Data sources and methods

Social Determinants of Undernutrition

Researchers
A higher score on the MWI is associated with improved material wellbeing, and is equivalent to a lower score on DEP, i. Working together for health. With the testimony of William Tompkins, we now have independent insider verification of Corey Goode's testimony that Nazis cut a deal with negative ETs. Some have discussed it privately, but not publicly. The book contains a "grand summary" of all insider information we have gathered over the years, with particular emphasis on our solar system's cosmic history. J Am Dent Assoc.

What does Soros want?

Childhood diarrhoeal deaths in seven low- and middle-income countries

The top contractor recipients and their percentage of all contracting during this time period include:. Congress angered animal rights advocates in December when it lifted a ban on funding horsemeat inspections by the U.

The ban was imposed in as a way to shut down the last remaining horse slaughterhouse in the U. But supporters of the new bill said the ban had produced unintended consequences, including a growing population of neglected horses during hard economic times. The legislation did not include funding for USDA inspections, leaving it to the agency to come up with the money. Since no USDA inspectors were funded, that makes horsemeat illegal because processing plants must meet federal standards.

Yet, entrepreneurs hoped to open a slaughterhouse either in Wyoming, North Dakota, Nebraska, or Missouri although the latter looked unlikely by July It was estimated a new facility could process up to , horses a year, with the meat being shipped to countries in Europe and Asia, including France and Japan. The controversy over genetically modified GM foods has raged for decades, as farmers, biotechnology companies, governmental regulators, non-governmental organizations and scientists have debated the advantages and disadvantages of GM.

GM foods are those possessing genes manipulated by scientists to give them more desirable traits, such as resistance to insecticides used on farms. GM can also mean plants that grow faster or possess added nutrients and vitamins, according to supporters. Some consumers oppose GM foods, claiming not enough testing has been done to know what the long-term implications of GM might be for humans. Organic farmers have complained too, citing problems with their fields becoming contaminated with GM crops.

Department of Agriculture has been in the thick of the GM controversy, approving numerous types of GM crops for production by large agricultural operations. Genetically modified food controversies Wikipedia.

Supporters of organic foods were outraged at the USDA in when it was discovered the USDA had allowed synthetic additives in certified organic products. One example cited in the media was Horizon Organic Milk with DHA Omega-3, which was not an approved additive for organic food, according to The Cornucopia Institute, a watchdog for the organic industry.

The Cornucopia Institute has sued infant formula manufacturers and Dean Foods, manufacturer of Horizon dairy products, for adding unapproved additives. Finger Pointing and Name Calling: The pilot project called for the Supplemental Nutrition Assistance Program SNAP, formerly known as food stamps to remove sugar-sweetened beverages from the list of approved food items. States were motivated to exclude soft drinks in an effort to tackle the problem of childhood obesity, which is exacerbated by sugary beverages.

Brownell and David S. Representatives of the meat industry reacted angrily toward a proposal by the U. Labeled as adulterants, the six strains are related to Shiga toxins and can cause severe illness and fatalities, with young children and seniors most at-risk. Food safety advocates hailed the move, while cattlemen said it was unrealistic for the USDA to think its plan would work.

That view is not supported by science. Coli Strains The Hagstrom Report. In February , the Obama administration announced a draft plan to protect one million acres of public land around Grand Canyon National Park from new uranium mining for 20 years. The proposal, announced by U.

Interior Secretary Ken Salazar, was one of four alternatives in the draft plan. Mining supporters claimed the move would prevent the creation of new jobs, while environmentalists countered that mining would harm the environment and adversely affect canyon tourism. In May , the Bureau of Land Management had authorized several new uranium exploration permits near the Grand Canyon, despite a congressional resolution the previous year barring new claims near the national park.

In March , three conservation groups filed a lawsuit to stop uranium exploration the Grand Canyon. It was the first of five such projects slated for the area. As a result of USFS policies, wildfires have gone from being high frequency, low-intensity events, which provide sustainability for certain ecosystems, to low-frequency, high-intensity events that make suppression of them futile, writes University of Maryland Professor Robert Nelson in his book A Burning Issue: A Case for Abolishing the U.

Due to the prolonged absence of fire and the reduction in timber harvests, the abundance of dead and dying trees provide a high fuel load and conditions for high-intensity fires that can cause enormous damage to soils, watersheds, fisheries, and other ecosystem components, Nelson argues.

Many environmental groups that view natural fires as an integral part of ecosystem management have also criticized fire suppression efforts, claiming that it lacks scientific basis. Meanwhile, firefighters and residents who live on forestland lobby heavily for fire suppression policies. A Historical Perspective U.

Forest Roads or Forest Fires? Forest Service, pdf. Republican lawmakers set out in to approve the release of large tracts of public lands from government protection. The bill potentially affected six million acres of BLM wilderness study areas and as much as 36 million acres of roadless areas in the National Forest System. Any BLM lands not designated as wilderness or under consideration for wilderness designation would have been eligible for release, under the legislation.

Similarly, the Forest Service would have been compelled to let go of roadless areas not deemed wilderness or not recommended for such designation. The Obama administration opposed the bill, saying it would undermine the ability of both agencies to carry out resource conservation. The USDA under President Barack Obama stirred controversy in December when it sought to change the nutrition guidelines for federally funded school lunch programs.

