Public Health Nursing Practice: Finding Evidence to Apply to Environmental Health Issues April 29th (or 30 th ), 2008 University of Wisconsin-Milwaukee Deborah Pasha WI Division of Public Health Urban Built Environments— where public health nursing intersects with the transportation culture

Would you want to walk here? (Dan Burden)

... or would you rather walk here? (Michael Cynecki)

Would you feel safe cycling along this road? (Dan Burden)

... or would you prefer to cycle here? (Dan Burden)

Community Client Assessment (Gabrielle Pasha) (Photographer unknown)

Community Client Assessment (Photographer unknown)

Health & Function Disease Health Care Well BeingProsperity Individual Response Behavior Biology Social EnvironmentPhysical EnvironmentGenetic Endowment Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science and Medicine, 31, Determinants of Health Model

The Precautionary Principle Precautionary approach to environmental health Opportunity for prevention Contrast to focus of resources on curing disease that resulted from preventable exposures Association to health disparities ANA’s Principles of Environmental Health for Nursing Practice with Implementation Strategies (2007)

Public Health Nursing: Scope & Standards of Practice The client or unit of care is the population Primary obligation is to achieve the greatest good for the greatest number of people Primary prevention is the priority when selecting activities Focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive... (ANA 2007)

sources/docs/phinterventions_manual2001.pdf Public Health Interventions March 2001 Minnesota Department of Health Public Health Nursing Section

Surveillance

Health Teaching

Collaboration Coalition Building Community Organizing

Enforcement Advocacy Social Marketing Policy Development

A System of Partners State & Local Public Health Departments Educators Colleges, Universities, & Technical Schools Healthcare Consumers Managed Care Hospitals & Clinics Healthcare Purchasers Community Health Centers Healthcare Providers Faith Community Professional Organizations Civic Organizations Foundations Community Residents Law Enforcement State and Local Elected Officials Agriculture, Natural Resources, Public Instruction, and other governmental agencies Advocacy Organizations Media Business & Labor

(Photographer unknown) Community- System Interventions

Literature search “Built environment”“Public health” “Traffic” “Physical activity” “Speed”“Injuries” “Aggressive driving behaviors”“Social efficacy” Literature Review: Credible authors and sources

Research findings Modern cities associated with costly injuries and illness due to inactivity 70% deaths, 60% medical expenditures in U.S. attributed to chronic disease 30% of these preventable with increase in physical activity Less than ½ of U.S. adults meet activity recommendations of 30 minutes most days

Research Findings U.S. bicycling and walking trips reduced from 10% (1977) to 6.3% (1995) Pedestrian and cycling fatalities are triple Canada and Northern European countries 20-40% of travel is by cycling and walking 4 E’s: Engineering, Enforcement, Education, Encouragement

Research findings One prospective cohort study surveyed a random sample prior to and following a traffic calming intervention Pedestrian counts at 3 places by age groups Pedestrian activity increased after the traffic calming Children were more likely permitted to play outside (Morrison, Thomson and Petticrew, 2004)

activity/StatePlan

Workgroup activity Success Story: Issue, Intervention, Impact Media release Talking points Community event flier Letter of support Issue paper

Street Share (ITE Pedestrian Bicycle Council)

(Photographer unknown) Healthy Community

“One good community nurse will save a dozen policemen.” Herbert Hoover