Development of the role of public health nurses in addressing child and family poverty: a framework...

Development of the role of public health nurses in addressing child and

family poverty: a framework for action

Benita E. Cohen & Linda Reutter

Accepted for publication 4 September 2006

Correspondence to Benita E. Cohen:

e-mail: [email protected]

Benita E. Cohen PhD RN

Assistant Professor

Faculty of Nursing,

University of Manitoba, Winnipeg,

Manitoba, Canada

Linda Reutter PhD RN

Professor

Faculty of Nursing,

University of Alberta, Edmonton,

Alberta, Canada

This article is part of the CSE Global Theme

Issue on Poverty and Human Development.

This is an international collaboration,

involving journals from developed and

developing countries, aimed at raising

awareness, stimulating interest, and

stimulating research into poverty and human

development. Please visit the following

website for more details: http://

www.councilscienceeditors.org/

globalthemeissue.cfm

COHEN B.E. & REUTTER L. (2007)COHEN B.E. & REUTTER L. (2007) Development of the role of public health

nurses in addressing child and family poverty: a framework for action. Journal of

Advanced Nursing 60(1), 96–107

doi: 10.1111/j.1365-2648.2006.04154.x

AbstractTitle. Development of the role of public health nurses in addressing child and family

poverty: a framework for action

Aim. The purpose of this paper is to invite dialogue about how public health nurses

could best address child and family poverty. Their current role is reviewed and a

framework for expanding this role is presented.

Background. The negative health consequences of poverty for children are well-

documented worldwide. The high levels of children living in poverty in wealthy

industrialized countries such as Canada should be of concern to the health sector.

What role(s) can public health nurses play in addressing child and family poverty?

Method. A review of scholarly literature from Canada, the United States of America

and the United Kingdom was conducted to ascertain support for public health

nurses’ roles in reducing poverty and its effects. We then reviewed professional

standards and competencies for nursing practice in Canada. The data were collected

between 2005 and 2006.

Findings. Numerous nursing scholars have called for public health nurses to address

the causes and consequences of poverty through policy advocacy. However, this role

was less likely to be identified in professional standards and competencies, and we

found little empirical evidence documenting Canadian public health nurses’ efforts

to engage in this role. Public health nurses’ roles in relation to poverty focus pri-

marily on assisting families living in poverty to access appropriate services rather

than directing efforts at the policy level. Factors associated with this limited

involvement are identified. We suggest that the conceptual framework developed by

Blackburn in the United Kingdom offers direction for a more fully developed public

health nursing role. Prerequisites to engaging in the strategies articulated in the

framework are discussed.

Conclusion. Given more organizational support and enhanced knowledge and skills,

public health nurses could be playing a greater role in working with others to make

child and family poverty history.

Keywords: child poverty, evidence-based practice, nurses, population health pro-

motion, public health, social policy

THEORETICAL PAPERJAN

96 � 2007 The Authors. Journal compilation � 2007 Blackwell Publishing Ltd

Introduction

Poverty remains an important issue in many industrialized

nations worldwide. Indeed, the recent ‘Make Poverty His-

tory’ campaign has received widespread public support

among citizens of developed countries. Although there is

evidence that the campaign’s key messages have filtered down

into government policy rhetoric in some cases [see Depart-

ment For International Development 2005, for a United

Kingdom (UK) example], there is little evidence of substantial

government action to reduce poverty in some of these

countries. In spite of being one of the wealthiest nations in

the world, Canadian poverty rates remain high compared

with most other nations within the Organization for Econo-

mic Co-operation and Development (OECD) (Bryant 2006).

According to the United Nations Children’s Fund (UNICEF

2005), Canada ranks 19th of 26 OECD countries in a global

survey of child poverty rates in industrialized countries (the

US ranked 25th) with one child out of every six in Canada

living in poverty (Campaign 2000, 2005). Poverty rates are

much higher, however, for Aboriginal children (40%) and

recent immigrant children (49%) (Campaign 2000, 2005).

Poverty rates in Canada are determined using Statistics

Canada’s ‘Low Income Cut-Off’ (LICO) income levels at

which Canadians, differentiated by family size and the

population of their community, spend 20% more of their

income on basic needs than the average proportion spent by

Canadians. Currently, families who spend >54Æ7% of their

income on basic needs are living below the LICO (Ross et al.

2000). A striking feature of child poverty in Canada is that,

contrary to common stereotypes of the poor, 31% of all low-

income children lived in families with at least one parent

working full-time, full year (Campaign 2000, 2005).

The negative physical and social health consequences of

poverty for children are well-documented worldwide (Schor

& Menaghan 1995, Phipps 2003). In Canada, infant

mortality rates in low-income neighbourhoods are almost

double that in high-income neighbourhoods, and children

from the poorest neighbourhoods have the highest rates of

low birth weight, infant hospitalization, teen pregnancy,

developmental problems such as hyperactivity and delayed

vocabulary, and the lowest rates of high school completion

(Kidder et al. 2000, Manitoba Centre for Health Policy

2004). There is also increasing evidence of a cumulative effect

of adverse economic and social conditions across the life span

that predisposes individuals to adult chronic disease, stroke

and adult-onset diabetes (Kuh & Ben Shilmo 1997, Raphael

& Farrell 2002, Davey Smith 2003, Raphael et al. 2003,

Raphael 2004). Given this link between early childhood

experiences and later health status, the persistent high levels

of children living in poverty in Canada (and elsewhere)

should be of particular concern to the health sector.

Public health nurses (PHNs) are in an ideal position to

build the capacity of the health sector to address child and

family poverty (CFP). Every day they encounter low-income

families while providing health promotion and illness/injury

prevention services in homes, clinics and schools. Yet, there is

little documented evidence of their involvement in poverty-

related work. The purpose of this paper is to invite dialogue

and discussion about how PHNs could best work to address

CFP. We begin by examining the current role of PHNs in

addressing CFP and then discuss a framework that may assist

nurses to expand their roles in this area. The focus on CFP is

not intended to suggest that poverty among other population

groups, such as homeless adults and older people, is less

important, nor that PHNs do not have a role in addressing

poverty among these other groups. Given that a significant

proportion of PHNs’ work is devoted to maternal-child care,

their potential impact on CFP is particularly strong. This is

also the case in other jurisdictions; for example, the PHN role

in the United States of America (USA) is very similar to that

in Canada and, in the UK, ‘health visitors’ provide similar

maternal-child care.

Support for public health nurse role in addressingchild and family poverty

The fact that the historical development of public health

nursing is grounded in struggles for basic human rights and

social justice has been well documented (Rogge 1987,

Erickson 1996, Drevdahl 2001, Falk-Rafael 2005a). There

is also theoretical and professional/regulatory support for

developing PHNs’ role in addressing poverty, which will be

the focus in the next two sections.

