NUR4244 Public Health Nursing Deliverable 3 Public Health Policy Executive Summary Competency Evaluate the impact of local, state, and national policy on public health. Scenario As a public health nurse, you have been asked to put together an executive summary of the impact of the Federal Women, Infant, and Children (WIC) program on the health of pregnant women, infants, and children in your state. This executive summary will be used by the agency director to provide the staff with a broad overview of the impact federal legislation can have on state decisions, as well as how policy can affect the populations you serve. Instructions Prepare an executive summary for the agency director that: Summarizes the purpose of the Women, Infant and Children (WIC) program. Evaluates the impact of the WIC program across local, state, and national levels focusing on four key areas: Birth outcomes Health care costs Infant feeding practices Immunization rates of children Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the executive summary. Resources Library Databases Health Source: Nursing/Academic Edition Database FAQ Websites Policy Map United States Department of Agriculture Food and Nutrition Service United States Department of Agriculture Economic Research Service Guides & FAQs Executive Summary FAQ Policy Map Tutorials Searching the Map Search by Census Tract and Block Group Data Layer Legend APA Guide Credible Sources FAQ Nursing Guide Rasmussen’s Answers/FAQs
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NUR4244 Public Health Deli 3 Material
Impact of State Level Policy
State Legislators
Each state government is patterned much the same as the federal
government and the process for legislation are similar at the state and
federal levels. One of the key differences is how often and how long state
legislatures meet, as they are rarely considered full time. Knowing this
cycle is key to understanding when to approach legislators about
sponsoring legislation and gathering coalitions to support or oppose
various bills. Since state legislators reside in their districts,
representatives and their staff members are much easier to approach
and more responsive to resident’s concerns.
It is important to understand that the role of the legislator is to raise and
distribute funds to support the citizens of the state with services.
Therefore, representatives must balance multiple constituencies with
demands from numerous areas of service including roads, infrastructure,
social services, commerce, labor, education, etc. Public health leaders,
who are advocating for more resources for environmental, mental, and
public health, are competing for a percentage of the same pool of dollars.
Influencing Legislation
As bills are introduced at the state level, there are health professional
organizations who review and comment on their stance on a bill and
suggestions for amendments. The state hospital association, the state
nursing organization, and smaller groups such as community health
center coalitions routinely monitor and post their recommended positions
for members to use in communication with state representatives. These
groups are often invited to testify before committees who are considering
the legislation before they vote to proceed and move to the full house for
a vote. Being active in these associations is a way to advocate for your
profession and your client population.
One example of a state-level policy that directly influences the nursing
profession is the regulation of the practice of nursing through the State’s
Nursing Practice Act. The recognition and the regulation of advanced
nursing practice vary across states, which then affects the availability
and access to primary care providers. A few states are still not allowing
nurse practitioners to prescribe certain medications, although the federal
policy through Medicare, Medicaid, and the Veterans Administration
allows for full reimbursement to nurse practitioners. Nurses have an
opportunity to reach out to individual representatives with information
about their districts and the need for health care access that nurse
practitioners provide.
Federal Grants
States are often the recipient of federal grants that specifically address a
population or disease.
State Level Policy
State legislatures also set policies regarding environmental
management, highway safety laws, gun laws, and restrictions, as well as
regulations for hospital and other healthcare facilities. They may also
regulate nursing staff ratios in hospital facilities. Other states weigh in on
areas where health and social services intersect, such as child and elder
abuse and neglect.
One of the most critical issues in state legislatures is how to deal with the
rising mental health issues and opioid abuse. New policies allow the
general public and first responders to get access to drug-reversal
medicines like Narcan. Other policies have established drug registries for
physicians prescribing opioids. Some states have allocated resources to
local community health coalitions to coordinate education, referral, and
expanded treatment programs. Some local communities have safe
needle exchanges and places for safe drug use. Increased funding for
mental health and substance abuse treatment is needed, particularly in
contacting hard to reach populations in rural areas, homeless camps,
and undocumented workers.
Nurses Involvement in Policy
All nurses, particularly public health nurses to stay informed and involved
in the policy process. Working with coalitions is another way to enlist
others in your cause. One of the most successful coalitions has been the
American Association of Retired Persons (AARP) working with nursing
on expanding nurse practitioner practice laws. Belonging to professional
associations gives you access to proposed legislation and its progress
through the system.
Title V Maternal and Child Health Services Block Grant Program. (2019,
January 01). Retrieved from
Underserved Populations And Health Programs
While federal grants to states often target specific populations that cross
all boundaries, individual communities have their priorities and
complexities. Public health at the local level most often requires
collaboration across social, rehabilitation, and health systems to ensure
that the unique needs of a population are met.
Public health funding is often directed towards addressing the needs of
specific populations, who may not be adequately served by the traditional
systems. Underserved populations include special needs groups such as
children with autism or physical handicap, persons living with AIDs, those
who are in prisons or jails, and the homeless population. The homeless
population is one example where local public health professionals must
collaborate with social service, law enforcement, and private partners to
meet their unique and complex needs.
Homeless Underserved Population
One of the most difficult populations to serve for public health nurses is
the homeless population. Within the homeless population, there are
special sub populations that have unique socio-economic and health
issues. Approximately half million Americans experience homelessness
each year. The US Department of Housing and Urban Development
regularly releases a report to Congress on the demographics of the
homeless population and an update on the Federal Strategic Plan to
Prevent and End Homelessness. The statistics from the last report in
2018 provides insights into some of the challenges that contribute to the
overall health status of the population.
