public health definition
1-preventing disease
2-prolonging life
3-promoting health and efficiency
public health
-the sanitation of the environment
-control of communicable infections
-education of the individual in personal hygiene
CDC public health definition
promoting health and quality of life by preventing and controlling disease, injury, and disability
IOM public health definition
what we as a society do collectively to assure the conditions in which people can be healthy
public health practice in the 21st century
-Prevent epidemics
-Protect against environmental hazards
-Prevent injuries
-Promote and encourage healthy behaviors and mental health
-Respond to disasters and assist communities at recovery
-Assure the quality and accessibility of health services
Public health practice, according to Winslow:
-Prevent disease
-Prolong life
-Promote health and efficiency through organized community effort for:
-The sanitation of the environment
-Control of communicable infections
-Education of the individual in personal hygiene
-The organization of medical and
Biostatistics
apply statistical procedures, techniques and methodology to investigate and characterize obesity in the population and evaluate outcomes of public health programs aimed at addressing it.
Epidemiology
systematically study the distribution and determinants of disease or disability in population groups. For example, epidemiologic findings led to the judgment by the U.S. Surgeon General in 1964 that there was a link between cigarette smoking and lung canc
Behavioral Science/Health Education.
Specialists in these fields use specific methods, skills and program strategies to help people choose healthier lifestyles, make more efficient use of health services or participate actively in the design and implementation of programs that affect health.
Environmental Health Sciences
work to protect the public from environmental health threats, may contribute expertise in the following areas:
Air quality
Food protection
Radiation protection
Solid waste management
Hazardous waste management
Water quality
Noise control
Environmental con
Health Services Administration
play a leadership role in regional, state, national and international public health agencies and organizations. For instance, they lead in formulating national public health strategies, such as those identified in Healthy People 2010 or in state or local
The Six Principles of Public Health
Principle of the Aggregate: Public health focuses on the health needs of the entire population.
Principle of Prevention: Public health emphasizes prevention.
Principle of Epidemiology: Public health relies on epidemiology (the science of understanding the
Principle of the Aggregate
Public health focuses on entire populations with similar health concerns or characteristics. "Entire populations" includes everyone who is affected (or potentially affected) by a health concern or who shares similar health characteristics.
One stereotype
Populations-of-interest
are essentially healthy but could benefit from certain factors that could promote or protect health. An example of a population-of-interest is the general population with no specific risk for HIV/AIDS infection, which could benefit from broad prevention e
Populations-at-risk
are those with a common, identified risk factor or risk exposure that poses a threat to health. One example: Mothers with, or at risk for, HIV and their babies, who are also at risk of HIV transmission before birth, during delivery or through breast-feedi
Primary prevention
includes actions designed to promote health (i.e., immunization) and to prevent disease and illness before it occurs.
Secondary prevention
includes activities aimed at detecting and treating problems early, before they become widespread and more serious. Screenings for cancer or for elderly citizens likely to be injured in falls in the home are examples.
Tertiary prevention
aims to stop existing problems from spreading or intensifying. For example, tertiary prevention occurs when public health collaborates with health care providers to assure that diabetics receive periodic examinations to prevent complications of the diseas
Through epidemiology, public health:
Describes the health status of populations;
Explains the etiology (cause or origin) and course of diseases;
Predicts the occurrence of diseases;
Controls the distribution of disease.
Principle of Community Organization
Public health organizes community resources to address community health priorities. By working with communities and the populations or sub-groups within them, public health increases its effectiveness.
Community organizing is part of public health's histo
Principle of Leadership
Public health, at the federal, state and local levels, has an obligation to lead in the protection and promotion of public health when no other provider has emerged, or when government is the entity best able to respond. This obligation carries the author
Principle of the Greater Good
Public health gives first consideration to interventions that provide the greater good for the greatest number of people. The benefit to the community as a whole is chosen over the benefit to any one individual. Public health's insistence on the greater g
The Three Core Functions of public health, which appear along the circumference of the circle, are:
Assessment, used to identify community health status, needs and available resources.
Policy development and planning, which uses data gathered during assessment to create health policies and proposals to improve population health.
Assurance, which transla
Assessment
used to identify community health status, needs and available resources.
Policy development and planning
uses data gathered during assessment to create health policies and proposals to improve population health.
Assurance
translates policies into services and makes sure that needed services are made available to all communities.
The assessment function requires putting on the hat of a detective to investigate such questions as:
What are the community's major health problems?
What population groups are at risk?
How are risks distributed geographically?
What services are available?
Are health resources/manpower adequate?
What do citizens perceive to be health concerns?
