Page 86 - Nutrition Counseling and Education Skills: A Guide for Professionals

Health Disparities in Diverse Population

The United States Department of Health and Human Services Office of Minority Health has developed
practice recommendations to address racial and ethnic health disparities.10 The overarching goals of Healthy
People 2020 are to increase the quality years of life, create social and physical environments that promote
health, and eliminate health disparities by promoting healthy development and behaviors for all population
groups.5 Two of the 10 leading health indicators that track and measure the health of our nation are physical
activity and overweight/obesity. Nutrition has been linked to treatment or etiology of 5 out of 10 leading
causes of death of Americans: cancer, diabetes, heart disease, kidney disease, and stroke, with obesity
identified as a confounding factor. These objectives are tracked, monitored, and measured over time to
determine if the targets have been met. Unfortunately, none of the objectives to achieve healthy weight and
reduce incidence of overweight and obesity are currently being met.5

Health statistics also clearly indicate higher risk among many of the culturally diverse populations in the
United States, particularly for obesity and diabetes. In fact, data show that the percentage of people outside of
the United States who are overweight and obese is also increasing as well as global malnutrition.28 These
health disparity data are extremely helpful in planning community programs and counseling individuals of
different ages and cultural or ethnic groups. An example is recent interventions to reduce the risk of diabetes
in Pacific Islander communities that started with focus groups to assess needs. Successful family-centered
education programs were implemented based on this community-focused process. Some of the educational
content is shown in Table 4-1.24,29

Nutrition and dietetics professionals need to determine which groups are the most vulnerable and create
nutrition messages targeted to those groups. Although all groups may benefit from nutrition education, it is
important to focus on particular populations that are most at risk, based on available consumption data. For
example, diabetes mellitus is higher in many diverse populations particularly Native Americans and Hispanics.
Many opportunities exist to increase awareness of native food patterns and retention of healthy cultural foods
in these populations to potentially reduce diabetes risk.11,30 Culturally-appropriate health messages and
treatment algorithms can further enhance adherence to medical nutrition therapy.31

Tailored Standardized

Family eating history exercise Review of general eating and exercise goals

Family meal planning exercise Review of typical healthy eating pattern

Identify community resources to support family Give standardized list of community resources
activities

Identify healthy lifestyle values shared by family Give list of healthy lifestyle practices
members

Table 4-1 ■ Examples of Tailored versus Standardized Population Focus Delivered in the Pacific Islanders Lifestyle Intervention

Community Education Program to Reduce Weight Regain.
Source: From Kaholokula JK, Mau MK, Efird JT, et al. A family and community focused lifestyle program prevents weight regain in Pacific Islanders: a
pilot randomized controlled trial. Health Educ Behav. 2011;5:1–10.

Another example of a cultural group of concern nutritionally and newly mentioned in Healthy People 2020

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