History of Public and Community Health - Essay Example

COMPARISON Public and community health—history There are similarities and differences between public and community health, but the similarities outweigh the differences. Generally, community health is seen to be a part of public health. Public health is more general, and is often attributed to the nation: community health is more specific, and is often attributed to a particular neighborhood or demographic area. The difference between public health and community health is basically semantic and based on scope: public health has a larger scope and reflects the healthcare needs, such as equity and accessibility, based on a wider range of the population than community health. However, what the two types of health and healthcare have in common, is an attention to the optimization of accessibility and equality, focusing on healthcare for all of the public, and all of the community, rather than just those who can afford it. In terms of the history of public and community health, public healthcare in the US started without any government involvement. It was basically run by religious organizations. Many hospitals maintain their religious roots today, in fact. After the Depression and the rise of social welfare, government support behind healthcare was increased and supported, and this created a support system. Then this social support system, a foundation of public health, was phased out more recently through the application of programs like managed care, Medicare and Medicaid being government, but with increasing business models and private involvement as well. Community healthcare today, based on this history, is often put in opposition to mainstream healthcare in America, because it focuses more on the client and less on the bottom line of profits. Public health, however, is often more mixed up with issues of managed care and government programs. “Grass roots initiatives contributed in part to the passage of Medicare, and they can work again. Ted Marmor says that “pressure groups that can prevail in quiet politics are far weaker in contexts of mass attention — as the AMA regretfully learned during the Medicare battle” (Dauner et al., 2005). Public healthcare today is a system that has drawbacks and advantages, depending on one’s perspective. Because it offers a wide variety of services in a cost-effective manner, many people support managed care as a balanced solution to healthcare which can potentially unite the agendas of community and public health. “Traditionally, health promotion and education efforts within the United States have been directed at the individual rather than communities and/or organizations. More recently, it has been recognized that health is tied to social and environmental conditions” (Dauner et al., 2005). These social and environmental conditions affect indivudals on the community level, in decreasing order from public health levels. “Community health promotion models typically combine community organization and citizen participation principles with behavioral theories to address ways to generate change at the individual and policy levels” (Altpeter et. al, 1998, p. 104). Different communication paradigms exist between the policy level and the individual level in making an effective community awareness program. “The social-ecological perspective of community health promotion emphasizes the need for coordinated interventions targeted at several levels of the community, ranging from individuals and their social networks to institutions and policymakers” (Altpeter et. al, 1998, p. 106). Within this system, derived from history, the nursing professional has various roles. Public and community health—role of the nurse There are various differences and similarities between public and community health, and the role of the nurse in these two settings must also be considered. Community and public healthcare have many advantages in that it seeks to support the whole of a society, whereas consumer health care is often about the bottom line and is dictated by supply and demand. Public and community healthcare put the bottom line at the quality of the care given to the patient, whereas the role of the nurse today is often in a system that makes free market negotiations more important than quality of care and access to all. The role of the nurse in public health is not to grant managed care organizations a right to all knowledge. Public and community health is about more than the healthcare organization delivering nothing more than is owed by the conditions of the contract with the plan. Consumer health care also brings benefits of increased technology, although community implementation is sometimes problematic. Accessibility is the key issue in the debate over public health. Managed care hopes to influence the rules of supply and demand in consumer care, and Medicare provide programs that increase accessibility for the poor and elderly. In the community healthcare plan, the nurse fulfills duties in two parts. “The first part is to serve as a resource and help create opportunities for people to share in community change efforts and the second part is to engage in the empowerment process as community partners” (Dauner et al., 2005). By uniting these parts as their duty, responsible nurses will be able to carry out their jobs as professionals, grounded in a secure knowledge about their skills and abilities. At the same time that the nurse is fulfilling this role as a public and community healthcare advocate, it must be remembered that “the social planning model complements the