Supplemental Food Program for Women, Infants, and Children, and 10% from the Maternal and Child Health Block Grant. Positions funded from state general revenue doubled from 8% in 1985 to 15% in 1987, while local revenue stayed at about 10%. The midpoint of state salary ranges for the public health nutritionists varied from $14,310 to $38,310. Perceived constraints to expanding nutrition services were inadequate state funding, low agency visibility, and low legislative priority. At a time when consumer interest in nutrition is high and research associates dietary factors with major public health problems, the challenge is to advocate more aggressively for public health nutrition services and funding.     

Putting food on the public health table: Making food security relevant to regional health authorities

Food security is emerging as an increasingly important public health issue. The purpose of this paper is to describe a conceptual model and five classes of food security indicators for regional health authorities (RHAs): direct, indirect, consequence, process, and supra-regional. The model was developed after a review of the food security literature and interviews with British Columbia community nutritionists and public health officials. We offer this conceptual model as a practical tool to help RHAs develop a comprehensive framework and use specific indicators, in conjunction with public health nutritionists and other community stakeholders. We recommend using all five classes of indicator together to ensure a complete assessment of the full breadth of food security. This model will be useful for Canadian health authorities wishing to take a holistic community-based approach to public health nutrition to develop more effective policies and programs to maximize food security. The model and indicators offer a rational process that could be useful for collaborative multi-stakeholder initiatives to improve food security.     

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.     

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care–related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.Position StatementIt is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.     

Streamlining and implementing nutritional assessment: the dietary approach.

Early methods of assessing food intake were developed to provide nutrition services for individuals in health care. Dietary methodologies increased in number and complexity as they were used in nutrition surveys of populations and as tools for nutrition research. Recent expansion of community health programs with nutrition components, and greater emphasis on nutritional assessment in health care require the use of streamlined methods of dietary inquiry and screening. The specialized knowledge and skills of the nutritionist/dietitian are best reserved for persons identified through screening as being at high risk for malnutrition.     

Nutritional care of the surgical neonate

The function of the nutritionist was to identify and anticipate nutritional problems, to facilitate complete care for each infant, and to serve as an educational resource to staff, patients, and families. Neonatal nutrition is an open and challenging field for nutritionists. An expanded role for the nutritionist as a member of the physician-nutritionist team, as demonstrated in this article, may provide direction for the organization of such a team in other health care facilities with neonatal intensive care units.     

Development of a master's in public health nutrition degree program using distance education

The Professional Practice Program in Nutrition (PPPN) uses distance education to offer a master's degree in public health (MPH) nutrition designed for practitioners who desire to maintain their employment and develop new skills. Public health nutrition leadership faces challenges in recruiting a large enough workforce to (a) carry out the core functions of assessment, policy, and assurance; (b) update current nutritionists in new skill areas to face the demands of dynamic health care and public health climates; and (c) conduct monitoring and surveillance of Healthy People 2010 objectives. In 1996, the University of North Carolina at Chapel Hill designed and implemented this program after a market analysis to identify advanced educational need in a nine state area. PPPN was initiated as a pilot program and enrolled two cohorts of students from 1996 through 1998. This project identified four key steps: (a) conduct a detailed market analysis; (b) establish an infrastructure to deliver the program; (c) tailor the curriculum using the technology; and (d) identify, accommodate, and develop student capabilities. The findings indicate that distance education strategies are appropriate to carry out a full MPH curriculum in nutrition, but sufficient enrollment is necessary to cover the added curriculum expenditures.     

Nutrition services and the Hamilton-Wentworth Home Care Program: a current overview

The structure of and services provided by the Hamilton-Wentworth Home Care Program are described. The goal of the Home Care Program is to provide coordinated multidisciplinary care for the patient in the familiar home setting, to facilitate early discharge from hospital, and/or prevent admission to a health care institution altogether. Nutrition counseling for patients and consultation for the multidisciplinary health care team is provided by the Home Care nutritionist, a registered dietitian. Her duties and activities are further delineated, as they exist in Hamilton-Wentworth. This unique position provides stimulating and rewarding work for the nutritionist who desires the challenge of therapeutic nutrition counseling in a community setting.     

