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| Barbara Mullan R.N. of the Delaware (Ohio) General Health District weighs an infant during a home visit. |
When researchers at the University of Wisconsin Population Health Institute teamed up with the Robert Wood Johnson Foundation to identify the healthiest counties across the U.S., some striking trends emerged. Urban/suburban counties tend to be healthier than rural ones and have better access to healthy foods. People in the least healthy counties acknowledged their poor health status in self reports, are more likely to smoke and have more frequent hospital admissions. Children in the least healthy counties live in poverty and face the specter of premature death.
Access to Healthcare
Joan Bowe, BSN, RN, director of the Personal Health Division of the Delaware General Health District, Delaware, OH, is proud of Delaware County's No. 1 ranking in both health outcomes and health factors. Health outcomes rankings reflect both mortality and morbidity. Mortality refers to how long people live and specifically addresses premature deaths, meaning those that occur before age 75. Morbidity reflects how people feel while they're alive, and encompasses health-related quality of life (overall health, physical health and mental health) as well as specific indicators such as low-birth weight babies.
Health factors include:
- health behaviors - tobacco and alcohol use, unsafe sex, diet and exercise;
- clinical care - access to care and quality of care;
- physical environment - quality of the environment and built environment; and,
- socioeconomic factors - education, employment, income, family and social support, and community safety.
"We are very fortunate to live in a highly educated county with a fairly high income that makes access to healthcare easier," said Bowe. "We've been able to collaborate with forward-thinking communities to promote features like sidewalks, trails and parks that promote physical activity."
Bowe stressed the collaborative focus of public health nursing. "[We] work pretty closely with multiple professions here to get things done," she said. "We have a fairly large health education program and work closely with that staff for health outreach. We have 14-17 different sites throughout the county where we offer health education and screening to the public. We include community members in our assessment process known as Mobilizing for Action through Planning and Partnerships. That process led to our Partnership for Healthy Delaware County that helped identify BOARD OF HEalth priorities for community education and programming. Community assessment results led to hiring a nutritionist to work with our public health nurses on issues like diabetes and obesity. We've worked with the high schools to affect changes in the foods offered in cafeterias, and are working with preschool staff and parents about healthy food choices."
Ten years ago, Delaware County made a commitment to be at the forefront of public health, going above and beyond basic program recommendations. "For example, we have a three-person team devoted to surveillance and investigation of infectious disease, and follow up all cases of STDs even though we're not mandated to do that," said Bowe. "Our concern now is our ability to sustain our services in light of the economy and state funding cuts. Now that we're ranked No. 1, it's very difficult to prove need for grant dollars, but at the same time, we would like to be able to continue our cutting-edge services as much as possible."
Identifying Priorities
Pendleton County ranked No. 1 among all West Virginia counties in terms of overall health outcomes rankings. "Priorities for public health nurses can vary from day-to-day and month-to-month, depending on what comes down the pike from the federal and state governments," said Christine Kile, RN, nurse director for the health department in Franklin. "This means we have to be very flexible in our duties in order to meet the identified needs of our communities. These can range from family planning to breast and cervical cancer screening and immunizations for children and adults. The most recent example of a full-scale effort is our immunization campaign against H1N1 influenza. We coordinated with Office of Emergency Management, private providers and school systems to immunize everyone we possibly could."
The county has fewer than 8,000 residents living in areas divided by mountains and valleys. "When we started focusing on threat preparedness after 9/11, we realized how difficult it is for us to communicate with all of our residents," Kile noted. "We have no local radio or television stations in our county and our only local newspaper is a weekly one. When we need to get announcements out immediately, we may have to use our 911 communication system. That works because almost everyone has a scanner to receive the message."
Internet access is sketchy at best in most parts of Pendleton County, but still helps public health officials reach residents. "When we trained last week on WISEWOMAN, the CDC program for breast and cervical cancer screening, we sat down to problem-solve how we can get the word out about this wonderful program," Kile said. "My 23-year-old daughter got me interested in Facebook, so I talked with someone from the office of technology in Charleston, who said we may be able to share it on Facebook and have it go out to people's cell phones and computers. That helps get around slow dial-up access many community residents have on their computers and the lack of local television stations for satellite subscribers."
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| Connie Frambes R.N. of the Delaware (Ohio) General Health District shares tobacco prevention information with youths at a Health Fair inside an elementary school gymnasium. |
Ability to Multitask
JoNell Devers, BA, RN, manager of the Boone County Clinic, Florence, KY, a service of the Northern Kentucky Health Department, described the bustling outpatient setting that she oversees. "Seventy-five percent of our patients are here for the WIC program that serves prenatal women, post-partum women for 6 months, and children up to 5 years," she said. "We also have folks who have lost their insurance, or never had health insurance, coming here for well-child exams and immunizations for their children. There are more social issues than people realize-a woman may bring one child in for immunizations, and when we start talking, we find out she has three other children who haven't been immunized."
One of four clinics within the public health department, the Florence facility has five RNs, an LPN, a registered dietitian, three nurse practitioners, clerks, and two Hispanic case managers who are shared with the other clinics to interpret and help clients connect with social services. "We also have two diabetes educators, one an RN and one an RD, who go together to clinics to see people with diabetes at their scheduled appointments," said Devers.
There are 29 different programs available in clinical services of the health department, and each has its own criteria that determine who qualifies for care. "No one can remember everything about each program in the clinic, so we use protocols for care in the Kentucky Public Health Practice Reference and teaching sheets for specific problems," said Devers. "It's a day-to-day, minute-to-minute situation where nurses have to multitask. One minute, you may be doing a well-child visit and the next you're dealing with someone who needs treatment for an STI."
Nurse practitioners provide women's health services, including pap smears, breast exams, cancer screening and birth control. "While this is an income-based service, so many people have lost their insurance after being laid off that many women in the area now come to the health department for care," Devers pointed out. "We provide STI education and treatment to patients who come in because they have symptoms, need testing or have had contact with someone who was diagnosed with an STI."
Devers also manages a group of visiting nurses who go into homes to assess the health of newborns. "They can pick up on situational and environmental issues impacting the family's health," she said. "They provide education about home safety, the risks of smoking and other topics. They also remind and encourage parents to use the services available to them through our clinics."
Sandy Keefe is a frequent contributor to ADVANCE.
Reference
County Health Rankings. (2010). County health rankings: national comparisons. Retrieved March 23, 2010 on the World Wide Web: http://www.countyhealthrankings.org/latest-news/county-health-rankings-national-comparisons.
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