lay orientation of locality development by focusing on the problem-solving skills of the professional community, such as health care providers, to help meet the communitys service needs” (Altpeter et. al, 1998, p. 106). This brings the problem back down to the immediate level of caregiver-client interaction, which is where real change can happen in terms of the caregiver being able to recommend an approach for the population of clients and the clients being able to take this advice and reach a healthier outcome. Nationalized healthcare is an ideologically controversial issue that involves enormous financial and professional stakes for nurse professionals in the field today, and is something that relates to their foundational knowledge. The debate over control of the healthcare system today, in terms of possible conflicts of community and public healthcare models, also focuses on people in many ways. Many families are able to get adequate healthcare for their children, if they do not face significant disabilities or illnesses, but this does not mean that there is not a need for a comprehensive reform program that stresses the need for expanded healthcare coverage and health insurance coverage for the public, within a universal healthcare system such as those that exist in Canada and most other developed, industrialized nations (with the notable exception of the U.S.). Therefore, in terms of evidence and justification, it is often the case that, for people who think that extending health insurance coverage to the entire population of the nation is a moral necessity, including all of the public, and therefore all communities, in a universal plan requires no further justification. Additionally, nurse professionals in the field today must think of the innocent children who have no say in the choices made regarding their access or opportunity to receive quality healthcare. These children have no voice, but still in many cases they suffer unnecessarily. Acute care vs. public and community health In today’s healthcare environment, nurses in acute care positions are increasingly moving towards ambulatory care. But nevertheless, acute care can be compared to public and community health in many ways. First of all, acute care for the nurse is mainly a stationary affair, with the nurse operating within the hospital or clinic, or another healthcare setting. In community and public healthcare efforts, however, nurses are more likely to be involved in community outreach programs that bring them away from this stationary base. Within acute care, containing Medicare costs was a part of managed care’s original impetus. In the future, managed care will most likely expand as a system that is more efficient as time works out some of its current imperfections, if the measures are still being advocated in terms of foresight. Managed care provides healthcare services for individuals who are part of managed care organizations. It is a system that was set up to help contain costs, and the care that comes through managed care organizations is offered as a cost-friendly alternative to more expensive plans. HMOs or Health Maintenance Organizations are part of managed care also, and they provide quality healthcare for individuals on a cost basis that includes a flat fee. “We want to know far more than how strong public health groups are politically; we want to know what central political goods or purposes lie behind modern public health campaigns” (Dauner et al., 2005). In an acute care situation, Medicare HMOs which dropped many individuals from coverage to remain cost-effective, and others which have adopted a marketing stance that appeals primarily to healthy individuals and denies those that are unhealthy the option of managed care. The diversity present in Medicare HMOs also has meant that within many acute care situations, despite a general trend towards simplification, in some areas the services have created a large number of options that tend to encourage overlap instead of making the process of managed care more efficient. Statistically, “In March 2004, 56% percent of the RNs were working in hospitals, this is a decrease from 59% in March 2000… 29% of RNs were estimated to be employed in ambulatory care, community health, and public health settings, an increase from 24% in 2000” (Swan, 2007). This shows the changing demographics of community and public healthcare versus acute care settings. The only justification and evidence that is needed in many cases is a simple understanding of how equity should work in the theoretical construction of national interest, and the courage to apply principles of advocacy towards reaching a balance between the theoretical concept of equity and its actual practice in the U.S. No one knows if coming healthcare reforms are actually going to be meaningful, or whether there is just going to be another brief interest followed by no substantive follow-up. National healthcare reform, acute care, ambulatory care, and public and community healthcare are all serious issues of political debate. The nurse professional’s role within this setting should be to act as an effective advocate. REFERENCE Altpeter, Mary, Earp, Jo Anne, and Janice H. Schopler (2008). Promoting Breast Cancer Screening in Rural African-American Communities: The Science and Art of Community Health Promotion. Health and Social Work 23(2), pp. 104-115. Dauner, K, M Greany, and B Reininger (2005). Developing competencies in community health development. Academic Exchange Quarterly. Swan, M (2007). Transitioning from acute care to ambulatory care. Nursing Economics. Read More