>>THANK YOU FOR
ATTENDING THE SECOND OF FOUR
MEETINGS FOR THE BIOMARKERS OF
NUTRITION FOR DEVELOPMENT
KNOWLEDGE INDICATING FOR THE
BOND-KIDS PROJECT.
I'M DREW BREEMER.
ON BEHALF OF THE EUNICE KENNEDY
SHRIVER NATIONAL INSTITUTE OF
CHILD HEALTH AND HUMAN DEVELOP.
IT'S MY PLEASURE TO EXTEND
PROFOUND THANKS AND GRATITUDE TO
THE FEDERAL AND NON-FEDERAL
MEMBERS WHO HELPED SHAPE THE
MEETING SERIES AS WELL AS THE
WORKING GROUP CHAIRS AND
MEMBERS.
ALL HAVE PUT IN COUNTLESS HOURS
OF TIME ON THE PROJECT AND WE'LL
BE HEARING FROM WORKING GROUP 2
TODAY.
YOU'VE BEEN DOING THIS AMIDST
YOUR DAY JOBS AND THE CHALLENGE
OF THE PANDEMIC.
I'D LIKE TO THANK MY COLLEAGUES
AND RECOGNIZE DAN RADDEN AS THE
ORGANIZER.
THIRD, I'D LIKE TO THANK ALISON
FOR HER AND HER TEAM.
THIS COULD NOT HAPPEN WITHOUT
HER.
AND DELIGHTED TO HAVE JENNY
WILSON AND FINALLY OUR CONTRACT
AND TECHNICAL AND A.V. TEAMS FOR
WORKING WITH US TO MAKE THE
DISCUSSIONS AVAILABLE TO THE
PUBLIC.
SHE SERIES OF WORK MEETING THE
CULMINATION OF HOURS OF
PREPARATION AND DISCUSSION AND
AS DAN WILL EXPLAIN, ARE MEANT
TO TAKE A DEEP DIVE IN THE
NUTRITIONAL NEEDS AND ASSESSMENT
OF SCHOOL-AGED CHILDREN.
I EXPECT ANOTHER FANTASTIC
SESSION TODAY.
IT'S MY PLEASURE TO INTRODUCE
DAN RADEN THE ORGANIZER OF THE
BOND-KIDS PROJECT.
TAKE IT AWAY.
>> HI, EVERYBODY.
WELCOME BACK TO BOND-KIDS.
IT'S THE SECOND IN THE SERIES OF
FOUR WORKSHOPS.
I'LL DESCRIBE THE WORKSHOPS ARE
PART -- THIS WAS INITIATED FROM
COLLEAGUES IN THE FIELD AND THE
USDA AND THE LONDON SCHOOL OF
HYGIENE TROPICAL MEDICINE WHO
LEADS A CONSORTIUM ON NUTRITION
FOR SCHOOL-AGED CHILDREN.
ONE OF THE REAL KEY ISSUES HERE
IS THAT THESE PROGRAMS AND
THERE'S LOTS OF THEM
DOMESTICALLY AND INTERNATIONALLY
TO PROVIDE NUTRITIONAL SUPPORT
TO KIDS, DO A PRETTY GOOD JOB AT
DELIVERING THE SERVICES.
BUT WE ARE LESS SUCCESSFUL AT
MEASURING THE IMPACT OF THOSE
SERVICES.
WE'RE TRYING TO DEFINE THE NEED
AND IMPACT.
ON THIS CARTOON EXEMPLIFIES OUR
APPROACH TO THIS PROJECT AND TO
ALL THE PROJECTS THAT WE DO WE
RECOGNIZE THE NEED FOR BALANCE.
WE'RE AN EXTRAMURAL RESEARCH
PROGRAM SO THERE'S A HEAVY
EMPHASIS ON RESEARCH BUT WE ALSO
RECOGNIZE WE LIVE IN THE REAL
WORLD AND THE FINDINGS OF THEE
THIS RESEARCH AND THE -- THIS
RESEARCH AND THE EVIDENCE
GENERATED NEEDS TO BE TRANSLATED
IN A MEANINGFUL, EQUITABLE WAY
TO HELP SUPPORT PROGRAM'S
EFFORTS TO IMPROVE THE HEALTH
AND WELL BEING OF THE POPULATION
BOTH IN THE U.S. AND ABROAD.
OUR BASIC ASPIRATIONS THE
PROJECT HAS BEEN TO PROVIDE
SUPPORT TO THOSE AGENCIES AND
ORGANIZATIONS AND THE COMMUNITY
INVOLVED IN PROVIDING
NUTRITIONAL SUPPORT TO
SCHOOL-AGED CHILDREN.
WE'RE HOPING DO THAT BY ENGAGING
THE ORGANIZATIONS THAT ARE
EVOLVED.
YOU MENTION THE SCIENTIFIC
STEERING COMMITTEE AND U.S. AND
DOMESTICALLY AND CIVIL SOCIETY
HAS BEEN INVOLVED IN THIS
ACTIVITY.
THE TECHNICAL EXPERTISE
REPRESENTED BY THE WORKING GROUP
MEMBERS AND SPEAKERS YOU'LL BE
HEARING FROM.
OUR GOAL IS TO IDENTIFY THE
EVIDENCE, WHAT IT IS WE KNOW AND
WHAT IT IS WE DON'T KNOW AND USE
THAT EVIDENCE AND MOVE IT
FORWARD BOTH FROM A
TRANSLATIONAL AND ADAPTATIONAL
POINT OF VIEW AND THE
DEVELOPMENT OF A RESEARCH AGENDA
TO ADDRESS GAPS.
TO BE CLEAR WHAT WE'RE NOT DOING
IS NOT DEVELOPING GUIDELINES OR
RECOMMENDATIONS OR MAKING
POLICY.
WE ARE SUPPORTING THROUGH THE
GENERATION OF EVIDENCE AND
KNOWLEDGE THOSE AGENCIES,
ORGANIZATIONS THAT DO BOTH IN
THE U.S.
THE TITLE IS BOND-KIDS.
THE BOND PIECE THE REASON WE'RE
USING THE BOND PLATFORM IS
BECAUSE FOR THOSE THAT MAY NOT
BE FAMILIAR WITH BOND, IT'S A
PROJECT THAT STARTED IN 2010 AS
A COLLABORATION BETWEEN US AND
THE BILL AND MELINDA GATES
FOUNDATION AND THE OFFICE OF
DIETARY SUPPLEMENTS AT NIH AND
THE OFFICE OF NUTRITIONAL
PARTNERS.
THE GOAL IS TO DEVELOP
DOCUMENTATION WHAT AND HOW TO
ASSESS NUTRITIONAL STATUS AND
WHAT DO WE NEED CONSIDER IN
ASSESSING NUTRITIONAL STATUS AND
RECOGNIZING THE IT NUTRITIONAL
THE BOND ARE RESPONSIVE TO THE
USER GROUPS WHETHER BENCH SIDE
OR CLINICIAN AND IN A PRIMARY,
SECONDARY, TERTIARY CARE SETTING
AND THOSE RESPONSIBLE FOR THE
EVALUATION OF THE PROGRAMS AND
POLICY MAKERS AND SUCH.
THEY ALL HAVE DIFFERENT NEEDS
AND CONSUME THE DATA AND USE THE
DATA AND USE THE ASSESSING
METHODOLOGIES SO THE BOND
PLATFORM IS INTENDED TO BE
RESPONSIVE TO THE NEEDS OF ALL
THOSE COMMUNITIES.
THE SECOND PIECE OF THE TITLE IS
KNOWLEDGE INDICATING DIETARY
SUFFICIENCY.
THAT WOULD IMPLY WHAT WE'RE
DOING IS TAKING THE TRADITIONAL
APPROACH TO MEASURING WHAT
PEOPLE EAT AND YOU MAY MEASURE
SOME ASPECT OF THEIR NUTRITIONAL
STATUS BIO CHEMICALLY OR
OTHERWISE AND IN FACT WE
RECOGNIZE NUTRITIONAL
SUFFICIENCY IS A MORE
COMPLICATED SET OF ISSUES.
WE TAKE AN ECOLOGICAL APPROACH
AND WE MEAN THE SET OF
RELATIONSHIPS BETWEEN A COMPLEX
BIOLOGICAL SYSTEM IN THIS CASE
THE SCHOOL-AGED CHILD, AND THEIR
ENVIRONMENT.
WE DIVIDE THAT ENVIRONMENT INTO
INTERNAL AND EXTERNAL.
THE INTERNAL IS THE BIOLOGY AND
NUTRITIONAL AND HEALTH AND
GENETICS, ETCETERA, THE SPECIFIC
FUNCTIONAL DOMAINS OF INTEREST.
THOSE WERE COVERED LAST WEEK.
THE EXTERNAL ENVIRONMENT THIS
NEEDS TO BE DETERMINED AND
RECOGNIZING WE LIVE IN A
COMPLICATED, COMPLEX ENVIRONMENT
AND THE ACKNOWLEDGEMENT OF THAT
ENVIRONMENT IS NECESSARY IN
ORDER TO DEVELOP CONTEXT
SPECIFIC APPROACHES AND THAT'S
WHAT WE'LL BE HEARING ABOUT
TODAY.
NEXT SLIDE.
THIS IS A REPRESENTATION OF OUR
VIEW OF THE ENVIRONMENT AND
TAKING A MORE HOLISTIC VIEW AND
NOT JUST TALKING ABOUT THE
PHYSICAL ENVIRONMENT BUT THE
ENVIRONMENT WRIT LARGE WE'LL
HEAR ABOUT TODAY.
WE ALSO RECOGNIZE THAT THE
REASON FOR THESE PROGRAMS TO
SUPPORT NUTRITIONAL CARE OF
SCHOOL-AGED CHILDREN IN MANY
CASES THERE'S PROBLEMS WITH THE
FOOD SYSTEM.
THE FOOD SYSTEM NEEDS TO BE
ACKNOWLEDGED AND THE FOOD SYSTEM
REPRESENTS ITS OWN ECOLOGY AND
REPRESENTED BY ISSUES AND THE
PHYSICAL ENVIRONMENT AND SOCIAL,
DEMOGRAPHIC CHOICES PEOPLE MAKE,
ETCETERA.
SO WHEN YOU PUT THESE SO IT
MAKES NUTRITIONAL ECOLOGY IN
SCHOOL-AGED CHILDREN AND HOW CAN
WE SET UP IN EFFORT TO EXPLORE
THE VARIOUS ASPECTS OF THIS
COMPLEX SET OF RELATIONSHIPS.
SO THE ISSUE OF SCHOOL-AGED
CHILDREN IS A COMPLICATED WIN.
WE'RE TALKING AGES 5 TO 19 WITH
DUE RECOGNITION OF THE
IMPORTANCE OF THE PRECURSOR OF
THE PREGNANCY THROUGH THE FIRST
FEW YEARS OF LIFE AND
PREDISPOSES CHILDREN TO THINGS
LATER IN LIFE.
OUR FOCUS IS GOING TO BE ON THE
DEVELOPMENT STAGES FROM 5 TO AGE
19.
EACH OF THE WORKING GROUPS IN
THE BOND-KIDS PROJECT DIVIDE
THEIR WORK INTO THREE SORT OF
FUNDAMENTAL PERIODS PRE AND
POST-PUBESCENT ADOLESCENCE AND
RECOGNIZE THE IMPORTANCE OF THE
FOOD SYSTEM.
THE GOAL IS WE'RE TAKE AN
ECOLOGICAL APPROACH TO ADDRESS
THE NEEDS OF SCHOOL-AGED
CHILDREN AND FOCUS ON HOW YOU
ASSESS THE FUNCTIONAL IMPACT.
NUTRITIONAL ASSESSMENT IS
MEASURED BY SOMEONE'S STATUS.
USUALLY WHETHER IT'S DIETARY
INTAKE OR BIO CHEMICAL MAYBE THE
STATUS AND BASED ON A
STATISTICAL CUT-OFF MAKE
DECISIONS WHETHER THEY'RE
ADEQUATE OR NOT.
THAT TELLS YOU SOMETHING ABOUT
THE RELATIONSHIP BETWEEN WHAT
THEY'RE EATING AND WHAT'S
HAPPENED BUT IT DIDN'T TELL YOU
MUCH ABOUT TO THE FUNCTIONAL
IMPLICATIONS AND THE IMPACT OF
THAT STATUS ON AN INDIVIDUAL'S
HEALTH AND DEVELOPMENT.
THAT'S WHAT WE'RE FOCUSSED ON
HERE.
THAT'S OUR GOAL IN PHASE 1 IS TO
COVER THOSE KINDS OF ISSUES AND
COVER THE INTERNAL AND EXTERNAL
ENVIRONMENT AND ALSO INCLUDE AN
APPRECIATION OF HOW TO ASSESS
AND PUT THOSE THINGS TOGETHER IN
AN ASSESSMENT BATTERY AND AGAIN
GETTING BACK TO BALANCE WE
RECOGNIZE THE IMPORTANCE OF
TRANSLATION AND THE FOURTH
WORKING GROUP YOU'LL HEAR ABOUT
ON MARCH 25 WILL COVER THAT.
THIS IS INTENDED NOT TO BE A
ONE-OFF.
THIS IS INTENDED TO BE THE FIRST
IN WHAT WILL HOPEFULLY BE A
SERIES OF ACTIVITIES IN
COLLABORATION WITH OUR PARTNERS
AT THE LONDON SCHOOL AND SCHOOL
MEALS COALITION LED BY THE WORLD
FOOD PROGRAM TO TAKE WHAT WE
LEARNED HERE AND TEST IT AND
IMPLEMENT IT AND SEE HOW IT
MIGHT WORK.
THIS IS A QUICK
CONCEPTUALIZATION OF THE
STRUCTURE OF THE PROJECT.
DREW MENTIONS OUR PARTNERS WITH
OUR ACADEMY FROM NUTRITION
DIETETICS AND THE SECRETARY OF
HHD AND THE MEMBERS ARE
AVAILABLE AND U.S. GOVERNMENT
AGENCIES INVOLVED IN PROGRAMS
PROVING SUPPORT TO CHILDREN AND
WHO AND UNICEF AND THE WORLD
FOOD PROGRAM AND ON THE THE
ACTUAL WORKING GROUPS THAT ARE
DOWN IN THE WEEDS GETTING WORK
DONE YOU'LL HEAR FROM TODAY.
THIS IS HOW WE -- I PUT THIS
TOGETHER ORGANIZATIONAL LY THE
VEN DIAGRAM AND YOU'LL SEE THE
OVERLAY ON THE RELATIONSHIPS AND
NUTRITIONAL STATUS.
ALL THOSE WILL THEN BE TAKEN BY
WORK GROUP 3, THE ASSESSMENT
GROUP AND WORK GROUP 4 WILL
FOCUS ON THE PATIENT ACTIVITY.
THAT'S A THUMB NAIL SKETCH OF
WHAT WE'RE TRYING TO DO AND IT'S
COMPLICATES ISSUES AND WE HAVE
DR. MARIE BLACK WHO'S DONE A
TREMENDOUS AMOUNT OF WORK AND
I'LL TURN IT OVER.
THANK YOU VERY MUCH.
>> THANK YOU, VERY MUCH, DAN.
I'M DELIGHTED TO BE HERE AND A
CERTAINLY THANK NICHD WITH DREW
AND DAN AND COMPANY AND THE
ACADEMY FOR NUTRITION AND
DIETETICS FOR THEIR
COLLABORATION AND THANK YOU FOR
PARTICIPATING IN OUR WORKSHOP
TODAY.
THE OBJECTIVES ARE FOR US TO
SHARE THE INFORMATION ON WHERE
WE ARE IN TERMS OF THE
ENVIRONMENT AND WE WOULD LIKE
VERY MUCH TO HAVE THIS BE AN
INTERACTIVE ASSOCIATION.
WE HAVE ALLOCATED SOME TIME FOR
DISCUSSION AND SO WE'RE LOOKING
FORWARD TO HAVING YOU JOIN US.
LET ME INTRODUCE THE WORK GROUP
2.
YOU CAN SEE WE ARE EIGHT MEMBERS
AND BETH WHO IS THE
REPRESENTATIVE FROM THE ACADEMY
FOR NUTRITION AND DIETETICS
KEEPS US ORGANIZED AND GOING AND
KEEPS US ALL IN GOOD SPIRIT.
THERE ARE FOUR MEMBERS WHO WILL
PRESENT PRESENTATIONS TODAY AND
THE OTHERS WHO CONTRIBUTED TO
ALL OF OUR PRESENTATIONS AND ALL
OF OUR WORK SO WE'RE VERY
EXCITED TO BE JOINING YOU TODAY.
SO THIS IS TO TELL YOU WHAT OUR
MISSION IS WE'RE LOOKING AT THE
CHILD AND ADOLESCENT ENVIRONMENT
5 TO 19 AND OUR TASK IS TO LOOK
AT HOW THE ENVIRONMENT RELATE TO
THEIR NUTRITIONAL ECOLOGY.
AS DAN TALKED ABOUT IT CONSISTS
OF VARIOUS ENVIRONMENTS.
CHILDREN SPEND A TREMENDOUS
AMOUNT OF THEIR HOMES, THEY
SLEEP, EAT AND ENGAGE IN MANY
ACTIVITIES.
THEY'RE ALSO IN SCHOOL WHERE
THEY LEARN, THEY PARTICIPATE,
MAYBE EVEN GRADUATE AND MANY
ACTIVITIES AND NUTRITION IMPACTS
THESE ACTIVITIES AND SPEND TIME
WHERE THEY PLAY AND WORK AND SEE
THE MANY INTERCONNECTIONS THEY
HAVE IN THE COMMUNITY.
BUT IT'S NOT ONLY THESE THREE
ENVIRONMENTS WHAT WE HAVE
LEARNED IS THAT THE ENVIRONMENTS
ARE CONNECTED TO ONE ANOTHER.
THERE ARE MANY CONNECTIONS IN
THIS COMPLEX SYSTEM.
THEY VARY BY THE CHILDREN'S AGE.
THE EXPERIENCES OF A 5-YEAR-OLD
ARE QUITE DIFFERENT FROM AN
11-YEAR-OLD OR FROM A
19-YEAR-OLD.
SO AS WE MOVE FORWARD AND LOOK
AT THE CHILDREN AND WHAT THEY'RE
DEVELOPMENT LOOKS LIKE WE CAN
SEE THERE ARE MANY COMPONENTS OF
CHILDREN'S DEVELOPMENT.
THERE'S THEIR COGNITION, THEIR
SOCIO EMOTIONAL DEVELOPMENT,
DIETARY INTAKE, DISEASE RISK,
PHYSICAL ACTIVITY, SCHOOL
PERFORMANCE AND ALL OF THESE ARE
INFLUENCED BY NUTRITION.
THAT'S NOT ONLY THE FOOD THAT
THEY EAT BUT THE EATING BEHAVIOR
AND THE CONTEXT IN WHICH
NUTRITION OCCURS.
SO AGAIN, THAT CONTRIBUTES TO
THE COMPLEXITY AND IT VARIES BY
THE CHILDREN'S AGE.
AGAIN, DIFFERENT FOR 5-YEAR-OLD
FROM A 19-YEAR-OLD.
MOVING FORWARD THIS IS A SLIDE
FOR THOSE WHO PARTICIPATED LAST
WEEK, AS MICHAEL SAID NEITHER HE
NOR I CAN DO A PRESENTATION
WITHOUT INCLUDING THIS SLIDE.
THIS IS BECAUSE THIS ILLUSTRATES
WHAT BRAIN DEVELOPMENT LOOKS
LIKE AND YOU CAN SEE DRAWN A BOX
AROUND THE FIRST 1,000 DAYS
BEGINNING AT CONCEPTION AND
CONTINUING UP TO AGE 2.
SO 9 MONTHS OF CONCEPTION, 24
MONTHS POST AFTER DELIVERY, 33
MONTHS MULTIPLIED BY 30 IS A
THOUSAND DAYS AND THERE'S A
TREMENDOUS AMOUNT OF BRAIN
DEVELOPMENT THAT HAPPENS DURING
THAT TIME.
WHEN WE STUDY CHILDREN LATER IN
LIFE WE HAVE TO CONSIDER THE
SUBSEQUENTLY WE'RE BUILDING ON
WHAT HAPPENED DURING THOSE FIRST
THOUSAND DAYS.
THOSE ARE INFLUENCED BY TIMING
OF MANY ASPECTS OF DEVELOPMENT
INCLUDING NUTRITION.
NOW, IF WE LOOK I'VE DRAWN BOXES
AROUND THE AREA THAT YOU'RE
STUDYING THE ELEMENTARY AGE
CHILD IS FROM 5 TO 11.
AND THEN WE HAVE THE EARLY
ADOLESCENT IN GREEN, THAT'S FROM
ABOUT 11 TO 12 TO ABOUT 15 OR
SO.
THEN THE MID TO UPPER ADOLESCENT
FROM 16 TO 19.
YOU CAN SEE THAT THEIR BRAIN
DEVELOPMENT IS CONTINUING
CERTAINLY DURING THAT TIME.
BUT IT BUILDS ON WHAT HAS
HAPPENED EARLIER IN LIFE.
SO IT'S IMPORTANT TO CONSIDER
THAT DEVELOPMENT IS PROGRESSING
THAT IT IS -- THERE'S A
TRAJECTORY THAT'S OCCURRING AND
THIS STILL A VERY FORMATIVE TIME
TO HELP CHILDREN DEVELOP HABITS
THAT WILL STAY WITH THEM
THROUGHOUT THEIR LIVES.
WHEN I SHOW THIS SLIDE I ALWAYS
ASK PEOPLE TO FIND THEIR OWN AGE
ON THE SLIDE.
CAN SEE INITIALLY IT GOES UP BY
MONTHS AND THEN GOES UP BY
YEARS.
SO AS WE FIND OUR AGE ON THIS
SLIDE, WHAT'S GOING ON IN OUR
BRAINS.
WELL, NOT MUCH JUST TRYING TO
KEEP THINGS TOGETHER.
THIS ILLUSTRATES HOW CHILDREN
LEARN, HOW CHILDREN INTERACT AND
IT IS A WHAT WE CALL A
RECIPROCAL OR A RESPONSIVE
PROCESS.
SO LET'S SEE HOW IT MIGHT WORK.
AS AN EXAMPLE, WE'RE USING A
CHILD AND WE'RE USING A MOTHER
BUT IT COULD WORK WITH A FATHER.
IT COULD WORK WITH A FRIEND.
IT COULD WORK WITH A DOG.
IT CAN WORK WITH MANY ASPECTS OF
THE ENVIRONMENT AND LOOKS LIKE
THIS.
THE CHILD DOES SOMETHING AND THE
MOTHER THEN SEES WHAT THE CHILD
HAS DONE, HEARS IT AND REACTS TO
IT AND THEN THE CHILD REACTS TO
WHAT THE MOTHER HAS DONE AND
THEN THE MOTHER REACT TO WHAT
THE CHILD HAS DONE AND SO ON AND
SO ON.
THIS RECIPROCITY, THIS BACK AND
FORTH ILLUSTRATE THE
INTERACTIONS WE ALL HAVE.
