U.S. still lags behind other countries in population health; nurses can make a difference.
By Debra Wood, RN, contributor
April 13, 2015 – During the past century, the United States has made tremendous strides in public health, but the country still lags far behind other industrial nations when it comes to health outcomes. The opportunities to improve are enormous, and nurses have a role to play–including health promotion and participating in interventions to improve population health.
“In the United States, we spend more on medical care than any other country, yet we are at the bottom of the list for industrial countries when it comes to life expectancy,” said Patricia J. Kelly, PhD, MPH, APRN, professor at the University of Missouri-Kansas City School of Nursing, editor of Public Health Nursing and chair-elect of the American Public Health Association’s public health nursing section.
Diane M. Santa Maria, DrPH, MSN, RN, said nurses are well equipped to provide health promotion coaching.
“Our focus has been on medical innovation and technology, not on more basic skills,” Kelly said. “We’re interested in profit and technology, not basic preventive things like community gardens and making sure people have access to fruits and vegetables.”
Diane M. Santa Maria, DrPH, MSN, RN, assistant professor of nursing systems at the University of Texas Health Science Center at Houston School of Nursing, added, “The United States provides cutting edge tertiary and specialized care to the few individuals who need that level of health intervention. Lacking are the funds and resources to address public health problems from an upstream, macroscopic, prevention-focused lens.”
That hurts when it comes to health outcomes.
How America ranks
A 2014 Commonwealth Fund report found that the United States ranks last overall of the 11 industrial nations studied. It also ranks last on indicators for efficiency, equity and outcomes. Yet the other countries spend significantly less per capita for health care, and health care represents a smaller percentage of gross domestic product in those countries than it does in the United States.
Patricia J. Kelly, PhD, MPH, APRN, encouraged nurses to get involved in their communities to improve public health.
The United States ranks 28th in the world in infant mortality, Kelly added. Maternal nutrition, preterm births, obesity, poverty and poor access to prenatal care contribute to the statistic.
The American Public Health Association (APHA) reports that, compared to our peers in other industrialized countries, people in the United States also have shorter lives, the highest rates of injury and homicide, the second highest rate of death due to heart disease, the highest rate of obesity and diabetes, greater prevalence of chronic lung disease, greater prevalence of disability in the older population, the highest rate of pregnancies and sexually transmitted diseases among adolescents, the second-highest rate of HIV and highest rate of AIDS, and the highest rate of mortality due to drugs and alcohol.
Some improvements in public health
The greatest strides in public health came in the first half of the last century, Kelly explained. During that time, improvements to housing, such as indoor plumbing and windows for fresh air, and a clean water supply made differences in morbidity and mortality.
In the 10-year period from 2001 to 2010, Centers for Disease Control and Prevention scientists reported in JAMA a number of public health achievements, including declines in cases of vaccine-preventable disease and prevention and control of infectious diseases. Yet in the four years since this report was published, the country has experienced outbreaks of measles, in large part due to lack of vaccinations, and an increasing number of infections caused by drug-resistant bacteria.
“In addition to the resurgence of diseases that are vaccine preventable, we have new, tougher and harder to treat bugs,” said Shirley Orr, MHS, APRN, executive director of the Association of Public Health Nurses. “We cannot let the guard down on communicable diseases, but at the same time, we have to focus on chronic [disease].”
Cynthia Stone, DrPH, RN, encouraged nurses to work with other sectors, such as education and commerce, to improve the health in their communities.
Gains have been made in promoting healthier lifestyles and reducing smoking (down to 19 percent of the adult population in 2013, according to the APHA), but the burden of chronic disease persists.
“We are gaining ground, but we have a huge road ahead,” Orr said.
Passage and implementation of the Affordable Care Act has increased access to health care and put a spotlight on population health and the importance of health promotion and quality improvement, added Cynthia Stone, DrPH, RN, clinical associate professor at the Indiana University Richard M. Fairbanks School of Public Health and immediate past chair of the American Public Health Association’s public health nursing section.
“Those are areas nurses have good experience in and can contribute,” Stone said. “There are a lot of opportunities for nurses.”
Nurses’ roles in public health
Orr agreed that the nation’s focus on population health offers opportunities for nurses.
“Public health nurses can lead the future of public health and health care, especially now as we try to more fully integrate public health with the health care delivery system,” said Orr, explaining that the traditional public health and health services silos must come down. “Nurses can help span that boundary.”
Santa Maria agreed, saying, “Nurses are uniquely positioned in the health care field for being highly trained to care for complex health conditions and to integrate and translate data-driven health care to community-based health promotion and disease prevention efforts, bridging the gap between health promotion science, practice and adoption in communities.”
“A core function of nursing is teaching and coaching,” she continued, “which are vital skills for public health. Nurses are prepared to assume the teaching-coaching role with various patient populations in primary care, acute care, and community settings.”
Nurses can work with providers, schools and workplaces to improve outcomes, Orr said.
“Health care alone will not get us where we need to be with a healthy population,” Orr added.
“Nurses have an ecological perspective on health that considers the social, psychological, and environmental determinants of health and health behaviors,” Santa Maria said.
Kelly encourages nurses to become educated and move out of their comfort zones and speak up, with good evidence, to make their voices heard, and to volunteer with community organizations.
Nurses can make a difference by helping to bring a grocery store to a neighborhood without one, organizing a community garden or collaborating with educators to help get their messages across to youngsters just forming health habits.
“Nurses are seen as one of the most trusted professionals and a respected source of health education, year after year, and are well equipped to provide health promotion and disease prevention coaching at the individual, community and policy level,” Santa Maria said. “Nurses are well positioned to lead the charge for primary care in the community setting to provide equitable availability and accessibility of health care at the primary, secondary and tertiary levels.”
© 2015. AMN Healthcare, Inc. All Rights Reserved.
