Continuing the debate on the philosophy of modern public health: social quality as a point of reference

Squaring the circle: Developing public-health competencies in primary care

Recent changes in UK Government health policy mark a shift towards giving greater prominence to public health, especially within primary care. These changes provide broad guidelines for improving public health practice but standards, beyond those for public health medicine specialists, on the competencies or skills needed to deliver the new public health agenda have not been agreed. This paper aims to explore the current policy agenda surrounding public health and primary care in England, and to consider its historical roots and new developments. Within the context of current health policy and practice in England it reviews the frameworks for defining a public health practitioner at primary care level and appraises the competencies and skill-mix required for delivering a public health-oriented programme. Focusing on community nursing, frameworks from other countries are discussed to elaborate a picture of what is needed for the future development of public health nurse specialists. It concludes by suggesting avenues for research and development that will promote the understanding of public health practice in primary care.

Disability from a public health perspective

At the Nordic School of Public Health (NHV), methods to alleviate problems with disability have been seen as an important part of actions to support public health. A programme for universal design was started in 2006. Some issues of public health perspectives on disability are presented in this paper, based on discussions from a PhD course held at the NHV. During the course, the students presented papers in which they reflected on the relationship between disability and public health. These essays were collected and published in 2012 at NHV.

Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals

BACKGROUND

Outpatients attending consultations at public hospitals may have unmet needs for preventive medical care. This study aimed to identify and assess the association between these needs, social vulnerability and mode of healthcare use.

METHODS

In a multicentre epidemiological study, a group of socially vulnerable outpatients, was compared with a non-vulnerable group in a sample of 1316 outpatients selected in hospital consultations, using a validated tool for detection of social vulnerability. Before the patient was seen by medical staff, investigators collected data on social characteristics, healthcare use and preventive medical care received (interventions, advice).

RESULTS

More than 75% of outpatients stated that they were regularly followed by a physician, usually a general practitioner, but fewer vulnerable than non-vulnerable outpatients were followed (77% vs. 89%, P < 10(-3)). For the majority of preventive interventions (vaccinations, screening for cardiovascular risk factors, gynaecological cancers), vulnerable outpatients presented a more marked shortage than non-vulnerable patients, but there was an overall shortage in both groups. When recommended preventive interventions had not been delivered, they had rarely been offered in either group. After adjustment for mode of healthcare use, the differences in preventive care received persisted to the disadvantage of vulnerable outpatients with regard to technical preventive interventions, but there was no difference between the two groups regarding advice received to reduce risk behaviours.

CONCLUSION

Unmet needs for preventive care primarily resulted from social inequalities in secondary access to such care. It may be necessary to set up specific interventions targeting vulnerable patients within hospital consultations.

Inégalités de santé et d'accès secondaire aux soins

The role of health care inequalities in social inequalities in health should be reconsidered since the quality of health care varies according to the social status. Some of the health care inequalities are constructed by not taking account of health inequalities in the development of programs or recommendations of medical practice and thus ending up with management procedures that do not reduce inequalities to a minimum but even contribute to increasing them. Other health care inequalities are due to omission, linked to the operating inertia of a health care system that does not recognize these inequalities and has no plan to catch them up. To reverse this situation it seems necessary to act at the three levels of the health care system: to change the clinical paradigm at the micro level, tackle the organizations issues at the meso level, and pursue the reform of the entire health care system at the macro level.

Evidence based practice in population health: a regional survey to inform workforce development and organisational change

STUDY OBJECTIVE

To assess current capacity to implement evidence based practice (EBP) in population health.

DESIGN

Postal survey of a regional population health workforce in Sydney, Australia.

SETTING

Division of Population Health, South Western Sydney Area Health Service.

PARTICIPANTS

104 population health staff (response rate: 73%).

MAIN RESULTS

In the sample of regional population health practitioners, views about the current promotion of EBP were positive. Non-medical respondents with less that Masters degree were more likely to report "high self assessed need" to increase their capacity in EBP (p = 0.022). Confidence in understanding of EBP terminology was not associated with seniority but with highest level of education reached (p<0.000) and having medical qualifications (p<0.000). Occupational category was not associated with respondents' self assessed "need for evidence", "need for EBP skills" or "need to increase their capacity in EBP" in their current position. The proportion of participants "strongly" supporting implementation of a colorectal cancer screening programme whose benefit was expressed as relative risk reduction was greater than that so supporting a programme whose benefit was expressed as number needed to screen (p = 0.008). Most respondents referred to their immediate managers when seeking support for EBP.

CONCLUSIONS

The findings provide a quantitative baseline for capacity building through workplace programmes. Managerial commitment has been increased and performance development is now underway.

Exploring the contribution of district nurses to public health

To date the public health role of district nursing has been less well defined than in other branches of community nursing. A qualitative study examining the public health role of district nurses was undertaken in a West Yorkshire primary care trust. The study explored the range of public health activities currently undertaken by district nurses, the agendas perceived as most conducive to input and the organizational barriers that prevented greater involvement in public health from district nurses. Focus group and individual semi-structured interviews were undertaken with 21 members of the district nursing team and analysed using thematic content analysis. The findings suggest that district nurses were already undertaking a range of public health and health education activities but much of the work was opportunistic. District nurses perceived themselves as well placed to undertake locally based health action because of their profile in the local communities together with local intelligence. However, ineffective referral criteria were considered to be the most prohibitive barrier against making a greater contribution to health improvement.

Public Health Nursing in Ireland: A Critical Overview*

The World Health Organization have stressed the importance of nurses and midwives as a "force for health" in society's efforts to tackle the public health challenges of our time. The public health challenges are both diverse and complex. Principally, they emanate from a social model of health that takes cognizance of our behavior, our environment, and the historical, political, and cultural structures that facilitate health or militate against it. This paper provides a critical overview of public health nursing in Ireland, toward situating both our contribution to public health and some of the challenges that lie ahead of us. Specifically, it looks at nonquantifiable practice, where, through the presentation of stories, the wealth of public health nursing work is demonstrated in the ordinary voices of public health nurses. The potential risk of ignoring and minimizing the contribution of public health nursing in future developments in primary care in Ireland is discussed. Finally, it is proposed that public health nurses need to get political.

Public health and the role of the nurse: the need for greater clarity

There is evidence that public health is currently taking centre stage in the challenge to improve the population's health. This represents a change from the 1980s and 1990s where health promotion was the dominant concept among community nurses. Public health means different things to different people and while nurses have a role to play, there is a need to be more precise about their specific contribution. The creation of public health nursing posts across the UK is contribution to this confusion, as there is little emerging consensus as to what professionals in these posts should do. At present, there does not appear to be a dominant strategy or model of working. A preliminary analysis of job advertisements for public health nursing posts indicates a requirement for a 'supercharged' health visitor to work in a specific area to provide a link between the professional and lay communities. The emphasis is on community development with little on population health. Government policy on public health clearly highlights the important role of nurses in contributing to the public health agenda. The current role and function of public health nursing posts may not allow them to be classed as specialist public health nurses/nursing and to provide educational opportunities for nurses to develop the knowledge and skills which will enable them to work alongside medical and other healthcare colleagues in the pursuit of specialist public health practitioner status.