Category Archives: Public health
Cassandra Standifer, BSN, PHN-NFP, is a public health nurse working in the Nurse Family Partnership program in Renton.
When I think about public health, I don’t think only of my nursing practice. I think about where I came from and how I got here. When I sit with my clients I can see in their situations my own mother, my aunt, my cousins and myself.
I work with first-time teen moms in a program called the Nurse Family Partnership. Today I met my client, Sarah*, at her transitional housing. As I sat outside waiting for her, I thought back to 1990 when I was seven years old and living with my mother and sister in transitional housing. My mother was addicted to cocaine and attempting recovery—again. Transitional housing was an improvement from the hotel we had been living in, but I was well aware, even then, that there had to be something better out there than this halfway house.
During our home visit we chatted about Sarah’s daughter. She exclaimed, “She has eight teeth on the bottom and eight teeth on the top, no cavities!”
Anneleen Severynen, RN, MN, PHN, is a public health nurse working on the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State.
I work as a public health nurse on King County’s mobile medical unit, traveling south of Seattle in a van, providing for the health care needs of homeless individuals. I perform many “nursing” tasks in my job – taking blood pressures, getting health histories, dressing wounds. But my most important nursing skill is my ability to listen.
This morning I met Charlie. Charlie is a 60-year-old Native American man who reported that he began drinking at age 12, while being passed around to various foster families.
At 17, he went to Vietnam to get away from abuse and neglect, only to be traumatized further by the war.
He called himself a “lost cause” and said he would probably never stop drinking, and knows that he “will die soon.” As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.
Lisa Campbell, DNP, RN, APHN-BC, is an associate professor at Texas Tech University Health Sciences Center, and director of Population Health Consultants, LLC in Victoria, Texas—a company that works to build human capital to improve population health. She serves as newsletter co-editor for the American Public Health Association, Public Health Nursing Section.
With 36 percent of the public health nursing workforce reporting age 56 or older, according to the new report from the Robert Wood Johnson Foundation, strategic planning by state and local health departments must include creative strategies to recruit. In order to increase the numbers of nurses in public health, hiring practices will require a paradigm shift. Public health nurses new to the field bring a unique perspective that will assist in bridging the gap between public and private partnerships. Furthermore, public health is charged with adaptive practice innovations to implement programs outlined in the Affordable Care Act. To illustrate this point, I would like to share my public health nursing journey.
I decided to become a public health nurse after being a nurse practitioner for more than 25 years. When I embarked on this journey, I had no idea where it would take me.
Laura Anderko, an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows (ENF) program (2005-2008), received a prestigious honor from the White House last week for her work to protect health in a changing climate.
The Robert and Kathleen Scanlon Endowed Chair in Values Based Health Care at the School of Nursing & Health Studies at Georgetown University, Anderko was named a “Champion of Change” by the White House. On July 9, she and 10 other “champions” who work at the intersection of the climate and public health attended an event with top government officials to discuss their work.
Anderko, PhD, RN, said in an interview that she was “honored, thrilled, and surprised” to receive the recognition and added that the honor will help raise awareness of the health implications of climate change. My hope, she said, is that this award helps this issue gain “more prominence in the minds of society, not just in America, but globally.”
The ENF program had a “huge impact” on my career, she added. It allowed me to “really immerse myself in environmental health” and taught me to “think big and consider unusual and unlikely partners”—a theme she addressed during the July 9 event at the White House.
“Champions of Change” are recognized by the White House for their work in a wide range of fields. The program was created as an opportunity for the administration to recognize American individuals, businesses and organizations that are “doing extraordinary things to empower and inspire members of their communities.”
“Laura Anderko is making strong efforts to change her community’s ways on treating the environment and is leading the way on climate and health,” a White House release stated.
Learn more about Champions of Change here.
Six libraries in downtown Tucson, Arizona, have some unexpected new employees: public health nurses. In what many believe to be a first-of-its-kind program, Pima County libraries teamed up with the county Health Department to start a jointly-funded “library nurse program.”
Libraries across the country often serve patrons living without shelter, health insurance, medical care or computer access, the Arizona Daily Star reports. As the need for health care and social services has grown in recent years due to a faltering economy and high unemployment, leaders in Pima County were inspired to provide more than just books to their patrons.
Now, five Pima County public health nurses divide the equivalent of one full-time public health nurse position among themselves, working weekdays at six local libraries. The nurses wear stethoscopes so they can be easily identified, but mostly provide health education and referrals to other health care resources in the area rather than actual medical care.
