essay on community health and environment

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What Is Community Health and Why Is It Important?

By Ashley Brooks on 03/04/2019

The community you live in is part of who you are. Even if you don’t see your neighbors every day, you recognize that the decisions you make impact those around you. You’re all in it together, and you wouldn’t have it any other way!

Improving your community and helping others is often at the top of your mind. So when the phrase “community health” crossed your radar, you had to know more. What is community health? And how does it affect the lives of those in your area?

Community health is the intersection of healthcare, economics and social interaction. Unfortunately, many people are unaware of the role this type of healthcare plays in their everyday lives. Join us as we explore the impact of community health on your neighborhood—and what you can do to improve it.

What is community health?

Community health is a medical specialty that focuses on the physical and mental well-being of the people in a specific geographic region. This important subsection of public health includes initiatives to help community members maintain and improve their health, prevent the spread of infectious diseases and prepare for natural disasters.

“Working at the community level promotes healthy living, helps prevent chronic diseases and brings the greatest health benefits to the greatest number of people in need,” reports the Centers for Disease Control and Prevention (CDC) . 1

Strong community health requires residents to look beyond themselves and take “collective responsibility,” says Caleb Backe, health and wellness expert at Maple Holistics . “It’s not just about the healthcare system, but focuses on the importance of leading a generally healthy lifestyle in order to protect the community as a whole.”

Community health is inextricably tied to individual wellness. “Good community health equates to healthy people, as a community is the ecosystem or environment in which people live,” says Thomas G. Bognanno, president and CEO of Community Health Charities . “It’s difficult to be healthy personally if your community is unhealthy.”

The far-reaching impact of community health

Community health flips the script on the old adage, “You take care of you; I’ll take care of me.” Instead, public health experts agree that the health of a community can have far-reaching—and sometimes surprising—impacts on individual health and beyond.

“Community health impacts everything—educational achievement, safety and crime, people’s ability to work and be financially healthy, life expectancy, happiness and more,” Bognanno says. “Health impacts every other facet of life, from a child’s ability to learn to an adult’s ability to work, so health is critical for education and financial well-being.”

The effect of health on quality of life can also impact the desire to participate in civic duties like voting, social functions and leisure activities, according to Healthy People 2020 , an initiative of the Office of Disease Prevention and Health Promotion. 2

Communities that are attentive to public health can even reduce inequality among their residents. “[Community health] also helps to reduce health gaps caused by differences in race and ethnicity, location, social status, income and other factors that can affect health,” reports the CDC . 1

The consequences of neglecting community health

A lack of focus on community health can lead to a range of complex problems that aren’t easy to correct. For example, crime and safety issues that result from neglected community health can quickly becoming a self-perpetuating cycle. “Repeated exposure to crime and violence may be linked to an increase in negative health outcomes. Children exposed to violence may show increased signs of aggression starting in upper-elementary school,” reports Healthy People 2020 . 2

Chronic diseases, such as diabetes and heart disease, can also increase if a community’s overall well-being is suffering. “An unhealthy community tends to be obese and struggle more from chronic diseases and other health challenges,” Bognanno says.

Chronic diseases like these not only reduce life expectancy, they have a dramatic effect on the economy. The CDC reports that 90 percent of the nation’s annual healthcare expenses are for people with chronic health conditions. 3

Curbing the spread of infectious disease is also a priority of community health programs. Without them, communities may find themselves battling outbreaks of illnesses that put vulnerable populations like the elderly at higher risk.

“If a community has to recover from an emergency event, such as a natural disaster, reducing the spread of disease becomes a crucial part of the recovery process,” Backe says.

Factors that improve community health

Improving community health is a huge undertaking that involves cooperation between public health workers, local government, volunteers and average citizens alike—and the end products of their work can take a lot of forms. “Communities benefit from walking trails and bike paths, from access to healthy food and playgrounds, from accessible healthcare services, schools and places of employment, as well as affordable housing,” Bognanno says.

Education also plays a large role in maintaining community health. Health fairs and advertising campaigns that expose the dangers of risk factors like tobacco exposure, poor nutrition and physical inactivity can raise awareness about the importance of choosing a healthy lifestyle. The CDC has also focused on promoting nutrition guidelines in schools and increasing the amount of physical education children receive. 4

Individuals can step up to the plate for their community’s health by volunteering at health fairs or blood drives, petitioning local officials to develop more green space and walking trails and maintaining their own health. “The collective responsibilities that individuals have for their communal health can lead to positive interactions within the community as a whole,” Backe says.

Take a stand for community health

What is community health? Now you know that it’s a vital component of public health—and it’s something every individual can play a part in improving. To learn more about how public health workers are improving the health of people across the nation, take a look at these articles, “ 6 Invaluable Ways Community Health Workers Improve Our Lives .” and " What Can You Do With a Health & Wellness Degree?"

6 Examples of Positive Workplace Health Practices
11 Healthy Heart Tips to Help Keep the Doctor Away
What's the Big Deal About Digital Health? Understanding This Revolution in Healthcare

1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Chronic Disease: A Significant Public Health Threat, [information accessed January 29, 2019] https://www.cdc.gov/nccdphp/dch/about/index.htm 2 Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Health-Related Quality of Life and Well-Being, [information accessed January 29, 2019] https://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-Life-and-Well-Being 3 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Health and Economic Costs of Chronic Diseases, [information accessed January 29, 2019] https://www.cdc.gov/chronicdisease/about/costs/index.htm 4 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Partnerships to Improve Community Health, [information accessed January 29, 2019] https://www.cdc.gov/nccdphp/dch/programs/partnershipstoimprovecommunityhealth/index.html

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About the author

Ashley Brooks

Ashley is a freelance writer for Collegis education who writes student-focused articles on behalf of Rasmussen University. She believes in the power of words and knowledge and enjoys using both to encourage others on their learning journeys

Posted in Health and Wellness

What is Environmental Health and What Critical Issues Impact Our Health?

What is environmental health, areas of environmental health, global environmental health, how you can help protect and improve environmental health.

Water quality, safe housing, healthy food access, and pollution -free transportation all contribute to human health, along with many other factors. Where people live and how they're connecting to the world can affect their health. The environmental health field—with its professionals, policies, and programs—is focused on these factors.

Your health is determined by personal choices (like whether you exercise or get vaccinated ) but also factors like local industry, the age of your home, food deserts , green space in your community, and more. Environmental stressors and advantages help to shape your options.

This article explains what environmental health is and how it can affect you and your community. It describes the work done by professionals and what you can do, too, to improve environmental health.

Environmental health is the public health field that monitors and addresses physical, chemical, and biological factors that impact your health though they're not always within your direct control.

Simply put, environmental health is the area of public health that deals with all the different ways the world can impact physical and mental well-being. Examples of impacts include:

Lead toxicity (poisoning) from the paint or water pipes in older homes and neighborhoods
Obesity and type 2 diabetes risk in food deserts and food swamps (communities with limited access to grocery stores and healthy food options, but often home to fast food stops)
Cancer and the impacts of air pollution, heat, ultraviolet radiation, and other carcinogens and climate factors
Stress, sleep disruptions , hearing loss , and other impacts due to traffic and other environmental noise
Depression, cognition, and other brain health factors can be affected by green space

If you live in an urban heat island with few trees, it may be hotter than other neighborhoods— affecting a range of issues, from heat-related illness to asthma and heart disease. It's harder to get outside and exercise, too. When your home was built and the materials used, what insects live nearby, and what food you can access affect your health and the health of your family.

Environmental health is one of the largest fields within public health because of the myriad ways external forces can impact how people eat, live, and grow. These forces can be about addressing the natural environment (as in the case for clean water or sanitation), but they can also be the consequence of human beings' actions—including societal norms.

There are a number of initiatives focused on environmental health in the United States. Among them is the Healthy People 2030 agenda, which highlights six key areas that encompass the various ways environmental health is crucial to the health of communities.

Air Quality

Air is non-negotiable for humans. It's needed to survive and air quality can have a significant impact on health.

Poor air quality has been linked to a wide range of health issues, including SIDS, lung cancer , and chronic obstructive pulmonary disease ( COPD ). Air pollution is also linked to low birth weight.

One2019 study found that people exposed to high levels of air pollutants in the early and late states of pregnancy were more likely to have babies with lower birth weights, or with preterm births, than their non-exposed peers.

The Clean Air Act

The Clean Air Act of 1970 marked the first time the federal government took responsibility for protecting the air quality for all U.S. citizens by regulating harmful emissions from things like cars and factories. The act was later expanded in 1990 to address acid rain and ozone depletion.