What do pro
Determinants of health
include income and social status, housing, nutrition, employment and working conditions, social support networks, education, neighborhood safety and violence issues, physical environment, personal health practices and coping skills and cultural customs an
The policy development and planning function
relies on "the scientific knowledge base," information of the kind gathered in the community health assessment.
The ultimate goal of policy development and planning
is actionable programs to meet the health needs identified through assessment.
Examples of public health policies
include laws mandating seat-belt usage and making it illegal for minors to buy tobacco products.
Policy development is a process. It involves asking - and gathering answers to - questions such as:
Based on needs and available resources, where should we focus our efforts?
What are our health priorities, given the size and seriousness of the problems and the acceptability, economic feasibility and effectiveness of interventions needed to address them
Assurance, the third Core Function
describes activities that ensure that the work of public health gets done.
The IOM defined assurance as
seeing "that services necessary to achieve agreed upon goals are provided either by encouraging actions by other entities, by requiring such action through regulation, or by providing services directly.
Assurance
Means the public health has the responsibility to see that they are provided (by private practitioners, non-profit organizations or others), that they are accessible and that they are acceptable to those who need and use them.
Public Health's 10 Essential Services
Monitor health status to identify community health problems
Diagnose and investigate health problems and health hazards in the community
Inform, educate and empower people about health issues
Mobilize community partnerships to identify and solve health pr
Community-level
practice aims to change community norms, attitudes, awareness, practices and behaviors;
Systems-level
practice seeks to change organizations, policies, laws and power structures - the systems that affect health
Individual/family-level
practice seeks to change knowledge, attitudes, beliefs, values, practices and behaviors of individuals, alone or as part of a family, class or group.
From the viewpoint of the World Health Organization, "health" is defined as:
Correct Answer:c) Physical, mental, and social well-being
Which of the following is the best definition of the term "population health"?
Correct Answer:c) The health outcomes of a group of individuals, including the distribution of such outcomes within the group.
Public health nursing
is the practice of promoting and protecting the health of populations using
knowledge from nursing, social, and public health sciences. The practice is population-focused
with the goals of promoting health and preventing disease and disability for all peo
..The core concepts from nursing that shape public health nursing include:
� Caring and compassion
� Holistic and relationship-centered practice
� Sensitivity to vulnerable populations
� Independent practice
The core concepts from public health that inform public health nursing include:
� Social justice
� Population focus
� Reliance on epidemiology
� Health promotion and prevention
� The greater good
� Long-term commitment to community
Individual/Family Level of Practice
Public health nurses (PHNs)
work with individuals and families to promote health and reduce risks.
Family functions include:
Provision of emotional support and encouragement
� Socialization of children to roles and community expectations
� Reproduction of family members by birth or
PHNs
work with individuals and families in many different community settings. Working with families
in the community helps you understand the diverse socio-economic, cultural, and environmental factors
that influence the level of health, wellness, and disease
individual/family level of
practice.
If you are working with an individual or family to help them adapt or change their values, health beliefs,
or behaviors to improve their health status, then you are working at the
Community Level of Practice
You initially identify the nature or characteristics of a community when you begin to work with vulnerable
individuals, families, and groups. A community can refer to a:
� Group of people or population group
� Physical place and time in which the populati
Individual/Family level
Population-based, individual-focused practice changes knowledge, attitudes, beliefs,
practices, and behaviors of individuals.
Directed at individuals, alone or as part of a family, class, or group.
Individuals receive services because they are identified
Individual/Family level examples
-Home visiting to newborn and parents
� Teaching hand washing to a firstgrade
class
� Checking for presence of lead-based
paint in a family home with preschool
children
� Developing a fall prevention plan for
an elderly person living alone
Community level
Population-based, community-focused practice
changes community norms, community
attitudes, community awareness, community
practices, and community behaviors.
(PHNs) are directed toward entire populations
within the community or occasionally toward
target
Community level examples
� Writing a letter to the editor of local
paper stressing the value of home
visiting to parents of newborns
� Creating a billboard about the
hazards of lead-based paint
� Holding community "town hall"
meetings to make the community
aware of safety hazards
Systems level
Population-based, systems-focused practice
changes organizations, policies, laws, and
power structures.
The focus is NOT directly on individuals and communities but on the systems that impact health.
Changing systems is often amore effective and long-last
Systems level examples
� Meeting with legislators to advocate
for reimbursement for home visiting
with families of newborns
� Developing a hand-washing program
at an elementary school
� Teaching local realtors how to
recognize lead-based paint in a home
� Developing a fall prev
1. Assessment
The public health nurse collects comprehensive data pertinent to the health status of populations
2. Population Diagnosis and Priorities
The public health nurse analyzes the assessment data to
determine the population diagnosis and priorities.