In addition to helping patrons get the health information they need, the program has also reduced the number of 911 calls from the libraries, “partly because nurses trained library staff to recognize when behavioral issues are escalating and to intervene appropriately,” Nurse.com reports.
“If I weren’t here, I think a lot of these individuals would fall through the cracks,” Daniel Lopez, one of the “library nurses” told Nurse.com. “I can open doors for them and they can walk on through. Overall, I think it makes for a healthier Pima County.”
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the final of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Addressing Social Determinants of Health: Given the current state of the clinical delivery system, it may seem unrealistically burdensome to ask health care institutions to address the social determinants of health (SDH). “In this country it’s an accomplishment if you can reward value for delivery,” noted Arnold Milstein, MD, MPH, “and social determinants approaches are a step or two beyond that.”
Examples of clinical engagement in social determinants, however, can be quite impactful:
· Lloyd Michener, MD, and Bob Lawrence, MD, described how Duke and Johns Hopkins both invested in SDH initially in order to repair or promote their public image. For example, Duke invested in some SDH programs and community partnerships in part to help repair their image in the setting of poor relationships with a minority, low-income community in Durham—though these investments have grown into more lasting partnerships.
· David Stevens, MD, pointed out the example of the 16th St Community Health Center in Milwaukee, where an environmental wing of the health center was created to combat lead poisoning—and then expanded over years into broader projects, such as combatting brownfields and creating green spaces for exercise.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the fourth of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
The Role of Primary Care and Clinical Incentives: Most discussants agreed that primary care and the patient-centered medical home (PCMH) movement are important foundations upon which to build broad-based population health activities. While acknowledging that these systems are already over-burdened with clinical responsibilities—and that current incentive structures are poorly aligned to accomplish this goal—many cited the degree of overlap in the missions of primary care and public health institutions as a starting point.
Community Care of North Carolina (CCNC), for example, evolved slowly and steadily over 25 years from a clinical quality network to a statewide multi-sectoral public-private partnership based on the PCMH. Allen Dobson, MD, described the key components as: the formation of cooperative provider networks; introduction of population management tools; case management; and data infrastructure with rapid feedback to providers. “Community Care is bottom-up and physician-led with respect to quality improvement…but because the collaboration includes the public health department, we are also looking at population metrics regardless of whether or not we’re managing that population.” Financing is organized using flexible per-member-per-month allotments that allow networks to put resources into quality measurement. Dobson cited external evaluations demonstrating that the overall project is cost-saving, with CCNC responsible for nearly $1.5 billion in lower costs from 2007-09.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the third of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Local and State Health Department Collaboration: Most discussants agreed that clinical systems and health departments use different notions of ‘population’—and historically are not well integrated. As David Stevens, MD, noted, “There’s capacity that needs to be built on a common language on how to work together that isn’t there because they've been separated so long.”
There was, however, a prevailing notion that this dynamic is changing in important ways. Many cited the convergence of IRS Community Health Needs Assessment (CHNA) requirements and new public health accreditation standards as a potential blueprint for future collaborations. Clinical delivery systems, generally well-resourced but with limited community assessment and intervention skills, are now responsible for conducting a CHNA every three years while developing and implementing an action plan to address identified needs.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the second of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Challenges in the Urban Context: Discussants converged upon care fragmentation and community diversity as the most difficult challenges associated with working in urban settings. There may be enormous heterogeneity within populations in urban areas with respect to racial, ethnic, and sociodemographic characteristics. Subgroups may vary with regard to exposures, behaviors, and values. The sense of community that can be essential to leveraging social groups may not necessarily be present or uniform throughout a geographic area, necessitating multiple tailored communication strategies. Even between cities, there is significant heterogeneity, such that non-clinical interventions may be less transferable than, say, a chronic disease model.
Communities that do exist may not necessarily conform to geographic boundaries, and the geopolitical boundaries and layers of jurisdiction in place may mean little to those communities. This changes how confident clinical systems can be for outreach and aspects of care that might reach beyond the office, and in general it can be particularly challenging to know what services are being provided for a patient, where, and by whom. This accountability problem makes it easier for high-risk patients to fall through the cracks.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders* in primary care and population health. In the first of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Defining Population Health: Many discussants cited the definition of population health developed by David Kindig, MD, PhD, as a reference point: “health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Regardless of specific vantage point, there was a generally shared sentiment that population health should be thought of broadly and in common terms by a range of clinical and non-clinical stakeholders.
More discussants described a baseline framework of a clinical delivery system oriented around patients in a practice, in contrast with a public health system oriented around geographic communities. A more clinical, or “population medicine,” perspective often centered around evidence-based interventions and disease management categories so as to triage and allocate health care resources in a cost-effective manner.