Community Health Assessment PDF

2 Chapter 4 Community Health Assessment A strategic plan that describes the health of a community by: o Collecting, analyzing, and using data to EDUCATE & MOBILIZE communities o Developing priorities o Obtaining resource...

2 Chapter 4 Community Health Assessment A strategic plan that describes the health of a community by: o Collecting, analyzing, and using data to EDUCATE & MOBILIZE communities o Developing priorities o Obtaining resources o Planning actions to improve health Assessment is one of the core public health functions It is the first step in the development of health programs and interventions, aimed at optimizing the health of a community/population o Assessment o o Policy development KNOW THIS FOR TEST o Assurance of intervention Conducting a Community Health Assessment o Think of ADPIE o Skills or competencies needed: o Selecting health indicators o Using appropriate methods for collecting data o Evaluating data o Identifying gaps o Interpreting and using data Definition of Community o A group of individuals who share a common denominator such as:  Culture is set of sharing ideas customs o Religious traditions beliefs ex clothing language cultural o Geographic location taboos religion rituals food Ethnicity is a group of ppl the identify based o Ethnicity on shared culture o Culture Ex:American Indian Hispanic native Hawaiian or Paci c Islander o Individuals within the community recognize their membership in the community Health of a Community o Health Status: o Selected biostatistics related to health and disease o Structures o Demographics of the community as well as the services and resources available in the community o Competence o Effective community functioning Effective Community Functioning o Select measures of community competence: o Commitment to the community o Conflict containment and accommodation (working together) o Decision making o Management of relationships with society o Self/other awareness o Effective communication** Purpose of the Community Health Assessment o Gather information o Identify areas for action aimed at improving the health of the community o Conduct the first step in health planning o Provide baseline data to help with evaluation of health  programs Types of Assessments o Comprehensive à all inclusive o Population-focusedà one characteristic (age, gender,etc) o Setting-specific o Problem or health issue-based o Health impact o Rapid needs Comprehensive Assessment o Collection of data about populations living in a community o Looks at assets, unmet needs, and opportunities for improvement o Uses community statistics: o Health status o Health needs o Data for epidemiological studies Population-Focused Assessment o Population: o A larger group whose members may or may not interact with one another but who share AT LEAST ONE characteristic ▪ Age, gender, ethnicity, residence, or common health issue o Examples: ▪ Pregnant women living within a community ▪ Immigrants from a specific country of origin ▪ Persons with diabetes over the age of 64 Setting-Specific Assessment o Focused on a specific setting  the Person o Strengths/weaknesses or policies and programs within an organization or setting o Identify indicators specific to the setting o Treats the setting as the community o Examples: ▪ Setting: Hospital Specific: How much PPE is in the hospital ▪ Setting: work/factory Specific: how many injured workers Problem/Health Issue-Based Assessment o Focus on specific problem or health issue o Analysis of data determines who is at risk o Promote understanding of: Trying to o Policies find out who o Practices is at Risk. o Environment o Who is at risk? o Example: Secondhand smoke: workers at risk Health Impact Assessment (HIA) o Definition: a means of assessing the health impacts of policies, plans, and projects in diverse economic sectors o using quantitative, qualitative, and participatory techniques. o Used to evaluate the impact of policies and projects on health o A successful health impact assessment is one which its findings are considered by decision makers to inform the development and implementation of policies, programs, or projects o Steps of the HIA: o Screening  o Scoping o Assessing o Developing o Reporting Rapid Needs Assessment o Help establish the extent and possible evolution of an emergency by measuring: o The present and potential public health impact of an emergency o Determining existing response capacity o Identifying any additional immediate needs** ▪ RAPID, NOW… Shooting, covid, natural disasters etc. Concepts of Community Assessments o Basic terms: o Needs o Assets o Community-based participatory research (CBPR) o The shift from NEEDSà ASSETS & CBPR reflects: o The importance of working with a community while maximizing the strengths of the community rather than focusing on deficits within the community Asset Assessment o Constructing a map of assets and capacities. o Three aspects of a community: o People o Places o Systems  o **Asset is the opposite of a needs assessment o An asset assessment is looking at what community has to offer o Needs assessment looks at what the community is lacking o ***Always look at assets not deficits Community-Based Participatory Research (CBPR) o Engagement of community members as full partners in an assessment o Collaborative o Interest o Knowledge o Expertise o Achieves change o **Co-learning, equal contribution, balance between research and