Sean Whitfield - Active Learning Guide NURS 4530 Community Health Nursing Module 1.1F24 - Complete.pdf

Class Guide N4530 Community Health Nursing Module 1 Public and Population Health Nursing, Thinking Upstream, & History of PHN Module 1: Introduction Welcome to Community Health Nursing! The introduction to this module is a bit long, but caring for populations is new to most nursing students so it i...

Class Guide N4530 Community Health Nursing Module 1 Public and Population Health Nursing, Thinking Upstream, & History of PHN Module 1: Introduction Welcome to Community Health Nursing! The introduction to this module is a bit long, but caring for populations is new to most nursing students so it is important to build the foundations for the rest of the course at the beginning. This course will focus on the community or populations as a whole. The “patient” will expand from the individual to the community or population as a whole. While this usually takes place outside of hospital settings, the setting does not necessarily determine this, for example, most of the time a nurse providing home health is not focused on community health, the focus is on the individual patient- this is community- based nursing. There are home health programs that are population-focused which will be presented later. At times it is difficult to determine because it may look very similar in the clinical areas because communities are made of individuals. So, the determination is where the outcomes are focused. For example, a community outcome would be to “decrease the rate of heart disease by 15% in the next 10 years in Arkansas” or to “increase the percent of the population who receive an influenza vaccination each year in Arkansas”. Objectives: After you complete this module, you will be able to:  Explain the mission, core functions, and essential public health services.  Explain the concepts of population health and case management.  Identify the roles of nursing in public health and in population health.  Identify the impact of the social determinants of health on a population.  Define the historical contributions to public health nursing and the continued impact today.  Differentiate the three levels of practice (individual/family, community, systems). Reading assignment: Ch. 1 & 3, Ch. 2 It is very important to understand what is meant by public health, community health nursing, and population health. Use the introduction to this module and the Nies & McEwen textbook to answer the questions. When a website is provided, use that as well which will also give you credible sites that are important resources for public health. 1. https://www.apha.org/what-is-public-health Watch the video on the front page of this site and look though the site to gain understanding of what public health does. 2. https://usphs.gov/about-us Explore this site for the Commissioned Corps of the US Public Health Service – this will add to your understanding of public health and you can see the nursing roles in the USPHS! 3. Review the discussion of how health is defined in the textbook. Note the change in the WHO definition from 1958 and the update in 1986. The definition was expanded to emphasize what? The definition of health was originally defined in terms of homeostasis. From the point of view of total physical, mental health and the complete absence of disease. In 1986 the the definition of health was changed and updated to include the capability of the person to include and conduct a life that is economically, socially and productive. This production is not focused on self. How is the individual able to contribute to his/her community. This update views health as more dynamic. Health includes things other than physical health. This expanded view of health includes social, economic, physical and mental aspects of life. This update for health also considers the environment the person is in. Is the person and community able to thrive, make good lifestyle choices and achieve well being. 4. Review the discussion of the term community in the textbook. What are the 2 types of communities? Geopolitical communities are those most traditionally recognized or imagined when the term community is considered. Geopolitical communities are defined or formed by natural and/or human-made boundaries and include cities, counties, states, and nations. Other commonly recognized geopolitical communities are school districts, census tracts, zip codes, and neighborhoods. Phenomenological communities, on the other hand, refer to relational, interactive groups. In phenomenological communities, the place or setting is more abstract, and people share a group perspective or identity based on culture, values, history, interests, and goals. Examples of phenomenological communities are schools, colleges, and universities; churches, synagogues, and mosques; and various groups and organizations, such as social networks. 