A Community View

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Chapter 2

Historical Factors: Community Health Nursing in Context

Stages* in the Disease History of Humankind

Hunting and gathering (before 10,000 B.C.)

Settled villages (10,000 to 6000 B.C.)

Preindustrial cities (6000 B.C. to 1800 A.D.)

Industrial cities (1700 to 1800 A.D.)

Present period (1900 to 2000 A.D.)

*Stages overlap and time periods are widely debated in the field of anthropology. Some form of each stage remains evident in the world today.

Aggregate Impact on Health

Increased population

Increased population density

Imbalanced human ecology

Resulted in changes in cultural adaptation

Evolution of Early Public Health Efforts

Prerecorded historic times (before 5000 B.C.)

Practices based on superstition or sanitation

Health practices evolved to ensure survival

Evolution of Early Public Health Efforts (Cont.)

Classical times (3000 to 200 B.C.)

Devised ways to flush water; constructed drainage systems

Developed pharmaceutical preparations

Embalmed the dead

Dealt with pollution

Hygienic code to protect food and water

Greek and Roman impact public health

Evolution of Early Public Health Efforts (Cont.)

Greeks

Literature contains accounts of communicable diseases

Endemic, epidemic, and pandemic

Hippocratic book on Airs, Waters and Places

Hygeia, goddess of health, or good living

Panacea, goddess of curative medicine

Balance of human life with environmental demands

Disease Definitions

Disease	Definitions
Endemic	Diseases that are always present in a population (e.g., colds and pneumonia).
Epidemic	Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles).
Pandemic	The existence of disease in a large proportion of the population—a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A).

Evolution of Early Public Health Efforts (Cont.)

Romans

Surpassed Greek engineering

Massive aqueducts, bathhouses, and sewer systems

Addressed occupational health threats

Priests mediated diseases and dispensed medicine

Public physicians worked in designated towns

Worked in groups much like today’s HMOs

Eared money to care for the poor

Hospital for sick poor established by Fabiola, a Christian woman

Evolution of Early Public Health Efforts (Cont.)

Middle Ages (500 to 1500 A.D.)

Monasteries promoted collective activity to protect public health.

Churches enforced hygienic codes.

A pandemic ravaged the world in the 14th century.

Modern public health practices (e.g., isolation, disinfection, quarantines) emerged.

Evolution of Early Public Health Efforts (Cont.)

Renaissance (15th, 16th, 17th centuries)

A theory about the cause of infection evolved.

Leeuwenhoek described microscopic organisms.

Elizabethan Poor Laws were enacted.

Evolution of Early Public Health Efforts (Cont.)

18th century

The Industrial Revolution occurred.

Poor children were forced into labor.

Vaccination was discovered by Edward Jenner.

Sanitary Revolution’s public health reforms were taking place.

Evolution of Early Public Health Efforts (Cont.)

19th century

Communicable diseases ravaged the population that lived in unsanitary conditions.

Edwin Chadwick examined death rates by occupation and class in England.

The General Board of Health for England was established in 1848.

Evolution of Early Public Health Efforts (Cont.)

19th century (Cont.)

Public health laws were enacted in 1849:

Healthy mental and physical development of citizens

Prevention of all dangers to health

Control of disease

John Snow demonstrated the transmission of cholera via the public water source.

Evolution of Early Public Health Efforts (Cont.)

19th century (Cont.)

Waves of epidemics occurred in the United States.

Lemuel Shattuck published vital statistics in Massachusetts; he called for child health reform.

The first Board of Health was formed in response.

The AMA was asked to collected vital statistics.

Efforts focused on determinants of health.

The advent of “modern” health care occurred.

Florence Nightingale (1820-1910)

Credited with establishing “modern nursing”

Concern for environmental determinants of health

Emphasis on sanitation, community assessment, and analysis

Use of graphically depicted statistics and comparable census data

Political advocate

Education reform for nurses

Figure 2-2

Public domain; courtesy University of Chicago Library.

Impact of Important Scientists

Louis Pasteur

Theory of existence of germs

Discovered immunizations in 1881 and the rabies vaccine in 1885

Robert Koch

Discovered causative agent for cholera and the tubercle bacillus in 1882

Joseph Lister

Surgical success with wound care

“Modern” Medical Care

Emergence of germ theory focused diagnosis and treatment on individual organism and individual disease.

Community outcry for social reforms forced governments to take action.

Boards of health and health departments began in 1866.

TB surveillance began in 1889.

“Modern” Medical Care (Cont.)

Flexner Report (1910) outlined shortcomings of U.S. medical schools.

Philanthropic foundations influenced health care efforts.

1916: Rockefeller Foundation established first school of public health at Johns Hopkins.

Community Caregiver

Traditional healer common in non-Western, ancient, and primitive societies.

Societies retain folk practices because of their success.

Folk healing practices are socially cohesive and involve support systems.

Although often overlooked, cultural practices affect health.

Establishment of Public Health Nursing

In England

District Nursing in England, 1850s

Rathbone worked with Nightingale to educate “health nurses,” 1859

Health Visiting in Manchester, England, 1862

In the United States

Visiting Nurses, 1877

Henry Street Settlement, 1893

Lillian Wald (1867-1940)

Established Henry Street Settlement in 1893 (along with Mary Brewster)

Played an important role in establishing public health nursing in the United States—later called “Visiting Nurses Association of NYC”

Role of Henry Street Settlement was “one of helping people to help themselves” (Wald, 1871)

The Children’s Bureau and the Social Security Act Legislation formed as a result of these efforts

Other Key Dates in the Establishment of PH Nursing

First School Nurse, Linda Rogers, 1902

Metropolitan Life Insurance Company provided home nurses for policyholders, 1909

Department of Nursing and Health at Teachers’ College of Columbia University in NYC, 1910

National Organization of Public Health Nurses formed, 1912 (Lillian Wald was first president)

Public Health Service appointed its first public health nurse, 1913

Changing Perspectives on Mortality in the 20th Century and Beyond

Change from infectious diseases to chronic conditions

Modern medical advances (vaccination programs and antibiotics)

Holistic approach to health

Better sanitation and nutrition

Grecian Hygeia (i.e., healthful living) vs. Panacea (i.e., cure) dichotomy

Multi-causal, not uni-causal, view of disease

Challenges for Community Health Nursing

Promote the health of populations

Need a broadened focus on the multiple causes of morbidity and mortality

Aware of increased technological advances

Understand the community need for a focus on prevention, health promotion, and home care

Focus on holistic care

Challenges for Community Health Nursing (Cont.)

Emphasis on population-based focus nursing

Work on behalf of aggregates

Understand social determinants of health

Gather information and statistics to make decisions

Be part of the solution to find ways to solve persistent health problems

Emphasize society’s responsibility for health

Empower people to help themselves