Intro to Community, Population, Public, & Global Health + Social Influences

OBJECTIVES Introduction to Community, Population, and Public Health

•Describe the health continuum including the concepts of health and wellness individuals and populations.

•Explain major concepts that guide public health and the practice of community and public health nursing.

•Compare and contrast the different frameworks (theories/models) used in community health nursing.

•Describe specific nursing interventions to promote health at all three (3) levels of prevention.

•Analyze major factors (determinants) influencing holistic health care for clients, families, and communities.

•Discuss the significance of the following community and public health concepts: leading health indicators, health outcomes, health disparities, healthy equity, equity, at-risk populations

•Apply evidence-based guidelines and strategies in the care of populations to meet the needs of aggregates across community health settings.

OBJECTIVES Introduction to Community, Population, and Public Health

define health for the individual

a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.

define health (community)

a community that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.

define wellness

health plus the capacity to develop a person’s potential leading to a fulfilling and productive life.

define illness

state of being relatively unhealthy.

what’re the charac. of a healthy community

•Appropriate housing

•High standards of personal hygiene in the community

•Accessibility for all to health care facilities and providers

•Safe Environment

•Positive interpersonal relationships among members

•Sound communication infrastructure

•Promotion of health equity

define community

Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging

define population

all the people who inhabit a geographic area or have the one or more personal or environmental characteristic. People don’t necessarily interact with one another or share a sense of belonging to the group. 

define aggregate

“a mass or grouping of distinct individuals who are considered as a whole or who are loosely associated with one another.”  Communities and populations are types of aggregates.

define subpopulation

a subset of a larger population.

what’re the 3 types of communities

geographic, common interest, and community of solution

define geographic community

•city, town, neighborhood (ATI only addresses geographic)

define common interest community

church, professional organization, people with mastectomies

define community of solution community

group of people who come together to solve a problem that affects all of them

define public health

•broader scope, supports entire region with a focus on promotion and disease prevention

define public health nursing (PHN)

•promotes and protects health of populations. It is population-focused

define community health

•often working in a subset of public health, like a neighborhood. Focus is “preventing disease and reducing health disparities through addressing social, behavioral, environmental, economic and medical determinants of health”

define community health nursing (CHN)

•provides an bridge between acute sector and community services. Embrace a social model of health to advocate and give a voice to the community accessing care. in a complex system. Community-focused

For this class, _________ will be used interchangeably in this course.

CHN and PHN

what’re the public health core functions?

Assessment Regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community (Ex: COVID rates surveillance)

Policy Development Use of assessment data to collaborate with law makers to develop policy and direct resources toward those policies.

Assurance ensuring that essential community-oriented health services are available, which may include providing essential health services for those who would otherwise not receive them. Also developing and monitoring quality of services provided.

breakdown 10 essentials of public health service

1.Assess and monitor population health

2.Investigate, diagnose, and address health problems and hazards

3.Communicate effectively to inform and educate

4.Strengthen, support, and mobilize communities and partnerships

5.Create, champion, and implement policies, plans, and laws

6.Utilize legal and regulatory actions

7.Assure equitable access

8.Build and support a diverse and skilled public health workforce

9.Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement

10.Build and maintain a strong organizational infrastructure for public health

what’s healthy people 230

National Public Health Policy – Our nation’s 10-year plan to improve health and well-being for all people of all ages and the communities in which they live.

what’re the goals of healthy people 2030?

• Attain healthy, thriving lives, free of preventable disease, disability, injury, and premature death

• Achieve health equity, eliminate disparities, and improve the health of all groups

• Create social and physical environments that promote good health for all

• Promote quality of life, healthy development, and healthy behaviors across all life stages

what’s the goal of community health nursing

•Decrease health inequities, improve health of community, reduce risks in the community

•Addresses social determinants of health  (SDOH)

what’re the portions of the nursing process that

• Assess: community data, trends, epidemiology, population growth data for planning services, and environmental risks

• Diagnose: identification of priorities, application of information and observation of changes, and emergence of new issues

• Plan and implement collaborative interventions, education, and advocates to influence change

• Evaluate: programs and interventions, rates, and research involvement

theoretical change model

theoretical change model

Public Health Nursing Interventions and Wheel

Public Health Nursing Interventions and Wheel

define omaha system

•A multidisciplinary standardized interface

•Incorporates documentation of nursing assessment and interventions

Key components:

•Problem classification scheme

•Intervention scheme

•Problem rating scale for outcomes

omaha system visual

omaha system visual

define upstream thinking

is used to focus on interventions that promote health or prevent illness as opposed to medical treatment models which focus on care after an individual becomes ill or injured.

what does upstream thinking look like?

