Three Core Functions in One Program: How a County Health Department Prevents Childhood Lead Poisoning
[Student Name]
University of Phoenix
NSG/486: Public Health: Health Promotion and Disease Prevention
Week 1 Assignment
[Instructor Name]
[Date]
The county, program and figures are a composite written for a model paper.
A child with lead poisoning rarely looks sick. The effects appear years later, in reading difficulties, attention problems and lower school achievement, and they cannot be reversed. That is why childhood lead poisoning is a public health problem rather than only a clinical one: by the time a physician could treat it in one child, the damage is done, and the cause, old paint and dust in the child's home, is still there for the next child. Public health exists for problems like this, where the only effective treatment is to change the environment before anyone becomes a patient. This paper provides an overview of public and community health by following a composite county health department's lead poisoning prevention program through the three core functions of public health.
Public Health and Its Core Functions
The Institute of Medicine (1988) framed public health as society's effort to secure the conditions people need to be healthy, and it defined three core functions for public health agencies: assessment, policy development and assurance. Assessment means regularly collecting and analyzing information about the community's health. Policy development means using that information to build comprehensive policies. Assurance means making sure that the services needed to meet agreed goals are provided, whether by the agency itself or by others.
The ten essential public health services describe the activities that carry out these functions. They were revised in 2020 to place equity at the center of the framework, and Castrucci (2021) argues that the revised framework gives public health a common language for explaining its work to policy makers and the public. The services include monitoring population health, investigating hazards, communicating effectively, strengthening partnerships, creating policies, using legal action, assuring equitable access, building a diverse workforce, improving through evaluation and research, and building a strong organizational infrastructure.
The Problem in the County
The composite county has 240,000 residents. About 38% of its housing was built before 1978, when lead-based paint was banned for residential use, and much of that housing is concentrated in two older neighborhoods with high poverty rates and a large share of rental units. Children younger than six are most at risk, because they put their hands and objects in their mouths and absorb lead more readily than adults.
The science on low-level exposure explains why the county acts on levels once considered safe. Lanphear et al. (2005), in an international pooled analysis of seven cohort studies, found that intellectual deficits occurred at blood lead levels below 10 micrograms per deciliter and that the steepest declines per unit of lead occurred at the lowest levels. The Centers for Disease Control and Prevention now uses a blood lead reference value of 3.5 micrograms per deciliter, based on the 97.5th percentile of blood lead levels among U.S. children, to identify children with higher exposure than most (Ruckart et al., 2021).
Assessment
The county's assessment work begins with surveillance. Laboratories report every blood lead test to the state, and the health department analyzes the results by neighborhood, age and housing age. The analysis showed that children in the two older neighborhoods were about three times as likely as children elsewhere in the county to have a level at or above the reference value, and that screening rates were lowest in exactly those neighborhoods. Assessment also includes investigating hazards: when a child's level is elevated, an environmental health specialist inspects the home to find the source, which is usually deteriorated paint, dust on windowsills or contaminated soil.
The Flint water crisis showed why this function matters. Hanna-Attisha et al. (2016) analyzed blood lead results from children before and after the city changed its water source and found that the proportion of children with elevated levels rose, most sharply in the neighborhoods with the highest water lead levels. Their spatial analysis of routine surveillance data helped bring the problem to public attention, an example of assessment leading directly to action.
Policy Development
The county's assessment findings led to policy. The health department worked with the city council and the housing authority to adopt a rental registration ordinance requiring landlords of pre-1978 housing to pass a lead-safe inspection before renting to families with young children. The department also partnered with pediatric practices and the local Medicaid plans to adopt a policy of universal blood lead testing at ages 12 and 24 months in the two high-risk neighborhoods. Policy development is where the essential services of creating policies and strengthening partnerships meet: the health department could not pass an ordinance alone, but it could supply the data and draft the language that elected officials needed.
Assurance
Assurance means making sure that services reach the people who need them. For children with elevated levels, the county assures a home visit by a public health nurse, an environmental inspection and follow-up blood testing until the level falls. For families who cannot afford repairs, it assures access to a federally funded lead hazard control grant program that pays for remediation. For the community, it assures outreach and education through schools, child care centers and the women, infants and children nutrition program.
