24th National Dietitians Association of Australia: lecture in honour of Joan Mary Woodhill OBE.

INTRODUCTION

Campfire stories, oral histories and cultural narratives are important components of social cohesion and continuity. The lecture in honour serves this purpose by recognising professional leadership, seen through its impact on those that follow. As with all leaders, there are many tributes to Dr Woodhill, but the themes drawn out here relate to observations that influenced my own career in nutrition and dietetics and remain highly relevant today.

A BRILLIANT CAREER

A number of DAA publications (1,2) provided the details that follow on Dr Woodhill's life. Born in Camden NSW in 1912, and raised on the South Coast, Joan Woodhill was early on a trailblazing woman for her time, gaining a degree in Agricultural Science from the University of Sydney. She was unemployed at first, but then her mother attended a meeting addressed by Edith Tilton the Dietitian from Sydney's Royal Prince Alfred Hospital and Joan's mother encouraged her to consider dietetics. It is worthwhile noting that on her marriage Edith was required to leave the hospital, so in those days women had to choose between family and career. In 1937 Joan undertook an apprenticeship training course in dietetics at RPA and in 1939 won a Carnegie scholarship for a study tour of England, the USA and Canada, did a short course at Columbia University and joined the American Dietetics Association (ADA). She returned to become secretary of the newly formed Dietetic Association of NSW and in 1942 was appointed to represent the National Council of Women on the NHMRC. By 1944 she was a signatory to the memorandum of the NSW Institute of Dietitians, a quasi-registration body, reflecting her hard work within the Department of Health. Notwithstanding these were the years of World War II, her mark was made on her new found profession.

With the mentoring she received through the ADA Joan Woodhill returned to the USA and undertook an MSc from the University of Minnesota, followed by a DSc in Nutrition and Pregnancy achieved in 1951 from the Harvard School of Public Health. Her counsellors there were Professor Frederick Stare and Dr Bertha Burke, of Diet History fame. (3) These years left her with a strong sense of internationalism, a significant attribute in things to come, not least being her work with the FAO in 1960 training Iraqi women in Baghdad to conduct dietary surveys in the villages. She justly received the Order of the British Empire in 1973 in recognition of her work in nutrition. With Una Venn Brown she represented Australia at the International Congress of Dietetics (ICD) in Stockholm in 1965, and consequently chaired the ICD in Sydney in 1977. This reflected a pattern of setting international benchmarks for dietetics in Australia. Her contribution to the profession was officially recognised with an Honorary Life Membership to DAA in 1983.

On her return to Australia in 1952 Dr Woodhill worked at the Royal Newcastle Hospital setting up dietetic training programmes, and 10 years later took up a research position with the Department of Medicine at the University of NSW, later to chair a new Division of Nutrition and Dietetics in 1970 until her retirement in 1977. It is this last part of her career that I would like to focus on, because this is where I came in.

INTRODUCING THE NEXT GENERATION

Soon after Dr Woodhill returned to Australia I came into the world. My generation of women was allowed to have paid employment and marry, although other barriers remained. Women were not necessarily encouraged to go to university, but teachers urged me study the new science of biochemistry. Through Dr Woodhill's programme 1 received a dietetics cadetship from Sydney's Prince Henry, Prince of Wales and Eastern Suburbs Hospitals group enabling training as a dietitian during university session breaks. It was a wonderful professional upbringing, with introductions to dietary intervention research in cardiovascular disease prevention (see the study by Woodhill et al. (4)). Dr Woodhill also worked on vitamin research and helped to set up the first dietetic clinics at Wollongong Hospital on the south coast. Her powerful mentoring extended to introductions to dietitians from overseas who came to work with us, and the ICD in our first years of practice. In time, I did get married and have children, and instead of going to Minnesota I went to Africa and took some lessons in life.

COMPARING CAREERS

How did my professional life span out with formal barriers removed but the reality of other contingencies? I learnt a lot in Africa and came home ready to take on the challenge of one of the new community nutrition positions set up by policy changes towards prevention in health care. Recognising the need for new knowledge and skills I did a masters degree at the WHO Regional Training Centre at UNSW, and produced my first formal publication. (5) With a different form of practice and a new degree enabling me to describe it, I moved into the competency development area, a milestone in contemporary dietetics as it helped to define our identity and build our future. As it should be, this research has been published, (6,7) and the baton for that early work has been passed onto others. The natural extension of this work was to go into teaching, and in 1990 I was involved in setting up the first new course in NSW at the University of Wollongong. With the background of competency standards and committed professionals, dietetic training has gone ahead in leaps and bounds across the country, to the credit of pioneers who trained us such as Joan Mary Woodhill.

