Shifting the conversation: Incorporating equity into Nutrition Month
This blog is part of a series on public opinion and communicating about the social determinants of health and health equity.
Guest bloggers Christine Johnson (health equity lead) and Karen MacKinnon (nutritionist) work with the Healthy Communities team of the Public Health program at the Nova Scotia Health Authority.
Nova Scotia Public Health’s Health equity protocol  encourages our system to build capacity among public health practitioners “to understand the principles of health equity and social justice, to develop critical analysis skills, and to apply health equity approaches and tools.” 
Shifting the conversation: A focus on the social determinants of health,  a resource I (Christine Johnson) developed when I worked with the Guysborough Antigonish Strait Health Authority (GASHA), was developed as one component of my position as health equity lead. This practical tool is designed to support staff as they shift their own ways of thinking and speaking about health equity issues and to mobilize health equity–focused communications.
As part of Public Health Eastern Zone’s overall strategy to support health equity–focused communications, in 2016 our team engaged in staff workshops to enhance public health practitioners’ understanding, knowledge and skill related to communicating about health equity. This included reflective discussions to learn about experiences using the tool and opportunities for further work.
In recognition of National Nutrition Month, which occurs annually in March, this blog post will highlight work done by public health nutritionists in the Eastern Zone of the Nova Scotia Health Authority to apply a health equity lens to their Nutrition Month communications.
Shifting nutrition communications
As a dietitian who has worked in public health for over 15 years, I (Karen) have always felt that campaigns like Nutrition Month focused too heavily on individual behavior. The emphasis seems to be on how someone can improve their diet versus what creates the environment that shapes how people eat in the first place. So many factors outside of an individual’s control are often overlooked.
For example, do people have enough money to purchase a nutritious diet? Do they have to travel far to access a grocery store? These are only two examples that illustrate how individualized messages fail to recognize the complexity of actually being able to follow well-intended recommendations. This is meant to demonstrate how connecting nutrition concerns to social determinants of health such as poverty can highlight solutions that help address barriers to healthy eating.
With this in mind, our team of public health nutritionists aimed to create health equity focused communications for Nutrition Month.
Understanding our audience
Our audiences and modes of communication have varied over the years, and have included:
- dietitians in various areas of practice;
- public health practitioners; and
- community-based partner organizations.
Knowing our audience and the predominant ways of understanding and viewing an issue like nutrition and healthy eating helped us to understand where to start our messaging and where we needed to provide evidence and emphasize expanded thinking about what supports healthy eating and what does not.
We used various methods that we thought would reach and resonate with different audiences, such as direct staff communications, social media and newsletters.
Unlocking the potential of food
For example, the Dietitians of Canada Nutrition Month theme for both 2018 and 2019 is “Unlock the Potential of Food” and focuses on how individuals can use food to become healthier. As nutritionists, we used the health equity communications tool to think about how we could expand this message to focus on upstream factors influencing a population’s ability to improve health, fuel activities and bring people together.
For example, in our communications we highlighted the fact that, while people need access to healthy nutritious food, access to food is not equitable and most often depends on income.
Another example included using research to challenge the myth that people living on low incomes don’t know how to cook or don’t budget. This understanding is used to support a focus on solutions that address inadequate income as a root cause of unhealthy eating, which will have greater impact for people experiencing food insecurity than programs teaching cooking and budgeting skills.
The Shifting the Conversation communications resource was very helpful in this work because it helped us think about how we could change our messages around Nutrition Month to focus on the social determinants of health and provide the health equity lens that our messages often need.
What we learned
Overall, it appears that the Shifting the Conversation tool has seen some success in increasing understanding and skill to support health equity–focused communications within public health.
When first starting, it can be quite challenging to shift dominant communication practices. Nutritionists on our team learned that while many colleagues were supportive, not everyone appreciated the critical shift to health equity focused messaging. This resistance was expected and it reinforced the need to challenge the established messages and practices that are not reflective of the realities of those experiencing inequities in health.
Moreover, using the Shifting the Conversation tool in discussions with colleagues gave us time to frame messages for intended audiences and desired outcomes, as well as reflect on the experience of incorporating this lens into our work. Continued practice in equity focused nutrition communications has made the practice easier. Overall, the end result was more health equity–related messages for Nutrition Month, collective skill among public health nutritionists in this area and a clearer understanding of specific actions that will support our role in building health equity.
- PROOF website
- Public Health Speaks: Upstream action on food insecurity (2017)
- Upstream action on food insecurity: A curated list (2017)
- Learning from Practice: Advocacy for health equity - Food security (2017)
Photo credit: Thought Catalogue
 Nova Scotia Public Health. Health equity protocol [Internet]. Halifax: Nova Scotia Public Health; [date unknown] [cited 2019 Feb 22]. 4 p. Available from: https://novascotia.ca/dhw/publichealth/documents/05-Health-Equity-Protocol.pdf.
 Johnson C. Shifting the conversation: A focus on the social determinants of health [Internet]. Antigonish, NS: Guysborough Antigonish Strait Health Authority; [date unknown] [cited 2019 Feb 22]. 13 p. Available from: http://nccdh.ca/images/uploads/comments/Shifting_the_Conversation_Communication_Tool_GASHA_(1).pdf.