Theoretical support

MacDonald (2002) notes that the foundational concept of the

environment in nursing practice has been challenged to

expand from a traditional narrow focus on the psycho-social

environment of the individual to a broader focus on the

socio-political context that affects the health of individuals,

groups and communities. This view has led to consideration

of an expanded conceptualization of a health-promoting

nursing practice. Perhaps the most well-known proponent of

an expanded notion of the contextual influences on health

(and nursing practice) is Butterfield (2001), who proposed a

theoretical perspective that focuses attention on the broad

societal factors that shape individual behaviour. Using this

approach, nurses would be expected to make an effort to

JAN: THEORETICAL PAPER Addressing child and family poverty

� 2007 The Authors. Journal compilation � 2007 Blackwell Publishing Ltd 97

change social conditions affecting their clients. This notion of

using an ‘upstream’ approach is often discussed within the

context of developing ‘population-focused’ or ‘population-

based’ nursing practice (Kuss et al. 1997, Keller et al.

2004a,b, SmithBattle et al. 2004).

The challenge of expanding the role of nursing to that of

social change agent or social activist (rather than changing

individual beliefs and practices) has been raised by several

nursing scholars, many of whom are influenced by critical

social theory and feminist theory. For example, social change

is viewed as a central concern of those who espouse

‘emancipatory nursing’ – which aligns nurses with the

oppressed to help them take action to change the forces of

oppression – as opposed to traditional nursing, which aligns

with dominant interests to help people cope and adapt to

their oppression (Moccia 1988, Kendall 1992, Stevens &

Hall 1992, Drevdahl 1995, Maxwell 1997, Starzomski &

Rodney 1997). VanderPlaat (2002) continues this theme

when she calls on PHNs (and all nurses, for that matter) to

see themselves as potential social activists, committed to an

emancipatory ethic, who challenge barriers that stand in the

way of meaningful social change.

Recently, Falk-Rafael (2005b) put forward the concept of

‘critical caring’, which aims to reincorporate the social justice

agenda characteristic of early public health nursing practice

that has not featured prominently in contemporary nursing

theories. One of the core ‘carative’ processes of PHNs’

practice that she identifies is contributing to the creation of

supportive and sustainable physical, social, political and

economic environments. Falk-Rafael argues that nurses who

practice at the intersection of public policy and personal lives

are ideally situated to include political advocacy efforts to

influence policy related to poverty and other social-economic

determinants of health. She joins others (Stevens & Hall

1992, Byrd 1995, Williamson & Drummond 2000) in

arguing that nurses have a moral/ethical and professional

obligation to be involved in socio-political activities that

address structural conditions contributing to health inequities

because they see the impact of these conditions every day.

Public health nurses’ role in advocating for healthy public

policies – including those that address root causes of ill health

such as poverty – has been clearly articulated in the literature

(e.g. Needleman 1995, Erickson 1996, Daly 1999, Falk-

Rafael 1999, Reutter 2000, Reutter & Williamson 2000,

Burdett 2002, Reutter & Duncan 2002, Drennan 2004,

Lynam 2005, Stewart et al. 2005). Daiski (2005) states: ‘As

nurses and healthcare practitioners on the frontlines…we

need to advocate for social equity, adequate welfare and

disability payments, wages that people can live on, affordable

housing as a right, and social inclusion of the poor’ (p. 37).

Needleman (1995) suggests that there are two levels of

advocacy that nurses can engage in: ‘case advocacy’ directed

at individual clients, and ‘class advocacy’ directed at chan-

ging policies and social conditions.

As far as PHNs’ role in addressing CFP specifically, there is

limited discussion in the nursing literature. The benefits of

PHN-managed home visitation to vulnerable and at-risk

families in early childhood are well-documented (Ciliska

et al. 1999, Hanks & Smith 1999, MacLeod & Nelson 2000,

Rains & Carroll 2000, Barnes-Boyd 2001, Olds et al. 2002,

Kemp et al. 2005), but these examples contain little or no

discussion of PHNs’ strategies for addressing poverty itself.

Williamson and Drummond (2000) point out that traditional

health education sessions with PHNs alone are not adequate

to significantly enhance low-income parents’ capacities to

promote their children’s health; they need to be accompanied

by policy advocacy and social action strategies that challenge

the socio-economic and political conditions that negatively

affect child health. The need for PHNs (and other nurses) to

address broader determinants of health of vulnerable or

marginalized families – such as food security (Bull 1996),

housing security and safe neighbourhoods (Handelman 2003,

Welch & Kneipp 2005), and access to welfare benefits

(Greasley 2005) – is also identified in the literature. Reutter

(2000) acknowledges the importance of supporting families

living in poverty, but argues that nurses must also attempt to

change public policy contributing to family poverty. She

describes how a continuum of empowering strategies (adap-

ted from Labonte 1993) – increasing personal empowerment,

small group development, community development, policy

advocacy, social/political action – can be used by community

health nurses when working with low-income families. A

conceptual framework that specifically addresses CFP is

provided by Blackburn (1992). The details of this framework,

including its potential for guiding the role of PHNs in

addressing CFP, will be discussed later in the paper.

Professional/regulatory support

In addition to historical and theoretical support for the role

of nurses in addressing poverty, this role is supported by

professional standards of practice and position statements,

although the depth and scope of support varies. At the

international level, the International Council of Nurses

(2004) states that nurses have a vital role in reducing poverty

and its impact on health and well-being, including such

activities as forming intra- and inter-sectoral partnerships and

networks to advocate for anti-poverty measures (e.g. job

creation, income supplements); assessing the impact of

poverty through family- and community-based care; lobbying

B.E. Cohen and L. Reutter


for equity in health and social services for the poor; and

lobbying for pro-poor social and health policy. In the USA,

Ballou (2000) has reviewed American Nursing Association

(ANA) position papers and standards of practice, and

concludes that nurses have a professional obligation to

engage in socio-political activities to facilitate equal access

to health care. However, nurses’ obligation to engage in

macro-level activities related to reform of public policy,

social, economic and cultural structures and systems is not

clearly spelled out in these documents.

In Canada, the Canadian Nurses Association (CNA) has

released several discussion papers that provide strong support

for nurses’ role in addressing poverty. Social determinants of

health and nursing: a summary of the issues (CNA 2005)

summarizes the impact of social and economic factors (such

as poverty and economic inequality, low social status, social

exclusion, job and food insecurity) on population health. The

CNA suggests that nurses can play an important role in

addressing these social determinants of health (SDOH) by

working on their individual practices (e.g. including SDOH

in client assessments and treatment and follow-up plans),

helping to reorient the healthcare system (e.g. ensuring that

health promotion programmes go beyond lifestyle and

behaviour to include SDOH), and advocating for healthy

public policies (e.g. using stories from patients to help

advocate for policies that address SDOH, making decision-

makers aware of the research on the links between socioe-

conomic factors and health). In Social justice: a means to an

end, an end in itself (CNA 2006a), it is proposed that, in

order to put social justice into practice, the nursing profession

must work towards 10 specific attributes, including ‘projects,

programmes and/or structural reforms of an economic,

political or social nature that reduce poverty, increase the

overall standard of living and/or increase the participation of

the poor in social and political life’ (p. 14).