action, culturally competent care in the community, engaging the community in the process of change o The end goal is to achieve change that will work toward improving the health of the community o **CBPR emphasizes the essential principles of capacity building, shared vision, ownership, trust, active participation, and mutual benefit. ** Assessment Models & Frameworks o Provide structure and guidance for conducting an assessment o The choice of model is based on what BEST FITS the type of assessment being conducted o CHANGEà Community Health Assessment and Group Evaluation o MAPPà Mobilizing for Actions Through Planning and  Partnerships examplem CHANGE Model o Based on the socioecological model do o Process provides a community with a foundation for conducting a program evaluation o **Idea is to START with the END in mind and include evaluation in the BEGINNING of the process. o Helps a community complete an assessment that provides a diagnosis and ends with the presentation of an action plan o Creates a living document that the community can use to prioritize the health needs of the community (creates an action plan) o Provides a means for structuring community activities around a common goal o If we were using this model, and wanted to get diff perspectives, and viewpoints from members of the community, how would we go about doing that? o **** ensure the team that is created comes from different backgrounds and ethnicities (diverse) for viewpoints from many groups. 8 ACTION Steps to the CHANGE Model 1. Assemble the community team 2. Develop team strategy 3. Review all 4 change sectors - 5 community sectors: At large, institution/organization, health care, school, and worksite. 4. Gather data 5. Review Data 6. Enter data 7. Review consolidated data  8. Build the community action plan MAPP Model o Mobilizing for Action through Planning and Partnerships o The vision: for communities to achieve improved health and quality of life by mobilizing partnerships and taking strategic action o 6 phases: 1. Organizing for success 2. Vision 3. Performing 4 assessments 4. Identifying strategic issues 5. Formulation of goals and strategies 6. Action o ***MAPP involves the full ADPIE**** o Change is Assessment and Diagnosis Data Collection o Primary Data o Any data collected DIRECTLY by the assessment team o Secondary Data o The examination of data ALREADY collected for another purpose, such as census data Primary Data Collection Method o Windshield Survey (Driving) o Primary Data Collection o Gives the “pulse of the community” o Gives an initial understanding of the community o ** sometimes viewed as the preassessment phase***  o So, before we find key informants, we need to perform windshield survey first. ***** o Shoe Leather Survey (Walking) o KEEPRA o Kinship/Economics/Education/Political/Religious/Ass ociations ▪ Kinship= Family life ▪ Economics= Stable Economy ▪ Education- Schools and other educational institutions ▪ Political= evidence of political activity ▪ Religious= Places of worship ▪ Associations= Neighborhood associations Preliminary Observational Data o CHANGE list of sectors o Surveys conducted for the assessment o Inventory of resources: questionnaires on different organization s such as healthcare institutions and schools o Quantitative surveysà Data that is numerical o Qualitative surveysà Data that is descriptive Conducting a Survey o Define the sample o Choose a sampling approach o Choose survey method o Decide on items to be included o Used Evidence-Based-Tools Secondary Data Collection Method o Sources include: o Census data, crime report data, national health  survey data, and health statistics (from state or local dept. of health) o Aggregate data: those that DO NOT INCLUDE individual level data o Example: Infant mortality rate o Deidentified data: INDIVIDUAL level data that DO NOT INCLUDE individual IDENTIFIERS SECONDARY DATA NOT SPECIFIC TO INDIVIDUALS o Examples of data related to the environment o Environmental pollutants o Number of vehicles using the roads o Information on farmers’ markets, the Food Access Research Atlas, and the Food Desert Locator (online map) o Information on organizations within the community such as: ▪ Hospitals, schools, police departments Qualitative Data ***ALL ARE PRIMARY DATA*** o Focus Group: o OPEN-ENDED QUESTIONS! o An interview w/ a group with similar experiences/background who meet to discuss a topic of interest o Key Informant: o They will tell you values, beliefs, and perceived needs of the community o Often represented as the gatekeeper o One who comes closest to representing the community o Photo Voice:  o Having community members photograph their everyday lives within the context of their communities Additional Tools o Community Mapping o Allows assessment team to: ▪ Visualize the community ▪ Study concentrations of disease ▪ Identify at-risk populations and risk factors ▪ Better understand program implementation o Geographic Information System (GIS) o A computer-based program used to collect, store, retrieve, and manipulate geographical or location- based information Analysis of Data o Making sense of the collected data: o Examine changes/trends over time ▪ Sociodemographic comparisons include: Changes from one census data collection period to another ▪ The time period for comparing disease trends varies by the prevalence of the disease o Compare with other populations/communities ▪ Are there disparities? Gaps in services? o The team