SOMETIMES THIS IS REFERRED TO AS
SERVE AND RETURN.
WHAT IT ILLUSTRATES IS IT'S NOT
STATIC.
THE ASPECTS OF CHILDREN'S
DEVELOPMENT AND OF THEIR
INTERACTIONS ARE NOT STATIC.
THEY ARE DEPENDENT ON WHAT HAS
HAPPENED BEFORE, WHAT THEY HAVE
PERCEIVED AND THEN THEY INTERACT
WITH THE ENVIRONMENT THAT THEN
RECEIVES THEIR INTERACTION.
IT'S A BACK AND FORTH PROCESS.
NOW, WHEN WE LOOK AT THAT AND
LOOK AT CHILDREN'S DEVELOPMENT,
THE CHILDREN ARE CONSTANTLY
LEARNING AND PERCEIVING WHAT IS
HAPPENING AROUND THEM.
AND SOMETIMES WE FORGET THESE
KINDS OF THINGS, WE'RE
INTERESTED IN MEASURING THEIR
COGNITION AND SOCIO EMOTIONAL
DEVELOPMENT BUT IT'S IMPORTANT
ALSO TO RECOGNIZE HOW THIS
DEVELOPMENT AND HOW WHAT GOES ON
AROUND THEM HOW CHILDREN ARE
PERCEIVING.
FOR EXAMPLE, BODY SIZE.
THERE'S STIGMA ATTACHED WITH
BODY SIZE.
MOST STIGMA IS ASSOCIATED WITH
BEING OVERWEIGHT.
WELL, WHAT DO WE LEARN ABOUT
CHILDREN'S PERCEPTION OF
OVERWEIGHT OR THE STIGMA
ASSOCIATED WITH IT?
WE LEARN THERE'S CONSEQUENCES.
THOSE CONSEQUENCES ARE OFTEN NOT
VERY POSITIVE FOR CHILDREN'S
DEVELOPMENT.
THINGS LIKE BINGE EATING, SOCIAL
ISOLATION, AVOIDANCE OF HEALTH
CARE, DECREASING PHYSICAL
ACTIVITY AND INCREASE IN WEIGHT
GAIN.
SO IT'S IMPORTANT TO UNDERSTAND
HOW CHILDREN PERCEIVE THINGS.
WE'LL BE TALKING LATER TODAY
ABOUT FOOD INSECURITY.
BUT WHAT WE LEARN IS FOOD
INSECURITY IS SOMETHING CHILDREN
ALSO RECOGNIZE.
MOST STUDIES WHERE WE LOOKED AT
KIDS FROM 8 OR 9 UPWARDS AND WE
LEARN THAT CHILDREN DO
UNDERSTAND WHEN THEY DON'T HAVE
ENOUGH FOOD.
THEY HAVE A COGNITIVE AWARENESS,
EMOTIONAL AWARENESS AND ASSUME
SOME RESPONSIBILITY FOR MANAGING
FOOD AND RESOURCES.
SO THIS IS NOT ONLY A HOUSEHOLD
PHENOMENON, IT IMPACTS
CHILDREN'S PERCEPTIONS.
THEN THERE'S THE ISSUE OF
EQUITY.
EQUITY GUIDES WHAT WITH ARE
THINKING ABOUT IN TERMS OF THE
ENVIRONMENT AND IN TERMS OF THE
WHOLE PROJECT.
CHILDREN ARE AWARE OF INEQUITIES
FROM THE GET GO.
FOR THOSE WOULD ARE PARENTS
YOU'LL RECOGNIZE ONE OF
CHILDREN'S FIRST WORDS IS MINE.
THEY RECOGNIZE WHAT IS YOURS AND
WHAT IS MINE.
AND THEY WANT WHAT IS MINE.
NOW, WE SEE DEVELOPMENTALLY
CHILDREN BECOME MORE AND MORE
SOPHISTICATED ABOUT EQUITY AND
FROM ABOUT AGES 7 AND 8, THEY
CAN RECTIFY INEQUITIES.
THEY CAN CHANGE INEQUITIES.
SO EQUITY HAS BEEN AN IMPORTANT
COMPONENT OF WHAT WE THINK ABOUT
AND USEFUL TO RECOGNIZE THAT
CHILDREN THINK ABOUT THIS AS
WELL.
THE DRAWING AT THE BOTTOM
ILLUSTRATES AN EXAMPLE OF
EQUITY.
YOU GET THE RESOURCES THAT YOU
NEED DEPENDING ON YOUR SIZE IN
THIS EXAMPLE.
AS WE THINK ABOUT VARIABILITY
AND IMPACT ON CHILDREN AND THIS
IS RECENT INFORMATION FROM
UNICEF FROM THE STATE OF THE
WORLD CHILDREN AND SEE
APPROXIMATELY 1 IN 3 CHILDREN
UNDER AGE 5 ARE EXPERIENCING ONE
OF THESE CONDITIONS.
SO UNDER NUTRITION LEADS TO POOR
GROWTH AND INFECTION AND
COGNITION AND POOR EARNING
POTENTIAL AND OVERWEIGHT
CONTRIBUTES TO MULTIPLE HEALTH
PROBLEMS, CARDIO VASCULAR
PROBLEMS AND DIABETES AND
IMPACTS EVERY SYSTEM AND AMONG
CHILDREN IT INCREASES THE RISK
OF LIFE LONG OBESITY.
THEN THERE'S HIDDEN HUNGER.
YOU HEARD SOME ABOUT LAST WEEK.
MICRONUTRITION AND SKIN IMPACT
AND IMMUNITY AND POOR HEALTH.
THERE'S MANY DIRECT CONSEQUENCES
THAT COME FROM THESE.
NOW, IF WE LOOK AT THE
PREVALENCE OF OVERWEIGHT OF
OBESITY IN E.U COUNTRIES WE SEE
IN THE U.S. OVERWEIGHT 49% AND
JAPAN IS 15%.
THIS IS LOOKING AT ONE SET OF
COUNTRIES AND WE SEE OVERWEIGHT
IS AN ISSUE.
MOVING ON, IF WE LOOK AT LOW AND
MIDDLE INCOME COUNTRIES WE SEE A
HUGE INCREASE IN OVERWEIGHT FROM
2010.
IF WE LOOK SPECIFICALLY AT
CHILDREN FROM 5-19, THERE WE CAN
SEE THERE'S BEEN A DRAMATIC
INCREASE IN OVERWEIGHT.
SO NUTRITION IS CERTAINLY
IMPACTING CHILDREN.
THE BOTTOM LINE THE YELLOW LINE
REPRESENTS CHILDREN UNDER 5 WHO
ARE ALSO INCREASING IN
PREVALENCE.
MOVING FORWARD THIS IS CHINA AND
WHAT WE SEE IN CHINA THE
ENORMOUS PURPLE OVERWEIGHT FROM
1995 TO 2015.
THE OTHER TWO LINES REPRESENT
THINNESS AND STUNTING WHICH HAVE
GONE DOWN TO SOME EXTENT.
WE QUAN SEE THE ISSUES THAT
WE'RE TALKING ABOUT ARE CLEARLY
GLOBAL.
NOW, TO MOVE FORWARD WE WANTED
TO SEE HOW FOOD SYSTEMS WERE
ORGANIZED AND LOOKED AT THE
INNOCENTI FRAMEWORK AND THIS IS
DONE BY UNICEUNICEF, WE SEE FOUR
DETERMINATES IN THE FOOD SYSTEM.
WE CAN SEE INTERNAL, EXTERNAL
FOOD ENVIRONMENT AND FOOD SUPPLY
AND RELATIONSHIP OF THE FOOD
GIVER AND ADOLESCENTS.
THAT'S A COMPLEX SYSTEM.
THERE'S EVEN MORE.
NOW, IF WE LOOK AT THE DRIVERS
THAT IMPACT THE FOOD SYSTEM WE
CAN SEE THERE ARE EVEN MORE
INVOLVED.
THERE'S DEMOGRAPHIC FACTORS AND
INNOVATIVE AND TECHNOLOGICAL
FACTORS AND SOCIAL AND CULTURAL
FACTORS AND THEN THE BIO
PHYSICAL FACTORS INCLUDING
THINGS LIKE CLIMATE CHANGE.
IT'S BECOME MUCH MORE
COMPLICATED THAN WE MIGHT HAVE
INITIALLY REALIZED.
MOVING FORWARD WE REALIZED IN
ORDER TO MEET THE TASK WE HAVE
BEEN ASSIGNED OF LINKING THE
ENVIRONMENT WITH NUTRITIONAL
ECOLOGY, WE NEED SOME HELP.
WE NEED TO BE INFORMED BY SOCIAL
ECOLOGICAL MODEL.
WE NEED TO UNDERSTAND THE
FUNCTIONAL COMPONENTS OF
CHILDREN IN ADOLESCENTS.
WE HAVE TO HAVE A DEVELOPMENTAL
PERSPECTIVE AND HAVE TO CONSIDER
EQUITY IN THIS.
SO WE HAVE BEEN WORKING ON A
CONCEPTUAL MODEL AND THIS IS
WHERE WE ARE.
SO THE IDEA OF THIS IS THAT IT
REPRESENTS SOME OF THE SYSTEMS
THAT WE NEED TO INVESTIGATE IN
ORDER TO LOOK AT THE LINKS AND
MEASUREMENTS OF ENVIRONMENT ON
CHILDREN'S NUTRITIONAL EQUALITY.
YOU CAN SEE IN THE FRAMEWORK AT
THE BOTTOM THERE'S A DEVELOPMENT
PERSPECTIVE AND WE'RE FOCUSSING
ON THE 5-19.
YOU CAN SEE THE PUZZLE PIECES
THAT REPRESENT THE CHILDREN'S
FUNCTION AND THEY NEED
DEVELOPMENT IN ALL THESE AREAS.
YOU CAN SEE THAT IT'S HEAVILY
INFLUENCED BY THE FAMILY BUT ON
THE OUTER LAYER IS THE
ENVIRONMENT THAT ARE INTERTWINED
AND CONNECTED.
THIS IS GUIDING OUR THOUGHTS AS
WE MOVE FORWARD.
SO IN ORDER TO HAVE HELP IN
DOING THIS WE LAID OUT THIS
WORKSHOP.
WE'VE INVITED THREE PEOPLE WHO
HAVE EXPERTISE IN ENVIRONMENTAL
SYSTEMS TO ASSIST US.
SO THE FIRST IS ROSS HAMMOND A
DISTINGUISHED PROFESSOR FROM
WASH-U AND ALSO THE DIRECTOR OF
THE CENTER ON SOCIAL DYNAMICS
AND POLICY AT TO THE BROOKINGS
INSTITUTE.
THEN WE HAVE CHRIS TINA ECONOMOS
THE DEAN FOR RESEARCH STRATEGY
AND THE NEW BALANCE CHAIR IN
CHILDHOOD NUTRITION AT TUFTS.
THEN WE HAVE HILARY SELIGMAN A
PROFESSOR AT THE UNIVERSITY OF
CALIFORNIA SAN FRANCISCO AND
HEADS THE NUTRITION AND OBESITY
POLICY RESEARCH AND EVALUATION
NETWORK.
THEN WE HAVE FOUR MEMBERS OF OUR
TEAM AND KRISTI, EBI AND LORRENN
RICHIE AND THEN AMY CAROL SCOTT
AND JAYNA MARKLAND DAVE WILL
DISCUSS ISSUES OF EQUITY AND
WE'LL HAVE QUESTIONS AND ANSWERS
THROUGHOUT AND THEN WE'LL HAVE
SOME REACTIONS FROM THE WORK
GROUPS AS WELL AS ANYONE ELSE
WHO WOULD LIKE TO REACT.
THESE ARE QUESTIONS DAN POSED
AND HOW THE PRESENTATIONS FIT
WITH THE INTERNAL ONES LAST WEEK
AND HOW WILL THE ENVIRONMENT BE
INTEGRATED INTO WORK GROUPS 3
AND 4 AND ARE THERE ASPECTS OF
THE ENVIRONMENT THAT SHOULD BE
INCREASED OR DECREASED AND WHAT
DR. -- WHAT ARE THE KEY
RESEARCH PRIORITIES.
I LEAVE YOU WITH THE KEY
INTRODUCTION AND ASK FLORIDA
COMMENTS OR QUESTIONS AND THEN
WE WILL MOVE ON TO THE NEXT
SPEAKERS.
I THANK YOU VERY MUCH AND WE'LL
STOP SHARING.
WE HAVE TWO OR THREE MINUTES IF
ANYONE HAS A COMMENT OR QUESTION
THAT YOU WOULD LIKE TO MAKE.
I SEE NONE.
OKAY, I WILL INTRODUCE OUR FIRST
SPEAKER WHO IS ROSS HAMMOND.
ROSS WILL BE TALKING ABOUT
COMPLEX SYSTEMS AND GIVING AN
OVERVIEW.
ROSS, I TURN IT OVER TO YOU.
>> QUICKLY, I NEEDED TO SAY AT
THE OUTSET THOUGH I HAVE A
NUMBER OF POLICY ADVISORY GOALS
IN THIS SPACE WE'RE TALKING
TODAY, NOTHING I SAY TODAY
SHOULD BE CONSTRUED TO THESE
BODIES MERELY MY OWN THOUGHTS.
I WANT TO START TACKLING THE
ISSUE OF COMPLEXITY MAUREEN DID
A GOOD JOB OF COVERING ALREADY
SO I WON'T GO IN MUCH DETAIL.
I LIKE TO PUT UP THE PICTURE
FROM A DIAGRAM FROM THE U.K.
IT'S A SYSTEMS MAP OF OBESITY.
I PURPOSELY MADE IT TOO IT SMALL
TO LOOK AT THE DETAILS AND I
WANT TO POINT OUT THREE THINGS.
THIS IS A SYSTEM WHICH DRIVES
OBESITY AS AN OUTCOME.
EACH BOX WITH A WORD IS A
MEASURABLE FACTOR THAT PLAYS A
ROLE IN OBESITY AS AN OUTCOME
AND EACH ARROW IS AN
EVIDENCE-BASED CAUSAL
RELATIONSHIP AND ONE KEY
IMPLICATION IS USING METH
LOGICAL TOOLS THAT REQUIRE US TO
REQUIRE FACTORS ARE INDEPENDENT
WON'T WORK WELL BECAUSE IT'S
DEEPLY INTERDEPENDENT AND NOTICE
THE SECTORS AND SCALES INVOKED
IN THE MAP SOME WE HEARD AND
I'LL TALK FURTHER ABOUT.
THE THIRD I WANT YOU TO TAKEAWAY
FROM THIS IS THERE'S DIFFERENT
ACTS INVOLVED IN THIS SYSTEM WHO
CAN BE VERY DIVERSE FROM EACH
OTHER AS WELL AS MANY COMPLEX
AND THERE'S THE IDEA OF
ADAPTATION.
THAT IT VERY FEW THINGS ARE
CONSTANT AND THERE'S CONSTANT
ADJUSTMENT TO CHANGING DYNAMICS
IN THE SYSTEM.
THE IMPLICATIONS OF THIS KIND OF
COMPLEXITY OR SCIENCE AND POLICY
IN NUTRITION IS A SEARCH FOR
SOME KIND OF SINGLE INDEPENDENT
CAUSE OF MANY OUTCOMES WE CARE
ABOUT WHETHER UNDER NUTRITION,
UNDER NUTRITION, ETCETERA IS
PROBABLY NOT A FRUITFUL REQUEST
AND STANDARD TOOLS TRYING TO
ISOLATE DRIVERS MAY HAVE LIMITED
USE FOR US.
THE SECOND IS THERE MAY BE NO
SINGLE SOLUTION TO THESE
PROBLEMS.
IT FITS ALL INDIVIDUAL
CIRCUMSTANCES AND CONTEXT AND WE
SOMEHOW NEED POLICY SOLUTIONS
SUFFICIENTLY BROAD TO SPEAK TO
MANY PARTS OF THIS COMPLEX MAP I
SHOWED AS WELL AS SUFFICIENTLY
COMPLEX SPECIFIC TO ACCOUNT FOR
DIFFERENT CIRCUMSTANCES THAT WE
FACE.
AND FINALLY, WE NEED TO SOMEHOW
HAVE COORDINATED INTERVENTIONS
TO TAKE THESE DYNAMICS AND
ADAPTATION INTO ACCOUNT.
THERE'S SOME NICE QUOTES HERE AT
THE TOP FROM A REPORT FROM THE
ACADEMIES ON ACCELERATED
PROGRESS AND OBESITY PREVENTION
WE WERE INVOLVED IN AND THE
SECOND ONE FROM A DIFFERENT
ACADEMIES REPORT STRESSING THE
IDEA OF MULTIPLE LEVELS OF
SECTORS AND THINKING ABOUT
ADAPTATIONS YOU THINK ABOUT LONG
RUN EFFECTS NOT JUST SHORT-RUN
EFFECTS.
THIS IS OF COURSE HARD TO DO.
COMPLEX SYSTEM TOOLS CAN HELP US
AND WHAT I WANT TO DO TO GIVE AN
OVERVIEW OF HOW THE TOOLS HAVE
BEEN VIEWED AND WHAT THE TOOLS
ARE AND HOW THEY MAYBE USED IN
THE FUTURE IN MY 15 MINUTES IS
TO REFER YOU TO TWO SPECIFIC
ARTICLES.
THE FIRST IS PUBLISHED IN 2009
AND THE FIRST ATTEMPT TO REALLY
LAY OUT A RESEARCH AGENDA USING
COMPLEX SYSTEMS IN OBESITY
RESEARCH.
THE SECOND IS 10 YEARS LATER IN
2019 A REVIEW AND META-ANALYSIS
OF ALL THE USES OF COMPLEX
SYSTEMS TOOLS TO DATE TO STUDY
THINGS RELATED TO DIET.
BOTH PAPERS SHARE IN COMMON
THREE THEMES I WANT TO HIGHLIGHT
IN MY ALLOTTED TIME TODAY.
THE FIRST IS THE IMPORTANCE OF
STUDYING APPROPRIATELY CONTEXT.
THERE MANY KINDS OF CONTEXTS.
WE OFTEN THINK OF THE PHYSICAL
ENVIRONMENT WHERE FOOD IS LOCATE
AND OUR ACCESS OCCURS AND
THERE'S SOCIAL ENVIRONMENTS AS
SHOWN IN THE DIAGRAM FROM A
PAPER ON THE RIGHT.
AND ONE OF THE KEY IDEAS THAT
HAS EMERGED FROM THE COMPLEX
SYSTEMS APPROACH TO THE TOPIC OF
NUTRITION IS THIS IDEA OF
TAILORING.
WE HAVE TO TAILER OUR
INTERVENTIONS TO ASPECT OF
CONTEXT IN ORDER TO CREATE
CHANGE AND PRECISION PREVENTION
AND THINK OF NOT ONLY THE KINDS
OF TREATMENTS WE DO IN MEDICINE
THAT ARE INDIVIDUALIZED BUT THE
KINDS OF PREVENTION WE'D LIKE TO
DO THAT IN MANY CASES ARE
PARTICULARIZED NOT TO
INDIVIDUALS BUT TO CONTEXTS LIKE
COMMUNITIES WE'LL HEAR ABOUT A
BIT LATER.
THE SECOND THING THAT'S ON MY
LIST IS THE IMPORTANCE OF SOCIAL
ENVIRONMENTS AND SO THERE'S
QUITE A FEW PAPERS IN PARTICULAR
THAT DELVE INTO THIS IDEA OF
SOCIAL CONTEXT AS BEING CRITICAL
FOR OUTCOMES IN NUTRITION AND
OBESITY.
THERE'S ONE PAPER IN PARTICULAR
HERE THAT I WANT TO HIGHLIGHT
SINCE I KNOW YOU'RE VERY
INTERESTED IN A LIST OF PAPERS
AND REFERENCES YOU CAN USE TO
DELVE FURTHER THAN I CAN GO TO
IN MY 15 MINUTES, THIS PAPER
LAYS OUT A SPECIFIC MECHANISM
FOR SOCIAL INFLUENCE AMONG
ADOLESCENTS THAT SHAPES DIET
BEHAVIOR AND HAS A LOT OF THE
CRITICAL SUPPORT USED IN OTHER
PAPERS SINCE THEN.
AND THERE'S THE LIFE COURSE
PERSPECTIVE.
AND I WANT TO HIGHLIGHT ANOTHER
PAPER I THINK MAY BE OF INTEREST
TO YOU THAT IS A PAPER ABOUT
PREFERENCES WHERE FOOD COMES
FROM AND HELP UNDERSTAND ONE OF
THE MYSTERIES IN THIS SPACE
WHICH IS SYSTEMATIC REVIEWS TRY
TO LINK FEATURES OF THE FOOD
ENVIRONMENT AS AN OUTCOME BY A
MIXED FIXTURE AND THIS PAPER AND
OTHERS THAT BUILD ON IT LATE OU
ONE PERSPECTIVE ON WHY THAT
MIGHT BE AND IT'S NOT TODAY'S
ENVIRONMENT WHICH IS MOST
IMPORTANT FOR TODAY'S BEHAVIOR,
BUT EARLIER ENVIRONMENTS THAT
SHAPED PREFERENCES WHICH HAVE
STICKY AND WHICH ARE STILL
GOVERNING A LOT OF BEHAVIOR
TODAY.
AND I DON'T HAVE TIME TO GO IN
THE DETAILS OF THE PAPER BUT I'D
BE HAPPY TO IN Q&A OR OFFLINE.
THIS PAPER ABOUT WHERE
PREFERENCES COME FROM HAS BEEN A
WHOLE LINE OF WORK AND THERE'S
POLICY IN THE LANCET PAPER HERE
I HAVE ABOUT HOW POLICIES MIGHT
ACTUALLY BE DESIGNED TO SHAPE
FOOD PREFERENCES MOVING FORWARD
FOR A WHOLE GENERATION OF
CHILDREN AND WHAT IT MEANS TO
TAKE THE LIFE COURSE PERSPECTIVE
PREFERENCE SERIOUSLY AND MANY
ATTEMPTS TO REFINE AND TEST THE
MODEL OF HOW THE PREFERENCES
FORM THROUGH THINGS LIKE COHORT
STUDIES AS SHOWN HERE AS PART OF
THE ECHO PROGRAM AT NIH THAT I
ALSO PARTICIPATE IN.
THE THIRD THEME IN BOTH THE
PAPERS I HIGHLIGHT IN THE
BEGINNING IS A REAL EMPHASIS ON
HOW WE SCALE AND SUSTAIN
INTERVENTIONS TO CHANGE THE
NUTRITION ECOLOGY AND THERE'S A
BROADER SYSTEM AND WE SAW NICE
VIEWS OF QUA THAT -- WHAT THAT
CONSISTS OF AND THERE'S MORE ON
THE LANCET REPORT AND IN THE
NICE REPORT ON THE FOOD SYSTEM
AND TRIES TO TALK ABOUT THE
RESISTANCE AND I THINK THINKING
ABOUT THE BROADER SYSTEM IS
IMPORTANT BECAUSE INTERVENTIONS
FOCUSSED WITH BLINDERS ON PART
OF THE SYSTEM OFTEN DON'T WORK
OUT AS PLANNED BECAUSE THEY'RE
NOT TAKING INTO ACCOUNT THE
REACTION OF OTHER PARTS OF THE
SYSTEM THAT ACTUALLY SHAPE WHAT
THE IMPACT OF THE INTERVENTION
WILL BE.