The CNA’s (2002) Code of Ethics for Registered Nurses

also provides some support for PHNs’ role in addressing

poverty. It suggests that nurses should promote social justice

by advocating for health and social conditions that allow

persons to live and die with dignity, and encourages nurses ‘to

the extent possible in their personal circumstances to work

individually as citizens or collectively for policies and proce-

dures to bring about social change…’ (e15). However, these

statements are buried within a much larger discussion of the

need for nurses to ensure equity and fairness in the allocation

of healthcare services. Advocacy for an equitable allocation of

social and economic resources needed for health is not

presented explicitly as an ethical responsibility of the nurse.

A recent CNA (2006b) discussion paper on the ethical

challenges of PHN practice is a welcome development in

terms of recognizing that ethical considerations in public

health practice (where concern for the common good is the

prime motivating principle) are often very different from

those in other areas of nursing (where concern for individual

rights and autonomy takes precedence). The discussion

paper acknowledges the need for public health practice to

be informed by ‘advocacy ethics’, which considers the

interests of populations, particularly the powerless and

oppressed. Unfortunately, the concept of advocacy ethics in

the context of public health nursing practice is not elabor-

ated upon, nor is there any reference to the PHN role in

advocacy to reduce poverty or related conditions (e.g.

unaffordable housing and food insecurity) that are root

causes of ill health.

At the provincial/territorial level – where responsibility for

regulation and licensing of nurses resides – standards for

nursing practice and/or entry-level competencies for nurses

provide only lukewarm support for nurses’ role in addressing

poverty. We reviewed standards/competencies for all prov-

inces and territories (except Quebec) (see Table 1). We found

no references to addressing the SDOH in any of the

‘standards for nursing practice’. Entry-level competencies in

six provinces (British Columbia, Manitoba, Nova Scotia,

Ontario, Prince Edward Island, Newfoundland/Labrador)

and two territories (NWT, Nunavut) refer to the need to

consider broad determinants of health in nursing practice;

however, there are no references to competencies related to

interventions to address SDOH such as poverty. In these

documents, references to nurses’ advocacy role is limited to

advocacy for clients’ rights related to healthcare needs; there

are no references to nurses’ role in advocacy for public

policies that influence population health.

The strongest support for nurses’ role in addressing poverty

comes from the Community Health Nurses Association of

Canada (CHNAC) (2003), which has developed Standards of

Practice that become basic practice expectations after 2 years

of experience in any of the domains of practice, education,

administration or research. Some of the nursing actions and

responsibilities identified in the Standards include identifying

and seeking to address root causes of illness and disease;

identifying which determinants of health require action/

change to promote health; promoting social responsibility for

health; applying principles of social justice and engaging in

advocacy in support of those who are as yet unable to take

action for themselves; and supporting community action to

influence policy change in support of health. The Standards

also state that the community health nurse has ‘an advocacy

function in creating policy, system and resource allocation

change (class advocacy) to increase opportunities for health

within society’ (p. 6).



Theory–practice gap

In spite of historical, theoretical and professional support for

the role of PHNs in addressing poverty, there is relatively little

empirical evidence documenting Canadian PHNs’ efforts to

engage in this role in practice. This is not to say that poverty-

related issues are not important or recognized by PHNs. On

the contrary, several studies of PHN practice in Canada

indicate that working with individuals, families and groups

who are vulnerable due to a variety of social determinants

such as poverty and social exclusion is an important part of

their role (Reutter & Ford 1996, Falk-Rafael 1999,

MacDonald & Schoenfeld 2003, Meagher-Stewart & Aston

2004, Cohen 2006). The role of PHNs in providing support to

families at risk of poor infant/child health outcomes is well

documented (Kearney et al. 2000, Williamson & Drummond

2000, Jack et al. 2002, Drummond & Marcellus 2005).

However, there is a little discussion in the literature about a

formal PHN role in monitoring, alleviating and reducing child

and family poverty and its related conditions. Few studies

have explored the extent to which PHNs engage in policy

advocacy and social action strategies that challenge and

attempt to modify socioeconomic and political conditions that

contribute to health inequities, and there is some indication

that involvement in such activities is limited (Williamson &

Drummond 2000).

This limited involvement has been associated with a

number of factors, including PHNs’ perception that they

lack the requisite knowledge and skills (and/or personality) to

engage in these types of activities; belief in personal respon-

sibility for health; lack of time, often due to the demands of

expanding mandatory programmes; lack of support/encour-

agement from managers (who may lack appropriate know-

ledge and skills as well); an organizational philosophy that

Table 1 List of Canadian Nurses’ Organization Regulations Consulted

Name of organization Details of publication

Alberta Association of Registered Nurses

(AARN)

Professional Conduct: Nursing Practice Standards. AARN, Edmonton, AB, 1999

Association of Nurses of Prince Edward

Island (ANPEI)

Standards for Nursing Practice. ANPEI, Charlottetown, PEI, 1999

Entry-level Competencies for Registered Nurses in the Year 2001. ANPEI,

Charlottetown, PEI, 1999

Association of Registered Nurses of

Newfoundland and Labrador (ARNNL)

Standards for Nursing Practice in Newfoundland and Labrador. ARNNL,

St John’s, NFLD (n.d.)

Competencies Required by Registered Nurses for Entry to Practice, 2000–2001.

ARNNL, St John’s, NFLD, 1998

College and Association of Registered

Nurses of Alberta (CARNA)

Entry-to-Practice Competencies. CARNA, Edmonton, AB, 2005

College of Nurses of Ontario (CNO) Professional Standards. CNO, Toronto, ON, 2004

Entry to Practice Competencies for Ontario Registered Nurses as of January 1, 2005.