Water and Sanitation

According to the Centers for Disease Control and Prevention, an estimated 780 million people worldwide don’t have access to safe drinking water, and a jaw-dropping 1.7 billion (or roughly a fifth of Earth’s population) lack adequate sanitation services like clean bathrooms.

The simple act of filtering and chlorinating water systems in the United States has resulted in significant declines in once-common diseases like typhoid . Historically, clean water is responsible for the bulk of the decline in childhood mortality in the country.

The environmental health impact of safe water can't be overstated. An estimated 2,200 children die every day worldwide of diarrheal diseases linked to improper water and sanitation. The United Nations estimates a return of $4.30 in medical and social costs for every dollar spent on clean water.

Toxic Substances and Hazardous Wastes

Toxicology—that is, the area of science devoted to understanding how chemicals and substances can affect people and their surroundings—is an important field in environmental health. Many of the materials needed to advance industries and technology, like heavy metals or even some plastics, can also hurt the human body and even lead to serious medical conditions.

The Flint, Michigan, water crisis is an example of lead poisoning effects in a community that can lead to long-term health complications, including brain damage in children. Economically disadvantaged kids are often most affected.

The Flint crisis, which exposed more than 100,000 people to unsafe lead levels in drinking water, was a prime example of how environmental health issues often hurt those whose health status is already most at risk.

Homes and Communities

Home and neighborhoods are at the core of environmental health. When a neighborhood has a lot of violence, for example, families or older people might not go outside to exercise. When roads aren't properly maintained, it can result in more car crashes. When sidewalks are in poor condition, people may avoid walking for fear of accidents.

An emerging field of environmental health is that of food access. In neighborhoods without full-service grocery stores, people rely on convenience stores, gas stations, and fast food restaurants. This limits fresh produce options—a vital part of a healthy diet. These food deserts contribute to health disparities for low-income and minority populations especially.

Environmental health professionals are urging communities to establish public gardens where residents can grow and harvest their own fresh produce, improve access to public transportation to full-service grocery stores and farmers markets, and change zoning laws to incentivize retailers to offer healthier food options.

Infrastructure and Surveillance

A primary piece of any public health strategy is information to identify risks and guide the resources and responses to prevent them. This includes investigating and responding to diseases—a field called epidemiology —as well as screening for hazards and establishing surveillance programs.

Surveillance activities involve either going out and looking for particular health concerns (active surveillance) or by asking professionals in other fields, such as medicine or agriculture, to alert environmental health agencies when they encounter them (passive surveillance).

An example of this in action is mosquito surveillance and abatement activities. These programs test mosquitoes for certain things, including the presence of dangerous infections like Zika virus , as well as monitor populations to ensure control measures are working. This information can help health officials know what to watch for in doctors' offices, direct local governments on where and how best to spray for mosquitoes, and alert the public if a mosquito-borne illness is spreading in the area.

In the coming decades, environmental health professionals are bracing for a warmer, wetter climate that will likely prompt or exacerbate threats to public health across the globe.

Disease-carrying mosquitoes can live in areas previously too cold for them to survive, upping the number of people impacted by vector-borne illnesses like dengue and malaria . As sea levels rise, whole coastal cities and island nations face flood risks and disease due to displacement.

Even though health outcomes have improved significantly over the past century—in wealthy nations like the United States in particular—environmental hazards and infectious diseases know no geopolitical boundaries. People today are traveling farther and more often than ever before, and conflicts in areas like Syria, Afghanistan, and South Sudan cause millions to flee their homes.

These increases in cross-border and cross-continental movements have the potential to threaten disease prevention efforts and overextend existing infrastructure. That's why it's crucial that countries look beyond their borders to improve the health of the global population overall.

Environmental health is supported by trained experts who assess nutrition and community health, test water for heavy metals, and do research on how rising heat might change where insects are likely to spread disease. They develop laws, policies, and programs at all levels of government.

And while environmental health doesn't focus on individual impacts and footprints, there's much you can do to help. Consider protecting environmental health and safety by:

Improving air quality. You can ride your bike, take mass transportation, or work from home instead of driving a car to and from work.
Testing for toxins. You can test for radon gas, lead paint, or heavy metal exposure in pipes to prevent toxicity. Don't forget your cooking stove, which can be a source of indoor air pollution.
Cooling your home. You can plant trees, install roofs designed for cooling, and make lifestyle choices (like closing off rooms or running certain appliances after dark) to limit heat impacts.
Promoting healthy food choices. Plant gardens, shop at local farmer's markets, join a food co-op, and consider eating less meat when opting for a diet that's friendlier to environmental health.

Keep in mind that visibility helps to drive environmental health policy. Talk with your government and local businesses about investing in environmental health to ensure every neighbor has the chance to live, work, and play in a healthy and safe community.

Environmental health professionals focus on factors like industrial air pollution, water quality, healthy food access, and safe housing that impact public health. In many cases, these factors (unlike the personal risk of genetics, for example) are preventable or can be changed to improve public health and overall health equity .

Most communities in the United States are served by environmental health agencies, whether at the local and state level or through federal authorities. You can help to improve environmental health by working closely with these professionals, local businesses, and other stakeholders.

But there's much you can do personally to make lifestyle changes, like limiting plastic waste and reducing energy use, that can limit environmental health risk both for you and the planet.

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Centers for Disease Control and Prevention. Sources of lead exposure .

Bevel MS, Tsai MH, Parham A, Andrzejak SE, Jones S, Moore JX. Association of Food Deserts and Food Swamps With Obesity-Related Cancer Mortality in the US . JAMA Oncol . 2023 Jul 1;9(7):909-916. doi:10.1001/jamaoncol.2023.0634.

Hiatt RA, Beyeler N. Cancer and climate change . Lancet Oncol . 2020 Nov;21(11):e519-e527. doi: 10.1016/S1470-2045(20)30448-4.

American Academy of Pediatrics. New AAP policy, technical report offer advice on reducing harms from excessive noise exposures .

Jimenez MP, Elliott EG, DeVille NV, Laden F, Hart JE, Weuve J, et al . Residential green space and cognitive function in a large cohort of middle-aged women . JAMA Netw Open. 2022;5(4):e229306. doi:10.1001/jamanetworkopen.2022.9306

Sampath V, Shalakhti O, Veidis E, Efobi JAI, Shamji MH, Agache I, et al . Acute and chronic impacts of heat stress on planetary health . Allergy . 2023 Aug;78(8):2109-2120. doi:10.1111/all.15702.

Department of Health and Social Services. Healthy People 2030 .

Lee JT. Review of epidemiological studies on air pollution and health effects in children . Clin Exp Pediatr. 2021 Jan;64(1):3-11. doi:10.3345/cep.2019.00843

Liu Y, Xu J, Chen D, Sun P, Ma X. The association between air pollution and preterm birth and low birth weight in Guangdong, China . BMC Public Health . 2019;19(1):3. doi:10.1186/s12889-018-6307-7

Environmental Protection Agency. Progress Cleaning the Air and Improving People's Health .

Centers for Disease Control and Prevention. Assessing access to water and sanitation .

Centers for Disease Control and Prevention. The water people drink .

Alsan M, Goldin C. Watersheds in child mortality: the role of effective water and sewerage infrastructure, 1880–1920 . Journal of Political Economy . 2019;127(2):586-638. doi:10.1086/700766

Center for Disease Philanthropy. Water, sanitation and hygiene .

United Nations. Every dollar invested in water, sanitation brings four-fold return in costs .

World Health Organization. Lead poisoning .

Brown J, Acey CS, Anthonj C, Barrington DJ, Beal CD, Capone D, et al . The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries. Lancet Glob Health . 2023 Apr;11(4):e606-e614. doi: 10.1016/S2214-109X(23)00006-2.

Economic Research Service, U.S. Department of Agriculture. Access to affordable, nutritious food Is limited in “Food Deserts” .

Centers for Disease Control and Prevention. Zika virus .

World Mosquito Program. Explainer: How climate change is amplifying mosquito-borne diseases .

U.S. National Library of Medicine. The impact of globalization on infectious disease emergence and control: Exploring the consequences and opportunities: Workshop summary .

Environmental Protection Agency. Radon .

Kiefner-Burmeister A, Heilman CC. A Century of Influences on Parental Feeding in America . Curr Nutr Rep . 2023 Dec;12(4):594-602. doi: 10.1007/s13668-023-00499-4.

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By Robyn Correll, MPH Correll holds a master of public health degree and has over a decade of experience working in the prevention of infectious diseases.