3.Outcomes Identification
The public health nurse identifies expected outcomes for a plan that is based on population diagnoses and priorities.
population of Interest
Population who is essentially healthy but could improve factors that promote or protect health
population of Interest examples
Families who live in urban areas with
little opportunity for exercise because
of lack of parks, playgrounds, or bike
paths
College students who have
increased stress because of study
needs and college debts and are
looking for ways to reduce their stress
population at risk
Population with a common identified risk factor or risk exposure that poses a threat to health
population at risk examples
Children who are not immunized for major childhood illnesses such as measles and chickenpox
Older members of a church congregation who live alone and are at risk for falls
primary prevention
both promotes health and protects against threats to health. It is designed
to keep problems from occurring in the first place. It promotes resiliency and protective factors
or reduces susceptibility and exposure to risk factors. Primary prevention occurs
Secondary prevention
detects and treats problems in their early stages. It keeps problems from
causing serious or long-term effects or from affecting others. It identifies risks or hazards and
modifies, removes, or treats them before a problem becomes more serious. Secondary
Tertiary prevention
limits further negative effects from a problem and aims to keep existing
problems from getting worse. Tertiary prevention is implemented after a disease or injury has occurred.
It alleviates the effects of disease and injury and restores individuals to op
Assessment�
Community assessment of population health needs by monitoring and investigating
levels of population health and illness
Policy Development�
Development of health policies, goals, plans, and interventions to meet
priority community health needs
Assurance�
Measurement of outcomes of health policies, goals, plans, and interventions and the competency and adequacy of public health professionals to determine that priority health needs of a community have been met in an efficient, effective, and timely manner
Epidemiology:
The study of the distribution and determinants of health-related states or
events in human populations and the application of this study to the prevention and control
of health problems
Agent:
The primary cause of the health-related condition.
-classified into six main types: physical, chemical, nutritive, infectious, genetic, and psychological
Communicability:
Likelihood that a pathogen or agent can be transmitted from a diseased or infected person to another person who is not immune and is susceptible
Risk Factor:
is the probability that a given individual will develop a specific condition.
An individual's risk of developing a particular condition is affected by a variety of physical,
emotional, environmental, lifestyle, and other factors
Protective Factor:
Factors including characteristics of individuals and their lifestyle, the physical environment, the social environment, and characteristics of the agent that lessen
risk for a disease or impairment.
Prevalence:
The number of existing cases of a disease or health condition within a population at some designated time
Life Course Epidemiology:
The study of long-term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood,
and later adult life
Incidence:
The number of individuals who develop the disease over a defined period of time or the number of new cases of a particular condition identified over a period
Host:
The human being affected by the particular condition under investigation.
Factors that the host brings to the triangle include intrinsic factors (age, gender, race, etc.); physical and psychological factors; and the presence or absence of immunity
Epidemiological Triangle:
Data are collected with respect to three elements: host, agent, and environment. The interrelationship of these elements results in a state of relative
health or illness
Epidemiology:
The study of the distribution and determinants of health-related states or events in human populations and the application of this study to the prevention and control
of health problems
Epidemic:
Occurrence in a community of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy
Environment:
The characteristics of the physical, biological, and social environment that contribute to health-related conditions.
Environment might include pollution issues, microorganisms, social interactions, or cultural issues
Epidemiologist activities
-Identifying risk factors for disease, injury, and
death
-Describing the natural history of disease
-Identifying individuals and populations at
greatest risk for disease
-Identifying where the public health problem is
greatest
-Monitoring diseases and oth
public Health nursing activities and
Interventions (from the public Health
Intervention Wheel)
-Disease and Health Event Investigation
-Health Teaching
-Outreach, Screening, Referral and Follow-up, Advocacy,
Case Management
-Surveillance, Disease and Health Event Investigation
-Consultation, Collaboration, Community Organizing, Policy Development a
PHNs are involved in every step of this process:
(1) identifying the questions that need to be asked,
(2) developing the data collection process,
(3) collecting the data,
(4)analyzing the data,
(5) using the data to inform future actions and program delivery.