CNO, Toronto, ON, 2004

College of Registered Nurses of British

Columbia (CRNBC)

Professional Standards for Registered Nurses and Nurse Practitioners. CRNBC,

Vancouver, BC, 2005

College of Registered Nurses of Manitoba

(CRNM)

Standards of Practice for Registered Nurses. CRNM, Winnipeg, MB, 2004

Entry Level Competencies for Registered Nurses in Manitoba. CRNM,

Winnipeg, MB, 2004

College of Registered Nurses of

Nova Scotia (CRNNS)

Standards for Nursing Practice. CRNNS, Halifax, NS, 2003

Entry-level Competencies for Registered Nurses in Nova Scotia. CRNNS,

Halifax, NS, 2004

Northwest Territories Registered Nurses

Association (NWTRNA)

Entry-level Competencies for Registered Nurses in the Year 2002. NWTRNA,

Yellowknife, NWT, 2000

Standards of Practice for Registered Nurses. NWTRNA, Yellowknife, NWT, 2002

Nurses Association of New Brunswick

(NANB)

Standards for Nursing Practice. NANB, Fredericton, NB, 1998

Entry Level Competencies. NANB, Fredericton, NB, 2000

Registered Nurses Association of British

Columbia (RNABC)

Competencies Required of a New Graduate. Registered Nurses Association of

British Columbia, Vancouver, BC, 2000

Saskatchewan Registered Nurses’

Association (SRNA)

Standards and Foundation Competencies for the Practice of Registered Nurses.

Saskatchewan Registered Nurses’ Association, Regina, SK, 2000

Yukon Registered Nurses Association

(YRNA)

Standards for Registered Nursing Practice in the Yukon. Yukon Registered Nurses

Association, Whitehorse, YT, 2005



does not promote these activities; workload measures that do

not capture these activities; narrow job descriptions; and

limited understanding/recognition among the public and

other health professionals about the potential role of the

PHN in these activities (Chalmers & Bramadat 1996, Leipert

1996, Reutter & Ford 1998, Meagher-Stewart 2001, Mac-

Donald & Schoenfeld 2003, Falk-Rafael 2005a, Cohen

2006).

A similar situation exists in the USA where, in spite of a

large body of literature describing the efforts of PHNs to

improve access to health services for under-serviced popula-

tions, there is evidence that most nurses are only minimally

involved in activities related to policy advocacy or social

action (Ballou 2000).

Moving forward: a framework for action

Blackburn (1992) has developed a useful framework that

outlines three broad roles for practitioners who work with

families living in poverty. Monitoring refers to gathering and

analysing information to assess the impact of poverty on

families. Alleviating and preventing involves helping families

to avoid and alleviate the effects of poverty. Bringing about

social change involves working for changes to team, organ-

izational, and government policies with the goal of reducing

or eliminating poverty. These roles can be carried out at

various levels of intervention: at the individual/family level; at

the neighbourhood/community level; and at the district/

regional level. Tables 2–4 outline activities/strategies within

each of the three broad roles that PHNs can use when

working with families living in poverty. A few salient issues

regarding each of the broad roles are discussed below.

Although some of the examples of activities (in the tables and

below) are taken from the Canadian context, the central

issues also will be relevant to PHNs elsewhere.

Monitoring

Public health nurses regularly encounter low-income families

in their work. As a result, they are in an ideal position to play

a vital monitoring role through assessing and recording the

effects of poverty on the health and well-being of children

and families. PHNs can provide information to local/regional

health authorities that ‘top down’ demographic and epide-

miological data can not capture, e.g. the living conditions of

families, their subjective experience of income, housing, and/

or food insecurity, and what families identify as their

personal and material support needs (including their need

for social services and child care services). In this way PHNs

can be ‘the eyes and ears’ of the poor, giving a voice to the

Table 2 Public health nurses’ monitoring role in addressing child and

family poverty

Monitoring: gathering and analysing information to assess the impact

of poverty on children and their families through:

• Poverty and health profiling (assessment)

• Monitoring and evaluating effectiveness of service provision in

meeting needs of low-income families

• Monitoring how specific non-health-sector policies affect families

(e.g. minimum wage, child care and housing)

• Monitoring how specific health-sector policies affect families (e.g.

Healthy Living)

Adapted from Blackburn (1992).

Table 3 Public health nurses’ role in alleviating child and family

poverty

Alleviating: helping families to avoid and alleviate the effects of

poverty through:

• Helping families to maximize income levels (e.g. helping families to

claim benefits)

• Case advocacy (e.g. with the Department of Child and Family

Services)

• Improving access to early childhood development services for poor

families, especially those at risk for poor child health outcomes (e.g.

Head Start, Baby First)

• Minimizing the financial and emotional costs of using services (e.g.

by offering them in easily accessible venues, at convenient times,

and in a format that is culturally and socially acceptable to different

ethnic and social groups

• Providing information about services (e.g. low-cost recreational or

parent support programmes), particularly about how to use and get

access to them

• Targeting resources to those with greatest needs

• Providing support and working in partnership with individuals and

groups


Table 4 Public health nurses’ role in bringing about social change

Bringing about social change: working for changes to team, local,

regional, and/or national policies through:

• Using empowering strategies with clients

• Initiating community discussion (directly or through use of the

media) about how poverty affects child and family health and how

policies can lock families into poverty

• Taking every opportunity to get the issue of child and family

poverty on the agenda of PHNs’ professional associations, their

employers, and their community partners

• Working with intra- and inter-sectoral partners for the development

of policies that decrease child and family poverty (e.g. employment

and education programs, living wages and adequate welfare in-

comes, child tax credits, access to affordable childcare and afford-

able housing)

• Transferring knowledge, skills, and control to local people so that

they have the information and resources to challenge the social and

economic causes of poverty themselves




effects that poverty has on health (Doult 1998). While

poverty monitoring, or profiling, has received little attention

in the discourse on PHN role development in North America,

it has received significant attention in the UK, where it is

considered a professional responsibility of community health

nurses (Royal College of Nursing 1996).

Blackburn discusses the practitioner’s role in monitoring

and evaluating the effectiveness of service provision, noting

that evaluation is the only consistent way to learn whether,

on balance, the strategies and responses of the health system

to family poverty are positive and achieving their intent. It

could be added that evaluation is also the only way to learn

whether public health programmes address the needs of low-

income families. For example, many public health depart-

ments in Canada are initiating programmes under the

‘Healthy Living’ initiative (Public Health Agency of Canada

2005). One of the stated goals of this initiative is to reduce

inequalities in health (including those related to socio-

economic status), yet concern has been expressed that the

definition of ‘Healthy Living’ makes no reference to condi-

tions of daily life as determinants of health, reducing the

focus to health-related behaviours (Raphael & Bryant 2006).

In its recent Annual Report, the Health Council of Canada

(2006) concluded that the targets set by the ‘Healthy Living’

initiative fail to address inequalities in health. PHNs are in an

ideal position to provide valuable information regarding the

effectiveness of ‘Healthy Living’ strategies in addressing the

needs of children and families living in poverty.

Another monitoring activity in which PHNs can engage,

alluded to by Blackburn, is the creation of ‘health impact

assessment groups’ (our term) to monitor how specific

policies (related to child care, housing, social assistance,

employment, taxation, etc.) affect children and families. An

example of this type of activity occurring among health

visitors in the UK is assigning each nurse in a team to monitor

and periodically report about a specific policy area (Rayner

2003).