Open access
Published: 24 September 2021

A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities

Suwei Wang 1 , 2 ,
Molly B. Richardson 3 ,
Mary B. Evans 4 ,
Ethel Johnson 5 ,
Sheryl Threadgill-Matthews 5 ,
Sheila Tyson 6 ,
Katherine L. White 4 &
Julia M. Gohlke 2

BMC Public Health volume 21 , Article number: 1738 ( 2021 ) Cite this article

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Metrics details

Focus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019.

Six focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019.

Consistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019.

Conclusions

Applying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

Peer Review reports

Introduction

A healthy environment is essential for improving the quality of life and the extent of healthy living. Worldwide, preventable environmental factors are responsible for 23% of all deaths and 26% of deaths among children less than 5 years old [ 1 ]. Environmental factors are diverse with far-reaching impacts on health [ 2 ]. Community engaged research in environmental health includes a variety of non-academic stakeholders, such as residents in affected neighborhoods, neighborhood leaders, non-governmental agencies, and government agency representation. It is designed to improve our understanding of environmental factors affecting health that may be the most promising to address based on local priorities and circumstances.

Focus groups are one of the methods for facilitating community-engaged research. It is an invaluable tool for researchers investigating community’s perceptions of environmental hazards, because they provide a setting for gathering resident’s knowledge and establishes common ground among participants and between participants and researchers [ 3 ]. Local focus groups can engage residents and identify ways to work towards solving a problem collaboratively [ 4 ]. Because of the small size and informal nature of focus groups, participants can build on and debate each other’s responses, which helps to better understand an issue and the influences surrounding it [ 5 ]. This understanding and information are obtained in a relatively short amount of time, so focus groups are an efficient way for researchers to attain information [ 6 ]. Furthermore, focus groups can enlighten researchers to perceived environmental hazards not previously considered [ 3 ]. All of these attributes are essential for developing a feasible, acceptable, and supported intervention to address health outcomes associated with environmental factors [ 7 ].

In 2010 we initiated a community-academic partnership, ENACT, between Friends of West End (FoWE) in Birmingham, Alabama (AL), and West Central Alabama Community Health Improvement League (WCACHIL) in Wilcox County, AL and Virginia Tech, University of Alabama at Birmingham, and Johns Hopkins University [ 8 ]. Through ENACT we work on environmental health issues in Alabama with successful completion of several environmental epidemiology studies, focus groups, workshops, and phone surveys [ 9 , 10 , 11 , 12 , 13 , 14 ]. In our initial focus groups in 2012, we found that abandoned houses was the highest environmental health priority in Birmingham, Alabama while inadequate sewer and water services was the top priority in Wilcox County, Alabama [ 9 ]. A follow-up larger scale and randomly sampled phone survey reaffirmed these priorities in each community and furthered our understanding of how resident priorities are similar or different from local health agency priorities [ 11 ]. Additionally, follow-up community-engaged research allows the dissemination of updated results and collection of new information to verify previous results and further refine the most appropriate path to mitigate health outcomes associated with environmental health priorities.

Water and sewage service issues and abandoned houses and lots are significant environmental health problems in rural and urban areas in the United States, respectively. Unsewered homes are common in rural areas of the United States, leading to increased risk of a variety of infectious diseases [ 15 ]. For example, soil transmitted helminth infections were identified in household members without adequate sewage in rural Alabama [ 16 ]. Drinking water service characteristics have also been associated with reported gastrointestinal illness in rural Alabama [ 17 ]. Garvin et al. (2013) found abandoned properties affect community well-being via overshadowing positive aspects of community, producing fractures between neighbors, attracting crime, and making residents fearful [ 18 ]. Other research found the problem is perceived as particularly widespread in the U.S. South, where our study areas are located [ 19 ]. Abandoned houses and lots can contribute to numerous health and safety hazards including falling debris, vermin, mold, standing water, toxic chemicals, and sharp rusty objects [ 20 ], and can have negative impacts on housing/neighborhood vitality, violence and crime prevention efforts, fire and vandalism risk, commercial district vitality, and assessed property values, etc. [ 19 , 21 , 22 , 23 , 24 ].

In the present study, we build from our previous findings to 1) better understand why those problems persist, 2) what residents feel the solution is, and who is responsible for enacting the solution 3) identify ways to support residents in identifying a process to address environmental concerns and 4) examine whether environmental health priorities change over time. Applying this community-engaged approach in both an urban and a rural location allowed us to better understand the unique opportunities and challenges in both locations.

Characteristics of focus group study populations

Birmingham, AL is the largest city in Alabama with a population of 209,403, of which 70.5% of the population identifies as Black or African American [ 25 ]. Birmingham has a poverty rate of 27.2%, and those identifying as Black or African American comprise 76.9% of those living in poverty [ 25 ]. Wilcox County, AL, a rural setting, has a lower population of 10,300, of which 71.3% identify as Black or African American [ 25 ]. A total of 33.4% of the population in Wilcox County live in poverty and of that 88.2% identify as Black or African American [ 25 ].

Focus group procedure

This study involved Virginia Tech and University of Alabama at Birmingham researchers collaborating with Friends of West End (FoWE) in Birmingham, AL, and West Central Alabama Community Health Improvement League (WCACHIL) in Wilcox County, AL as part of an ongoing community-academic partnership, ENACT [ 8 ]. The protocol was approved by the Virginia Tech Institutional Review Board (15–761). The community partners recruited participants aged at least 18 without regard to sex, ethnicity or ancestry. WCACHIL recruited 51 participants in Wilcox County and FoWE recruited 60 participants in Birmingham using a convenience and snowball sampling approach. The number of focus groups ( N = 12, 6 in Birmingham city, AL and 6 in Wilcox County, AL) was based on the need to expand our line of questions from our previous focus groups investigating environmental health priorities in 2012 ( N = 8 in total, 4 in Birmingham, AL and 4 in Wilcox County, AL) [ 9 ]. This new direction led us to include two more focus groups in each location, and this number of focus groups is consistent with previous studies exploring data saturation across a wide range of topics [ 26 , 27 , 28 , 29 ].

Community and academic partners together drafted and agreed upon a guide of questions to ensure appropriateness and consistency between groups. The guide followed a natural progression of identifying positive attributes of participants’ neighborhoods, determining whether previously identified environmental health priorities (abandoned houses and overgrown lots in Birmingham and drinking water access and quality in Wilcox County) [ 9 ] were still priority issues, why the problems persisted, who was responsible for solving them, and what participants felt were the solutions to address those priority issues.

We took a positivist approach in focus group data collection and analysis. The facilitator guide (Additional file 1 ) emphasized encouraging all participants to contribute, embracing new ideas, and enforcing respect for all participants’ comments [ 30 ]. Members of the community-academic partnership served as facilitators in each group. Facilitators were encouraged to utilize strong listening and questioning skills, prodding participants with prompts to encourage them to speak up or clarify statements. All facilitators had training in the value of focus groups and the best practices for facilitating focus groups that are partly based on works by Franz et al., Drake et al. [ 31 , 32 ] . Facilitators aimed to document subjects opinions and attitudes in an objective way, assuming a detached, independent role in the discussion, but ensuring focus groups followed the structured guide [ 33 ]. Facilitators were provided guidance and practice on how to draw out concerns while not bringing bias by sharing their own views [ 34 , 35 , 36 , 37 ], drawing adequate participation from each participant, and minimizing the influence of dominant speaker(s) views. In training and planning for focus groups, we placed emphasis on the importance of the role of the facilitator, having groups be of reasonable size (8–10 individuals), and individuals not being too familiar with other group members [ 33 ].

Twelve focus groups were conducted in September 2016, six in Birmingham and six in Wilcox County. Focus groups were organized to be at a time when participants would be available and within familiar neighborhood gathering places to increase comfort in active participation. Approximately 10 participants sat at each table with facilitators. Facilitators went through formal Institutional Review Board consent, then initiated recording of the focus group with digital recorders. Focus groups lasted approximately one-hour and participants completed a written survey. Facilitators’ field notes were considered during the coding process, described below.