Targeting Underserved Populations
Public health workers have reported that rates of acute and chronic
illness are high among the homeless, as well as mental health issues
being present in a significant percentage of the population (Baggatt,
2010). Homeless people have inadequate access to healthcare and
difficulty with paying for care, medications, dental work, and vision
services. Thus, the emergency room is often the primary point of care for
the homeless: inadequate nutrition, poor sanitation, and exposure to
adverse weather conditions further compound health issues. Over 14%
of homeless have been in institutional settings (prison or jail) before
becoming homeless.
Local shelters often serve homeless adults and families. Reasons for
families seeking shelter include the high cost of housing during times of
unemployment, under-employment, and domestic violence. Often,
children who are homeless experience social, physical, and educational
challenges. Often unaccompanied youth come from unhealthy homes
and are recruited into sex worker networks. The rate of substance abuse
and the risk of sexually transmitted disease and HIV are significant in this
School health nurses should pay particular attention to the health and
immunization status of homeless children, and educators need to be
aware of the higher risk for developmental and learning delays. Working
with homeless youth can be particularly challenging due to issues of
mistrust and fear of being sent into the social service system. Having
been in foster care is a risk factor for homelessness.
Federal policy has focused mainly on working with communities to
change local systems to prevent and deal with homelessness. Governors
of almost all of the states and territories have taken steps to form
interagency councils and task forces to deal with the problem of
homelessness. The continuum of care is a model for providing
communication and coordination among housing and social/health
services to meet the needs of the homeless (US Dept. of HUD, 2018).
These models are designed to have community groups develop a plan to
end homelessness and to do so in a way that accommodates local
needs. Public health nurses often work as case managers for the
homeless, particularly families where children and adults have
individualized needs.
Addressing the Needs of an Underserved Population
One of the success stories comes from veterans services who hire public
health nurses and social workers to work with homeless veterans as
case managers. These case managers seek out homeless veterans in
the camps and shelters where they live and encourage them to access
VA medical and mental health support services. At the same time, they
work with housing officials to arrange for transitional housing, often in
smaller group settings where social workers can provide continuing
psychological support. Veterans are paired with vocational rehabilitation
programs that help with the transition to the civilian workforce. The rate
of homeless veterans has dropped by 45% since 2009, primarily due to
this comprehensive case management approach.
Health and human service professionals who work with this population
and the various sub-populations often report burnout and turnover can be
high. If you are interested in working with this population, seek out local
community groups who work with the homeless and see about
volunteering or employment opportunities.
Institute of Medicine (US) Committee on Health Care for Homeless
People. (1988, January 01). Health Problems of Homeless People.
Retrieved from
US Department of Housing and Urban Development, Office of
Community Planning and Development. (2018). The Annual Homeless
Assessment Report to Congress. Washington, DC. Retrieved from:
Public Health Program’s Policies
Some broad federal policies have significant implications for state public
health officials and state legislatures if new laws or additional financial
resources are required. These changes, such as those to Medicare and
Medicaid programs that cross all states must then be considered at the
local level. Additional rules and regulations, changes in funding formulas,
and restrictions on services are felt at all levels.
Health Policy
Both federal and state governments set policy and enact laws to protect
the health of the public. There have been numerous discussions about
state’s rights versus the rights of the federal government, guided by the
US Constitution. State’s rights advocates often argue that, given the
diversity of the 50 states and territories, one universal federal policy
cannot be implemented fairly.
One example of a federal policy that has met with various levels of state
acceptance is the Affordable Care Act’s (ACA) expansion of Medicaid,
the joint federal-state program to provide healthcare to those in poverty.
Each state has traditionally set the rules and the framework for the
delivery of Medicaid services to their citizens. The ACA offered to provide
90% of the funding for Medicaid expansion to state that matched the
dollars by 10%. The federal match decreases over time. The purpose of
the Medicaid expansion was to encourage more states to provide health
coverage to the uninsured population.
Impact on State Programs
Before the ACA Medicaid expansion, nearly 44 million non-elderly people
were uninsured. The decision within state legislatures to expand
Medicaid has ranged from full expansion to hybrid programs to no
expansion at all. Many of the arguments against expansion were
economically based on the projected costs to state budgets. One of the
decisions that state lawmakers are entrusted with is the collection and
allocation of financial resources to support the mission of government. As
a result of Medicaid expansion, the rates of the uninsured have
decreased in some areas of the country, with estimates and research
that only now are measuring population health outcomes. Having health
insurance does not necessarily guarantee a healthier population, as
health behaviors influence lifestyle decisions that affect health status and
risk for diseases such as diabetes and heart disease.
You are encouraged to explore your state’s policies further. Credible
resources include the Kaiser Family Foundation, Families USA, and the
National Conference of State Legislators. The statistics on the uninsured
in your state are indicative of the number of individuals that still require
health resources at the local level and often utilize high-cost emergency
rooms since they have no access to primary care services.
The impact on local communities may decrease the numbers of
uninsured, but issues regarding access and acceptability remain. Access
requires convenient hours of service, available and affordable
transportation, and providers willing to accept Medicaid as payment.
Access is particularly challenging in rural and inner city areas that are
already medically underserved. Services must also be acceptable to
clients, which means that families from various cultures, languages, and
socioeconomic status must feel welcome.
Public health nurses are an important part of providing care to these
individuals, many of whom have delayed seeking regular primary care
and pose numerous mental and social challenges. While Medicaid
programs may cover primary care, not all program provide dental or
vision services, which can affect the health status of certain populations.
Public health nurses can be their voice to advocate for these services at
the local, state, and national level.
Families USA: The Voice for Health Care Consumers. (n.d.). Retrieved
Foutz, J. Squires, E., Garfield, R., & Kaiser Family Foundation. (2017).
The Uninsured: A Primer. San Francisco: Kaiser Family Foundation.
Retrieved from
National Conference of State Legislators. (n.d.). Retrieved from
The Henry J. Kaiser Family Foundation. (n.d.). Retrieved from

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