8.2: Neighborhood and Built Environment
By the end of this section, you should be able to:
- Explain the link between food insecurity and food deserts.
- Describe the relationship between crime and violence and health outcomes.
- Define the term built environment .
- Examine how the built environment influences health.
- Assess the effect of housing and environment on health.
- Explain how environmental conditions impact population health.
Healthy People 2030 objectives focus on creating neighborhoods and environments that promote the health and safety of the places in which individuals live, work, learn, and play (ODPHP, 2020b). The neighborhoods where people reside have a major impact on their health and well-being.
Food Access
Nutritious foods are an essential component of a healthy diet. Vegetables, fruits, whole grains, low-fat dairy, protein, and oils are all nutritious foods when consumed in healthy portion sizes. Healthy eating habits, defined as eating a variety of nutrient-dense foods and beverages across all food groups within calorie limits, can lower the risk of chronic disease. Foods and beverages with added sugars, saturated fat, and sodium, along with alcoholic beverages, are associated with unhealthy diets. Research has consistently demonstrated that healthy eating habits are associated with decreased cardiovascular disease, obesity, type 2 diabetes, and breast and colorectal cancer and improved bone health (ODPHP, 2020q). Therefore, access to healthy and affordable food is vital for health.
Often a result of economic insecurity and poverty, food insecurity is a condition in which individuals or families have limited access to adequate amounts of high-quality food (ODPHP, 2020r). Factors influencing food security include income, employment status, race, ethnicity, and disability. Food insecurity increases when income is limited or unavailable due to unemployment. In 2020, BIPOC households were more than twice as likely as the national average to struggle with food insecurity. Individuals living with disabilities are also more likely to experience food insecurity due to limited employment opportunities and health care expenses (ODPHP, 2020r). In 2020, almost 14 million U.S. households were food insecure at some point in the year, and almost 30 percent of low-income households were food insecure compared to the national average of almost 11 percent (ODPHP, 2020r). Factors influencing this disparity are thought to be related to neighborhood conditions, transportation access, and physical access to food (ODPHP, 2020r).
Healthy food choices are inaccessible in many neighborhoods because full-service grocery stores are not readily available, particularly in certain rural areas and low-income neighborhoods (ODPHP, 2020r; U.S. Department of Agriculture [USDA], 2017). These areas where residents have limited or no options for affordable and healthy foods are often termed food deserts (ODPHP, 2020r; RHIhub, 2020b; USDA, 2017). Limited access to healthy and affordable food sources, income level, transportation access, and distance are barriers to healthy food access for many Americans. Almost 13 percent of the U.S. population lives in low-income food deserts (USDA, 2017). Food deserts are common in locations with small populations and high rates of vacant or abandoned homes; in areas where residents have lower incomes, lower levels of education, and higher rates of unemployment; and disproportionately within BIPOC communities (The Annie E. Casey Foundation, 2021). Lack of transportation also contributes to food insecurity. Lack of or limited public transportation is a barrier to accessing affordable healthy food. Further contributing to health disparities among vulnerable populations, individuals experiencing disabilities, those with chronic diseases, BIPOC communities, and those living in rural areas are more likely to lack transportation to full-service supermarkets (ODPHP, 2020r).
This video explores food deserts by profiling two families living in Memphis, Tennessee. Their stories emphasize the contrast between the food choices available to the higher-income and lower-income areas within the city, highlighting the income and zip code divide with a 13-year life expectancy difference between the two parts of Memphis.
Watch the video, and then respond to the following questions.
- How did you feel as you watched the video and listened to the stories? What, if anything, surprised you as you watched the video?
- What is the relationship between the former practice of redlining and the current existence of food deserts?
- What are some actions the community health nurse can take to address these food deserts?