Focus group data analysis

Researchers do not editorialize participants’ opinions and remained non-judgmental and respectful [ 37 ]. Recordings were transcribed by the second author. In the first stage, transcriptions were coded into categories based on questions posed (determined a priori) from the script independently by second author and third author (Additional file 2 ). The second author then went through all coded transcripts combining responses identified to be most inclusive [ 38 ]. In the event that a statement responded to multiple questions (i.e., responsible parties and solutions), they were coded to each question response. In the next stage, the second author and third/seventh author independently further subcategorized the inclusive coded transcripts per the subcategorization coding tree (Additional file 2 ). Summaries were then consolidated and presented by focus group and by location with verbatim. Recordings from all focus groups were analyzed and coded to ensure all themes discussed are presented in the results. Interrater reliability was assessed for topics: reasons for persistence, responsible parties, sources of trusted information, and other priorities brought up. Interrater reliability rate (IRR) was high in both Wilcox County transcripts and Birmingham transcripts (IRR = 90.6% in Wilcox County, 91.9% in Birmingham). An IRR of 90.6% reflects that 512 out of 563 responses were categorized the same between the two coders.

Follow-up workshops

Preliminary results from the focus groups were compiled and used to develop a survey instrument to further explore environmental health priorities and solutions and implemented at workshops in May 2018. Fifty-three participants from the same urban and rural locations (23 in Birmingham and 30 in Wilcox County) attended the workshops and completed the survey. A total of 92 participants from the same urban and rural locations (49 in Birmingham and 43 in Wilcox County) attended another two follow-up workshops in September 2019. A collaborative presentation by researchers and community partners on spatially explicit risk maps developed from our retrospective analysis of adverse health outcomes associated with heatwaves in Alabama was given. Participants filled out a written survey ranking the most concerning environmental health issues. Demographic information was also collected in the survey instruments administered in 2018 and 2019. The agendas for the workshops are shown in Additional file 1 . All survey instruments are accessible at our research outreach website [ 39 , 40 ].

Answers to the surveys were summarized and compared between Birmingham and Wilcox County participants in 2018 and 2019, respectively. The responses to open-ended questions were first coded into categories by the first author, then independently coded by the eighth author using the categories established by the first author. Any differences were discussed to resolve final categorization. The rankings of six environmental health issues were converted to Likert scale, with average ranks computed for ties. For a specific environmental health issue, the Mann-Whitney test was used to determine whether the medians of the ranks were different in Birmingham vs. Wilcox County.

Study population

Most participants in the 2016 focus groups (92%) and 2018 (98%) and 2019 (86%) workshops self-identified as Black or African American (Table 1 ). In 2016 focus groups, urban and rural participants had similar gender ratio (67, 80% female, respectively), education level (48, 53% with higher than high school diploma, respectively), annual household income (68, 55% at <$ 20,000, respectively), and general health (92, 90% responding in good health condition, respectively) while urban participants were older compared to rural participants (mean age 60 in urban vs. 52 in rural, p -value 7.9E-03). In 2018 workshops, the only urban-rural difference among participants was that a higher percent of rural participants participated in the 2016 focus groups (63% in rural vs. 26% in urban, p -value 0.02). In 2019 workshops, urban participants were younger (mean age 50 in urban vs. 58 in rural, p -value 0.02), had a lower percent in annual household income ≥$20,000 (42% in urban vs. 76% in rural, p- value 1.6E-04), a lower percent in participation of 2017 monitor study (16% in urban vs. 60% in rural, p -value 3.4E-05) and a lower percent in participation of 2016 focus groups (18% in urban vs. 62% in rural, p -value 8.8E-05) (Table 1 ).

Environmental health priorities and responsible parties identified in 2016 focus groups

A total of 83% participants in Birmingham and 12% participants in Wilcox County believed urban areas had worse environmental problems than rural areas ( p- value 6.3E-13). Most participants (88% participants in Birmingham and 84% participants in Wilcox County, p-value 0.56) believed their communities did not receive its fair share of state and local resources devoted to environmental health problems.

Table 2 reports the environmental priority findings in the six focus groups in Birmingham. All six groups agreed that the main priority was abandoned and unmaintained houses: “ All you have to do is ride through to see. It is a disgrace. Just driving through it’s so grown up (overgrown) that you can’t even see the house. ” Groups mentioned many health concerns they believed were exacerbated by abandoned housing and overgrown lots including general health (2 groups), carbon monoxide, cough, mold, and infectious diseases (1 group). For the reason(s) this issue persists, five groups brought up that authorities were unresponsive or they did not follow through, four groups discussed government maintenance was limited and slow, and four groups believed money was an issue. “ We’ve been going on 15 years trying to get something going with our councilor. You couldn’t get nothing. ” Five groups identified Birmingham City Council as the top responsible party. Solutions were proposed by participants. More individuals attending city county meetings (4 groups), contacting government agencies and reporting issues (4 groups), and asking for government patrol of abandoned houses and additional maintenance of properties (3 groups) were top suggested short-term solutions. For long-term solutions, ideas included greater participation in community and neighborhood meetings (2 groups): “(You) Gotta go out there and see. And if you don’t go out there and participate then you’ll never see. ”, buy or mortgage abandoned houses/lots (2 groups), community hold authorities accountable (2 groups), and government confiscates, tears down (5 groups) and transfer the ownership of abandoned houses for better maintenance (4 groups).

Table 3 reports the results in the six focus groups in Wilcox County. In Wilcox County, the focus groups focused on the priority issue of drinking water access and quality with some discussion on sewage and septic issues. All six groups were concerned about the smell, look and taste of water. Five groups were concerned about the lack of water access and water-borne diseases. Primary health concerns that arose in discussion included cancer (5 groups), obesity (1 group), and infectious agents associated with poor sanitation (1 group). “ And it’s just awful. It’s awful because it makes your yard smell. It makes everything smell like septic. ” Four groups believed this issue has persisted because of unresponsiveness from authorities, particularly the county commissioners, and three groups suggested the lack of knowledge, information, and resources led to problem persistence. As for individual level solutions, participants suggested pressuring and reaching out to local government representatives (5 groups), attending county commission meetings and water board meetings (4 groups), and avoiding the use of county water (e.g., use bottled water) (2 groups). At the neighborhood level, participants mentioned organizing petitions and protesting would raise awareness (5 groups) and building trust, uniting, and engaging communities and organizing community meetings (3 groups). At the government level, they saw providing grants for installation and improvement of septic systems (5 groups) as well as testing water and distributing findings (3 groups), as important next steps to solve this issue.

Environmental health priorities change over time

Compared to our initial focus groups in 2012 [ 9 ] and our follow-up phone surveys in 2016 [ 11 ], and finally our focus groups in 2016 and workshops in 2018 and 2019 described herein, environmental health priorities changed over time in Birmingham, but stayed consistent in Wilcox County. In the follow-up workshops in 2018, 16 (70%) of participants in Birmingham agreed that abandoned housing was the primary environmental health priority while 21 (70%) of participants in Wilcox County agreed that drinking water and wastewater issues was the primary environmental health priority (Tables 4 - 5 ). However, in the 2019 follow-up workshops, participants from both locations ranked water quality as the No.1 environmental health priority (Fig. 1 ). Based on the median ranks, Wilcox participants ranked sewage and septic systems a higher priority compared with Birmingham participants (4.0 in Wilcox vs. 3.0 in Birmingham, Mann-Whitney test p -value 0.049) while they ranked abandoned houses/lots a lower priority (2.0 in Wilcox vs. 3.0 in Birmingham, Mann-Whitney test p- value 0.046).

Mean Likert scale for environmental health issues in 2019 workshops. 95% confidence intervals were shown. Water.qual = water quality, climate.chg = climate change, Air.pollut = air pollution, Sewage = sewage and septic, Abnd.house = abandoned houses and lots, Anim.pest.ctrl = animal and pest control

In the 2018 follow-up workshops, more than half of the participants believed state and local resources were not fairly distributed to communities to address environmental health problems (87% in Birmingham and 67% in Wilcox, p- value 0.59), and both communities suggested a lack of leadership at the local level was the top reason behind this unfair distribution. In these workshops, Birmingham participants built from the 2016 focus group results described above, stating they would like to see neighborhood leaders attend city council meetings and report back to neighborhood residents (48% participants), and communicate progress, plans and timelines on addressing abandoned housing and vacant lots in their neighborhoods (22% participants). Birmingham participants stated that more state and local government resources should be devoted to hiring more work crews to tear down abandoned houses, mow overgrown lots (61% participants), provide incentives to build new business or new homes (26% participants), and provide more police presence (22% participants). Wilcox county participants in the 2018 follow-up workshops suggested community leaders should write grant proposals for money to fix the septic issues (50% participants) and hold local meetings to inform and unite residents (33% participants). They would also like to see state and local governing officials put more resources towards water lines, wells, and wastewater treatment (50% participants), and evaluate whether the pipes are safe or need to be replaced (37% participants) (Tables 4 - 5 ).

