I am a nurse, but I have never worked in a hospital or a doctor’s office; I never really wanted to. Hospitals are full of the drama of emergency rooms, operating rooms, of pediatrics and oncology and obstetrics. No thank you! I opted for public-health nursing instead. While other nurses take care of individual patients, I do that plus I help to take care of an entire community, too. That is public health, and we will be celebrating our unique work this year April 4th to 10th during Public Health Week.

My specialty and certification is in HIV; my role at Frederick County Health Department is to provide direct care to individuals living with HIV as well as to provide HIV testing and counseling services. I also work to reduce the incidence of new infections in our community by providing HIV prevention education and referral services.

The motto of public health is three-pronged: Promote, Protect, and Prevent. To this end, those of us in public health collaborate with other organizations and agencies to ensure the highest safety of the public. This can be anything from inspecting restaurants for food safety, to planning to prevent an Ebola outbreak in the country, or to conducting a mass immunization clinic to prevent an H1N1 Influenza (Swine Flu) epidemic. It can also be working with the local school board to develop and implement programs to prevent childhood obesity or working with local employers to promote workplace safety.

Each local health department is structured differently depending on the health issues that directly impact that particular population and that are not addressed in the private sector. For instance, In Frederick County, there aren’t enough infectious disease practitioners to provide care for everyone here living with HIV. When there aren’t enough resources in the private sector to meet the needs for a specific health service, and that health issue left unaddressed could have an impact on the community, then it is up to public health providers, typically the local health department, to step in and manage the issue.

How a local health department is structured can also depend on the funding that is available. During the 2008 economic crisis, when state revenues decreased dramatically, our health department’s funding was cut by 42%, and nearly a third of our nursing staff was laid off. Unfortunately, when budgets are cut, so are services to the public. Eight years later, we still have not recovered from those cuts, and we no longer have an in-house family planning or STI clinic.

Because health department nurses are employed by the state, the recession has meant that we have not had the usual cost-of-living adjustments over the past eight years, and in several years, our pay was actually cut. And that is on top of the fact that Community Health Nurses have the lowest pay scale of all types of nursing. Still for some of us, there is no other kind of nursing we’d rather do.

There will be some really hot topics in public health in 2016. Probably the most noteworthy is our country’s heroin epidemic. If you don’t know it already, we are in big trouble in regards to heroin. We are facing what may be the most devastating drug problem of the past century. Stay tuned to Health Chat for a future article devoted to this public health crisis. Another hot topic is health equity. This is a look at the difference that income, education, race, and access to quality care have in quality and quantity of life. For the less fortunate, these things mean 15 years less in life expectancy.

Did I infer that there was not as much drama in public health as in a hospital? Well maybe that’s wrong – there’s just a different kind of drama. For me, public health is both fascinating and rewarding. It’s kept this nurse happy to come to work each day in the last 13 years.

You can find more information about public-health initiatives here: Apha.org.

Debbie Anne is a public health nurse with the Frederick County Health Department in Frederick, Maryland. In 2014 she was awarded a Governor’s Citation for her work with Marylanders living with HIV/AIDS.