5. Match the term population and the term aggregate to the definitions and examples below: Subgroups or subpopulations with a common characteristic or concern, such as pregnant teens in a school district. Which term does this describe? Aggregate  A group of people with common personal or environmental characteristics or all people in a defined community such as all residents of a small town. Which term does this describe? Population 6. Explore the section of chapter1 focused on the determinants of health and the indicators of health. Think through the determinants of health, such as genetics, and the social determinants of health (SDOH). Explore the sites below to develop a more through understanding of factors that impact health. Go to the Healthy People 2030 site https://health.gov/healthypeople scroll down on the homepage and read more about the SDOH and the leading health indicators (LHI). Note that you will have an assignment using HP and so this is also an intro to this site if you haven’t used it before. 7. Go to the UnNatural Causes site, https://unnaturalcauses.org/ click on The Documentary link, then Watch Clips and watch the Health in America and the Impact of Poverty and Stress on Diabetes among Native Americans. There are other really interesting video clips you might want to check out too! A summary statement from this video is that “health is more than healthcare” that jobs, income, schools, and neighborhoods are as important as our genes, behaviors, and medical care. (note: this is a dated video so the numbers will not be up-to- date but the major points are helpful to understand the SDOH). Health outcomes are impacted significantly by the social determinants of health (SDOH) and are shown in disparities in nearly all health outcomes data, life expectancy, infant mortality, rates of most chronic diseases, etc. If you are from Arkansas, you probably know that the counties in the Mississippi River Delta area are socioeconomically disadvantaged. As you look through reports in the following links to the Arkansas Dept. of Health and County Health Rankings and note disparities in patterns that you see in multiple maps of the state. Click on the State Health Report 2020 and find the maps in the report https://www.healthy.arkansas.gov/programs-services/topics/state-health-assessment- book Red County report by the ADH – look at the maps in the report https://www.healthy.arkansas.gov/images/uploads/publications/Red_County_Report_20 18_Complete_(rev_05-19-2020).pdf 8. Which county in AR has the highest life expectancy? Benton County. The lowest? Phillips County.  What is the difference in life expectancy between these counties in AR? 17 years. County Health Rankings: on this page type in Arkansas into the Find Data by Location button https://www.countyhealthrankings.org/explore-health-rankings look at the health rankings on this map and then scroll down to look at data about the state. 9. What is life expectancy in AR? 74.3% The US? 79.46% What percent of adults smoke in AR? 22% In the US? 15% How many teen births per 1000 female teens in AR? 30% In the US? 17% What percent of children in AR live in poverty? 21% In the US? 16% 10. Now click on the What Impacts Health link. Then Explore Health Topics. According to the CHR model shown on this page what percent of impact on health outcomes do Social and Economic Factors have? 40% The physical environment? 10% So at least what percent of health outcomes in a population is dependent on the SDOH? 50% 11. Now briefly summarize, using what you have learned from these sites and the textbook, ways that the SDOH impact health outcomes? Social Determinants of Health can considerably influence the health outcomes of people due to the many inputs and contributions of the the environment, economics, education and access to healthcare can influence the delta in differences in health outcomes. There are 3 Core Functions of Public Health. List the core function by the definition below: 12. Use of information gathered during assessment to develop local and state health policies and to direct resources toward those polices, is which core function? Policy Development 13. Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community, is which core function? Assessment  14. Focus on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations and the capacity to respond to critical situations and emergencies, is which core function? Assurance 15. Review the 10 Essential Services of Public Health in Box 1.2. They are grouped by the 3 core functions of public health. Box 1.2 Essential Public Health Services Assessment Assess and monitor population health status, factors that influence health, and community needs and assets. Investigate, diagnose, and address health problems and hazards affecting the population. Policy Development Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it. Strengthen, support, and mobilize communities and partnerships to improve health. Create, champion, and implement policies, plans, and laws that impact health. Utilize legal and regulatory actions designed to improve and protect the public's health. Assurance Assure an effective system that enables equitable access to the individual services and care needed to be healthy. Build and support a diverse and skilled public health workforce. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement. Build and maintain a strong organizational infrastructure for public health. In the section of chapter 1, focus of public health and community health, it is noted that actions for public health are done through organized community effort. 