identifies the important health issues for the community Post-Assessment Phase o Create, Disseminate, and Develop an Action Plan o Evaluate the assessment process: o Involves including stakeholders in reviewing the findings and having an opportunity for feedback o Seek validation from stakeholders and engage in a  collaborative process to help come to a final decision on priorities** Chapter 5 Health Programming for Communities o Community Program Planning is: o The process that helps communities understand how to move from where they are to where they want to be o A multi-step process that: o Generally, begins with the definition of the problem and development of an evaluation plan o Includes a feedback loop with findings from program evaluation used for program improvement Health Program Planning at All Levels o Planning occurs at all government levels: o Local o State o Federal o ***When you start planningà start at the local level and expand from there o Part of strategic planning for the public health happens at the global level o One of the 10 essential public health services that should be undertaken in all communities Community Capacity o Definition: the ability of community members to work together to organize their assets and resources to improve the health of the community o Building community capacity can: o Increase quality of life o Promote long-term community health  o Increase community resilience FOUR Steps of Health Program Planning o The nursing process is applied to POPULATIONS rather than individuals o ***It is important that after assessment is completed, you must STOP and evaluate assessment before going into planning and why (diagnosis) o FOUR STEPS: ADIE 1. Assessment 2. Development of interventions 3. Implementing interventions 4. Evaluating the effectiveness of interventions 1988 Report: “Future of Public Health” o Public health practice was recognized as being focused on populations, not individuals. o Health planning was recognized as important at the local level. o The core public health functions of assessment, policy development, and service assurances were identified. o Individual careà shifted focus to the community*** Healthy People 2020 & Beyond o From its inception in the 1970’s, Healthy People has sought not only to assess health status, but also to project improved status with outcome measurement. o The intent of the new HP 2030 is to continue to guide efforts to plan, implement, and evaluate health promotion and disease prevention interventions for the nation MAPIT Framework for Healthy People o Stands for: o Mobilize partners o Assess needs of the community  o Create and implement a Plan to reach objectives o Track the community progress o FIRST STEP: We are going to start by mobilizing partners: get together with key stakeholders MAPIT o Program Planning Models o Precede/Proceed o CHANGE o MAPP o Logic Model Precede/Proceed PRECEDE PROCEED Predisposing, Policy, Reinforcing and Regulatory, Enabling factors, and Organizational Causes in Constructs in Educational Education, and Diagnosis and Environmental Evaluation Design o PRECEDE:  o Begins with a comprehensive community assessment o Then it provides a guidance on how to examine administrative and organizational issues o Ends with design, implementation, and EVALUATION of a program o PROCEED: o Reflects an effort to modify social environment and promote healthy lifestyle, which has evolved a clear need o This model serves as the basis for other program planning models such as MAPP and CHANGE** Logic Model o Underlying theory that drives design o Moves in logical order o FIVE STEPS: 1. Resources 2. Activities 3. Outputs 4. Outcomes 5. Impact o Helps stakeholders visualize how the program goals relate directly to the objectives*** The Basic Logic Model o **Inputà Resources: Staff members, equipment o Activities: health education, tools, technology, what you are DOING for your program o Output: o Outcome: leads to change in 1-3 or 4-6 years o Impact: long term 7-10 years o Program Planning o Key components of health program planning: o Active involvement of the community as a partner o Personnel needed to do the work must be determined o Funding opportunities o Gaining trust of the community o Skill and time to do a competent assessment o Shared conclusions with the partners of the needed interventions o Actual program planning, interventions, and evaluation o Social justice: human rights and equity o Planning= CLEAR goals and objectives established*** Community Organizing o Helping people to act jointly in the best interests of their communities o Most frequently, community organizing occurs in poorer communities that are disenfranchised, uniting people to gain power and fight for social justice.  o Inclusive Process o The role of the nurse in community organizing is one of listener, facilitator, and developer of community leadership skills. Social Justice o To ensure social justice is being considered while planning a program we need to make sure we are assisting vulnerable populations. *** o Society is based on the constructs of human rights and equity. o Those who have plenty are willing to share with those who do not. o Everyone should have access to basic health services, economic security, adequate housing and food, satisfactory education, and a lack of discrimination based on race or religion Community Diagnosis o = the LAST phase of the community assessment o The FIRST phase of planning process  o A clear statement of the health problem and the causal reasons or theories for the health problem o Guides the community team’s thinking in how to design the program and decide what components are necessary Four Parts: o The problem o The population o What the problem is related to (characteristic of the problem) o How the problem is demonstrated (indicators of the problem) o Written as: (The problem 1. and the population) 2…related to _________ 3.