The Public Health Nurse's Role
The public health nurse works inside all three functions. In assessment, she helps identify children who were never screened by comparing the surveillance list with immunization records and following up with families. In policy development, she brings stories and data from home visits to community meetings, where they give weight to the numbers. In assurance, she provides case management for each child with an elevated level: she visits the home, teaches the family how to reduce exposure through wet cleaning, handwashing and nutrition rich in iron and calcium, coordinates with the child's pediatrician and the environmental inspector, and follows the child until the level returns to normal. She also watches for developmental concerns and refers children to early intervention services when needed.
Public Health Compared With Individual Care
The lead program shows the main difference between public health and individual clinical care. A pediatrician treats the child in the exam room; the public health department works to make sure no child in the county is exposed in the first place. The pediatrician's patient is the child, and the department's client is the population of children and the homes they live in. The two depend on each other, since screening happens in pediatric offices and remediation depends on public health policy, but their goals and tools differ.
Conclusion
Public and community health focuses on the conditions that shape health across a population, organized around assessment, policy development and assurance. A county's childhood lead poisoning prevention program shows all three functions at work: surveillance and home investigations identify the problem, ordinances and testing policies address it, and nurse home visits, remediation grants and outreach make sure help reaches families. The public health nurse contributes to each function, but her largest contribution is the one that cannot be seen: the children in the county who never develop lead poisoning at all.
References
Castrucci, B. C. (2021). The "10 essential public health services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189
Hanna-Attisha, M., LaChance, J., Sadler, R. C., & Champney Schnepp, A. (2016). Elevated blood lead levels in children associated with the Flint drinking water crisis: A spatial analysis of risk and public health response. American Journal of Public Health, 106(2), 283-290. https://doi.org/10.2105/AJPH.2015.303003
Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091
Lanphear, B. P., Hornung, R., Khoury, J., Yolton, K., Baghurst, P., Bellinger, D. C., Canfield, R. L., Dietrich, K. N., Bornschein, R., Greene, T., Rothenberg, S. J., Needleman, H. L., Schnaas, L., Wasserman, G., Graziano, J., & Roberts, R. (2005). Low-level environmental lead exposure and children's intellectual function: An international pooled analysis. Environmental Health Perspectives, 113(7), 894-899. https://doi.org/10.1289/ehp.7688
Ruckart, P. Z., Jones, R. L., Courtney, J. G., LeBlanc, T. T., Jackson, W., Karwowski, M. P., Cheng, P., Allwood, P., Svendsen, E. R., & Breysse, P. N. (2021). Update of the blood lead reference value: United States, 2021. MMWR Morbidity and Mortality Weekly Report, 70(43), 1509-1512. https://doi.org/10.15585/mmwr.mm7043a4
How this NSG 486 Week 1 example is structured
The University of Phoenix library guide for NSG/486 lists Week 1 as an Overview of Public/Community Health. The paper uses one program as a lens because the public health framework is easiest to understand when every function is attached to something a health department actually does. It defines public health and its core functions briefly, applies each function to the lead program with the essential services it contains, and then describes where the public health nurse fits. The closing section contrasts public health with individual care, which is the idea an overview week most needs to establish. Students search this week as NSG 486 Week 1, NSG486 Wk 1 or NSG/486 Wk 1; all three are the same assignment.
NSG/486 Week 1 questions, answered
What does NSG/486 Week 1 usually ask for?
The library guide for NSG/486 lists Week 1 as an overview of public and community health. Many sections ask for a paper introducing public health nursing, the core functions of public health and the essential public health services, often applied to the writer's own community. Your instructions decide the exact prompt.
What are the three core functions of public health?
Assessment, policy development and assurance, a framework that grew out of the Institute of Medicine's 1988 report on the future of public health. The ten essential public health services, revised in 2020 with equity at the center, describe the activities that carry out those functions.
Why use one program as an example?
Because an overview paper that only defines terms is hard to grade against application. Following one program through all three functions shows the reader that you understand what each function looks like in practice, which is what most rubrics reward.
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