Loop Me In

Broadening the frame:

Lessons Learned - Prevention Conference 2012

Following nursing school at UW-Madison, I worked as a Registered Nurse for two years on a neurosurgical unit at St. Mary’s Hospital. Almost daily, we admitted a middle-aged patient who had suffered a debilitating stroke just hours ago. Reading through their medical chart, I would commonly see a long history of tobacco use, physical inactivity, and poor diet.

Donning scrubs and caring for individual patients, it is easy to blame the individual for their detrimental health behaviors. This frequently frames the problem of their poor cardiovascular health as caused by a lack of knowledge or motivation. Patient education on healthy lifestyles is an important role for nurses, but I think that few nurses see the larger picture of how environment shapes health behavior.

 While I greatly enjoyed the individual patient interactions that bedside nursing allows, finding fulfillment in providing health education to those suffering from disease, I also appreciate the necessity for prevention efforts at the community level.  

My first year as a Master of Public Health student at the University of Minnesota has driven in my mind the need to focus on social and environmental determinants of health, rather than solely on intrapersonal factors such as knowledge. Attending the Wisconsin Prevention Conference 2012 last week, I was encouraged to hear this theme echoed throughout presentations. As presenter Julie Swanson discussed, how you define the problem limits the potential solutions. Childhood obesity can be framed as the parent’s fault, which indicates the need to educate parents. But broadening the frame and examining the landscape, we can appreciate childhood obesity as fault by the school, community and environment, indicating the need for policy and systems change.

While the need for policy and environmental change for obesity prevention in Wisconsin is obvious, how to do it effectively is more complex. At the prevention conference, I learned about several useful tools for community assessment, a key process which shapes the way we look at problems and solutions. Tools like Community Health Assessment aNd Group Evaluation (CHANGE) and Participatory Photo Mapping (PPM) help us understand the current status of a community’s health and community members’ lived experience. From Suzanne Gaulocher’s presentation, I learned that PPM allows qualitative data from stories, photographs and maps to be put on quantitative demographic data. This mixed methodology takes us past assumption-based decisions to better understand how people in a community experience the built environment. In particular, I found it interesting how often we make assumptions that access equals action or consumption. For instance, we may assume that living close to a public park is a proxy measure for physical activity. However, many other factors are at play that we can only learn from hearing stories from community members. These stories are a powerful way to communicate information to policy makers in order to make our communities healthier.

Attending presentations and conversing with public health professionals at the prevention conference reenergized my choice to enter the public health field. I hope to use the tools and lessons learned as a public health student and in my future career.