… as indicated by _______…. 4. o Example: The homeless population of San Francisco is at an increased risk for communicable diseases related to needlesticks as evidenced by used needles on the ground. Program Goals & Objectives o Program Goals o A broad statement of the impact expected by implementing a program o A statement of outcome rather than activity o Usually only a few goals for a program o No actual outcome measurements included in the goals  o Should be realistic and reachable o Objectives o Clarify the goal o Design an outcome measurement o Keep the program focused on the intended intervention o Measurable, time-limited, action-oriented o Include who will achieve what, by how much, by when o ***objectives should be SMART Examples: ▪ Community objective: By June 12, 2026, we will partner with The Queen’s Medical Center hospital to open up a new primary care clinic that will serve residents of West Oahu. ▪ Individual objective: The patient in the cardiac rehab program will walk on the treadmill before lunch after work for twenty minutes three times per week. Cultural Context o The team always must consider the culture, ethnicity, and language of the community. o Cultural competency may take on a central role.  o Integrating cultural components into a program is essential. Evidence Based Practice with Program Planning o Evidence-based practice (EBP) o Literature review o Population-based approaches o Evaluation o Examine the theory and rationale for other programs Program Implementation o Encompasses TWO phases: o Resources needed o Mechanism for delivery o Five stages: o Community acceptance of the program o Specifying tasks and estimating needed resources o Developing specific plans for program activity o Establishing a mechanism for program management o Putting the plan into action Program Evaluation o *** What happens during eval phase? o review cost benefit of program o evaluate program strength/weaknesses o determine how the community is changing o does this program still meet the community’s needs? o The systematic collection of information about activities, outputs, and outcomes to enhance a program and its effectiveness o Analysis provides useful feedback related to whether: o Activities were implemented as they were designed. o The program was cost-effective  o The intervention and program theories were correct. o The timeline was appropriate o The program should be expanded or duplicated in another location. Formative Evaluation o Ongoing feedback about performance of the program o Occurs during the development of the program while the activities are forming and being implemented for the first time o ALLOWS FOR CHANGING: o The way outcome measurements are collected o Parts of the program to better meet the program goals and objectives Process Evaluation o A type of formative evaluation * o Investigates the process of delivering the program or technology o Looks at alternative delivery procedures o Includes detailed information on: o How the program actually worked (operations) o Any changes made to the program o How those changes have impacted the program Summative Evaluation o Occurs at END of program o Evaluation of the objectives and the goal: o Assessment of ▪ the outcome and impact of the benefits the selected population has received by participating in the program o Evaluation of  ▪ the causal relationship and the theoretical understanding of the planned intervention o Examination of ▪ program cost, looking at COST- EFFECTIVENESS and cost benefit 9 Steps to Program Evaluation Chapter 13 Public Health Department & Public Health System o PHD is an official government body o Public Mandate: protect & improve health in partnership with the community o Work with the community to: o Ensure essential community health services  o Facilitate partnerships o Address public health concerns o Coordinate services 1700’s (18th Century) o Boards of health formed: o Philadelphia, Baltimore, Boston, Washington DC, New Orleans, NYC o Concerns during this time: o Communicable disease in highly populated cities o Recognition of the relationship between disease and need for proper sanitation 1900’s o Passage of the Social Security Act of 1935 o Provided for maternal and child health services for public health o First Public Health Department o Jefferson County in Kentucky o Rockefeller Foundation o Funded many rural programs in early 1900s ▪ Improvement of sanitation ▪ Hookworm education for medical professionals ▪ Employ additional people for PH service Mission of Public Health o Mid-19 century mission focus on problems of: th o Urbanization o Immigration o Industrialization o Focus on: o Housing conditions o Communicable disease  o Social Reformers: o Henry Street o Lillian Wald o Hull House o 1933: Two primary goals of PH agencies: o Control communicable disease o Promote child health o By 1940à Committee on Administrative Practice of the American Public Health Association (APHA) decided on 6 additional minimum factors Functions