16. The term public health includes that it is organized, legislated, and funded by what means? Indeed, “public health nursing” was seen as a subspecialty nursing practice generally delivered within “official” or governmental agencies. Public health  enterprises are regulated, controlled and managed via legislation and funded through taxing the public or another mechanism of funding. 17. Community health extends the realm of public health in that it includes both governmental and private agencies. Give an example of a private agency that works in community health efforts: ◦ American Red Cross (Private Non Profit), works side by side government agencies to improve public health services. ◦ Provides Disaster Relief ◦ Military Family Support ◦ Blood Donation Services ◦ Health and Safety Training 18. Where is the focus of outcomes for public health or community health? The term community health extends the realm of public health to include organized health efforts at the community level through both government and private efforts. Participants include privately funded agencies such as the American Heart Association and the American Red Cross. A variety of private and public structures serves community health efforts. Public health efforts focus on prevention and promotion of population health at the federal, state, and local levels. These efforts at the federal and state levels concentrate on providing support and advisory services to public health structures at the local level. The local-level structures provide direct services to communities through two avenues: Community health services, which protect the public from hazards such as polluted water and air, tainted food, and unsafe housing. Personal healthcare services, such as immunization and family planning services, well-infant care, and sexually transmitted disease (STD) treatment. 19. The following table may be a helpful framework to categorize PH programs. Are they taking place at a local, state, or national level and whether it is a public or private initiative or a partnership between the two sectors. Put an X where a health department vaccine program offering flu shots in the schools each fall would be placed and why. Public Private Local X State National Local: Flu shot programs are organized and rolled out by the local health department that is located within a defined community, section or region. To implement this at the school level this would need to be a localized effort. Public: Due to its funding and management, this will be categorized as a public program. In chapter 1 of the textbook in the section on preventative approaches to health there is a good description of the levels of prevention. Throughout this course we will explore primary, secondary, and tertiary prevention and how the levels are applied. Be sure to study and know these! Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Examples include promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise. Specific protection efforts reduce or eliminate risk factors and include such measures as immunization, seat belt use, and water purification. Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis. Secondary prevention is implemented after a problem has begun, but before signs and symptoms appear, and targets those populations that have risk factors. Mammography, blood pressure screening, COVID-19 testing, and prostate-specific antigen (PSA) tests are examples of secondary prevention. Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Aims of tertiary prevention are to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning. Examples include teaching how to perform insulin injections and disease management to a patient with diabetes, referral of a patient with spinal cord injury for occupational and physical therapy, and leading a support group for grieving parents. Much of public health nursing practice is directed toward preventing the progression of disease at the earliest period or phase feasible using the appropriate level(s) of prevention. For example, when applying “levels of prevention” to a client with HIV/AIDS, a nurse might perform the following interventions: Educate students on the practice of sexual abstinence or “safer sex” by using barrier methods (primary prevention).  Encourage testing and counseling for clients with known exposure or who are in high- risk groups; provide referrals for follow-up for clients who test positive for HIV (secondary prevention). Table 1.1 Examples of Levels of Prevention and Clients Served in the Community Definition of Client Primary (Health Secondary (Early Tertiary (Limitation of Served Promotion and Specific Diagnosis and Disability and Prevention) Treatment) Rehabilitation) Individual Dietary teaching during HIV testing Teaching new clients pregnancy with diabetes how to Screening for cervical administer insulin Immunizations cancer Exercise therapy after stroke Skin care for incontinent patients Family (two or more Education or counseling Dental examinations Mental health individuals bound by regarding smoking, counseling