The information provided by PHNs through their monit-

oring role can help validate existing research that documents

the impact of poverty and related public policies on child/

family health (e.g. Rude & Thompson 2001, Kerr et al. 2004,

Williamson et al. 2005), and identify the need for further

research. Nurses’ monitoring efforts also form the basis of the

next two areas of work.

Alleviating/preventing

Activities within this role are aimed at helping families to

alleviate or minimize the effects of poverty. The majority of

these activities relate to developing, or increasing, access to

services for low-income families. For example, informing

low-income parents about how to access health and social

services and programmes is an important part of PHNs’ day-

to-day work (Cohen 2003). Facilitating the creation and

operation of community gardens, community kitchens, and

early childhood development initiatives are other examples of

the ways that PHNs can alleviate the effects of poverty on

low-income families. This role can also involve ‘case advo-

cacy’ on an ad hoc basis, where the PHN intervenes on behalf

of a client who is unable (perhaps due to illiteracy or feelings

of powerlessness) to negotiate ‘red tape’ with a particular

government service. In the UK, where many people are

missing out on benefits to which they are entitled, health

visitors are actively involved in helping families to claim

eligible social service benefits (Hoskins & Lakey 1997,

Greasley 2005). Kniepp (2000) discusses community health

nurses’ role in the USA in screening women on welfare who

may be at risk for poor health outcomes and referral to

welfare advocates; otherwise, PHNs’ involvement in welfare

benefits screening/advocacy has received little attention in the

North American nursing literature.

Bringing about social change

Public health nurses have an important role to play in

bringing about social change to reduce child poverty. At the

individual level, using empowering methods of practice is one

way that PHNs can contribute to social change, the assump-

tion being that empowered clients may then have the

confidence, knowledge and skills to engage in community

initiatives to change social and economic policies that

contribute to poverty (Blackburn 1992). However, interven-

tions at the neighbourhood and regional levels will have a

greater effect. For example, Blackburn suggests that nurses

can initiate public discussions on the health effects of poverty

and how policies (e.g. inadequate social assistance rates, lack

of subsidized child care) can lock families into poverty. They

can support local anti-poverty groups, get family poverty on

the agenda of their professional organizations, and use the

media to increase awareness. The information gathered by

PHNs from their monitoring activities could be used by

health regions to advocate for healthy public policies with

appropriate government levels and private sector organiza-

tions, to support community groups who advocate for these

policies, and to inform the public (via the media and other

forms of communication) about the impact of poverty on

child and family health.

Policy advocacy is best done collectively and may be

especially useful in situations where nurses do not have

organizational support for an advocacy role. Nursing organ-



izations are particularly well positioned in this regard as they

have power in numbers, organizational infrastructure, and

political linkages and knowledge. Moreover, these organiza-

tions are often called on to respond to draft documents

regarding potential policy changes and they may in turn

consult with their members before submitting their response

(see, for example, the list of consultation documents on the

UK Royal College of Nursing’s website at http://www.

man.ac.uk/rcn/policy/rcncons.html). Yet, in many countries

including Canada, nursing organizations are not as likely to

engage in advocacy for specific social policy that influences

health (i.e. healthy public policy) as they are for healthcare

policy. A notable exception in Canada is the Registered

Nurses Association of Ontario, which has made efforts to

influence policy in such areas as homelessness, social exclu-

sion, inadequate welfare support and minimum wages (see

their website at http://www.rnao.org). Several nursing organ-

izations (e.g. CNA, College and Association of Registered

Nurses of Alberta) have excellent information on their

websites about strategies that would assist individual nurses

to engage in policy advocacy in their own jurisdictions.

Beyond nursing organizations, PHNs can also work colla-

boratively with other professionals through multi-disciplin-

ary organizations such as public health associations (e.g.

Canadian Public Health Association and its provincial/

territorial affiliates).

Prerequisites for role development

There are three prerequisites for developing PHNs’ role in

addressing CFP.

Appropriate knowledge and skills

Blackburn (1992) suggests that nurses need to have

comprehensive knowledge about several issues related to

CFP, including: how poverty in general, and CFP in

particular, is defined and measured; the most recent data

regarding the prevalence of CFP in their regions and those

most at risk; and the most recent evidence regarding the

link between poverty and child/family health and well-

being. We suggest that they also need to be knowledgeable

about current social and economic policies that might be

affecting child/family health, current initiatives in their

community/region to address CFP, potential partners with

whom to collaborate, public understandings of CFP and its

effects, public opinion regarding desired/proposed policy

changes, and the political dynamics of their community/

region that might influence (either hinder or facilitate)

action to address CFP.

However, knowledge on its own may not be sufficient.

Empirical evidence suggests that many PHNs are familiar

with the concepts and principles related to advocacy for

healthy public policy (and other population-level health

promotion strategies), but they do not feel that they have

the skills to apply their theoretical knowledge due to lack of

practice opportunities during their clinical education or

current clinical work (Cohen 2006). Although there is

increasing emphasis on policy advocacy in nursing curricula

(Rains & Carroll 2000, Reutter et al. 2000, Reutter &

Duncan 2002), there is also a need to provide practicing

PHNs with opportunities for continuing education and

practice in these areas.

Appropriate values, beliefs, attitudes

Public health nurses’ ability to address CFP effectively will

require that they place a high value on social justice and

equity, support structural explanations of poverty, believe

that social/political action is a legitimate part of their role,

and have a positive attitude towards individuals living in

poverty. For example, Blackburn (1992) notes the evidence

that health and social service practitioners may find it easier

to redefine financial and material problems as issues of

personal or emotional inadequacy rather than taking into

account structural explanations. Opportunities for PHNs to

explore their values, beliefs and attitudes related to CFP on a

regular basis are essential.

Organizational commitment

Ultimately, the ability of PHNs to fulfil their potential role in

addressing CFP will depend on the support that they receive

from their employers. Without organizational commitment to

put poverty on the central agenda of public health work, even

the most well-intentioned PHNs may be unable to engage

successfully in this type of work. Public health organizations

may be reluctant to challenge government policies when they

depend on government funding; however, there are good

examples of Canadian public health agencies that have not

shied away from an anti-poverty advocacy role (Raphael

2003). Organizational commitment must include resources to

enhance knowledge and skills, and organizational policies

and processes that support PHNs’ work in this area. An

encouraging development in this regard is a recent discussion

paper (Lefebvre et al. 2006), which argues for the integration

of social and economic determinants of health into the formal

mandate of the Ontario public health system, and emphasizes

the need for capacity-building at the level of local boards of

health and public health staff. In Canada, the health sector’s



role in addressing poverty reduction has been limited (Will-

iamson 2001).