PH efforts/legislation to address poverty, access to prevention services, job training, educational inequality,

food insecurity, etc. at community level

what does midstream thinking look like?

Access to smoking cessation resources, healthy foods, exercise opportunities, behavioral support and management.

what does downstream thinking look like?

Cancer treatment, heart failure treatment, rehabilitation services

levels of prevention visual

levels of prevention visual

define tertiary prevention

rehab, preventing complications and improve QOL

people w a health problem

define secondary prevention

screening of a risk individual, control of risk factors and early intervention

people at risk of a problem

define primary prevention

health promotion and addressing risk factors, social and genetic factors

well population

what does primary prevention aim to do

Aims to prevent disease or injury before it ever occurs.

Examples: vaccines, teach hand hygiene, N95 mask fit-tests, safe sex education, needle exchanges

what does secondary prevention aim to do

Aims to detect or reduce the impact of a disease or injury that has already occurred (anything done to lessen the impact of the disease)

Example: STD testing, mammogram

what does tertiary prevention aim to do

Aims to soften the impact of an ongoing illness or injury that has lasting effects

Examples: Diabetes self-management education, rehabilitation, home health, curative treatment, social support (SSI Disability, food stamps, WIC)

OBJECTIVES Social Influences

•Describe the impact of social determinants of health.

•Analyze the trends that influence access to quality health care for diverse communities.

•Explore benefits of community access to quality education for diverse communities.

•Analyze the effects of economic stability on community and population health.

•Evaluate how social and community support impact the health of the community.

•Examine the evidence on the importance of neighborhoods and environments on the health of the community. (CAP)

OBJECTIVES Social Influences

what is some primary prevention for HPV?

Teach abstinence,  condoms, HPV Vaccine

what is some secondary prevention for HPV?

HPV smear done with Pap Test

what is some tertiary prevention for HPV?

Treat pre-cancerous changes and genital warts.

5 domains of health determinants visual — External factors that influence health, well-being, and quality of life

5 domains of health determinants visual — External factors that influence health, well-being, and quality of life

define health indicators

outcome metric for measuring progress toward national public health goals (i.e. Healthy People)

Indicator	For Individual	For Community
Blood Pressure	170/105	32.7% have high blood pressure (Brazos Valley Health Assessment)
Weight	252	Adult obesity rate 29% (County Health Rankings - CHR)
BMI	37.9	21.5% adults in Brazos County have BMI of 30 or above (BVHA)
A1c	9.1	8% of Brazos County Residents have diabetes (CHR)

health indicators visual/example

health indicators visual/example

what are the leading health indicators

•Access to health services

•Clinical preventive services

•Environmental quality

•Injury and violence

•Maternal, infant, and child health

•Mental health

•Nutrition, physical activity, and obesity

•Oral health

•Reproductive and sexual health

•Social determinants

•Substance abuse

•Tobacco

define health outcomes

Changes in a patient's health status that results from a healthcare intervention. Health outcomes can be physical or psychological, and can include: 

•Length of life

•Quality of life

•Patient attitudes and behaviors

•Provider attitudes and behaviors

•Population attitudes and behaviors

•New evidence, research, and prevention strategies

•Treatments and care models

define health disparities

differences in the quantity of disease, burden of disease, and other adverse health conditions present in different groups

health disparity visual

health disparity visual

What determinants are impacting this patient’s ability to achieve optimum health?

The patient A lost her job 2 ½ years ago and has been unable to find work without a GED.  The community unemployment rate is 19.2% and GED classes haven’t been offered in years. Initially, patient A was eligible for COBRA insurance but could no longer afford the  COBRA payments after her unemployment benefits ran out.  Patient A is currently uninsured.  The closest free clinic is 45 miles away and she had to sell her car to pay rent. The city bus does not have out of town routes. She relies on the church pantry for food and they don’t offer food disease specific food boxes.  Patient A was asked to increase her activity, but she rarely walks due to the high crime rate in her neighborhood.

Limited Employment Opportunities, Access barrier to education, Access barrier to healthcare, Access barrier to affordable housing, Transportation barrier, Access barrier to healthy foods, & Safety barrier