This paper proposes a community health promotion initiative grounded in the priorities outlined by Healthy People 2020 and supported by findings from the CDC's National Expert Panel on Community Health Promotion. Drawing on research by Navarro et al. (2007) and Freudenberg and Ruglis (2007), the paper examines the social, environmental, and educational determinants of health, including the relationship between school dropout rates and poor health outcomes. It then argues for a nurse-practitioner-led community health initiative, detailing the advanced clinical training, holistic care philosophy, and collaborative role of nurse practitioners in delivering cost-effective, community-based preventive and chronic disease management services.
Navarro et al. (2007), writing in "Charting the Future of Community Health Promotion: Recommendations From the National Expert Panel on Community Health Promotion," published by the Centers for Disease Control and Prevention, report that "in the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change" (p. 1). The National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion in order to identify methods by which these problems could be addressed at local and national levels (Navarro et al., 2007, p. 1).
Community health promotion emphasizes "the social, cultural, and environmental contexts that shape health status and works through collaborative partnerships to improve the health of a population within a defined geographic area. Community-based participatory strategies, such as community organization and mobilization, bring to bear shared values and experiences of community members, who are viewed as having the best knowledge of and perspective on improving the health of their community. The community is regarded as an influential determinant of health, and community members are involved in all aspects of public health research, interventions, and evaluations" (Navarro et al., 2007, p. 1). The largest challenge facing public health leaders is sustaining the "important role of long-term community health promotion in addressing the social and environmental determinants of health in an atmosphere that demands evidence of health impact and return on investment" (Navarro et al., 2007, p. 1).
Findings from the expert panel indicate that "ecological models have been useful in furthering community health promotion efforts, particularly as they relate to environmental influences on health status and behavior. In addition, the panel acknowledged CDC's valuable role in validating effective practices of community health promotion and supporting community-based participatory research and public health surveillance. The panel also affirmed CDC's role in disseminating public health knowledge across communities and serving as the voice among federal agencies for community health promotion" (Navarro et al., 2007, p. 1).
The expert panel also noted that even the best operational measures of the socioecological approach missed critical opportunities for change, including mental health and wellness, spirituality, and complementary and alternative medicine; access to care; political and economic contexts of decisions; race, racism, and discrimination; cultural beliefs and values as risk and protective factors; and elements of community efficacy such as social capital and community competencies. The panel called for an ecological approach sufficiently flexible to allow community choices based on available resources and local realities, and recommended that future approaches facilitate discussions on power relationships, the political process, chronic social stressors such as poverty, acute situations such as natural disasters, and the engagement of nontraditional partners (Navarro et al., 2007, p. 1).
Among the panel's specific recommendations were the following: (1) enhancement of surveillance systems beyond tracking individual risk factors to include community health indicators and social determinants of health; (2) promotion of community-based participatory research; (3) support for training and capacity building to ensure that the public health workforce possesses the knowledge, skills, and tools necessary to implement community health promotion approaches; (4) promotion of a state-of-the-art electronic mechanism to share expertise and knowledge about community health promotion; (5) support of a focus on wellness, including mental health, spirituality, and complementary and alternative medicine (CAM); (6) a shift of a measurable portion of NCCDPHP's community health promotion programs toward improving living conditions across the lifespan; (7) maximizing the impact of federal resources dedicated to community health promotion; and (8) provision of funding tailored to the realities of community health (Navarro et al., 2007, p. 1).
Freudenberg and Ruglis (2007), in "Reframing School Dropout as a Public Health Issue," published by the Centers for Disease Control and Prevention, report that good education is predictive of good health, and that disparities in health and educational achievement are closely linked. Despite these connections, public health professionals rarely make reducing school dropout rates a priority, even though nearly one-third of all students in the United States — and half of Black, Latino, and American Indian students — do not graduate from high school on time (p. 1). While education is highly correlated with income and occupation, evidence suggests that education exerts the strongest independent influence on health (Freudenberg & Ruglis, 2007, p. 1).
Formal education is consistently associated with lower death rates, while less education predicts earlier death. The less schooling people have, the higher their levels of risky health behaviors such as smoking, being overweight, or having a low level of physical activity (Freudenberg & Ruglis, 2007, p. 1). Health interventions focused on reducing school dropout rates aim to change individuals, families, schools, school systems, or public policies related to poverty, welfare, or employment. School-based interventions include coordinated school health programs, health clinics, mental health programs, substance abuse prevention and treatment programs, comprehensive sex education and HIV prevention programs, pregnancy prevention programs, special services for pregnant and parenting teens, violence prevention programs, and interventions designed to improve schools' social climate (Freudenberg & Ruglis, 2007, p. 1).
Freudenberg and Ruglis recommended five priorities for action: (1) targeting schools and cities with the highest dropout rates for intensive intervention; (2) developing, implementing, and evaluating health interventions that improve student completion rates; (3) strengthening support for health education teachers and developing new approaches to school-based health education and services that can reduce dropout rates — efforts that require well-trained health education teachers, nurses, and mental health professionals, each currently in short supply; (4) advocating for evidence-based interventions that improve health and reduce dropout rates; and (5) placing the reduction of high school dropout rates on the public health agenda (Freudenberg & Ruglis, 2007, p. 1).
"Nurse practitioner-led community health initiative proposed"
"NP qualifications, roles, and community health impact"
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