Public health nutrition. Dietary guidelines
We have traction in Australia
Madam
Current public health nutrition definitions, teaching and practice too readily identify the discipline as a branch of clinical nutrition, says Geoffrey Cannon(Reference Cannon1). The result of this positioning, he contends metaphorically, is that public health nutrition is sitting on a twig on a public health branch of a dominant medical sciences tree.
In Australia this was the situation until recently. However, a broader public health approach to the discipline is gaining traction. At its 2006 annual meeting in Hobart, the Australian Public Health Nutrition Academic Collaboration explored how the New Nutrition Science project(Reference Leitzmann and Cannon2) might present an opportunity to undertake a ‘root and branch’ reform of public health nutrition’s framing and practice.
The Collaboration invited Geoffrey Cannon, Tony McMichael (Intergovernmental Panel on Climate Change) and Boyd Swinburn (WHO Collaborating Centre on Obesity Prevention) to discuss how environmental and social dimensions could be integrated with the biological dimension in policy and practice. Emerging from the meeting was the ‘Hobart Accord’ that provided many practical recommendations. In addition, the Accord responded to Boyd Swinburn’s insistence that the economic dimension be included in the New Nutrition Science in its own right, and not be seen merely as a division of the social dimension.
A broader public health approach is now being applied in Australia to the development of an important public health nutrition policy agenda that conventionally has been framed almost exclusively within a biological dimension. In 2008 the National Health and Medical Research Council (NHMRC) of Australia commenced its latest review of the Dietary Guidelines(3). The revision process is explicitly including environmental, social and economic considerations as themes in the systematic literature reviews to be undertaken to obtain the evidence base that will inform the review.
Evidence-based practice remains a core principle in the review of the Australian dietary guidelines. However, the relevance to public health nutrition of conventional approaches to evidence-based practice, that evolved from evidence-based medicine, has been questioned(Reference Brunner, Rayner, Thorogood, Margetts, Hooper, Summerbell, Dowler, Hewitt, Robertson and Wiseman4, Reference Mann5). Further, the NHMRC is currently running a pilot of its new, additional levels of evidence and grades for recommendations for developers of guidelines(6).
The NHMRC document states that different questions can require ‘different evidence hierarchies that recognise the importance of research designs relevant to the purpose of the guideline’. In addition, one practical step being undertaken to broaden the public health approach in the dietary guidelines revision process, is that consultants are being asked to undertake a systematic review of the whole literature on food, dietary patterns and nutrition, as distinct from a conventional clinical approach that confines reviews to literature reporting abstract nutrient–health relationships.