descriptive epidemiological studies
focus on the distribution of disease
analytic epidemiological studies
focus on the causes of disease; focuses on why and how
descriptive epidemiological studies:
look at time factors, location, and population counts
consider frequency and pattern
analytic epidemiological studies:
look further into the data describing the public health issue to identify the determinants of the disease
agent, host, and environment are the focus of the studies
epidemiologists
-data collection and analysis
-design and implementation of surveillance systems, screening practices, and interventions
-evaluation of public heath programs
demographic characteristics
age
gender
race/ethnicity
use of tobacco or drugs
socioeconomic factors
insurance status
geographical data
place of birth
place of residence
zip code
state
county
cross sectional study
point in time study
focuses on picture of health issue at that point in time
survey
does not establish cause/effect
cohort study
takes place over time
seeks to define populations, collect info about differing exposures, determine outcomes, determine follow-up time, compare results of groups with differing exposures
case-control study
retrospective study
involves collecting data of two pops: one with disease and one without
Regulatory functions
Permitting, monitoring, enforcement, registration and licensing
Record keeping, reporting, and developing inventories
Remediation and emergency response
Laboratory support
Standard setting, litigation, and administration
Public health functions
Health surveillance and epidemiology
Health risk assessment, toxicology, and applied research
Communication, education, training, and consultation
aggregate
refers to groups of people or populations with common characteristics and needs. If we identify what the population has in common we identify and prioritize the interventions to protect the health of the whole community.
The common characteristics that can define the population in public health practice include:
-human biological characteristics (age or gender).
-social characteristics (income or education).
-organizational characteristics (access to health care, organization of service).
-environmental characteristics which include the natural and man-made spati
Physical factors
are structural elements including such things as the building, equipment, noise, radiation, light and temperature and forces such as mechanical and electrical energy. In the community we refer to geological formations versus buildings, climatologic elemen
Chemicals
are present in all environments. found in raw form such as in laboratories or in day to day operations such as cleaning. can come in the form of dusts, fumes and gases, as well as solids and liquids.
Biological factors
are all living things and their products. Physical factors such as needles may cause harm (i.e., puncture wounds) while potentially carrying many biological hazards.
Psychosocial factors
include all the responses and behaviors that people exhibit based on the attitudes and values learned from their cultural backgrounds and life experiences. With our culturally diverse population we are more and more aware of how attitudes and values can i
environmental health
we are discussing the control of all of those factors in the human environment which exercise, or may exercise, a deleterious effect on human development, health and survival.
environmental health is
the "freedom from illness or injury related to exposure to toxic agents and other environmental conditions that are potentially detrimental to human health.
Promoting Health -
start with a healthy population and increase their wellbeing through interventions such as fitness and stretching exercises, and nutritional counseling.
Preventing Disease and Injury -
preclude what has not yet occurred through such interventions as immunizations, fluoride in the drinking water, and physical and emotional stress management.
Protecting Humans from environmental exposure -
Examples include wearing hard hats and safety shoes, wearing ear plugs in the work environment to protect the workers from noise, respirators for dusts and chemicals, and, in the community, fences around swimming pools, seatbelts, and wearing helmets whil
Etiological agent:
a substance living or inanimate or its presence in relative excessive or deficient amounts which is the immediate or proximate cause of the disease or injury- infectious agents (bacteria, helminths, viruses, rickettsia, fungi), chemical agents (solvents,
Reservoir:
people, animals, soil, water or any part of the ecosystem that harbors the agent, usually for a part of its life cycle. Reservoirs may includ natural habitats such as humans, animals (wild, domestic), soil (botulism), or water (legionella) or sources (e.g
Escape from the reservoir:
For infectious agents this includes respiratory, enteric, erosion, vector bites (bloodborne) etc. For chemical and physical agents it can be by way of a process such as grinding, spraying, burning, radiating, etc.
Transmission by a vector/vehicle:
The agent moves from its reservoir to the host by means of living vectors or inanimate vehicles. Without a method for moving along this pathway, the presence of a potentially harmful substance will not be adequate to cause harm.
Portal of entry:
Entry into the body occurs through respiratory, dermal, ingestion, and parenteral mechanisms.
Susceptible host:
The person experiencing exposure or health effect. The host's level of susceptibility is very important, and can sometimes be modified by previous exposure to the agent or preventive actions such as vaccination. Some characteristics that can affect suscep
The interventions employed in public health fall into three general types of strategies for promoting change listed from least to most invasive -
Education, Engineering and Enforcement
Education
is voluntary and involves changes in action based on information and persuasion - most typically thought of as training efforts. However, I've also classified personal protective devices, in part, as education because they require active participation of
Engineering
is typically thought of as the environmental control measure of choice because it does not count on elective changes in human behavior. This approach involves changing, developing and mainipulating systems including social systems and environmental system
For example engineering controls to prevent auto crashes include:
-isolation: barriers between lines of traffic, walkways over busy streets
-dilution or dispersion: (not as readily thought of as applicable to injury control but can be applied here) dispersing interstate traffic around the cities to decrease intercity tr
Eventually we get to the most invasive control measure and that is Enforcement -
mandated change, by means of rules that have the force of law. This is an administrative approach (when referring to internal policy or 'laws').