The academic role also required new knowledge and skills, this time in formal research. The challenge was how to do this in a brand new faculty with a full teaching load and preschool-aged children. Much of my time was spent in clinics teaching students counselling skills yet I needed more evidence for what we were teaching. I built my thesis around data from these clinics using a disciplined form of social research known as conversational analysis, made possible through collegial connections in the UK, USA and Finland. I found that the dietetic interview in this context could be reliably described and thereby taught from a valid theoretical position, publishing no less than Dr Woodhill would have expected of me. (8-11)

The next phase was strongly influenced by Professor Len Storlien who shared a vision of practice with Dr Woodhill of one underpinned by strong science. We did substantial work in Europe with the KANWU group, (12) and in China through an AUSAid China Links grant. (13) I translated my knowledge of the dietetic interview to the context of the research clinic, and value-added to these trials through contributions to design and with measurements of dietary change. This brought me into the realms of dietary methodology, and the opportunity to work with students in building this knowledge base in the profession. (14,15) The final stage in this development involved running our own dietary trials, asking questions of interest to dietitians. (16) A critical observation in one of our trials was that low-fat dietary advice did not translate into ideal fatty acid intakes. In fact the famed P : S ratio of the diet likely suffered. Working with food analyses we confirmed that advice on the right kind of fat-rich foods was critically important if we are to achieve what we think we are achieving. (17)

These stages represent the development of track record, enabling a place for dietetic studies in the next level of research endeavour, the research centre. Notice that I now use the word 'we', because this kind of work can only be achieved through a team. We lead the Clever Cuisine programme of the ARC Key Centre for Smart Foods and undertook studies substantiating the effects of food situated in dietary models based on a clear understanding of the food-nutrient interface. Our research designs clearly targeted translation to practice, but they were also very relevant to the emerging science of substantiation of health claims on food. (18)

With steady and continuous productivity, we extended our linkages further, into what is today the National Centre of Excellence in Functional Foods. Part of the National Food Industry Strategy, (19) NCEFF is a collaboration of CSIRO, the Department of Primary Industries Victoria and the ARC Key Centre for Smart Foods at the University of Wollongong. The Foods for Life programme works on a platform of research underpinning foods addressing requirements during the life cycle, and the Centre's scope links science with market trends, regulatory requirements and company capability to deliver. (20)

REFLECTIONS

There were a number of lessons learnt on this professional path. The first is that of interdependence. I heard this term used by President Bill Clinton at the BIO 2006 meeting in Chicago. I heard that in this multicultural context we need to protect against divisiveness by working towards shared values, shared contribution and shared effort responsibilities. Our various work contexts lend themselves well to this goal. Our conference programmes reflect our own multiculturalism, seen in diversity of practice such as taking action to govern children's access to food to addressing the problems of human metabolism. With a commitment to evidence-based practice at all levels, there is so much we can achieve.

The second learning follows then as a commitment to science. We now have research leaders in nutrition and dietetics across the nation, building teams, and passing on the baton as new research graduates emerge. We have tools such as our journal, Nutrition & Dieteics, providing avenues for research outputs and intellectual engagement. The move to online publication with Blackwells, the inclusion of the New Zealand Dietetics Association journal and the publication of these conference abstracts are all giant steps forward. We are building capability as we go with new trained researchers taking active roles on the journal editorial board, and then working in partnership with the conference scientific programme subcommittee to provide the necessary peer review process for these abstracts. The types of manuscripts published in the journal provide opportunity from across levels of experience and practice, for the price of commitment to scientific rigor.

All of this leads to building the profession, a third important lesson. If we have doubts then let us remember the words of a poem (21) used in the inaugural speech of another great statesman, Nelson Mandela: (22)

  Our deepest fear is not that we are inadequate.

  Our deepest fear is that we are powerful beyond measure. It is our
  light, not our darkness that most frightens us. We ask ourselves, 'Who
  am I to be brilliant?' Actually who are you not be?

Reflecting on all the above we can see the path of career development in nutrition and dietetics is both exciting and challenging. We can, and should, all contribute to the profession depending on the stage of our lives and the relative constraints and opportunities. Contributing to the management of the organisation through committees and activities is essential. It is important to start early and keep doing it. The organisation needs its members, and the benefits are tremendous.

FINALE

The last few times I saw Joan Woodhill were at functions hosted by Jo Rogers for the joint meetings of DAA-NSW and the NSW Institute of Dietitians, and I recall a number of things. First, she would greet me with warm motherly hugs, an expression of her essential humanity and kindness more formally presented in the work environment. Second, she would tell me of the disappointment with emerging health problems, and how old she was. I recall her emphasising it, 'Linda I'm 73 years old!'--I still didn't get it, she was Joan Woodhill and she would live forever. But death came suddenly in December 1990. The last time I saw her was the 1990 function, the year we started the dietetics course at Wollongong in the region of her childhood. She asked me how we were going, and I told her the course was accredited. She stood tall and she said these three words, 'good on you'.

