"Keep your eye on the..."
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Keep your eye on the donut, not on the
hole |
Introduction to Community
Health
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The Science of Nursing in the Community |
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N5290 |
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Jill Gallin, CPNP |
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Assistant Professor of Clinical Nursing |
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Columbia University School of Nursing |
Student Experience?
Brief History of Community
Health
500 B.C.-A.D. 500
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Greeks |
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Exercise in physical games of strength |
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Romans |
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Aqueducts |
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Sewer system |
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Refuse removal |
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hospital |
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A.D. 500- 1500
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Spiritual era of public health |
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Belief of disease from supernatural
causes |
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Spread of communicable diseases |
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Leprosy |
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Plague (half the population of London,
France 1 in 10 survived) |
Leprosy/ Hansen’s Disease
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Mycobacteriumleprae |
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Skin and nerve damage |
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Manifestations of disease |
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Skin lesions, nodules, plaques |
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Thickened dermis |
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Involvement of nasal mucosa, epistaxis |
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Necrosis of body parts |
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Sensory loss, numbness |
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Muscle weakness |
leprosy
Leprosy
Leprosy
Bubonic Plague
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Usually result of a bite from an
infected rodent flea, or by handling infected animals |
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Does NOT usually spread person to
person |
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Symptoms |
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high fever |
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enlarged, tender lymph nodes, often in
the groin |
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Incubation period: 2-10 days |
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Treatment: antibiotics |
Pneumonic Plague
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Result of sufficient dose of bacterial
organisms is inhaled; a small percentage of bubonic cases develop pneumonic
plague |
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Can be spread person to person |
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Incubation period: 2-3 days |
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Bacillus viable one hour after attack |
Plague
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Signs and Symptoms |
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Acute fulminate pneumonia with high
fever |
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dyspnea |
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cough w/ blood tinged or purulent
sputum |
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cutaneous manifestations: |
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livid cyanosis |
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ecchymosis |
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necrosis of digits and nose |
Ring Around the Rosy
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Ring around the rosy |
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(rose-colored purpuric lesions) |
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Pocket full of posies |
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(flowers carried to prevent the disease
and cover the stench) |
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Ashes, Ashes |
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(death) |
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We all fall down |
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(we all die) |
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Slide 15
Plague
A.D. 1500-1700
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Renaissance and Exploration |
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Plague killed saints and sinners alike |
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Environment played a role in disease |
Eighteenth Century
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Overcrowded cities |
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Poor water supply |
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Poor sanitation |
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Unsafe workplace |
Eighteenth Century
communicable disease
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Small pox |
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Cholera |
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Typhoid fever |
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Yellow fever |
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Average age of death: 29 |
Smallpox
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Orthopoxvirus family, (variola major) |
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Can spread from person to person,
aerosolized |
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Signs and symptoms |
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flu-like beginning with high fever |
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maculopapular rash usually starts on
face and hands then forearms and trunk and legs |
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become vesicular and pustular (embedded
in dermis) |
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all lesions occur at same level of
development |
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leave pitted scar after separation from
skin |
Slide 21
Cholera
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Infection of small intestine by Vibrio
cholerae, ingesting contaminated food and water |
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watery diarrhea |
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Severe dehydration |
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Review symptoms |
Typhoid
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Infection by salmonella typhi in
contaminated food, water |
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Diarrhea |
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Systemic disease, high fever, weakness,
fatigue, delirium |
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Rash “rose spots” abdomen and chest |
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Yellow Fever
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Virus transmitted by mosquitoes |
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Fever, jaundice, generally ill |
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15% progress to intoxication period |
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Kidney failure, hemorrhage, brain
dysfunction, seizures, coma, death |
Eighteenth Century Advances
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1790 George Washington ordered the
first US census (done every ten years since) |
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1796 Edward Jenner demonstrated vaccine
against small pox by injecting a boy with cowpox. |
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1798 Marine health center (will become
US Public Health Service) |
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1799 Municipal boards of health in
major cities |
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Nineteenth Century
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1849 Dr. John Snow |
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1850 Lemuel Shattuck, Massachusetts |
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1862 Louis Pasteur’s germ theory
disproved spontaneous generation |
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1876 Robert Koch: a particular microbe
and no other causes a particular disease |
