The case for mass public education campaigns

[JVBT, ASN]

Step One: The case for mass public education campaigns

“We are seeing this pandemic because it's been fueled by a slower pandemic of chronic illness that makes people at high risk, and we have not had the emphasis on disease prevention in our society that we all need and deserve.” -Dr Howard Koh on Yahoo Finance, July 5, 2020

As we now know, embedded structural inequities like redlining, underfunding of public schools, public sector/frontline employment, inability to afford healthy food, food swamps and the built environment, have contributed to disproportionate Covid-19 rates of infection, complications, and death among much of the country’s minority populations. But it’s important also to realize that, regardless of race or ethnicity, much of the destruction that SARS CoV-2 leaves behind clearly reveals the effects of diets high in processed food. As addictive as nicotine and heroin, processed food is a huge driver of hypertension, obesity, and diabetes – comorbidities one, two and three in Covid-19.

I am a clinic nurse, and I say this as someone who has dedicated hundreds of hours to education: It is not your fault or my fault or our fault that we have the current burden of chronic disease that we do, and it’s not our fault that processed food caused it, but though we as healthcare workers are nominally part of the solution, at times it seems like we are asked to be the entire solution.

A system whereby you ask doctors and nurses to one by one by one educate thousands of food-addicted, undernourished people could not be more inefficiently designed.

It is beyond time to seek ways to launch massive public education campaigns, definitively linking diets high in ultra-processed food directly to poor health outcomes.

Diet has been the kindling that has allowed this pandemic to blaze through. If all public health agencies and companies do is fall back on the assumption that stress and poverty lead to a poor diet, and leave it to a few doctors and nurses to talk to a handful of residents, the ramifications of a poor diet are not addressed at a mass level, and we have no hope of slowing the rate of severe chronic disease. I believe that people, even people under stress, presented with information vital to their health in a way that grabs their attention can (and have been shown to) adjust, to both make and demand better food choices.

Such a campaign is not meant to be unsympathetic to those forced to sustain themselves on unhealthy food, but rather a tool in the larger struggle for health equality.

And it is only step one in better health equity – making the case. While it does not preclude weaving in other strategies, illustrating the link between processed food consumption and chronic disease is fundamental to firmly situating health as a key driver and indicator of equality.

[A Hit With The Ladies, BSN, RN]

So how is "knowledge" about diet going to translate in our day-to-day lives? Americans' work-lives are stressful, and the last thing people need is stress over preparing and procuring delicious yet healthful meals. When you have a single-parent household or both parents needing to work, that becomes even harder. Food is stress relief and a mental break from life's hardships. Now, I'm not condoning McDonald's drive-thru every day - it's a sad state of affairs to live on an unhealthy diet, for sure - but I definitely do empathize with the legions of Americans who cannot eat healthy on a regular basis. Trying to "teach" people who already know is a bit patronizing and won't be received well.

It may be better use of resources to lobby Chipotle and Subway to offer drive-thru everywhere to spread healthy food options as a rival to McD's and Whataburger.

[JVBT, ASN]

1 hour ago, A Hit With The Ladies said:

So how is "knowledge" about diet going to translate in our day-to-day lives? Americans' work-lives are stressful, and the last thing people need is stress over preparing and procuring delicious yet healthful meals. When you have a single-parent household or both parents needing to work, that becomes even harder. Food is stress relief and a mental break from life's hardships. Now, I'm not condoning McDonald's drive-thru every day - it's a sad state of affairs to live on an unhealthy diet, for sure - but I definitely do empathize with the legions of Americans who cannot eat healthy on a regular basis. Trying to "teach" people who already know is a bit patronizing and won't be received well.

It may be better use of resources to lobby Chipotle and Subway to offer drive-thru everywhere to spread healthy food options as a rival to McD's and Whataburger.

My point is, that nutrition education is in fact happening right now, regardless of what you or I think. And I maintain that, for those conducting the education, it is like pushing a too-heavy boulder up a hill. Without an overlay of support that mass public education can provide, we will never push it all the way up that hill. In other words, we will never get the outcomes we want.

Let me take a different tack - we don't tell people: "Aw, I know your life is stressful, it's OK that you smoke." Again, I along with thousands of others, do this education. I meet with stressed out people, often with few resources. It is not meant to castigate or patronize anyone. If that's what is taken away from my OP, then I have done a very bad job at communicating!

[A Hit With The Ladies, BSN, RN]

What I'm saying is that public education campaigns come off as trite and patronizing when they don't meaningfully change the reality of the world around us. People will, in the interest of politeness, nod their heads to what you say and then throw your pamphlets in the trash on the way out the door. I have nothing against education campaigns, but I am telling you that people are going to mentally retort, "Well, you should see the reality of my life and how impractical your ideas are to implement in my life!" Things are not going to change unless you can offer people alternatives that are easy to access and stress-relieving, rather than stress-inducing. Come up with "healthy food trucks" and lobby for healthy drive-thrus. You have to meet people where they're at.

[toomuchbaloney]

States have a pretty long history of taking funds from public health budgets for other purposes...you know, like for paramilitary police equipment.

[JVBT, ASN]

On 7/7/2020 at 5:52 PM, toomuchbaloney said:

States have a pretty long history of taking funds from public health budgets for other purposes...you know, like for paramilitary police equipment.

