Back when H1N1 was on the rise, the city of Worcester, Massachusetts laid off all but one of its public health nurses, much to the consternation of the public health community. Public health has rarely been understood by Americans in general, and perhaps the H1N1 pandemic has brought the benefits of the public health infrastructure into the spotlight for both the public and politicians.
Back in October when I left my position as a public health nurse for a small college town in Western Massachusetts, I felt guilty that I was leaving at a time when I was needed the most. Luckily, I was quickly replaced by a skilled and capable nurse who was able to pick up the gauntlet and lead the town through the maze of H1N1 prevention and immunization clinics.
Now I have learned that the public health nurse position in that particular town has been eliminated, and the new director---a former public health nurse for the town---will fulfill the responsibilities of both nurse and department head, a monumental task that seems altogether untenable, no matter how capable and earnest this individual can be. From the surveillance of infectious disease to the management of tuberculosis, public health nurses need time and resources to fulfill their duties, and more and more nurses are being asked to decrease their hours and the scope of their practice, significantly limiting their overall effectiveness.
Public health is often seen as an expendable expense by politicians and bureaucrats, and the signs all point to the fact that public health---and public health nurses---are still not appreciated for the ways in which they safeguard the health of the population and work to prevent the spread of infectious disease.
The gutting of public health programs around the United States is a travesty, and when the ability of a local public health department to fulfill its responsibilities is emasculated in the interest of saving money, everyone loses.