THE OTHER PART OF THIS IS
THINKING ABOUT WHAT IT MEANS TO
TAILOR INTERVENTIONS TO CONTEXT
IN A WAY THAT ALLOWS THEM TO BE
SUSTAINABLE AND I WORKED WITH
KRIS ECONOMSO AND WE LOOKED AT
THE UP STREAM PART OF DESIGNING
INTERVENTIONS TO THINK WHAT DOES
THE COMMUNITY LOOK LIKE IN WHICH
YOU'RE INTERVENING, WHAT'S THAT
MEAN HOW TO FIELD THE
INTERVENTION THAT WILL WORK AND
HAVE SUSTAINABILITY IN THAT
CONTEXT AND HOW CAN YOU USE A
VARIETY OF COMPLEX SYSTEM TOOLS
TO HELP YOU DO THAT.
WHEN I TALK ABOUT COMPLEX
SYSTEMS TOOLS I WANT TO QUICKLY
SAY THERE ARE VERY MANY SUCH
TOOLS IN THE METHODOLOGICAL
TOOLB
TOOLBOX.
THIS IS FROM A REPORT WHICH I
THINK IS STILL VERY RELEVANT IN
THINKING ABOUT THE MAIN TOOLS
PEOPLE USE THEY INCLUDE THINGS
LIKE SYSTEM DYNAMIC MODELLING,
AGENT-BASED MODELLING AND
THERE'S MANY SUCH TOOLS.
SOME ARE QUALITATIVE AND SOME
MAKE PREDICTIONS AN SOME USE
LOTS OF DATA.
SOME CAN WORK WITHOUT DATA TO
HELP US BUILD THEORY AND
HYPOTHESES.
IN GENERAL THE TOOLS GET USED SO
FAR IN PUBLIC HEALTH IN GENERAL
AND NUTRITION SPACE IN
PARTICULAR IN THERE'S IMPORTANT
WAYS.
FIRST, COMPUTATIONAL
LABORATORIES TO TAILOR NEW
POLICIES OR INTERVENTIONS AND
SIMULATING COUNTER FACTUALS
THINGS THAT HAVE NOT YET BEEN
OBSERVED IN THE WORLD TO PREDICT
HOW TO HE SYSTEM MAY CHANGE IF
YOU PERTURB IT AND BECOME A WAY
TO TEST POLICIES IN THE VIRTUAL
WORLD OF A COMPUTER TO IDENTIFY
THE MOST PROMISING ONES BEFORE
YOU FIELD SOMETHING LIKE AN RCT
IN THE REAL WORLD TO TEST OUT
THIS IS A POPULAR USE AND WIDELY
USED FOR EXAMPLE, INFECTIOUS
DISEASE MODELS DURING THE
PANDEMIC AND IN TOBACCO CONTROL
IT'S COMMON AND IT'S JUST
STARTING TO BE USED IN THE
NUTRITION SPACE BUT LOOKS
PROMPTING.
SECOND IS AS RETROSPECTIVE TOOLS
TO LOOK AT INTERVENTIONS ALREADY
DONE AND TRY TO UNDERSTAND WHAT
WORKED AND DIDN'T WORK AND HOW
DEPENDENCE OF CONTEXT MAY PLAY
OUT IN TRYING TO TRANSLATE OR
SCALE INTERVENTIONS.
THIS IS VERY MUCH WHAT THE
COMPACT INTERVENTION I TALKED
ABOUT EARLIER -- COMPACT STUDY
IS ABOUT.
THE THIRD USE OF THE MODELS
WHICH ENCOMPASSES THE KIND OF
MORE IDEOLOGICAL MODELS I TALKED
ABOUT EARLIER LOOK AT THE LIFE
COURSE OR SOCIAL INFLUENCE IN
OBESITY AND NUTRITION, THE GOAL
IS TO TRY TO IDENTIFY MECHANISMS
NOT DIRECTLY OBSERVABLE BUT
ACTUALLY REPRESENT THE DYNAMICS
THAT TRANSLATE SEQUENCE OF
EXPOSURES EXPERIENCED BY
INDIVIDUALS INTO OUTCOMES WE CAN
MEASURE.
WHAT WE OFTEN CAN'T DO IS
UNDERSTAND IN DETAIL WHAT THE
MECHANISM IN BETWEEN THAT
CONNECTS THE EXPOSURES TO THE
OUTCOMES LOOKS LIKE AND WHAT THE
DYNAMIC PROPERTIES ARE AND
MODELS ALLOWING US TO TEST
HYPOTHESES AND TO SEE WHICH ONES
HAVE THIS ABILITY TO CREATE
PATTERNS OF OUTCOMES OVER TIME
AND SPACE GIVEN INPUTS AND
EXPOSURES OVER TIME.
-- AND ACROSS INDIVIDUALS.
BY DOING THAT WE HOPE TO
IDENTIFY KEY LEVERAGE POINTS FOR
FUTURE INTERVENTION.
THERE'S MANY CHALLENGE INVOLVED
IN DOING THIS KIND OF WORK.
DATA CHALLENGES, ENGAGEMENT WITH
STAKEHOLDERS, TEAM BUILDING.
ONE CHALLENGE I WANT TO
HIGHLIGHT IN EXPANDING COMPLEX
SYSTEM TOOLS FURTHER IN THE
SPACE DESPITE MANY EXHORTATIONS
FROM THE NATIONAL ACADEMIES AND
MAJOR JOURNALS AND SO ON IS
THERE'S STILL A LIMITED AMOUNT
OF TRAINING IN HOW TO USE THE
TOOLS EFFECTIVELY AND HOW TO
BECOME EXPERT IN THEM AND
SCATTERED AROUND A HANDFUL OF
UNIVERSITIES AROUND THE COUNTRY.
I'M FORTUNATE ENOUGH TO BE AT
ONE OF THOSE AND WE NEED MORE OF
THIS KIND OF TRAINING IF WE'RE
GOING TO GROW USE OF THIS TOOL
SET MORE BROADLY AND I'LL LEAVE
YOU AND ALLOW TIME FOR QUICK Q&A
BECAUSE I HAVE TO LEAVE AND YOU
WITH THIS QUOTE WHICH ARGUES
THERE SHOULD BE TRAINING IN ALL
COMPLEX SYSTEM APPROACHES NOT
JUST IN ACADEMIA BUT IN THE
PRIVATE SECTOR AND IN GOVERNMENT
AGENCIES SUCH AS NIH AND THIS
SHOULD INCLUDE NOT ONLY SYSTEMS
RESEARCH DESIGN BUT FROM
ANALYTICAL METHODOLOGIES SUCH AS
MODELLING.
I'LL STOP THERE AND STOP SHARING
MY SCREEN.
>> THAT WAS AMAZING.
WE APPRECIATE HOW YOU WERE ABLE
TO EXPLAIN THE COMPLEX SYSTEMS
AND THE REFERENCE US ADDED TO
ENABLE US TO UNDERSTAND IT AENT
MORE.
WE REALIZED IN OUR NIRNL LOOK AT
THIS TASK THAT WE HAD TO LEARN
MORE ABOUT COMPLEX SYSTEMS.
IT WAS YOU COULD NOT USE A
SIMPLE LINEAR STRATEGY TO MEET
THE DEMANDS OF OUR TASK.
I THANK YOU VERY MUCH FOR DOING
THIS.
WE HAVE A Q&A SCHEDULED AT
11:20.
DO YOU REMAIN THAT LONG?
>> I'LL TRY TO BUT I MAY HAVE TO
DROP OFF I THOUGHT I'D PUT MY
E-MAIL ON THE SLIDE.
>> I'LL TAKE ADVANTAGE OF THE
TWO OR THREE MINUTES RAND ASK IF
SOMEONE HAS A QUESTION THEY'D
LIKE TO ASK.
I SEE DON BUNDY.
YOU'RE ON.
>> THANK YOU, MAUREEN AND ROSS
FOR A REALLY INTERESTING
PRESENTATION.
I WONDERED IF YOU COULD SHARE
EXAMPLES WITH US WHERE THAT KIND
OF DYNAMIC COMPLEX SYSTEMS
APPROACH IS BEING USED IN LOW
INCOME COUNTRIES OR MIDDLE
INCOME COUNTRIES?
WE'RE THINK WHERE WE GO NEXT
WITH SOME OF THIS THINKING.
>> THESE TOOLS CAN BE USED IN
THAT CONTEXT AND THE COMPACT
STUDY WORKED WITH A VARIETY OF
COMMUNITIES TRIED TO ADOPT THIS
APPROACH INCLUDING EXPLORATORY
WORK A COMPACT APPROACH AND THE
TOOLS IN NEW ZEALAND AND ALSO
WITH INDIGENOUS POPULATIONS IN
NORTH AMERICA I'D BE HAPPY TO
TALK FURTHER ABOUT WITH YOU IF
YOU'RE INTERESTED IN THAT.
ALSO THE KINDS OF MODELS WERE
USED PRETTY MUCH ACROSS THE
BOARD IN THE DEVELOPING WORLD TO
HELP MANAGE COVID AND DESIGN
POLICIES DURING THE PANDEMIC.
>> THE VERY MUCH.
I WAS MEANING IN THE TERMS OF
NUTRITIONAL --
>> YES.
>> OKAY.
MAYBE WE CAN FOLLOW-UP.
THAT WOULD BE SUPER.
>> GREAT.
>> FOLLOWING ROSS WE'LL HAVE A
COLLEAGUE AND PARTNER IN CRIME
OF ROSS'S AND CHRISTINA, YOU'RE
UP.
>> I'M HAPPY TO FOLLOW ROSS.
WE'VE BEEN CLOSE COLLEAGUES FOR
A LONG TIME AND I'LL PIVOT TO
SHOW YOU HOW SOME OF THE WORK IS
OPERATIONALIZED IN THE REAL
WORLD AND THE RESEARCH WE'RE
DOING NOW.
I WAS ASKED TO SPEAK ABOUT SHAPE
UP SOMERVILLE RESEARCH ARE I DID
ALMOST 20 YEARS AGO AND SHOW YOU
HOW WE RESOLVED THE SCIENCE AND
STUDIED THE COMPLEX ECOLOGICAL
SYSTEMS CHILDREN ARE EMBEDDED
WITHIN AND A LOT OF TOOLS WE'RE
USING ARE WHAT ROSS JUST
DESCRIBED.
I'LL TRY TO MAKE THEM COME TO
LIFE IN ILLUSTRATIONS OF HOW
WE'RE WORK WITH COMMUNITIES
ACROSS THE COUNTRY TO STUDY
THESE COMPLEX SYSTEMS.
WE KNOW THERE'S BEEN AN
EVOLUTION IN TERMS OF THE
RESEARCH WE DO AND HOW WE
APPROACH IT IF WE THINK BACK,
30, 40 YEARS AGO WE WERE VERY
MUCH FOCUSSED ON INDIVIDUAL
BEHAVIOR CHANGE AND THOSE
APPROACHES WHERE WE COULD TREAT
PEOPLE ONE-ON-ONE AND IMPLEMENT
EVIDENCE-BASED STRATEGIES AND
THROWS IMPORTANT BUT WE CAN'T
REACH THE WORLD AND THEN THE
POLICY EVOLVED IN DEVELOPING A
SUITE OF ASSESSMENT TOOLS IN THE
REAL WORLD TO UNDERSTAND WHETHER
THE INTERVENTIONS WERE EFFECTIVE
OR NOT.
MANY WERE DONE ONE BY ONE AND
STARTED TO COME TOGETHER 25
YEARS AGO IN MULTI-LEVEL,
MULTI-SECTOR DESIGNS AND EXPECT
IT IN THAT CATEGORY AND THE
WHOLE OF SYSTEM SCIENCE
APPROACHES.
I'LL TRY TO ILLUSTRATE WHAT
TYPES OF POLICY SYSTEMS SHOULD
WE IMPLEMENT WITHIN COMMUNITIES
TO INFLUENCE NUTRITION AND
HEALTH.
WHO MAKES THAT HAPPEN HOW DO WE
DO THIS WITH A SYSTEMS APPROACH
AND EQUITY LENS AND HOW DO WE
APPROACH EVALUATION.
I'LL I'LL GO BACK TO SHAPE UP
SOMERVILLE AN APPROACH TO
PREVENT OBESITY BETWEEN 2002 AND
2005.
THIS WAS SET UP AS A THREE-YEAR
CONTROLLED TRIAL TO STUDY
1st-3rd GRADERS OUTSIDE BOSTON.
WE DESIGNED AN INTERVENTION TO
ADDRESS THE ENERGY GAP WHICH WE
KNOW CAUSES UNNECESSARY WEIGHT
GAIN AND OBESITY IN CHILDREN BY
IMPLEMENTING AND EVALUATE
PORTFOLIO OF EVIDENCE-BASED
STRATEGIES THROUGHOUT THE
COMMUNITY.
AND WE USED A MULTI-LEVEL
APPROACH, MEANING WE WORKED
BEFORE, DURING AND AFTER SCHOOL
IN THE HOME, THE COMMUNITY AT
LARGE INVOLVING MANY DIFFERENT
ORGANIZATIONS AND SECTORS THAT
YOU SEE.
THE GOALS OF THIS CITY WERE TO
EXAMINE THE EFFECTIVENESS OF
THIS MULTI-SECTOR, MULTI-LEVEL
MODEL ON THE PREVENTION OF
UNDESIRABLE WEIGHT GAIN IN
CHILDREN.
WE WANT TO PREVENT WEIGHT GAIN
BUT PREVENT THE UNNECESSARY
WEIGHT GAIN FROM OCCURRING.
AND THOUGHT AT THE TIME WE COULD
TRANSFORM ONE COMMUNITY AND
SOCIAL CHANGE AT THE NATIONAL
LEVEL.
THE PORTFOLIO OF INTERVENTIONS
THAT WE IMPLEMENTS WE'RE USING
EVIDENCE-BASED STRATEGIES WE
KNEW AT THE TIME TO BE EFFECTIVE
WHEN THEY WERE IMPLEMENTING ONE
BY ONE OR EVEN IN A PAIR AND
THERE HADN'T BEEN TRIALS WHERE
THESE THINGS WERE PUT TOGETHER
IN A LARGE PORTFOLIO.
WE KNOW ONE SINGLE STRATEGY IS
UNLIKELY TO WORK.
THIS SHOWS A LONG LIFT OF THE
KINDS OF THINGS WE DID
THROUGHOUT THE COMMUNITY.
AND TO BRING IT BACK TO THE
EVIDENCE BASED WE FOCUSSED ON HE
REDUCTION OF SUGAR-SWEETENED
BEVERAGES AND ENCOURAGED DIETARY
GUIDELINES, INCREASING PHYSICAL
ACTIVITY, FAMILY MEALS.
ALL THE THINGS WE KNOW IN THE
NUTRITION LITERATURE AT THE TIME
WERE IMPORTANT BUT NEED TO BE
BROUGHT INTO THE REAL WORLD AS
INTERVENTIONS THAT ARE PART OF
EVERYDAY LIFE.
WE SAW A DECREASE IN THE SCORE
AND THE INTERVENTION COMMUNITY
IS THE SECOND LINE FROM THE TOP.
CHILDREN WERE MEASURED AT FOUR
TIME POINTS BEFORE AND AFTER TWO
CONSECUTIVE SCHOOL YEARS.
THERE WAS A REDUCTION IN THE
SCORE COMPARED TO EACH CONTROL
INDIVIDUALLY OR THE COMBINED
CONTROLS THE ANALYSIS WE PLANNED
AND YOU'LL NOTE A RISE IN THE
SUMMER AND THIS SHOULDN'T BE
NEWS IF YOU LOOKED AT CHILDREN'S
UNSTRUCTURED SUMMERTIME BEHAVIOR
AND WHAT WE'RE SEEING FROM THE
PAST TWO YEARS IS MANY CHILDREN
EXPERIENCE TWO YEARS OF
UNSTRUCTURED ACTIVITY WHICH HAS
LED TO A SIGNIFICANT INCREASE IN
OBESITY ACROSS THE COUNTRY.
IN ADDITION TO BIOLOGY WE SAW
BEHAVIORAL CHANGE LIKE SUGARY
DRINK INTAKE AND SCREEN TIME
REDUCTION OF ACTIVITIES AND
SPILLOVER FROM PARENTS AND
OBESITY AND SAW CHANGES AT THE
COMMUNITY LEVEL.
THIS HAS BEEN SUSTAIN OVER TIME
AND THE STUDY DID INFORM
NATIONAL EFFORTS.
EQUALLY IMPORTANT WAS THE
ECONOMIC ANALYSIS I DID WITH
SOME HEALTH ECONOMISTS LOOKING
AT THE OVER TIME ROI.
WE KNOW PREVENTION TAKES TIME TO
REAP THE BENEFITS.
IN THIS CASE IT WAS ABOUT THE
SIX, SEVEN YEAR MARK WHERE IT
STARTED TO PAY BACK AND THE PAY
BACK WAS BIG AND IF WE WERE TO
LOOK AT PREVENTION AND BELIEVE
IT DOES TAKE TIME BUT IT'S
IMPORTANT AND THE PAY NOW, PAY
LATER MODEL AND WE'D ARGUE IT'S
WORTH THE INVESTMENT RIGHT NOW.
WHEN THE STUDY WAS OVER, WE
PIVOTED TO TRY TO UNDERSTAND
WHAT HAPPENED IT WAS A LINEAR
MODEL IN HOW TO ACCOMPLISH THIS
MULTI-LEVEL, MULTI-SECTOR
INTERVENTION AND I REALIZED IT
WASN'T LINEAR BUT A SYSTEM
OPERATING IN AN INTERACTIVE AND
THERE WERE FEEDBACK LOOPS OVER
TIME AND I NEEDED TO UNDERSTAND
WHAT WAS GOING ON AND I
CONTACTED A SYSTEM SCIENTIST AND
FROM THERE FORWARD I'VE BEEN
USING SYSTEM SCIENCE IN MY
APPROACH.
I'M SHOWING THE COMMUNITY AND
THE MICROSYSTEMS OR SECTORS
WITHIN A COMMUNITY THAT
ULTIMATELY INFLUENCES INDIVIDUAL
BIOLOGY AND HEALTH.
AND THIS IS IMPORTANT TO
UNDERSTAND SO WE COULD REPLICATE
THE MODEL AND THE GROUP WE
BROUGHT TOGETHER OF LEADERSHIP
IN THE COMMUNITY WAS THE DRIVING
FORCE OF INTERVENTION ACTIVITIES
AND WHAT CAUSED THE
IMPLEMENTATION TO BE SUCCESSFUL
AND SUSTAINED OVER TIME.
BEGAN TO THINK MORE ABOUT THE
PEOPLE BEHIND THE INTERVENTION
AND HOW WE DON'T OFTEN STUDY THE
UP STREAM GROUP OF STAKEHOLDERS
RESPONSIBLE FOR MAKING THIS
HAPPEN.
WE PIVOTED AS A RESULT OF
COMPACT THE TRIAL ROSS MENTIONED
WE WERE CO-P.I.s ON AND OUR WORK
NOW TO LOOK TOWARDS SYSTEM
THINKING AND ACKNOWLEDGE THE
COMPLEX AND BUILDS ON COMMUNITY
STRENGTH TO IMPROVE THE HEALTH
AND WELL BEING OF CHILDREN AND
FAMILIES.
THIS IS CALLED STAKEHOLDER
COMMUNITY DIFFUSION.
ON THE LEFT YOU SEE THE UP
STREAM CONSTRUCTS AND THE
MIDSTREAM CONSTRUCTS INCLUDING
POLICY PRACTICE AND SYSTEM
ENVIRONMENT AND TO DRIVE
POSITIVE CHILD HEALTH OUTCOMES.
WE TRIED TO ENGAGE ON THE
COALITION THEY'RE PART OF AND
THE EFFICACY OF THE WORK OF THAT
COALITION.
WE DO A LOT OF WORK UP STREAM
AND TO DIFFUSE THAT USING THEIR
SOCIAL NETWORKS AND ULTIMATELY
IMPACT POLICIES, SYSTEMS AND
ENVIRONMENT TO DRIVE POSITIVE
HEALTH OUTCOMES.
THIS MODEL IS REALLY IMPORTANT
BECAUSE MOST PEOPLE START WITH
POLICY SYSTEMS AND ENVIRONMENTS
AND EXPECT THE HEALTH OUTCOMES
TO CHANGE BUT WE WOULD ARGUE IF
YOU DON'T DO THIS UPSTREAM WORK
IT WON'T BE SUSTAIN OVER TIME
AND YOU WON'T IMPACT THE PEOPLE
IN THE COMMUNITY WHO ARE
ACTUALLY DOING THE IMPLEMENT --
IMPLEMENTATIONS AND LOOK AT THE
DRIVERS AND STRUCTURES PREVENTED
FROM BEING POSITIVE FOR CHILDREN
IN THE FIRST PLACE.
YOU'LL SEE WHEN I ILLUSTRATE
THROUGH THE COMMUNITY WORK WE'RE
DOING NOW, THESE ARE THE KINDS
OF THINGS PEOPLE IN COMMUNITIES
WORK ON AND CARE ABOUT NUTRITION
AND HEALTHY BEHAVIOR BUT KNOW
YOU NEED TO LOOK AT ECONOMIC
DEVELOPMENT, RACISM AND
STRATEGIC PARTNERSHIPS.
WE WORK WITH THE STAKEHOLDER
GROUPS TO LOOK AT COMMUNITY
BASED SYSTEM DYNAMICS WHICH FIT
IN THE SUITE ROSS TALKED ABOUT
AND HAVE THEM MAP OUT WHAT
STARTS IN THE COMMUNITIES AND
MODEL WHAT'S HAPPENING.
YOU CAN SEE FROM THIS COUNTY IN
CLEVELAND AN ACTUAL MAP CREATED
TO IDENTIFY THE COMMUNITY AND
ENVIRONMENTAL FACTORS WITHIN
THIS PARTICULAR COMMUNITY THREE
ARE PRESENT AND INTERCON COCONNECTED
AND NEED TO BE WORKED ON TO
INFLUENCE BIOLOGY AT THE
INDIVIDUAL LEVEL.
I'M PULLING OUT FOR YOU THE
KINDS OF THINGS WITHIN A
COMMUNITY THAT WILL BE
IDENTIFIED THAT NEED TON
STUDIED, CHANGED, EVALUATED AND
SUSTAIN OVER TIME.
FOR EXAMPLE, BUILT ENVIRONMENT,
WALKABILITY, TOXIC STRESS LIKE
POVERTY AND TRAUMA AND FOOD
ACCESS FROM THE RETAIL AND
FARMER'S MARKET TO FOOD BANKS
AND SHELTERS, POLITICAL WILL AND
COST OF CHILDCARE AND SO ON.
THESE ARE ALL IMPORTANT TO MAKE
THE ENTIRE SYSTEM WORK AND YOU
CAN SEE HERE THEY'RE
INTERCONNECTED.
