Intro to Community Health Notes
Public Health Focus and Core Concepts
- Public health focus: prevent disease, prolong life, promote health through organized community efforts to benefit citizens.
- Major shift in health care delivery: emphasis on population health, prevention, and community-based care.
U.S. Health Care System and Nursing Roles
- Role of the nurse within the U.S. health care system.
- Cost considerations: high cost of caring for the sick; discussion of how funds are allocated between care for illness and prevention.
- The number of nurses employed in community health and ambulatory care settings more than doubled.
- Indicates a systemic shift from illness- and institution-based care toward health promotion and prevention.
- Major goal: preserve the health of the community and surrounding populations by focusing on health promotion and health maintenance of individuals, families, and groups within the community (Nies & McEwen, 2024).
Core Concepts of Public Health
Public Health: Definition and Core Aims
- Public Health is the art and science of:
- Preventing disease
- Prolonging life
- Promoting health through organized community efforts to benefit each citizen
Public Health Mission and Justice (Ethical Foundations)
- Mission: social justice that entitles all people to basic necessities (adequate income, health protection) and accepts collective burdens to make health possible (Nies & McEwen, 2024).
- Market Justice vs. Social Justice:
- Market justice (US model): individuals entitled to what they have gained through their own efforts; rights are respected; collective action and obligations to others are minimal.
- (Note: The slide presents market justice as predominant in the US context.)
Definitions: Health and Community
Definition of Health
- World Health Organization (WHO) 1958: health is the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
- 1980s expansion: health includes physical, social, role, mental, and general perceptions of health status.
- Pre-1996: focus on geographic boundaries and social attributes.
- Now: a collection of people who interact with one another and whose common interests or characteristics form the basis for unity or belonging (Rector, 2018, as cited in Nies & McEwen, 2024).
Determinants of Health and Healthy People 2020
Determinants of Health & Disease
- Determinants (factors that influence health outcomes) include:
- Physical environment
- Health services
- Social factors
- Individual behavior
- Biology and genetics
Healthy People 2020 Overarching Goals
- Attain high-quality, longer 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.
Indicators and Measurements
Indicators of Health and Illness
- Individual behaviors: e.g., cigarette smoking, calories from added sugars, annual influenza vaccinations.
- Physical and social environmental factors: e.g., household food insecurity.
- Health systems issues:: e.g., access to medical insurance.
- Population or group indicators: e.g., infant mortality, obesity in children/adolescents, maternal mortality, new cases of diagnosed diabetes.
- Health promotion: activities that enhance resources directed at improving well-being.
- Disease prevention: activities that protect people from disease and its effects.
- Three levels of prevention:
- Primary prevention
- Secondary prevention
- Tertiary prevention
The Three Levels of Prevention (with Examples)
- Level 1 – Primary Prevention: Prevention of problems before they occur
- Level 2 – Secondary Prevention: Early detection and intervention
- Example: Screening for sexually transmitted diseases
- Level 3 – Tertiary Prevention: Correction and prevention of deterioration of a disease state
- Example: Teaching insulin administration in the home
Prevention versus Cure (Economic Perspective)
- Cure: spending more money on cure in health care has limited impact on population health gains.
- Prevention: investing in prevention yields greater improvements in population health and reduces costs of cure over time.
Healthy People 2030
Historical Context and Broad Goals
- Healthy People launched in 1989, following Healthy People 2000.
- Three broad goals:
- Increase the span of healthy life for Americans.
- Reduce health disparities among Americans.
- Achieve access to preventive services for all Americans.
Vision and Mission of Healthy People 2030
- Vision: A society in which all people can achieve their full potential for health and well-being across the lifespan.
- Mission: To promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.
Leading Health Indicators (LHIs)
- LHIs are a small subset of high-priority Healthy People 2030 objectives selected to drive action toward improving health and well-being.
- Emphasizes preservation and protection of health.
- Services include both direct and indirect care.