of Public Health o Minimum Functions o Vital statistics o Environmental sanitation o Communicable disease control o PH laboratory services o Maternal and child health o PH education o CORE Functions of Public Health o Mission of PH was revisited in 1988 by the IOM: ▪ Fulfilling society’s interest in ensuring condition in which people can be healthy o THREE CORE FUNCTIONS: o Assurance o Assessment o Policy Formation Structure of Public Health Departments o PHD differs state to state o Are organized by one of three major delivery modes: Centralized Decentralized Mixed Operated by STATE: Operated by LOCAL Gov’t Shared authority of -health agency or board of -State health agency health -Board of health -Local Gov’t PH functions under STATE NO BOARD OF HEALTH agency 5 states use 27 states use 16 states use Public Health Service Delivery o The size of the population served o Ratio of services to the size of the population o Almost half the US population (49%) served by 5% of the PHD’s Public Health Jurisdiction o Differ based on type of jurisdiction or territory served: o Majorityà County based (68%) o Combined city/county (4%) o City or a town (21%) o Multicounty or regional (8%) ▪ Strengthens public health in rural areas Public Health Departments o Workforce o Usually fewer than 100 employees o Interdisciplinary o 18% are NURSES o PH workforce does NOT always represent the diversity of the population served o Rural Areas o Challenges: ▪ Limited resources ▪ Poor infrastructure ▪ Different health issues from urban areas Examples: o Agricultural pollution  o Unsafe mining o Logging practices Role of Public Health NURSE o Nurses comprise the largest number of professionals in the health department o Promote and protect the health of the population through 3 core functions: o Population ASSESSMENT o ASSURANCE of a well-coordinated system o POLICY development PHN Frameworks FIVE Major Activities of PHDs 1. Environmental health services 2. Data collection and analysis 3. Individual and community health 4. Disease control, epidemiology, surveillance, and regulation 5. Inspection and licensing* Environmental Services o Focus on community safety o Water  o Food o Sanitation o Today, includes both state and local responsibilities Data Collection & Analysis o Mostly State-level functions o Begins @ local level** o Vital statistics o Birth o Death o Marriage o Divorce o Data eventually go to the CDC @ the National level o Data collection & analysis cont’d Prenatal Info Postnatal Info Outcomes of neonates Newborn data Risk factors length Protective factors weight Parental demographics Head circumference Behavior variables Congenital defects Use of drugs and alcohol during pregnancy Weeks of gestation Prenatal visits and when pregnancy began Provider information Type of delivery Family information Helps to understand trends How well Healthy People goals and objectives are being met Mortality Data Death Info Basic demographics of deceased Conditions contributing to death Filed by funeral director Tobacco use Where death occurred Race Medical examiner certifies death and Other variables information as to cause Used to evaluate trends Injury  disease homicide Accidental Natural Suicide Fetal Deaths Birth/Death certificates used for: Spontaneous intrauterine death of a fetus Needed for: anytime in pregnancy Most state report 20+ weeks gestation or 350 Establishing citizenship grams or more in weight Gender Social security cards Cause Driver’s licenses Conditions Probating a will Helps with population assessment Genealogy research Program planning/education o Globally helps: o Explain the health of populations o Determine life expectancy o Develop interventions to improve health ▪ Environment ▪ Individual/community ▪ Licensing/inspection ▪ Disease control/epidemiology/surveillance/regulatio n ▪ Vital statistics Funding for PHD Services o Federally Qualified Health Centers (FQHC) o Funded through Health Resources and Services Administration (HRSA) under section 330 of the Health Service Act ▪ Reimbursement from Medicaid/Medicare ▪ Serve the underserved ▪ Sliding Scale ▪ Comprehensive services  ▪ Ongoing Q A program Maternal & Child Health Services o Key component of PHD o Improve health of mothers and babies o Improve health of mothers & children through preventative interventions o Link clients with available services o Most common ones: o Home visits o WIC (Women, Infants, and Children Services) o Family Planning o Healthy Start Program School Nurses and PHDs o Main goal: ensuring health of ENTIRE SCHOOL POPULATION o School nurses take leadership for: o Developing policies o Providing clinical care for promotion of health o Ensuring safe care practices in a nonmedical setting o Funding and staffing patterns for school nurses employed by PHDs and school districts vary between states and counties o Nurses’ roles include: o Medication administration, immunizations, emergency for crisis or disaster o Screening for vision problems and obesity o Monitoring any health problems acting as barriers to learning Immunizations o Essential component of public health  o Outbreak of disease: the PHD is often the entity responsible for mass immunization o PHDs manage the program requirements associated with administration and use of vaccines for preventable disease PHDs and Public Health Clinics o Role of nurse in providing individual care: o One-on-one clinical interventions o Medications o Home visiting with high-risk