01.01 Intro to Community Health

Hello. Welcome to Introduction to Community Health. It’s important to know that to meet the basic and complex needs of individuals in the community, we should understand the contributing factors of health and wellness. We will address each in this lesson.

What is community health? To understand this we need to understand what each word means separately. A community is a group of people that share the same geographical location. We often refer to communities in terms of religion, culture, ethnicity, and so on.  But we mean community in terms of the area we live in. These communities consist of the aggregate, or the specific population within the community. These are your men, women, children and elderly, and here is where we group cultures and ethnicities together as well. The definition of health is a state of well-being. So when we put these together, we understand that we are talking about the well-being among a group of people that share the same surroundings. The overall goal of community health is to protect and promote the well-being of the members of a specific community. With that being said, let’s dive in.

To truly understand community health needs we have to ask what factors have an impact on our health? What influences it? We know that higher social status plus higher income, equals better care. Why? We are more likely to take advantage of the access we have to healthcare if we can get it without breaking the bank. This ties into our behaviors. We make choices based on our needs and wants. Take meal planning for instance. The idea is, you have to prepare your meals for the week so you can save money, and eat healthier. But not everyone is able or willing to do this. My meal plan consists of the leftovers from Sunday’s dinner. But after a while even good leftovers get old so I’ll go buy something completely unhealthy that tastes good! Why? Because it’s different, it’s easier and because I can. Not necessarily cheaper but, choices, right? Environment influences health a lot as well and it’s one factor we can’t completely control. In California, the air quality is terrible most of the time. In Flint, Michigan, the drinking water was polluted and full of harmful chemicals. I work in an old building where they used lead paint and asbestos before they were found to be harmful. If I get sick, the first thing I’m pointing to is the conditions I work in. So the environment can be an enemy to health. All of these examples can be detrimental to our health. Then we have genetics. What runs in the family? If hypertension and diabetes run in your family, you are at a higher risk of developing them. We see these things and the question becomes, what do we do about it? I will answer this question for you in a little bit.

We talked about what influences our health, now let’s talk about how we measure the health of a community. Every time I go to the ER or a specialist within a hospital system, I get a survey in the mail about my experience. The point of the survey is to determine patient satisfaction and help them incorporate new ideas into their system or fix anything rated less than excellent. Health indicators work the same way. They are measurable and describe the health of a population with regard to things like disease prevalence, mortality and life expectancy for instance. So for example, a few years back, Ebola made a comeback. Everyone that walked into a facility had to answer specific questions to determine their risk of exposure to the disease and what needed to be done to protect that patient and the public. That’s how we use health indicators. Health indicators are used to create or change policies and how systems work and also help determine the cost and quality of healthcare in an area.   Is it available and affordable? Why or why not? What changes can we make so it is? Determinants of health are the things that influence health and are another health indicator. We talked a little about what they are in the previous slide and we will continue to discuss how they are used in more detail in future lessons.

What kinds of approaches do we use when talking about community health? We have systems thinking and upstream thinking. The best way to remember the differences between these two approaches is their focus. Systems thinking focuses on the system as a whole. What parts can we change to make things better? This approach is used to determine what policies and programs are needed with a goal in mind to prevent illness. Upstream thinking is a little harder. It’s a broader focus. Think in terms of swimming. It’s hard to swim upstream. Isn’t it easier to just go with the flow? Well, in terms of health, how hard is it to make smarter healthier choices? If I have a choice between a healthy $8 salad and an unhealthy burger from the $1 menu, I’ll choose the burger every time because it’s easy. The easiest choice isn’t always the best choice. That’s when I have to use upstream thinking. It’s making the best choices to improve my quality of life.

Maslow’s Hierarchy of Needs points out basic and complex human needs. You can find a lesson about this in Fundamentals, but I’d like to give you an example of how it relates to community health. Mrs. Smith has no friends or family so she spends most of her time alone. She has a limited income so she’s consistently having to choose between stocking her fridge or paying bills. She can’t keep up with her personal care or maintaining her house appropriately. She has multiple health problems but doesn’t see her doctor regularly because according to her, they only want to make money off of her, not help her. She’s doing fine all by herself. But to us, she is barely managing. Using Maslow’s theory, we know Mrs. Smith’s basic needs are important and have to be met before we can begin to discuss her complex health needs.

Something else to remember is the difference between health promotion and disease prevention in the community. Health promotion is designed to empower people to take control of their health. The idea is to have them engage in better lifestyle choices to improve their overall health. This typically takes place in wellness clinics, health fairs, all to raise awareness in the community. When we talk about disease prevention, we are talking about specific efforts to minimize the risk of an illness. The overall goal is to eliminate risk for the disease. We see this with vaccinations. We’ll discuss this more in depth in the health promotion and disease prevention lesson.

We’ve been talking about concepts that are used in policy development so why not discuss policy development? The purpose of healthcare policy is to set goals for healthcare. How do we do that? Just like anything else, developing a policy is a process. First we identify the problem. This comes from all that data collected from our health indicators and surveys for a population. We are looking for the priorities. What are the biggest concerns from the results? Next we analyze the options. What can we do to meet the health needs of this population? This is your planning stage. Once we’ve figured out what we can do, we put it in writing and for government, get it passed so we can implement it.  After the policy is implemented, we go back and evaluate it. Is it working? What can or should be tweaked to make it work? Is there anything we can add to it to make it better? Does this process sound familiar to you? ADPIE!

Earlier in this lesson we talked about what influences health and I asked what can we do? Here’s the answer. It’s important to remember that we as nurses are our patients’ biggest cheerleaders. We listen to their goals, wants and needs and we advocate for their health. For those patients who do not have a voice or whose voices cannot be heard, we are there to support and protect them. If there is something wrong or changes need to be made, we voice it.  Of course, we can’t voice what we don’t know so we are always assessing! So pay attention to all the cues: verbal, non-verbal and physical! Assurance is access to care. We have a responsibility to educate our community members. This doesn’t just mean we tell them about the disease process and the most important things they should know. We also have to provide resources and ensure that they have the correct access to care when they need it. The 3 A’s are our key responsibilities when it comes to community health so we can continue to spread awareness and prevent illness.

Some key points to review. Maslow’s hierarchy says that basic needs should be met in order to move up the levels. At its base are physiological and safety needs, which are core needs in the community. Health promotion is bringing awareness to the members of the community. Disease prevention is stopping the disease before it starts. Health indicators are statistics we gather to figure out what factors determine our health. Last but not least, remember that we must respect patient goals, wants and needs, which is the basis of patient centered care. With respect to this, our key responsibilities are to serve as an advocate, an assessor and to ensure that people in the community have the resources necessary to gain access to meet their healthcare needs.

That's it for our lesson on the introduction to community health. Make sure that you check out all of the resources attached to this lesson as well as the rest of the community health course. Now, go out and be your best self today. And, as always, happy nursing!