Category Archives: Public health

Dec 30 2013
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YOUR Favorite Blog Posts of 2013 – Part One

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.

A Closer, More Dispassionate Look at Obesity  RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.

A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place  In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.

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Dec 16 2013
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Explaining the Link between Income, Race, and Susceptibility to Kidney Disease

Deidra Crews, MD, ScM, an alumna of the Harold Amos Medical Faculty Development Program (2009-2013), was named the 2013-2015 Gilbert S. Omenn Anniversary Fellow at the prestigious Institute of Medicine. Among her current research is a study examining the association between unhealthy diet and kidney disease among low-income individuals.

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Human Capital Blog: Congratulations on your fellowship! What are your priorities for the coming year?

Deidra Crews: Over the next two years, I'll be participating in different activities of the Institute of Medicine (IOM). I'll be working with IOM committees and participating in roundtables and workshops. That's the main function of the fellowship. The great thing about it is I'll get to experience firsthand the activities of IOM and hopefully contribute to one or more of the reports that will come out of the IOM over the next couple of years. Because of my interest in disparities in chronic kidney disease, I will be working with the committee on social and behavioral domains for electronic health records, which falls under the IOM board of population health and public health practice. We will be making recommendations on which social and behavioral factors should be tracked in patients' electronic health records.

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Dec 9 2013
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Do Mergers with State Medicaid Programs Result in Cuts to State Public Health Department Funding?

Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW).  Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*

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It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.

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Nov 1 2013
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A Closer, More Dispassionate Look at Obesity

Abigail Saguy, PhD, is an alumna of the Robert Wood Johnson Foundation Scholars in Health Policy Research program (2000–2002). In January, she published the book, “What's Wrong with Fat?”

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Human Capital Blog: You argue in your book that the focus on the “obesity epidemic” obscures a deeper, more important question: How has fatness come to be understood as a public health crisis at all? How do you answer that question?

Abigail Saguy: It’s multilayered. On the deepest level, the fact that we perceive obesity as a public health crisis is related to the fact that fatness, or corpulence, has become an undesirable social characteristic. It has not always been that way, and it is not that way everywhere even today. In many places and times in history, being heavier has been considered a positive social characteristic, particularly in times and places where food is scarce. This is why, in certain contexts, women or girls are fattened up for marriage; there, the woman’s fatness symbolizes the wealth or status of their families.

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Sep 17 2013
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“Something Must be Done!” A 20th Century Rallying Cry for the Future of Public Health Nursing

Pamela A. Kulbok, DNSc, RN, PHCNS-BC, FAAN, is a Robert Wood Johnson Foundation Executive Nurse Fellow. She is the Theresa A. Thomas Professor of Nursing and a professor of public health sciences at the University of Virginia, chair of the Department of Family, Community, and Mental Health Systems, and coordinator of the public health nursing leadership track of the master’s in nursing program.

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With the recent release of second edition of the Public Health Nursing: Scope and Standards of Practice (American Nurses Association, 2013), now is a perfect time to reflect on the past and look toward the future of public health nursing (PHN). Public health nurses have always focused on improving the health of populations through health promotion and disease prevention. Since the establishment of visiting nursing in Boston and the Henry Street Settlement in New York City in the late 1800s, public health nurses have worked with families and communities in schools and homes, with immigrant populations in industrialized cities, and with rural communities to address challenging social conditions and to promote the health of the public.

It was evident with the founding of the National Organization of Public Health Nurses in 1912 that “something must be done” to prepare nurses with a broader education and emphasis on social conditions and prevention. Today, more than ever before, when health care in the United States is shifting its emphasis from an illness care system to one focused on health promotion and prevention, we need public health nurse generalists and advance practice public health nurses prepared to lead health care reform. 

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Aug 14 2013
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U.S. Needs Primary Prevention, Especially for the Poor and Underserved

Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.  He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.

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With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.

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Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.

It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.

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Aug 2 2013
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Are You Considering a Career in Public Health Nursing?

Marni Storey, BSN, MS, is interim director of Clark County Public Health in Vancouver, Washington, chair-elect of the Washington State Association of Local Public Health Officials, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2013-2016).

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I am often asked if I recommend public health nursing as a career option. My enthusiastic answer is ABSOLUTELY! I have been a public health nurse for more than 25 years and am one of a very few Americans who wakes up every day believing I have the best job in the world. There are many reasons I enjoy this profession, but three important pillars of public health nursing have kept me engaged for more than 25 years, and will keep me enthusiastic for many years to come.

The first pillar is that public health nursing services—including nursing assessment, intervention, and evaluation—are focused on a population, not on individuals. Whether you are interested in women, children, ethnic or cultural groups, or if you are interested in conditions such as HIV/AIDS, communicable diseases or obesity, the strategies used by public health nurses affect entire communities. While challenging, this population focus is also rewarding because, as a public health nurse, you are developing an understanding of an entire group of people or community in order to effectively carry out your nursing duties. This is very different from the individual relationships you develop in other nursing fields. Also rewarding is the chance to witness community transformation as a result of the collective impact of communities working together.

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Jul 26 2013
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One Public Health Nurse’s Full Circle Journey

Cassandra Standifer, BSN, PHN-NFP, is a public health nurse working in the Nurse Family Partnership program in Renton.

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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!”

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Jul 24 2013
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Helping One Person at a Time

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.

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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.

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Jul 22 2013
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The Challenge to Grow the Number of Public Health Nurses

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.

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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.

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