Lead
naturally occurring nonferrous metal present in the earth's crust in varying concentrations. Natural sources that contribute to the emission of lead into the atmosphere include silicate dust, volcanic halogen aerosols, forest fire smoke, aeosolic sea salt
micro environments examples
home, workplace, lead poisoning
Macroenvironments
air, water resources and the impact of solid and hazardous waste on our land resource.
Environmental risk assessment
the use of scientific facts and assumptions to determine the probability of human illness from exposure to environmental hazards...educated guesses that blend science, experience and judgment to estimate potential risk."
used within the government regula
Hazard identification:
the process of determining whether exposure to some risk factors can produce an increase in the rate of cancer, birth defects or other condition being investigated (epidemiology, animal bioassay, in vitro effects, comparison of molecular structure).
Dose-response relationship:
the greater the dose the greater the response as seen with smoking and its relationship to outcomes such as lung cancer and cardiovascular disease.
Exposure assessment:
the determination of the concentration (or dose) to which people are exposed, such as concentrations of chemicals in foods, water, and air; exposure assessments must determine which groups may be at greatest risk of exposure; multiple or mixed exposures a
Risk characterization:
the estimate of the anticipated magnitude of the public health problem.
Risk management...
is the process of sorting through the data and choosing between possible alternatives.
Risk management
includes the consideration of uncertainties, limited analytic resources, complexity of information, external pressures, and visible economic interests.
Comparative risk
is a risk management tool that is used by environmental agencies to compare risks posed by a wide range of environmental problems based on available technical information.
The purpose is to rank environmental problems based on the degree of risk they pose
Comparative risk has three components:
(1) analytical technical-based issue assessment,
(2) ranking process based on professional judgment and informed public opinion, and (3) implementation phase translating ranking into action.
The following framework provides steps to follow in ethical decision making:
1-Define the dilemma.
2-Identify the key values under consideration for all the players involved.
3-List the alternative approaches available for solving this dilemma.
4-Write down the prefered alternative.
5-Identify some organizational changes in policy
Ethics
refers to the rightness or wrongness of human behavior.
Ethical analysis
helps provide guidelines for action that are "consistent; justifiable by appeal to commonly held values, principles or rules; and able to withstand close moral scrutiny
Valuing
is a system of ideas, attitudes and beliefs about the worth of a thought, object, or behavior
Values
indicate what is judged to be good, imply preferences, shape perceptions and evoke feelings. They specify a course of action and produce consequences.
Values shape practice and are potential sources of conflict such as:
Right to Know vs. Trade Secrets
Confidentiality vs. the Need to Know
Whistle Blower vs. Code of Silence
There are three types of values that come into play when we talk about environmental health practice:
Personal values
Organizational values
Social values
There are seven steps to values clarification of personal values
When one values something, one chooses, prizes and acts.
1 chooses freely;
2 chooses from alternatives;
3 chooses after careful consideration of the consequences of each alternative;
4 is proud of and happy with the choice;
5 is willing to affirm the choi
Understanding ones own personal values
is important in defining the consequences of the decisions one makes, for oneself and for the effect this position may have on others and the values they hold.
autonomy, or the right to self-determination
This value encompasses confidentiality and truth telling concepts, respecting others right to privacy and refusal of treatment. This values also plays a role in a person's perception of acceptable risk, concept of safety, expectations about health protect
The value of autonomy
asserts that communities have the right to participate in decisions to minimize risk and limit exposure through environmental controls.
Beneficence
means doing good and promoting well being for others.
For example health promotion programs at the work site including physical fitness, nutrition programs, and stress management classes offered to employees are based on this value.
Non-maleficence
means avoiding infliction of harm to others. This value takes presidence over doing good in a public health ethic.
For example a risk assessment based on specific hazard analysis allows the practitioner to counsel prospective communities on the need for c
Justice
is treating people fairly, giving to each person what is her or his due, distributing benefits and burdens equitably (fairly) in society. Two conditions
Market and Social
Professional standards are created to:
protect the public and the profession,
articulate minimum professional competencies,
control and direct the practice,
encourage thoughtful revision, and
assure minimum quality of care.
Codes:
create awareness of ethical considerations; and, provide a framework for decision making
Some American social values have been expressed as
productivity, materialism, education and freedom of choice.
Social values
reflect the struggle to balance environment, economic and equity issues.
market justice.
people are entitled only to those valued ends such as status, income, happiness, etc., that they have acquired by fair rules of entitlement, e.g., by their own individual efforts, actions or abilities
social justice
is proposed as a counter-ethic to market justice and the ethics of individualism.
based on the premise that all persons are entitled equally to key ends such as health protection or minimum standards of income.