- Primary client: the community as a whole.
- Emphasizes managing acute or chronic conditions.
- Services are direct.
- Primary client: the individual.
Core Public Health Functions
- Core Public Health Functions (Box 1.1):
- Assessment: Regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community.
- Policy development: Use information from assessment to develop local and state health policies and allocate resources toward those policies.
- Assurance: Ensures the availability of necessary health services throughout the community; includes maintaining the capacity of both public health agencies and private providers to operate and respond to emergencies.
- Overview of integrating PET outcomes into community nursing practice.
PET Outcome #1
- Goal: Adhere to standards of professional, ethical, and legal nursing as outlined in the SWOSU Nursing Handbook and ANA Code of Ethics.
- Example activity: Team building at Crowder Lake.
PET Outcome #2
- Goal: Identify simple client assessment data and make basic clinical decisions using clinical nursing judgment.
- Activities include: SLP Part B, first meeting; A: Identify simple client assessment data and make basic clinical decisions using the nursing process in the community; B: Reflective journal portion of rubric.
- Rubric highlights: List pertinent abnormal assessment findings; Describe clinical decisions made.
PET Outcome #3
- Goal: Describe the essentials of a safe care environment.
- Activity: Flu Clinic.
- Deliverables: A detailed description of the essentials of a safe care environment; reflective journal; sign-in sheet.
- Rubric: Describe essentials of safe care assessment and safe administration of vaccines; provide example of safe care during flu shot clinicals.
PET Outcome #4
- Goal: Define client-centered care.
- Activity: School Health Screening.
- Deliverables: A detailed definition with family/community as client; reflective journal; sign-in sheet.
- Rubric: Describe how client-centered care was provided; evaluate care providers’ performance.
PET Outcome #5
- Goal: Explore the relationship between information technology and safe nursing practice.
- Activity: SLP Part B, second meeting.
- Deliverables: A detailed description of how IT was used to develop an educational presentation for community health improvement; reflective journal.
- Rubric: How IT aided presentation development and health education delivery.
PET Outcome #6
- Goal: Identify basic concepts of the teaching-learning cycle.
- Activity: After SLP Part C – Presentation to the Community.
- Deliverables: A description of how the teaching-learning cycle concepts were applied in the community presentation; includes at least two examples of content.
- Rubric: Describes the education topic, content examples, and potential health restoration benefits.
PET Outcome #7
- Goal: Describe the roles of interdisciplinary health care team members.
- Setting: Health Department/Doctor’s Office/NP Office/SWOSU Nurse.
- Deliverables: A detailed description of the role of another health care discipline, reflection, and sign-in sheet.
- Rubric: Describe how collaboration with another discipline enhances patient care.
PET Outcome #8
- Goal: Define concepts of leadership skills and quality improvement.
- Activity: SLP Part A.
- Deliverables: Definition of leadership and quality improvement in community projects; group work description.
- Rubric: Describe leadership experiences, group dynamics, and pursuit of quality improvement.
PET Outcome #9
- Goal: Identify elements of evidence-based practice and the importance of research to clinical practice.
- Activity: Community in Pictures.
- Deliverables: Analysis and data from a health problem shown in a photo; research findings with statistics; references; proposed action.
- Instructions: Include research showing the problem’s prevalence, related risks, and how the proposed action would help.
- PETs integrate ethics, clinical decision-making, safe care, client-centeredness, information technology, teaching-learning, interdisciplinary collaboration, leadership/quality improvement, and evidence-based practice into community nursing activity.
References (Cited in Course Materials)
- National Center for Health Statistics. Health, United States, 2020–2021. CDC.
- Nies, M. A., & McEwen, M. (2024). Community/Public health nursing – Promoting the health of populations (8th ed.). Elsevier.
- U.S. Department of Health and Human Services. ODPHP Leading Health Indicators (LHIs). (Accessed Aug 24, 2025.)