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1872 American Public Health Association
founded |
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1890 pasteurization of milk |
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1895 septic tanks introduced |
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Nineteenth Century Nurses
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Florence Nightengale |
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Military at home and in the Crimean War |
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Research, lobbying, health care |
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Lillian Wald |
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1893 Henry Street Settlement |
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Home health |
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First school nurse |
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Mary Seacole |
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Jamaican and other Caribbean populations |
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Dorothea Dix |
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Mentally ill |
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1881 Clara Barton |
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American Red Cross |
Twentieth Century
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Mass immigration and poverty |
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Malnutrition |
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Pellagra, rickets |
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Communicable diseases |
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Influenza, pneumonia, tuberculosis, GI,
polio |
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Death associated with pregnancy &
childbirth |
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Pellagra
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Vitamin deficiency, niacin or
tryptophan Manifestations |
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Skin sores |
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Diarrhea |
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Inflamed mucous membranes |
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Mental confusion |
Rickets
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Vitamin D deficiency, phosphate |
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Manifestation |
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Soft bones, bow legs, spinal
deformities, fractures |
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Dental deformities |
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Bone pain |
Poliomyelitis
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Poliovirus, person to person contact by
infected secretions of nose or mouth, feces |
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Worldwide epidemic 1840-1950’s |
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Sub-clinical (95% cases) |
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Non-paralytic |
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Paralytic |
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Brain and spinal cord involvement |
Poliomyelitis
Poliomyelitis
Poliomyelitis
Twentieth Century Advances
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Results of immigrant conditions |
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1906 Pure Food and Drug Act |
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1910 Workman’s compensation |
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1902 Rochester City Hospital School for
Nurses |
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1918 Johns Hopkins School of Public
Health |
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Prohibition |
Twentieth Century Advances
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Roosevelt & WWII |
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1935 Social Security Act |
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1937 National Cancer Institute |
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Penicillin: pneumonia, RF, syphilis,
strepp |
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DDT: malaria |
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CDC, Atlanta |
Twentieth Century Advances
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Post war (1950’s) |
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Polio Vaccine |
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Eisenhower’s heart attack |
Aerial view of a crowd
awaiting polio immunization, San Antonio, 1962
Twentieth Century Advances
Twentieth Century Advances
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1980 |
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Eradication of smallpox |
Twentieth Century Advances
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1970- present |
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The period of Health Promotion and
Disease Prevention |
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Diseases due to one’s lifestyle or
health behavior |
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Global Health |
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In Summary
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What have we accomplished from a
community and public health perspective? |
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How & Where is our work cut out for
us in the future? |
Slide 43
"Break"
"Organizations in
Community Health"
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Organizations in Community Health |
Governmental Agencies
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International |
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National |
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State |
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Local |
International Agencies
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WHO, 1948, Geneva |
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Six Regional Offices: AFRO, AMRO/PAHO,
EMRO, EURO, WPRO, SEARO |
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Funded by country members “sliding
scale” |
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1980 eradication of smallpox |
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UNICEF, 1946 |
National Agencies
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Department of Health and Human Services
(HHS) |
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Department of Agriculture |
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WIC |
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Environmental Protection Agency |
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Department of labor |
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OSHA |
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Department of Commerce |
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Censes |
HHS
State Agencies
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Carry out core functions of public
health |
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Link between federal and local agencies |
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Laboratory services |
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Environmental health ie. Water and air
pollution |
Core Functions of Public
Health
Local Agencies
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City or County Health Department |
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School Health Program |
Quasi Governmental Health
Organizations
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American Red Cross |
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Federal responsibilities |
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Voluntary contributions |
Non-governmental Health
Agencies
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Voluntary Agencies |
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MADD, SADD |
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Professional Health Organizations |
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American Nursing Association |
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Philanthropic Foundations |
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Rockefeller, Robert Wood Johnson,
Kaiser, Kellogg, Doris Duke |
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Service, Social and Religious
organizations |
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Rotary |
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"Questions?"
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Questions? |
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Remember to sign up for community
assessment presentations |