Nurses can address diseases of despair and improve public health

Today’s centralized, medicalized system of care is unequipped to handle the surge of patients with “diseases of despair,” such as substance abuse, states a recent report.

Given nursing’s history, it makes sense to arm nurses with the tools they need to step in and address the unmet public health crisis of diseases of despair in the 21st century, according to Patricia Pittman, PhD, FAAN, author of the report and co-director of the George Washington University Health Workforce Institute.

Pittman analyzed the literature and interviewed nurse leaders, policymakers and others to write the report, “Activating Nursing to Address Unmet Needs in the 21st Century,” released March 12, 2019, by the Robert Wood Johnson Foundation.

Looking back at public health and nursing

Nursing has long played a role in public health activism, Pittman said.

Patricia Pittman, PhD, FAAN

“Between 1910 and 1930, particularly coming out of New York and spreading all across the country, there were nurses who were visiting the tenements,” she said. “They were doing not just well-baby and well-mother care, but also all kinds of activities in collaboration with social workers to ensure families had sufficient food, transportation; access to hospital care when needed; opportunities for job training; and adequate clothes.

“They really approached health in a very holistic way, which we would call now the social determinants of health,” she continued. “They were a significant component of the healthcare system at that time.”

Metropolitan Life Insurance Company paid public health nurses in the U.S. to do this kind of work because it extended people’s lives. That led to the country’s first federally-funded healthcare program — the Sheppard-Towner Act, created in 1921, which focused on maternal and child healthcare.

“That was really the pinnacle of the influence of nursing in our country,” she said.

But a series of historical forces conspired against nurses’ work in the subsequent decade, pushing nursing into a more subordinate role where they were tasked with clinical duties to support physician roles, Pittman said.

By 1929, Pittman wrote, the medical profession had mounted a campaign against the maternal-child programs of the Sheppard-Towner Act leading to the act’s repeal and a reallocation of funds to American Medical Association priorities.

“That was a significant blow to the funding for this kind of work,” Pittman said. “Then, as private prepaid health insurance emerged in the late ‘30s and ‘40s, Metropolitan Life Insurance began to back out of the contracts with these independent nurses arguing that the prepaid health insurance should pick up those services. Of course, you know that traditional health insurance benefits do not, for the most part, cover home visits and those kinds of wrap-around services that were more holistic.”

By the 1940s, a major expansion of hospitals concerned physicians at the time who worried about maintaining their independence. Physicians saw nurses as loyal auxiliaries to them in the hospital setting.

And with the start of Medicare in 1965, physicians’ economic stature climbed as their wages basically doubled because Medicare created a guaranteed payment system for fee-for-service, according to Pittman.

“That also …read more

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