Health equity – the practice of removing obstacles to provide a fair chance at healthfulness – is an issue that affects multiple aspects of the human experience, from economic and sociocultural factors to environmental and societal conditions. Health equity addresses the disparity between health and healthcare and is viewed as both a process and outcome.
For the past two decades, researchers have worked to uncover the definition of health equity and the driving factors behind healthcare disparities. The goal is to advance health equity as a building block of a positive health culture. The leading public health organizations – including the Centers for Disease Control and Prevention (CDC), the American Public Health Association (APHA), the World Health Organization (WHO) and the Robert Wood Johnson Foundation (RWJF) – are collaborating with nurse leaders to outline the critical steps in creating health equity for big-picture solutions.
“System-level changes are needed to reduce poverty, eliminate structural racism, improve income equality, increase educational opportunity, and fix the laws and policies that perpetuate structural inequities,” the National Academies of Sciences, Engineering, and Medicine said in its Communities in Action research report.
A key component of the work is partnerships among healthcare leaders, including nurses who have earned Doctor of Nursing Practice (DNP) degrees. By definition, working in nursing management means performing leadership functions. DNP-educated registered nurses (RNs) have the expertise and ability to determine the best definition of health equity for positive results.
Tips for Evolving Roles and Responsibilities in Health Equity
When the Affordable Care Act (ACA) passed in 2010, the healthcare community was charged with putting a greater emphasis on population health, which is defined as the health outcomes of groups of individuals. Since then, the roles and responsibilities of nurses on all levels have evolved. Because nurses often serve as the primary contact for patients, families and communities, they play a key function in improving how the healthcare system responds to issues, the National Advisory Council on Nurse Education and Practice (NACNEP) said.
Researchers identified nine determinates that drive health inequities:
- Income gaps
- Inferior housing
- Insufficient health systems and services
- Inadequate employment options
- Substandard education opportunities
- Transportation scarcities
- Dangerous social environments
- Public safety limitations
- Shoddy physical environments.
To that end, the Association of Public Health Nurses (APHN) and other healthcare organizations have offered recommendations for nurse leaders as they strive to promote healthcare equity:
Be mindful of the approach
Many communities that have little to no access to healthcare remain leery of providers, sometimes because of language barriers and other times due to a lack of nearby services. Taking small steps to build trust, such as seeking immersion experiences, can ingratiate nurses to a community.
In learning about the challenges that face communities, nurses should remember to display humility and respect of cultures, traditions and beliefs. An awareness of cultural differences can promote greater ties to the community.
Examine the underlying causes of illness and disease in a community
Review the social determinates of health, including the conditions in which residents live, work and age, for a deeper understanding of what causes medical problems.
By reviewing the multiple underlying factors of poor health conditions, nurses can begin to peel back the layers of health inequities. The work can establish pathways to strengthen individual and community health.
Work collaboratively with the community
Establishing a foundation for health equity means chipping away at divisiveness and promoting cooperative work that strengthens the community. Communities that consider themselves full stakeholders in health outcomes can be full contributors to the process and progress.
The APHN said nurses have a responsibility to build new relationships, strengthen old relationships and encourage community members to take charge to create health equity.
Partnerships with community groups, organizations, elected and appointed officials, health and human service professionals and volunteers should be focused on improving human conditions in specific communities.
By working with other agencies and institutions, nurses and other stakeholders can identify strategies, create action plans and implement approaches for health equity.
Advocate for needs
As public health policymakers, DNP-educated nurses are positioned to advocate for needs within communities. Advocacy begins with identifying specific needs, determining who can take the appropriate actions and encouraging dedicated support for improvements. The primary goal should be to protect the health, safety and rights of the individuals and the community.
“Public health nursing leaders are often uniquely placed in government agencies and are often in a position to be consulted on issues related to policy and legislation,” the APHN said. “These opportunities should be embraced as an opportunity to help ‘put the face’ on public health issues and problems. The stories of those we serve can provide a powerful motivation to policymakers and legislators.”
Nurse Education and Health Equity
The NACNEP, which advises the U.S. Department of Health and Human Services and Congress on issues related to nursing education and practice, said nursing education and educators must meet the new demands of the changing healthcare system to promote health equity.
The organization recommends shifting the current undergraduate nursing education model from acute care to a broad-based approach that gives attention to population health, particularly in underserved communities.
“For these populations, nurses need to develop broad-based knowledge, have a cradle-to-grave perspective on health, and learn to work and collaborate in new models of care including interprofessional healthcare teams,” the organization said in its “Preparing Nurses for New Roles in Population Health Management” report.
Indeed, nurse leaders are positioned to redress health inequities in several ways. Since DNP-educated nurses play roles in healthcare leadership and nursing education, they can advance healthcare equity in population health and nurse education.
At Duquesne University, DNP students have the opportunity to address health equity through concentrations that include nursing education, forensic nursing and transcultural nursing. The online DNP program provides opportunities for helping individuals and communities.
About Duquesne University’s Online DNP Program
Duquesne University’s online DNP program prepares graduates to influence health inequities that have plagued the United States for generations. The curriculum builds on existing knowledge and experience for a comprehensive education that is focused on problem solving and innovation.
Students also have an opportunity to participate in one of three residency experiences: academic writing, leadership and abroad. For more information, visit the university’s online DNP program website.
Building a Culture of Health: Robert Wood Johnson Foundation
Communities in Action: National Academies of Sciences, Engineering, and Medicine
Preparing Nurses for New Roles in Population Health Management: National Advisory Council on Nurse Education and Practice
The Public Health Nurse’s Role in Achieving Health Equity: Eliminating Inequalities in Health: Association of Public Health Nurses