Joan Woodhill passed on a lot of batons to a lot of people. For me it was a commitment to science, an international outlook and loyalty to the profession. I hope I have passed a few batons around now too and, God willing, in 20 years time, I hope you can tell me of how you have built this profession so I can stand tall and, with that same smile on my face say, 'good on you'. Ladies and gentlemen I give you Dr Joan Mary Woodhill.

Linda Tapsell, PhD, FDAA 

Editor, Nutrition & Dietetics

Director, National Centre of Excellence in Functional

Foods, University of Wollongong, Wollongong, New South Wales, Australia

REFERENCES

1 Venn-Brown U. Joan Mary Woodhill, OBE, BScAgr, MS, DS, AID, MDAA 1912-1990 (Obituary). Aust J Nutr Diet 1991; 48: 34-5.

2 Nash H. The History of Dietetics in Australia. Canberra: DAA, 1989; 29-30.

3 Burke BS. The diet history as a tool in research. J Am Diet Assoc 1947; 23: 1041-6.

4 Woodhill JM, Palmer AJ, Leelarthaepin B, McGilchrist C, Blacket RB. Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Adv Exp Med Biol 1978; 109: 317-30.

5 Tapsell LC, Tranter D. Food fables: a community nutrition education program incorporating nutrition surveillance. In: Truswell, AS, Wahlquist, ML, eds. Food Habits in Australia. Ch 32. Victoria: Rene Gordon, 1988; 371-80.

6 Phillips S, Ash S, Tapsell LC. Relevance of competency standards to entry level practice. Aust J Nutr Diet 2000; 57:198-207.

7 Phillips S, Ash S, Tapsell LC. Dietitians' views of the current competency standards for entry level dietitians. Aust J Nutr Diet 2000; 4: 190-97.

8 Tapsell LC. Dietetics as everyday practice: an approach to research. Aust J Nutr Diet 1997; 54: 82-7.

9 Tapsell LC. Client centred practice: an interactional case study in dietary counselling. Health 1997; 1: 107-20.

10 Tapsell LC. Using conversation analysis to teach novice dietitians history taking skills. Hum Stud 2000; 23: 281-307.

11 Tapsell LC, Brenninger VL, Barnard JA. Applying conversation analysis to support accurate reporting in the diet history interview. J Am Diet Assoc 2000; 100: 818-24.

12 Vessby B, Uusitupa M, Hermansen K et al. Reducing saturated fat in the diet improves insulin sensitivity in healthy men and women-the KANWU study. Diabetologia 2001; 44: 312-19.

13 Wang Y, Storlien LH, Jenkins AB et al. Dietary variables and glucose tolerance in pregnancy. Diabetes Care 2000; 23: 460-64.

14 Tapsell LC, Pettengell K, Denmeade SL. Assessment of a narrative approach to the diet history. Public Health Nutr 1999; 2: 61-7.

15 Martin GS, Tapsell LC, Batterham MJ, Russell KG. Relative validity of a diet history interview in an intervention trial manipulating dietary fat in the management of type II diabetes mellitus. Prev Med 2003; 36: 420-28.

16 Tapsell LC, Gillen LJ, Patch CS et al. Including walnuts in a low fat/modified fat diet improves HDL: total-C in patients with type 2 diabetes mellitus. Diabetes Care 2004; 27: 2777-83.

17 Gillen LS, Tapsell LC. Structured dietary advice incorporating walnuts achieves optimal fat and energy balance in patients with type 2 diabetes mellitus. J Am Diet Assoc 2005; 105: 1087-96.

18 Aggett PJ, Antoine JM, Asp NG et al. PASSCLAIM: consensus on criteria. Eur J Cln Nutr 2005; 44 (Suppl. 1): i5-30.

19 National Centre of Excellence in Functional Foods. (Cited 12 Jul 2006.) Available from URL: http://www.nceff.com.au

20 National Food Industry Strategy. (Cited 12 Jul 2006.) Available from URL: http://www.nfis.com.au

21 Williamson M. Return to Love. (Cited 12 Jul 2006.) Available from URL: http://skdesigns.com/internet/articles/quotes/williamson.html

22 Mandela N. Inaugural Speeches. (Cited 12 Jul 2006.) Available from URL: http://www.newgenevacenter.org/biography/mandela2.htm