Sources of trusted information

The most trusted sources of information were news on television (TV), city council and city council representatives, and word-of-mouth in Birmingham, all of which were mentioned by four focus groups. Radio (5 groups), news on TV (4 groups), and word-of-mouth (3 groups) were the most trusted source of information in Wilcox County. One group in Wilcox County reported trust in local government, but not the county commission or mayor. In contrast, Birmingham focus groups frequently cited the government as a trusted source of information, in particular their city council and city council representative. Of the two Birmingham focus groups that did not cite the government as a trusted source of information, one did not mention any sources of trusted information and the other only cited the news and newspaper. While the Birmingham focus groups never mentioned distrusted sources of information, one group did say there was a lack of a trusted source of information. Similar to 2016 focus group results, in the 2018 follow-up workshops, Birmingham survey participants identified TV, city council meetings and neighborhood meetings, and conversations with community leaders as the most trusted information sources, while Wilcox County participants identified TV, radio, and county commission meetings as the most trusted information sources (Tables 4 - 5 ).

The ENACT community-academic partnership has been engaging with residents in Birmingham AL and Wilcox County AL since 2010 to understand environmental health priorities through focus groups, phone surveys, written surveys and workshops [ 9 , 11 ]. Here we present results from our most recent focus groups and workshops that clarified priorities, possible solutions, responsibly parties, and sources of trusted information on priority issues. We found that the environmental health priorities of abandoned houses in Birmingham and drinking water issues in Wilcox County in the focus groups were consistent with our previous findings [ 9 ].

The results suggest that participants saw local government non-responsiveness as the top reason for issues with abandoned housing persisting (5 of 6 focus groups), while also acknowledging government actions as the most promising solutions in addressing the abandoned housing issue in Birmingham (Table 2 ). In the 2018 workshops, 39% participants in Birmingham reported they believed local government (city, mayor, city councils) were most responsible for getting rid of abandoned houses (Table 4 ), showing consistency over time. In Wilcox County, five out of six focus groups discussed a range of solutions at the individual level, community level and government levels, which suggests that participants in Wilcox County see involving all stakeholders to tackle the water and sanitation problems is most promising.

The results, together with identified persistence reasons and potential solutions at the individual, community, and government levels may serve as evidence-based tools for identifying actions in the future. Follow-up workshops not only provided the opportunity to examine whether the identified environmental health priorities change over time but also serve as the events where research results were disseminated back to residents. As environmental health is a dynamic and evolving field, the environmental issues in Birmingham and Wilcox County communities can change over time. For example, Birmingham City Council programs initiated between 2016 and 2019 [ 41 , 42 ] could have contributed to reducing residents’ concerns over abandoned housing and vacant lots in 2019. Alternatively, the number of Public Water Systems with any violation dropped from 117 in 2013, to 61 in 2018, to 110 in year 2020 in Alabama [ 43 ], suggesting water quality issues have not changed.

Knowing from what sources people get trusted information on environmental health issues can shed light on why people are concerned about particular risks. Results showed that both communities trusted news on TV and word-of-mouth, and Birmingham groups trusted city council and Wilcox groups trusted radio programs. We also found a lack of trust in government in Wilcox groups. The results are consistent with a similar study surveying rural residents in El Paso, Texas where 54 and 46% participants had high confidence in television and radio, respectively, and the participants had low confidence in the government as a source of information [ 44 ]. As suggested by Byrd et al. (1997), the way that risk is portrayed by the media and the selection of stories may impact people’s perception of environmental health priorities [ 44 ]. Knowing the trusted information source may help community leaders monitor emerging or ongoing environmental health priority topics as well as use these sources to involve more residents, spread updates of meetings and policies, and disseminate evidence-based solutions. The names of specific TV programs or radios stations where participants get trusted information can be collected in future studies.

There are some limitations in the study. Bias may have been introduced with the use of nonprobability sampling methods to recruit focus group and workshop participants; however similar participant demographics in Birmingham and Wilcox County reduced potential bias when comparing results between the two locations, as studies have shown that gender, race, and culture are primary influences on risk perception [ 45 ]. As is common in health studies [ 46 ], the results presented herein reflect higher participation rates of women in both Birmingham and Wilcox County events, therefore male perspectives, if different, are underrepresented. Focus group participants may have refrained from bringing up issues in front of other community members or respected community leaders. However, in the focus group setting, participants could add to others’ responses to clarify issues and direct discussion in a meaningful way. Participants may also feel empowered by voicing their opinions and insights with other residents. There were some technical challenges in understanding some of the audio recordings, specifically distinguishing individual speakers within the group. This technical challenge coupled with high agreement within each group led to group-wise comparisons instead of individual counts as reported in previous focus groups [ 9 ]. As noted in the methods, the coding groups were not mutually exclusive, and topics could be counted multiple times, which is common to focus group analysis methodologies [ 38 ]. There was a higher percent of returning participants in Wilcox compared to Birmingham, which may have contributed to the result that drinking water quality was consistently the number one environmental priority in Wilcox County, however we do note that a randomly sampled phone survey we conducted also identified water quality as a top priority [ 11 ] .

Focus groups conducted in 2016 reaffirmed the identified environmental health priorities in 2012 focus groups, in both urban and rural communities. The top environmental health priority remained water quality and sewage treatment in the rural community in 2018 and 2019 surveys but switched from abandoned houses to water quality in the urban community in 2019. Participants identified ways to support the community in identifying and enacting solutions to their environmental concerns, which can be useful for community leaders to make future changes to address the problems.

Availability of data and materials

The dataset generated and analyzed during the current study are not publicly available due to the identifiable audio recordings, identifiable demographic information and questionnaires from participants. De-identified and aggregated data can be obtained by request to the corresponding author, Julia Gohlke, at [email protected] .

Abbreviations

Friends of West End

West Central Alabama Community Health Improvement League

Interrater reliability rate

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Acknowledgements

The authors gratefully acknowledge the funding from a grant from the National Institute of Environmental Health Sciences (R01ES023029). They recognize the crucial role of the Center for the Study of Community Health, supported by the Centers for Disease Control and Prevention (cooperative agreement number U48/DP001915). Thanks to focus group and workshop participants and volunteers from community organization partners for their time and efforts.

This work was supported by a grant (R01ES023029) from National Institute of Environmental Health Sciences.

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Suwei Wang & Julia M. Gohlke

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Molly B. Richardson

Center for the Study of Community Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA

Mary B. Evans & Katherine L. White

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SW analyzed and interpreted data from workshops in 2018 and 2019, contributed to the data acquisition, and was one of the major contributors in writing the manuscript. MR analyzed and interpreted data from focus groups in 2016 and workshops in 2018, contributed to study design and data acquisition, and was one of the major contributors in writing the manuscript. ME, EJ, STM, ST contributed to study design and data acquisition. KW analyzed and interpreted data from focus groups in 2016. JG contributed to the conception, design of work, data acquisition and substantively revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Julia M. Gohlke .

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This study was approved by Virginia Tech Institutional Review Board (protocol #15–761). All methods were carried out in accordance with the Declaration of Helsinki. Informed consent was obtained from all the participants in the current study.

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Supplementary Information

Additional file 1..

Semi-structured discussion guide for focus groups and activities for workshops.

Additional file 2.

Transcript coding tree to identify persistence reasons, responsible parties, solutions, and source of trusted information.

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Wang, S., Richardson, M.B., Evans, M.B. et al. A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities. BMC Public Health 21 , 1738 (2021). https://doi.org/10.1186/s12889-021-11799-1

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What makes a community healthy? According to the Lincy Institute , health isn’t just determined by the lack of illness, but also by the all-around wellbeing of residents physically, mentally, and socially. Here are 10 factors that contribute to a healthy and happy community.

Education isn’t just about being smart. Studies show that children who do poorly in school have a higher risk of being physically unhealthy than adults. Quality education is also linked to the socio-economic background since poorer communities often have access to lower-quality education programs due to funding. Better and higher education leads to a higher quality of life and longevity, as well as less substance abuse .

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There is a strong connection between consistent employment and good health. Unemployed individuals usually have “higher levels of impaired mental health including depression, anxiety, and stress as well as higher levels of mental health hospital admissions, chronic disease (cardiovascular disease, hypertension, musculoskeletal disorders) and premature mortality.”

Unemployment is also linked to higher drug, alcohol, and cigarette use. This doesn’t mean that people not working are automatically compelled to drink and smoke. However, external stresses of being unemployed, as well as the extra unstructured time, influence these choices.

