Although populations have historically been the focus of public health practice, specifically defined populations are becomingafocusofthebusinessofmanaged care;therefore moremanagedcareexecutivesarejoiningpublichealthpracti- tionersinbecomingpopulationoriented.Increasingly,managed careexecutivesandprogram managersareusingthebasicsci- encesandanalytictoolsofthefieldofpublichealth.However, theirfocusisonusingsuchepidemiologicalandstatisticalstrat- egiestodevelopdatabasesandanalyticalapproachestomaking decisionsatthelevelofadefinedpopulationorsubpopulation enrolled in a particular care delivery organization or those covered by a particular insurance company. A population- focused approach to planning, delivering, and evaluating variousaspectsofcaredeliveryisincreasinglybeingusedinan effort to achieve better outcomes in the population of interest andhasneverbeenmoreimportant.
Theseconddecadeofthetwenty-firstcenturyfindstheUnited Statesenteringanerawhenmorepublicattentionisbeinggiven to efforts to protect and improve the health of the American peopleandtheenvironment.Despitewhatmanyseeasafailure tomakefundamentalchangesinthedeliveryandfinancingof health care, significant change has occurred. Federal and state initiatives, private market forces, the development of new sci- entific knowledge and new technologies, and the expectations of the public are bringing about changes in the health care system.With the national legislation that passed in 2010the PatientProtectionandAffordableCareAct(ACA)(www.hhs.)which in part was designed to increase access to care; concerns have been raised about the availability of adequate numbers of professional personnel to provide services, particularly in primary care and strained healthcarefacilities.Despiteinitialturbulenceinimplementa- tion of the legislation, including difficulties with enrollments due to technological problems, initial reports are that good progress has been made in enrolling people and the Congres- sional Budget Office projected that by 2014 the number of uninsuredpeoplewilldecreaseby12millionandby26million by 2017 (Blumenthal and Collins, 2014). Blumenthal and Collins(2014)alsoreportedthattheUrbanInstituteprojected that the proportion of uninsured people adults in the United States fell from 18% in the third quarter of 2013 to 13.4% in Mayof2014.BeforethepassageoftheACAmanyatthenational levelwereseriouslyconcernedaboutthegrowingcostofmedical careasapartoffederalexpenditures(Orszag,2007;Orszagand Emanuel, 2010). The concern with the cost of medical care remains a national issue and Blumenthal and Collins (2014) arguethatthesustainabilityoftheexpansionsofcoveragepro- vided by theACA will depend on whether the overall costs of care in the United States can be controlled. If costs are not controlled the resulting increases in premiums will become increasingly difficult for allconsumers, employers, and the federalgovernment.Otherhealthsystemconcernsfocusonthe qualityandsafetyofservices,warningsaboutbioterrorism,and globalpublichealththreatssuchasinfectiousdiseasesandcon- taminated foods. Because of all of these factors, the role of public health in protecting and promoting health, as well as preventingdiseaseanddisability,isextremelyimportant.
C H A P T E R O U T L I N E Public Health Practice: The Foundation for Healthy
Populations and Communities DefinitionsinPublicHealth PublicHealthCoreFunctions CoreCompetenciesofPublicHealthProfessionals QualityImprovementEffortsinPublicHealth
Public Health Nursing as a Field of Practice: An Area of Specialization
Public Health Nursing versus Community-Based Nursing Roles in Public Health Nursing Challenges for the Future
BarrierstoSpecializinginPublicHealthNursing DevelopingPopulation-FocusedNurseLeaders ShiftingPublicPolicytowardCreatingConditionsfora
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5CHAPTER 1 Community and PreventionOriented, Population-Focused Practice
thereisincontrovertibleevidencethatpublichealthpoliciesand programswereprimarilyresponsibleforincreasingtheaverage lifespanfrom47in1900to78in2005,anincreaseof66%in just a little over a century. They asserted that most of that increase was through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety,immunizingchildren,andimprovingnutrition,hygiene, andhousing(Fieldingetal,2008).
In an effort to help the public better understand the role public health has played in increasing life expectancy and improving the nations health, in 1999 the Centers for Disease Control and Prevention (CDC) began featuring information on the Ten Great Public Health Achievements in the 20th Century. The areas featured include Immunizations, Motor Vehicle Safety, Control of Infectious Diseases, Safer and Healthier Foods, Healthier Mothers and Babies, Family Plan- ning, Fluoridation of Drinking Water, Tobacco as a Health Hazard, and Declines in Deaths from Heart Disease and Stroke (CDC, 2014).A case can be made that the payoff from public health activities is well beyond the resources directed totheeffort.Forexample,recentdatareportedbytheCenters for Medicare and Medicaid Services (CMS) showed that in 2012 only 3% (up from 1.5% in 1960) of all national expen- ditures supported by governmental entities supported public health functions (CMS, 2012).
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