Data considerations for the success of policy to restrict in‐store food promotions: A commentary from a food industry nutritionist consultation

New plans to restrict in‐store price and location‐based promotions of less healthy foods and drinks in the UK aimed to encourage healthier choices. With responsibility for implementation likely falling to food retailers, it is important to understand the feasibility of implementation and to ensure policy success. To ensure compliance, retailers will need to assess which products are restricted under the legislation. The large number of products in retailers’ portfolios poses a problem of scale. A recent research case study found the data available to retailers to be insufficient to accurately apply the rules‐based approach set out by the policy proposal. Misclassification would result in some less healthy products being incorrectly promoted and vice versa. Problems with implementation feasibility have the potential to undermine the public health goals of the legislation. Interviews were carried out with nutrition representatives from the UK food retail and manufacturing sector, to understand the real‐world implications of the proposed legislation. Industry nutritionists recommended a review of the use of the UK’s Nutrient Profiling Model as the legislative basis, proposed data‐related solutions to implementation problems and suggested a need for shared retailer‐manufacturer responsibility, given the context of data availability.     

Collaboration between the dietetic profession and the food industry in health education—a discussion paper

The predicted trend towards increased use of nutrition and health information in food marketing in the 1990's is likely to promote consumer interest in nutrition. In order to capitalize on this trend, the author contends that the dietetic profession should increase the priority given to nutrition education campaigns aimed at improving the diets of consumers. In practice however, the resources available to dietitians to implement substantial nutrition education campaigns are likely to be minimal, unless innovative approaches are considered. The author puts forward two suggestions for consideration by dietitians. First, nutrition education campaigns should use nutrition and health information provided on food labels and in advertisements as major resources.
Secondly, an effective way of resourcing nutrition education campaigns could be by collaboration between the dietetic profession and the food industry. This paper elaborates these proposals and examines implications for the British Dietetic Association (BDA).     

公共服务产业理论视野下农村社区卫生服务模式的构建

目的：探讨农村社区卫生服务机构和新型服务模式的构建。方法：应用公共服务产业理论对农村社区卫生服务模式进行探讨与构建。结果：农村公共卫生服务体系应形成政府、公共卫生组织和农村居民三方相互制衡机制。政府以购买的方式向公共卫生组织购买公共卫生服务。公共卫生组织成为独立机构,作为＂第三部门＂的姿态出现。农村社区服务机构是最为可能的第三部门,将以＂六位一体＂的方式开展公共卫生和医疗服务工作,同时居民将与政府一同对社区卫生机构评估和监督。结论：公共服务产业理论框架下的此种模式以及其实践性应展开进一步研究。     

A simple way of evaluating the healthiness of ready-to-eat foods and developing healthy foods in the food industry

In this study we have developed a new way of evaluating the healthiness of ready-to-eat foods. In the developed method, ready-to-eat foods were classified into specific product categories, and the nutritional quality of classified foods was analysed using the national dietary recommendations and the national dietary survey as a basis for the dietary calculations. The method was tested with the products of ‘Saarioinen’, which is the leading brand in the Finnish ready-to-eat food market. Results indicate that this low-cost method can easily be used in the food industry as a tool in product development and marketing in order to develop healthy foods. The method could also be applied to the restaurant and catering trade, as well as to other public institutions serving food. By using this model, nutritional researchers and the food industry could work together to prevent nutrition-related health problems.     

Trends in stillbirths, early and late neonatal mortality in rural Bangladesh: the role of public health interventions

Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.     

Connecting food,well-being and environmental sustainability: towards an integrative public health nutrition

Modern society has no shortage of human nutrition science, nor interventions designed to improve the way we eat. Yet nutrition science, and the models, approaches and interventions derived from this, is apparently delivering diminishing returns in terms of population weight gain, unhealthy eating patterns and the obesity ‘epidemic’. We draw on a range of literature(s) to argue that public health nutritionists in affluent societies face an ingenuity gap – a series of complex and inter-connected challenges which are neither fully recognised nor easily amenable to resolution through conventional thinking and practice. Four such challenges are: nutritionism; economism; consumerism and individualism. We use an integrative framework to explain their significance for public health nutrition, where they exert a combined and compounding influence. In addition to these problems, insights from other disciplines show that ‘modern’ society and some of its key characteristics are linked to increasing environmental threats. The latter undermine food security and the sustainability of society itself, and possess global impact. For public health nutrition to be situated in and responsive to this broader context, the discipline will need a better understanding of the relationship between modern society, food choice and environmental sustainability. As ‘healthy eating’ may not be an achievable goal within the present social, economic and cultural system, public health nutrition has a unique and vital role to play in shaping change for the future.     