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Reliable and safe transportation is essential for having access to healthcare, jobs, public facilities (like parks), grocery stores, and being able to socialize. Walking, while healthy, can be dangerous, especially if you have to walk through unsafe neighborhoods or highways. Plus, walking everywhere isn’t sustainable, especially in spaced-out areas. Thus, being able to take a bus or a train is essential for a healthy community.

Exercise and Nutrition

Eating correctly, maintaining a healthy weight, and moving enough are all important for general health and chronic disease prevention in a community. The Lincy Institute states that “people are more likely to be physically active or to maintain a healthy weight if they live in a community which supports physical activity and healthy eating.” Well-maintained sidewalks, low traffic and crime, walking and cycling trails, parks, public recreational facilities, and even a lack of graffiti all help get people out and move more.

Healthcare

Healthcare and health insurance seem to go hand in hand in the United States. Individuals without health insurance or more likely to push visiting the doctor or getting a prescription because of cost. Children also bear the weight of not having access to affordable healthcare or health insurance, and won’t get the preventative healthcare they need to grow into healthy adults.

Investing in Community

Putting money back into the community improves the lives of its residents. It’s projected that a $10 investment per person per year in “ community-based health promotion programs ” would create 1.7 billion dollars in savings for the state of California in three years. Eating better, moving more, not smoking, and drinking less are the focuses of these community programs.

Well-Built Homes

Unsafe or poorly-maintained homes can negatively affect those who live in them. They can make them sick or increase the risk for household accidents. Lead poisoning is higher in houses built before 1978. Other concerns include neurotoxins like pesticides, bad ventilation, pests, damp and mold.

Sex Education

Proper sex education teaches teenagers how to be safe, including how to avoid STIs and STDs. It also gives them more knowledge about relationships and consent, not just sex itself. When they receive the correct information they need and deserve to know, they can make the right choices regarding their bodies and relationships.

Clean Water

According to the World Health Organisation , convenient access to water can “boost countries’ economic growth and can contribute greatly to poverty reduction.” Contaminated water is also incredibly dangerous, and can spread diseases like diarrhea, typhoid, polio, cholera, and dysentery. Access to water also means that households don’t have to spend hours a day walking to and from a well. Instead, they can use that time to focus on education, building a career, or spending time with family.

Protection Against Domestic Violent

Women are safer in communities that reduce the risk of sexual violence . Having a safe place to ask for help, or just living in a society that believes women and protects them from domestic violence is an important part of women living healthy, violence-free lives.

Safe, clean, healthy, and happy homes make a healthy community. Some of these factors are objectively more important than others, but together they significantly improve the lives of a community’s residents, especially the lives of the children. Hopefully, our leaders will take these into account and prioritize people rather than corporations. It’s time that money be invested into communities and their wellbeing, rather than just continuing to find last-minute bandaid solutions to pervasive issues.

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Community Health and Population, Essay Example

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Professional mission statement

Being a nurse has always been my life goal ever since I joined high school. However, back then, I did not know the type of nurse I would like to be. It was during my training program that I decided I wanted to be a public health nurse. A public health nurse practices in several settings with the primary objectives of preventing diseases, reducing the vulnerabilities of individuals to illnesses, and promoting health. Public health nurses achieve these vital objectives, primarily through the evaluation and control of social determinants. Therefore, in this statement, I will provide my professional portfolio that demonstrates my competencies in various nursing concepts.

Professional summary

The completed works in my portfolio are essential for my development as a healthcare professional and as a learner. These artifacts include tasks on professional roles and values, reports on applied leadership in nursing, assessment on leadership and organizational structures, studies on evidence-based practice in healthcare, and research about community health and nursing interventions for the general population. These studies have ensured that I am knowledgeable about the various concepts in medical care. Therefore, these works also represent my strengths as a healthcare professional.

In addition to this, the artifacts in my portfolio present me not only as a professional but also a learner. As a learner, I have researched numerous concepts in the healthcare sector to gain more knowledge and skills. For instance, I have conducted two studies regarding evidence-based care. In these studies, I explored the effects of oral opioid and nonopioid on acute pain. I have thus gained immense knowledge about this aspect.

Moreover, I am more appreciative of the role of evidence-based practice in healthcare. As a professional, it is my role to explore the various approaches to treatment that improve the quality of medical care and health intervention programs. The tasks in my portfolio, like the tasks on professional roles and values, have facilitated me to achieve this objective.

The works I have completed in the program also present my strengths as a medical care provider. These skills include communication skills, problem-solving skills, analytical strengths, research and evaluation skills, and negotiation skills. These artifacts also indicate that I am knowledgeable about the several crucial aspects of healthcare. Moreover, my works in professional roles and values have described my ethical principles in my career. For a public health nurse, these elements are vital in performing the various duties that form the three main objectives of the profession. A public health nurse must be able to communicate with multiple stakeholders and patients, offer solutions to various health and social challenges in the community, and negotiate and lobby for different policies. Moreover, a health profession must have the necessary skills to analyze multiple policies and health intervention programs. These are the core strengths that will establish me in this profession.

The problem that I have gone through during my advancement in this program is communication challenges with various patients. Some patients find it difficult to understand the different health intervention programs that may be beneficial to them. Moreover, patients come from a variety of backgrounds and cultures. These cultures influence their perception and reception of various healthcare programs. Therefore, one of the primary challenges that I have faced is knowing how to offer healthcare that meets the cultural requirements of these patients.

However, I have utilized my primary strengths and skills to overcome this challenge. As noted above, communication skills are essential in the healthcare profession, and these skills are part of my core professional strengths. I have been able to communicate with several patients and established the proper way of inquiring about the healthcare programs that they prefer and those that they find to be offensive. Communicating with patients is also essential to determine their perception and responses to several health interventions. I have established that patients from multiple backgrounds and cultures appreciate healthcare providers who are keen on their needs and respect their preferences.

A healthcare professional must fulfill several roles, such as scientist, detective, and manager of the healing environment in the professional program. As a scientist, the healthcare professional has to help in the prevention, diagnosis, and treatment of diseases in patients. I have achieved this role by practically working with several patients in multiple settings. Moreover, I have conducted several studies in my role as a scientist on the role of opioid and nonopioid analgesics in pain management.

As a detective, the primary role of a healthcare professional is to analyze and forecast the outcomes of several health intervention programs and the effect of deviations of some aspects in the provision of medical care. I have also achieved this role by evaluating my practice in realistic settings, whereby I have utilized my analytical skills to gauge the effects of specific policies and innovations in medical care provision. I also examined the consequences of my decisions in various ethical dilemmas like when I handled a patient who requested personal help which conflicted with my ethical principles.

In addition to this, I have fulfilled the role of a manager of the healing environment in my program by creating suitable conditions for patients that meet their various preferences, including the social, cultural, political, and economic aspects. Through this process, I have worked to reduce environmental and internal stressors that may affect the healing process of my patients. Furthermore, I have analyzed several elements that contribute to the treatment process, such as privacy, waiting times, and spacing in the healthcare center, and formulated ways to address them. This factor also reduced the environmental stressors for patients.

Through all these processes, I have grown both personally and professionally. As a healthcare professional, I have grown to understand the various factors that affect the treatment process to patients and the patient’s perception of these factors. This process has enabled me to offer better care to patients and improve their treatment outcomes. In addition to this, I have developed several skills that are necessary for the development of health intervention programs and policies. For instance, I now understand the benefits and necessity of using evidence-based practices in healthcare provisions. Moreover, I have evaluated the quality of my care through analyses of realistic scenarios.

Quality and safety

From my studies on professional roles and values, I have defined quality of care as the level to which the healthcare providers meet the needs of the patient by offering medical care, which improves the health outcomes of patients. Safety refers to this component of improved health outcomes. The safety aspect of healthcare programs may also refer to programs that do not endanger the life or wellbeing of individuals. Therefore, quality and safety are interrelated components that form the foundation of healthcare programs.

This program contained tasks that required me to evaluate professional roles and values in healthcare. In these tasks, I conducted several studies, such as reviewing the Novice to Expert Theory, the importance of sanitary conditions in treating patients, and the roles of nursing associations and regulatory agencies. Through these studies, I have understood the aspects of quality of treatment procedures and developed the definitions.

The works in this program that enable me to define the quality of healthcare and safety are my tasks in the roles and values of medical professionals. These studies have helped me to evaluate the different elements in healthcare programs and their effects on medical care provision. Moreover, I have also conducted several studies on evidence-based practices in healthcare, which have informed me regarding the aspects of quality and care and have assisted me in formulating a suitable definition.