Under new regulations developed by the USDA, the calorie intake of school lunches for primary students would be reduced to for each student, for middle school, and for high school students.

The change also called for using more multigrain breads instead of white bread and making sure vegetable servings were really made up of vegetables. Existing guidelines allowed for an eighth of a cup of tomato paste to equal one serving of vegetables, which allowed school lunches to serve pizza to meet its vegetable requirement.

The changes sought to eliminate this loophole over the opposition of tomato farmers. The USDA also wanted to cut back on salt, potatoes, and saturated fats in school lunches, while boosting the consumption of fresh fruits and vegetables. Adams, Los Angeles Times. The case was settled out of court 11 years ago, when the department found that black farmers had to wait three times longer for loans and subsidies.

In October , U. On July 19, , Shirley Sherrod was forced to resign her position as Georgia State Director of Rural Development days after video excerpts were posted online by Andrew Breitbart, blogger and media commentator, which purported to show her making racist remarks to a gathering of the NAACP Freedom Fund.

Sherrod, who is black, was making precisely the opposite point with an uplifting story of how she helped a white family avoid loss of their farm through foreclosure in while employed at a private advocacy firm for African-American farmers. Large sums of money are given annually through price supports for certain crops or farmers. These subsidies artificially keep American produce prices low on foreign markets, harming struggling foreign farmers, critics argue.

While a number of pundits still deny global warming science, in May , the U. Climate Change Science Program issued a report on the threats of climate change to agriculture and other key natural resources, which was authored by 38 researchers from universities, national laboratories, non-governmental organizations, and federal service. The USDA was the lead agency for the report and is using the findings to develop a new strategic plan for climate change research.

Shifts in plant productivity and type will likely also have significant impact on livestock operations. Higher temperatures will also likely reduce livestock production during the summer season, but these losses will likely be partially offset by warmer temperatures during the winter season.

Increased CO 2 and temperatures will also more rapidly progress the lifecycle grain and oilseed crops, but as temperature rises, these crops will increasingly begin to experience failure.

Climate change will also likely lead to a northern migration of weeds, the report found. Climate Change Science Program. Climate Change Program Report. Downed cattle are prohibited from the food supply as the risks of infection, contamination, and disease are heightened with lame animals.

Following the story, these products were placed on hold, and million pounds of beef was recalled—the largest beef recall in U. The recall included beef products dating back to February of Statement by Secretary of Agriculture Ed Schafer.

USDA officials maintain that they follow regulations as directed by the department and Congress, but those regulations are increasingly confusing or opaque. Requirements for determining eligibility for RD assistance tend to be quite variable and even subjective, depending on the program itself and leaving room for lawmakers to weigh in. For some programs, assistance is limited to towns with populations below 2,, but for others numbers can reach up to 50,, and some census-based decisions can divide eligible communities by street or block.

Rural Aid Goes to Urban Areas: Gaul and Sarah Cohen, Washington Post. The report was in response to concerns raised by Senator Tom Harkin D-Iowa in on possible inflation of actual investigations conducted by the competition division in annual GIPSA reports to suggest a higher rate of enforcement activity.

The report confirmed accusations that top officials had intentionally blocked investigations by refusing to provide clearance for employees to conduct investigations and inflating the number of investigations to give the misleading appearance that the agency was responding to pressures to clamp down on anti-competitive practices and market concentration.

The report identified three areas of material weaknesses: Additionally, it said the agency had not taken sufficient actions to strengthen operations in response to a finding previously reported by the Office of Inspector General in and the Government Accountability Organization GAO in The main issues of concern were that the GIPSA investigations were led by economists without the formal involvement of attorneys from the Office of General Counsel; and that the investigations process was designed for traditional trade practice and not suited to the more complex anti-competitive practices currently at issue.

In response, the bipartisan U. Packers and Stockyards Programs: In the second term of the George W. Bush administration, budget cutbacks resulted in the closing of FSA offices across the United States. Many farmers protested these cuts, as local FSA offices have been a crucial connection between farmers and the department since the s. Ben Nelson D-Nebraska launched an investigation after learning that the Department of Agriculture was skimming funds off of congressional earmarks.

Nelson asked the Congressional Research Service to investigate, which resulted in a finding that the federal government had no umbrella legal authority that allowed agencies to take a cut of each earmark and no overall standard for how much agencies should take.

The amount taken from earmarks varied within an agency. The Food and Nutrition Service finds itself at the center of ideological battles that question the role of the state in dealing with poverty and welfare, as well as business and subsidies. It is a complex debate that questions the causes and persistence of poverty.

Compounding these questions are disagreements over how hunger and poverty are defined and quantified. Often, the debate falls along party lines. Liberals focus on societal and systemic causes for poverty, such as disproportionate advantages and opportunities given to the middle class and wealthy. Many on the left see poverty as a societal creation and therefore a responsibility of government. Welfare programs are necessary to the marriage of capitalism and democracy, and welfare programs correct for market failures and redistribute wealth, allowing all members of democracy to be engaged in political and economic processes, many liberals argue.

The Poverty of Welfare: Congressional Food Stamp Challenge: Conservative opinions of poverty tend to reflect ideals of choice and personal responsibility. This view sees the poor as architects of their condition. To the Right, welfare programs reward laziness and encourage dependence.

