Recent developments in Public Health Nutrition

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Recent developments in Public Health Nutrition

• Barrie Margetts

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Outline

• Where are we now?
• Where do we need to go?

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Where are we now?

• In the past ten years we have
• Clarified and consolidated definitions and area

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Public Health Nutrition

• The promotion and maintenance of nutrition
  related health and well-being in the population
  through the organised efforts of society

this implies more than the prevention of
illness includes physical activity
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Current behaviour
Desired behaviour
Evaluation
Evidence
Action
Decision making criteria -Strength of
evidence -Plausible mechanisms -Modifiable
factors -Knowledge of what works
Policy
Political commitment
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• The Nutrition Society has set competencies
• developed a individual registration system, and
• a course accreditation system
• In the UK in the process of protecting title of
  Public Health Nutritionists

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• Masters level courses being run in a number of UK
  institutions
• We have published a core text book

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At European level

• Agreed core curriculum for a European masters in
  PHN
• Work lead by Karolinska Institute
• Recently received EU funding to
• Develop e-learning material
• Explore ways to establish registration and
  accreditation system

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Internationally

• Australia very well advanced and funded posts in
  place in many states, supported by federal
  government
• Some progress in Latin America
• Established (9 years) international journal
• First World Congress in Barcelona

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Some challenges and issues

• Do we all agree what PHN is about?
• Individuals and Society/Population
• Prevention and promotion and balance with
  treatment
• Collective action and responsibility
• Challenges to developing a view?
• Ideology- free market/state control
• Competing forces
• Adequate and appropriate training
• Are we ensuring graduates fit for practice

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Building the profile

• If we have more and better trained people what
  difference do we expect it to make?
• Better health
• More equity
• Environmental impact
• Who says so?
• Who sets the agenda?
• How do we show impact of our work?
• Process and outcome evaluation
• Level of staff and skills required not same for
  all
• Advocacy policy roles

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What should PHNists be doing?

• Where is workforce currently engaged?

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PHNist roles

• Research
• Government (policy, surveillance)
• National
• Local
• Industry
• NGOs
• Agencies

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• Are these the right places
• Do people have the optimal skills for these
  different roles
• Are people being used most effectively to improve
  health in the population?

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• Work force will grow if it is relevant and
  effective to policy and decision makers if we
  solve problems, not just create them!
• How many will be required?

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• There will be different training and skills needs
  for people at different levels need to support
  all of these, not just those at top or bottom
• Needs to be integrated with skills development of
  wider workforce
• How do we train and support (CPD), those already
  in jobs?

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Links between Universities and service providers
Research
Teaching
Evidence based evaluation
Developing skilled workforce
Service
Tools
Making a difference
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• Recently, we have carried out a review of the
  needs for workforce development in Hampshire and
  the Isle of Wight, specifically in relation to
  the knowledge and skills in nutrition. This
  review highlights a major mismatch between the
  needs and expectations for service delivery
  compared with those found in practice

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To date

• Much PHN work has been naïve and simplistic
• Rarely properly funded and implemented
• Rarely evaluated

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What next

• Show that if train and employ the right people
  in the right place that this will make a real
  difference to public health.
• Move from academic to practically oriented,
  problem solving approach

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• Give people skills and framework within which to
  operate, not just the theory, but practical
  experience
• Become professional!