The Institute of Healthcare Improvement

The Institute of Healthcare Improvement (IHI) is a globally acknowledged organization, particularly on the aspects of innovation, quality, and exemplary learning. Therefore, the IHI certificate will propel my carrier as a professional nurse. This certificate will enable me to work with numerous other professionals in the fields of research, policy formulation, and public health sectors. Furthermore, the IHI certificate will facilitate me to unlock future learning and career opportunities. I would like to advance my education in this field, and I believe the IHI certificate will aid me in securing a place in quality learning institutions. By so doing, I will also advance my career.

Evidence-based practice

Evidence-based practice refers to the development and use of healthcare programs and policies based on evidence from scientific studies. These studies must encompass the use of systematic data and information. Therefore, evidence-based practices focus on the quality of healthcare programs and the safety of patients by ensuring the health interventions that healthcare providers offer to patients have scientific backing. Evidence-based practice helps to avoid adverse effects on patients’ health by using unproven interventions. Moreover, evidence-based practices ensure that healthcare interventions are safe for all patients, including in the aspects of the social determinants that affect them.

The program has been influential in shaping my definitions of evidence-based practices. In my first evidence-based practice task, I evaluated the effect of different analgesics on acute extremity pain in the emergency department. In contrast, my second task on evidence-based research considered the aspect of the nurse to patient staffing ratios. These assessments have given me a background in the study of these practices, which has informed my definition. I have, therefore, gained significant knowledge regarding these facets of the healthcare profession. I am also more capable of formulating a definition of evidence-based practices according to my background analyses.

The evaluation of primary research is essential in the utilization of evidence-based practices and applying these concepts to my nursing practice. The most critical elements in these assessments are establishing the accuracy of data, determining the differences between research and improvement of quality aspects, and analyzing primary and secondary research and their implications.

Reflection on my understanding of evidence-based practices

To establish the relevancy and accuracy of data, one assesses whether the researchers have disclosed any bias in the study. Moreover, an assessment of the methodology of the study, including the sampling method and data collection process, determines the study’s accuracy. One can also resolve the accuracy and relevancy of the study by comparing the results between different studies.

The significant difference between quality improvement and research is that the latter applies the methodology of data collection and data analysis to draw inferences relating to various elements. However, quality improvements do not rely on methods for analysis but instead focuses on improving patient outcomes by using systematic procedures from completed research. Therefore, one can distinguish these two facets by examining the methodologies in the studies. Research is applicable in the development of new processes or interventions, while quality improvement is applicable in using analysis from research to formulate procedures and responses.

Furthermore, the difference between primary studies and secondary research is that the former involves the firsthand collection and analysis of data. In contrast, secondary research consists of studying research which other researchers have already done and concluded. Primary data is often applicable when there is no specific information from completed studies, and therefore, a researcher has to analyze data to develop the needed information. The program has enabled me to determine these aspects and differences by guiding me through the processes of using various studies for different requirements.

Applied leadership

Applied leadership in healthcare is the process by which nurses use their learned leadership skills to communicate with other individuals within their teams professionally. Nurses and healthcare providers must effectively communicate with their teams to ensure they coordinate the healthcare delivery process to the patients. In addition to this, applied leadership is also essential for professional collaboration. Applied leadership in nursing follows the core principles of assessing the vulnerabilities of patients to diseases, using evidence-based practices for continuous improvement, and improving the efficiency and coordination of healthcare delivery. I will, therefore, employ the leadership skills I have gained throughout the program to offer quality care to all my patients.

I have conducted several studies in the program regarding applied leadership, including one on organizational systems and quality leadership. Through this task, I learned several aspects relating to medical care, like the role of the National Database of Nursing Quality Indicators (NDNQI). The (NDNQI) has helped me to define the various facets of applied leadership by establishing the professional mission statement of medical professionals. The program also provides the qualities and principles that are essential in applied clinical leadership. Moreover, the task of quality leadership has also taken me through various practical scenarios where I have applied my leadership skills in my team for the patients’ benefits.

Several items that form the basis of my definition of applied leadership include the lists of readings that I have undertaken, reports of various studies in which I have participated, and transcripts of my clinical rotations. My clinical rotations form the most significant elements of my practical experiences in the nursing program. These experiences have shaped my perspective of several aspects in the profession, including the facets of leadership. Moreover, these artefacts have aided me in the development of the definition of applied leadership by providing the various cases in which leadership is applicable in the clinical setting.

Interprofessional collaboration refers to the holistic engagement of various healthcare providers and other caregivers like parents and the community with the patients. Interprofessional collaboration aids in the integration of different perspectives from all these parties to deliver high quality and safe care to the patients. Therefore, the most significant benefit of interprofessional communication is the improvement of patient outcomes. Moreover, interprofessional collaboration also improves the relationship among different fields in healthcare and other professions.

Community and population health

My portfolio also includes a report on the elements of community health nursing. This study influenced my definition of these facets of healthcare by offering me insights regarding the various elements of public health. In my interpretation, public health encompasses both community and population health. Moreover, the program also equipped me with the necessary skills for community and population health provision through my practical experiences when working with various communities and populations. I gained these experiences through my community health nursing task. The program also required me to assess multiple studies regarding the elements of public health provision.

The items in my portfolio which have guided my understanding of population and community health are my reports regarding the studies on public health, and particularly on the facets of community health and population health. These artifacts support my definition by analyzing the concepts of community health and population health. Moreover, these studies also offer insights regarding the various elements of these health intervention programs. These perspectives relate to the approaches of community health programs and their benefits and have shaped my understanding of community health.

The main lesson from my community health task is that communities comprise of persons with different health needs. These individuals also face social determinants that influence their health and health needs in different ways. Therefore, community health programs must consider these factors in the formulation of health intervention programs for the community. By so doing, the healthcare providers will be able to target the multiple health needs of the individuals in the community for better outcomes. Moreover, healthcare providers must partner with various members of the community to ensure they can effectively diagnose the different healthcare requirements of the community members.

In my initial community diagnosis, I had established that the main social determinants that influenced the community’s health are poor nutrition and unstable economic conditions. I also determined that these social determinants led to conditions such as malnutrition for some of the community members, while others suffered from similar ailments such as iron deficiency. However, after working with the community and several leaders of the population, I established that the community did not have a challenge with its economic conditions. The main factor for the community’s health needs was that they lacked the necessary information regarding the proper ways to prepare healthy diets.

Summary of American Museum of Natural History

The American Museum of Natural History (AMNH) professional course focuses on the elements of genetics, genomics, and genetics. These aspects offer promise for the future of medicine in the treatment of multiple diseases and the development of vaccines. Moreover, genetics and genomics will allow scientists to use genetic information to solve various medical issues that do not have a practical solution at the moment. Therefore, the AMNH certificate will enable me to understand these fields and work in these critical studies relating to genetics and genomics.

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v.163(5); 2000 Sep 5

Environment and health: an overview

In the 1980s biologists began to observe startling declines in frog populations around the world, even in isolated and relatively pristine environments. It appears that no single factor is responsible. Rather, the health and reproductive success of amphibians is being damaged by an increase in the intensity of ultraviolet (UV) light (because of thinning of stratospheric ozone), traces of globally distributed toxic chemicals, competition from introduced predator species and infections caused by virulent fungi and bacteria. 1 , 2 The declining health of frogs, birds and thousands of other organisms may be one of the clearest indications of environmental threats to human health. Although local environmental tragedies of climate change, species extinction and deforestation have marked every period of human history, today's environmental degradation is rapidly creating an unprecedented global crisis driven by population growth and industrialization. 3 , 4 , 5 , 6 , 7

For the first time, human beings are altering the basic operations of the Earth's atmosphere, geosphere and biosphere. In a recent essay, 4 prominent biologists noted with concern that "human alteration of Earth is substantial and growing. Between one-third and one-half of the land surface has been transformed by human action; the carbon dioxide concentration in the atmosphere has increased nearly 30% since the beginning of the Industrial Revolution; more atmospheric nitrogen is fixed by humanity than by all natural terrestrial sources combined; more than half of all accessible surface fresh water is put to use by humanity, and about one-quarter of bird species on Earth have been driven to extinction." 8 In 1992 the World Scientists' Warning to Humanity 9 was endorsed by more than 1600 scientists from 70 countries, among them 104 Nobel laureates, including most of the science prize recipients. The warning cited clear evidence of a growing environmental crisis. 9

Ten years ago Alexander Leaf wrote about the potential effects of global environmental change on human health. 10 This essay in CMAJ introduces a series of articles that continue Leaf's initial exploration. In each article, the authors will present a brief state-of-the-science review of their topic, an interpretation of the problem, and suggestions for medical and public health responses. The intent of the series is to examine the links between environmental change and human health and to suggest programs and policies that will protect both health and the environment. These essays do not address environmental hazards for which the association with disease is well understood, such as environmental lead poisoning, particulate and ozone air pollution, radon and tobacco smoke. Instead, these papers will focus on global environmental changes precipitated by human activity and their likely role in emerging health problems.

