Public Health and Epidemiology

This research book presents a critical analysis of mandatory food fortification as a technology for protecting and promoting public health. Increasing numbers of foods fortified with novel amounts and combinations of nutrients are being introduced into the food supplies of countries around the world to raise populations’ nutrient intakes. Three topical food fortification case studies representing the different public health rationales for adding nutrients to food were assessed for their public health benefits, risks and ethical considerations: Universal salt iodisation (USI) to help prevent iodine deficiency disorders; mandatory flour fortification with folic acid (MFFFA) to help prevent neural tube defects; and mandatory milk fortification with vitamin D (MMFVD) to help prevent vitamin D deficiency. These assessments found that whereas USI performs strongly as a public health intervention, MFFFA and MMFVD are associated with more risks and less ethical justification than an alternative policy option. Food fortification can be a blunt policy response to complex policy problems. The findings highlight that the primary predictor of a mandatory food fortification policy’s benefits, risks and ethics is its ability to address the underlying cause of the policy problem. The analysis of the policy-making processes for each case study found that certain powerful actors use their influence to determine what counts as evidence in policy processes to privilege food fortification activities over alternative policy options. Policy-making frequently was notable for the low prominence it afforded ethical considerations and its lack of public engagement. Priority activities to help strengthen policy processes and outcomes are suggested.

Health Impact Assessment (HIA) is a process which helps decision making by predicting the consequences for health of choosing different options in terms of policies, plans, and projects. There is growing interest among health professionals, planners, and politicians in using HIA to help safeguard and improve the health of populations and reduce health inequalities. This book explores the past development of HIA, its current practice, and possible future. Written in two parts, the first section provides an overview describing the various ways in which an HIA can be done. Practical in emphasis, it describes how HIA can be applied in different contexts to meet the needs of different decision makers and answer a variety of questions. It deals not only with the many good reasons for using HIA but also critically examines the weaknesses of current practice. The second part consists of chapters demonstrating the various pressures and legislative frameworks that have shaped the evolution of HIA. The aim is to illustrate the range of views about the reasons for doing HIA and how it should be done, and to reveal how the practice of HIA has been adapted to suit different cultures and help decision making in varying situations.

This book is about the complex relationships between diet and risks of important diseases, such as cancer and cardiovascular disease. The book starts with an overview of research strategies in nutritional epidemiology—still a relatively new discipline that combines the vast knowledge compiled by nutritionists during this century with the methodologies developed by epidemiologists to study the determinants of diseases with multiple etiologies and long latent periods. A major section is devoted to the methods of dietary assessment using data on food intake, biochemical indicators of diet, and measures of body composition and size. The reproducibility and validity of each approach and the implications of measurement error are considered in detail. The analysis, presentation, and interpretation of data from epidemiologic studies of diet and disease are explored in depth. Particular attention is paid to the important influence of total energy intake on findings in such studies. To illustrate methodological issues in nutritional epidemiology, the relationships of dietary factors to the incidence of lung and breast cancer, heart disease, and birth defects are examined in depth. This new edition, in addition to updating existing chapters, includes new chapters on assessment of physical activity, nutrition, and genetic epidemic ology, and the role of nutritional epidemiology in policy.