Availability,affordability and quality of a healthy food basket in Adelaide,South Australia

Aim: To investigate the cost, affordability, availability and quality of a healthy food basket in high and low household income areas of Adelaide, and to investigate food promotion in supermarkets. Methods: A cross‐sectional survey was undertaken in May 2009 with a sample of 61 supermarkets, 27 greengrocers and 34 butchers in metropolitan Adelaide. Samples were selected based on household income for extreme tertiles across Adelaide. Results: Low‐income families were significantly worse off in comparison with high‐income families (P < 0.05) regarding affordability of the healthy food basket. The data analysis demonstrated that families on welfare payments and low incomes would need to spend 28–34% of their income in order to be able to afford a healthy food basket. However, there was no significant difference in the cost, availability, and quality of the healthy food basket and food promotions between high and low household income areas. Conclusion: The present study examined the cost, affordability, availability and quality of the healthy food basket, as well as an assessment of food promotions in supermarkets, finding no difference between high and low household income areas. The study provides valuable information to assist in a deeper understanding of food security in Adelaide. It is recommended that a longitudinal study would assist in establishing a reliable healthy food basket monitoring system that could lead to more robust policy outcomes.     

The WIC program: A classic example of where individuals do make a difference

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is viewed as one of the most successful public health nutrition programs in the United States. Senator George McGovern, at the May 2000, National Nutrition Summit, referred to WIC as the perfect program. Despite the broad, bipartisan support the program has enjoyed, WIC has had an often stormy history. This paper chronicles the events that were instrumental in shaping the progam as we now know it. The influence of key organizations and individuals in the WIC program are discussed.     

The role of comics in public health communication during the COVID-19 pandemic

Abstract

As the COVID-19 pandemic sweeps the globe, evolving containment measures have created an unprecedented need for rapid and effective science communication that is able to engage the public in behavioural change on a mass scale. Public health bodies, governments, and media outlets have turned to comics in this time of need and found a natural and capable medium for responding to the challenge. Comics have been used as a vehicle to present science in graphic narratives, harnessing the power of visuals, text, and storytelling in an engaging format. This perspective paper explores the emerging role and research supporting comics as a public health tool during the COVID-19 pandemic.     

提升农村公共卫生安全建设社会主义新农村

建设社会主义新农村，是中共中央在全面建设小康社会的关键时期作出的又一个重大决策。但我国当前农村还存在众多不和谐因素，特别是农村公共卫生还存在重大安全隐患，公共卫生设施不足、医务人员素质不高、环境污染严重等一系列潜在风险的存在相当普遍，因此，提升农村公共卫生安全，改变农村公共卫生状况，为建设社会主义新农村服务，是当前农村卫生工作的重要任务。     

Maintaining and updating food composition datasets for multiple users and novel technologies: Current challenges from a UK perspective

The UK national food composition dataset, maintained at the Quadram Institute Bioscience, is a valuable national resource for a variety of users. The UK has a long history of compiling and utilising food composition data, which started for the specific purpose of understanding war‐time nutrition, and is now fundamental to multiple areas of research, policy, food manufacturing and consumer behaviour. The rise of mHealth technologies has brought food and nutrition data direct to the consumer and presents new challenges for food data compilers relating to coverage of foods and nutrients, and accessibility and transparency of data. In addition, emerging efforts in sustainable food production, changing diets and the ever‐increasing burden of non‐communicable diseases requires an integrated approach that will span the agri‐food, nutrition and health space. In order to achieve this, there needs to be continued efforts in food data standardisation, international collaboration and stronger emphasis in making food and nutrition data FAIR (findable, accessible, interoperable and reusable). The UK national food composition data and the emerging initiatives in food and nutrition it supports are playing an important role in the future development of healthy and sustainable UK diets.     

The role of the Faculty of Public Health (Medicine) in developing a multidisciplinary public health profession in the UK

The Faculty of Public Health (FPH) started out its life as the Faculty of Community Medicine. Its initial membership was drawn from the ranks of Medical Officers of Health (MOsH), medical administrators and consultants working in communicable disease. Born under the aegis of the three Royal Colleges of Physicians, it was de facto for members of the medical profession. This was despite the intention of some of the prime movers in its creation that its membership should reflect the multidisciplinary nature of specialist public health. As such, whilst the Faculty's establishment was indeed a triumph, the triumph was only partial, since many senior public health professionals were precluded from full membership. Over the years this situation has changed, but the road to the Faculty's current open policy, based on achieving public health excellence rather than holding a professional badge, has not been a smooth one. The fears of many medical members that the specialty would be down graded through opening up its membership posed successive presidents with many, often justifiable, challenges. In this article we, former presidents, reflect on the key events during our successive tenures.     

