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Advocating for national health and nutrition polices

Private versus public sector policies

At the national level, food and nutrition policies have evolved over the years from
both private and public sector initiatives. Figure 6-1 shows the converging forces that
influence food and nutrition policy development. These include scientific bodies, indusrty,
health proffesional associations. Voluntary health organizations, consumer interest groups,
media, and government. The influence each entity exerts varies woth the issue, the profile of
that entitys leadership, and its stature

All along the food system, which includes farmers, producers, food processors, food
retailers, food services, and industry, policy decisions affect consumer food choices. Producer
and distributor policies guide pricing, marketing, production, distribution, safety, sanitation,
and product promotion decisions. In turn, what food consumers can obtain and at what price
profoundly influences the publics health and nutritional status.

Nutrition professional association, voluntary health organizations, and consumer


interest groups also adopt policies that affect the public. These organizations policy
statements guide their legislative initiatives, public awarness campaigns, standards of practice
, continuing education requirements, and the content of their publications. Appendix L list
some of the influential health and nutrition organizations, food trade associations, and
consumer advocacy groups

Quasi-governmental scientific bodies such as the national academy of sciences (NAS)


issue publications with important policy implications. Influential NAS reports include the
recommended dietary allowances, diet, nutrition, and cancer, designing foods, and diet and
health.

In government, federal food, nutrition and health policy initiatives are implemented
through laws enacted by the congress and through regulations promulgated and enforced by
the executive branch agencies. Figure 6-2 ilustrates the three branches-that develop policy ;
these are discussed futher in chapter 7 . the public is at the center as both the benefactor and
the beneficiary of these policies. The media, special interests, and scientific evidence exret
their influences.

In the legislative branch, food, nutrition and health issues are under the jurisdiction of
a number of committees of the house of Representatives and the senate. In the excecutive
branch, a number of agencies in the cabinet level departments take responsibility for various
aspects of food, nutrition, and health. The department of health and human services (DHHS)
and the Department of Agriculture (USDA), however, dominate federal nutrition activities.

Appendix E lis the key congressional committees and their counterpart executive
agency offices responsible for nutrition education, food assistance, nutrition research and
monitoring, and food safety. Most of the federal agencies have staff who offer consultation
administer grants, contracts, or cooperative agreements ; sponsor continuing education ; and
prepare distribute publications appropriate to their respective nutrition program areas. Federal
agency resources are listed in Appendix G. These activities influence, implement, and
disseminate policies. Evaluations of the federal food programs, for example, have been
widely cited when new policies or changes in existing policies are being considered.

MAKING NATIONAL POLICY

Successes and failures in nutrition services, education, food assistance, and research
reflect, among other rhing, the status of federal nutrition.

Exhibit 6-1 Operational steps of policy making

1. Identify needs
2. Draft preliminary polici statements
3. Generate strong support
4. Hear public testimony
5. Refine policy document
6. Reject or approve policy statement
7. Implement approved policy
8. Monior implementation to ensure compliance

Policy in the united states over time. Understanding the steps and identifying the participants
in federal polici making prepare the nutritionist to contribute to the process. Sequencing the
steps suggests that there is a logical progression, but in reality, steps may be omitted or
reserved.

The eight policy making steps described below are summarized in exhibit 6-1 :

1. Policymakers (e.g., members of Congress or heads of federal agencies) identify needs


from reported assessments or direct communications from constituents, scientific
studies, or governmental reports. The media often amplify these needs by focusing
broader and more dramatic attention on the problem. Legislative and administrative
staffs also attempt to forecast future needs by studying trends. The office of
Technology Assessments of the U.S.Congress is charged with responsibility for
generating reports based on its objective analyses of emerging issues.
2. Staff from Congress or the administration draft preliminary policy statements (e.g.,
legislations or regulations). In drafting statements, staff review past and current
policies and actions, and address concerns related to the identified need.
3. Policymakers generate strong advocacy for a new policy or a policy change. Staff
assess likely sources of support or opposition as they develop the purpose, scope, and
rationale for the policy. Effective policy statements are worded to maximize support
and minimize opposition. Support is sought from scientists, educators, professionals,
concerned constituents, and other policymakers who will commit time and resources
to an issue campaign.
4. Policymakers hear public testimony
5. Staff refine the policy document to reflect public sentiment
6. Policymakers approve (or reject) the policy statement and appropriations, if
authorized
7. Agency staff translate approved policy statements or legislation into programs to be
implemented in communities across the nation. Regulations are written to guide
program implementation.
8. Program staff and the public monitor implementation to ensure program compliance
with the new policy.