or referral for COVID-19 testing for kinship, law, or living dental care, or nutrition family in crisis family potentially arrangement and with (e.g., grieving or Adequate housing exposed common emotional ties experiencing a divorce) and obligations [see Dietary instructions and Chapter 20]) monitoring for family with overweight members Group or aggregate Birthing classes for Vision screening of a Group counseling for (interacting people with pregnant teenage first-grade class grade-school children a common purpose or mothers with asthma Mammography van for purposes) AIDS and other STI screening of women in a Swim therapy for education for high low-income physically disabled school students neighborhood elders at a senior center Hearing tests at a senior Alcoholics anonymous center and other self-help groups Mental health services for military veterans Community and Fluoride water Organized screening Shelter and relocation populations (aggregate supplementation programs for centers for fire or of people sharing space communities earthquake victims Environmental over time within a (e.g., health fairs) sanitation Emergency medical social system [see Lead screening for services Chapter 6]; population Removal of children by school groups or aggregates environmental hazards Community mental district with power relations health services for and common needs or chronically mentally ill purposes) Home care services for chronically ill 20. What level of prevention is testing blood glucose and HbgA1c levels during a health fair? Secondary (Early Diagnosis and Treatment) It is important to clarify the difference in community or public health nursing where goals are focused on improving the health of a community or population, and community-based nursing. See Question 18 Above. 21. Where is the focus of outcomes for community-based nursing? Community-based nursing practice refers to “application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the healthcare system” (McEwen & Pullis, 2009, p. 6). Community-based nursing is setting specific, and the emphasis is on acute and chronic care and includes such practice areas as home health nursing and nursing in outpatient or ambulatory settings. Zotti, Brown, and Stotts (1996) defined it as community-based nursing emphasizes managing acute or chronic conditions. Community-based nursing, the primary clients are the individual and the family. Finally, services in community-based nursing are largely direct. 22. To clarify the focus of care there are 3 levels of care – community, systems, and individual/family. Know the basics of the 3 levels. Which level of care is provided with community-based nursing? Community-based nursing includes direct care and the health services offered to individuals/families in the community. The focus is to manage acute/chronic health conditions and to improve health at the family and individual level.  Community Level of Care→ Focused on promoting health outcomes for an entire population or community via a widely implemented public healthcare roll out. Systems→ Changes at the systemic or organizational level, like a healthcare system or policy that can influence large groups of individuals. Individual/Family→ Direct care is offered to individuals and or families to manage conditions of health and improve wellness. The same focus as community-based nursing. 23. Summarize what public health is, what are the major goals of public health and provide examples of public health interventions. Discuss the role of a public/community health nurse. Public health is focused on the protecting and promotion of health of populations via organized efforts and informed decisions of organizations, society, public/private sectors, individuals and communities. Involves the inhibition of disease, promotion of health and prolonging of life via multiple activities. Major Goals of Public Health Inhibition of Disease: Public health is focused on the prevention of the occurrence of disease via interventions like vaccines, health education and the promotion of healthy activities. Prolonging Life: Activities/efforts to prolong life expectancy via activities like chronic disease management, promoting safer environment and improving healthcare access. Promoting Health: Promoting a healthy lifestyle and environment to enhance the overall quality of life of communities and individuals. Possible Public Health Interventions:  Vaccination Program  Screening Program  Health Education  Environmental Health and Sanitation  Emergency Preparedness Public/Community Health Nurse Roles  Assessing Community Needs  Developing and Rolling Out of Nursing Interventions   Providing Direct Care  Collaboration with Other Healthcare Sectors/Professional  Advocating for Health Population health is discussed in the textbook, and another use of the term is becoming more popular where a Population Health department is in a hospital, clinic, or insurance company for example. Look at these resources to learn more about this role for nurses. An example of this might be where a clinic system is providing interventions such as nurses calling to be sure all of their patients with diabetes are able to get medications filled, are monitoring their blood glucose as directed, and are able to eat healthy foods and exercise. Then they work to find solutions to any barriers faced by patients to manage their diabetes. The clinic system might have a population goal (of their patients with diabetes) to have a set percent with HbgA1c less than 7%. 