According to Blackburn (1992) the key to success in

developing the capacity of frontline practitioners to address

family poverty is team effort. She notes that traditional

approaches to staff development and training provide limited

opportunities for health (and other social service) workers to

explore practice issues together as a team. ‘Putting poverty on

the central agenda of health and welfare work requires teams

to examine together the issue and what it means for their

collective and individual practice’ (p. 3). The idea that teams,

not individuals, are the fundamental learning unit in an

organization, and that the most successful learners use

collective strategies that involve colleagues, staff, supervisors

and clients as co-learners, has led to several action research

initiatives to address poverty (Bond 1997). Intersectoral

collaboration with relevant stakeholders is crucial; involving

low-income people is key to ensure relevancy and can be

empowering (Reutter et al. 2005). Blackburn’s (1992) train-

ing handbook provides a step-by-step approach to team

learning and planning around issues of family poverty,

including exploring attitudes and clarifying views about

poverty. Development of similar capacity-building approa-

ches, adapted to the context of PHN practice in Canada (or

elsewhere), is essential.

Conclusion

There is historical, theoretical, and professional support for

PHNs’ role in addressing child and family poverty.

Although there is documented evidence of their role in

providing support and services to low-income families, there

is relatively little discussion in the literature about their

formal role in monitoring, alleviating, and reducing child

and family poverty and its related conditions. We recognize

that PHNs may be engaging in these activities and therefore

recommend that research be conducted to explore their

current role in addressing poverty in general, and CFP in

particular. Research is also urgently required to explore

strategies to build PHNs’ capacity to address poverty, with

particular emphasis on policy advocacy and social action

strategies. Developing capacity through team building and

team learning approaches with other sectors and profes-

sionals, and with low-income people, is a promising

approach. Given more organizational support and enhanced

knowledge and skills, PHNs could be playing a greater role

in working collaboratively with others to make child and

family poverty history.

Author contributions

BC was responsible for the study conception and design and

the drafting of the manuscript. BC performed the data

collection and data analysis. BC and LR made critical

revisions to the paper.

References

Ballou K. (2000) A historical–philosophical analysis of the profes-

sional nurse obligation to participate in sociopolitical activities.

Policy, Politics, and Nursing Practice 1(3), 172–184.

Barnes-Boyd C. (2001) Promoting infant health through home visit-

ing by a nurse-managed community worker team. Public Health

Nursing 18(4), 225–235.

Blackburn C. (1992) Improving Health and Welfare Work with

Families in Poverty: A Handbook. Open University Press, Buck-

ingham, UK.

Bond M. (1997) A learning team in the making. Journal of Inter-

professional Care 11(1), 89–98.

Bryant T. (2006) Politics, public policy, and population health.

In Staying Alive: Critical Perspectives on Health, Illness, and

Health Care (Raphael D., Bryant T. & Rioux M., eds), Canadian

Scholars Press, Toronto, ON, pp. 193–216.

Bull S. (1996) Cooking on low income. Health Visitor 69(9), 374–

375.

What is already known about this topic

• Poverty has a multitude of negative outcomes for chil-

dren and these may persist into adult life.

• Public health nurses regularly encounter low-income

families in their work and are engaged in assisting them

to deal with the effects of poverty.

• Policy advocacy is key to reducing poverty and its

negative effects.

What this paper adds

• There is strong theoretical support from nursing schol-

ars for a public health nursing role in addressing pov-

erty that includes advocacy for poverty-related issues.

• The role of public health nurses in addressing poverty is

less likely to be identified in professional nursing

standards and competencies in Canada, and there is

little empirical evidence documenting Canadian nurses’

efforts to engage in this role.

• The role of public health nurses in addressing child and

family poverty could be expanded, and the prerequisites

for this role development are appropriate knowledge

and skills; appropriate values, beliefs and attitudes; and

organizational commitment.



Burdett T. (2002) Poverty – a threat to health. Journal of Community

Nursing 16(10), 12–14.

Butterfield P.G. (2001) Thinking upstream: conceptualizing health

from a population perspective. In Community Health Nursing:

Promoting the Health of Aggregates (Swanson J.M. & Nies M.A.,

eds), Saunders, Toronto, ON, pp. 69–82.

Byrd M.E. (1995) A concept analysis of home visiting. Public Health

Nursing 12(2), 83–89.

Campaign 2000. (2005) Decision Time for Canada: Let’s Make

Poverty History. 2005 Report Card on Child Poverty in Canada.

Retrieved from http://www.campaign2000.ca/rc/rc05/05National

ReportCard.pdf on 1 March 2006.

Canadian Nurses Association (2002) Code of Ethics for Registered

Nurses. Retrieved from http://www.cna-nurses.ca/cna/documents/

pdf/publications/codeofethics2002_e.pdf on 27 June 2006.

Canadian Nurses Association (2005) Social Determinants of Health

and Nursing: A Summary of the Issues. Retrieved from http://

www.cna-nurses.ca/cna/documents/pdf/publications/

BG8_social_determinants_e.pdf on 5 April 2006.

Canadian Nurses Association (2006a) Social Justice: A Means to an

End, An End in Itself. Retrieved from http://cna-aiic.ca/CNA/

documents/pdf/publications/social_justice_e.pdf on 5 April 2006.

Canadian Nurses Association (2006b) Public Health Practice and

Ethical Challenges. Retrieved from http://cna-aiic.ca/CNA/

documents/pdf/publications/ethics_in_practice_Jan_06_e.pdf on 5

April 2006.

Chalmers K. & Bramadat I. (1996) Community development: theo-

retical and practical issues for community health nursing in

Canada. Journal of Advanced Nursing 24, 719–726.

Ciliska D., Mastrilli P., Ploeg J., Hayward S., Brunton G. &

Underwood J. (1999) The Effectiveness of Home Visiting as a

Delivery Strategy for Public Health Nursing Interventions to

Clients in the Prenatal and Postnatal Periods: A Systematic

Review. Ontario Ministry of Health, Hamilton, ON.

Cohen B. (2003) Building Capacity for Population Health Promotion

in Manitoba’s Regional Health Authorities. Unpublished Disser-

tation. Manitoba, University of Manitoba.

Cohen B. (2006) Barriers to population-focused health promotion:

the experience of public health nurses in the province of Manitoba.

Canadian Journal of Nursing Research 38(3), 52–67.

Community Health Nurses Association of Canada (2003)

Canadian Community Health Nursing Standards of Practice.

Retrieved from http://www.communityhealthnursescanada.org/

standards/standards%20practice%20jun04.pdf on 28 June 2006.

Daiski I. (2005) The Health Bus. Policy, Politics, and Nursing

Practice 6(1), 30–38.

Daly M. (1999) People not statistics. Nursing Standard 13(34),

22–23.