In addition to accessibility issues, food affordability is a major obstacle, as healthier diets are more expensive than diets rich in processed and refined foods (The Annie E. Casey Foundation, 2021). Because nutrient-poor foods tend to be cheaper and more convenient to access than nutrient-dense foods, low-income individuals and families tend to rely on them. Convenience stores often have higher food prices with lower quality and less variety of foods than full-service supermarkets (ODPHP, 2020q). Residents of neighborhoods with fewer full-service supermarkets with fresh produce are at higher risk of obesity and diabetes, whereas rates of these conditions are lower among those who live in areas with increased access to grocery stores (ODPHP, 2020q). Studies have demonstrated a link between individuals experiencing food insecurity and higher rates of obesity and chronic diseases such as hypertension and heart disease. In children experiencing food insecurity, studies have demonstrated increased risks of obesity and developmental issues and even a negative impact on mental health (ODPHP, 2020r).
The Role of the Nurse in Addressing Food Access Disparities
Community health nurses play a major role in advocating for individuals experiencing food insecurity. School nurse s nationwide have paved the way for free breakfast and lunch for students from low-income families via the National School Lunch Program (NSLP) (ODPHP, 2020r). School nurses, in conjunction with school administrators, are also at the forefront of promoting healthier food options for school-provided breakfast and lunch. Nurses both promote access to food and ensure that the food provided is nutritionally appropriate. This is one example of how community health nurses impact the health of the communities in which they serve.
Community health nurses often work with local food pantries to help families in need access food. Nurses can also help individuals obtain food benefits through programs such as Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) (ODPHP, 2020r). These government-sponsored programs provide food assistance to lower-income individuals and families. SNAP gives a monthly dollar amount, determined by income level, which must be used to purchase food. WIC is meant for pregnant, breastfeeding, or postpartum parents and for children under age five and provides nutrition education, breastfeeding support, and nutrient-dense foods (Benefits.gov, 2021). Community health nurses can advocate for increasing access to nutrient-dense foods in low-income neighborhoods to address food disparities and their subsequent negative impacts on health. At the policy level, public health nurses can be involved in policies to limit the number of fast-food restaurants in a community or to incentivize full-service supermarkets to expand into underserved neighborhoods.
Crime and Violence
Violence is a public health issue that adversely affects the target, any witnesses, the communities in which they live, and the perpetrator. It may include child abuse , firearm violence, intimate partner violence , sexual violence, or elder abuse . Violence has cumulative biological effects on the brain, neuroendocrine system, and immune response, resulting in increased incidence of depression, anxiety, posttraumatic stress disorder (PTSD), and suicide and increased risk of cardiovascular disease and premature death (Rivara et al., 2019). Repeated exposure to crime and violence is linked to an increase in negative health outcomes such as asthma, hypertension, cancer, stroke, and mental disorders (ODPHP, 2020e).
Childhood exposure to violence at home, at school, online, or in the neighborhood is considered an adverse childhood experience (ACE). ACEs are traumatic events such as experiencing or witnessing violence or abuse at home or in the community, having a family member attempt suicide, or any event that undermines a child’s sense of safety, security, and bonding (CDC, 2022c). ACEs are linked to lifelong negative health outcomes such as chronic disease, mental illness, and substance use problems. Additionally, research has found that ACEs can negatively impact education levels, future job opportunities, and overall earning power. Evidence also links exposure to violence in childhood to an increased risk of experiencing intimate partner violence or being violent in adulthood (USDHHS Office on Women’s Health, 2021). Exposure to violence as an adult is also associated with poor health outcomes, such as mental health disorders, depression, anxiety, suicidal ideation, and physical injuries from violence (ODPHP, 2020e). See Caring for Vulnerable Populations and Communities for more information on ACEs.
Individuals who are economically insecure are more likely to live in impoverished neighborhoods that lack resources and have higher rates of crime and violence (ODPHP, 2020e). Additionally, the national homicide rate is higher for BIPOC adolescents and young adults than their White counterparts (ODPHP, 2020e). Individuals who feel unsafe in their neighborhoods are more likely to avoid community gatherings and outdoor spaces, placing them at higher risk of poor physical and mental health (ODPHP, 2020e). If a community experiences violent crime, families will likely avoid utilizing public parks and partaking in outdoor physical activity out of safety concerns. This negatively affects the family, causing increased isolation and mental health stress and decreased physical activity, socialization, and play for children.