2006—2019年广州市食物中毒突发公共卫生事件流行病学特征分析

目的 掌握广州市食物中毒突发公共卫生事件规律和特点,为提高其有效应对和防控提供科学依据。 方法 收集2006—2019年国家“突发公共卫生事件报告管理信息系统” 报告的广州市食物中毒突发公共卫生事件,应用描述性流行病学方法进行统计和分析。 结果 研究的14年间,广州市共报告食物中毒突发公共卫生事件89起,原因查明率为94.38%,中毒人数2 692人,死亡11人。69.66%的事件发生在5—9月。75.28%的事件致病因素是细菌,副溶血弧菌是细菌性食物中毒事件的首要致病菌,63.64%的死亡病例归因植物性食物中毒,78.65%的事件中毒场所在集体食堂。事件持续时间的中位数为13.50 h(范围为:0~135.33 h)。首例病例发生时间到接报的中位数是0.60 d(范围为:0.04~5.69 d),r=0.601,P＜0.01。 结论 加强食物中毒事件和食品安全风险监测,尽早介入处置,加强针对性的宣传,落实重点场所防控督导巡查,将有助于减少食物中毒事件发生和危害影响。     

A review of UK housing policy: ideology and public health

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.     

Multi-sectoral health promotion and public health: the role of evidence

BACKGROUND: Evidence-informed health promotion and public health is an emerging and ever-changing theme in research and practice. A collaborative approach to gathering and applying evidence is crucial to implementing effective multi-sectoral health promotion and public health interventions for improved population outcomes. This paper presents an argument for the development of multi-sector evidence and discusses both facilitators and challenges to this process. METHODS: Sector-specific contacts familiar with decision-making processes were selected from referrals gained through academic, government and non-government networks and interviewed (in-person or via telephone) as part of a small scale study to scope the use of evidence within non-health sectors where decisions are likely to impact on public health. RESULTS: The views gathered are preliminary, and this analysis would benefit from more extensive consultation. Nonetheless, information gathered from the interviews and literature search provide valuable insights into evidence-related decision-making paradigms which demonstrate similarities with, and differences from, those found in the health sector. CONCLUSIONS: Decisions in health promotion and public may benefit from consideration of the ways in which disciplines and sectors can work together to inform policy and practice.     

Utilization of district health services by injured persons in a rural area of Ghana

INTRODUCTION: Injury is a significant health problem in many less developed countries. However, strategies for dealing with it have been only minimally addressed. GOALS: We ought to assess the pattern of health care utilization by injured persons in rural Ghana. We thus hoped to provide data that would assist in strengthening injury treatment in this setting. METHODS: Using household interviews, we surveyed 9442 person. We sought information on any injury during the previous year that resulted in one or more days of disability. Injured persons were interviewed regarding the mechanism of injury, treatment obtained and length of disability. RESULTS: During the previous year, 923 nonfatal injuries were reported. Half the injured persons (49%) received no formal medical care. When treatment was received, it was primarily delivered by a non-doctor staffed primary health care (PHC) clinic. Such clinics provided treatment for 30% of all injured persons (58% of those receiving formal medical care). Twenty percent of the injured received hospital-based care (39% of those receiving formal medical care). Among those using hospitals, the majority (92%) used district hospitals. CONCLUSIONS: In this setting, efforts to improve injury treatment should include district hospitals and PHC clinics. At both there is a need to advance the concept of 'essential' injury treatment services, addressing equipment, supplies and training.     

Lay food and health worker involvement in community nutrition and dietetics in England: definitions from the field

Background  Community-based food initiatives have developed in recent years with the aim of engaging previously 'hard to reach' groups. Lay workers engaged in community nutrition activities are promoted as a cost-effective mechanism for reaching underserved groups. The primary objective of the study was to explore perceptions and definitions of lay helping within the context of National Health Service (NHS) community nutrition and dietetic services to identify existing terms and definitions and propose an overarching term.
Methods  Interpretive qualitative inquiry; semi-structured interviews with lay food and health worker (LFHW) and NHS professionals employed by community-based programmes, serving 'hard-to-reach' neighbourhoods, across England.
Results  In total, 29 professionals and 53 LFHWs were interviewed across 15 of the 18 projects identified. Across all the projects, there was a preference for the use of one of two terms, either Community Food Worker or Community Nutrition Assistant, in reference to lay workers. There was no consensus in terms of a unifying term or definition for this new role.
Conclusions  Current variation in the terms and definitions used for this role is problematic and is hindering development and effective utilization of lay helping within the broad remit of community food and health and dietetics. The umbrella term 'Lay Food and Health Worker' is proposed based upon definitions and interpretations from the field.     

The role of the schools of public health in the development of primary health care

Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.