Welfare programs hurt both the poor and society because they engender dependence, discourage ambition, and perpetuate the cycle of poverty, the report found. The agreement did away with all non-tariff barriers to agriculture, either immediately or phased out over periods of five to 15 years. The treaty also protected intellectual property rights and removed investment barriers.

Furthermore, the parties to NAFTA formed the largest trading bloc in the world in terms of the members combined gross domestic product. NAFTA also produced no shortage of opinions, both pro and con, about its merits. Supporters and opponents have been especially vocal in the U. United States Trade Representative. President Felipe Calderon defended the removal of protections for corn, beans, milk and sugar, while admitting the treaty was far from perfect for his country.

Nevertheless, Calderon argued increased trade integration with the U. Case, Dallas Morning News. Some of the most vocal advocates for the treaty have been large corporations, which promised that the removal of trade barriers would create hundreds of thousands of new high-wage jobs, raise living standards in all three countries, improve environmental conditions and transform Mexico into a vibrant developed nation.

Even in Mexico, farmers disagreed with President Felipe Calderon, saying they feared the removal of barriers would result in a flood of cheap U. The result would be the loss of more farm jobs, on top of the two million already impacted by the treaty. The farmers promised to continue their public protests of NAFTA until the government provided more support to the agricultural sector.

Stiglitz, New York Times. Secretary of Agriculture Tom Vilsack called for policy reforms in to avoid another collapse of milk prices that put many dairy farmers out of business two years earlier. At that time, plummeting prices wreaked havoc for farmers, especially those in Wisconsin, which lost more than 2, dairy producers.

Without specifically endorsing any plans, Vilsack said he welcomed changes from Congress, noting that the U. Department of Agriculture had limited authority in imposing major changes in policy. Dairy Reform Necessary, U. Federal officials proposed revamping the U. Department of Agriculture USDA loan guarantee program so advanced biofuels projects could receive more assistance. The plan for the Biorefinery Assistance Program, first proposed in Section in the Farm Bill, was intended to support the development and construction of new biorefineries and the remodel of existing facilities using eligible technologies beginning after Proposed changes included allowing loan guarantees to apply to the bond market, something they currently could not do.

Officials said the change was necessary due to the difficulty of acquiring financing to support loan guarantees through commercial banks. The USDA also wanted to allow foreign entrepreneurs to own domestic biofuel refineries, which was not permitted under existing regulations.

In October , ZeaChem Inc. Among its other additional investors were companies from Japan and Australia. State of the Union The purpose of the new rule was to identify biobased products composed of a minimum amount of renewable plant or animal materials. USDA officials said the labeling initiative would serve to more clearly identify biobased products and promote their sale. Ed Schafer , January 28, January 21, Johanns , January 21, - September 20, Veneman , January 20, - January 20, Back to Departments Back to Department of Agriculture.

Nutrition Food and Nutrition Service: Rural Development Rural Development: Marketing Farm Service Agency: Research Agricultural Research Service: The top contractor recipients and their percentage of all contracting during this time period include: Horse Slaughter Controversy Congress angered animal rights advocates in December when it lifted a ban on funding horsemeat inspections by the U.

Coli Ban Representatives of the meat industry reacted angrily toward a proposal by the U. Farming While a number of pundits still deny global warming science, in May , the U. Keep the Food Stamp Program Liberals focus on societal and systemic causes for poverty, such as disproportionate advantages and opportunities given to the middle class and wealthy. End the Food Stamp Program Conservative opinions of poverty tend to reflect ideals of choice and personal responsibility.

Stiglitz, New York Times Mexico: Vilsack Endorses Dairy Reforms Secretary of Agriculture Tom Vilsack called for policy reforms in to avoid another collapse of milk prices that put many dairy farmers out of business two years earlier. Johanns , January 21, - September 20, Ann M. Veneman , January 20, - January 20, Daniel R.

Madigan, March 8, - January 20, Clayton K. Yeutter, February 16, - March 1, Richard E. Lyng, March 7, - January 21, John R. Block, January 23, - February 14, Robert S. Bergland, January 23, - January 20, John A. Knebel, November 4, - January 20, Earl L. Butz, December 2, - October 4, Clifford M.

Hardin, January 21, - November 17, Orville L. Brannan, June 2, - January 20, Clinton P. Anderson, June 30, - May 10, Claude R. Wickard, September 5, - June 29, Henry A. Wallace, March 4, - September 4, Arthur M. Hyde, March 6, - March 4, William M. Jardine, March 5, - March 4, Howard M. Gore, November 22, - March 4, Henry C.

Wallace, March 5, - October 25, Edwin T. Meredith, February 2, - March 4, David F. See all 34 comments Comments Elaine 1 month ago. I have a box containing specimens of wool It Says "official standards of the united states for grades of wool top". It is numbered Few of these graphics or guides have been evaluated for effectiveness. There are also a number of other issues raised about food guides. These include the extent to which a guide should reflect the current food supply and food practices or whether it should represent an "ideal", the extent to which guides should sacrifice accuracy or completeness for the sake of simplicity, the extent to which guides should reflect a concern for sustainability of the food supply, and the extent to which a food guide should "stand alone" or be part of a more extensive education strategy.

Other issues frequently raised are, whether the food guides should address only the daily "foundation" diet or total intake, and whether a country should have several food guides for different ages and needs or only one to improve consistency.