The Role of the Nurse in Addressing Violence
Strategies for public health nurses to address crime and violence include educational programs on building resilience and developing healthy interpersonal relationships. The community health nurse can collaborate to offer school-based programs that build emotional self-awareness and regulation, problem-solving, and teamwork skills to prevent violent behavior. Such educational and training programs can occur in a community center or even an outpatient community health clinic. Building resilience and emotional self-awareness and regulation skills, even from a young age, creates a culture of accountability and can reduce violence. Community and public health nurses can also offer parenting classes to help educate families on how to model resilient behaviors and give strategies for dealing with difficult parental situations. Finally, community health nurses can work with community members to provide high-quality child care, mentoring programs for young individuals, and safe, affordable after-school programs to keep children engaged with playing and learning in a supervised environment.
In this short video, Kaiser Permanente highlights its innovative and effective model for addressing family violence and transforming the health care response to domestic violence. Community and public health nurses are well positioned in the community to utilize this approach in assessing for intimate partner and domestic violence.
Watch the video, and then respond to the following questions.
- How does family violence impact a community?
- What are the components of the innovative model?
- How might a community health or public health nurse use components of this model in their communities?
The Built Environment
A community’s built environment includes transportation access and roadways, the availability of green space, locations for community gatherings, and the buildings or other physical structures within the neighborhood (ODPHP, 2020d). Almost 20 percent of economically insecure households in the United States lack access to private transportation (Langston, 2018). Low-income individuals without a vehicle are doubly burdened if they reside in neighborhoods without adequate and affordable public transportation, such as bus routes or subways. These individuals may struggle to access schools, work, health care, and other necessary resources. Economically insecure individuals, particularly those who identify as Black, Native American, and mixed/other race, are more likely than those who identify as White, Latina/Latino, or Asian or Pacific Islander to report dropping out of the labor force due to transportation issues (Langston, 2018).
The availability of outdoor green space and access to sidewalks and bike lanes have major health impacts on a community. A lack of green space for outdoor activities and community gatherings negatively affects residents’ physical and mental health and well-being. Children need green space to play outside. Play is a means for children to learn and grow as individuals. It is difficult to socialize with groups of other children if play is limited to indoors only. Walking is a free and easy exercise activity, but residents may be hesitant to participate in this beneficial physical activity without a sidewalk or wide road shoulder to permit safe walking. Bike paths are also a cost-effective way to increase walking, biking, roller-skating, and other leisure activities and can serve as a means of transportation, but if there is not a safe way to engage in these physical activities, they will not occur.
Read the scenario, and then respond to the questions that follow.
As described previously, Serena and her husband are trying to meet the basic needs of their family of five while living paycheck to paycheck. Their middle child was recently diagnosed with asthma after having numerous respiratory illnesses. The health care provider has told Serena that she should remove all carpets from the house and ensure there are no pets, woodstove smoke, or second-hand tobacco smoke near her child, as these are all possible triggers for an asthma attack. Serena is very upset, as the apartment they rent has carpet in every room except the kitchen and bathroom and her first-floor neighbors are smokers. Though Serena and her husband do not smoke, they can always smell cigarette smoke in their apartment.
- What assessments and screenings should the nurse conduct with Serena?
- How could the nurse assist Serena in getting some much-needed resources for her child who has asthma?
- How might a community health nurse work with Serena and her family to find strategies to improve their living environment?