families o Primary Prevention o Activities that focus on IMPROVING the ability of individuals and populations to practice healthy living ▪ Protecting individuals and populations from disease… Vaccinations ▪ Health education ▪ Public health announcements and alerts Disease Control, Epidemiology, and Surveillance o Examples: o Tuberculosis management o STI’s o Lead Poisoning o Unintended poisoning o Emerging or Reemerging Infections: o Goal: to increase PH Infrastructure ▪ Increase laboratory services (essential services) ▪ Increase epidemiology services (essential services) ▪ Incorporate core competencies into curricula of accredited academic programs ▪ Increase personnel ▪ Increase state and local PH jurisdictions as well as  their accreditation ▪ Quality improvement ▪ Information technology to share clinical records o **** the 3 notifiable STI’s (to the CDC)/Gov’t authorities): o Gonorrhea o Chlamydia o Syphilis ▪ ***TB must be reported as well Challenges for the Future o Zoonotic Diseases o PHD’s called on to conduct surveillance of zoonotic disease and institute prevention programs o Emergency preparedness and Disaster Management o “All hazards” planning o Public Health Workforce o A shortage of public health workers PHDs and Information Technology o The field of public health informatics focuses on the use of information technology by public health professionals o Examples: o Geographic Information System (GIS) o Electronic health records Public Health Department Financing o Complex and related to disparities in county size, needs, and local community capabilities to provide services o An inverse relationship between per-person expenditures and revenues and size of population served o Primary funding streams for PHDS: o Federal (24%) o State (21%)  o Local (55%) o ***This means smaller PHD end up spending more and make more while larger PHD spend less and make less*** Chapter 21 Public Health Policy o Policy o Authoritative decisions made in government, agencies, or organizations that are intended to direct or influence the actions, behaviors, or decisions of others o PUBLIC HEALTH Policy o Policies that are specifically intended to direct or influence actions, behaviors, or decisions that influence the health of populations o Policy & the PHN o Health policy is an explicit part of professional life: ▪ Advocating for, identifying, interpreting, and implementing public health laws, regulations, and policies*** ▪ Educating the public on relevant laws, regulations, and policies o PH policies are more focused on impacting public health Public Health Policy & the Healthcare System o The U.S. economic culture supports an _open_ market. o Attempts to intervene in the market system to promote quality, supply, and equity/fairness leads to tension_ between those principles and allowing or even facilitating an open market system*** o Universal health_ coverage: o When all individuals and communities receive essential health services without financial hardship  ▪ Open market: free of gov’t regulations (tariffs, taxes, licensing) ▪ In US we do not provide universal health coverage, but higher income countries have it Market Economy o Prices of goods and services are set by SUPPLY and DEMAND. o Government intervenes in the market economy to ensure QUALITY, SUPPLY, and EQUITY/FAIRNESS. o U.S. governmental role in the health-care market is restrained because of cultural factors that emphasize individual rights and a relatively unfettered market system. ▪ Market Economy is the system we have in US ▪ We don’t like the govt controlling what products we have out there when it comes to health care ▪ It is an open market which means pricing is set by supply & demand, there is limited interference from the govt ▪ Free market: ppl have more info about goods & services they are purchasing Disparities o The AFFORDABLE CARES ACT (ACA) (Obamacare) was an attempt to decrease disparities by ensuring individual insurance coverage. o Race, ethnicity and especially socioeconomic status play a role: o Individuals living at or below the FEDERAL POVERTY LEVEL may qualify for public insurance programs: ▪ They also frequently lack other resources, such as transportation or flexible working hours, making access to health-care services challenging.  o Increase morbidity and mortality Affordable Care Act o Following implementation of ACA, healthcare coverage has INCREASED o 91.2% for all or part of 2017 people with health insurance coverage o 2016-2017 number of people with health insurance increased by 2.3 million to 294.6 million National Health Policy o In the U.S., most health-care goods and services are exchanged in the private market. o U.S. and state governments fund: o Medicare, Medicaid, and services for soldiers, veterans, prisoners in federal facilities, and American Indians/Native Americans o Private health insurance coverage is more prevalent than government (67.2 % v.s. 37.7%). Medicare o Coverage for: o hospital care o long-term care o pharmaceutical, physician, and other services o Coverage available for: o individuals 65 and older o specified groups of people with disabilities under 65 including individuals with end-stage renal disease ▪ pays for 100% cost of a kidney transplant if they do the procedure at a Medicare facility ▪ Covers 80% of dialysis tx and immunosuppressant  medications Medicaid o Medicaid is jointly financed by federal/state government o States set own guidelines with mandated federal services