It's true that that we like to starve our public health agencies, I don’t think there’s any doubt about that. Nevertheless, it would be great if more people could weigh in on what I'm discussing - I don't think it's wholly dependent on any one state's public health agency. Maybe I’m way off base here, but I don’t think I am. I think what's staring us in the face is this link between junk processed food and dire health outcomes. And I feel like there’s a lot of sidelined energy, energy that’s just sitting at home looking at Youtube videos when a lot of us could be doing a whole lot more. There’s just a lot of energy that’s not being put to use right now and I find that incredibly frustrating. And in this specific instance what I’m talking about is junk food. What I’m talking about is making a direct link from junk food to poor health outcomes. To metabolic conditions. To kidney disease. To stroke. To amputations. To chronic infections. To acute Covid infection, ICU admittance, intubation, and death. To me the connection is crystal clear, and if ever there was a time to compassionately mobilize and get out a clear message, it would seem to be now.

[NRSKarenRN, BSN, RN]

There have been a lot of mass public nutrition education campaigns, especially when Michelle Obama was the First Lady and spearheaded efforts to reduce childhood obesity. Many TV nutrition ads targeted Southeast PA/NJ/DE area where I live near 2 of nations poorest cities: Camden, NJ and Chester, PA. Additionally, programs developed with low literacy in mind.

Lets Move! https://letsmove.obamawhitehouse.archives.gov/

My Plate --now has an app to download

USDA's food icon, MyPlate, serves as a quick visual reminder to all consumers to make healthy food choices when you choose your next meal, built off of the Dietary Guidelines for Americans. MyPlate can help prioritize food choices by reminding us to make half of our plate fruits and vegetables and shows us the other important food groups for a well-balanced meal: whole grains, lean proteins, and low fat dairy.

https://choosemyplate-prod.azureedge.net/sites/default/files/printablematerials/2013-WhatsMyPlateAllAboutInfographic.pdf

USDA Communitiy Nutrition Education

https://nifa.usda.gov/sites/default/files/resource/Community Nutrition Education Overview Brochure.pdf

Expanded Food and Nutrition Education Program (EFNEP)

Nutrition insecurity is a significant national health concern, especially among low-income populations that disproportionately experience poor health. Often associated with food insecurity, nutrition insecurity is characterized by poor nutrition, limited physical activity, and unsafe food practices. The Expanded Food and Nutrition Education Program (EFNEP) is the nation’s first nutrition education program for low-income populations and remains at the forefront of nutrition education efforts to reduce nutrition insecurity of low-income families and youth today. https://nifa.usda.gov/program/expanded-food-and-nutrition-education-program-efnep

SNAP Education resources, includes Spanish language material

https://snaped.fns.usda.gov/snap-ED-works/nutrition-education

Smart Choices: A Community Nutrition Education Program

Smart Choices: Eating and Exercising for Good Health (Adult Fact Sheet https://snaped.fns.usda.gov/library/materials/smart-choices-community-nutrition-education-program

PA's Program: Be Healthy includes cooking basics, healthy food substitutions, healthy eating tips for kids, healthy beverage choices.Hoe to shop and read food labels, healthy eating on a budget, need to MOVE-places to be active -outdoors and indoors, benefit physical activity..

https://www.behealthypa.org/

[JVBT, ASN]

It has been said about more than one thing, but I think Dolly Parton's quote - you have no idea how much it costs to look this cheap - is in this case very apt. We are paying dearly for our cheap nutritionless food.

@NRSK

Thanks. I'm not looking for links, though no doubt they are helpful to others, as I have logged countless hours of nutrition / diabetes / hypertension education in my job. Some of the links are out of date, and very unfortunately Ms Obama is out of the picture now, though I agree it was great when she was here, and I loved the garden on the White House grounds. We use the plate method which emphasizes a half plate of vegetables, not a quarter, and de-emphasizes processed carbohydrates, if not advocating their absolute elimination. My point is that it is - well, I've posted several times here, no need to repeat!

Thanks for taking the time to log your input.

[emtb2rn, BSN, RN, EMT-B]

I didn’t see any mention of food deserts. All the education in the world won’t help if you don’t have access to healthy food options. There are so many urban & rural communities that simply don’t have well stocked supermarkets or farmers markets available. Fast food becomes the default nutrition source.

I did a quick search for .gov links on food deserts. The most recent one I found was from 2015. So I guess it’s not a priority anymore...

[JVBT, ASN]

1 hour ago, emtb2rn said:

didn’t see any mention of food deserts.

Hi there - did you see my original posting? I said, "As we now know, embedded structural inequities like redlining, underfunding of public schools, public sector/frontline employment, inability to afford healthy food, food swamps and the built environment, have contributed to disproportionate Covid-19 rates of infection, complications, and death among much of the country’s minority populations." I didn't use the word deserts, but swamps. Same deal. ?

There are now some very dynamic (but currently) stressed nonprofits working this issue, but with 1. the pandemic and 2. the administration, it is extremely difficult to handle on their own. There's no question that this needs to come from the government, preferably the federal government. But again, the point is it's not just either take on food deserts (or swamps) or do PSAs linking processed food to chronic disease. It's both! But the case is not now nor has seriously ever been made against processed food in a highly publicized way, like it has been against tobacco (see one of my other comments above).

[NRSKarenRN, BSN, RN]

Chester PA, a city of 56,000 people is one of the food desert locations. In 2013, Philabundance a non-profit food bank that serves the Philadelphia and Delaware Valley region of PA helped establish a non-profit supermarket Fair and Square -first time city had a supermarket in 12 years. It lasted until 2018, sold to for profit Cousins supermarket--location now closed.

Even Walmart is located 1 mile outside the city

https://nextcity.org/daily/entry/nations-first-non-profit-supermarket-opens-in-chester-pa

[JVBT, ASN]

Krispy Kreme's honoring first reponders with 18 million donuts is like honoring firemen with napalm.

Bill Maher on the "Quarantine 15." Lots of nurses have commented.

https://www.Youtube.com/watch?v=vDaQOy7ML38