Prevention Opportunities ASPHN amp NWA Webinar Series October 26 2017 ASPHN is a nonprofit membership organization providing state and national leadership on food and nutrition policy programs and services aimed at improving the health of our population ASPHN membership is composed of nearl ID: 805140
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Nutrition and the Life Course: Prevention Opportunities
ASPHN & NWA Webinar SeriesOctober 26, 2017
Slide2ASPHN is a nonprofit membership organization providing state and national leadership on food and nutrition policy, programs and services aimed at improving the health of our population. ASPHN membership is composed of nearly 300 public health nutritionists nationwide. Members receive key resources, professional development, and beneficial peer support. ASPHN promotes the value of public health nutritionists and highlights their initiatives through print, digital and social media. To learn more, visit www.asphn.org and www.facebook.com/asphn.
About ASPHN FundingThe Public Health Nutrition Webinar Series – a collaboration between NWA and ASPHN - is supported by the Cooperative Agreement Number 5 U38 OT 000137 - 02, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Slide3HousekeepingMuting PhonesContinuing EducationCertificate of ParticipationEmail Shameka Jennings at sjennings@nwica.org Q & ACan submit questions at any timeEvaluation
Slide4Nutrition and the Life Course: Prevention Opportunities
Flojaune Griffin Cofer, PhD, MPHDirector of State Policy & ResearchFC@PHAdvocates.org
ASPHN & NWA Webinar Series
October 26, 2017
Slide5Overview and ObjectivesThis webinar will explain life course theory and identify immediate prevention opportunities for professionals who focus on family nutritionObjectivesTo understand the five key concepts of life course theory and how they shape the protective and risk factors which influence health outcomesTo identify program opportunities for nutrition that optimize interventions by using the life course theory framework
Slide6What is life?“Most people think life sucks, and then you die. Not me. I beg to differ. I think life sucks, then you get cancer, then your dog dies, your wife leaves you, the cancer goes into remission, you get a new dog, you get remarried, you owe ten million dollars in medical bills but you work hard for thirty five years and you pay it back and then one day you have a massive stroke, your whole right side is paralyzed, you have to limp along the streets and speak out of the left side of your mouth and drool, but you go into rehabilitation and regain the power to walk and the power to talk and then one day you step off a curb at Sixty-seventh Street, and BANG you get hit by a city bus and then you die. Maybe.”-Dennis Leary, Actor/Comedian
Slide7Life Course PerspectiveExperiences in life impact us in different waysUnderstanding the life course perspective can help explain these changesThis is not a novel conceptSome research supports what we knowSome research gives us a new understanding that can impact our work
Slide8Key Concept # 1TIMELINEToday’s experiences and exposures influence tomorrow’s health
Next GenerationYour LifeYour Mother’s/Father’s Life
Slide9Conception
Birth
Pregnancy
Delivery
Age
5
Puberty
Disparity at Birth
Poor Birth
Outcome
Optimal
Birth Outcome
Excellent
Health
Poor
Health
Protective Factors
Risk Factors
Poverty
No Social Support
Mistimed Pregnancy
Adverse
Childhood Events
Exposure to Toxins
Poor Nutrition
Obesity
Unsafe Neighborhood
Poor Education
Lack of Health Care
No Family Planning
Tobacco/Alcohol/Drugs
Nutrition
Healthy Relationships
Social Support
Exercise
Education
Health Care
Family Planning
Safe Neighborhood
Healthy Relationships
Financial Security
Planned Pregnancy
2
nd
Pregnancy
©Flojaune Griffin, 2012
Slide10Cumulative PathwaysChronic accommodation to stress results in wear and tear on the body’s adaptive systems, leading to declining health and function over timeImage used with permission from CRAFT: Comparative Risk Assessment Framework and Tools
Slide11Obesity Across the Life Course
Slide12Key Concept #2TIMINGHealth pathways are particularly affected during critical or sensitive periods
Image used with permission from SirColby.com
Slide13Early ProgrammingExperiences during sensitive developmental periods in early life may encode function of organs or systems the manifest in health and disease later in lifeImage used with permission from Columbia University Mailman School of Public Health
Slide14Barker Hypothesis: Fetal Origins of Disease
D.J.P Barker, K.M Godfrey, P.D Gluckman, J.E Harding, J.A Owens, J.S Robinson. Fetal nutrition and cardiovascular disease in adult life. The Lancet, Volume 341, Issue 8850, Pages 938-941Birthweight and Insulin Resistance
Slide15Adverse Childhood Experiences (ACEs)
Slide16Key Concept #3ENVIRONMENTThe broader community environment strongly affects the capacity to be healthy
Image used with permission from Irish Impact: Social Entrepreneurship at University of Notre Dame
Slide17Genetics 101
Genetic expression is determined by the environmentImage used with permission from the NIH: National Institute of Environmental Health Sciences
Slide18IOM, 2005
$10 BILLION SPENT ANNUALLY
MARKETING FOOD TO CHILDREN
Slide19Designed for DiseaseDemonstrated Link Between Local Food Environments and Obesity and DiabetesHigher the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors the higher the prevalence of obesity and diabetes
Slide20Sources of Added sugars
SUGAR SWEETENED BEVERAGES
Slide21DIABETES & PRE-DIABETES IN CALIFORNIACalifornia adults withPrediabetes: 46%1/3 of young adults 18-39Diabetes: 9%
55%
Slide22Source: 2011 American Human Development Project
PLACE MATTERS: LIFE EXPECTANCY IN CA
Slide23Key Concept #4GENERATIONSHealth is shaped by human context across lifetimes and generations
Slide24Diabetes Across Generations
Dabelea D et al. Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians. J Maern-Fetal Med 2000;9:83-8.