The Role of the Nurse in Addressing the Built Environment
Public health nurses are well positioned to work within the local community and government to advocate for shared public green spaces. Building community partnerships is a core policy development role for a public health nurse. From a windshield assessment of the community to raising awareness at the local level and collaborating with policymakers and community leaders, public health nurses can effect positive change within the community. Working with urban design planners and city planners, nurses can advocate for the construction of playground structures, tennis or pickleball courts, and basketball courts to afford more physical activity and community-building opportunities. School nurses can also be involved in this process by advocating for more physical education and outdoor recess time at school and by advocating for more gathering places for children and families to congregate, socialize, and play after school.
This short video highlights how a little green space can make a big difference in low-income city neighborhoods by featuring the relationship between the environment and the health of residents living in a Philadelphia neighborhood. Community and public health nurses can be advocates and change agents, creating more green spaces in urban areas.
Watch the video, and then respond to the following questions.
- In what ways did the neighborhood environment affect the health of its residents both before and after the Philadelphia LandCare program?
- Where did the intervention described in the video have the biggest impact?
- What steps can nurses take to improve the physical environment of the clients in the communities they serve?
To find out more about the LandCare program described in the video, which is now part of the Pennsylvania Horticultural Society, visit their website .
Quality of Housing
Housing quality refers to a home’s physical condition and the quality of the environment (neighborhood) in which it is located. Quality housing is characterized by clean air, home safety, enough space per individual, access to heating and cooling systems, and the absence of environmental risk factors. Crowded living conditions are associated with food insecurity, infectious diseases, and poorer mental health (ODPHP, 2020k). Low-income individuals are more likely to live in older homes and homes needing maintenance and repair.
Poor housing quality and poor living conditions contribute to negative health outcomes for a variety of reasons. The presence of lead, mold, asbestos, radon, poor air quality, and overcrowding are all associated with illness and disease. Children under age six are at increased risk for adverse health outcomes due to lead exposure because their bodies are rapidly growing and developing and because they tend to put their hands and other objects into their mouths. Children can be exposed to lead from touching, swallowing, or breathing in lead dust from lead paint, pipes, and water faucets. Lead exposure can result in slowed growth and development, damage to the brain and nervous system, learning and behavioral problems, and hearing and speech issues, all of which may result in lower IQs and underperformance in school (CDC, 2022f). Many of the outcomes associated with lead exposure are permanent; for example, lead poisoning may result in infertility, hypertension, heart disease, renal disease, and even premature death (NIOSH, 2021). Even low levels of lead in the blood have been linked to negative outcomes in a child’s attention span and academic achievement (CDC, 2022f).
Many modifiable environmental risk factors related to housing are associated with negative health outcomes. Water issues such as leaking are associated with mold growth, increasing the likelihood of childhood asthma and triggering asthma exacerbation. Mold is also associated with respiratory illnesses, coughing, and wheezing. Exposure to asbestos, a class of mineral fibers used in various industrial products like insulation, cement, textured paint, and shingles, may place individuals at increased risk of developing several health conditions. Asbestos in good condition is not considered harmful, but handling asbestos products may release the fibers into the air; if inhaled, they accumulate in the lungs and may cause lung cancer, asbestosis, pleural disease, and mesothelioma (Agency for Toxic Substances and Disease Registry, 2016; CDC, 2023). While most modern products do not contain asbestos, homes built before the 1970s may have asbestos, placing families living in older rental homes at higher risk of exposure to it (U.S. Consumer Product Safety Commission, n.d.). Exposure to vermin such as cockroaches and rodents causes an increased risk for developing asthma and allergies and places exposed individuals at increased risk of psychosocial distress (CDC, 2009).
The Role of the Nurse in Addressing Quality of Housing
Community health nurses can promote the overall health and well-being of an entire neighborhood and community by addressing the quality of housing. Widespread deterioration in neighborhoods can negatively impact the mental health of residents in that community. The social and economic conditions in a neighborhood affect health outcomes as much as the quality of housing, further disadvantaging low-income groups, creating even more health disparities. To fulfill their core assessment function, community and public health nurses should assess the lived experience of community members; appropriately screen for issues such as lead poisoning, mold-related illnesses, mental health illness, and communicable diseases; and then work to develop policies to address these issues. By championing new laws and regulations on housing quality and strengthening support for affordable housing, the nurse is well positioned to lead effective change. Past successes in public health efforts on quality housing include banning lead paint products and creating local building codes and state statutes governing rental properties.
