History Essay

529 words - 3 pages

change the environment—from housing to
food safety—moved from public health to other
governmental agencies.
The limitations of our medicalized public
health system, with its focus on individual
behavior, have become clear when we review the
lack of progress over recent decades in reducing
rates of diabetes, asthma, and obesity, or in
creating equitable health status across racial and
ethnic lines.
Today’s public health challenges require that
the public health workforce travel well upstream
to have a positive effect on the health of their
communities. As public health practitioners
become attuned to the critical interaction of
populations with their social, cultural, and
physical environments, they are identifying
strategies beyond individual solutions and
addressing environmental factors to create living
conditions that promote health. Nurses make
up the single ...view middle of the document...

Historical background
The modern public health enterprise in the United
States owes much to Lillian Wald, who established
public health nursing in the US and practiced in
Manhattan’s lower east side beginning in the 1890s.
She and her nurse colleagues recognized first-hand
the limitations of treating illness and offering
health education to people who were living in
crowded tenements. Wald noted the irony when
she wrote, “Impressing upon the poor the latest
findings of science without simultaneously urging
reform in housing, child protection, and wages is
cruelly sardonic on the part of the nurse.”
As frustration with unhealthy living conditions
grew, the visiting nurses of Wald’s Henry Street
Settlement concluded that reforming those
conditions was the best hope for improving health
in their communities. Henry Street Settlement
nurses and community activists took on social
and environmental reforms related to housing,
child labor, unsafe cottage industries, and other
factors contributing to poor health. The concept
of independent public health nurses addressing
the social conditions that affect health spread
rapidly to other cities and towns.
As infectious disease rates plummeted, chronic
health conditions attracted more practitioner
attention and became seen as personal medical
problems rather than public health issues. By the
end of the 20th century, the public health system
had been thoroughly medicalized under the
pressures of specialization, fee-for-service direct
care, and division of labor. Much of the scope
of public health nursing narrowed to affecting
the behaviors of individual clients. Efforts to
Betty Bekemeier
Photo: A public health nurse
crosses over tenement roofs to
visit families, c. 1908.
Throughout its history, public health nursing has challenged social
norms and driven reforms to improve community health.
Visiting Nurse Service of New York, www.vnsny.org
Today’s public
health challenges
require that the public
health workforce
travel well upstream to
have a positive effect
on the health of
their communities.

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