Nutritionists need to understand each step in the development of food, nutrition, and
health policies. They should be ready and willing to provide data from their needs
assessments, recommend policies, participate in drafting statements, mobilize support,
testify, and refine policy statements. They should also know how to translate policies into
funding priorities, regulations, standards, and implemented programs.

EVOLUTION OF THE NATIONS NUTRITION POLICY

The broad concern of preventing disease as a step beyond curing it has traditionally
guided public health legislation and administrative policies. Historically, nutrition policy
emerged as a companion to some more central concern-public health, food safety, consumer
protection, national security, antipoverty reforms, or international relations. Exhibit 6-2list
selected federal domestic nutrition policy initiatives from 1862 to 1988.

EARLY DEVELOPMENTS IN NATIONAL NUTRITION POLICY

In the early 1900s, concerns about food safety provided the impetus for strong
legislation on pure food and drugs, milks inspection, and better sewage disposal. The federal
pure food and drug act of 1906 prohibited interstate commerce in misbranded and adulterated
food, beverages, and drugs

Also during the early 1900s, researchers such as E.V.McCollum isolated vitamins
A,B and D strongly advocated eating a proper diet to prevent deficiency diseases and perhaps
to guard agains the more or less constant, but unperceived causes that undermine health. In
1917, the USDA published its first dietary guidance plan, five food groups, to help consumers
select nutritionally balanced diets.

Continuing the prevention movement in a different direction, the state of Michigan


began the first iodine fortification campaign in 1924 to prevent the endemic problem of
goiters caused by iodine deficiency. George Rosen, in his History of Publice Health,
described the attention to nutrition as an elixir in america: By the third decade of this
century, scientific nutrition had become in the united states not only an important medicine,
but an important component of industry and commerce as well as a major instrument of
social policy.

The early pioneers in community nutrition-Lucy Gillet in New York, Frances Stern in
Boston, and Lydia Roberts in Chicago worked with pediatricians to advance nutrition as
essential to child growth and development. The high percentage of selective services
rejectees in World War I suggested that poor nutrition delayed physical development of the
nations youth. To reverse this trend, several public policy inititives were launched, among
them the (1) 1918 childrens year campaign that included weighing and measuring infants
and preschool children, (2) federal publications that stressed giving children of low-income
families in the appalachian area of kentucky.

During the 1920, federal funds provided under the shepherd Towner Maternity and
Infancy Act enabled nine states to employ the first nutritionists as consultants to other health
workers. Passage of Title V in the Social Security Act of 1935 expanded public health
nutrition services in state and local health agencies. With the 1963 and 1965 amendments to
title v of the social security act, nutrition services were further expanded in direct health care
programs such as the maternal and infants (M&I) and Children and Youth (C&Y) projects
and in diagnostic and treatment programs for children who are mentally retarded or have
developmental disabilities.

Federal food assistance programs began in 1930 when the USDA and the Federal
Emergancy Relief Administration bought and distributed surplus agricultural commodities as
food relief. Distributin of surplus commodities marked the beginning of child nutrition,
school lunch, and food stamp programs during the 1960. The national school lunch program
and the special milk program were established in 1946 and 1954, respectively.

National Nutrition Policy From The 1960 To The Present

The 1969 White House Conference on food, nutrition, and health positioned food and
nutrition on the national agenda in its own right.

Conference participants made recommendations to

Enhance nutrition in health services throughout the life span


Improve nutrition education in schools, in the training of health care providers, and
for the public
Improve food assistance to low income families
Expand and coordinate basic and applied nutrition research
Establish a nutrition monitoring and surveillance system for the entire population and
for targeted high-risk groups
Strengthen food safety and inspection

These concepts laid the groundwork for todays array of national nutrition policies

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