Healthy Communities

Page 98 of our text book for part1 of the assignment.

Healthy Communities

Complex community systems receive many varied stimuli. The community’s ability to respond effectively to changing dynamics and meet the needs of its members indicates productive functioning. Examining the community’s functions and subsystems provides clues to existing and potential health problems. Examples of a community’s functions include the provision of accessible and acceptable health services; educational opportunities; and safe, crime-free environments.

The model in Fig. 6.2 suggests assessment parameters that can help a nurse develop a more complete list of critical community functions. The community health nurse can then prioritize these functions from a particular community’s perspective. Americans’ views on health and healthy communities frequently reflect concern for quality-of-life issues over the absence of disease, and in particular safety and low levels of crime are of high priority. These findings are echoed in city-sponsored health surveys across the nation: ensuring safe and healthy environments that allow for healthy lifestyles, which include activity and nutritious food, is as important to residents as accessing quality health care.

Movements such as Healthy Cities and Healthy Places urge community members and leaders to bring about positive health changes in their local environments (CDC, 2014; World Health Organization, 2017). Involving many cities around the nation and world, these models stress the interconnectedness among people and the public and private sectors essential for local communities to address the causes of poor health. In particular, examining the role the “built environment” has on community health (e.g., its physical and environmental design) is an increasing priority (Robert Wood Johnson Foundation, 2017). Urban communities are encouraged to consider the health consequences of new policies and programs they introduce by conducting health impact assessments (Pew Charitable Trusts, 2017). These assessments of projects, such as the potential impact of zoning decisions, transit systems, and sick leave policies, serve the important function of bringing a public health perspective to urban and civic initiatives.

FIG. 6.2 Diagram of assessment parameters.  Modified from Anderson ET, McFarlane J: Community as partner: theory and practice in nursing ed 7, Philadelphia, PA, 2015, Wolters Kluwer.

Each community and aggregate presumably will have a unique perspective on critical health qualities. Indeed, a community or aggregate may have divergent definitions of health, differing even from that of the community health nurse. Nevertheless, nurses and health professionals work with communities in developing effective solutions that are acceptable to residents. Building a community’s capacity to address future problems is often referred to as developing community competence. The nurse assesses the community’s commitment to a healthy future, the ability to foster open communication and to elicit broad participation in problem identification and resolution, the active involvement of structures such as a health department that can assist a community with health issues, and the extent to which members have successfully worked together on past problems. This information provides the nurse with an indication of the community’s strengths and potential for developing long-term solutions to identified problems.

Assessing the Community: Sources Of Data

The community health nurse becomes familiar with the community and begins to understand its nature by traveling through the area. The nurse begins to establish certain hunches or hypotheses about the community’s health, strengths, and potential health problems through this down-to-earth approach, called shoe leather epidemiology. The community health nurse must substantiate these initial assessments and impressions with more concrete or defined data before he or she can formulate a community diagnosis and plan.

Windshield Survey

Brookshire is a town of about 3500 in Southeast Texas.

Sugar mills and farms are the source of most jobs.

Accessible and affordable health care is a challenge. This van provides services to unskilled workers and area elders.

The economy of the town is predominantly agriculture and processing.

The car’s thermometer shows 99°, evidence of a pervasive health threat in the summertime.

Much of the housing is substandard and suggests low-income families.

Many people live in small homes on multiple-acre lots.

The important determinants of a health community include a low crime rate, a good place to bring up children, good schools, a strong family life, good environmental quality, and a healthy economy. (iStock 540095516, 683792276, 504534788, 470237304, 638480042)

Photos courtesy of University of Texas Health Science Center at Houston, School of Nursing, Community Health Division.

Community health nurses often perform a community windshield survey by driving or walking through an area and making organized observations. See illustrations depicting an actual “windshield survey” in this chapter’s photo novella. The nurse can gain an understanding of the environmental layout, including geographic features and the location of agencies, services, businesses, and industries, and can locate possible areas of environmental concern through “sight, sense, and sound.” The windshield survey offers the nurse an opportunity to observe people and their role in the community. Box 6.2 provides examples of questions to guide a windshield survey assessment.

In addition to direct observational methods, certain public health tools become essential to an aggregate-focused nursing practice. The analysis of demographic information and statistical data provides descriptive information about the population. Epidemiology involves the analysis of health data to discover the patterns of health and illness distribution in a population. Epidemiology also involves conducting research to explain the nature of health problems and identify the aggregates at increased risk. The rest of this section provides data sources and describes how the community health nurse can use demographic and epidemiological data to assess the aggregate.

 Active Learning Exercise

Walk through a neighborhood, and describe the sensory information (i.e., smells, sounds, and sights). How does each relate to the community’s health?

BOX 6.2 Questions to Guide Community Observations During a Windshield Survey

· 1. Community vitality:


1. • Are people visible in the community? What are they doing?

