Public Health Nursing and Essential Public Health Functions: A Basis for Practice in the twenty-first Century

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Introduction

“Improve the health of the population” is the goal of the health ministry or agency in most nations. In recent years policy discussions on how to accomplish this goal have expanded to include a discussion of essential public health functions or essential public health services as the basis on which specific goals can be accomplished. Those developing health policy have come to understand that without an adequate infrastructure such as that involved in these essential services it is not possible for a jurisdiction to move effectively toward health improvement for all people. While treatments for specific diseases and activities to minimize individual risks can be successfully provided one by one, they cannot be sustained without an organized public health structure. Further, the conditions of concern for a city, a region or a nation will change over time. The presence of a well-developed network of essential public health functions and services allows flexibility and growth in programming over time.

The topic of essential functions has received attention in many countries individually. Internationally the World Health Organization (WHO)i and the Pan American Health Organization (PAHO) have led collaborative processes that facilitate cooperation and mutual learning. While much of the work done have been generic to all public health practice, there have also been efforts to identify the contributions made by individual health professions to the overall effort. For example, public health nurses in the United States have moved to specify how improved public health practice within the discipline can strengthen the public health infrastructure of a community or nation.

Many nurses who are contributing to the essential functions do not describe themselves as doing so, because they are unfamiliar with the emerging language of public health. Many more nurses could become active contributors to the public health enterprise if they saw more clearly how the practice of nursing fits as an integral part of the process. The group of nurses working together on public health nursing and essential functions believe that while much of the workforce development associated with essential functions of public health should be done with interdisciplinary groups, there is justification for a special focus on nurse because nurses fill key roles in public health in the Americas. They share a perception that nurses need some professional-specific education and tools to be ready for interdisciplinary practice, especially because many are not prepared at the baccalaureate or higher level. Public health nurses, for purposes of this analysis, are primarily those who have post-secondary nursing education and work in a population-focused practice or program in an official public health agency or one contracted by the government. There are some nurses practicing in other organizations (voluntary health organization, non-governmental program or health service systems) who may be practicing public health, but are not a primary focus at this time.

This document reviews current thinking about essential public health functions and the particular contributions of public health nurses to these services in PAHO countries, based on review of available literature and published models and case studies of public health nursing work in PAHO countries. In addition to describing what is currently the case, areas for future research and development are presented. These areas include potential practice changes, as well as ways in which nurses in PAHO countries can strengthen nursing education about public health practice and essential functions and provide continuing support for improvement.