o Inpatient/outpatient care o Early screenings o Laboratory o Radiology o Skilled care/long-term care o Family planning o Care for those less than 21 years of age o Eligibility for Medicaid is 103% of the poverty line o Medicaid is jointly financed by federal / state govt BUT states set their own guidelines as long as they fulfill the mandated services they have to (like radiology, family planning) Healthy People 2030 o In the U.S: o Healthy People: a prevention policy agenda to guide interventions for the improvement of health outcomes in areas such as infant mortality, years of healthy life, and racial and ethnic health disparities o Includes: ▪ Targets that are examples of federal health policy ▪ Specific goals and objectives for policy changes o **Healthy People is a national compilation of disease and prevention and promotion goal and objectives for better health o One of their objectives includes policy changes we need to make** Patient Protection & Affordable Care Act 2010  o Purposes: o Improve access to affordable health coverage for everyone, including the most vulnerable o Provide ways to bring down health-care costs o Improve quality of care by improving health outcomes o Examples of how the ACA impacts PHN: o Authorized, mandatory funds for evidence-based early childhood home visitation o CDC-authorized national diabetes prevention program o Loan repayment to increase public health workforce o Programs to help educate more public health professionals o School-based health centers o Community health centers and nurse-managed clinics*** o Covers: ambulatory care, hospital care, and _______ o Benefits: o denial of coverage for preexisting conditions was prohibited o Allows people to stay on parents’ coverage till 26 o if they have a business with 50 or more full-time employees, they have to offer insurance coverage or they will pay a fine o Preventative healthcare services were provided at no additional cost (cancer screenings, flu shot), any essential services HAVE to be covered by insurance companies Occupation Safety & Health Administration (OSHA) o Mission: to prevent WORK-RELATED injuries, illnesses, and deaths.”*** o Since the agency was created in 1971, occupational deaths have been cut by 62% and injuries have declined by  42%.*** o Special Populations & Governmental Agencies: o Department of Veteran Affairs o INDIAN Health Services (IHS) o Prisons/ VA services o **OSHA- was a key player during the pandemic. They enforced places like hotels hospital etc in making sure there was a plan to keep the employees safe during this time o IHS: special population that federal govt provide coverage for** State Health Policy & Medicaid o Medicaid is jointly financed and administered by federal and state governments o STATES set their own guidelines for eligibility and services o States must INCLUDE federally determined categories such as low-income families with dependent children, low- income older adults, and disabled individuals. (need to be below poverty line/ have a disability to qualify) o States set other health policy, for example: o Establishment of predetermined criteria for health- care providers and facilities*** o Each state has an official state public health agency.** o State-based public health agencies participate in the U.S. Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN). o *** HAN: program that includes a secure website and emergency messaging system for sharing reputable info about urgent PH events like bioterrorism, communicable diseases, and environmental threats o The whole point of HAN is help communication with PHDs and hospitals, they all work together to communicate  important PH events o PH agencies participate in CDC’s HAN o *** State public health agency is led by the state commissioner. PH agencies work to monitor health status, enforce PH laws & regulations, distribute federal and state funds for PH activities to local PH agencies. Local Health Policy o Derive authority from state and local laws o Deal with issues such as: o Safety o FLUORIDATION ** o Sanitation o INFECTIOUS DISEASES o Sanitary food and beverages o Regulate/own health care facilities o Hospitals o Clinics o Nursing homes o Local health department personnel o DEVELOP o MONITOR o ENFORCE local health laws/regulations o Local health departments can choose to undergo a voluntary accreditation process. o **With LOCAL health policy, think about more of your environmental concerns, regulating & licensing the facilities in the area. Business/Organizational Health Policy o Develop policies for employees/customers o Offer health insurance  o Paid SICK leave o Nutrition information provided by restaurants o Smoke-free campus o Not selling TOBACCO o Not selling inhalants to minors Principles of Public Health Policy Health Policy Assessment & Planning o Assessment of health status o Social data o Needs o Resources o Goals and objectives o Gather input from STAKEHOLDERS*** Evaluating Public Health Policy o Focus on the 3 E’s o Must be politically feasible Explicit Evaluation Criteria for Policy Planning o Health Determinants o Focus on health determinants o Health status is o Interaction with the environment o Socioeconomic o Genetic o Health service o Behavioral (lifestyle changes) Upstream Thinking o Influencing determinants of health prior to the development of poor health or even physiological changes  that would lead to poor health o usually associated with laws and policies that