Davey Smith G. (2003) Health Inequalities: Life-course Approaches.

Policy Press, Bristol, UK.

Department For International Development (2005) Eliminating

World Poverty: A Consultation Document. DFID, London.

Retrieved from http://www.dfid.gov.uk/pubs on 7 September 2006.

Doult B. (1998) Nurses are the ‘eyes and ears’ of the poor. Nursing

Standard 13(2), 10.

Drennan V. (2004) Sustaining public health activities by community

practitioners and health visitors. Community Practitioner 77(9),

325.

Drevdahl D. (1995) Coming to voice: the power of emancipatory

community interventions. Advances in Nursing Science 18(2),

13–24.

Drevdahl D. (2001) Reinvesting in social justice: a capital idea for

public health nursing? Advances in Nursing Science 24(2), 19–31.

Drummond J. & Marcellus L. (2005) Making a difference: using a

social determinants of health approach to strengthen the role of

maternal infant health nursing. Neonatal, Paediatric and Child

Health Nursing 8(1), 6–11.

Erickson G.P. (1996) To pauperize or empower: public health nur-

sing at the turn of the 20th and 21st centuries. Public Health

Nursing 13(3), 163–169.

Falk-Rafael A. (1999) From rhetoric to reality: the changing face of

public health nursing in Southern Ontario. Public Health Nursing

16(1), 50–59.

Falk-Rafael A. (2005a) Speaking truth to power: nursing’s legacy and

moral imperative. Advances in Nursing Science 28(3), 212–223.

Falk-Rafael A. (2005b) Advancing nursing theory through theory-

guided practice: the emergence of a critical caring perspective.

Advances in Nursing Science 28(1), 38–49.

Greasley P. (2005) Welfare advice in general practice: a resource for

community nurses. British Journal of Community Nursing 10(8),

368–372.

Handelman E. (2003) Community rebirth in Cornwall. American

Journal of Nursing 103(8), 77–79.

Hanks C.A. & Smith J. (1999) Implementing nurse home visitation

programs. Public Health Nursing 16(4), 235–245.

Health Council of Canada (2006) Health Care Renewal in Canada:

Clearing the Road to Quality. 2006 annual report. Retrieved from

http://www.healthcouncilcanada.ca on 8 February 2006.

Hoskins R. & Lakey T. (1997) Till death do us part. Nursing Times

93(32), 24–36.

International Council of Nurses (2004) ICN on poverty and health:

breaking the link. Nursing Matters. Retrieved from http://

www.icn.ch/matters_poverty.htm on 22 July 2004.

Jack S., DiCenso A. & Lohfeld L. (2002) Opening doors: factors

influencing the establishment of a working relationship between

paraprofessional home visitors and at-risk families. Canadian

Journal of Nursing Research 34(4), 59–69.

Kearney M.H., York R. & Deatrick J.A. (2000) Effects of home visits

to vulnerable young families. Journal of Nursing Scholarship 32(4),

369–376.

Keller L., Strohschein S., Lia-Hoagberg B. & Schaffer M. (2004a)

Population-based public health interventions: practice-based and

evidence-supported. Part I. Public Health Nursing 21(5), 453–

468.

Keller L., Strohschein S., Lia-Hoagberg B. & Schaffer M. (2004b)

Population-based public health interventions: innovations in

practice, teaching, and management. Part II. Public Health Nursing

21(5), 469–487.

Kemp L., Anderson T., Travaglia J. & Harris E. (2005) Sustained

nurse home visiting in early childhood: exploring Australian nur-

sing competencies. Public Health Nursing 22(3), 254–259.

Kendall J. (1992) Fighting back: promoting emancipatory nursing

actions. Advances in Nursing Science 15(2), 1–15.

Kerr M., Frost D. & Bignell D. (2004) Don’t We Count as People?

Saskatchewan Social Welfare Policy and Women’s Health. Prairie

Women’s Health Centre of Excellence, Winnipeg, MB.



Kidder K., Stein J. & Fraser J. (2000) The Health of Canada’s

Children: A CICH Profile, 3rd edn. Canadian Institute on Chil-

dren’s Health, Ottawa, ON.

Kniepp S. (2000) The consequences of welfare reform for women’s

health: issues of concern for community health nursing. Journal of

Community Health Nursing 17(2), 65–73.

Kuh D. & Ben Shilmo Y. (eds) (1997) A Life-course Approach to

Chronic Disease Epidemiology. Oxford University Press, Oxford,

UK.

Kuss T., Proulx-Girouard L. & Lovitt S. (1997) A public health

nursing model. Public Health Nursing 14(2), 81–91.

Labonte R. (1993) Health Promotion and Empowerment: Practice

Frameworks. Centre for Health Promotion and Participaction,

Toronto, ON.

Lefebvre S., Warren C., Lacle S. & Sutcliffe P. (2006) A Framework

to Integrate Social and Economic Determinants of Health into the

Ontario Public Health Mandate: A Discussion Paper. Sudbury and

District Health Unit, Sudbury, ON.

Leipert B. (1996) The value of community health nursing: a phe-

nomenological study of the perceptions of community health

nurses. Public Health Nursing 13(1), 50–57.

Lynam M. (2005) Health as a socially mediated process. Advances in

Nursing Science 28(1), 25–37.

MacDonald M. (2002) Health promotion: historical, philosophical,

and theoretical perspectives. In Transforming Health Promotion

Practice: Concepts, Issues, and Applications (Young L. & Hayes

V., eds), F.A. Davis Co., Philadelphia, PA, pp. 22–45.

MacDonald M.B. & Schoenfeld B. (2003) Expanding roles for public

health nursing. The Canadian Nurse 99(7), 18.

MacLeod J. & Nelson G. (2000) Programs for the promotion of

family wellness and the prevention of child maltreatment: a meta-

analytic review. Child Abuse and Neglect 24(9), 1127–1149.

Manitoba Centre for Health Policy (2004) Manitoba Child Health

Atlas 2004. Retrieved from http://www.umanitoba.ca/centres/

mchp/reports/child_inequalities on 28 June 2006.

Maxwell L. (1997) Foundational thought in knowledge for social

change. In Nursing Praxis: Knowledge and Action (Thorne S. &

Hayes V., eds), Sage, Thousand Oaks, CA, pp. 203–218.

Meagher-Stewart D. (2001) Public health nurses’ community devel-

opment practice with women in high-risk environments. Unpub-

lished Dissertation. University of Toronto, Toronto, ON.

Meagher-Stewart D. & Aston M. (2004) Fostering Citizen Partici-

pation and Collaborative Practice: Tapping the Wisdom and

Voices of PHNs in Nova Scotia. Dalhousie University, Halifax,

NS.

Moccia P. (1988) At the faultline: social activism and caring. Nursing

Outlook 36(1), 30–33.

