Public Health Nursing Practice:

Finding Evidence to Apply to Environmental Health

Issues

April 29th (or 30th), 2008 University of Wisconsin-

Milwaukee

Deborah Pasha

WI Division of Public Health

Urban Built Environments—where public health nursing intersects

with the transportation culture

Would you want to walk here?

(Dan Burden)

. . . or would you rather walk here?

(Michael Cynecki)

Would you feel safe cycling along this road?

(Dan Burden)

. . . or would you prefer to cycle here?

(Dan Burden)

Community Client Assessment

(Gabrielle Pasha)(Photographer unknown)

Community Client Assessment

(Photographer unknown)

http://dhfs.wisconsin.gov/statehealthplan

Health &Function Disease Health Care

Well Being Prosperity

IndividualResponse• Behavior• Biology

Social Environment Physical Environment Genetic Endowment

Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science and Medicine, 31, 1347-1363.

Determinants of Health Model

The Precautionary Principle

• Precautionary approach to environmental health• Opportunity for prevention• Contrast to focus of resources on

curing disease that resulted from

preventable exposures• Association to health disparities

ANA’s Principles of Environmental Health for Nursing Practice with Implementation Strategies (2007)

Public Health Nursing: Scope & Standards of Practice

• The client or unit of care is the population

• Primary obligation is to achieve the greatest good

for the greatest number of people • Primary prevention is the priority when selecting activities • Focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive . . .

(ANA 2007)

http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/phinterventions_manual2001.pdf

Public Health Interventions

March 2001

Minnesota Department of Health Public Health Nursing Section

Surveillance

http://www.dot.wisconsin.gov/

Health Teaching

Collaboration

Coalition Building

Community Organizing

Enforcement

Advocacy

Social Marketing

Policy Development

A System of Partners

State & Local Public Health Departments

Educators

Colleges, Universities,& Technical Schools

Healthcare Consumers

Managed Care

Hospitals & Clinics

Healthcare Purchasers

Community Health Centers

Healthcare Providers

Faith Community

Professional Organizations

Civic Organizations

Foundations

CommunityResidents

Law Enforcement

State andLocal Elected

Officials

Agriculture,Natural Resources, Public Instruction,

and other governmental

agencies

Advocacy Organizations

Media

Business& Labor

(Photographer unknown)

Community-System Interventions

Community-System Interventions

Literature search

•“Built environment” •“Public health”

•“Traffic” •“Physical activity”

•“Speed” •“Injuries”

•“Aggressive driving behaviors” •“Social efficacy”

•Literature Review: Credible authors and sources

Research findings

• Modern cities associated with costly injuries

and illness due to inactivity• 70% deaths, 60% medical expenditures in U.S.

attributed to chronic disease• 30% of these preventable

with increase in physical activity• Less than ½ of U.S. adults meet activity

recommendations of 30 minutes most days

Research Findings

• U.S. bicycling and walking trips reduced from 10% (1977) to 6.3% (1995)• Pedestrian and cycling fatalities are triple• Canada and Northern European countries 20-40% of travel is by cycling and walking

• 4 E’s: Engineering, Enforcement,

Education, Encouragement

Research findings

• One prospective cohort study surveyed a random sample prior to and following a traffic calming intervention

• Pedestrian counts at 3 places by age groups• Pedestrian activity increased after the traffic

calming• Children were more likely permitted to play

outside(Morrison, Thomson and Petticrew, 2004)

http://www.wisconsinwalks.org/

http://www.bfw.org/

http://www.bikewalk.org/

http://www.bikewalk.org/

http://www.dhfs.state.wi.us/

http://dhfs.wisconsin.gov/health/physicalactivity/StatePlan

http://www.cdc.gov/

http://www.apbp.org/website/

Workgroup activity

• Success Story: Issue, Intervention, Impact

• Media release • Talking points• Community event flier• Letter of support • Issue paper

Street Share

(ITE Pedestrian Bicycle Council)

(Photographer unknown)

Healthy Community

“One good community nurse will save a dozen policemen.”

Herbert Hoover