November 18, 2009, 12:42 pm

It Matters Where You Live

cherry_ames_rural_nurseI never read this Cherry Ames book.

It couldn’t possibly be as interesting as working in a hospital!

Nurses were supposed to work in hospitals! Where they would wear their cap! Why on earth would you want to do anything without your cap? Back in 1966 it was the sole reason I was planning nursing school!

(Cut me some slack, I was nine.)

Today, I am in the midst of studying public health. Yes, there is life outside the hospital.

But there was never a “Cherry Ames, Public Health Nurse”. Or so I thought. I was wrong. This is it. Here is the quote from

Cherry, the only nurse assigned to an entire county, uncovers a phony folk medicine production operation using ginseng growing wild in swamp water tainted with harmful bacteria.

Whoa! This was written in 1961 and we have environmental pollution, the potential for infectious disease, pharmaceutical fraud and a million opportunities for patient education! I’d list all the public health nursing interventions involved, but I realize not everyone is as jazzed about public health nursing as I am at the moment.

Thanks to a colleague who gave me an entire collection of the Cherry Ames series, I have this book.

Time to read it!


I actually started this post one week ago – I hate when life gets in the way of blogging. It’s so bad I actually tell myself “I have to blog this!” in my dreams. Not blogging is just not acceptable. It’s like forgetting your underwear, you can’t shake the fact that something is missing! I shan’t allow it to happen again!

I’m not the only one who has been MIA – Change of Shift was supposed to be over at last week, but she is also out of range at the moment!  Hey Emily – make like ET and phone home! Maybe Grand Rounds did her in! Have no fear, the next Change of Shift will be right here next Thursday, so send in those nurse-related submissions!

And if you are in the mood for a great Wednesday carnival, Jenny has Patients for a Moment up at ChronicBabe! It’s a great edition – many, many submissions with fantastic topics. In fact, since I’m sitting here in Starbucks for the first time in ages, I’m gonna read them as soon as I finish this post!


I was part of the USC Annenberg School of Communication and Journalism’s “Health and the Blogosphere” conference/brainstorming session last week.  Bloggers and other health writers were invited to give input on a new professional training program, and I was honored to be a part of that group.

I took away so much more than I contributed. An unexpected focus (for me) was the idea of taking the blogosphere dialog about our own health (“my health”) and expanding that into a discussion about the health of our communities (“our health”).

But haven’t we’ve been doing that for the last year, health care reform having been debated ad nauseam?

Well, no.


We talk about access, the medical home and affording medical care. From screening to vaccinations to treatments for illness and the cost of prescriptions drugs, it’s all about keeping the individual healthy.

We are talking trillions-with-a-capital-T to reform our health care system.

With health care reform, access and education, life expectancy will increase and health disparities will be a thing of the past.



Well, no.

Our health care system looks to remedy problems. Fix them. Change behaviors. Treat illness. Educate.

Reform will mean that everyone is equal. Everyone has access. Everyone covered.

No more health disparities.

A noble and worthy goal.

But it doesn’t address the root cause of the majority of those disparities.


It matters where you live.


All the health care in the world means nothing if your housing is sub-standard, dilapidated and full of lead-based paint.

In neighborhoods full of empty lots and garbage.

All the health care in the world means nothing if you don’t have the means to purchase food (healthy or otherwise) because your job, if you have one, pays nothing and there are no grocery stores in your neighborhood, just liquor stores and fast food joints.

All the health care in the world means nothing if the crime rate in your neighborhood qualifies it as a war zone and you take your life in your hands just walking down the street.

And you can’t get a decent education because what little teaching actually goes on in your underfunded, understaffed neighborhood school is hard to retain when you are going to school hungry. Or watching your back.


It matters where you live.

We will never have true health care reform unless we deal concurrently with social inequities, specifically poverty.

It’s like putting a band-aid on a deficient immune system.

It looks good, but it isn’t really doing much for the patient.


For the record, this is not bleeding-heart “save the world” banter.

I’m not talking hand-outs and welfare that goes on for generations.

I’m talking about providing the basics, the tools that can help raise people out of poverty, the cause of health disparities.

Social justice.

Believe me, I’m all about “pulling yourself up by the bootstraps”.

But shouldn’t we make everyone has a pair of boots, first?