Overall, the intent of food guides is appropriate and desirable. Their functionality and impact, however, will depend on their developmental process and fit with the target audiences' perceived needs and desires.

Most food guides probably need revision in order to meet these considerations. However, a food guide that makes sense to the target audience is a valuable addition to the curriculum. One of the drawbacks of a "stand-alone" curricular approach is that nutrition will often not be taught if it is not required of teachers to do so. In addition, when nutrition is taught in this fashion, it may become disconnected from everyday life and the other subject matter in the school curriculum.

In the s, an integrated curricular approach was begun as an alternative, and is becoming more commonplace on a world-wide basis. For example, Malaysia integrated nutrition instruction in the primary schools first six years of schooling into subjects such as Man and His Environment, Islamic Studies, Moral Education and Music Education, where food and its basic functions are taught as well as the concept of a balanced diet.

In Malaysia's secondary school curriculum, nutrition is incorporated into Physical and Health Education, where the relationship between nutrition, health, exercise, and concepts pertaining to overnutrition are taught Karim, India evaluated the integration of nutrition education in health education and environmental sanitation during the third-fifth year of primary schooling.

Results at the local school level indicated a significant change in height and weight indicators among children, and a marked decrease in observable deficiency symptoms, e. One of the drawbacks of an integrated approach is that nutrition may be taught in a fragmented, uncoordinated, and uncomprehensive fashion.

The net result may be less meaningful learning, comprehension and behaviour change than might be accomplished if nutrition were taught as a separate subject. Fragmentation can be avoided, however, if care is taken in curricula development to ensure that nutrition concepts are taught in a systematic, comprehensive approach where new knowledge is added to prior knowledge in a pre-planned sequence of steps and learning objectives.

This approach requires a co-ordinated effort across subjects, often involving teams of teachers and administrators. Studies to evaluate the impact of nutrition education in schools are relatively rare.

However, there is a general sense of disappointment with the results of classroom-based education. Less than optimal results may be due to a number of different factors, including too little time given to nutrition instruction, use of a non-participatory classroom approach, lack of family involvement especially at the primary level, or lack of self-assessment of eating patterns at a secondary level.

School programmes that are not behaviourally-based and theory-driven are also less likely to be successful. Regardless of the quality of instruction, the learning will not be put into practice and behaviour change will not be accomplished unless the immediate environment supports such practices or changes.

Creating supportive environments Offering food to school children is the most important immediate environmental support. School feeding programmes may be offered to school children as a stand-alone programme or they may be integrated with classroom instruction on nutrition. Supplementary feeding programmes are probably the most commonplace; the provision of meals, most often lunch and more rarely breakfast, is widespread in some countries.

The purpose of meal programmes is to accomplish the above three objectives as well as develop the eating habits and skills needed for life-long, positive, healthful eating practices. There are two principal problems with feeding supplements, such as "Incaparina" to children: Moreover, even if the supplement is available on the market-place, it will not become a part of the regular diet because it is "foreign" to the everyday food habits of the local people.

Meal-feeding programmes as opposed to single food supplements may be partially or completely subsidised by the government or local community. Meals are preferable from a learning perspective, because the children are eating foods they can recognise and obtain in their own homes and communities.

The feeding situation can then be an extension of the classroom, in essence, a learning laboratory, where proper eating habits can be demonstrated and reinforced in practice. Another important way to build a supportive environment for the school curriculum in nutrition is to involve the parents. Children can take their learning home and share it with other household members, but it is important to engage these other family members in the learning experience as much as possible.

Dialogue between the parents and the teachers, as well as their children, should be encouraged. Parents can also become involved in food production, especially in school gardens, as well as in the planning for, and preparation of school meals for children. Creating links between the school and the community School programmes will have greater impact and be sustained longer if they are tied to community activities, programmes, and other private and non-governmental organisations. School gardens provide an excellent opportunity for community involvement, as access to water, land, material input plants, seeds, tools, etc.

Thailand exemplified how such community linkages can be developed with a school-based nutrition education programme. To encourage the use of the ivy gourd plant a rich source of vitamin A and school market gardens which raised food for the children to eat as well as for school income , they solicited help from the extension service and experienced home gardeners to start local projects.

They involved key officials including school administrators, agricultural officers and the district committee to judge ivy growing and garden competitions between schools and districts. Mobile dramas also travelled to schools in all participating districts and provided entertainment with education to reinforce the communication message.

They also involved Buddhist monks who played a promotional and educational role in the project. Finally, the message was also incorporated into local festivals and holidays, including New Year's cards with an ivy gourd greeting Smitasiri, et al. Together, these various activities involved a large number of community members and opinion leaders, strengthening both the school programme and the community in the process.

Another logical linkage can be made between schools and health monitoring programmes. Children's growth and immunisation can be readily monitored in schools. Partnerships between health workers and agencies can provide access to children and needed support to all participants.

Other potentials include involvement in teacher training and medical doctor training programmes, where the schools invite students into their classrooms to learn as well as teach.

Libraries can also provide important links between the school and the larger community. Volunteers can be trained in, and work with schools to broadcast programmes, motivate audiences, and coordinate nutrition and other health-related messages to children and the broader community.

Implementing special or system wide promotions Linkages that occur at the local level can be extended to district, regional or system-wide programmes as well, especially in the area of nutrition surveillance and child growth monitoring programmes, other Ministry of Health programmes, child care centres, women's development programmes, home economics training for women's groups, or any programme that promotes home food production or home consumption.

