Linking the community and clinical settings

Coming into my clinical nutrition placement I did not expect to find many connections with my other interests of community development and food security. In my previous clinical experience, working in a large hospital, it seemed half the time I was figuring out how much to give someone in their tube feed. One thing I knew for sure was that this calculating side of dietetics is not for me, incredibly important, but not something I enjoyed doing on a regular basis.

What I'm realizing in this current setting is how deeply rooted food security is in  the dietetics profession.  Food security isn't just about the affordability of a nutritious diet, but is also about health literacy, participation, and the availability of nutritious food.

When counselling a client who knows what to eat, but just can't afford to buy food to keep her family healthy, this is a food security issue. As is when an individual does not know how to cook anything but kraft dinner and hotdogs, or someone that is reliant on others for transportation and can't go out to the store to get food on a regular basis.

Of course as a new graduate who's been trained to give diet advice, helping a client come up with solutions is quite challenging. Canada's food guide will only get you so far.

As an outpatient or inpatient dietitian you are working on food security issues at the individual level. I am developing a better understanding of food issues in Moose Factory, but understanding is not always enough. It gets frustrating having to work through limitations imposed by the political, social, and economic environment.

This diagram from the Ryerson University food security program provides a good depiction of how individual nutritional outcomes are shaped by the environment. It is important to have an understanding of how each level impacts nutrition status and eating habits, in order to help someone come up with ideas to overcome these barriers.

While it can be frustrating when you realize the difficulties people face to eat healthy. These limitations, imposed on us by our environment, force people to become creative problem solvers, and aiding a client navigate these challenges can be a rewarding experience.

The importance of advocating for clients, and developing programs in the community is important. To move forward as a profession, and affect healthy change, dietitians need to blur the line between the "clinical" and "community" settings. This will foster creative solutions to the complex issues we face in our food environment.

JK