The inspiration for this post is a direct result of a presentation given at USC by Anthony Iton, M.D., J.D., MPH, Senior Vice President of Healthy Communities for the California Endowment: “Beyond Disease: Blogging on Obstacles to a Healthy Society”. Dr. Iton had been the director and county health officer for the Alameda County Public Health Department until September of 2009. I thought this slide was particularly impressive, so I’m including it here:



  • Rachel

    November 18, 2009 at 12:54 pm

    Absolutely, social justice needs to happen. (See, even opposite political parties can agree, oh wait, we don’t work in Washington…)

    Good to see a post!

  • Candy

    November 18, 2009 at 1:05 pm

    Are you the same Republican Kim I know and love? You go, woman! I agree with all of this, especially the boots. I’ve been saying forever that equal opportunity is easy to say when you have a roof over your head and enough food to eat. Every American should have the same shot at the American dream, and if that means diverting funds from somewhere that doesn’t need them as much, so be it (yes, I am a little socialistic).

  • Wellescent Health Blog

    November 18, 2009 at 3:21 pm

    It is sad but true that poverty is one of the key problems that is unaddressed by reforms like these being created now. However, providing some form of guaranteed access to care at least means that the ranks of those in poverty does not increase as people are driven to bankruptcy by their medical bills. If we actively tackle one problem at a time, we might eventually get create a fair society where place is less relevant.

  • KatieBeeRN

    November 19, 2009 at 6:14 am

    Thanks for the public health vote of confidence! Public health is true nursing – reading through Notes on Nursing by Flo, and reading her chapters on hygiene, nutrition, sunlight, you start to realize that nursing isn’t just about starting IVs and paperwork.
    Also, you may be interested in the American Public Health Association’s annual meeting next November in Denver – the theme is Social Justice. So fitting!

  • Nursing Education Blog

    November 19, 2009 at 9:36 am

    Public Health Nursing is one of my key interests too! By the way, I know Emily planned to do COS, but she had to go on TDY assignment.

    Social justice, reducing poverty and cleaning up crime infested urban wastelands are all worthy yet difficult to accomplish goals.

    Take a failed city like Detroit for example. There are NO grocery stores in Detroit. Residents must buy packaged foods at food marts or drive to a suburb to get fresh fruit, veggies, or meat. Entrepreneurs hunt small game & sell packets of racoon meat to the locals.

    Convenience store owners pay armed guards to protect food delivery trucks as they unload. So many houses are abandoned wrecks in Detroit that banks can’e even sell the foreclosures there for $5. Urban gangs, thugs, drug dealers, and other less than desirable sorts are par for any part of the city.

    Most of the folks there worked in manufacturing, yet the auto makers aren’t manufacturing there anymore. No jobs, no outlook for any, and little hope.

    Social justice? Government can help by trying to get the gang bangers & drug dealers locked up. Then perhaps the city could be turned around IF tax incentives are put in place that encourage businesses to move back into the city. The rest of the solution has to come from within at that stage- the residents themselves have to become actively engaged and involved in bettering their lives.

    If people have a safe place to live and a job to allow them to support their family, then safe schools for their children it is then up to the individual to strive for achievement in order to achieve the education or skills needed to climb out of poverty. No government program or “war on poverty” can succeed until the drive to succeed and achive something burns inside the individual.

  • Jennie

    November 19, 2009 at 12:09 pm

    I want to read Cherry Ames too! Working in the county ED I can clearly see your points. We see the same people coming in with no access to basic human needs let alone access to healthcare. I can talk till I am blue about smoking, drugs and eating healthy, but these folks are in survival mode. I am all for getting everyone a pair of boots! Thanks for your posts, I love reading them.

  • Stephanie Thorvalson

    November 20, 2009 at 10:11 pm

    Hi, Kim! New reader and loving it. Re: Grand Rounds, I’m not sure what the protocol is for submissions, but I’m a nursing student graduating next month and frequently blog about my experiences. Take a gander if you like and feel free to link.

    Keep up all the good work!

  • Stephanie Thorvalson

    November 20, 2009 at 10:12 pm

    K, well, I thought the website address would be published, too. Oops!


  • storytellerdoc

    November 23, 2009 at 4:10 am

    Great website. Enjoyed reading your various topics. I just started my own site and am a little nervous here. It should be fun, though.

    I will be following.

  • […] It Matters Where You Live […]

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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