adequate insurance coverage. Tied closely to these efforts is the concern for controlling health care costs. Nursing leadership has firmly supported such reforms. Not incidental to proposals by nursing leaders is the call for increasing the supply and inclusion of advanced practice nurses (e.g., nurse practitioners, clinical specialists, and certified nurse midwives) in community-based systems of primary care. Compelling data have been compiled that demonstrate the potential to increase accessibility of care and decrease cost, without a loss of quality of care (Boex et al., 1993).
Struggling for attention in the current health care reform debates, which focus largely on care for the sick, is the message from those in public health settings that it requires more than seeing a doctor for people to stay healthy. The public health community (e.g., state and federal governmental agencies; professional associations; and the Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services [DHHS]) has been a persistent voice for a broader perspective of health care that encompasses preventive strategies as well as traditional care and cure models.
Public Health in America (PHS, 1994) describes the core functions of public health as follows:
prevents epidemics and the spread of disease,
protects against environmental hazards,
promotes and encourages healthy behaviors,
responds to disasters and assists communities in recovery, and
assures the quality and accessibility of health services.
To fulfill these core functions, public health advocates, including environmental health professionals, appeal for funding that is distinct from reimbursement of sick care services. Strategies include a set-aside in the health care budget or a separate, reliable appropriation to carry out governmental responsibility to protect the health of populations.
Nurses, dispersed throughout the health care system, have potential for demonstrating that competent health care can be accessible, affordable, and acceptable to the public. The heritage of nursing services designed to strengthen the populations they serve, the principles of social justice, and nursing's broad definition of health are assets for nurses who are willing to take up new and expanded practice roles that include environmental health. Nurses' ability to see the interconnectedness of environmental influences with opportunities for preventing health problems and controlling overall system costs can be invaluable.