In public health nutrition, many of the most effective measures need to be implemented at the local level. Even the best policies or actions will fail if the local level is not prepared, for example with knowledge, skills, structure and systems, that allow pertinent implementation. In the latest policies and action plans at European and national levels, local environmental action is often emphasized. These types of action can involve for example city planning, transportation planning, school-yard size and design, local safety and lighting. The local level has also been important from the more traditional public health nutrition perspective, where focus has often been on access to good food, food stores, restaurants, school meals and a meal service or delivery system for elderly.
Residential environments and their importance for health
A favourite paper of the Editor-in-Chief of this journal is the one by Ana Diez-Roux, published in 2003(Reference Diez Roux1). This paper discusses the importance of residential environments from a cardiovascular risk perspective, providing a schematic overview of factors of importance, from physical environment to social. The presence of safe roads for biking and walking, nice areas for outside play and city planning on the whole in relation to where food stores are located are important factors. Having a good local social network is also of immense importance for health and this can be improved by the way a local community is set up and functioning. We need to be reminded of how public health is so closely interlinked to what our home environment looks like. The schematic outline in Dr Diez-Roux's paper(Reference Diez Roux1) is especially well suited for starting up a discussion on the local angle of public health nutrition.
The time has come to dig out the old term ‘community nutrition’ and evaluate what we have learnt about local action since the 1980s, when community nutrition was in fashion.
The Ottawa Charter
The good old Ottawa Charter for Health Promotion, first published in 1986(2), lays out a number of factors that are prerequisites for health, including peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. It also defines what health promotion action actually means, and defines the following parts: building a healthy public policy; creating supportive environments; strengthening community actions; developing personal skills; reorienting health services; and moving into the future. This definition places much of the responsibility for public health in local hands. In several countries, the responsibility for public health action is increasingly being transferred to the local community and this puts new demands on local decision makers and public servants.
The Ottawa Charter can be used as a framework for building healthy communities, as well as healthy nations and a healthy world. Healthy public policy means considering health in the development of all policies at every level, and installing a public health board at the local level to make sure that relevant information, workforce and capacity are available and that the process is kept on track.
Agenda 21
Most of us remember Agenda 21(3) and the environmental development that was inspired by the UN Conference on Environment and Development in Rio de Janeiro in 1992, which actually led to local committees being formed in communities in a large number of countries. This example teaches us that local action can happen on a grand scale, the problem is keeping it sustained. Local action cannot run without fuel like a perpetual motion machine. There is a need for constant inspiration, re-evaluation, updating, workforce development, supervision and political support, the latter independent of party politics, in order to keep it moving.
The CDC approach CHANGE
The Centers for Disease Control and Development (CDC) launched a new approach last year, Community Health Assessment aNd Group Evaluation (CHANGE) – Building a Foundation of Knowledge to Prioritize Community Needs – An Action Guide (4), as part of its Healthy Communities Program. This very nice tool can be used in most communities – sometimes in partnership with local universities or other stakeholders – in order to develop a local action plan building on local needs.
In this issue
Due to the current heartfelt need for examples of local research and action, the editors have identified a series of locally based papers for this issue of Public Health Nutrition. You can read about local monitoring, local interventions and local food store environments, workplace interventions and other useful topics(Reference Adams, Ganiti and White5–Reference Gustafson, Sharkey and Samuel-Hodge17). We hope that you will enjoy the local reading while sitting in your local armchair, eating your local apple, and be further inspired to local action and global publishing.