2. • Who are the people living in the neighborhood? What is their age range? What is the predominant age (e.g., elderly, preschoolers, young mothers, or school-aged children)?

3. • What ethnicity or race is most common?

4. • What is the general appearance of those you observed? Do they appear healthy? Do you notice any people with obvious disabilities, such as those using walkers or wheelchairs, or those with mental or emotional disabilities? Where do they live?

5. • Do you notice residents who are well nourished or malnourished, thin or obese, vigorous or frail, unkempt or scantily dressed, or well dressed and clean?

6. • Do you notice tourists or visitors to the community?

7. • Do you observe any people who appear to be under the influence of drugs or alcohol?

8. • Do you see any pregnant women? Do you see women with strollers and young children?

· 2. Indicators of social and economic conditions:


1. • What is the general condition of the homes you observe? Are these single-family homes or multifamily structures? Is there any evidence of dilapidated housing or of areas undergoing urban renewal? Is there public housing? What is its condition?

2. • What forms of transportation do people seem to be using? Is there public transit? Are there adequate bus stops with benches and shade? Is transportation to health care resources available?

3. • Are there any indicators of the kinds of work available to residents? Are there job opportunities nearby, such as factories, small businesses, or military installations? Are there unemployed people visible, such as homeless people?

4. • Do you see men congregating in groups on the street? What do they look like, and what are they doing?

5. • Is this a rural area? Are there farms or agricultural businesses?

6. • Do you note any seasonal workers, such as migrant or day laborers?

7. • Do you see any women hanging out along the streets? What are they doing?

8. • Do you observe any children or adolescents out of school during the daytime?

9. • Do you observe any interest in political campaigns or issues, such as campaign signs?

10. • Do you see any evidence of health education on billboards, advertisements, signs, radio stations, or television stations? Do these methods seem appropriate for the people you observed?

11. • What kinds of schools and day care centers are available?

· 3. Health resources:


1. • Do you notice any hospitals? What kind are they? Where are they located?

2. • Are there any clinics? Whom do they serve? Are there any family planning services?

3. • Are there doctors’ and dentists’ offices? Are they specialists or generalists?

4. • Do you notice any nursing homes, rehabilitation centers, mental health clinics, alcohol or drug treatment centers, homeless or abused shelters, wellness clinics, health department facilities, urgent care centers, mobile health vehicles, blood donation centers, or pharmacies?

5. • Are these resources appropriate and sufficient to address the kinds of problems that exist in this community?

· 4. Environmental conditions related to health:


1. • Do you see evidence of anything that might make you suspicious of ground, water, or air pollutants?

2. • What is the sanitary condition of the housing? Is housing overcrowded, dirty, or in need of repair? Are windows screened?

3. • What is the condition of the roads? Are potholes present? Are drainage systems in place? Are there low water crossings, and do they have warning signals? Are there adequate traffic lights, signs, sidewalks, and curbs? Are railroad crossings fitted with warnings and barriers? Are streets and parking lots well lit? Is this a heavily trafficked area, or are roads rural? Are there curves or features that make the roads hazardous?

4. • Is there handicapped access to buildings, sidewalks, and streets?

5. • Do you observe recreational facilities and playgrounds? Are they being used? Is there a YMCA/YWCA or community center? Are there any daycare facilities or preschools?

6. • Are children playing in the streets, alleys, yards, or parks?

7. • Do you see any restaurants?

8. • Is food sold on the streets? Are people eating in public areas? Are there trash receptacles and places for people to sit? Are public restrooms available?

9. • What evidence of any nuisances such as ants, flies, mosquitoes, or rodents do you observe? Are there stray animals wandering in the neighborhood?

· 5. Social functioning:


1. • Do you observe any families in the neighborhoods? Can you observe their structure or functioning? Who is caring for the children? What kind of supervision do they have? Is more than one generation present?

2. • Are there any identifiable subgroups related to one another either socially or geographically?

3. • What evidence of a sense of neighborliness can you observe?

4. • What evidence of community cohesiveness can you observe? Are there any group efforts in the neighborhood to improve the living conditions or the neighborhood? Is there a neighborhood watch? Do community groups post signs for neighborhood meetings?

5. • How many and what type of churches, synagogues, and other places of worship are there?

6. • Can you observe anything that would make you suspicious of social problems, such as gang activity, juvenile delinquency, drug or alcohol abuse, and adolescent pregnancy?

· 6. Attitude toward health and health care:


1. • Do you observe any evidence of folk medicine practice, such as a botánica or herbal medicine shop? Are there any alternative medicine practitioners, such as healers or curanderos?

2. • Do you observe that health resources are well utilized or underutilized?

3. • Is there evidence of preventive or wellness care?

4. • Do you observe any efforts to improve the neighborhood’s health? Planned health