HOW DO WE MEASURE WHETHER OR NOT
WE'RE HAVING AN IMPACT?
THIS IS ONE EXAMPLE WHERE THEY
IDENTIFIED THESE VARIABLES AND
WE SET A PLAN FOR ACTION AND
OVER TIME THEY ACTUALLY
IDENTIFIED WHERE THEY WERE
MAKING THE MOST PROCESS AND
THAT'S HIGHLIGHTED IN THE FIRST
BOX HERE AND MODEST PROGRESS AND
THE LAST BOX SHOWS WHERE THEY
NEEDED MORE PROGRESS.
THIS ENABLED US TO MEASURE
WHETHER THESE THINGS ARE BEING
ADDRESSED AND WHETHER THEY
BELIEVE THEY'RE HAVING AN
IMPACT.
OBJECTIVELY WE USED VALIDATED
INSTRUMENT TO LOCK AT POLICY,
PRACTICES AND LOOK AT SCORES.
YOU'LL HEAR MORE COMING UP BUT
THIS IS ONE COMMUNITY WHERE THE
SCORE IMPROVED OVER TIME BY
OBJECTIVE MEASUREMENT AND YOU
CAN SEE THAT IT WAS SIGNIFICANT
INDICATING THE PSE CHANGES WERE
POSITIVELY MOVING.
WE ALSO LOOKED AT SOCIAL
NETWORKS.
BECAUSE WHAT'S IMPORTANT IS THE
DIFFUSION OF ALL THIS.
HOW ARE PEOPLE DIFFUSING THIS
KNOWLEDGE AND INFORMATION AND
IMPLEMENTATION OF THE
EVIDENCE-BASED STRATEGIES.
THIS IS AN EXAMPLE OF A
STAKEHOLDER NETWORK WITHIN A
COMMUNITY AT FIVE TIME POINTS
AND MEASURED THINGS LIKE THE
DISCUSSION NETWORK, FREQUENCY OF
CONNECTION, INFLUENCE ON EACH
OTHER AMONG OTHER SOCIAL NETWORK
VARIABLES THAT ARE OF INTEREST
TO US BUT THIS ILLUSTRATES FOR
YOU OVER TIME YOU CAN SEE THE
DIFFERENT TYPES OF CHANGES AND
THE GROWTH OF A NET WORK WE
OFTEN SEE WHICH IS THE GOAL TO
GET MORE PEOPLE PART OF THE
INTERVENTION.
AND YOU SEE THE WHOLE OF
COMMUNITY APPROACHES ARE
DIFFERENT AND LEVERAGE COMMUNITY
ASSETS AND BUILD CAPACITY AND
HELP WITH ENGAGEMENT AND WE HAVE
TO MEASURE THESE CONSTRUCTS AS
WELL AS THE MID STREAM AND DOWN
STREAM ASPECTS.
COORDINATION BETWEEN SECTORS
USING SYSTEM SCIENCE
METHODOLOGIES WHICH CAPTURES THE
COMPLEXITY.
IMPOSING ENVIRONMENTAL AND
POLICY INTERVENTIONS AND
EVALUATIONS NOT CONTEXT SPECIFIC
AND DEVELOPED WITH ENGAGEMENT
MAY NOT BE SUSTAINABLE.
REDUCING DISPARITIES REQUIRING
EQUITY ORIENTED DISPARITY
ADDRESS THE UNDERLYING
STRUCTURES AND DISADVANTAGES AND
ROSS ALSO EMPHASIZED FUTURE
LEADERS NEED THIS TYPE OF
INTERDISCIPLINARY TRAINING IF
WE'RE TO MAKE PROGRESS
INFLUENCING THE HEALTH OF
CHILDREN.
THANK YOU.
>> THANK YOU.
WE APPRECIATE THE EXAMPLES OF
SHAPE UP SOMERVILLE AND BEYOND.
THE NEXT SPEAKER WILL BE HILARY
AND SHE'LL TALK ABOUT HEALTH AND
ECONOMIC SYSTEMS.
>> DO WE HAVE TIME FOR
QUESTIONS, MAUREEN?
>> WELL, WE COULD HAVE TIME FOR
ONE QUESTION.
WE'RE TRYING TO KEEP ON THINGS,
DAN, BUT YES, IF YOU HAVE A
QUESTION OR SOMEONE ELSE HAS
TIME FOR ONE QUESTION, WE COULD
DO THAT.
>> MY QUESTION IS THIS THE TWO
PRESENTATIONS WE HEARD HAVE MADE
AN IMPORTANT CASE FOR DEVELOP
AND IMPLEMENTATION OF PROGRAMS
TO ADDRESS OUTCOME OF INTEREST.
THEY WERE LESS FOCUSSED ON
IMPACTING A PRE-EXISTING
PROGRAM.
CHRIS OR ROSS MIGHT WANT TO
RESPOND.
CHRIS MENTIONED SOME ASPECTS OF
THE WORK SHE'S DONE ON MEASURING
THE IMPACT OF THOSE PROGRAMS AND
LOOKING AT THE IMPACT OF
CHILDREN AND HOW DO WE APPLY
SYSTEMS APPROACHES TO THAT?
>> IT'S NOT A PROBLEM APPLY
THESE METHODOLOGIES AND I'LL
ROSS TALK ABOUT THE MODELLING
ASPECT BUT FROM THE SOCIAL
NETWORK AND ASPECT I'VE TALKED
ABOUT, YOU CAN DO THAT WITH AN
EXISTING PROGRAM.
WHAT I DIDN'T EMPHASIZE TODAY
BECAUSE I THINK THIS IS PART OF
OTHER WORKING GROUPS, WHAT ARE
THE SPECIFIC ENVIRONMENTAL
POLICY AND SYSTEM TOOLS YOU'RE
USING?
I ALOLUDED THOSE CAN BE USED WITH
AN EXISTING PROGRAM.
AND WE DID THAT
RETROSPECTIVELY -- ME MIGHT HAVE
HAD TO DROP OFF.
ROSS AND I PUBLISHED THAT
TOGETHER AS PART OF THE NIH
COMPACT TRIAL WHERE WE LOOKED AT
INTERVENTION HAVE BEEN DONE AND
TRYING TO UNDERSTAND WITH A
SYSTEM'S LENS, WHAT THEY
ACCOMPLISHED AND DONE AND USED
MODELLING AND ONE OF THOSE
PAPERS IS PUBLISHED AND ONE IS
ABOUT TO BE PUBLISHED.
YOU CAN COME INTO AN EXISTING
STUDY AND USE THE METHODOLOGY AS
WELL.
I THINK WHAT I WAS TRYING TO
EMPHASIZE WAS THE CONTEXT
SPECIFIC IMPORTANCE OF IMPLEMENT
POLICY SYSTEMS AND VARIETAL
INTERVENTIONS AND THE BEST WAY
TO DO THAT IS TO WORK FROM THE
COMMUNITY FROM THE BEGINNING.
>> THANK YOU VERY MUCH.
WE KNOW IT'S FASCINATE AND KNOW
MUCH OF WHAT HAS BEEN DONE HAS
NOT HAD THE IMPACT WE HOPED IT
WOULD.
OUR CHARGE IS TO DOCUMENT WHAT
HAS WORKED AND WHAT WE KNOW AND
DON'T KNOW YOU'RE HELPING THANE
WAY.
NEXT WE HAVE HILARY SELIGMAN.
>> THANK YOU FOR INVITING ME TO
TALK TODAY.
>> I'VE BEEN GIVEN A LARGE TOPIC
ON HEALTH AND ECONOMIC SYSTEMS
IN 12 MINUTES.
I'LL BRIEFLY TOUCH ON A FEW
IMPORTANT TOPICS AT THE END GIVE
YOU THOUGHTS ON RESEARCH
CONSTRUCTS.
I THINK ABOUT THIS THROUGH THE
LENS OF FOOD INSECURITY.
THE 20 NUMBERS FROM THE USDA
SHOW OVERALL IN THE U.S., FOOD
INSECURITY NUMBERS DID NOT
INCREASE BETWEEN DECEMBER 19 AND
DECEMBER 2020 IN THE MIDST OF
THE PANDEMIC.
A LOT OF THE POLICIES PUT IN
PLACE TO ADDRESS ECONOMIC
INSECURITY AND FOOD INSECURITY
WERE IMPACTFUL AND I THINK
THERE'S IMPORTANT LESSONS THERE.
THERE'S ALSO AN IMPORTANT LESSON
IN THE FACT THAT CHILD FOOD
INSECURITY TICKED UP AND I THINK
THAT IT EMPHASIZED THE HOUSEHOLD
IS AND HOW QUICKLY CHILDREN ARE
IMPACTED BY ECONOMIC AND INCOME
CHANGE.
THE SMALL INCREASES IN FOOD
INSECURITY ARE LARGER IN BLACK
AND BROWN HOUSEHOLDS AND THIS IS
A RECURRENT PATTERN WHERE
THEY'RE MORE SENSITIVE TO
ECONOMIC SHOCKS.
I'M A PHYSICIAN BY TRAINING.
I WANT TO EMPHASIZE ADVERSE
HEALTH OUTCOMES AMONG CHILDREN
AND I LISTED A NUMBER HERE.
WHAT IS INTERESTING IS ABOUT
THESE ARE TWO THINGS.
NUMBER ONE, EVEN VERY LOW LEVELS
OF FOOD INSECURITY WHAT WE CALL
MARGINAL FOOD INSECURITY IS
ASSOCIATED WITH POORER HEALTH
AMONG CHILDREN.
IT'S IMPORTANT THAT WE PREVENT
FOOT INSECURITY IN HOUSEHOLDS
AND EMPHASIZE THE RELATIONSHIPS
DON'T ONLY OCCUR BECAUSE OF
CHANGES IN DIETARY CHANGES.
IF WE LOOK AT THE ENTIRE
LITERATURE OF DIETARY INTAKE WE
SEE AN EXAMPLE FROM THIS
SYSTEMATIC REVIEW.
EACH DOT REPRESENTS A STUDY AND
THE STUDIES IF THE RED BOX
SHOWED AN ADVERSE IMPACT ON THE
NUTRIENT ARE, MACRO NUTRIENT
ASSOCIATED WITH FOOD INSECURITY.
THERE'S MANY OTHER PATHWAYS THAT
LINK FOOD INSECURITY TO POOR
HEALTH INCLUDING AMONG
HOUSEHOLDS WITH CHILDREN AND I
THINK IT'S IMPORTANT WE TAKE A
10,000 FOOT VIEW OF THIS AND
DON'T ONLY THINK OF DIETARY
INTAKE AS THE MECHANISM FOR
IMPACTING CHILDHOOD HEALTH AND
LONG-TERM OUTCOMES.
WITH THAT IN MIND I WANT TO GIVE
YOU THE LIST OF THINGS I THINK
HAVE AND THERE'S A POLICY
APPROACH IN THE U.S. AND
DECREASED RATES OF FOOD
ENSECURITY.
THEY INCLUDE SNAP, THE EARNED
INCOME TAX CREDIT, SCHOOL
BREAKFAST AND LUNCH PROGRAMS AND
WIC AND POLICIES FOR LOW-INCOME
HOUSEHOLDS.
THESE I THINK ARE CLEAR.
I THINK HAVE AN A SINGLE STUDY
OR OBSERVATIONAL STUDIES AND
THERE'S FOOD SERVICES AND THE
ADULT AND CHILD FOOD PROGRAM AND
FOOD THAT COMES FROM A NETWORK
OF FOOD BANKS AND PANTRIES AND
MEDICAID EXPANSION AND OTHER
PROGRAMS THAT WHICH ALLOW PEOPLE
TO SPEND MORE ON FOOD.
CASH TRANSFERS, WHICH ARE
GETTING INCREASED AND HOUSING
SUBSIDIES AND THEN I'LL TALK FOR
A MINUTE ABOUT FOOD AS MEDICINE.
WE LOOKED AT THE HEALTH OUTCOMES
AND OBESITY RATES IN THE
LONG-TERM.
THIS STUDY LOOKED AT THE ROLL
OUT AND LOOKED AT THE SNAP
PROGRAM IN THE 1970s AND
CHILDREN WHO HAD ACCESS TO SNAP
AND DIDN'T AND LOOKED AT THEIR
SNAP AVAILABILITY IN YOUR COUNTY
AS A CHILD HAD SIGNIFICANT
IMPACTS ON OBESITY RATES IN
ADULTHOOD AND POSITIVE AFFECTS
ON HIGH SCHOOL COMPLETION I WANT
TO MENTION FOOD MEDICINE
APPROACHES BECAUSE INCREASINGLY
IT WILL BE A SECTOR WHERE
CHILDREN ACCESS FOOD BUT NOT A
SECTOR WE TRADITIONALLY THINK OF
BEING ACCESS.
FOOD AS MEDICINE HAS BEEN
DEFINED AS THE INTEGRATION OF
THE FOOD AND NUTRITION
INTERVENTION IN CLOSE
COLLABORATION WITH THE HEALTH
CARE SYSTEM.
OFTEN, PARTICULARLY IN PEDIATRIC
POPULATIONS THE FOOD AS MEDICINE
INTERVENTIONS TARGET PEOPLE AT
HIGH RISK OF FOOD INSECURITY.
I WANTED TO CALL ATTENTION TO A
COUPLE PROGRAMS I THINK ARE
GAINING MOMENTUM PARTICULARLY IN
PEDIATRIC POPULATIONS.
AND THOSE WOULD BE THINGS LIKE
PRODUCE DESCRIPTION WHERE THE
PEDIATRICIAN OFFERS A DEBIT CARD
TO PURCHASE FRUITS AND
VEGETABLES, AND THERE'S EXAMPLES
OF MEDICALLY TAILORED GROCERIES
WHERE ARE HOUSEHOLDS TAKE HOME A
HEALTHY BAG OF GROCERIES.
AND THERE ARE ALSO MANY EXAMPLES
NOW OF HAVING PEOPLE ENROLLED
IN -- EMBEDDED IN HEALTH CARE
SYSTEMS TO HELP FAMILIES ENROLL
IN FEDERAL NUTRITION PROGRAMS
AND CLINICAL REFERRALS FROM THE
HEALTH CARE SECTOR ARE ALSO
CONSIDERED FOOD AS MEDICINE.
THIS CONCEPTUALIZE THE PROB AS
BEING LACK OF ACCESS TO
NUTRITION OPPOSED TO FOOD
INSECURITY WHICH MAY BE MORE
BROADLY UNDERSTOOD AS ACCESS TO
CALORIES WHICH IS FOOD
INSECURITY AS WELL.
THERE'S PHYSICAL AND SOCIAL,
ECONOMIC ASPECT TO FOOD MEETING
DIETARY NEEDS AND PREFERENCES
FOR AN ACTIVE HEALTHY LIFESTYLE.
THIS IS CONCEPTUALLY WHERE
PEOPLE ARE GOING WITH THE
NUTRITION INSECURITY MEASURE.
I THINK THERE'S LOTS OF
ADVANTAGES TO MAINTAINING FOOD
INSECURITY IN THE CONSTRUCT.
WE HAD MANY USE OF SURVEILLANCE
DATA AND PRETTY MATURE
LITERATURE ON THE DRIVERS AND
IMPLICATIONS.
ON THE OTHER HAND, NUTRITION AND
SECURITY AND THIS MAYBE BETTER
ALIGNED WITH PUBLIC HEALTH GOALS
AND THE NEXT STEP IS A CENSUS
FOR HOW IT'S DEFINED, MEASURED.
AND FIRST OF ALL, FOOD
INSECURITY IS UNDERSTOOD AS A
HOUSEHOLD MEASURE AND IT'S VERY
CONSISTENTLY DEFINED AND
MEASURED AND FOR SURVEILLANCE
STUDIES THE APPROPRIATE ITEM IS
THE HUNGER VITAL SIGN.
IT'S NOT CLEAR HOW IT'S TO BE
MEASURED BUT I THINK IT NEEDS TO
BE MEASURED AT THE INDIVIDUAL
LEVELS IN LOOKING AT NUTRIENT
NEEDS BUT THERE'S THOUGHTS OF
COMBINING MEASURES OF FOOD
INSECURITY AND DIETARY INTAKE TO
COME UP WITH SOME MEASURE OF
NUTRITION.
THEN THERE'S OTHER CONSTRUCTS I
THINK ARE WORTH THINKING ABOUT.
THE FIRST IS WHETHER THERE'S
SNAP AND SCHOOL LUNCH AND EITC
AND THE OTHER IS LOOKING AT
ENVIRONMENTAL OR OVERALL COUNTRY
WIDE ACCESS AND REACH OF PROVEN
PROGRAMS LIKE SNAP AND CITC AND
WHO IS UTILIZING THE PROGRAMS
AND WHO ISN'T ABLE TO UTILIZE
THE PROGRAMS.
HOW ARE THEY BEING SUPPORTED IN
THEIR COMMUNITIES THROUGH
IMPLEMENT AND MAINTENANCE
STRATEGIES AND FINALLY
PARTICULARLY IMPORTANT FOR
HOUSEHOLDS WITH CHILDREN IS HOW
WELL DOES THE STATE SUPPORT
ENROLLMENT IN MULTIPLE PROGRAMS
SIMULTANEOUSLY BECAUSE THE
BEARC
BUREAUCRATIC ISSUES HAVE
DIFFICULT.
>> IT'S NOT EASY TO AND ACCESS
SOME PROGRAMS YOU TALK ABOUT.
THE ISSUE IS BEING FOOD
INSECURITY IS AMAZING WE HAVE IN
THIS COUNTRY AND CERTAINLY
GLOBALLY.
DAN, DO YOU HAVE A QUESTION?
>> I HAVE TWO QUESTIONS IN
REGARD TO THE IMPACT OF CLIMATE
AND WONDER IF YOU HAVE DATA AND
WE TALKED ABOUT COVID'S IMPACT
AND IT DOES NOT CHANGE FOOD YIP
SECURITY BUT WE HAVE RAMPANT
FOOD INSECURITY NONETHELESS AND
CLIMATE GLOBALLY HAS BEEN
IDENTIFIED AS A MAJOR
CONTRIBUTOR TO HUNGER GLOBALLY
AND LEADS TO THE DEFINITION OF
FOOD INSECURITY WHEN YOU COMBINE
HUNGER AND FOOD INSECURITY AND A
REFLECTION OF CALORIE VERSUS
FOOD.
CAN YOU COMMENT ON THE
DIFFERENCE BETWEEN HUNGER AND
FOOD INSECURITY?
HUNGER IS INCREASING GLOBALLY
AND THE TWO PRIMARY COMPONENTS
OF THAT ACCORDING TO WHO IS
CONFLICT AND CLIMATE CHANGE.
ALSO, SPEAK ON THE IMPACT OF
CLIMATE.
>> LET ME START BY THE IMPACT OF
CLIMB -- CLIMATE CHANGE.
>> WE HAVE LOOKED AT FOOD
INSECURITY AND CLIMATE CHANGE.
WE HAVE DONE A LESS GOOD JOB I
THINK IN THE UNITED STATES
UNDERSTANDING THIS.
I THINK WE HAVE BEEN FORTUNATE
TO NOT THINK ABOUT IT FOR A LONG
TIME AND SUPPLY CHAIN
DISRUPTIONS IN THE U.S. AS PART
OF THE PANDEMIC HAVE I THINK
MADE MANY MORE PEOPLE REALIZE
HOW VUL FESHL OUR FOOD SYSTEM IS
AND THE EXTENT TO WHICH FOOD
INSECURE HOUSEHOLDS WILL BEAR
THE BRUNT OF CLIMATE CHANGE
INEQUITIES.
HOW WE UNDERSTAND THAT IN THE
CONTEXT OF FOOD INSECURITY IN
THE U.S. IS NOT WELL UNDERSTOOD
AT THIS POINT AND WE NEED MORE
INTERDISCIPLINARY RESEARCH ARERS
TO HELP THE FIELD BETTER ADDRESS
THAT.
THAT'S MY PERSONAL OPINION.
YOUR SECOND QUESTION IS ABOUT
HUNGER AND FOOD INSECURITY THERE
ARE OFFICIAL DEFINITIONS IN THE
DOUBLE SPACE BUT I'LL GIVE MY
OWN THOUGHTS WHY YOU GIVE FOOD
INSECURITY IN THIS CONTEXT.
I THINK OF THE TERM HUNGER AS
BEING A PHYSICAL SENSATION THAT
EVERYBODY EXPERIENCES WHEN THEY
LACK ACCESS TOED TO FOR ANY
REASON.
THE CONTEXT IT'S NOT THE FEELING
OF HUNGER, IT'S THE COPING
STRATEGIES PEOPLE ARE FORCED IT
USE IN ORDER TO AVOID THE
PHYSICAL SENSATION OF HUNGER.
CHANGING DIETARY INTAKE TO LESS
EXPENSIVE FOOD AND BINGE EATING
IN ANTICIPATION OF AN UPCOMING
FOOD SHORTAGE.
CONCENTRATING DIETARY INTAKE ON
A SMALL VARIETY OF FOODS.
THESE COPING STRATEGIES ARE
ADAPTIVE IN THE SHORT TERM AND
KEEP YOU FROM GOING HUNGRY BUT
THEY'RE MALADAPTIVE IN THE LONG
TERM BECAUSE THESE ARE THE
PATTERNS THAT EXPOSE PEOPLE TO
CHRONIC DISEASE.
ONE WAY I PERSONALLY LIKE THINK
ABOUT FOOD INSECURITY IS HUNGER
AND THE COPING STRATEGIES THAT
HOUSEHOLDS ENGAGE IN ORDER TO
AVOID THE PHYSICAL SENSATION OF
HUNGER, I PUT THOSE UNDER THE
UMBRELLA OF FOOD INSECURITY.
>> VERY COMPREHENSIVE RESPONSE.
>> CHRISTINE DO YOU HAVE A
QUESTION?
>> ONLY IF THERE AREN'T OTHERS.
THANKS, HILARY.
THERE'S TALK ABOUT ADOPTION AND
THE ABILITY TO MAINTAIN
PARTICIPATION IN THE PROGRAMS
YOU MIGHT KNOW THIS IS FOCUSSED
ON TRANSLATION AND
IMPLEMENTATION.
CAN YOU TALK ABOUT THE FACTORS
YOU'VE STUDIED OR RUN ARE INTO
WITH RESPECT TO DIFFERENTIAL
ADOPTION WHEN YOU LOOK AT THE
STRATIFICATION OF A POPULATION
AND WHAT WE CAN DO ABOUT THAT.
>> FIRST OF ALL, THANK YOU FOR
CALLING THAT OUT BECAUSE IT'S
IMPORTANT THE AVAILABILITY OF A
PROGRAM DOES NOT MEAN PEOPLE IN
THE COMMUNITY ARE ABLE TO ACCESS
IT AND I GIVE EXAMPLES OF THE
WAY I'VE SEEN THIS SHOW UP.
