The American Hospital Association (AHA) has renewed its commitment to ending healthcare disparities with its #123forEquity Pledge to Act Campaign. More than 700 hospitals to date have signed on, pledging to increase cultural competency training and stratify at least one quality measure by race, ethnicity, income, or some other social determinant of health within 12 months of taking the pledge.
Health disparities are well documented. According to the Institute of Medicine (IOM), “a large body of published research reveals that racial and ethnic minorities experience a lower quality of health services, and are less likely to receive even routine medical procedures than are White Americans.” The Centers for Disease Control and Prevention report on Health Disparities and Inequalities found that mortality rates from various chronic illnesses were all higher for certain minority populations. For example, while African-American women develop breast cancer at lower rates than white women, they are more likely to die from their disease.
Disparities exist for ethnic populations due to factors that may include:
- Segregation and/or social isolation
- Language barriers or culturally ingrained health behaviors
- Direct and indirect discrimination by the healthcare system
- Environmental factors
- Socioeconomic status
- Access to care and health insurance
This last factor, socioeconomic status, is a particularly strong indicator of health status and outcomes: When people are ranked by income, education, or occupation, those at the top of the hierarchy fare better in terms of health. Even among smokers, those with higher incomes and/or education levels have better outcomes than those at the bottom of the social pyramid. This is why the AHA and other organizations are calling for renewed efforts to build health equity across all populations.
Demographics are shifting in the U.S. Statistical models project that, by 2043, over half of our population will consist of minorities. This means that eliminating health disparities and building health equity is no longer about social justice and medical ethics—it is quickly becoming essential to maintaining a high-quality healthcare system and improving community health.
So what can nurses do?
First of all, it’s important to remember that nurses have a long history of caring for underserved and vulnerable populations, and this should continue—but with a focus on practices that may help to end disparities. Cultural competency can go a long way in helping minority patients overcome barriers that stand in their way of receiving excellent care, particularly for nurse case managers and oncological nurse navigators. An article in Minority Nurse also highlighted the role of nurse educators in engaging nursing students to recognize and work toward eliminating disparities. So if you’re mentoring a younger nurse, don’t hesitate to bring up the subjects of health equity and culturally competent care.
Increasing workforce diversity among nurses will also likely play a role in eliminating disparities. We all know that the majority of nurses have traditionally been white and female. This isn’t changing very rapidly: In 2008, 83.2 percent of nurses still identified themselves as white and non-Hispanic. In its landmark report, The Future of Nursing: Leading Change, Advancing Health, the IOM called for a more diverse nursing workforce and for all providers to increase cultural competency. The idea is that a diverse nursing workforce will be better equipped to serve a diverse community.
No matter what race or ethnicity you identify with, you can support your employer’s efforts to identify disparities through data and eliminate them through proactive quality initiatives. For more information, take a look at the AHA’s Equity of Care Toolkit or the Department of Health and Human Services’ Healthy People web page on disparities.
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