24. American Hospital Association link https://www.aha.org/center/population-health- fundamentals 25. and the CDC chronic disease/population health https://www.cdc.gov/nccdphp/divisions-offices/about-the-division-of-population- health.html?CDC_AAref_Val=https://www.cdc.gov/chronicdisease/resources/ publications/aag/population-health.htm 26. Explore the nurses’ role in population health, See the article linked on the National Library of Medicine, Population health: a nursing action plan. https://academic.oup.com/jamiaopen/article/1/1/7/4996946 Ch. 3 Thinking Upstream: Nursing Theories and Population-focused Nursing Practice 27. Compare the analogy of pulling people out of the river without seeing who or what is pushing them in - to healthcare and public/community health. In this analogy, doctors are so busy rescuing victims from the river that they fail to look upstream to see who is pushing patients into the perilous waters. Many things could cause a patient to fall (or be pushed) into the waters of illness. Refocusing upstream requires nurses to look beyond individual behavior or characteristics to what McKinlay terms the “manufacturers of illness.” McKinlay discusses factors such as tobacco products companies, companies that profit from selling products high in saturated fats, the alcoholic beverage industry, the beauty industry, exposure to environmental toxins, and occupationally induced illnesses. “Manufacturers of illness” are what push clients into the river. Recent example is the toxicity of baby powder. Heavy Metals: Some baby powders may contain heavy metals, like nickel that could be toxic if used for a long time.  Cancer: Some studies have found a connection between genital talc use and ovarian cancer, but other studies have not. One study followed 61000 postmenopausal women for 12.4 years and found no link. But, diseases like cancer may not appear until years after using talcum powder. The HBM and Milio's prevention model focuses on personal health behaviors from a disease avoidance or preventive health perspective; nurses may also analyze this phenomenon using critical social theory. Again, McKinlay's upstream analogy refers to health workers who were so busy fishing sick people out of the river that they did not look upstream to see how they were ending up in the water. Later in the same article, McKinlay (1979) used his upstream analogy to ask the rhetorical question, “How preventive is prevention?” (p. 22). He used this tactic to critically examine different intervention strategies aimed at enhancing preventive behavior. Fig. 3.2 illustrates McKinlay's model, which contrasts the different modes of prevention. He linked health professionals' curative and lifestyle modification interventions to a downstream conceptualization of health; the majority of alleged preventive actions fail to alter the process of illness at its origin. Political-economic interventions remain the most effective way to address population determinants of health and to ameliorate illness at its source. Healthcare focuses on the needs of an individual that is already sick/injured. Like rescuing a person after falling into the river. Public/Community Health focused on prevention of people falling into the river by addressing the manufacturers of illness that are upstream to reduce the need of interventions downstream. 28. Briefly summarize the differences in approach using the nursing theories where the individual is the focus of change and the ‘upstream’ theories where society is the focus of change. In the discussion use an example that could be addressed by both. Individual Focused Theories: Individual focused theories stress direct interventions that are aimed at modifying individual attitudes, health practices and behaviors. Concentrated on personal health management/control along with adjustments in behavior. Health Belief Model, focuses on an individuals understanding and perception of health risks and benefits. This understanding can influence an individuals decisions about health behaviors. Ex, a nurse may implement this model to promote healthier eating practices that are centered around their perception of the risks of diabetes. Society Focused Theories (Upstream): Society theories are concentrated on a broad/wide changes in society that create an environment that is instrumental in promoting health. This approach aims to focus on systemic issues, social determinants of health and policy changes that impact populations. Ex, Social Determinants of health. This understanding promotes the need to focus on and address inputs like socioeconomic status, education and availability/access to healthcare. A possible intervention may include advocating for policies that enhance access to healthy affordable foods in an area that has been traditionally known as a food desert. An example that is addressed by both of these approaches