Slide25ACEs Across GenerationsACEs are commonChildren raised by an adult with 1 or more ACEs are 1000x more likely to suffer their own ACEs
Slide26Environment/Behavior Across GenerationsPeople within a family often shareGeneticsIntergenerational TraumaEnvironmentBehaviors
Slide27Key Concepts #5EQUITYInequality in health reflects more than genetics and choice
Slide28Health InequityA systematic and unjust difference in health and illnessRelated to but *different* than health disparitiesNot all health disparities result from inequitiesBased on membership in an oppressed group with historical/ongoing restricted access to societal resourcesNot “natural”Public health has a responsibility to remediate inequities
Slide29Racial & Ethnic Disparities: Infant MortalityNational Center for Health Statistics 2002
Slide30Levels of Racism Personally mediated racism - an acute stressor, including individual insults and discriminatory actsInstitutionalized racism - discriminatory, race- or class-based policies and practices (informal and formal). Internalized racism - acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worthCultural racism – determines which group qualities and characteristics are valued/devalued(adapted from CP Jones AJE 2001;154;299-304) and Project Change 1999
The new racism is to deny that racism exists
Slide31Slide32Implicit BiasAttitudes and stereotypes that affect our understanding, actions and decisions in an unconscious mannerFavorable and unfavorableActivated involuntarilyDo not necessarily reflect our declared beliefsFavor our own groupMalleable
Slide33Designed for DiseaseThe Link Between Local Food Environments and Obesity and DiabetesHigher the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors the higher the prevalence of obesity and diabetesThe highest rates of obesity and diabetes are among people who live in lower-income communities and have worse food environments
Slide34Ethnicity
American IndianLatinoAfrican-AmericanAsianWhiteCALIFORNIADiabetes by Ethnicity
Diabetes
(40-54)
15%
14%
9%
9%
6%
9%
2.5x
2.3x
1.5x
1.5x
California Health Interview Survey, 2014
Slide35Income
<100% FPL ($25k)100-199% FPL200-299% FPL>300% FPL ($75k)
CALIFORNIA
Diabetes by Income
Diabetes
(40-54)
20%
10%
10%
5%
9%
4x
2x
2x
California Health Interview Survey, 2014
Slide36UNSAFE DRINKING WATER300 communities and 1 million Californians lack safe water1 in 4 schools in Central Valley have unsafe drinking water20% of residents pay 5-10% of income on water in addition to costs for non-potable water
Slide37This is a Paradigm ShiftLimited science on how to address inequities in birth outcomesPrenatal care has not been the answerPatterns of birth outcome inequities suggest that social factors are involved:Stress, especially chronic stress associated with racism and low incomeSocial support may directly improve health and affect health behaviorsEmpowerment: Self-efficacy plays key role in health behaviorsKEEPCALM
this requires a PARADIGM SHIFT
Slide38How do we improve health?
Smallest ImpactLargestImpact
Slide39What is the Role of Public Health?
Slide40Healthy
Prediabetes
Diabetes
Complications
Policy / Systems / Environmental Changes
Healthy eating
Physical activity
Screening
Diabetes self management
Quality treatment & Adherence
Diabetes Prevention Program
A COMPREHENSIVE APPROACH
Slide41Life Course Theory AppliedTIMELINE: Review literature and analyze program data to better understand cumulative risk
EQUITY: Explore institutional racism and implicit bias within your organizationTIMING: Taking advantage of transitions and life stage opportunitiesENVIRONMENT: Advocate for policy strategies that improve the retail food environment
GENERATIONS: Focus
on the entire family and ensure interventions are modifiable and respectful of culture
Slide42Priorities: Change the FrameUnderstand Your Implicit BiasHarvard Implicit Bias Test - onlineRead about White Privilege and RacismWaking up White – Debby IrvingRacism without Racists – Eduardo Bonilla-SilvaBetween the World and Me – TaNehisi CoatesExplore Narratives about IntentWhat’s wrong with you? VS What happened to you? What is your organizational culture?Does your organization have racial/ethnic diversity at all levels? If not, why?
Slide43Resource: Interconception CareBeforeandbeyond.org
Training Modules for Preconception and Interconception CareIncludes NutritionPostpartum WeightAnemiaBreastfeeding
Slide44Resource: System & Environment Changes
http://cdph.ca.gov/NUPA-MCAH
Slide45Practical ApplicationWhat are you currently doing that you will STOP doing because it is harmful or isn’t working?What haven’t you done that you will START doing because it may work with your clients or program?What are you already doing that you will CONTINUE doing because it works well?
Slide46SummaryKNOW THE SCIENCE: Key concepts of life course theory influence behavioral and health outcomesKNOW YOURSELF: Understand your own trauma, triggers, and biases to become a better practitioner and advocateCHANGE THE FRAME: Instead of asking “what’s wrong with you?” ask “what happened to you?”DEVELOP A STRATEGY: Identify needs and resources to thoughtfully put a plan into placeSTART, STOP, CONTINUE: Commit to continuously improve your work
Slide47QUESTIONS?Please type in your questions.Any questions that we do not have time to answer during the call will be answered via email.Thank you!
Slide48Reminders & ContactsContinuing EducationCertificate of ParticipationEmail Shameka Jennings sjennings@nwica.org EvaluationFeedback and comments are used to improve webinarsNutrition and the Life Course Evaluation Link (click here). Also sent via emailEvaluations will be compiled 2 weeks after each webinar
ASPHN – Shana Patterson, Nutrition Consultantshana@asphn.orgPH Advocates - Flojaune Griffin Cofer, PhD,MPH FC@PHAdvocates.org
Slide49Thank You!