In this short video, FIRST 5 Santa Clara County discusses health screenings using evidence-based, standardized screening tools to identify health needs for follow-up assessments. These screenings are completed in elementary schools, preschool programs, and public health clinics, as good health is linked to readiness to learn, fostering better educational opportunities for children.
Watch the video, and then respond to the following questions.
- How are health and education related?
- What are some of the barriers to obtaining health care described in the video?
- What is meant by the term high touch, high tech , and how is it related to the role of the nurse?
Environmental Conditions
The most common environmental conditions that may negatively impact population health are air quality, water safety, and extreme weather. Indoor and outdoor air quality is a major contributor to health.
Air Quality
Globally, air pollution is estimated to be responsible for nine million deaths per year, equating to one in six deaths worldwide (Fuller et al., 2022). The USDHHS reports that air pollution is associated with 100 to 200 thousand annual deaths in the United States (ODPHP, 2020p). Air quality is affected by pollution from smoke, dust, carbon monoxide, ozone, and nitrogen oxides. Indoor air quality can be affected by environmental smoke, cooking oils and smoke, secondhand smoke, and exposure to mold or radon. Outdoor air pollution can be affected by environmental smoke, car exhaust fumes, and other outdoor air pollutants. Pollution occurs with motor vehicles and industrial plant emissions and fires (Figure 8.4). Poor air quality can cause or exacerbate respiratory illness, and air pollution has been linked to lung cancer and heart disease. Urban communities tend to have more sources contributing to pollution and therefore tend to have worse air quality than more rural areas (ODPHP, 2020p). BIPOC communities disproportionately encounter more air pollution than predominantly White communities due to a history of structural racism. BIPOC neighborhoods are more likely to be located near factories and other industrial facilities that emit more pollution due to discriminatory city planning (ODPHP, 2020p). See Structural Racism and Systemic Inequities for more information.
Exposure to loud noises and living in close proximity to hazardous waste sites are other environmental community factors that adversely impact health. Traffic and construction contribute to noise pollution, which is associated with hearing loss and has been found to elicit stress responses in the body. BIPOC communities and low-income communities are disproportionately impacted by noise pollution. Living near hazardous waste sites or industrial facilities is also associated with increased rates of cancer, respiratory disease, skin conditions, and adverse pregnancy outcomes compared to those not living near these sites (Taylor, 2022).
Water Quality
Access to safe, regulated water for drinking, bathing, and cleaning is an important determinant of health. While the U.S. water supply is generally considered safe, it can be contaminated with pathogens or chemicals that can cause illness and disease (ODPHP, 2020e). Each year, an estimated 7.2 million individuals in the United States become ill from waterborne diseases such as cryptosporidiosis, giardiasis, pseudomonas, and vibriosis (CDC, 2020b). See Epidemiology for Informing Population/Community Health Decisions. The Safe Drinking Water Act (SDWA) allows the Environmental Protection Agency (EPA) to set and enforce standards for drinking water quality (CDC, 2022e). Despite these regulations, water quality can still be affected by the natural and built environment and by sociopolitical factors. Studies have found a higher risk of exposure to water contaminants, like nitrates, and arsenic, and to poor water quality in BIPOC communities and communities with lower incomes (ODPHP, 2020p). In addition, the SDWA does not regulate private wells, placing some individuals and families at increased risk for water-related issues if their wells are not properly maintained, particularly those living in rural areas without municipal water sources. Well water also has higher levels of nitrates than water from municipal water systems (ODPHP, 2020p). Arsenic is associated with nausea, vomiting, anemia, abnormal heart rhythms, and paresthesias, and nitrates decrease the blood’s ability to carry oxygen to the tissues and can cause hypotension, tachycardia, headaches, gastrointestinal upset, and vomiting (CDC, 2022d).