Obesity Prevention: Individual Focused, a nurse may work with an individual to create a personalized weight loss plan that includes counseling in regards to exercise and diet and assisting them in setting specific goals that are achievable. Upstream Focused, Public health officials may work toward the implementation of policies that can enhance the access to exercise facilities, promote healthier school lunches and or improve the public administration to promote physical activity. Ch. 2 History of Public Health Nursing Watch the short video, 200 Countries 200 Years to set the stage for the global situation in the time frame when we are exploring health in the US. https://www.youtube.com/watch?v=jbkSRLYSojo 29. What 2 measures are represented on the X and Y axis and how are they correlated? X Axis is population size. Y Axis is annual increments Look at the UN The World at Six Billion report. Chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.un.org/ development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/ 2020/Jan/un_1999_6billion.pdf 30. Go to page 3 of the report. When did the global population reach 1 billion? 1804 On page 5, where is the population numbers expected to stabilize? 2200 Go to the Census Bureau site www.census.gov and scroll down to the population clock. What is the current global population? 8,069,321,757 What is the current US population? 337,014,288 (knowing these numbers will help you put data into perspective – so you might see these on a test or two this semester!) Now let’s look at some of the historical events that impacted the health of people. Note all the societal happenings that positively or negatively impacted health. 31. Which book of the Bible included the first written hygienic code? Book of Leviticus 32. During the middle-ages what percent of the world’s population died in a pandemic of bubonic plaque? 30-50%. Are outbreaks of plaque still possible today? Yes. The plague has not been entirely eradicated. 33. US Poor Laws were based on the Elizabethan Poor Laws of 1601 where the poor, blind, and lame (disabled) were to be cared for in their county or township. It also established work houses to employ the poor. What group that were wards of the parish were also forced to work? Children. When the sanitary revolution began to implement public health reforms, what group was not included in the reforms? The poor and the marginalized populations. During America’s Colonial period, early efforts to improve the health of populations included local boards of health to address epidemics and included measures to improve water quality, sewage, and burial of the dead. Collection of vital statistics was also undertaken (you will look up current vital statistics for a community as part of the community project in clinical). Other efforts included improved sanitation and control of communicable diseases entering through seaports. When we think about public health measures, especially restrictions, it is important to note that they have been used since Colonial times in America. Measures that most of the world knows very well at this point due to the Covid pandemic were not new but have been used for many years! 34. In the US the Marine Hospital Service, established in 1798, had the primary function to care for merchant seaman and to protect the coastal areas from? The spread of infectious diseases. The Marine Hospital Service later became the US Public Health Service. 35. The United States in the 1800s also still saw epidemics of what illnesses? Yellow Fever Smallpox Typhoid Fever Cholera Tuberculosis What factors aided the spread of these diseases? Poor sanitation Overcrowding Increased Travel and Trade  Lack of Public Health Infrastructure Boards of Health were established locally to address these infectious diseases. Other control measures implemented in local areas included improving water quality, sewage, land management, and burial of the dead (laws related to the care of bodies are important to public health! Many things we think of as traditions or customs, started as public health protections – such as burial being 6 feet underground, and in places below sea level, such as New Orleans, above-ground vaults are used). 36. Reports such as those by Edwin Chadwick in England showed that unsanitary conditions shortened lives, especially among the laboring class. He found that death rates were high in large industrial cities where more than what percent of all children born to working class parents died by age 5? 50% 37. In the US the Shattuck Report, published in 1850, in Boston showed high overall mortality and very high infant and maternal mortality. What reasons were associated with these statistics? Poor Sanitation Lack of Medical Knowledge Infectious Diseases Poverty and Poor Living Conditions 38. Florence Nightingale and the Crimean war – she used her studies of nursing to respond to the appalling conditions surrounding sick and wounded soldiers. To show the importance of the nurses interventions she kept statistics showing that by the end of the war the death of soldiers decreased from 42% to what percent of those treated? 