Elsevier

Nutrition

Volume 17, Issues 7–8, July–August 2001, Pages 594-599
Nutrition

Applied nutritional investigation
International perspectives: the profession of dietetics

https://doi.org/10.1016/S0899-9007(01)00565-2Get rights and content

Abstract

A survey about the professional characteristics of dietetics practice was mailed to 109 countries and representatives from 61 countries responded. Using the Human Development Index (HDI), a measure that reflects the life expectancy, education, and income of the population of each nation, countries were categorized as high, medium, or low HDI. This allowed comparisons among the HDI scores in the areas of education, professional practice, education, and practice competencies. Responding countries were 36.1% high HDI, 49.2% middle HDI, 8.2% low HDI, and 6.6% were unclassified. Dietetics was a nationally recognized profession in 81% of countries, with most having a professional association that represented dietitians. Clinical dietetics was the most frequently selected area of practice, followed by food service. Undergraduate academic programs in dietetics were available in 79% of countries and 49% offered graduate degrees. Most respondents rated competencies in clinical and community nutrition, along with competencies in professional practice, as important to their work. The results of this study can serve as a baseline as the profession evolves. Leaders in the dietetics profession can use these results to identify areas that need improvement. Collaboration with the United Nations family and sources that fund global initiatives can help in providing resources for the advancement of the profession. When the effectiveness of dietitians is improved, favorable changes in nutritional well-being on the global level can be expected.

Introduction

Assessing the degree of professionalization of dietetics on the international level is an important topic for dietetic leaders. These results will provide dietetic leaders with insight into the degree of organization within the field, along with strengths and weaknesses. Ultimately, if the effectiveness of dietitians can be improved and if the profession advances, this will increase the opportunities for dietitians to meet the overall goal of helping to improve health and well-being around the world. Another reason to study the degree of professionalism is to document the state of dietetics in the beginning of the year 2000. This study is unique. No other studies in the scientific literature used quantitative methods for assessing the degree of professionalization of the field of international dietetics.

There is a positive association with high-functioning, healthy nations and proper nutrition.1 Ill health caused by improper nutrition decreases the productivity of a nation’s citizens, leading to tremendous human and financial costs. The World Health Organization (WHO) considers nutrition so important for reaching global health goals that nutrition has been included in three of eight health-priority areas for 2002 to 2003. These areas are maternal health, cardiovascular disease and diabetes, and food safety.2 The overpowering need for nutrition intervention has been well documented (Table I). Dietitians have the knowledge and skills to address all of these nutrition problems.3 Nutrition experts, especially those working in public health, have been trained to assess, develop, design, implement, and evaluate strategies for preventing and solving malnutrition problems (including over- and undernutrition).4

The field of dietetics is a young profession compared with other fully established professions such as clergy, medicine, and law.5 In the United States, dietetics has existed for fewer than 100 y.6 In some developing countries, the dietetics profession is very new to non-existent.7 Fortunately, over the past five decades, channels of communication with dietetics and nutrition leaders of other countries have been established (e.g., the International Congress of Dietetics and the International Union of Nutrition Sciences), but the effectiveness of these channels is limited as dietitians face a host of significant barriers for providing solutions to nutrition problems.

Some of these prominent hurdles are lack of resources, cultural obstacles, and lack of academic programs.7 Another barrier is gender inequality. Because the dietetics professional is predominantly female, the status of dietitians in a male-dominated world is limited.8 In addition, home economics was the origin of the dietetics field. That history has led to a traditional association with dietitians being food-service managers of hospital kitchens rather than highly educated members of a health care team.6 The consequences of these barriers are lower professional status and lower monetary compensation than for other female health professionals with similar levels of education and training.9 Two other significant challenges are lack of recognition of nutritional expertise by other health care professionals and encroachment of other disciplines over the control of nutrition-related work.6, 7, 10 Dietitians have recognized their important contribution to the goal that humans have the right to have food and be well nourished.3 However, because of some of these barriers, it has been difficult for dietetic professionals to play major roles in improving world nutrition problems even though dietetics is the only discipline that focuses solely on nutrition.3

Section snippets

Study design

A cross-sectional survey design with descriptive analyses was used to assess dietetic professionalization on an international scale. Study participants were dietetics professionals (licensed, degreed, or possessing a nutrition specialty conferred by a university) who were identified by dietetics organizations, researchers, and staffs of international organizations. The primary outcome of interest was to describe and compare core elements of professionalization in the field of dietetics

Respondents

Almost one-third of all countries was represented in the current study (61 of 190).17 Countries with respondents are listed according to the descending HDI values in Table II. With regard to the HDI, 36.1% of respondents were from countries categorized as high HDI, 49.2% from those categorized as middle HDI, and 8.2% from those categorized as low HDI; 6.6% were not classified.

Countries from all six WHO regions were represented: 14.9% from Africa, 29.5% from the Americas, 37.7% from Europe,

Conclusion

Dietitians in leadership roles may find the study results and recommendations useful in providing a basis for planning future directions to strengthen the profession. It is important for leaders in the dietetic profession to collaborate with other agencies that can promote favorable political will and provide resources. Proper nutrition is more than supplying food; it is making sure that the nutrition intake of the population is such that citizens can fulfill their human potential. Improved

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