Key principles social justice
controlling the hazards of this world,
to prevent death and disability,
through organized collective action,
shared equally by all except where unequal burdens result in increased protection of everyone's health and especially potential victims of death a
Environmental Justice initiatives
stemmed from the concern for the unequal burden of pollution experienced by disadvantaged populations
Statutory law
refers to a particular law passed by a legislative branch of the government which declares, commands or prohibits something.
Most of these statutory laws define:
who the regulating board will be,
what the practice consists of,
who the professional is,
what the levels of practice are, for instance advanced practice, and
each of the components rights and responsibilities including disciplinary action.
Common law terminology
refers to judge-made law or decisional law today. is an aggregate of decisions in numerous cases through the years. Therefore, when a court renders a decision, that decision becomes a part of the body of 'common' law and establishes a precedent to guide t
common law
includes tort law and case law
There are three components to an exposure history:
Exposure Survey, Work History, and Environmental History.
exposure history form
Part 1: Exposure Survey
Part 2: Work History
Part 3: Environmental History
exposure survey
The questions investigate the following: known exposure to metals, dust, fibers, fumes chemicals, physical agents, and biologic hazards; details about known toxicant exposure; other persons affected; temporal patterns and activities; changes in routines a
Part 2: Work History
a comprehensive inventory of the client's occupations, employers, and current and potential exposures in the workplace. No questions on allergies and principal symptoms have been included, because it is presumed the clinician will include these elsewhere
Part 3: Environmental History
contains questions regarding the home and surrounding environment of the client. Dialogue should include queries about the location of the house, the house water supply, and changes in air quality.
Strength:
What is the rate of increase in the symptom/disorder in the exposed population compared to the rate prior to exposure?
Consistency:
Has the association been observed by different investigators in different populations using different methods?
Specificity:
Is the association limited to people with specific exposures and to particular physiological systems and types of disease?
Temporality:
Does the exposure precede the disease? Have the symptoms developed after environmental diseas was suspected?
Biological Gradient:
Is there a dose-response curve?
Plausibility:
Is the association biologically plausible?
Coherence:
Is the association consistent with known facts of the disease?
Experiment:
Does some intervention targeting the chain of transmission prevent the disease or injury?
Analogy:
Is the association analogous to a well-characterized disease?
Microenvironment-
residential, institutional and workplace
Microenvironment examples
-Indoor air pollution (including tobacco smoke)
-Substandard housing (i.e., lead paint, garbage)
-Occupational exposures
-Common household products
Macroenvironment-
air, water and land
Macroenvironment examples
-Hazardous waste (i.e., mercury)
-Ambient air conditions (i.e., extremes in heat/cold, pollution)
-Quantity and quality of water sources
Components of an Exposure History
Part 1. Work History
A. Exposure Survey
B. Health and Safety Practices at Work Site
Part 2: Environmental History
Part 3: Personal Health History
Part 4: Cultural History
1-work history
Description of all previous jobs (including short-term, seasonal, part-time jobs, and military service
Description of present job(s)
A. Exposure Survey
-Current and past exposure to metals, dust, fibers, fumes, chemicals, biologic hazards, radiation, nois
Part 2: Environmental History
Present and previous home locations and age of housing
Jobs of household members ("take-home" exposures)
Home insulating and heating and cooling system
Home cleaning agents
Pesticide use
Water supply
Recent renovation/remodeling
Indoor and outdoor air pol
Part 3: Personal Health History
Current state of health
When and under what conditions symptoms started
Past and chronic health problems
Mental health history
Last physical exam and medications
Tobacco use history and environmental tobacco smoke
Part 4: Cultural History
Language(s) commonly used
Family physician and/or traditional healer used
Traditional folk medicines used
Culturally specific foods and beverages in diet
Imported fresh or canned foods in diet
Food or beverage stored in glazed imported ceramic pots or lea
How an environmental risk is __________ has the overriding influence on perceptions and decisions.
framed
The framing of the issue
influences how it is received and acted upon.
All of these are true statements
It is not necessary to know specific occupational jargon to illicit information about exposures.
When attempting to identify toxic exposure, focus your inquiry on job description and work environment rather than on job titles; job titles alone can be misl
Goals of an exposure history are:
Identifying past and present toxic exposures
Ending the client's exposure to toxins
Proper treatment of the client's illness
TRUE / FALSE : An exposure history should only be taken on those who work in jobs with potentially toxic exposures.
False
True statements
The clinician must consider potential long-term, latent effects from the past in addition to the immediate concerns.
Job descriptions should be included in exposure history forms as job titles themselves may be misleading.
These forms may be administered
Where can you find a national perspective in environmental and public health priorities for the U.S.?
Department of Health and Human Services/Healthy People 2010.