From a biomedical standpoint health is viewed as an attribute of the individual. The fields of medicine and public health acknowledge environmental causes of illness and assign risk to specific exposures. In the past decade, biologists, ecologists and physicians have developed the concept of ecosystem health. This idea recognizes that humans are participants in complex ecosystems and that their potential for health is proportional to the health of the ecosystem. 11 An ecosystem-based health perspective takes into account the health-related services that the natural environment provides (e.g., soil production, pollination and water cleansing) and acknowledges the fundamental connection between an intact environment and human health. 12

Environmental degradation exaggerates the imbalance between population and resources, increases the costs of development, and worsens the extent and severity of poverty. Population growth and the "corporatization" of agriculture and forestry have forced poor people onto land that is the least productive and ecologically the most fragile. In crowded or poor countrysides, people often abandon traditional and sustainable land use practices in favor of short-term survival strategies such as farming on steep slopes and living in areas threatened by flood or drought. The need for farmland, fuel wood and timber for export results in deforestation, which in turn increases soil erosion, flooding and mud slides and reduces agricultural productivity. In short, interactions between poverty, population growth and environmental degradation impede sustainable economic development and worsen population health. 13

The problems resulting from environmental change pose new challenges for traditional public health science. 14 The health effects of global change are often indirect and difficult to assess, and the quality of evidence for the health- related outcomes of global environmental change varies widely. 7 For example, the prevalence of malaria has increased worldwide, but no clear relation to climate change has been established. Similarly, exposure to UV light (especially UVB) increases skin cancer and cataract formation, but large studies across geographical areas with different levels of UV exposure have not been performed. Furthermore, the health science necessary to understand global environmental change is increasingly interdisciplinary and requires collaboration among meteorologists, chemists, biologists, agronomists, biologists and health scientists, over long periods. Organizing and funding such science is difficult. Finally, the science of global change frequently relies on computer models to suggest the direction of change, but politicians and policy-makers are loath to commit resources to predicted but unproven future outcomes.

It is important for scientists to anticipate the potential consequences of environmental change. 15 Serious environmental problems are often unknown or unrecognized. The stratospheric ozone hole produced by chloroflurocarbons, although anticipated, was discovered by accident. 16 At the time of the first major international conference on the environment, held in Stockholm in 1972, global warming, acid rain and tropical deforestation were not recognized as major problems. Explanations of the decline in amphibian populations, cancer outbreaks in fish and the bleaching of coral reefs are still inadequate today. Furthermore, change in natural systems may be sudden and nonlinear. For example, fish populations that have remained stable during long periods of intense harvesting may suddenly collapse.

Global environmental issues at this special moment in history are unique in their scope and consequences, and discussion of them may be emotionally and politically charged. 17 Global change may seem so remote from our daily lives that we become indifferent to the litany of environmental apocalypse. We may not perceive the actual degradation of the Earth. 18 Some of us distance may ourselves from the discussion because we find it frightening or overwhelming As a result, policy-makers and politicians are not pressed to confront the consequences of the continuing expansion of human enterprise. For example, climate change produced by the accumulation of greenhouse gases, primarily carbon dioxide, seems increasingly certain. The 1995 second report of the Intergovernmental Panel on Climate Change concluded that "man's impact on climate is discernible," and many climate scientists believe that we are already experiencing global warming effects. 19 But it is difficult for us to acknowledge that industrial carbon dioxide — invisible, odourless and nontoxic — is a pollutant. International political leadership has only recently begun to seek solutions to the global issues of climate change, toxic pollution, species loss and deforestation.

Two recent developments have drawn renewed attention to the health risks of persistent organic pollutants (also known as POPs): the identification of medical waste as a significant source of toxic pollution and the emergence of the new toxicological field of endocrine disruption. Medical waste incineration is a major source of the dioxin and mercury released into the environment. Almost all humans have measurable residues in their tissues of chlorinated hydrocarbon chemicals, including pesticides, polychlorinated biphenyls (PCBs) and dioxin. In some cases these levels approach the threshold of public health concern. 20 Pressured by advocacy organizations, the health care industry has begun efforts to better manage medical materials and waste. The second development is the emerging toxicological field of endocrine disruption. Endocrine disruptors are a class of chemicals, including many of the persistent organic pollutants, that imitate or block hormones. These chemicals produce a variety of reproductive and neurodevelopmental disturbances in wildlife, laboratory animals and humans, often at very low doses. Endocrine disruption, currently the object of renewed study by government, industry and academia, offers a new toxicological paradigm that may supplement carcinogenesis as the outcome of concern. 21 , 22

Public concern about environmental degradation in both rich and poor nations is developing into a broad environmental health movement. 23 But to argue, as some do, that the quality of human existence is improving because life expectancy is increasing and child mortality is decreasing in many parts of the world is to miss what McMichael has called the "essential newness" of environmental change. 14 The carrying capacity of the Earth may appear adequate at this moment in history, particularly for those of us in affluent countries. Economic development and improved access to public health programs have produced expected improvements in less developed countries. Although the world's population has increased fourfold in the last 150 years, the food supply has kept pace. But can we support another approximate doubling of the population by 2050, from 6 billion to 10 or 12 billion, the high-fertility forecast by the United Nations? 24 Will the food supply remain adequate? What are the health consequences of global warming and climate change? 25 What are the consequences of loss of biodiversity, forests and marine life? 26 Science has only begun to address these questions.

To protect the health of populations we must develop systems of food, energy and industrial production that can be sustained over generations. We also need value systems of stewardship, precaution and prevention to guide environmental protection and health promotion. Finding solutions to the threats posed by environmental change is the major health challenge of the next century. 27 , 28

Dr. McCally is with the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY.

Organization of the series "Environment and Health" was supported by a grant from the Jennifer Altman Foundation.

Correspondence to: Dr. Michael McCally, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York NY 10029; fax 212 360-6965; [email protected]

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Effects of long-term application of nitrogen fertilizer on soil acidification and biological properties in china: a meta-analysis.

1. Introduction

2. materials and methods, 2.1. data collection, 2.2. data categorization, 2.3. meta-analysis, 2.4. data analysis, 3.1. overview of the dataset, 3.2. effect of climate conditions on the response of soil ph and enzyme activities under long-term nitrogen fertilizer application, 3.3. effect of climatic conditions on the response of soil microbial community alpha diversity and community composition to long-term nitrogen fertilizer application, 3.4. effect of climatic conditions on the response of functional genes related to nitrogen cycling under long-term nitrogen fertilizer application, 3.5. importance of mat and map for soil ph and biological properties, 3.6. structural equation modeling analysis of the pathways through which long-term nitrogen fertilizer application and climate conditions affect soil acidification, 4. discussion, 4.1. effects of long-term nitrogen application on soil ph in china, 4.2. effects of long-term nitrogen application on soil enzyme activities in china, 4.3. effects of long-term nitrogen application on the structure and function of soil microbial communities in china, 4.4. climatic conditions as a major influence on soil acidification and changes in biological properties in china under long-term n application, 5. conclusions, supplementary materials, author contributions, data availability statement, acknowledgments, conflicts of interest.

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Zhang, L.; Zhao, Z.; Jiang, B.; Baoyin, B.; Cui, Z.; Wang, H.; Li, Q.; Cui, J. Effects of Long-Term Application of Nitrogen Fertilizer on Soil Acidification and Biological Properties in China: A Meta-Analysis. Microorganisms 2024 , 12 , 1683. https://doi.org/10.3390/microorganisms12081683

Zhang L, Zhao Z, Jiang B, Baoyin B, Cui Z, Wang H, Li Q, Cui J. Effects of Long-Term Application of Nitrogen Fertilizer on Soil Acidification and Biological Properties in China: A Meta-Analysis. Microorganisms . 2024; 12(8):1683. https://doi.org/10.3390/microorganisms12081683

Zhang, Liqiang, Zehang Zhao, Bailing Jiang, Bate Baoyin, Zhengguo Cui, Hongyu Wang, Qiuzhu Li, and Jinhu Cui. 2024. "Effects of Long-Term Application of Nitrogen Fertilizer on Soil Acidification and Biological Properties in China: A Meta-Analysis" Microorganisms 12, no. 8: 1683. https://doi.org/10.3390/microorganisms12081683

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