THERE'S ENORMOUS VARIABILITY
ACROSS STATES IN THE PERCENTAGE
OF PEOPLE ENROLLED AND WHEN YOU
ASK PEOPLE ABOUT THEIR
EXPERIENCES IN THE ENROLLMENT
OFFICE , A LOT OF WHAT COMES
THROUGH IS THE APPROACH IN SOME
OFFICES IS I WANT TO GET
EVERYBODY IN MY STATE ENROLLED
WHO IS ELIGIBLE FOR THIS PROGRAM
BECAUSE THIS PROGRAM IS FOR YOU
AND IN OTHER OFFICES THE
APPROACH SEEMS TO BE MORE ALONG
THE LINES OF I NEED TO FIND A
WAY TO KEEP YOU OUT OF THIS
PROGRAM.
AND THAT APPROACH -- THAT
DIFFERENCE IN APPROACH SEEMS TO
BE A VERY PROFOUND DRIVER WHEN
WE TALK TO COMMUNITY MEMBERS
AROUND WHETHER PEOPLE ARE
ACTUALLY COMPLETING THE PROCESS
FOR SNAP OR WIC OR WHATEVER
ELSE.
IT IS THE CULTURE AND THE
OFFICE.
IT'S THE BUREAUCRATIC HURDLES
AND THE COMMUNITY FEELING AND
STIGMA AND ALL INCLUDING USDA
OVER THE HAS DEVOTED TIME AND
ATTENTION TO BUT WE NEED THOSE
ON THE GROUND APPROACHES TOO SO
MAKE SURE THE CHANGES AND
ADVANCEMENTS AND ADOPTION
STRATEGIES ARE REACHING THE
PEOPLE WHO ARE ELIGIBLE.
>> THANK YOU, THIS IS WHERE I
THOUGHT ABOUT THE MESSAGES
AROUND ADOPTION BUT NEGATIVE
MESSAGES TRAVEL AS FAST IF NOT
FASTER.
>> EXACTLY.
>> I CAN'T HELP BUT THINKING OF
THE WHOLE APPROACH AND THE
NEGATIVE ASPECTS IN SOME
COMMUNITIES YOU TALK ABOUT ARE
THERE AND HOW TO SO JUST MAKING
A POLICY AVAILABLE BUT MAKE IT
ACCESSIBLE IS A MORE COMPLICATED
ISSUE THAN WE REALIZE.
THIS IS AMAZING.
I DON'T SEE OTHER QUESTIONS.
WE'RE ON TIME.
YOU FOLKS ARE INCREDIBLE.
WE'RE HALFWAY THROUGH THE
SESSION AND HAVE A FIVE-MINUTE
BREAK
>> WE'LL RESUME NOW.
>> I APPRECIATE ALL THE EARLIER
PRESENTATIONS.
THEY WERE OUTSTANDING.
I WANT TO STEP BACK AND TAKE THE
BROADEST POSSIBLE PERSPECTIVE.
THERE'S A BROAD RANGE OF CHANGES
GOING ON NOT JUST CLIMATE CHANGE
BUT OTHER CHANGES THAT WILL
AFFECT THE DISCUSSIONS TODAY AND
IN THE WORKING GROUPS.
THERE'S A FRAMING CALL PLANETARY
BOUNDARIES LOOKING AT CHANGES
AROUND THE WORLD AS A RESULT OF
HUMAN ACTIVITIES.
YOU CAN SEE NOTICE RED ZONE AND
PHOSPHORUS FROM AGRICULTURE AND
GENETIC DIVERSITY AND THEY'LL
ALL AFFECT THE QUALITY AND QUAN
QUANTITY OF FOOD IN THE FUTURE.
THIS SHOWS CHANGES IN GLOBAL
TEMPERATURE CHANGE FROM 1850 TO
2020.
CLEAR PATTERN.
WE HAVE CHANGE THE CLIMATE.
IT'S UNEQUIVOCAL AND THE CHANGES
WILL IN SOME WAYS ACCELERATE IN
THE COMING DECADES.
THE REASON I'M TALKING ABOUT
THIS IS THERE ARE MULTIPLE
ELEMENTS OF THE FOOD SYSTEM THAT
ARE CLIMATE SENSITIVE.
THIS IS NOT A COMPLETE LIST BUT
IT GIVES YOU A SENSE OF THE WIDE
RANGE OF ISSUES THAT ARE OF
CONCERN IN TERMS OF FOOD
INSECURITY AND MEASURES THAT
NEED TO BE TAKEN TO MAKE SURE WE
HAVE ADEQUATE YIELD, ACCESS AND
BE ABLE TO TRANSPORT OUR FOOD TO
THE END USE.
WHEN WE LOOK WORLD WIDE 65% OF
THE CALORIES IN THE WORLD COME
FROM WHEAT AND RICE.
THIS SHOWS INTEMPERATE AND
TROPICAL AREAS AND THE RED AND
BLUE HAVE TO DO WITH DIFFERENT
ASSUMPTIONS OF ADAPTATION OF OUR
AGRICULTURAL SYSTEMS AND IN THE
U.S. WE'LL MOSTLY BE FINE BUT
THE SMALL INCREASE OR DECREASE
IN WHEAT YIELDS BUT MOSTLY WE'LL
BE FINE.
WE MAY HAVE TO MOVE TO NEW
LOCATIONS BUT WE'LL HAVE THE
WEATHER PATTERNS THAT WILL BE
SUPPORTIVE FOR ADEQUATE WHEAT
YIELDS.
THE TROPICS ARE A COMPLETELY
DIFFERENT STORY.
ANY INCREASE IN LOCAL MAIN
TEMPERATURE TRULT -- RESULTS IN
LOWER CROP YIELD.
THE TWO FIGURES SHOW ON THE LEFT
A RANGE OF CLIMATE MODELS MAKING
DIFFERENT KINDS OF ASSUMPTIONS
AND SEE A DECLINE IN CROP YIELDS
AND ON THE RIGHT SHOWING THIS
TRANSLATES DIRECTLY TO STUNTING.
THE PROJECTIONS FOR STUNTING IN
2030 AND 2050 IRREGARDLESS OF
ASSUMPTIONS ABOUT DEVELOPMENT,
WHAT CAN HAPPEN AS WE DEVELOP
FURTHER, HOPEFULLY ALONG A
SUSTAINABLE DEVELOPMENT PATHWAY
WE'LL SEE AN INCREASE IN
STUNTING IN CHILDREN UNDER THE
AGE OF 5.
THERE'S ONE GLOBAL ASSESSMENT
THAT ESTIMATED MORTALITY DUE TO
CLIMATE CHANGE IN ABOUT 2030
WHICH IS VERY CLOSE NOW.
YOU CAN SEE THE RISKS VARY QUITE
A BIT WITH THE BIGGEST RISK FROM
UNDER NUTRITION.
THE EVIDENCE SINCE THEN HAS BEEN
GROWING THE RISK FOR UNDER
NUTRITION ARE VERY HIGH.
THIS IS FROM THE
INTERGOVERNMENTAL PANEL ON
CLIMATE CHANGE.
I'M NOT SURE WHY IT'S NOT
SHOWING AND HOPEFULLY YOU CAN
SEE NORTH AMERICA.
I HAD IT OUTLINED EARLIER BUT IT
DIDN'T WORK.
YOU CAN SEE FOOD SCARCITY
INCREASING IN SOME PLACES AN
SIMILAR WITH AGRICULTURE AND
CROP PRODUCTION AND THERE'S
LIVESTOCK AND INCREASES AND
DECREASES IN AQUA CULTURE AND
THEY HAVE IMPACTS ON HUMAN
HEALTH AND WELL BEING.
HERE'S CONCLUSIONS FROM THE
REPORT ON FOOD SECURITY.
FIRST IS PRESSURE ON FOOD
PRODUCTION AND ACCESS.
SECOND IS ABOUT THE INCREASES
AND FREQUENCY INTENSITY AND
SEVERITY OF CLIMATE CHANGE AND
INCREASING EVIDENCE CLIMATE IS
WEAKENING SOIL HEALTH AND
SERVICES AND INCREASING PRESSURE
IN DISEASES AND UNDERLYING FOOD
PRODUCTIVITY.
THERE'S LOTS OF RISK TO HEALTH
AND ALSO TO FOOD PRODUCTION AND
RELATED TO EXTREME EVENTS BUT
ALSO INCREASING PRESSURE FROM
HEAT INDUCED PRODUCTIVITY
LOSSES.
THERE'S HEALTH RISKS AND
SYSTEMS-BASED APPROACHES ARE
CRITICAL.
THIS IS TO SYNTHESIZE THE RISK
FROM A VARIETY OF SYSTEMS.
WHEN YOU LOOK AT THE FIGURE, THE
ZERO LINE IS PRE-INDUSTRIAL.
THE REPORT WAS PUBLISHED THROW
YEARS AGO AND THE TEMPERATURE
HAD INCREASED ABOUT ONE DEGREE
AND WE'RE 1.1 DEGREE
PRE-INDUSTRIAL.
THE COLORS IN THE FIGURE WHEN IN
WHITE SHOWS NO CHANGE IN DRY
LAND WATER SCARCITY.
WHEN IT TURNS TO YELLOW IT MEANS
THERE'S BEEN A CHANGE AND THE
CHANGE IS AT LEAST PARTIALLY
ATTRIBUTABLE TO CLIMATE CHANGE.
RED MEANS THE RISK IS HIGH AND
PURPLE IS VERY HIGH WITH THE
POSSIBILITY OF IRREVERSABILITY
WE CALL THEM THE FLYING M INING EMBERS
AND WHERE WILL WE SEE THE
PRESSURE POINTS SHIFT AS
TEMPERATURES CONTINUE TO RISE.
AND FOOD PRODUCTION WILL BE
AFFECTED SEVERELY WITH
ADDITIONAL COMPLOIMENT CHANGE.
THERE'S -- CLIMB CHANGE.
ON THE LEFT YOU SEE ELEMENTS
INCLUDED IN MANY MODELS AND ON
THE RIGHT SOME OF THE MANY
ELEMENTS NOT INCLUDED.
WHICH GIVES AN OVERALL SENSE
THAT PROBABLY THE PROJEBBPROJECTIONS
AND OPTIMISTIC AND THE RISK IS
HIGHER WITH LESS WARMING THAN
WHAT WE'RE PROJECTING RIGHT NOW.
ONE OF THE EXAMPLES IS EXTREME
WEATHER AND CLIMATE EVENTS.
THE MAP ON THE LEFT SHOWS THE
NUMBER OF YEARS WITH FREQUENT
HOD HOT DAYS AND ON THE RIGHT AN
EXAMPLE OF THE REDUCTION IN
HARVEST DURING THE 2003 EUROPEAN
HEATWAVE THAT KILLED ABOUT
70,000 PEOPLE.
THE OTHER ASPECT IS IT'S NOT
JUST EXTREME EVENTS AND
PRECIPITATION BUT ALSO CARBON
DIOXIDE ITSELF.
ALL PLANT HAVE MECHANISMS TO
TAKE CARBON DIOXIDE IN FROM THE
ATMOSPHERE AND BREAK IT A PART.
85% OF OUR PLANT USE ONE
PARTICULAR PATHWAY, BIO
CHEMISTRY OF IT MEANS IT'S
CALLED A C3 PATHWAY.
THIS INCLUDES WHEAT, RICE,
BARLY, POTATO, SPINACH, TREES
AND GRASSES.
WHAT HAPPENS IS THE PLANT HAS
MORE CARBON.
YOU MAY HAVE READ IN THE
RIGHT-WING MEDIA, CO2 IS PLANT
FOOD AND TRUE AND C3 PLANT ARE
SOMEWHAT DEFICIENT IN CARBON SO
WHEN THEY HAVE MORE CARBON THEY
DO GROW MORE.
THERE'S TWO CONSEQUENCES.
ONE, PLANT HAVE A LOT MORE
CARBOHYDRATES IN THEM.
THE OTHER IS BECAUSE YOU'RE
CHANGING THE BALANCE OF CARBON
AND NITROGEN THERE'S A 10%
REDUCTION IN PROTEIN AND 30%
REDUCTION IN B VITAMINS BECAUSE
THEY'RE ALSO NITROGEN-BASED
COMPOUNDS AND BECAUSE WHEN C3
PLANT HAVE MORE CARBON, THEY'RE
MORE WATER EFFICIENT SO THEY
DRAW LESS MICRONUTRIENTS FROM
THE SOIL AND OVERALL FROM THE
EXPERIMENTS DONE, MICRONUTRIENTS
DECLINE ABOUT 5%.
THIS INCLUDES IRON AND ZINC.
THERE'S ABOUT 1.5 BILLION WOMEN
AND GIRLS AROUND THE WORLD WITH
IRON DEFICIENCY ANEMIA AND WHAT
COULD BE THE CONSEQUENCES OF THE
CHANGES TO THE NUTRITIONAL
CAUGHT OF OUR CROPS WITH HIGHER
CO2 ARE IN THE HUNDREDS OF
MILLIONS OF PEOPLE.
IT'S NOT JUST THAT CHANGE.
WE HEARD ABOUT FOOD AS MEDICINE.
WE HEARD ABOUT THE CHANGE IN THE
CARBON NITROGEN RATIO.
THERE'S CHANGES SUCH AS WHEN YOU
HAVE HIGHER SOIL TEMPERATURE YOU
HAVE HIGHER ARSENIC IN RICE AND
OTHER COMPOUNDS IN PLANT AND
DON'T FORGET IT'S NOT JUST
HUMANS THAT EAT PLANT BUT
LIVESTOCK AND THERE'S GROWING
EVIDENCE HERE IN THE U.S. WITH
HIGHER CO2 CONCENTRATIONS,
GRASS-FED CATTLE ARE BECOMING
INCREASINGLY PROTEIN STRESSED
LIKELY BECAUSE OF THE CHANGES IN
THE GRASS.
SO WHEN WE THINK OF CLIMATE
CHANGE I HOPE EVERYBODY THINKS
ABOUT CHILDREN.
85% OF THE CLIMATE CHANGE RISK
ARE IN CHILDREN AND I HOPE YOU
THINK OF KIDS.
THANK YOU.
>> THANK YOU, THAT WAS AMAZING
AND ALSO FRIGHTENING TO THINK
ABOUT.
HOW DO WE MEASURE THIS?
ARE THERE ASPECTS ONE CAN
MEASURE BEYOND THE HEAT
TEMPERATURE WHICH IS AMAZING HOW
MUCH THAT'S CHANGED?
AS WE THINK ABOUT WHAT TO DO
ABOUT IT AND HOW DO WE CONTINUE
TO MONITOR WHAT'S HAPPENING?
>> EXCELLENT QUESTION.
ON THE AGRICULTURE SIDE THEY
THERE'S A CONSORTIUM THE IT
AGRICULTURAL MODELLING
INTERCOMPARISON PROGRAMS WITH
ABOUT 1,000 PARTNERS AROUND THE
WORLD AND TRYING TO UNDERSTAND
HOW CURRENT CHANGES IN
TEMPERATURE AND EXTREME EVENTS
IS AFFECTING CROP YIELDS.
THERE'S FROM MY PERSPECTIVE A
VALLEY OF DEATH BECAUSE WE DON'T
THEN HAVE THE MEASUREMENTS OF
WHAT THAT MEANS FOR PEOPLE.
WE ALSO DON'T HAVE GOOD
MEASUREMENTS OF THE QUALITY OF
THE CROPS.
WE KNOW HOW MUCH IS BEING
PRODUCED.
WE HEARD A BIT ABOUT THE
ECONOMICS AND INCENTIVES WITHIN
THE U.S. FOR HOW MUCH YOU
PRODUCE, NOT THE QUALITY OF WHAT
YOU PRODUCE.
AND WE HAVE VERY FEW
MEASUREMENTS OF THE QUALITY AND
EVEN IN THE U.S. WE HAVE
OCCASIONAL NUTRITIONAL SURVEYS
BUT WE'RE NOT TRACKING THIS WELL
AT ALL.
WHERE YOU OF WE KNOW THERE'S
CONSEQUENCES FOR OUR FOOD AND
VERY LITTLE IS BEING MEASURED IN
THE SPACE.
>> CHRIS, ARE YOU AWARE OF
EFFORTS.
WE HAVE A SYSTEM IN THE UNITED
STATES AND IN MANY PLACES AROUND
THE WORLD WHERE WE MEASURE
DIETARY EXPOSURE AND WE USE
EXISTING DATABASES FOR NUTRIENT
COMPOSITION OF FOODS.
THERE'S BEEN SOME EFFORTS TO
LOOK AT CHANGES IN THE FOOD
SYSTEM AS WE LOOK TO THE
DATABASE BUT AT THIS POINT I
DON'T THINK USDA IS DOING THIS.
I THINK THERE'S BEEN SOME
EFFORTS THAT FOA LOOKED AT THIS.
ARE YOU AWARE OF EFFORTS TO LOOK
AT THE CHANGE IN THE FOOD
COMPOSITION TABLES FOR THE
CLIMATE?
>> NO, THAT NEEDS TO BE DONE.
PEOPLE ASK AND ASK HOW MUCH RICE
DO YOU DO EVERY DAY AND WE DON'T
KNOW HOW REFLECTIVE THE LOOK-UP
TABLES ARE FOR WHAT PEOPLE ARE
CONSUMING TODAY BASED ON
PARTICULARLY THE CO2 RESPONSE.
AND THESE ARE FIELD EXPERIMENTS
WITH HIGHER CONCENTRATIONS OF
CO2 AT THE MOMENT IT LOOKS LIKE
THE RELATIONSHIP IS LINEAR
BETWEEN CO2 AND MICRONUTRIENT
PROTEIN AND VITAMIN CONTENT
WHICH SUGGESTS OUR FOOD SUPPLY'S
ALREADY BEEN AFFECTED.
WHAT OUR GRANDPARENTS ATE
PROBABLY HAD HIGHER NUTRITION
THAN WHAT WE'RE EATING TODAY BUT
WE DON'T KNOW AND NOBODY'S
STEPPING FORWARD YET TO DO THOSE
KINDS OF ANALYSES.
>> THERE'S VECTOR BORN DISEASES
AND INFLAMMATORY CONDITIONS.
YOU MIGHT BE AWARE OF THIS IS
THERE DEVELOPMENT PERSPECTIVE ON
CHILDREN AND WE NEED TO LOCK AT
THE VARIOUS AREAS OF FUNCTION.
AND NEURAL DEVELOPMENT AND THE
STRESS ASSOCIATED WITH CLIMATE
AND THE IMPACT ON NEURAL
DEVELOPMENT IN CHILDREN IS
ANOTHER THING WE MAY NIGEED TO
THINK ABOUT MEASURING.
>> I AGREE THIS IS AN AREA WHERE
WE CAN ALL OUT WHAT SHOULD BE
MEASURED AND WHAT'S AVAILABLE SO
WE'RE MORE OF AWARE OF THE
POTENTIAL CONSEQUENCES.
>> I'LL START WITH A DISCLAIMER,
DAN, THIS IS ABSOLUTELY NOT YOUR
FAULT.
THERE'S ALMOST NO FUNDING FOR
RESEARCH.
EVERYBODY COMPLAINS THERE'S NOT
ENOUGH RESEARCH FUNDING IN
CLIMATE HEALTH.
THE NIH BUDGET ON CLIMATE CHANGE
AND HEALTH HAS BEEN RUNNING AT
0.02 TO 0.04 OF THE BUDGET.
>> I FEEL YOU.
PRESIDENT BIDEN PUT SOME IN THE
BUDGET BUT IT'S STILL 0.2%.
>> IT'S LARGELY ON FOOD NOT
NUTRITIONAL HEALTH.
>> MY UNDERSTANDING IS THE $110
MILLION.
WE ARE REALLY CONCERNED ABOUT
THIS THOSE WHO WORK IN CLIMATE
CHANGE AND HEALTH AND, MAN, WE
JUST NEED WAYS TO START
ANSWERING THESE QUESTIONS.
>> THESE ARE HUGE ISSUES.
THANK YOU FOR AN ENLIGHTENING
DISCUSSION.
NEXT WE HAVE THE DIRECTOR OF THE
NUTRITION POLICY INSTITUTE AND
COOPERATIVE EXTENSION NUTRITION
SPECIALIST AT UNIVERSITY OF
CALIFORNIA IN THE AGRICULTURE
AND NATURAL RESOURCES.
THANK YOU.
>> THERE'S ENVIRONMENTAL FACTORS
IN RELATIONSHIP TO CHILD
NUTRITION AND HEALTH.
YOU CAN SEE ON THE NEXT SLIDE AN
ENORMOUS CHALLENGE IS THERE'S
MANY FACTORS WHICH RELATE TO
WHERE SEARCH PLAY AND LEARN AND
THESE RANGE AS YOU KNOW FROM THE
BIG KEY POLICIES AND THE FEDERAL
ASSISTANCE PROGRAM TO FACTORS AT
MORE LOCAL, STATE OR COMMUNITY
LEVELS FOR SCHOOLS AND CHILDCARE
SETTINGS TO INDIVIDUAL
ORGANIZATIONS SUCH AS FOOD BANKS
AND PANTRIES AND AS OUR SYSTEM
SCIENCE FOLKS TALKED ABOUT,
THERE'S INTERACTIONS ACROSS ALL
THESE LEVELS AND BETWEEN THE
INDIVIDUAL PROGRAMS AND
ENVIRONMENTAL FACTORS WITHIN
LEVELS AND THE FACT THERE'S SO
MANY FACTORS BEGS THE QUESTION,
HOW CAN WE MEASURE QUANTIFY,
COMPARE AND RANK ALL THE
DIFFERENT ENVIRONMENTAL
EXPOSURES?
AND I WILL ARGUE THAT THERE'S
MUCH WORK REMAINS TO BE DONE BUT
I WANT TO SHARE A FEW EFFORTS
THAT HAVE TRIED TO ADDRESS THIS
CHALLENGE.
THE NEXT SLIDE SHOWS WHAT I'LL
HIGHLIGHT SOME EVOLVING
APPROACHES THAT HAVE BEEN USED
TO MEASURE EXTERNAL
ENVIRONMENTAL FACTORS IN
RELATION TO NUTRITION AND HEALTH
AMONG SCHOOL-AGED CHILDREN.
THE DIFFERENT STUDIES FOLLOW AND
BUILD ON EACH OTHER FIRST IS THE
KAISER PERMANENTE PROGRAM WITH
SIX STATES WITH AN IDEA OF
TRACKITRACK
ING WHAT WAS GOING ON AND
SPEAKING TO DAN'S COMMENTS ABOUT
EXISTING PROGRAMS, POLICIES AND
ENVIRONMENTAL FACTORS.
THE NATIONAL COMMUNITY STUDIO
INVOLVED RETROSPECTIVE DATA
SELECTION AND 130 DIVERSE
COMMUNITIES IN THE
U.S. INCLUDING ONE LIKE SHAPE UP
SOMERVILLE AND OTHERS TO
UNDERSTAND WHAT THEY WERE DOING
ON THE GROUND AND RELATE THAT TO
CHILD HEALTH AND FINALLY THE
CALIFORNIA HEALTHY KIDS STUDIES.
THEY GATHERED INFORMATION ON
ENVIRONMENTAL CHANGES AS THEY
WERE OCCURRING USING INTERVIEWS
AND SURVEYS OF STAKEHOLDERS AND
PARTNERS THEY WERE INTERVIEWED
AND LOOKED AT BMI MEASUREMENTS
AND BODY MASS INDEX.