In fact, linkages should be systematically promoted at all levels, from local community administrators and extension workers to district committees, provincial government officials, and high level government officials. Such linkages should be used to frame and institute policy changes at each of these levels to assure that nutrition education and communication programmes, especially highly successful efforts, are sustained over time. Facilitating policy development There are many areas where government policy has an impact on nutritional status, food security, and nutrition education at national, regional, and local levels.

Some of these areas include agriculture, including animal husbandry, crop production, fisheries, and forestry; health; environmental policy; women's development; population; urbanisation; international economics; and trade agreements policy. Education, advertising and consumer policies are discussed less often in terms of their interaction with nutrition, but are probably as important.

Policy is inalienably a matter of politics. At the same time, the school system is charged with a custodial responsibility for children. It therefore seems that schools should also be involved in policy development to protect and sustain children's development. Food and nutrition policies are integral to that interest.

It should be recognised that the strategies for poverty alleviation have changed significantly in the past decade or so. It is now accepted by experts in behaviour change and nutrition communication that people's participation is fundamental for any sustainable improvement in the welfare of the poor.

Participation means local people organising to shape the terms of the social, political, and economic processes that affect them. In other words, the people create organised demands upon governments and agencies as well as private and commercial bodies to meet their needs using indigenous expertise and technologies.

Participation also implies capacity building and the strengthening of local institutions Haralambous, Naturally, agenda-setting and policy formation play an important role in this effort.

Food and nutrition policy may be among the most important and most obvious to people at the local level and local schools may be a natural focal point for such organization and participation. However, in some countries, the style of government does not permit the type of citizen participation discussed here. Mass media and social communication Using mass media to increase awareness The mass media were not used widely in nutrition communication until the s.

Before then, nutrition communication relied almost entirely on face-to-face instruction in health clinics Lediard, Many early efforts using mass media in nutrition communication yielded disappointing results.

This was often because the quality of many past programmes was inferior due to a lack of training or preparation, inadequate resources, or because it was used for inappropriate purposes. Media cannot, for example, cure poverty Lediard, But, neither can media be relied upon to change behavioural patterns by itself. Media-based nutrition education projects are now legion. Some have produced changes in behavioural practices, such as campaigns for oral rehydration salts in Egypt, the Honduras, Gambia, and Swaziland, but changes in nutritional status are rare Hornik, It is now known that the best use of media, particularly for stand-alone media campaigns, is to build public awareness about a new issue, problem, or resolution.

One of the most powerful aspects of the media is its ability to set the public's agenda. That is, media shapes what people view as important in the world, and it identifies and defines concerns, issues and problems. This is another form of building awareness. Other forms of two-way communication may be needed to persuade the public to adopt a different behavioural approach, for example, to infant feeding. Developing single message strategies Today, the strategies used to develop mass media communications in nutrition are taken from social marketing literature.

Several sources provide good descriptions of how to plan persuasive messages such as Andrian , Rasmuson et al. Generally, four questions are posed at the beginning stages. Who is the target audience or consumer for the communication?

What is the product? What is the message? What are the channels of communication? Market research is used to answer these questions and the media messages and campaign are designed accordingly. There are four elements involved in designing an effective single message Hornik, Some of the key points include creating messages that are clear, concise, credible, and easy to remember, all from the target audience's perspective.

Above all, the messages need to appeal to the target audience's perceived need for information. The most effective messages include a precise behaviour change recommendation, use a memorable slogan or theme, and are presented by a credible source in a positive, uplifting style that is not offensive to any member of the target audience US Department of Health and Human Services, Finally, a focus on motivation, not just information, is needed.

Of course, all media should be thoroughly pre-tested with members of the target audience, as described earlier in this chapter. A variety of media may be used to communicate a single message, including bulletin boards, booklets, pamphlets, posters, radio and television messages, newspapers, community bill boards, and promotional give-aways to name just a few.

Promotional give-aways are products that carry slogans or short messages including calendars, T-shirts, caps, vests, ball point pens and pencils, notepads, pins, and bags. Effective promotionals are items that are regularly used by the recipients, routinely reminding them and those with them, of the message. Print messages should specifically avoid jargon and technical terms, abbreviations and acronyms, small type, and long words, sentences, and paragraphs. Text should be written in an active voice and use organising headers, bold print and "boxes" to highlight important points.

Graphics should be immediately identifiable to the target audience, relevant to the subject matter, and kept as simple, but up-to-date, as possible. Short second public service announcements, spots, or plugs on radio or television should also recommend a specific action, make a positive not a negative or fearful appeal to the audience in simple language with a memorable theme, music, visual, or character to deliver the message. Even the best designed message needs to be repeated many times if it is to build general public awareness or accomplish any other outcomes.

Any form of mass media has a limited effect when it is delivered only once or for a short period of time. The audience needs frequent exposure to the message, even if it is familiar, but especially when it is new or novel to them.

The greater the reach, frequency, and duration of a mass media message, the greater the number of people who will be reached and the greater the likelihood that change will occur. Using mass media as the centre piece for a multi-channel campaign A fundamental dilemma in nutrition communication is that interpersonal communication may be more effective at promoting behaviour change, but its reach, and ultimate impact, is limited by the size of the audience Gillespie, The mass media reach far more people in far less time.

