TheQuadCouncilofPublicHealthNursingOrganizations wasfoundedintheearly1980s,andiscomposedofrepresenta- tivesfromfourorganizationsthatincludepublichealthnurses: The Association of State and Territorial Directors of Nursing (ASTDN, established in 1935), known since 2012 as theAsso- ciation of Public Health Nurses (APHN); the Association of CommunityHealthNursingEducators(ACHNE,establishedin 1977); the Public Health Nursing Section of the American PublicHealthAssociation(PHN-APHA;theSectionwasformed in 1923); and the American Nurses Association Council on NursingPracticeandEconomics(ANA).
In 1979 the : The Surgeon Generals Report on Health Promotion and Disease Prevention asserted that the health of the Ameri- can people has never been better (U.S. Department of Health, Education, and Welfare [USDHEW], 1979, p. 3). But this was only the prologue to deep criticism of the status of American health care delivery. Between 1960 and 1978, health care spending increased 700%without related improvements in mortality or morbidity. During the 1950s and 1960s, evidence had accumulated about chronic disease risk factors, particularly cigarette smoking, alcohol and drug use, occu- pational risks, and injuries. But these new research findings were not systemati- cally applied to health planning and to .
In 1974 the Government of Canada published A New Perspective on the Health of Canadians (Lalonde, 1974), which found death and disease to have four contributing factors: inadequacies in the existing health care system, behavioral factors, environmental hazards, and human biological factors. Applying the Canadian approach, in 1976 U.S. experts analyzed the 10 leading causes of U.S. mortality and found that 50% of American deaths were the result of unhealthy behaviors, and only 10% were the result of inadequacies in health care. Rather than just spending more to improve hospital care, clearly prevention was the key to saving lives, improving the quality of life, and saving health care dollars.
A multidisciplinary group of analysts conducted a comprehensive review of prevention activities. They verified that the health of Americans could be signifi- cantly improved through actions individuals can take for themselves and through actions that public and private decision makers could take to promote a safer and healthier environment (p. 9). Similar to Canadas New Perspectives,
Americas Healthy People (USDHEW, 1979) identified priorities and measurable goals. Healthy People grouped 15 key priorities into three categories: key pre- ventive services that could be delivered to individuals by health providers, such as timely prenatal care; measures that could be used by governmental and other agencies, as well as industry, to protect people from harm, such as reduced exposure to toxic agents; and activities that individuals and communities could use to promote healthy lifestyles, such as improved nutrition.
In the late 1980s, success in addressing these priorities and goals was evalu- ated, new scientific findings were analyzed, and new goals and objectives were set for the period from 1990 to 2000 through Healthy People 2000: National Health Promotion and Disease Prevention Objectives (U.S. Department of Health and Human Services [USDHHS], 1991). This process was repeated 10 years later to develop goals and objectives for the period 2000 to 2010 (USDHHS, 2000), and for the current decade of 2010 to 2020Healthy People 2020: Improving the Health of Americans (USDHHS, 2010). Recognizing the continuing challenge to using emerging scientific research to encourage modification of health behav- iors and practices, Healthy People 2020 addresses health equity, elimination of disparities, and improved health for all groups across the life span through disease prevention, improved social and physical environments, and healthy development and health behaviors.
Just as the public health nurse in the early twentieth century spread the gospel of public health to reduce communicable diseases, todays population-centered nurse uses Healthy People to reduce chronic and infectious diseases and injuries through health education, environmental modification, and policy development.

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