Centre for Health Promotion Research (CHPR)

Like many things in life, there is probably no one, simple answer to this question. But at least people are trying to answer it.

One way is to use regulation to get major chain restaurants to provide calorie information on their menus. New York City did this in 2008. A study on the outcome of the New York regulation showed that 15% of customers in 2009 reported using the calorie information and purchased 106 fewer kilocalories than customers who did not see or use the calorie information (Dumanovsky et al., 2011). Fifteen per cent of customers might seem like a small proportion but it is still sizeable, especially if some of these are repeat customers. For example, three meals a week at the same restaurant could net a 300-calorie reduction. That’s about half an hour of running to burn those calories! The question is how to get as many of the remaining 85% of customers as possible to see or use the calorie information to reduce their calorie intake.

While providing calorie information to customers helps them make personal decisions, another strategy is to actually improve the nutritional content of the food itself. McDonald’s just announced their “Commitments to Offer Improved Nutrition Choices” plan. One of the three goals is to expand and improve nutritionally-balanced menu choices. By 2015, McDonald’s will reduce sodium an average of 15% overall and by 2020 it will “reduce added sugars, saturated fat and calories through varied portion sizes, reformulations and innovations.” Improving the nutritional content of food items puts less onus on the consumer to make a conscious decision. Sometimes, you just want those fries! But at least the fries will soon have less salt. “Soon” is relative though. McDonald’s self-set deadlines are still 4 years and 9 years away. Hopefully, McDonald’s actions will inspire other restaurant chains and even independent restaurants to do the same and in a shorter time frame.

The above two examples are from the U.S. What’s happening in Canada? Here in Vancouver city, there are no regulations. Any calorie information would be provided by restaurants on a voluntary basis (from a business perspective, this could give these restaurants a competitive advantage). The BC provincial government is exploring the idea of menu nutrition labelling for foods served in restaurants and food service establishments. In Ontario, Bill 90 (a private member’s bill to get food establishments to provide calorie information) had its first and, so far, only reading in the Legislative Assembly in June 2010. There is some obvious interest in Canada to follow in the footsteps of New York City. I’m sure there are other examples in Canada that I haven’t heard about.

Restaurants comprise only part of the food industry. There are a lot of processed foods sold in stores. Food manufacturers could also improve the nutritional content of their manufactured food. In the absence of regulation, this would most likely be driven by consumer demand.

What works well to reduce people’s calorie intake remains to be seen. It will most likely be a combination of strategies that aim to change individual behaviour and to change the surrounding environment so that healthier choices don’t necessarily have to be conscious choices.

Reference:

Dumanovsky et al. (2011). Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ 343:d4464.

Addendum (August 10, 2011)
Update: The BC provincial government is partnering with the BC restaurant industry to introduce the Informed Dining program to provide restaurant customers with the nutrition information they need to make healthier choices.

I just read an hilarious article on how a guy survived 7 days without social media. Remember the days before Facebook and Twitter?

The article reminds me that social media has changed how we interact, including about health. Now we can ask family and friends, and even strangers, questions about health. We can get answers on how to cope or learn about a range of experiences that doctors are not privy to. Social media is another way for people to connect and share.

Social media can also be used by health organizations to provide information to the general public. For example, Health Canada uses Twitter to provide information about product recalls and safety information.

Being in the field of population and public health, the next question that arose in my head was: How can social media be used to reduce health inequities and improve population health? Upstream changes in policy and in social and economic conditions are needed rather than a focus on changing individual behaviour. It means targeting an audience of policy-makers and others who have the power to change social and economic conditions (and those who support them). It also means communicating an underlying or explicit message of equity and engagement (to work towards common goals) regardless of audience.

A lot of the dialogue on social media and health seems to relate to health care. It’s time to shift some of that dialogue to prevention.

CIHR just announced a call for submissions for a casebook of population and public health ethics. The casebook will help identify ethical dimensions of ‘doing’ population health.

The casebook has three objectives:

• Increase awareness and understanding of population and public health (PPH) ethics, and the value of ethical thinking in PPH research, policy, and practice;
• Highlight cases across PPH research, policy, and practice that feature different ethical issues and dilemmas; and
• Create a tool to support instruction, debate, and dialogue related to cases in population and public health ethics research, policy, and practice.

The deadline for submissions is September 30, 2011. The publication of the casebook is planned for Spring 2012.

CIHR has just launched a new funding opportunity for population health intervention research, signifying that the field of population health continues to gain ground. This is good news for those who are interested in promoting health and health equity.

The deadline for a Letter of Intent is September 15, 2011, while the full application is due on December 16, 2011.

Although the poorest group of Canadians are enjoying a minimally higher level of income, the income gap between the rich and the poor in Canada got wider. That was what the Conference Board of Canada concluded in its analysis of income inequity in a report titled How Canada Performs that was released on July 13, 2011.

Income gaps are associated with inequalities in health. Overall, the rich are healthier, while the poor are the least healthy. A widening income gap forecasts a potential widening of health inequalities. This poses a warning for public health to prepare for increasing inequalities.

First, public health can find what is working to reduce health inequities, and step it up.

Second, public health can try and find new ways to effectively reduce health inequities.

It is likely that what works will address multiple determinants of health, and will be done through multi-sectoral partnerships.

Lastly, and this is not specific to public health, I think our society needs to move away from viewing personal wealth as a main indicator of success in life. Many people feel ashamed about being poorer than other people, and this leads to a chain of events that eventually leads to poorer health. Personal wealth is only a means to a good life, and it is not the only means.