2%. She later differentiated “sick nursing” and “health nursing” and stated that “Unless you have the health of the unity, there is no community health” (1894) She understood that conditions in a community affect the health of all living there and this is still a major part of public health. Read though the contributions of Pasteur and Lister! So many contributions that we will study in this class! Do you think Pasteur would approve of the renewed interest in drinking raw milk? (not in the book) Due to his commitment to public health and the inhibition of infectious diseases, Pasteur would more than likely be concerned about the consumption of unpasteurized milk that has a high risk of containing dangerous pathogens. 39. District nursing was established in England in the mid-1850s.  What were the major roles of these nurses? Home Visists Health Education Medical Care and Treatment Advocacy Monitoring and Assessment Support for Families During the latter part of the 1800s, wealthy people funded settlement houses and Visiting Nurses Associations (VNAs). Settlement houses were established in poor, more vulnerable neighborhoods and the nurses lived in them as part of the community, working in programs offered at the settlement house and in the surrounding community. They were neighborhood centers that were hubs of health care and social welfare programs. In the 1890s. 2.3 million people lived in New York City and 90,000 residents lived in tenement houses in the Lower East Side of Manhattan (these were often substandard housing, crowded – this is optional, but if you’d like to know more about life in those neighborhoods at this time visit the Tenement Museum website. Immigrants worked in sweatshops, and because of crowded housing and workplaces, there were high rates of communicable diseases. 40. Lillian Wald is considered the founder of community health nursing in the US. In 1893 she and Mary Brewster established the Henry Street Settlement on the lower east side of NYC. Besides healthcare what other needs and community issues were addressed by the agency? Social Services Child Welfare Education Community Development Nutrition Advocacy and Social Reform Housing Reform Vocational Training Read the inspiring excerpt from The House on Henry Street written by Lillian Wald. Box 2.6 or this link to the book (note when competed) https://www.google.com/books/edition/The_House_on_Henry_Street/An_aAAAAMAAJ? hl=en&gbpv=1 Photos by Karen Kelley, Henry Street Settlement, and the surrounding area today. Visit the Henry Street Settlement website (optional) https://www.henrystreet.org/ There is a great video linked on the home page called Baptism of Fire that shows how Henry Street started! https://www.youtube.com/watch?v=WCCnzzu3nno Visit the Tenement Museum site (optional) https://www.tenement.org/about-us/ 41. WW I and II saw an increased need for nurses. What other public health historical event occurred at the time of WWI? 1918 Influenza Pandemic 42. The mid 1900s saw a change from infectious disease being the leading causes of death in the US to chronic diseases. While many changes in food and food safety, water purification, pasteurization of milk, better sewage management, etc. contributed to the decrease in infectious disease two major developments in the mid-1900s completed the shift. Widespread vaccination programs were started in the later 1950s and what other medical intervention became available about this time? Antibiotics Mortality rates decreased. And as often happens when something works…funding goes away. Decreased funding for public health and increased funding for advanced technologies to improve sick care were on the horizon. We will soon see intensive care units and advanced testing, etc. This is of course a major improvement in the ability to save lives and improve quality of life. It also sets the stage for health care to become very expensive. 43. In 1900 life expectancy in the US was 47 years. The 30-year gain in life expectancy since 1900 is mostly attributed to public health. Ten Great Public Health Achievements of the 20th Century https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm are listed on this CDC page. The second part of this page gives a bit more information about the list. Look at the 6th bullet point about healthier mothers and babies. This includes both preventive reasons and advances in medical care. How much did infant mortality decrease between 1900 - 1999? 90%. How much did maternal mortality decrease? 99%. History has a lot to teach us about how we can manage health care and public health today. Rapid changes are occurring in healthcare including in public health. Technology and research have enabled remarkable advancements in care and in disease prevention. But many questions remain, how do we pay for healthcare? How do we gain equity in health outcomes across populations? (not to answer here, just ponder the questions) The Future of Nursing 2020 – 2030, IOM report emphasizes the importance of public health nursing into the future stating that public health nurses are “uniquely positioned and trained to bridge healthcare and social needs and advance health equity” https://nap.nationalacademies.org/catalog/25982/the-future-of-nursing-2020-2030- charting-a-path-to