THEY CREATED A POPULATION DOSE.
FOR EACH POLICY OR ENVIRONMENTAL
FACTORS DOCUMENTED AND COMPUTED
AS A PRODUCT OF REACH TIMES
STRENGTH AND IT'S THE PERCENT OF
CHILDREN TOUCHED BY A PARTICULAR
ENVIRONMENTAL FACTOR AND THE
STRENGTH IS AN ESTIMATE OF THE
EFFECT SIZE ON EACH REACH.
AND THE WAY THEY DID THAT IN
THIS PARTICULAR STUDY WAS BASED
ON STUDIES THAT EVALUATED
SIMILAR ENVIRONMENTAL CHANGES
USUALLY THEY IMPUTED AN EFFECT
SIZE.
THIS IS A WAY TO COMBINE AND
COMPARE ENVIRONMENTAL STRATEGIES
THAT EXIST CROSS SETTINGS USING
A COMMON YARD STICK.
LET ME PUT THIS INTO CONTEXT BY
GIVING YOU AN EXAMPLE.
THE NEXT STEP IS TO LOOK AT
STRATEGY TARGET THE SAME
OUTCOME.
THE EXAMPLE I PICKED SHOWS
MULTIPLE STRATEGIES FOR
CERTAINLY VEGETABLE INTAKE ALONG
WITH EACH STRATEGY AND SPECIFIC
DOSE SCORE IN THEIR REACH AND
STRENGTH AND DOSE.
AND THE TOTAL POPULATION DOSE IS
THE SUM OF THE INDIVIDUAL DOSES
ADDED TOGETHER.
RESEARCHERS FOUND IT WORKED
PRETTY WELL AND IMPROVED CHILD
NUTRITION OUTCOMES IN MANY
SPACES BUT NOT SO WELL IN
OTHERS.
FOR EXAMPLE IT WORKS PRETTY WELL
IN FOOD AND VEGETABLE INTAKE BUT
NOT SUGARY BEVERAGES.
WHY IS THAT?
IN THE HEALTHY COMMUNITY STUDY
INCLUDING SHAPE UP SOMERVILLE
AND RANDOMLY SELECTED ONES, DATA
ON POLICY AND ENVIRONMENT WAS
COLLECTED RETROSPECTIVELY AND
STRUCTURED INTERVIEWS AND
SURVEYS, WE ALSO DID
OBSERVATIONS.
AND LOOKING AT HOW MUCH TIME
THEY ATE AND WHAT WAS THEIR
ACCESS TO FOODS AND POLICY
DOCUMENTS WERE WE VIEWED.
IN THIS LARGE STUDY THERE WERE
SOME COST PROHIBITIVE TO LOOK AT
THE POLICIES AND STRATEGIES
DOCUMENTED.
INSTEAD EACH WAS CODE ON
ATTRIBUTE
ATTRIBUTES FOR THE SCORE.
THEY LOCKED AT HOW MANY CHILDREN
WERE TOUCHED AND THE DURATION
HOW LONG OR HOW OFTEN AND WHAT
BEHAVIORAL STRATEGY WAS USED WAS
THERE INFORMATION AND SCORES
WERE 0 TO 1 AND ACROSS THE 10
YEARS FOR THE COMMUNITY.
AND LOOKING AT FOR THE
COMMUNITIES AND FOR THE STUDY
PERIOD THIS SHOWS THE MEAN
INTENSITY SCORE AND THE LAST
YEAR AND THE SCORE START OUT
RELATIVELY LOW AT ABOUT 12
INCREASING TO ABOUT 35 IN THE
FINAL YEAR LUOOKING AT THE
ENVIRONMENTAL FACTORS AND THE
PATTERNS CHANGED QUITE AENT.
SOME INCREASES AND THAT WAS
QUITE A RISE FROM MAX OF 80 IN
THE HIGHEST COMMUNITIES AT THE
TOP TO ABOUT 10 IN THE
COMMUNITIES AT THE LOW END.
THE NEXT SHOWS THE RELATIONSHIP
BETWEEN THE INTENSITY SCORES AND
ONE OUTCOME WE MEASURED BODY
MASS INDEX AND IT REPRESENTS THE
COMMUNITY'S BMI FROM THE LOWEST
TO THE HIGHEST INTENSITY SCORE
VALUE AFTER ADJUSTING FOR THE
SOCIO DEMOGRAPHIC
CHARACTERISTICS.
WE FOUND COMMUNITY EFFORT WAS
ASSOCIATED WITH A DECREASE IN
BMI FOR CHILDREN SCHOOL AGED AND
INTERPRETATION OF THE BLACK LINE
GOING DOWN THE MIDDLE IS A
COMMUNITY WHERE TO CHANGE FROM
HAVING THEIR LOWEST INTENSITY
SCORE TO THE HIGHEST INTENSITY
SCORE WE WOULD PREDICT THE CHILD
BMI WOULD DECREASE YOU CAN SEE
ALL BE IT, AN INCREASE IN
INTENSITY WAS ASSOCIATED WITH AN
DECREASE IN BMI.
WE FOUND A TEMPORAL RELATIONSHIP
AND IT WON'T SURPRISE YOU BUT
THE BMI CHANGE WAS CONSIDERED
OVER THE TWO YEARS PRIOR TO THE
BMI MEASURE AND THOSE SCORES
THAT WERE OVER A TWO-YEAR
DURATION AND TAKE TIME TO
OBSERVE AN IMPACT.
AND THIS IS WITH RESPECT TO
CHANGES IN THE CHILD'S
ENVIRONMENT.
THE NEXT SLIDE SHOWS THE TRENDS
WERE NOT THE SAME FOR ALL
POPULATIONS OF CHILDREN.
WE TALKED ABOUT CONTEXT AND
EQUITY.
WHAT WE OBSERVED WAS THAT
OVERALL THERE WAS A SIGNIFICANT
RELATIONSHIP BETWEEN WHAT
COMMUNITIES DID AND IMPACT ON
BMI AND HIGHER INTENSITY SCORES
WERE SIGNIFICANTLY RELATED FOR
NON-HISPANIC WHITE CHILDREN.
THAT BAR IN THE DARK BLUE WERE
NOT SIGNIFICANT THOUGH THEY WENT
IN THE SAME DIRECTION FOR BLACK
CHILDREN THE RED LINE FOR
HISPANIC CHILDREN AND THE GREEN
LINE AND GREATER CHANGES WITH
PARENTS WITH HIGHER EDUCATION
THAN WITH LOWER EDUCATION AGAIN
SUGGESTING THE SAME POLICIES AND
ENVIRONMENTS IN THE WAY WE
MEASURED THEM STILL END UP
HAVING THE SAME RESULT ARE FOR
THE CHILDREN.
-- RESULTS FOR THE CHILDREN.
THERE'S EDUCATION WITH POLICY OR
OTHER SUPPORT ARE LIKELY TO
ACHIEVE BEHAVIOR CHANGE AND
THERE'S SOME LESSONS SHARED WITH
US IN SHAPE UM SOMERVILLE AND
THERE WAS A TARGET BEHAVIOR THAT
IS THE WHAT AND THAT IS BASED ON
THE ASSUMPTION THAT BEHAVIORS IS
BETTER THAN RECOGNIZE DIETS ARE
MADE UP OF MANY FACTORS NOT
IMPACTING ONE WILL SOLVE ALL OF
OUR PROBLEMS.
WE FOUND THAT A HIGHER DOSE OR
INTENSITY WAS ASSOCIATED WITH
INCREASED CONSUMPTION OF LOWER
FAT OVER WHOLE MILK AND THERE
WERE LOWER INTAKE OF UNHEALTHY
ITEMS LIKE SUGARS AND SUGARY
DRINKS.
WE OBSERVED HIGHER INTAKE OF
HEALTHIER ITEMS LIKE FOODS AND
VEGETABLES AND WE HAVE UP TO 10
YEARS OF DATA AS THE OPTIMAL
PERIOD FOR DIETARY CHANGE.
WE FOUND ABOUT FOUR YEARS WAS
NECESSARY FOR BMI CHANGES AND WE
FOUND FOR DIETARY IMPACTS WAS
ABOUT SIX YEAR AND THE MAPS
CHRISTINA SHARED WITH US IN THE
CALIFORNIA HEALTHY KIDS STUDY WE
LET THE DATA DO THE TALKING
RATHER THAN DEFINE ENVIRONMENTAL
FACTORS.
WE APPLIED NOVEL METHODS
COMBINING REDIMENSION --
DIMENSION AND WITH THE HEALTHY
COMMUNITY TEAM AND WE RECENTLY
OBTAINED NIH FUNDING TO LOOK AT
THE DATA ADAPTIVE APPROACHES AND
USE GRADIENT BOOSTING MACHINES
AND WHILE I DON'T HAVE FINDINGS
YET WE'RE HOPEFUL WE'LL HAVE A
LOT OF LEARNING TO SHARE ABOUT
THE DATA AND SCIENCE APPROACHES.
THE LESSONS LEARNED ARE THE DOSE
CONCEPT AND ASSESSMENT IS USEFUL
FOR CAPTURING POLICY AND
ENVIRONMENTAL EXPOSURES.
WE CAN DO THESE THINGS
RETROSPECTIVELY BUT PEOPLE'S
MEMORY ARE -- MEMORIES FADE AND
IT'S HARD TO FIND IN THOSE
ENVIRONMENTS WE KNOW ARE THE
WINDOW OF INFLUENCE.
CLUSTERING THE DOSE AND ING ON
EXPOSED CHILDREN MAY HELP
MEASURE IMPACTS.
LONGER ASSESSMENTS ARE BETTER
THAN SHORTER.
AND WE CAN'T JUST MEASURE WHAT'S
GOING ON HERE AND WE ARE GOING
TO TRY TO UNDERSTAND WHY THHEALTHY
VARIATION WE SAW THE DIFFERENCES
AND THOSE FACTORS CAN STILL BE
EXPLORED AND FINALLY WE'RE
HOPING SYSTEM SCIENCE APPROACHES
WILL HELP US NOT RELY SO MUCH ON
SCORING AND SOME OF THE
ASSUMPTIO
ASSUMPTIONS.
I WANT TO SHOW AND ACKNOWLEDGING
THE MANY WONDERFUL COLLEAGUES
INVOLVED IN THIS WORK AND ADDED
REFERENCES TO ALL MY SLIDES BUT
THEY'RE ALL THERE IN CASE YOU
HAVE MORE QUESTIONS AND DIG
DEEPER INTO THAT INFORMATION.
AND WITH THAT I'LL TURN IT BACK
OVER TO MAUREEN.
THANKS, MAUREEN.
>> THANK YOU, THAT WAS AMAZING.
IT'S INNOVATIVE AND PROMISING TO
LOOK AT THE WAY THAT YOU HAVE
BEEN ABLE TO LOCK AT
RETROSPECTIVE AND THEN
PROSPECTIVE EVALUATIONS OF THE
IMPACT OF THESE ENVIRONMENTAL
POLICIES.
INSPIRING TALK.
QUITE INNOVATIVE.
NEXT WE HAVE AN INTERESTING CASE
STUDY DONE BY AMY CAROL SCOTT AT
DREXEL UNIVERSITY IN
PHILADELPHIA AND SHE'S GOING TO
BE TALKING ABOUT THE WEST
PHILADELPHIA PROMISE
NEIGHBORHOOD MODEL.
>> I'LL ATTEMPT TO APPLY THE
APPROACH AND DIG DEEPLY IN THE
COMMUNITY CONTEXT AND MULTIPLE
LEVELS THROUGHOUT THE CITY OF
PHILADELPHIA.
THIS SAY -- IS A FEDERALLY
CENTERED INITIATIVE AND TO
REFLECT ON THE CHALLENGES AND
OPPORTUNITIES THAT OCCUR WHEN
ATTEMPTING TO EVALUATE THESE
KINDS OF FEDERALLY FUNDED
INITIATIVES NOT SPECIFICALLY SET
UP TO ACHIEVE OR MEASURE SYSTEMS
CHANGE.
IT'S FUNDED BY THE
U.S. DEPARTMENT OF EDUCATION LED
BY DREXEL UNIVERSITY AND
KNITTING TOGETHER SYSTEMS OF
SUPPORT IN WEST PHILLY USING A
CRADLE TO CAREER OPPORTUNITY
MODEL.
WE RECEIVE ABOUT $6 MILLION A
YEAR AND EVERY YEAR THE FUNDS
HAVE TO BE APPROVED BY CONGRESS.
WE'RE CURRENTLY IN A 18-MONTH
NO-COST EXTENSION DUE TO COVID
FOCUSSED ON ANALYSIS AND
DISSEMINATION.
I HAVE NO RESULTS TO SHARE TODAY
BUT INSTEAD WAS ASKED TO SHARE
OUR EVALUATION DESIGN AND
CHALLENGES AND OPPORTUNITIES.
THE STAFF AT PROMISE
NEIGHBORHOOD AND DREXEL DON'T
RUN PROGRAMMING.
WE RUN WITH EXPERTS IN THE FIELD
AND COMMUNITY AT SCHOOLS TO FUND
AND SUPPORT THEIR WORK AND LOOK
AT THE WHOLE CHILD APPROACH TO
IDENTIFY THE PROGRAMS WE SUPPORT
FOCUSSING NOT ON BUILDING STAND
ALONE PROGRAMS BUT SYSTEMS TO
LINK IN LEVERAGE TO EACH OTHER
MORE EFFECTIVELY.
WHAT IS A PLACE-BASED INITIATIVE
IT'S MULTI-SECTORIAL, EDUCATION
HELP, HOUSING, ECONOMICS, IT'S
MULTI-LEVEL AT THE COMMUNITY
NEIGHBORHOOD, SCHOOL, MUNICIPAL
GOVERNMENT LEVEL.
WHAT YOU SEE ON THE LEFT HERE IS
THE AREA WE FOCUS ON WEST PHILLY
NEIGHBORHOOD.
IT'S PREDOMINANTLY AFRICAN
AMERICAN AND HALF THE FOLKS LIVE
UNDER THE FEDERAL POVERTY LEVEL
AND AN AREA WITH TREMENDOUS
ASSETS OR PROMISE INCLUDING A
FABRIC OF CIVIC AND
COMMUNITY-BASED ORGANIZATIONS WE
WORK CLOSELY WITH IN PROMISE
NEIGHBORHOOD.
IT'S SURROUNDED BY MANY MEDS,
PENN HOSPITAL AND IT'S AN
OVERSTUDIED COMMUNITY THAT NOT
ONLY MISTRUSTS THE INSTITUTIONS
BUT SEES THEM AS DRIVERS OF
GENTRIFICATION AND DISPLACEMENT,
RIGHTFULLY SO.
THIS IS A HUD NEIGHBORHOOD AND
ANOTHER OBAMA INITIATIVE.
THERE'S GRANT GOALS WE DISTILLED
INTO THESE FIVE ALL INTERRELATED
AND THE NUTRITION AND FOOD
ACCESS PROGRAMS FALL WITHIN THIS
ONE.
CHILDREN AND FAMILIES THRIVE IN
HEALTHY, SAFE AND STABLE
COMMUNITIES.
IT'S BASED ON THE ZONE MODEL AND
HAS COALITION AND COLLABORATION
APPROACH AND THERE'S A BACKBONE
ORGANIZATION AND COMMON AGENDA
FOR CHANGE AND SHARED
MEASUREMENT AND MUTUALLY
REINFORCING ACTIVITIES AND OPEN
AND CONTINUOUS COMMUNICATIONS.
THIS IS AN A MIX OF PHILADELPHIA
ORGANIZATIONS AND HEALTH CARE
DELIVERY ORGANIZATIONS AND WEST
PHILLY COMMUNITY ORGANIZATION
AND CIVIC ORGANIZATIONS AND
PARENT ORGANIZATIONS.
WE CAN SEE THAT WE'RE REQUIRED
TO COLLECT AND SHOW
POPULATION-LEVEL CHANGE ON 15
REQUIRED ARE INDICATORS AND WE
MAP THEM ON THE SOCIAL
DETERMINATES OF HEALTH AND
THEY'RE HOUSED AT OUR SCHOOL OF
PUBLIC HEALTH AND TO PROVIDE A
FRAMEWORK HOW TO ANALYZE AND
RECORD THE DATA AND EVERYTHING
IS IN PARTNERSHIPS WITH THESE
COMMUNITIES.
AND I'LL TRY TO DO THIS QUICKLY
AND HIT THE HIGHLIGHTS.
FIRST IS OUR PRIMARY DATA
COLLECTION AT SCHOOL AND
NEIGHBORHOOD LEVELS AND THESE
ARE TO COLLECT REQUIRED GIFTS AS
WELL AS CO-CREATED MEASURES WITH
OUR PARTNERS.
THE SECOND IS A LONGITUDINAL
DATA SYSTEM THAT'S CHILD
CENTERED AND THE STRATEGY
REQUIRED BY THE DEPARTMENT OF ED
TO EVALUATE THE SUCCESS OF THE
MULTIPLE SYSTEMS OF SUPPORT.
THE THIRD SAY TRACKING SYSTEM WE
ADDED TO ENSURE WE'RE ALSO
TRACKING PROGRESS AND OUTCOMES
OF INDIVIDUAL PROGRAMS AND A
SYSTEMS LEVEL INTERVENTION.
FOUR, IS ANOTHER EVALUATION
STRATEGY WE ADDED TO CAPTURE
CONNECTS BETWEEN EXISTING
PROGRAMS AND SYSTEMS THAT SERVE
CHILDREN AND FAMILIES IN WEST
PHILADELPHIA AND FIVE, WE BUILD
A COMMUNITY-BASED PARTICIPATORY
MODEL TO ALL ASPECTS OF OUR WORK
TO BUILD TRUST AND AUTHENTIC
ENGAGE MANY AND DEMOCRATIZE
ACCESS INTO OUR DATA
INFRASTRUCTURE.
AND WE HAVE OUR ANNUAL SCHOOL
CLIMATE SURVEY TO WHICH WE ADDED
MEASURES STARTING IN 2017
INCLUDING OUR FRUIT AND
VEGETABLE CONSUMPTION MEASURES
AND PROVIDE SUPPORT FOR
OUTREACH, RECRUITMENT AND
ADMINISTRATION OF THE SURVEYS
WITH PARENTS AT OUR SEVEN
SCHOOLS WE SUPPORT GIVE LOW
RESPONSE RATE AMONG PARENT
SURVEYS WHICH I'VE SEEN IN YOUR
SCHOOL DISTRICTS AS WELL.
OUR NEIGHBORHOOD SURVEY DESIGN
IS A LONGITUDINAL COHORT DESIGN
AND ADDRESS S ARE STRATIFIED DUE
TO PROVISION OF IMMUNIZATION OR
ENROLLMENT IN THE PUBLIC SCHOOL
SYSTEM AND ADDRESSES ARE
RANDOMIZED.
WE HAVE 2018, 2019 AND 2021
WE'RE WRAPPING UP AND HAD AN
ADDITIONAL PHONE COVID SURVEY
CONDUCTED IN SUMMER AND FALL OF
2020.
ALL ELIGIBLE HOUSEHOLDS IN WEST
PHILADELPHIA ARE INCLUDED AND
ADDITIONAL SURVEY INCLUDING
HEALTH, HOUSING, SAFETY, POLICE
INTERACTIONS, EDUCATION,
EMPLOYMENT, PERCEPTIONS OF THE
NEIGHBORHOOD BUILT ENVIRONMENT,
SOCIAL COHESION AND AVAILABILITY
OF RESOURCES AND ASSETS IN THE
COMMUNITY.
OUR MODEL IS TO TRAIN AS
SURVEYORS.
THEY'RE THE ONLY ONES WHO CAN
WALK DOOR TO DOOR, KNOCK ON THE
DOOR AND ACTUALLY INCENTIVIZE
FOLKS TO PARTICIPATE IN OUR
SURVEY.
MANY HAVE BEEN PROMOTED TO OTHER
POSITIONS WITHIN THE PROMISE
NEIGHBORHOOD INITIATIVE.
TO SHARE SOME OF OUR NEW TRIGS
RELATED MEASURES AND THE RECENT
WAVE YOU SEE THERE'S LOW DAILY
SERVINGS OF FRUIT AND VEGETABLES
AMONG CHILDREN AND CAREGIVERS
AND LOW ENCOURAGEMENT FOR FRUIT
AND VEGETABLE CONSUMPTION AND WE
SEE THERE'S A VERY HIGH REPORT
ING OF UNHEALTHY EATING LIKE
SUGARY BEVERAGES AND YOU SEE THE
SECOND FROM THE BOTTOM FROM THE
SCHOOL DATA THAT A LOW
PERCENTAGE OF FRUIT AND
VEGETABLE CONSUMPTION THROUGH
THE SCHOOL SURVEY AND LASTLY I'D
LIKE TO POINT OUT OUR HIGH
SECURITY RATE.
THIS IS ONLY 19% IN WAVE 1 AND
HEALTH STUDY IN WAVE 2 AND JUMP
JUMPED TO MORE THAN DOUBLE
DURING COVID AND THESE ARE
HOUSEHOLDS SUSCEPTIBLE TO THE
GLOBAL SHOCK OF THE PANDEMIC.
OUR INTEGRATED SYSTEM WAS
INTENDED TO INTEGRATE A VARIETY
OF CHILD-FAMILY HOUSEHOLD
PROGRAMS AND SCHOOL AND
NEIGHBORHOOD INFORMATION
TOGETHER OVER TIME TO UNDERSTAND
EACH CHILD'S HOLISTIC NEEDS FOR
CARE AND COORDINATION AS WELL AS
EVALUATE IMPACTS OF THE
INITIATIVE OVER TIME.
THIS IS THE BACKBONE OF
EVALUATING PROGRAMMING AS
REQUIRED BY THE DEPARTMENT OF
ED.
YOU CAN SEE HERE THE LEVELS ARE
IN THE CIRCLES.
THE DATA SOURCES IN THE ARROWS
AND OF COURSE NOT ALL OF THESE
ARE NESTED SO NEATLY WITHIN EACH
OTHER AS THERE'S PROGRAMS AT THE
SCHOOL LEVEL AND ONLY PROGRAMS
AT THE SCHOOL LEVEL NOT NESTED
THAT WAY AND ONLY A THIRD ATTEND
A SCHOOL IN THEIR NEIGHBORHOOD
MAKE IT CHALLENGING.
AND IT'S NOT YET BEEN REALIZED
IN THE SIX NO-COST EXTENSION
YEAR.
WE'VE BEEN NEGOTIATING AND
CONSENSUS BUILDING AROUND
PRIORITIES, GOALS, PROCESSES,
DATA USE AGREEMENTS AND
LIABILITY ISSUES.
THE DATA SOURCES COME FROM
CHILDREN AND FAMILIES INCLUDING
BEHAVIORAL HEALTH, PUBLIC HEALTH
AND HUMAN SERVICES, HOMELESSNESS
SERVICES AND CORRECTIONS.