Access to safe drinking water is a social determinant of health. Consuming contaminated water has serious negative health consequences, such as is being seen in Flint, Michigan, where children are still experiencing the consequences of lead toxicity caused by unsafe drinking water. The problem began in April 2014, when, for economic reasons, the city changed the source of its water supply from Lake Huron to the Flint River without first taking necessary corrosion control measures. This switch caused water distribution pipes to corrode, ultimately causing dangerously high levels of lead to leach into the drinking water supply. Soon after the change, residents started complaining about the water quality, noting discoloration, smell, and taste, but they were largely ignored.
Pediatrician Dr. Mona Hanna-Attisha was concerned with the number of elevated lead levels she was seeing in her clinic. She compared the blood lead levels of 1,700 Flint children prior to the water switch with their levels after the switch and found that in areas where the water lead levels were highest, there was the greatest increase in children’s blood lead levels. In 2015, Dr. Hanna-Attisha sounded the alarm about her findings and held a press conference. Two weeks later, Michigan governor Rick Snyder ordered the water to be switched back to Lake Huron (Alfonsi, 2020). However, the corroded pipes continued to release lead into the drinking water. The governor declared a state of emergency in January 2016 (Ruckart et al., 2019).
Lead poisoning is a preventable environmental health threat to children, who are most susceptible to the adverse effects of lead exposure. There is no safe level of lead; it is an irreversible neurotoxin and impacts cognition and behavior, resulting in potential developmental delays and lowered IQ levels. Lead toxicity can affect every body system, causing neurological, renal, hematological, endocrine, gastrointestinal, cardiovascular, reproductive, and developmental effects. Lead also crosses the placenta, placing pregnant clients exposed to lead in danger of exposing their developing fetus. Low levels of lead in developing babies have been found to affect cognitive development and behavior (CDC, 2020a; Ruckart et al., 2019). Following the Flint water crisis, an estimated 14,000 children under the age of six may have been exposed to lead in their water. “Three years after the crisis began, the percentage of third graders in Flint who passed Michigan’s standardized literacy test dropped from 41% to 10%” (Alfonsi, 2020, para. 32).
Flint is a city with a majority BIPOC population, and 40 percent of the population lives in poverty (Kennedy, 2016). Do you think complaints of discolored and foul-smelling water would have been ignored for 18 months if the demographic profile of the Flint population were different? What is the role of a community health nurse in addressing this public health issue? What interventions could the community health nurse implement to assist families affected by this crisis?
Extreme Weather
Severe weather events such as heat waves, tornadoes, and floods may cause direct injury and death or infrastructure damage that leads to negative health effects. Individuals who experience severe weather may undergo declines in mental health and worsening chronic medical conditions. Often, during severe weather events, the health care system is unable to function normally, creating a backlog of clients in addition to the increased number of individuals who require medical care from direct effects of the weather.
Severe weather events correlate with climate change , a long-term change in weather patterns that describes how rising temperatures and changes in amounts of rainfall impact the planet, with rising sea levels, shrinking glaciers, and associated changes in the blossoms of flowers and plants (Denchak & Turrentine, 2021). More than an environmental issue, severe weather due to climate change is a “fundamental threat to human health and well-being” (Levy et al., 2018, p. 1). The effects of climate change, with increasing numbers of severe weather events and shifts in weather patterns, are expected to continue. Variable weather can include unusually harsh conditions in areas that are not used to and are therefore not prepared to deal with them. Individuals and families in affected regions may experience new or exacerbated financial hardships as they manage living with extreme heat, drought, floods, or snowfall.