What are major factors that have the potential to impact health no matter what environment you are in?
physical and chemical factors.
biological factors.
psychosocial factors
What practice priority is emphasized in environmental health programming?
promotion
What mechanisms of intervention are used in environmental health practice?
education and engineering strategies
engineering and enforcement strategies
Sources of information that may be helpful to the provider in treating and managing an exposed client include the following:
MSDS
Poison control
AOEC's
What are the components of the risk assessment process?
hazard identification, dose response, exposure assessment, risk characterization
Risk Assessment includes
identification, dose response, exposure assessment and risk characterization.
Risk management includes
the consideration of uncertainties, limited analytical resources, complexity of information, external pressures and visible economic interests.
Sources of consultation in evaluating a potentially exposed patient include the following:
Industrial hygienists
Toxicologists
Public health departments
The PHNs identified several strategies for empowering their patients:
begin with the patient's perspective, tune
into the readiness of the patient, assess holistically and build rapport with their patients.
catalyst
This means that someone needs to initiate the collaborative process, which then continues to develop with the input of the people who contribute their perspectives and skills to the collaboration
Individual level:
PHNs collaborate with individuals through mutual decision making about how to reach health goals.
For example, a PHN might bring information to a family about where to find additional services for a child with special needs and work the family on their pl
Community level:
PHNs work with groups in the community and assist in establishing self-help groups.
A PHN might find many elderly individuals in his or her caseload with adult children or spouses who are experiencing stress from the added caregiving responsibilities. Aft
Systems level:
PHNs can collaborate with systems that implement policy and program changes such as
governmental organizations, schools, and hospitals.
For example, the PHN might work with community leaders to institute a policy that addresses teen smoking.
examples of professional collaboration
sharing educational opportunities (emergency preparedness strategies),
selecting a common screening tool to be used by all (assessment of child development),
sharing knowledge about resources for referral (food programs),
linking to interdisciplinary refe
The following list provides a summary of best practices for effective collaborative action.
-Effective leadership
� Commitment of the participants
� Shared values and a sense of purpose
� Linkages between groups and individuals
� Identification of strategies and resources to achieve the goals, a structure to support the collaborative
work
� Inte
A framework for collaborative group that develops the relationships and interaction patterns for working on a common public health goal (Tuckman's
stages of normative group development)
forming, storming, norming, and performing
forming phase
group members work to understand one another. They need to determine their boundaries and focus; group leaders emerge during the forming phase
storming phase
phase in which conflict emerges; some resistance to following group direction forms and some "testing of the waters" and concern might occur about whether the focus and direction of
the group is the right way to do things.
Conflict management skills can b
norming stage
trust among membership develops.
They identify themselves as a group and become cohesive in choosing the goal of the collaboration.
performing stage
the group focuses on accomplishing specific tasks.
The group has established rules for working together, formal or informal, but the rules are flexible rather than rigid. Group rules serve to help the group function and accomplish the public health goal.
CCPH Principles of Partnership
1. Partnerships form to serve a specific purpose and may take on new goals over time.
2. Partners have agreed upon mission, values, goals, measurable outcomes, and accountability for
the partnership.
3. The relationship between partners is characterized b
social capital
(community resources).
Research shows that social capital (resources that promote a sense of belonging)
contributes to health by serving as a protective factor against chronic illness; social capital is also associated with better access to health care
Neighborhood mapping:
A technological tool PHNs can use when collaborating with communities to identify assets and needs within a defined geographic community is neighborhood mapping, which uses geographic information system (GIS) software.
Used to identify and locate physical
Principles of the Community-Based Participatory Research Model.
1. A community is a unit of identity that is reinforced through social interactions and characterized
by shared values and norms and mutual influences.
2. Activities should build on community resources and relationships.
3. Programs should establish equal
Rule Ethics (principles)
� The goal is beneficence or promoting good (improvement in health status) for the community and community members.
� Encourage autonomy of community members by ensuring that their perspective contributes input in determining interventions to improve heal
virtue Ethics (character)
� Be courageous in working with those with different views and perspectives.
� Be persistent in working through disagreement and tension in collaboration with others.
Feminist Ethics (reducing oppression)
� Encourage inclusion of the voices of all stakeholders in the collaboration.
� Respect everyone.
� Strive for equality in provision of programs and services.
� Emphasize community strengths.
� Advocate for individuals and community groups who have less p
Public health nurses
collaborate with many partners: other nurses, health professionals, lay workers, community members, health care and community organizations, businesses,
and government organizations.
Effective partnerships
share a common goal and require respect for and equality of partners.
Collaborative partnerships for promoting the health of the public
should integrate community assets that develop intervention strategies, which contribute to social capital;
design interventions that will be accepted by community members; and garner the buy-in and contributions of community organizations.
Tools for using community assets and building social capital
are neighborhood mapping and community-based participatory research.