THERE'S ALL KINDS OF TECHNICAL
CAPACITY AND TIME ISSUES AND
LOGISTICS OF DATA GENERATION AND
SHARING AND SECURITY ISSUES AND
LEGAL PARAMETERS AROUND DATA
SHARING AND DATA PRIVACY
CONCERNS.
AS A RESULT WE STILL DO NOT HAVE
A FULL IDEA.
WE ARE COMPLETING A
DEMONSTRATION PROJECT WITH THE
FIVE-YEAR BIRTH COHORT AND
THINGS HAVE WORKED QUITE WELL
AND WE'RE LOOKING TO LAUNCH INTO
A ONE-TIME INTEGRATION TOO THE
DATA TO EVALUATE PROMISE
NEIGHBORHOOD AND HOPE THAT WILL
ALLOW US TO WORK WITH OUR
COLLEAGUES TO DO MORE SYSTEMS
MODELLING WITH OUR DATA.
ALSO WANT TO LET YOU KNOW
BRIEFLY WE HAD TO BUILD OUR OWN
INFORMATION PORTAL TO LINK
INFORMATION BETWEEN SERVICE
PROVIDERS AND TRACK PROGRAM
PROGRESS AND OUTCOMES OVER TIME.
WE ALSO CREATED OUR OWN TA WAS
VETTED BY OUR SURVEYORS.
THIS IS WITH BOOTS ON THE GROUND
COMMUNITY MEMBER VERIFIED
RESOURCES WE MAKE AVAILABLE IT
ALL OF THE PROGRAMS AND
PROVIDERS OF SERVICES THAT WE
FUND THROUGH PROMISE
NEIGHBORHOOD AND WE LINK THESE
ALL TOGETHER THROUGH THE PIP.
OUR FOOD SECURITY CHALLENGES ARE
DELIVERED WITHIN THE BACKDROP OF
VIOLENCE INTERVENTION STRATEGIES
AND FOOD RESOURCES ARE THE MOST
COMMON RESOURCES ASKED FOR BY
OUR COORDINATOR WHICH IS OUR
MAIN SYSTEMS LEVEL INTERVENTION.
THINK OF A COMMUNITY HEALTH
WORKER MODEL EXTENDING FROM A
COLLECTIVE IMPACT MODEL OF
VARIOUS SYSTEMS.
YOU'LL SEE A LISTING OF BOTH
INDIVIDUAL LEVEL AND ALSO SCHOOL
AND NEIGHBORHOOD LEVEL NUTRITION
AND FOOD SECURITY RELATED
STRATEGIES HERE.
YOU'LL SEE A LOT OF THESE ARE
LINKING TOGETHER FOOD AND
NUTRITION RESOURCES INTO
EXISTING STRATEGIES AND
ADVOCATING FOR THINGS LIKE FOOD
DISTRIBUTION SITES.
WHEN COVID HIT IT BECAME CLEAR
THERE WAS NOT SUFFICIENT FOOD
DISTRIBUTION WITHIN THIS
COMMUNITY.
IN FACT, OUR OUTREACH MANAGER
WAS DISTRIBUTING FOOD ON HIS
FRONT PORCH FOR A LONG PERIOD OF
TIME ADVOCATING FOR AND CREATING
NEW FOOD DISTRIBUTION SITES AND
WINTERIZE EXISTING FOOD
DISTRIBUTION INFRASTRUCTURE.
I DO WANT TO MENTION FOR A
SECOND THAT WE DID BUILD IN AN
ORGANIZATIONAL NETWORK SURVEY.
THIS WAS NOT REQUIRED BY THE
DEPARTMENT OF ED BUT WE FOUND IT
VERY IMPORTANT TO UNDERSTAND HOW
SYSTEMS -- HOW INDIVIDUAL
PROGRAMS AND SYSTEMS OF SUPPORT
ARE CONNECTED TO EACH OTHER BY
CATEGORY AND BY NETWORKS.
SO ONE OF THE NETWORKS WE TOOK A
LOOK AT WAS HOW THEY LOOKED AT
EACH OTHER AND COORDINATION AND
STRATEGIC PLANNING AND
COLLABORATION AND DATA SHARING.
LASTLY, OUR DATA DISSEMINATION
AND USING DATA BOARDS AND
DEMOGRAPHIC BRIEFS,
PRESENTATIONS AND COMMUNITY TOWN
HALL MEETINGS AND ALSO DATA
REQUESTS.
WE WILL PROVIDE WHAT DATA WE ARE
ALLOWED TO PROVIDE GIVEN OUR
VARIOUS IRB AND DATA USE
AGREEMENTS INCLUDING FOR
EXAMPLE, THE MANY HUNDREDS OF
COMMUNITY INDICATORS THAT WE
DEVELOPED IN OUR ROLE AS THE
PHILADELPHIA LOCAL DATA UNIT
INTERMEDIARY.
ANY OF OUR CIVIC OR COMMUNITY
PARTNERS WHO REQUEST THESE DATA
IS MADE AVAILABLE TO THEM.
WHAT ARE THE CHALLENGES OF THIS
KIND OF WORK?
FIRST IS THE GRANT SUPPORTS AND
REPORTING REQUIREMENTS ARE BASED
ON TRADITIONAL THINK OF GRANT
IMPACTS.
THEY'RE STILL REQUIRING ARE --
REQUIRE ARE
-- WE'RE INTEGRATING SYSTEMS AND
INFORMATION CLOEOLLECTED FROM THE
SAME FAMILY AND IT'S EASIER TO
REQUEST DATA FOR RESEARCH THAN
PROVIDING HOLISTIC SUPPORT FOR
KIDS AND THAT'S JUST NOT JUST OR
EQUITABLE.
AND INCORPORATES PROGRAM
MONITORING AND OTHER TRACKING
DATA SYSTEMS THAT DON'T SPEAK
WELL TO EACH OTHER AND THERE'S
ALSO THE CHALLENGE OF LINKING
LOTS OF SMALL DATA FROM PROGRAMS
TO BIG DATA.
AND NO REALLY GOOD PRACTICAL
HISTORY OR MODELS TO DO THIS.
THERE'S ALSO COMPLEXITY
PROCEDURES REQUIRED BY PROMISE
NEIGHBORHOODS, SCHOOL DISTRICT
TO CITIES, DREXEL, THE VARIOUS
PROGRAMS THAT CHALLENGED A LOT
OF INTEGRATION AND ADOPTION OF
OUR.
I PORTAL AND LASTLY I'LL SAY THE
TRADITIONAL FUNDING TIME LINES
DOES NOT ALLOW FOR POPULATION
LEVEL CHANGE.
YOU CAN'T CHANGE SYSTEMS OF
SYSTEMIC RACISM IN FIVE YEARS
AND CHANGE NEEDS TO HAPPEN AT
THE HOUSEHOLD SCHOOL,
NEIGHBORHOOD AND SYSTEMS LEVELS
BEFORE WE'LL SEE ANY KIND OF
POPULATION CHANGE IN COMMUNITIES
LIKE THIS.
SO THE METHODS AND INDICATORS
EVALUATING THESE MULTI-LEVEL S
NEED TO FOCUS ON DETECTING THESE
PROCESS AND SYSTEMS CHANGES
BEFORE EXPECTING TO SEE
SIGNIFICANT AND SUSTAINABLE
CHANGE AMONG CHILDREN AND YOUTH
AT THESE DIFFERENT LEVELS.
THAT IS IT.
>> THANK YOU.
YOU ARE VERY BRAVE FOR
UNDERTAKING SUCH AN ENORMOUS
TASK.
I WAS DELIGHTED TO HAVE HEARD
MORE ABOUT THE PROCESSES AND
METHODS AND HOW YOU THOUGHT
ABOUT IT.
OF COURSE WE'RE ANXIOUS TO THINK
ABOUT THE OUTCOME BUT IT WAS
WONDERFUL TO BE ABLE TO HEAR
METHODS YOU USED IN SOME OF THE
CHALLENGES SO THANK YOU VERY
MUCH.
THE NEXT SPEAKER THAT WE HAVE IS
JAYNA DAVE FROM THE BAYLOR
COLLEGE OF MEDICINE AND TALK
ABOUT ISSUES OF EQUITY.
>> CAN YOU HEAR ME NOW?
>> YES, PERFECT.
>> I'LL GIVE AN OVERVIEW OF
EQUITY AND RELATED CONCEPTS AND
WHY THEY'RE IMPORTANT WHEN WE
LOOK AT CHILD HEALTH.
SO HEALTH EQUITY IS PROVIDING
EVERY PERSON WITH THE SAME
OPPORTUNITY TO STAY HEALTHY FOR
COPE WITH DISEASE IN CRISIS
REGARDLESS OF THE SOCIAL
ECONOMIC CONDITIONS, RACE,
GENDER, AGE, SOCIAL STATUS,
ENVIRONMENT AND ANY OTHER SOCIAL
DETERMINATED FACTORS.
SOME STEPS WHEN WE TALK ABOUT
HEALTH EQUITY INCLUDE HEALTH
DISPARI
DISPARITIES, SOCIAL DETERMINATES
OF HEALTH AND DIFFERENCES IN
HEALTH OUTCOMES AND CAUSES AMONG
GROUPS OF PEOPLE AND ACHIEVING
HEALTH EQUITY AND REDUCING
HEALTH DISPARITIES ESPECIALLY IN
CHILDREN IS A MAJOR PUBLIC
HEALTH GOAL.
THE SOCIAL FACTORS THAT FLOUNCE
HEALTH CARE AND HEALTH OUTCOMES
ARE THE SOCIAL DETERMINATES OF
HEALTH AND THESE ARE THE
CONDITIONS WHERE PEOPLE ARE
BORN, LIVE OR AN AGE.
ACCORDING TO WHO, THESE
CIRCUMSTANCES ARE SHAPED BY THE
DISTRIBUTION OF MONEY, POWER AND
RESOURCES GLOBAL AND NATIONAL
AND LOCAL LEVELS.
NOW, THE UNFAIR AND AVOIDABLE
DIFFERENCES IN HEALTH STATUS
SEEN WITHIN POPULATIONS AND
WITHIN COUNTRIES IS WHAT HAS
HELPED INEQUITIES AND SOCIAL
DETERMINATES OF HEALTH HAVE
MOSTLY RESPONSE ARABLE FOR THE
HEALTH INEQUITIES.
THIS IS INCLUDED AS ONE OF THE
OVER ARCHING GOALS FOR THE
DECADE AND THE SOCIAL
DETERMINATES OF HEALTH APPROACH
BASICALLY INCORPORATES IN DEPTH
ANALYSES OF GROWING AND STUDYING
CHIERNZ ENVIRONMENT AND ADDRESS
THE ROOT CAUSE IN ADDITION TO
THE INDIVIDUAL AND COMMUNITY
BEHAVIORS.
IT'S A MULTI-SECTORIAL APPROACH
BY DEFINITION ITSELF.
ADDITIONALLY, WHO ALSO
EMPHASIZES THE CONCEPT OF SOCIAL
DETERMINATES OF HEALTH AND HAVE
A REPORT PUBLISHED BACK IN 2008
I THINK ON IT.
THERE ARE A FEW MEASURES FOR
SOCIAL DETERMINATES OF HEALTH
THAT HAVE BEEN PUBLISHED.
ONE IS PROTOCOL FOR RESPONDING
TO AND ASSESSING EXPERIENCES BY
THE NATIONAL ASSOCIATION OF
COMMUNITY HEALTH CENTERS.
AND IT ALIGNS WITH THE HEALTHY
PEOPLE 2020 PRIORITIES AND IS
AVAILABLE ON DIFFERENT
ELECTRONIC ELECTRONIC HEALTH
RECORD PLATFORMS.
THIS PARTICULAR TOOL LOOKS AT
SOCIAL DEMOGRAPHICS, HOUSING
STATUS, HOUSING STABILITY,
EDUCATION, EMPLOYMENT, STRESS,
INSURANCE, INCOME, MATERIAL
SECURITY INCLUDING MONEY AND
RESOURCE ARE WHICH ALSO INCLUDE
THE FOOD, TRANSPORTATION, SOCIAL
INTEGRATION OF SUPPORT AND
SEASONAL WORK.
THE OTHER TOOL THAT IS AVAILABLE
IS THE HEALTH RELATED SOCIAL
NEEDS SCREENING TOOL BY THE
ACCOUNTABLE HEALTH COMMUNITY
CENTER FOR MEDICARE AND MEDICAID
SERVICES.
IT WAS DEVELOPED TO ADDRESS
CRITICAL GAP BETWEEN CRITICAL
AND COMMUNITY SERVICES.
WE LOOK AT HOUSING INSTABILITY,
FOOD INSECURITY, TRANSPORTATION
NEEDS, UTILITY NEEDS AND
INTERPERSONAL SAFETY.
THERE IS ANOTHER TOOL CALLED THE
PATIENT REPORT THE OUTCOMES
QUALITY OF LIFE WHICH WHICH
BASICALLY ASKS WHICH OF THE
FOLLOWING REPRESENTS YOUR SINGLE
BIGGEST CONCERN RIGHT NOW AND
THE BIGGEST CONCERNS INCLUDED
ARE PERSONAL RELATIONSHIPS,
MONITORING HEALTH, EMOTIONAL
HEALTH, MONEY, HEALTH BEHAVIORS,
MEDICINE, GETTING HEALTH CARE
WORK, PHYSICAL HEALTH OR ANY
OTHER CONCERN.
AND THEY ASK ABOUT THE DIFFERENT
PROBLEMS AROUND MEDICINE AND
GETTING HEALTH CARE AND
INSURANCE.
ANOTHER CONCEPT WHEN WE TALK
ABOUT HEALTH EQUITY IS
ENVIRONMENT JUSTICE THE FAIR
TREATMENT AND ENROLLMENT OF ALL
PEM REGARDING OF RACE AND
NATIONAL ORIGIN OR INCOME WITH
RESPECT TO THE DEVELOPMENT,
IMPLEMENT OF ENFORCEMENT OF
LAWS, REGULATIONS AND POLICIES.
WHAT WE MEAN BY MEANINGFUL
ENROLLMENT IS ACTIVE ENGAGEMENT
OF PEOPLE IN HER DECISION-MAKING
ACTIVITIES THAT MAY AFFECT THEIR
ENVIRONMENT OR THEIR HEALTH
THREW APPROACHES AND THIS CAN BE
DONE USING APPROACHES SUCH AS
COMMUNITY ENGAGED RESEARCH OR
COPR.
WE SPOKE ABOUT FOOD INSECURITY
AND I THINK FOOD SECURITY AND
ENVIRONMENTAL JUSTICE ARE SOCIAL
MOMENTS BOTH INTERESTED IN
EQUITY AND JUSTICE AND
SYSTEM-WIDE FACTORS AND SHARED A
CONCERN FOR ISSUES OF DAILY LIFE
AND THE NEED TO ESTABLISH
EMPOWERMENTS BY COMMUNITY AND
EMPOWERMENT STRATEGIES.
IN BOTH OF THESE MOVEMENTS HAVE
ALREADY BEGUN TO RESHAPE THE
SUSTAINABLE FOOD SYSTEM HOWEVER,
THE COMMUNITY FOOD SECURITY AND
ENVIRONMENTAL JUSTICE IS STILL
REMAINING AS SEPARATE MOMENTS
INDICATING INCOMPLETE COURSES IN
RESHAPING AGENDAS AND JOINING
THESE MOVEMENTS THROUGH
EMPOWERMENT AND LEVEL ANALYSES
WE HEARD SOME THROUGH THE CASE
STUDIES TODAY WOULD ENHANCE THE
DEVELOPMENT OF A MORE POWERFUL
AND INTEGRATED APPROACH.
AND SOME OF THESE EFFORTS WOULD
INCLUDE MAKING COMMUNITY FOOD
PRODUCTION AND COMMUNITY
DEVELOPMENT AND PLANNING.
AND WITH IMBALANCES IN THE FOOD
SYSTEMS ARE MAJOR DRIVERS OF
NUTRITION INEQUITIES AND CAN
RESTRICT ACCESS OR PROMOTE
LOW-QUALITY DIETS.
WE ALL KNOW THE FOOD ENVIRONMENT
WHERE CONSUMERS MAKE DECISIONS
IS INEQUITABLE FOR MANY WITH
ADVERTISING AND QUALITY OF FOOD.
AND THE INEQUITIES PROVIDE AN
INTEGRATED RESPONSE AT TO THE
GLOBAL AND NATIONAL LEVELS
BRINGING TOGETHER THE CAPACITY
OF MULTIPLE SECTORS AND AN
EQUITY-SENSITIVE APPROACH TO
FOOD SYSTEMS THAT DELIVERS
HEALTHY DIETS WOULD SEEK TO
REDUCE INEQUITIES AS WELL AS
DIRECTLY ADDRESS FOOD
AVAILABILITY, ACCESSIBILITY AND
PRICE IN LOCAL FOOD
ENVIRONMENTS.
SO ADDRESSING HEALTH DISPARITIES
IN GENERAL AS MAUREEN STARTED
TALKING ABOUT IT EARLIER THIS
MORNING, IT'S GROUNDED IN SOCIAL
AND ECOLOGICAL MODEL WHICH ALSO
SUPPORTS THE FRAMEWORK THAT
WE'RE USING FOR THE WORK.
AND I WON'T TALK TOO MUCH ABOUT
THIS BUT I WOULD WANT TO SAY
INTERSECTI
INTERSECTIONITY SHAPE HOW CHANGE
AND THESE ARE IMPORTANT IN
IDENTIFYING POINTS OF
INTERVENTIONS TO IMPROVE HEALTH
BEHAVIORS.
INTERSECTIONAL ITY
INTERSECTIONALITY, ARE RACE,
CLASS, GENDER GEOGRAPHY AND AGE
AND INTERACT TO FORM UNIQUE
MEANS AND COMPLEX EXPERIENCES
WITHIN THE WEN GROUPS AND SOEFTZ
AND SHAPES ADAPTATION PROCESSES
TO OUTCOMES AND IN ORDER TO
BETTER ASSESS AND ADDRESS
INEQUALITIES ASSOCIATED WITH
POLICIES AND PROGRAMS FOR
ADAPTATION AND SOCIAL ECOLOGICAL
CHANGE AND ADDRESS THESE.
BEFORE I END I WANTED TO HAVE
RECOMMENDED PRACTICES FOR
MEASUREMENT OF HEALTH
DISPARITIES OR HEALTH INEQUITIES
AND SOCIAL DETERMINATES OF
HEALTH.
AND THESE INCLUDE ASSESSING THE
DIFFERENCES IN HEALTH AND ITS
DETERMINATES THAT ARE ASSOCIATED
WITH THE SOCIAL POSITION AND
ASSESSING SOCIAL AND STRUCTURAL
DETERMINATES OF HEALTH AND
CONSIDERING MULTIPLE LEVELS OF
MEASUREMENT.
THE RATIONALE FOR GROUPS TO BE
COMPARED.
SHOULD WE SIMULTANEOUSLY
CLASSIFY SOCIAL STATUSES AND
EVALUATING THE IMPACT OF PUBLIC
POLICIES ADDRESSING SOCIAL
DETERMINATES OF HEALTH
INEQUITIES OVER TIME TO SEE IF
THE IMPACT IS SUSTAIN OVER TIME.
THOUGH MUCH IS UNDERSTOOD ABOUT
THE SOCIAL DETERMINATES OF
HEALTH IN SHAPING THE HEALTH OF
THE POPULATIONS WE AS RESEARCH
ARERS NEED TO CONTINUE TO
ADVANCE UNDERSTANDING THE
PATHWAYS THROUGH WHICH WE
OPERATE ON HEALTH OUTCOMES.
THERE'S STILL WE NEED TO LEARN
ON SOCIAL DETERMINATES OF HEALTH
ON GLOBAL AND NATIONAL LEVELS.
WITH THAT I WILL END.
>> THANK YOU.
THANK YOU FOR TALKING ABOUT
THESE INEQUITIES AND WE KNOW
ISSUES OF INEQUITY INFLUENCE
ACCESS THAT EVEN IF WE HAVE
AVAILABLE FOOD SERVICES OR
AVAILABLE ASPECTS OF NUTRITION
AND ACCESS CAN BE IMPLEMENTED BY
THE INEQUITIES THAT HAVE GONE
ON.
AND IT'S IMPORTANT TO CONSIDER
THAT AS WE CONSIDER HOW THE
ENVIRONMENT RELATES TO
CHILDREN'S NUTRITIONAL ECOLOGY.
I HAVE TO THANK THE SPEAKERS FOR
STAYING ON TIME.
WE NOW HAVE AN OPPORTUNITY TO
ASK QUESTIONS AND MAKE COMMENTS.
I SAID IN THE BEGINNING DAN HAS
ASKED ABOUT TALK ABOUT TE
DRIVERS OF NUTRITION ECOLOGY
THAT ARE CONSIDERED AND HOW THAT
INFORMS THE MEASUREMENT AND WORK
GROUP 4 THEN CONSIDERS SOMETHING
ABOUT THE TRANSLATION.
WE'LL OPEN THE FLOOR AND IF YOU
WOULD LIKE IT MAKE A COMMENT,
RAISE YOUR HAND AND WHEN TALKING
IT WOULD BE HELPFUL TO TURN ON
YOUR VIDEO TO HAVE A SOMEWHAT
PERSON TO PERSON EXCHANGE.
CONNIE, I SEE YOUR HAND UP.
>> CAN YOU HEAR IS THE
>> YES, I CAN.
>> VERY GOOD.
SO THANK YOU FOR THIS EXCELLENT
WORKSHOP.
I THINK YOU MANAGED THE TIMING
OF YOUR PRESENTATIONS BETTER
THAN WE DID TRYING TO CRAM ALL
THE BIOLOGY INTO A SIMILAR TIME
FRAME TO I APPRECIATE THE
DISCUSSION.
WHAT I'D LIKE TO SEE, YOU DID A
GREAT JOB THE WHOLE GROUP ON
EXPRESSING THE COMPLEXITY AND
THE SYSTEMS APPROACH AND LET'S
SAY WHAT OUR FINDS ARE FOR
EVALUATING EFFICACY OF SOME
SCHOOL INTERVENTION OR A
SCHOOL-AGED CHILDREN
INTERVENTION WHICH I THINK THE
BIGGEST ONE IS SCHOOL LUNCH AND
BREAKFAST, THAT SORT OF THING.
LET'S SAY IT'S FOUND THERE'S
SOME DEFICIENCY IN A SCHOOL OR
REGION OR WHATEVER.
WHAT ARE THE PATHWAYS FROM THAT?
IN THE U.S. I KEEP THINKING THE
MAIN STRATEGY IS TO MAKE SURE WE
GET A THIRD OF THE DIETARY
GUIDELINES IN EACH OF THE MEALS
BUT THEN GIVING THE NUTRIENTS TO
SOME COOL OR REGENTS IDENTIFIED
IT HAS SOME PROB OR DEFICIENCY I
DON'T EVER HEAR OF OKAY, THERE'S
A MICRONUTRIENT SUPPLEMENTATION
IN THE U.S.
I KNOW I HEAR ABOUT THEM
INTERNATIONALLY BUT I DON'T KNOW
WHO DECIDES THAT.
WHO MAKES IT HAPPEN.
