This document discusses community health and food systems. It provides an overview of food systems and how they relate to community health. Chronic disease health disparities are discussed, with obesity being a major issue globally and locally in Hawaii. The document examines social determinants of health and how financial barriers can influence access to healthier diets. Community food system interventions are suggested, including restoring traditional Hawaiian foods and assessing local resources and barriers.

1. COMMUNITY HEALTH AND
FOOD SYSTEMS
Elise Dela Cruz - Talbert, MPH
University of Hawaii at Mānoa
PALS/ PLACES Teacher’s Professional Development Series
July 24, 2017

2. Agenda
❖ Overview of Food Systems and Community
Health
❖ Chronic Disease Health Disparities
❖ Food System Interventions

3. Source: Greater Kansas City Food Policy
Coalition
Food System Model

4. American Food System
 Polluted air and water
 Increased antibiotic-resistant bacteria
 Increase food-borne pathogens
 Collapsing rural communities
 Inability to provide future generations with fresh air, water, and
food
 Obesity crisis
 Poor nutrition affects 4/6 leading causes of death: heart
disease, stroke, diabetes, and cancer
Jamie Harvie, “Redefining Healthy Food”

6. Nutrient Content of the U.S. Food Supply:
Macronutrients per Capita per Day 1909-2010
Hazel A.B. Hiza, PhD, RDN, USDA Center for Nutrition Policy and Promotion
Fat
doubled!

7. HAWAIIAN FOOD SYSTEMS

11. Food Systems Supporting Health
Availability of affordable, culturally appropriate
healthy foods in neighborhoods should include:
❖ retail access
❖ school meals and snacks
❖ healthy worksite cafeterias
❖ community-based food production
❖ public hunting, gathering, fishing rights
❖ home gardens

12. Student project example:
Loko I`a (fishponds) -- restoring indigenous
food systems
❖ Historical Loko I`a:
– An inventory in the early 1900s found 360 loko
i‘a in the islands and identified 99 active ponds
with an estimated annual production total of
about 680,000 lbs
– Loko i‘a produced an average of 400–600
lbs/acre/year (Keala 2007).

15. Survey of Oahu Loko I`a
❖ What foods are they producing now?
– Fish: Moi, Tilapia, Amaama, Paalu, Papio,
Baraacuda, Toau
– Seaweed: Gorilla Ogo
– Fruits: bananas
– Vegetables: Kale, Amaranth, Chili Pepper,
Eggplant, Collard Greens, Swiss Chard
– Shellfish: Samoan Crab

16. Survey of Oahu Loko I`a
❖ Community Activities Conducted:
– Growing traditional food (100%)
– Hunting, fishing, gathering traditional food
(100%)
– Cooking traditional food (100%)

17. Discussion 1
❖ What are five components of the food
system?
❖ How does the history of Hawaii effect what
we eat?
❖ What are some challenges to people eating
traditional Hawaiian foods now?

18. Chronic Disease Health Disparities
Pobutsky, A., Bradbury, E., & Wong Tomiyasu, D. (2011). Chronic disease disparities report 2011: Social
determinants. Honolulu: Hawaii State Department of Health, Chronic Disease Management and Control Branch.

19. Public Health Implications of
Obesity
■ Underweight and obesity status were both associated with
excess deaths when compared to normal weight, overweight
was not.
■ Obesity contributes to cardiovascular disease, Type II
diabetes, osteoarthritis, and some cancers.
■ In the United States, 1 in 3 adults are obese.
■ Global adult obesity prevalence nearly doubled from 4.8% to 9.8%
for men and 7.9% to 13.8% for women in the span of 1980 to 2008.
■ Among preschool aged children (up to the age of 5 years), global
OWOB prevalence increased from 4.2% in 1990 to 6.7% in 2010.
■ As country income increases obesity prevalence increases,
however among developed countries low-income sub-
populations have greater obesity risks.

20. Global disparities:
– Oceania countries have the highest country-level rates, while
American women had the highest group prevalence.
– For ages 2-8y in Hawaii, Alaska, and the US-AP OWOB is (~7%)
higher than the global estimate and that prevalence increased with age,
from 21% at age 2 years to 29% at age 8 years.

21. Social disparities:
Higher obesity prevalence seen
among:
• Low SES neighborhoods
• Black, Hispanic,
and Pacific Islanders
• Females
Childhood obesity disparities in Hawaii
Graph Source: Novotny, R., Oshiro, C. E. S., & Wilkens, L. R. (2013). Prevalence of childhood obesity among
young multiethnic children from a health maintenance organization in Hawaii. Childhood Obesity, 9(1), 35-42.

22. US obesity spatial disparities
US Adult (>18) Obesity Prevalence County
Level, 2013 CDC BRFSS Data

23. Food Environment Atlas, U.S. Department of Agriculture,
Economic Research Service
Fascinating, what about Hawaii?

24. Prepared by Elise Dela Cruz-Talbert, 2014

25. Food Security
❖ “Food security exists when all people, at all
times, have physical and economic access to
sufficient, safe and nutritious food to meet their
dietary needs and food preferences for an active
and healthy life. The four pillars of food
security are availability, stability of supply,
access and utilization.”
-United Nations, World Food Security, Plan of
Action statement

26. Principles of Food Justice
❖ Food Security, personal diet choices and
community health are influenced by our social-
ecological context
❖ The food that we consume is one aspect of the Food
System
❖ Health inequalities = Disparities in health that are a
result of systemic, avoidable and unjust social and
economic policies and practices that create barriers
to opportunity (Healthy People 2020)

27. Importance of Affordability
❖ Energy-dense grains, fats, and sweets
represent the lowest-cost dietary options to the
consumer.
❖ Good taste, high convenience, and the low
cost of energy-dense foods + portions and
low satiation, may be the principal reasons for
overeating and weight gain.
❖ Financial disparities in access to healthier
diets may help explain why the highest rates
of obesity and diabetes are found among
minorities and the working poor.
❖ If so, then encouraging low-income
households to consume more costly foods is
not an effective strategy for public health.
(Source: Drewnowski and Darmon, 2005)
www.businessinsider.com

28. Discussion 2
❖ What are examples of social
determinants of health?
❖ Who experiences health disparities
globally?
❖ Who experiences health disparities in
Hawaii?

29. Community Assessment and
Interventions
ss

30. Group Activity
Community Assessment Tools:
Barriers and Resources

31. Contact:
Elise Dela Cruz-Talbert, MPH
University of Hawai`i at Mānoa
808-
‘A‘ohe hana nui ke alu ‘ìa. (No task is too
big when done together by all.) –‘Olelo
No‘eau #141
Photo by Dr. Kalama Niheu, MD