However, single messages are unlikely to change strongly held attitudes or behaviours. Mass media campaigns are defined as planned, large scale, multimedia efforts to communicate a single concept idea to a target population s in a prescribed amount of time Wallack, Generally, mass media campaigns: Mass media campaigns may speed the rate of behaviour change, but rarely initiate it.

They can also play a role in facilitating one or more steps in the behaviour change process. They work best, however, in synchrony with other intervention components. Several family members should be targeted by messages in order to facilitate a supportive home environment for the desired behavioural changes.

Different media have different effects on different people. Heavy users of the media react differently to media messages than light users. Heavy users those who listen to or watch media for four or more hours a day tend to rely on the media for information about their community and the larger society. Some people are interested in certain topics e. A multi-channel nutrition communication campaign that introduces new messages with star personalities drawn from these interest areas can take advantage of this.

For example, in Brazil, the captain of Brazil's World Cup football team, a well-known male musical entertainer, and three well-known television actresses were used in second television commercials to support breast-feeding ad Kahn, Alternatively, nutrition messages can be incorporated into pre-existing heavily watched media e. Other communication channels can then be used to reinforce these messages and stimulate behaviour change, especially at the local level.

In Thailand, for example, Buddhist monks were very influential within communities, but mass media was useful for initiating community campaigns for change Smitasiri et al. Facilitating pro-active use of mass media Several factors contribute to the potency of any media campaign. Media effects are limited when interpersonal relations and prior beliefs conflict with the message. Media effects can be powerful when they coincide with interpersonal relations. When the public hears a message that makes them uncomfortable, they may selectively pay no attention to it, misinterpret it, fall back on their own rationalisations, disbelieve it, or attack the source's credibility to reduce their discomfort with the message.

People will be less resistant to a new message if it is introduced by opinion leaders in the local community or general society. Only sound market research prior to message development can anticipate and accommodate the conflicts the target audience might have with the messages. Because multi-channel media campaigns are by definition complex, partnerships are highly recommended to facilitate their development, implementation, and evaluation.

Nutritionists need to form partnerships with social scientists and communication or media specialists. In addition, multi-sectoral partnerships are also routinely required. They may involve private industry, non-governmental agencies, government agencies, religious leaders, and grassroots participation at the local level. Policy-makers should, in particular, be thought of as a target audience and be included in communication design.

Desired changes are most likely to occur within a supportive environment for change. Only broadly based partnerships can create that context. Authoritarian-type governments may provide a better context for a co-ordinated, multi-sectoral communication programme than more democratic-type governments where communication industries are independent, commercially oriented, and owned by many different people.

In recent years, innovative mass communication approaches have been effectively integrated into mass media campaigns to create widespread attention, interest, motivation, and recall for particular nutrition, health and population messages. One approach has been called "enter-educate. The enter-educate productions are aired over radio and television, featured in magazines and newspapers, and even through live shows in shopping malls.

A similar approach, "info-tainment", combines the objectives of informing while entertaining the public via comedy and drama programmes over radio, television, and comics. Info-tainment has also been used by community development workers to reinforce their interpersonal approaches. Using mobile audio-visual vans, they present certain video documentaries on agricultural technology, alternating with a full length movie of the audience's choice.

The advertising industry has also introduced "values advertising" and "development plugs" to inject messages with developmental value in their advertisements. Enter-educate, info-tainment and developmental plugs are unlikely to work effectively unless they are created by a team of nutrition educators and mass media specialists.

Inter-sectoral partnerships can accomplish two objectives. They may increase the broadcast of more positive nutrition messages, and thereby change the communication mix.

They may also decrease the broadcast of negative messages as partners recognise the number and kind of negative messages already broadcast in the mass media. They may then voluntarily withdraw certain negative messages or work to change some of those messages.

Training media journalists There is a shortage of media specialists in developing countries, especially those associated with ministries of health or education. In some cases, a ministry of agriculture may have access to communication expertise. Health ministries and education ministries should be encouraged to create positions for media specialists and include them in the earliest stages of programme development.

They should also try to work inter-sectorally to support training for media specialists and create an infrastructure to support their activity. Media journalists tend to be trained as generalists. Few have the expertise to correctly communicate health and nutrition information to the public. Therefore, multiple training programmes are necessary to promote effective nutrition communication campaigns: This will require training on how to incorporate innovative technologies into programme planning as well as the use of traditional communication modalities.

This will require additional training in the behavioural and social sciences. Training of media journalists and communication experts can be costly in itself, but the Union of National Radio and Television Organisations of Africa URTNA has developed an effective model that may be appropriate in many parts of the world.

URTNA has 48 member countries that team together to sponsor training sessions and an exchange of programmes and teachers across international boundaries. In a three year period, they have graduated technicians from their training programmes and have exchanged over 2, radio and television programmes for broadcast.

Regular meetings held every two weeks between communicators from national broadcast organisations and experts in family planning and maternal and child health are considered a key element in this programme's success.

The meetings foster open communication between these two fields and stimulate teams in different countries to produce higher quality programmes Demena, Effective training programmes are needed, but are not sufficient, for the creation of successful communication programmes. Successful programmes require not only the incorporation of communication technologies, but also institutional infrastructure and a supportive policy and philosophy to sustain such communication efforts across a region or country.