In areas unaccustomed to warm weather, the warming climate increases the risk of vector-borne diseases and waterborne pathogens. Warmer temperatures increase the geographic distribution of where vectors, such as mosquitoes and ticks, can survive, breed, and spread disease. Increasing rainfall, often secondary to warming temperatures, can produce standing water, creating more breeding grounds for mosquitoes. Warmer temperatures also increase the likelihood of waterborne diseases, as warmer temperatures facilitate pathogen survival, and heavy rainfall further mobilizes pathogens and compromises water and sanitation systems (Levy et al., 2018). Extreme heat is associated with respiratory and heat-related illnesses. These heat-related ailments are especially prevalent in urban areas, where the concrete footprint traps and intensifies heat, creating what is referred to as an urban heat island, a city or metropolitan area with a higher temperature than the rural areas around it.
Weather changes disproportionately affect BIPOC communities and those with low incomes due to issues around location, access to resources, and quality of infrastructure. Additionally, individuals who are Hispanic or Latina/Latino are more likely to work construction and agriculture jobs that expose them to more severe weather (ODPHP, 2020p). A study found that in 169 of the 175 largest U.S. urban areas, BIPOC individuals were more likely than White individuals to live in urban heat islands. The temperature difference between an urban heat island and an outlying area can be as high as 20 degrees Fahrenheit (Ndugga & Artiga, 2021). See Environmental Health for more information.
This short CDC video discusses the intersection of the environment and the social determinants of health, highlighting the importance of environmental health.
Watch the video, and then respond to the following questions.
- What are some examples of how the environment can negatively affect health?
- How might a nurse use tools like the CDC’s Environmental Public Health Tracking Network described in the video when caring for clients in their community?
The Role of the Nurse in Addressing Environmental Conditions
Community and public health nurses work within the core functions of assessment and policy development to monitor environmental conditions and their effects on health outcomes. They assess and monitor population health, investigating and addressing health hazards and their root causes. In areas with high levels of air pollution, these nurses monitor the community’s respiratory health, as poor air quality can cause or exacerbate respiratory health conditions. For any increased prevalence of air pollution-related respiratory issues, these nurses educate the public and mobilize community partnerships to address the issue. By cataloging the detrimental health effects of air pollution, public health nurses have evidence to support the implementation of new laws and policies to address its causes. For residents struggling with poor indoor air quality, educating individuals and families on the importance and use of indoor air filters is a great mitigating and possibly a primary prevention intervention.
Community health nurses assess poor health outcomes related to contaminated water and investigate or address these health outcomes. While the EPA sets standards for water quality within public municipal water systems, compliance is often left to local governments. Once a link between water quality and health outcomes is established, community and public health nurses communicate with and educate the local government and the public, and they mobilize efforts to address the root cause. Using legal and regulatory avenues, the public health nurse assures that the community can access one of the most basic human rights, safe water. See Pandemics and Infectious Disease Outbreaks for more information on waterborne disease.
Community and public health nurses should familiarize themselves with environmental health concerns and join environmental nursing groups such as the Alliance of Nurses for Healthy Environments (ANHE) to stay current on the latest climate change information. A national nursing organization focused on the intersection of health and the environment, ANHE offers many learning opportunities, with podcasts, webinars, newsletters, and other events. Its goal is to advance research, incorporate evidence-based practice on the environment, and influence policy (ANHE, n.d.). Massachusetts General Hospital Institute of Health Professions (MGH IHP) has opened a Center for Climate Change, Climate Justice, and Health , created and driven by nurse scholars passionate about tackling climate change issues. This center offers many opportunities for health professionals to learn about the issues and to “address mitigation, adaptation, and resilience through education, practice, research, and service related to the health effects of climate change” (MGH IHP, 2023, para. 1).
Nurses can use information from these resources to implement community interventions and to advocate for policy changes to address climate change. Some community interventions require community health nurses to collaborate with local government, city planners, and urban designers to investigate ways to mitigate the effects of climate change, such as promoting the planting of more trees and greeneries, on the street and on rooftops, to relieve heat and improve air quality. At the family level, the community health nurse can direct families struggling with heating or electricity costs to resources such as low-income home energy assistance programs.