Partnership development
requires trust between partners and a commitment to spend the time needed to develop that trust.
Collaboration:
Working together "to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health
Interdisciplinary Collaboration:
Brings all members of the health team together," which is needed because "most health care processes involve more than one discipline
Partnership:
A close mutual cooperation between parties having shared interests, responsibilities,
privileges, and power
Community Asset:
Anything that can be used to improve the quality of community life" including people, physical structures, businesses, and organizations
Social Capital:
Resources that promote a sense of belonging, including social networks, social support, reciprocity, and trust that lead to a socially cohesive society
nonjudgmental
to "...establish a ... communion into which I enter having cleansed myself of harmful bias through honest self-reflection; and, in which I exude humility and openness
Unconditional:
A form of respect that involves profoundness of feeling, treasuring, warm
regard, [and] solicitous concern
Acceptance:
-"To consider their patients' culture and incorporate it in care..."
-the "respect of another's individual person and self-defined reality
ways that nurses demonstrate nonjudgmental and unconditional public health nursing
� Listening to others in an unbiased manner
� Respecting others' points of view
� Promoting the expression of diverse opinions and perspectives
� Identifying the role of cultural, social, spiritual, religious, and behavioral factors when selecting
or desi
steps to becoming nonjudgmental
1. Recognize judgmental feelings. (Becoming nonjudgmental begins with openness to yourself,
even though it might be painful to acknowledge judgmental feelings.)
2. Accept your judgmental feelings for what they are. (Without acceptance, you aren't able to
culture
learned, shared and transmitted beliefs, norms and
life practices of a particular group that guides thinking, decisions and actions in patterned ways
acceptance at the systems level
-most often reflected in policy or program level strategies.
-ex: Policies that support interpreter services for those who do not speak English
acceptance at community level
focuses on cultural diversity and becoming familiar with influential people within a culture
Harm Reduction
A public health philosophy which promotes methods of reducing the physical, social, emotional, and economic harm associated harmful behaviors on individuals, their family and community
Harm reduction
emphasizes practical rather than idealized goals
Assessment-
�Community assessment of population health needs by monitoring and investigating levels of population health and illness
Policy Development
�Development of health policies, goals, plans, and interventions to meet priority community health needs
Assurance
�Measurement of outcomes of health policies, goals, plans, and interventions and the competency and adequacy of public health professionals to determine that priority health needs of a community have been met in an efficient, effective, and timely manner
three core functions of public health
assessment, policy development, assurance
essentials of public health: harm reduction
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, and Empower
4. Mobilize Community Partnerships
5. Develop Policies
Primary Prevention goal
to protect healthy people from developing a disease or experiencing an injury in the first place.
Primary Prevention
-promotes health
-protects against threats to health
-designed to keep problems from occurring in the first place
-promotes resiliency and protective factors
-reduces susceptibility and exposure to risk factors
-targets essentially well populations.
Secondary Prevention
-detects and treats problems in their early stages
-keeps problems from causing serious or long-term effects
-identifies risks and modifies, removes, or treats them before a problem becomes more serious
-targets populations that have risk factors in commo
Tertiary Prevention interventions
help people manage complicated, long-term health problems
tertiary prevention
-limits further negative effects from a problem and aims to keep existing problems from getting worse.
-implemented after a disease or injury has occurred.
-alleviates the effects of disease and injury and restores individuals to optimal level of function
Ten Essential Services of Public Health
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, and Empower
4. Mobilize Community Partnerships
5. Develop Policies
6. Enforce Laws
7. Link to/Provide Care
8. Assure Competent Workforce
9. Evaluate
10. System Management & Research
Examples of primary prevention
-Risk assessment for specific diseases
-Health education about preventing illness
-Immunization against specific illnesses
Examples of secondary prevention
Screening for specific illnesses such as developmental disabilities, cancer, or hypertension
Examples of tertiary prevention
-Teaching an individual (or family of an individual) with diabetes and chronic kidney disease about diet (e.g., low protein) to prevent complications.
-Referring an individual and/or coordinating care for an individual with end stage emphysema and post-CV
Public health nursing
-the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.
-The practice is population-focused with the goals of promoting health and preventing disease and disability for all peop
The core concepts from nursing that shape public health nursing include:
Caring and compassion
Holistic and relationship-centered practice
Sensitivity to vulnerable populations
Independent practice
Social Determinants of Health: Three principles of action
1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age.
2. Tackle the inequitable distribution of power, money, and resources - the structural drivers of those conditions of daily life - globally, n
The fundamental conditions and resources for health are:
peace,
shelter,
education,
food,
income,
a stable eco-system,
sustainable resources,
social justice, and equity.