Work-site programmes Establishing the benefits to employers and employees Healthy work-site programmes became popular in the s and nutrition education is a common component of these interventions. They have been reported in telephone companies, police departments, Fortune companies, and small local businesses. Healthy work-site programmes emphasise disease prevention or health promotion.

For example, it is less costly to prevent hypertension via education than it is to treat it via medication. Some of these chronic diseases are related to food habits and choices. Since these food-related behaviours are not fixed, communication and other interventions designed to modify these behaviours may decrease the risk associated with these diseases, and presumably increase worker productivity, decrease company costs and improve the company's public image.

Work-site nutrition education programmes are appealing for many reasons. From the employer's perspective, they may increase workers' productivity, decrease absenteeism and turnover, improve recruitment of personnel, and generally improve company morale.

From the health-care provider's perspective, work-site nutrition education programmes provide access to workers who may not otherwise be served by the health-care community, enable cost-effective and efficient screening opportunities, provide a forum where nutrition information can be efficiently disseminated, and an environment where behaviour can be monitored and social or peer influences can be used to reinforce behaviours.

From the employees' perspective, work-site nutrition education programmes may be attractive because they are convenient, meaningful, credible, and ongoing. If successful, they can decrease health-care costs and improve the happiness, health, and quality of life for individual workers and their families Johnson, et al.

Screening and needs assessment Groups of participants can be screened, counselled, and followed in a time-efficient and cost-efficient way Johnson, et al. These screening data should be used to design appropriate interventions and communication campaigns for the company as a whole and possibly, for individuals within the company.

Baseline data should be collected about the individual workers, their home and community environment, and their employers and work environment before a work-site programme is designed and implemented. Assessment of the work-site should include management style e. Some of these variables are important in order to determine how to introduce and sustain a work-site programme in the most acceptable manner to both workers and management.

Catering programmes, nutritional improvements of food services, and point of sale promotions Many family members, including school children, spend a major part of their day in the workplace or in school. This means that they must eat at least one meal and about two snacks outside the home.

This has led to the growth of the food service industry, particularly street-food vending in developing countries. The street-food trade is a source of livelihood for many people among the low income group, and is a source of cheap food for low to middle income people. Recognising the need to protect consumers against unhygienic and low quality street-foods, FAO supported pilot projects on the improvement of street-food safety and quality in several developing countries in Asia and Latin America.

An education and communication component was built into the projects, addressing consumers on one hand, and educating street-food vendors on the other, on topics like basic nutrition, food preparation, hygiene, and sanitation. Seminars and training in the workplace had been successfully carried out for both groups, reinforced by well researched and properly designed print and audio-visual media such as posters, flyers, brochures, flipcharts, and training modules.

In these programmes, employers offer their workers choices of nutrient-dense foods e. These foods may or may not be offered along with other less desirable choices. Often nutrient information in the form of labels or posters accompanies the foods in the cafeteria environment. Entrepreneurial lunch wagons can offer nourishing food to field work-sites that are remote from feeding facilities.

Facilities for washing before eating are also important. Some companies subsidise in-plant food services partially or totally, making them nutritious, attractive and convenient to employees. Some employers have also added nutrition awareness games and incentive raffles e. Research studies have generally produced positive trends in dietary intake but often only outcomes over a short period of time are evaluated.

Most of the catering programmes reported in the literature have concentrated on heart health issues, but other issues that could be considered include use of fluoridated water, iodised salt, adequate protein, clean water, and iron. Nutrition education as a stand-alone work-site programme Nutrition education that is not connected to any other form of health education at the work-site can be described as a stand-alone programme.

Carefully targeted materials and classes can have a significant impact on nutritional status, not only for employees, but for their family members as well.

The success of stand-alone programmes depends on how supportive the company environment is of the recommendations. Stand-alone programmes are unlikely to work if they include only information dissemination. Generally, work-site nutrition education programmes require supportive environments such as cafeteria or food catering programmes as described above. It is essential that employees have access to appropriate food choices.

Release time from work and employer commitment to the programme are also viewed as important to success. Employees respond best to healthy work-site programmes that are simple, practical, and relevant and that allow them to participate actively in the learning activity during work time. Eating pattern messages which include specific foods or brand names and behaviourally oriented programmes are better accepted than messages containing medical jargon and lengthy background explanations McCarthy et al.

Nutrition education as part of an integrated health programme Nutrition education can also be integrated into a more comprehensive health programme at the work-site that might include, for example, smoking cessation programmes, drug and alcohol education, stress management, child-care education, and breast-feeding support. It may be combined with an exercise or fitness programme or more often, a weight control programme. Work-site nutrition education programmes can also be integrated into the broader community.

Community-based wellness councils, for example, team non-profit health organisations with small businesses and vendors within and across communities.

The councils do not compete. Rather, they bring together local providers with common interests to share ideas and resources to offer healthy work-site programmes that they cannot afford themselves. Often they share newsletters and strategies with one another. Wellness councils may publish "how to" guides, hold delegate meetings and annual meetings, or share the cost of bringing in an outside consultant or nationally known speaker Kizer, Ideally, community-based wellness councils match local expertise to local needs and help small businesses lever their limited resources for maximal impact.