help prevent injuries from happening and help the community o Seat belts = upstream thinking. Solving laws/ policies before they occur Ethical & Cultural Implications o Basic assumption of public health policy is that society has the RIGHT and even an OBLIGATION to collectively ensure conditions for healthy people. o Sometimes can impose on INDIVIDUAL RIGHTS for the sake of the COMMON GOOD Culture & Policy o Learned knowledge, attitudes, and behaviors of groups of people, which often are accepted without question o Must also remember that communities and workplaces have cultures o Public health policies can affect culture by changing knowledge, attitudes, and behaviors of individuals and groups. o Culturally acceptable health policies:  o Make sense to those affected o Target VULNERABLE groups** o Incarcerated, migrants, immigrants, refugees, asylee The Legislative Process o Public health policies and nursing: o Nurses should have an understanding o Right and duty to be politically active o Bc it affects how they will be able to care for patients o Individual participation/advocacy: o Support or defense of a cause and the act of pleading on behalf of another person o When a nurse is involved in policymaking they serve as an advocate because they are a voice for people that may not have a voice Policy & Nursing o Collective participation: o Join nursing organizations o American Nurses Association (ANA) o Specialty nursing societies o Professional organizations employ professional lobbyists to influence legislators and form political action committees. o Nurses are a big part of shaping public health. o *We are advocates for our patients o Professional organizations make it really easy for the nurse to be involved in impacting policies Planning, Policy, & Finance cont’d o Public health finance- complex system that involves:  o Funding streams o Economic factors o Policy and political changes Health Economics Public Health Economics Encompasses the process for understanding the The financing of public health from a supply and demand of health-care services governmental perspective with a focus on the delivery of public health goods and services and the financing of public health programs** Public Health Funding o Varies by state, community, neighborhood, and city o Federal funds o State funds o Local funds o All are dependent on the size of the population served.** Other Sources of Funding o GRANTS: o Monetary awards to plan and implement a program o LOCAL HEALTH DEPARTMENT budget o Assess and identify public health issues with stakeholder input o Can vary in annual amount** o Public health department staff members play critical roles in BUDGET process o The local health dept budget is going to change every year o ***PHDs that are in charge of specific programs have to provide mandatory reports to the funding source in order to ensure there is continued funding. Otherwise, they are not going to finance it. o If you’re a nurse in the local health dept. and you want  to get continued program funding you need to provide mandatory reports to the funding source. Funding Access to Care o Government health insurance programs o Medicare ▪ 65+ ▪ Under 65 with certain disabilities ▪ Anyone with end-stage renal disease ▪ Part A: Hospital insurance ▪ Part B: medical insurance ie doctor visits, outpatient care, PT/OT ▪ Part C: “Medicare Advantage”à Allows people to receive all their care through a selected private provider organization (PPO) ▪ **Part D= Prescription drug coverage Separate coverage; MUST BE PURCHASED THROUGH PRIVATE INSURER o Medicaid ▪ Any age ▪ Lower incomes, disabilities, older people, some families with children ▪ **ELIGIBILITY RULES VARY STATE TO STATE ▪ Services that MUST be covered for children (and sometimes adults): physical, occupational, or speech therapy; eye doctor visits, eyeglasses; audiology, hearing aids; prosthetic devices; mental health services; respite and other in-home,  long-term care; case management; personal care services; and hospice services o o CHIP (CHILDREN HEALTH INSURANCE PROGRAM) ▪ A Federal & State partnership ▪ provides coverage for children who live in families that earn incomes too high to qualify for Medicaid but too low to afford private health insurance. ▪ Basic eligibility is focused on three groups: children up to age 19 pregnant women and other citizens and legal immigrants o Temporary Assistance for Needy Families ▪ Cash assistance programs are generally limited to 60 months in an adult’s lifetime. o People with disabilities ▪ SSDI Social Security Disability Insurance if the disabled person has worked long enough in the past (40 quarters, 10 years) to pay Social Security tax, and is expected to be unable to work for at least 1 year. It can be provided on a temporary or permanent basis as defined by the disability. There is no income or resource restriction. ▪ SSI Supplemental Security Income o Social Security o SNAP (SUPPLEMENTAL NUTRITION  ASSISTANCE PROGRAM) ▪ Food stamp program ▪ administered by the Food and Nutrition Service of the U.S. Department of Agriculture. ▪ *People who are eligible for TANF and SSI are automatically eligible for SNAP o WIC ▪ Federal grant program **Not an entitlement program ▪ Provides nutritional supplements to: nutritionally at-risk, low-income pregnant women until 6 weeks postpartum Breastfeeding mothers until infant’s 1 st birthday Children up to 5 years ▪ Pays for essential items (eggs, milk, baby formula)