Back to the Future: Public Health Nursing in the 21st Century

Background and Issues: At the turn of the 20th century, Lillian Wald addressed social injustices and dire health problems by engaging system partners to change policies and provide healthier living and work environments for immigrants and the working poor. In the 21st century, problems such as asthma, lead poisoning, and obesity, have joined infant mortality, injuries, and communicable diseases as major causes of chronic disease, disability, and premature death. Significant health problems, then and now, are differentially borne by socially disadvantaged groups. Furthermore, they are largely issues that result from problems of the built environment. Description: This presentation emphasizes how public health nurses can help communities accomplish their goals by using leadership skills to mobilize the system, establish common priorities, leverage resources, and advance policies. We discuss processes to accomplish system-level interventions that engage the entire community--residents with indigenous knowledge of the community and various disciplines with technical expertise. Together, they develop a common understanding which they apply to sustainable solutions. Strategies, which are robust, incorporate key public health interventions that can be used to meet various community priorities regardless of the specific population or locale. Lessons Learned: We describe challenges and solutions in finding entrée to community-based and governmental organizations, and engagement of the community in environmental public health issues. Recommendations: Consistent with the IOM reports (1988, 2002, 2003), public health nurses need organizational support and continued competency development to engage in community/systems level population-focused interventions.