Financing nutrition services in a competitive market

Budget deficits and inflationary medical care costs threaten nutrition services, which until recently have been funded largely by federal, state, and local revenues. Nutritionists and dietitians responding to demands in the marketplace should develop innovative programs and pursue new sources for financing through the private sector, third-party payers, business/industry health promotion, and consumer fees for their services, as well as targeted federal, state, and locally funded food assistance, nutrition education, and health care programs. Trail-blazing dietitians are successfully offering their services in health maintenance organizations (HMOs), hospital or industry fitness programs, private practice, voluntary health agencies, and official agency programs. With the new federalism, nutritionists must articulate their role in comprehensive health care and market their services at the state and local levels in addition to the federal level. Nutrition services are defined to include assessment, planning, counseling, education, and referral to supportive agencies. Data management, managerial, and marketing skills must be developed for dietitians to compete effectively. Basic educational preparation and continuing education for practicing professionals must develop these competencies.     

Nutrition project in a remote Australian aboriginal community.

Much of the ill health of Australian indigenous populations can be attributed to diet-related diseases. This community nutrition project is part of a wider renal screening and prevention program based in the Umoona aboriginal community in Coober Pedy in South Australia's far north. The nutrition project facilitates the capacity of the Umoona aboriginal community to identify and redress nutrition-related issues considered important in improving their overall health status. Project nutritionists developed and implemented a specialized nutrition training program with the Umoona aboriginal health workers. The nutritionists were responsive to requests from community groups to provide nutrition expertise and support in program development. Individual nutrition counseling for adults and children taking part in renal health screening was also provided. The aboriginal health workers reported increased nutritional knowledge and confidence in addressing nutrition-related issues within the community after nutrition training. Individual consultations and partnerships formed with community groups have increased awareness and prompted action to address the importance of nutrition in renal disease and overall health in the Umoona community.     

Community nutrition in Canada: an overview.

This paper provides an overview of the scope and diversity of community nutrition in Canada today and illustrates the many community organizations that include a nutrition component. The relationship of public health nutrition to the broader field of community nutrition is outlined, and health promotion concepts and strategies are described as a basis for community nutrition programs. Strategies such as education, mass communication/social marketing, advocacy, self-help/mutual aid, community organization, economic support, policy development/legislation, and environmental change are identified with some examples from programs in Canadian communities. Future directions are proposed as research, better surveillance and monitoring, more effective program evaluation, and a forum for the exchange of community nutrition information.     

Merolicos and health education

Research on merolicos provides valuable information about receptiveness to public health communication. Merolicos are Mexican medicine showmen who by entertaining means such as ventriloquism, mental telepathy, and snakehandling captivate audiences while imparting medicinal information. It was observed that trust in the merolicos extends to people seeking out advice, consultation and explanations. The effective folk traditional health orientation, accessibility and communicative style of the showmen were appealing aspects of the merolicos to the townspeople. In a pilot project the medicine show method of communication was explored in a specific area of infant nutrition in order to evaluate whether the showmen were able to bring about changes in the knowledge, attitudes and behavior patterns of their audience. This involves community selection, message content control, preparation and surveys. Impressive results were seen in adolescents who showed curiosity and attentiveness during the shows. Many young girls valued information about infant care and nutrition. Mexican medicine showmen combine an ability to dramatically work information into community health programs at low potential cost while discreetly disseminating vital health oriented information.     

Nutrition and health promotion: recent perspectives

In recent years, health promotion has been introduced as a promising strategy for the public health field. The current study is intended to link nutrition into the recent debate on health promotion, analyzing the role of nutritionists in this process. Given the complexity of the Brazilian nutritional situation due to the nutritional transition currently under way in the country, the health promotion proposal points to both new perspectives and challenges for eating and nutrition. New demands in academic training and the nutritional care model tend to foster a search for partnerships, innovation in eating practices, and nutritional education aimed at the achievement of nutritional citizenship.     

The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled “The State of Food and Nutrition Series” to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist–led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.     

Home-Delivered Meal Programs for Homebound People with HIV/Aids

In major cities within the past decade, 17 community-based, home-delivered meal programs have emerged to meet the specialized nutrition needs of homebound people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (HIV/AIDS). This review includes specifics about these meal programs: funding, eligibility criteria, establishing and following nutrition and food safety standards, creating a network of volunteers for delivery of meals, providing nutrition counseling, and conducting periodic program evaluation. People living with HIV/AIDS may need the services of home-delivered meal programs throughout the course of HIV disease. Clinical dietitians and public health nutritionists should become familiar with existing programs and refer clients to services as needed. J Am Diet Assoc. 1995; 95:476–481.