Editor’s note: This commentary is by Vicki Harrison MSN of Barnard, retired from 45 years in social work and community health nursing, with a subspecialty in mental health and substance abuse.

Believe it or not, “social determinants of health” have been a main study of social work and community health nursing for 100+ years. Bachelors of science students in community health nursing spend their senior year studying their communities and learning how to be effective in community health assessment and care. Informally, midwives and herbalists have always intrinsically understood these human circumstances and their wide-ranging effects. Prior to the last several years, very few doctors were ever interested in discussing these factors, as these factors did not MAKE MONEY! This is the wrong time for such a complex, expensive, undoable, potentially privacy-exposing program in a U.S. system that provides minimal safety net and a tiered health care approach.

Dartmouth-Hitchcock and UVM Medical Center are the big players here, and OneCare represents their taking of resources via privatization. The goal is to decrease health expenses in a money-making venture where providers receive funds based on their care effects. U.S. Public Health Infrastructure was deconstructed 25 years ago. Further, nursing, growing in its educational basis in the 1980s, began to assert its priorities for underserved populations, and was promptly sidelined by the stated priorities of ‘managed care.’ The lack of creative nursing perspective in the media is profound. Nurses, however, are trusted 90% vs. physicians trusted at 45%.

Nursing always provides the check and balance to medicine. Licensed nurses are trained to provide only appropriate care to patients. Thus, in whatever setting we specialize — ICU, orthopedics, medical, or community health — we integrate the expected medical standards into patient care, questioning and seeking clarification of inappropriate MD orders for a patient condition and executing nursing standards. continue reading