SO DO YOU FOLLOW WHAT MY
INTEREST IS?
>> YES, THANK YOU.
>> I'M GOING TO MAKE A VERY
QUICK COMMENT AND THEN I'M GOING
TO ASK LORRENE TO ADDRESS THIS
ISSUE RELATED TO SCHOOL PROGRAMS
AND I GUESS MY QUICK COMMENT
WOULD SAY, WELL, WE HAVE HAD
THINGS LIKE THE HEALTHY
HUNGER-FREE KIDS ACT THAT HAVE
TRANSFORMED SCHOOL MEALS, FOR
EXAMPLE, AND FROM MY PERSPECTIVE
I THINK SOME OF THE
TRANSFORMATION HAS COME FROM THE
FEEDBACK THAT THEY'VE INCREASED
THE NUTRITIONAL CAUGHT OF SCHOOL
MEALS BUT THERE'S ALSO BEEN AN
EFFORT TO INCREASE THE ACCESS
THE PRESENTATION OF SCHOOL MEALS
AS WELL.
WHIL THE NUTRITION PART IS
INCREDIBLY IMPORTANT AND THAT IS
WHY WE'RE DOING IT, IT'S
RECOGNIZED THAT YOU HAVE TO PUT
THE OTHER PIECES IN PLACE TO
MAKE IT ACCESSIBLE TO THE
SCHOOLS TO THE YOUTH AND IT
THEY'RE WILLING TO PARTICIPATE
IN IT AND THAT'S WHERE SOME OF
THE ENVIRONMENTAL THINGS.
LET ME TURN TO LORENE.
>> WE CAN BUILD IT AND WE HAVE.
THE SCHOOL MEAL PROGRAMS ARE
QUITE WIDESPREAD.
ALMOST ALL SCHOOLS HAVE THEM AND
THE NUTRITION STANDARDS ARE
QUITE ROBUST AND CAN BE IMPROVED
ALWAYS BUT WE'VE MADE
SIGNIFICANT HEADWAY IN ENSURING
ALL SCHOOLS DELIVER MEALS THAT
ARE HEALTHY.
HOWEVER, IF YOU BUILD IT THEY
DON'T ALWAYS COME.
ONLY 60% OF KIDS PARTICIPATE IN
THE SCHOOL MEAL PROGRAMS
REGULARLY AND THE FACTORS SHE
ALLOWEDED TO WHICH BAN THE
TOPICS WE TALKED ABOUT IN THE
WORKSHOP ALL THE WAY FROM DANA'S
EXAMPLES OF EQUITY AND THERE'S
STIGMA ASSOCIATED WITH THOSE
SCHOOL MEALS AND PLACES THEY'RE
CONSIDERED MEALS AND WE HAVE ALL
THE OTHER FACTORS THAT WE
MEASURE AND HOW MUCH TIME DO
KIDS HAVE TO EAT, IS THERE A
PLACE FOR THEM TO SIT AND DO
THEY VALUE THAT MEAL, DO THEY
COME BRINGING A BUNCH OF OTHER
STUDENTS FROM HOME THAT COMPETE
WITH THE SCHOOL MEALS.
THERE'S DIFFERENT FACTORS IN
CALIFORNIA WE'RE WORKING TO
ADOPT A PRESCHOOL MEALS FOR ALL
THAT WILL HOPEFULLY ANSWER
QUESTIONS ABOUT ACCESS AND REE
REDUCING STIGMA AND YOU PROBABLY
KNOW AS WELL I DO OUR BIOLOGY WE
LOVE SUGAR, FAT AND SALT.
THAT'S WHAT KIDS IN THE UNITED
STATES ARE USED TO EATING WHEN
WE HAVE FOODS WITH LESS ADDED
SUGARS, FAT AND SALT IT'S HARD
ON THEIR PALATE.
THERE'S A LOT OF WE NEED TO
IMPLEMENT BEFORE EVERYBODY GETS
EXCITED ABOUT THE SCHOOL MEALS
AND QUALITY AND FRESHNESS AND
PRODUCING THOSE WITH DOLLARS.
EACH SCHOOL MEAL ONLY GETS
REIMBURSED FOR $2.
WE MAY HAVE TO THINK ABOUT THAT
AS A SOCIETY INVESTING MORE TO
GET MEALS OUT ON THAT BUDGET BUT
HOW DO WE MAKE THEM APPEALING.
>> THERE'S SOME RELATED WITH MY
RATES OF ANEMIA AND ARE THERE
PRATH WAYS TO SAY, OKAY, THERE'S
EXTRA ATTENTION NEEDED FOR THE
ONE NUTRIENT SOMEHOW?
>> DO THEY TAKE ON
SUPPLEMENTATION OF IRON AND
ANEMIA --
>> NOT SCHOOL MEALS TAKE IT ON
BUT
>> THE ASSESSMENT --.
>> THIS CONVERSATION HAS GONE
FRON THE BEGINNING AND ARE WE
FOCUSSING ON SCHOOL-CENTRIC
PROGRAMS OR EFFORTS TO ASSESS
NUTRITION ON SCHOOL-AGED
CHILDREN.
THERE'S ISSUES RELATED TO WHAT
NUTRIENT MOST RESPONSIVE TO
SPECIFIC TYPES OF PROGRAMS THAT
MAY BE WORTHY TO CONSIDER FOR
ASSESSMENT.
IN TERMS OF THE PROGRAM THE
WRAP-AROUND [INAUDIBLE] -- MANY
KIDS WE'RE TALKING ABOUT
PARTICULARLY IN
NON-U.S. SETTINGS LOW-RESOURCE
SETTINGS ARE [INDISCERNIBLE] AND
THAT TO BE CONSIDERED AS WE
ASSESS IMPACT.
IT'S NOT JUST THE IMPACT OF WHAT
KIDS ARE RECEIVING IN THE SCHOOL
BUT TO TRULY ASSESS THE IMPACT
WE NEED TO RECOGNIZE THE
NUTRITIONAL BIOLOGY OF THE
CONTENT.
I THINK [INDISCERNIBLE]
[OFF MIC]
>> DAN, WE'RE LOSING YOUR VOICE.
>> WHAT PART DID YOU MISS?
>> IT WAS GETTING QUIET.
IT WAS GOING DOWN.
WE COULD NOT HEAR.
>> DID YOU HAVE ANOTHER COMMENT,
DAN?
IT WAS DAN, DON AND JAYNA.
DO YOU HAVE ANOTHER COMMENT,
DAN?
>> THERE WERE QUESTIONS OUTLINED
AND WE NEED TO HEAR FROM
[OFF MIC]
THERE WERE SPECIFIC FUNCTIONAL
OUTCOMES.
IN TERM OF OUR ABILITY TO FORM
GROUP 3 AND 4 I'D LIKE TO HEAR
FROM THEM.
>> WE'LL HAVE DON NEXT AND THEN
JAYNA AND THEN AMY.
>> I WANTED TO RESPOND.
THERE'S NOT UNLIKE THE OTHER
COUNTRIES, THERE'S NOT MANY
PROGRAMS THAT RESPOND TO
MICRONUTRIENT DEFICIENCIES IN
THE U.S. AND THERE ARE SOME
THROUGH INSURANCE BUT MOST THE
PROGRAMS ARE PROBABLY GEARED
TOWARDS OBESITY PREVENTION.
WHEN YOU LOOK AT SCHOOL PROGRAMS
THOUGH THEY DO HAVE THE
REQUIREMENTS, NUTRITION
REQUIREMENTS FOR SCHOOL MEALS
AND SO ON, I DON'T THINK THERE
IS A FOLLOW-UP ON MICRONUTRIENT
DEFICIENCIEIES AS MUCH AS FOR.
>> THE WIC PROGRAM RESPONDED TO
THE IRON DEFICIENCY AT ITS
FORMATION AND IS MORE DRIVEN
TOWARD THE NUTRIENT REQUIREMENTS
OF CHILDREN UP THROUGH AGE 5 BUT
THAT DOES NOT APPLY TO CHILDREN
IN THIS AGE GROUP.
THERE'S ALSO SOME OF THE FOOD AS
MEDICINE INTERVENTIONS THAT
WOULD BE ASSOCIATED WITH
PARTICULAR PROBLEMS THAT HILARY
SPOKE ABOUT IN HER TALK ON FOOD
INSECURITY.
NOW WE'LL GO TO DON AND I WOULD
ASK PEOPLE TO BE SOMEWHAT BRIEF
IS WE END ON TIME.
>> THANK YOU.
CONGRATULATIONS ON A SUPER GREAT
SESSION.
GREAT PRESENTATIONS.
I WANT TO RESPOND ON TWO ISSUES
IN TERMS OF WORK GROUP 2.
ONE IS AROUND THE COMPLEXITY OF
THE DYNAMICS AND THE LIFE COURSE
AND THAT COMES THROUGH AS A
CHALLENGE IN THE COMPLEXITY OF
THE INDICATORS WE'RE
CONSIDERING.
TALKING ABOUT METHODS AND WE
HAVE TO MEASURE A LOT OF THINGS
IF WE'RE GOING UNDERSTAND THIS.
THE EXAMPLES WERE GIVEN WHICH
WERE BRIL -- BRILLIANT IN
LOW-RESOURCED COMMUNITIES AND
PARTICULARLY WELL FUNDED
MONITORING METHODS IN CONTRAST
TO WHAT RESOURCE-POOR COUNTRIES
WOULD HAVE TO INVEST IN THIS
KIND OF MONITORING.
I THINK IT WOULD BE HELPFUL IF
WORKING GROUP 3 IN THINKING
ABOUT THIS ADDRESSES A KEY ISSUE
ABOUT HOW DO WE MINIMIZE THE
SCOPE AND COMPLEXITY WITHOUT
LOSING SITE OF THE NEED TO
EMBRACE COMPLEXITY.
I'M PUTTING THAT FORWARD AS A
CHALLENGE.
I'M CLEAR WE NEED TO MAKE THESE
MEASUREMENTS BUT HOW DO WE GET
TO AN OPTIMAL MINIMAL GROUP ON
THIS.
>> I HEAR YOU ASKING FOR A
BALANCE TO RESPECT THE
COMPLEXITY NOT IGNORE IT AS WE
HAVE IN OUR SILOED HISTORY BUT
WE CANNOT HAVE EVERYTHING RELATE
TO EVERYTHING.
>> THAT'S RIGHT AND FOR SOME
RESOURCED SETTINGS IT'S VITAL TO
STEP UP AND DO SOMETHING
IMPORTANT.
AND A MISSING PIECE BECAUSE DAN
ASKED US TO REFLECT ON THOSE I
THOUGHT IN THE PLANETARY
PRESENTATION ONE THING THAT WAS
WORTH EMPHASIZING IS FOOD
SYSTEMS DO ALLOW SOME CLIMATE
SENSITIVE IN THE WAY WHICH WE
RESPONSE TO SOME OF THESE IT
THINGS IN NEPAL WHERE WHAT WAS
USED IN SCHOOLS ROSE FROM 3 TO
28 WHEN LOCALLY SOURCED
MATERIALS WERE ENCOURAGED AS
PART OF IT.
THIS ROLLED BACK THE IDEA OF
FOOD PRODUCTION TO THE MORE
SUSTAINABLE BIO DIVERSITY
APPROACHES AND MORE CULTURALLY
APPROPRIATE APPROACH WHICH SEEMS
TO BE MORE RESPONSIVE TO
CLIMATE.
AND WE DON'T SEE DICHOTOMIES
VERY CLEARLY AND DISCUSSION OF
BANNING MEATS IN THE NORTH FOR
GOOD REASONS AND MEANWHILE WHEN
LOOKING AT LOW-RESOURCED
COUNTRIES, NUTRIENT DENSE
ANIMAL-SOURCED FOODS LIKE MILK
AND EGGS REMAIN VITALLY
IMPORTANT, ACTUALLY.
THAT KIND OF DISCUSSION I DON'T
THINK WE'VE CAPTURED AT THE
STAGE IN OUR DISCUSSIONS.
>> THANK YOU.
AMY.
>> I WANTED TO GO BACK TO THE
DISCUSSION THAT CONNIE HAD ABOUT
PROGRAMS AND ADOPTION OF
PROGRAMS AND THE COMMENT SUSAN
HAD HARKENING BACK TO HILARY'S
COMMENT ABOUT THE NEED TO MAKE
SURE PROGRAMS ARE SOCIALLY AND
CULTURALLY DRIVEN AND I WANT TO
SAY IN MY OWN EXPERIENCE AND
IT'S VERY DOMESTIC AND HYPER
LOCAL BUT IN TERMS OF IMPLEMENT
AND ALL OF US ARE THINKING ABOUT
METRICS AND MEASURES, COMMUNITY
ENGAGEMENT IN THE CULTURAL
LINGUISTIC CONTEXTUAL ADAPTATION
OF SUCCESSFUL PROGRAMS AND
INTERVENTIONS IS KEY.
AND THEIR ENGAGEMENT CAN HELP US
TO LIKE A PATIENT-CENTERED
OUTCOMES RESEARCH THINKING ABOUT
COMMUNITY-CENTERED OUTCOMES
RESEARCH APPROACH TO CO-CREATING
METRICS TO THOSE CO-CREATED OR
CO-TAILORED INTERVENTIONS TO
MAKE SURE THAT WE'RE DESIGNING
BOTH IMPLEMENT AND EVALUATION AT
THE SAME TIME IN THE MOST
SUCCESSFUL WAY.IN THE
COMMUNITIES I WORK WITH, PRIOR
FAILED NUTRITION, PHYSICAL
ACTIVITY, CHRONIC DISEASE
PREVENTION AND COMMUNITY
VIOLENCE PREVENTION PROGRAMS
JUST CONTINUE TO STIGMATIZE AND
RECREATE COMMUNITY-LEVEL TRAUMA
AND SO I THINK IT'S BOTH
ESSENTIAL TO THE EFFECTIVE ROLE
TO HEALTH EQUITY AND TO ALL OF
US TRYING TO DO THE WORK AND
MEASURE IT AND BE ABLE TO SHARE
BEST PRACTICES.
>> THANK YOU.
CAN I ASK A QUICK QUESTION AND I
HOPE I CAN ASK IN NOT TOO --
NAIVE A WAY AND WHAT CHRISTINE
TALKED ABOUT EARLIER TODAY ALSO
IS HOW -- IT'S A QUESTION OF HOW
DO HAVE THE TOP-DOWN AND
BOTTOM-UP AND NOT BEING
SIMPLISTIC IN DOING THAT BUT YOU
HAVE THE STAKEHOLDERS OR THE
GOVERNMENTAL ASPECTS OF A
COMMUNITY INVOLVED AND YOU ALSO
THEN ARE RESPONSIVE TO THE
COMMUNITY LEVEL OR THE HOUSEHOLD
LEVEL.
HOW DO YOU GET BOTH OF THEM, IF
THEY ARE INVOLVED IN CREATING A
WHOLE SYSTEMS APPROACH OR HOW DO
YOU -- BECAUSE IT SOUNDS AS
THOUGH YOU'RE NEEDING BOTH OF
THEM.
>> IT'S VERY DIFFICULT.
IT HAS TO BE INTENTIONAL AND A
MODEL CAN DO THAT BY CENTERING
COMMUNITY VOICES AS IMPORTANT
AND ESSENTIAL EXPERTISE THAT
ADDS TO THE COLLECTIVE EXPERTISE
OF EVERYONE INVOLVED IN MAKING
THESE LARGE INITIATIVES HAPPEN.
AND YOU HAVE TO BE VERY
INTENTIONAL WITH TRUST BUILDING,
COMMUNICATION AND JARGON USE IN
THE BEGINNING AND SOMETIMES IT'S
AS SIMPLE AS LEVELLING THE
PLAYING FIELD AND MAKING SURE
FOLKS ARE APPROACHING THEIR
CONTRIBUTION TO THE WORK WITH
SOME CAPACITY BUILDING AND SOME
TERMINOLOGY DEFINITIONS SO FOLKS
WHO ARE TYPICALLY NOT POWERED,
MORE EMPOWERED TO CONTRIBUTE
THEIR EXPERTISE AND THOUGHTS.
IT'S COMPLEX BUT WE HAVE LOTS OF
LARGE FIELD FOCUSSED TO THIS AND
LOTS OF TOOL KITS AND BEST
PRACTICES.
>> THANKS, THANKS.
SARABH.
>> THANK YOU.
I WILL THANK YOU FOR THE
PRESENTATIONS AND
CONGRATULATIONS.
FROM THE WORK GROUP 3
PERSPECTIVE, WE HAVE ASSESSMENT
AND FOOD FOR THOUGHT AROUND HOW
TO BALANCE THE COMPLEXITY OF THE
THINGS WE MEASURE AND THE
FEASIBILITY OF WHAT CAN BE DONE.
HOPEFULLY WE'LL BE ABLE TO REACH
OUT TO YOUR GROUP AS WELL AS TRY
TO WORK ON THOSE STEPS OF
ASSESSMENTS.
THANK YOU.
>> WONDERFUL, THANK YOU.
>> RAPHAEL.
>> GOOD AFTERNOON.
A QUICK COMMENT ABOUT THE
SURVEILLANCE IN THE U.S. VERY
LIMITED.
THE ONLY SOURCE WE VERY IS THE
NHANES SURVEY AND TRYING TO LOOK
AT THE LOCATION OF 5-19.
WE WORK IN THAT AREA BUT OUR
PRIORITY IS THE FIRST 1,000
DAYS.
THE MOTHER AND THE KIDS.
THERE'S A SYSTEM LOOKING INTO
THIS WHEN YOU LOOK BACK TO THE
STATES IN THE U.S. AND
TERRITORIES AND TRIBES.
THERE'S NO DATA WHATSOEVER WE
CAN USE.
THIS IS A KEY AREA.
IF WE ARE GOING TO BE THINKING
ABOUT WHAT IS THE STATUS OF THE
SCHOOL CHILDREN 5-19 USING THE
SCHOOL AS FIRST WE NEED TO KNOW
THE SITUATION.
OVER.
>> I'LL RESPOND TO SOMETHING DON
SAID AND IF CHRISTIE WANTS TO
RESPOND WITH CLIMB AND HOME
SYSTEMS IT STILL DOESN'T ADDRESS
THE IT ISSUE OF CARBON DIOXIDE
IN THE ENVIRONMENT WHICH WILL
AFFECT QUALITY.
IT ASSESSES PROGRAMS OF SCHOOL
CHILDREN.
HOW DO WE ATTRIBUTE ASPECTS OF
THE CHILD'S ECONOMY TO IMPACT
EVALUATION.
WHILE IT'S IMPORTANT TO
UNDERSTAND THE PROGRAMS WE STILL
ARE NOT DISCUSSING THE IMPACT OF
THE CHILD ON THE CHILD.
WHETHER IT'S CLIMATE, IF YOU'RE
ASSESSING GOING BACK TO WORKING
GROUP ONE AND ASSESSING
NEUROLOGICAL OUTCOME OR IMMUNE
FUNCTION IF YOU DON'T CONSIDER
THE CHILD'S PHYSICAL ENVIRONMENT
YOU'LL FALSELY ATTRIBUTE TO A
LIMITED SET OF BARRIERS.
THE CHALLENGE STARTS WHAT
VARIABLE WE NEED TO INCLUDE IN
THIS ASSESSMENT BATTERY THAT
GETS A HANDLE ON THE IMPACT OF
THE PROGRAMS ON KIDS IN THE
ENVIRONMENT THEY LIVE IN.
AND THAT'S A FOCUS WITH THE
PROGRAMS ON THE CHILD AND IT WIZ
-- WAS MADE CLEAR US TO WE
DON'T KNOW THROUGH FOCUS ON THE
CHILD'S HEALTH AND DEVELOPMENT.
THAT'S WHAT WE NEED TO BE
FOCUSSED ON.
THANK YOU.
>> THANK YOU.
I THINK WE HAVE REACHED THE
HOUR.
SO I THANK YOU VERY MUCH FOR A
VERY RICH DISCUSSION.
I'VE CERTAINLY LEARNED A LOT AND
I THINK WHAT I WOULD SAY IS THAT
TO FOCUS ON THE CHILD WE
RECOGNIZE THE CHILD IS PART OF
THEIR COMMUNITY AND IT STARTS
WITH THEIR FAMILY AND IT EXTENDS
TO THE SCHOOL, TO THE COMMUNITY,
TO BEYOND THEM.
WE'VE AGREED TO TAKE A SOCIAL
ECOLOGICAL MODEL TO HELP US
UNDERSTAND THIS THAT EXTENDS
MULTI-LEVELS UP AND WE
RECOGNIZED HOW SOMETHING AS
STRONG AS CLIMATE HAS AN IMPACT
THAT COMES DOWN AND IMPACTS THE
FAMILY, THE FOOD SYSTEMS AND
IMPACTS THE CHILD.
WE CAN SEE FROM THE PANDEMIC HOW
SOMETHING AS A PANDEMIC
CERTAINLY HAD AN IMPACT AT THE
LEVEL OF THE CHILDREN.
WE HEARD TODAY PEOPLE TALKING
ABOUT NOT HAVING ACCESS TO
SCHOOL MEALS DURING THE PANDEMIC
AND WE HEARD THAT CHILDREN
GAINED WEIGHT DURING THE
PANDEMIC BECAUSE FOR SOME
REASONS, THE MULTIPLE REASONS
ONE, THEY DIDN'T HAVE THE
STRUCTURED ENVIRONMENT OF THE
SCHOOL NOR DID THEY ALWAYS HAVE
ACCESS TO THE SCHOOL MEALS.
WE SEE THE ENVIRONMENT DOES
REACH TO THE LEVEL OF THE CHILD
AND IF OUR ROLE IS TO THINK
ABOUT THAT ENVIRONMENT AND HOW
THAT REACHES THE LEVEL OF THE
CHILD AND HOW WE MEASURE IT AND
HOW WE MONITOR IT, I THANK THE
PRESENTERS TODAY THAT
REMEMBERIREMEMBEINDING
US THINK FROM A SILOED
PERSPECTIVE WON'T HELP CHILDREN
IN HOW PROGRAMS IMPACT THEM.
I'D LIKE TO THANK THE EXTERNAL
SPEAKERS WHO SPENT TIME WITH US
AS WELL AS THE INTERNAL
SPEAKERS.
THANK YOU VERY MUCH AND I
APPRECIATE THE DISCUSSION.
HAVE A WONDERFUL WEEKEND.
YOU CAN REACH OUT TO US THIS
SESSION HAS BEEN RECORDED.
AND SO YOU'RE WELCOME TO LISTEN
TO IT TO LOOK AT IT AGAIN AND
ALL THE BEST.
>> I WANT TO THANK EVERYONE AND
THANK THOSE FOR JOINING VIA THE
VIDEOCAST.
WE'RE CAPTURING COMMENTS AND WE
DO APPRECIATE INPUT FROM
EVERYONE AND A WANT TO BE
RESPECTFUL OF TIME AND I WISH
EVERYONE A WONDERFUL WEEKEND AND
STAY SAFE, BE WELL AND WE'LL SEE
YOU BACK NEXT FRIDAY.
>> THANK YOU, EVERYONE.