Together, they may also affect an entire community to create a more healthful and supportive environment for its citizens. Number of work-site programmes Given the advantages of, and opportunities for work-site nutrition education programmes, it is interesting to note their small number, especially in developing countries. This may, in part, be due to the lack of an infrastructure for these programmes, but there are several other considerations as well.

Work-site programmes have been criticised because many tend to serve only healthy workers or well-paid, professional employees, neglecting those in greatest need. They may increase personnel costs to the company, at least initially, and they may subject a company to liability concerns Ostby, Relatively little attention has been given to developing methods for institutional commitment, and this seems critical to programme success.

Conclusions This review has led us to draw four broad conclusions: These conclusions are further developed below. Nutrition education and communication should be thought of as an integral part of a country's development plan. The nutritional status of a country's population is an important indicator of national development. The causes of poor food habits are complex. The simple provision of food or supplements does little to resolve long-term nutritional problems.

Nutrition education and communication can have a significant impact on a population when there is political stability, social coherence, and a favourable economic climate. Nutrition education and communication provide people with the knowledge, know-how, motivation, and reinforcement to empower them to effectively address their own long-term food and nutrition problems. Changing food and nutrition behaviours to improve nutritional status at a country level is a long process comprising many steps in many sectors at many levels.

Recognition of this fact may call for a reorientation in thinking about nutrition programmes. A long-term, holistic view of nutrition education and communication is needed, with nutrition education seen as a central component, not merely as a tool to use on occasion.

This holistic view may also require a re-examination of the philosophy, processes, strategies, messages, and methodologies used in nutrition interventions. It involves many actors including policy makers, planners at community and national levels, educators and communicators, NGOs and other providers of resources, field support staff and service delivery personnel, community leaders, and finally, mothers, children, and other family members.

Nutrition education and communication programmes need to be comprehensive and coordinated for effectiveness. Mass media messages, although cosmetically perfect, will be ineffective as stand-alone interventions. Rather, several communication channels should be used. At least some of these channels should involve two-way communication. These activities require an administrative infrastructure, including organisational structure and managerial mechanisms to support a coordinated effort.

Usually these efforts will have to be multi-sectoral in nature. Commitment to the programme effort at all levels is needed for sustained programmes. Nutrition education and communication programmes need to be participatory in order to effective. Interventions should be problem-solving, decision-making and action-oriented. Ideally, the target audience should feel a sense of ownership of the programmes.

Therefore regular interpersonal communication is needed with at least some representatives in all development, implementation, and evaluation procedures. Recommendations The conclusions lead to four specific recommendations: These recommendations are described in further detail below. The commitment of political leaders, policy makers and resource providers should be sought as an initial step to programme planning and launching of the implementation strategy.

Advocacy efforts can help to enlighten policy-makers and resource-providers about the importance and effectiveness of nutrition communication in influencing behaviour changes to improve nutritional well-being. Continuous support and commitment is essential to success. A two-way flow of information and resources should be emphasised in all nutrition and communication programmes. A two-way flow implies the effective use of both top-down and bottom-up as well as lateral communication.

It assumes that programme or project formulation begins with the target groups and it uses consultation, co-ordination, collaboration, and co-operation m feedback, information-sharing and decision-making. As a result of the public's participation in the process, they should be able to decentralise the provision of services and institutionalise policy for communication and behaviour change in their own community development strategy.

More and better quality training programmes are recommended. Training should not be a mere one-off effort. Rather, continuous in-service training is needed in order to respond to changing priorities and problems, to share relevant experiences or lessons learned, and to develop educational and communication technology.

Training in programme management should also be included in education and communication technology. A train-the-trainer approach could be used within country or across national boundaries.

The first level of training, then, would be the training of more trainers. The second level should be training of field support staff, community workers, teachers, and curriculum developers. The third level should be the training of specific target groups such as women or school children. Nutrition communication and education efforts should effectively combine the processes and approaches of social marketing, social mobilisation, and development support communication.

No single approach will be continuously effective or suitable to the resolution of all problems, but each of these approaches has proven effective for certain problems at certain stages of behaviour change and development.

Programme planners should be adept at all these strategies and employ each wherever it is suitable, again in a comprehensive and co-ordinated manner. Other theories and approaches to behaviour change should also be explored. In conclusion, development should concern everyone. Nutrition improvement is a basic requisite to development. Concerted efforts in nutrition education and communication may facilitate its realisation, providing sufficient resources are available.

Yet, co-ordinated action on all the causes and effects of under-nutrition must be taken as well. Issues involving over-nutrition may not yield as readily to mass communication campaigns. A guide for nutrition educators at the work-site. J Nutr Educ, 18 1: A guide to planning, implementation and evaluation. Social communication in nutrition: A methodology for intervention. Institutionalizing nutrition communication programmes.

Threats to internal validity in worksite health promotion programme research: Common problems and possible solutions. The six months worth a lifetime: Brazil's national breast feeding programme. Media and health behavior: Building partnerships between broadcasters and health professionals. Nutrition education in India: Impact on knowledge, behavior and health status of students. J Nutr Educ, 18 3: Creating a well-fed world. Nutrition and Development- A Global Assessment. International Conference on Nutrition.

Perspectives on communication for development. Communication theory as a basis for nutrition education. J Am Diet A, 87 9: The state of world rural poverty: A profile of Latin America and the Carribean. Rome, International Fund for Agricultural Development. A state of the art review.

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