Needleman C. (1995) Nursing advocacy at the policy level: strategies

and resources. In Nursing, Health, and the Environment (Pope A.,

Snyder M. & Mood L., eds), Retrieved from http://www.nap.edu/

openbook/030905298X253.html on 23 January 2006, pp. 253–

261.

Olds D.L., Robinson J., O’Brien R., Luckey D.W., Pettitt L.M.,

Henderson C.R., Ng R., Sheff K., Korfmacher J., Hiatt S. & Talmi

A. (2002) Home visiting by paraprofessionals and by nurses: a

randomized controlled trial. Pediatrics 110(3), 486–496.

Phipps S. (2003) The Impact of Poverty on Health: A Scan of

Research Literature. Canadian Institute for Health Information.

Retrieved from http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_

page¼GR_323_E on 28 June 2006.

Public Health Agency of Canada (2005) Healthy Living Strategy.

Retrieved from http://www.phac-aspc.gc.ca/hl-vs-strat/index.html

on 30 November 2006.

Rains J.W. & Carroll K. (2000) The effect of health policy education

on self-perceived political competence of graduate nursing stu-

dents. The Journal of Nursing Education 39(1), 37–40.

Raphael D. (2003) Barriers to addressing the societal determinants of

health: public health units and poverty in Ontario, Canada. Health

Promotion International 18(4), 397–405.

Raphael D. (ed.) (2004) Social Determinants of Health: Canadian

Perspectives. Canadian Scholars’ Press Inc., Toronto, ON.

Raphael D. & Bryant T. (2006) Public health concerns in Canada,

the U.S., the U.K., and Sweden: exploring the gaps between

knowledge and action in promoting population health. In Staying

Alive: Critical Perspectives on Health, Illness, and Health Care

(Raphael D., Bryant T. & Rioux M., eds), Canadian Scholars

Press, Toronto, ON, pp. 347–372.

Raphael D. & Farrell E.S. (2002) Beyond medicine and lifestyle:

addressing the societal determinants of cardiovascular disease in

North America. Leadership in Health Services 15, 1–5.

Raphael D., Anstice S., Raine K. & McGannon K. (2003) The social

determinants of the incidence and management of Type 2 diabetes

mellitus: are we prepared to rethink our questions and redirect our

research activities? Leadership in Health Services, 16, 10–20.

Rayner F. (2003) Community nursing is key to stamping out health

inequalities. Nursing Times 99(41), 10–11.

Reutter L. (2000) Socioeconomic determinants of health. In Com-

munity Nursing: Promoting Canadians’ Health (Stewart M., ed.),

W.B. Saunders Co., Toronto, ON, pp. 174–193.

Reutter L. & Duncan S. (2002) Preparing nurses to promote health-

enhancing public policies. Policy, Politics, and Nursing Practice 3,

294–305.

Reutter L. & Ford J. (1996) Perceptions of public health nursing:

views from the field. Journal of Advanced Nursing 24, 7–15.

Reutter L. & Ford J. (1998) Perceptions of changes in public health

nursing practice: a Canadian perspective. International Journal of

Nursing Studies 35, 85–94.

Reutter L. & Williamson D. (2000) Advocating healthy public pol-

icy: implications for baccalaureate nursing education. Journal of

Nursing Education 39(1), 21–26.

Reutter L., Neufeld A. & Harrison M. (2000) A review of the

research on the health of low income Canadian women. Canadian

Journal of Nursing Research 32(1), 75–97.

Reutter L., Stewart M.J., Raine K., Williamson D., Letourneau N. &

McFall S. (2005) Partnerships and participation in conducting

poverty-related health research. Primary Health Care Research and

Development 6, 356–366.

Rogge M.M. (1987) Nursing and politics: a forgotten legacy. Nursing

Research 36, 26–30.

Ross D.P., Scott K.J. & Smith P.J. (2000) The Canadian Fact Book on

Poverty. Canadian Council on Social Development, Ottawa, ON.

Royal College of Nursing (1996) Profiling Poverty: A Guide for

Nurses in the Community. Royal College of Nursing, London, UK.

Rude D. & Thompson K. (2001) Left in the Cold: Women, Health,

and the Demise of Social Housing Policies. Prairie Women’s

Health Centre of Excellence, Winnipeg, MB.



Schor E.L. & Menaghan E.G. (1995) Family pathways to child

health. In Society and Health (Amick B.C., Levine S., Tarlov A. &

Chapman Walsh D., eds), Oxford University Press, New York,

pp. 18–45.

SmithBattle L., Diekemper M. & Leander S. (2004) Moving

upstream: becoming a public health nurse, Part 2. Public Health

Nursing 21(2), 95–102.

Starzomski R. & Rodney P. (1997) Nursing inquiry for the common

good. In Nursing Praxis: Knowledge and Action (Thorne S. &

Hayes V., eds), Sage, Thousand Oaks, CA, pp. 219–236.

Stevens P.E. & Hall J.M. (1992) Applying critical theories to nursing

communities. Public Health Nursing 9(1), 2–9.

Stewart M., Reutter L., Makwarimba E., Rootman I., Williamson D.,

Raine K., Wilson D., Fast J., Love R., McFall S., Shorten D.,

Letourneau N., Hayward K., Masuda J. & Rutakumwa W. (2005)

Determinants of health-service use by low-income people. Cana-

dian Journal of Nursing Research 37(3), 104–131.

UNICEF (2005) Child Poverty in Rich Countries, Innocenti Report

Card No. 6. UNICEF Innocenti Research Centre, Florence, Italy.

VanderPlaat M. (2002) Emancipatory politics and health promotion

practice: the health professional as social activist. In Transforming

Health Promotion Practice: Concepts, Issues, and Applications

(Young L. & Hayes V., eds), F.A. Davis Co., Philadelphia, PA,

pp. 87–98.

Welch D. & Kneipp S. (2005) Low-income housing policy and so-

cioeconomic inequalities in women’s health: the importance of

nursing inquiry and intervention. Policy, Politics and Nursing

Practice 6(4), 335–342.

Williamson D.L. (2001) The role of the health sector in addressing

poverty. Canadian Journal of Public Health. Revue de Sante

Publique 92(3), 178–183.

Williamson D.L. & Drummond J. (2000) Enhancing low-income

parents’ capacities to promote their children’s health: education is

not enough. Public Health Nursing 17(2), 121–131.

Williamson D.L., Salkie F.J. & Letourneau N. (2005) Welfare

reforms and the cognitive development of children. Canadian

Journal of Public Health. Revue de Sante Publique 96(1), 13–17.



Development of the role of public health nurses in addressing child and family poverty: a framework...

Documents

Transcript of Development of the role of public health nurses in addressing child and family poverty: a framework...