The United States is a leading force on many fronts, but, unfortunately, healthcare isn’t one of them. The Commonwealth Fund recently released a report on healthcare in the U.S. compared to other high-income countries, and the title says it all: Mirror, Mirror 2021: Reflecting Poorly.
The U.S. ranked dead last among 11 countries in terms of healthcare services for citizens. So, what is contributing to this poor performance?
Consequences of Health Inequities
The Commonwealth Fund looked at five domains of healthcare in its analysis:
- Access to care
- Care process
- Administrative efficiency
- Health care outcomes
While equity was its own domain, one can see how the others intertwine and contribute to large-scale inequity. For example, the U.S. remains the only high-income country lacking universal health insurance coverage. This shortcoming limits access to care. Individuals with lower incomes in communities with few healthcare resources have poorer health outcomes.
It’s important for all healthcare workers, including nurses, to understand the consequences of inequity — both on an individual patient level as well as within the bigger picture of the healthcare landscape.
Pro-Equity Efforts Nurses Can Employ Today
A definition by the World Health Organization (WHO) sets the stage for this conversation. WHO defines health inequities as, “systemic differences in the health status of different population groups.”
While not all-encompassing of pro-equity efforts, a great place for nurses to start is with the following inclusive practices:
1) Gender-Affirming Language/Use of Chosen Pronouns
Gender identity exists on a spectrum. For example, in the transgender community, each individual may have different identity preferences, such as identifying as non-binary, gender-expansive, genderqueer or trans-feminine/trans-masculine. Therefore, nurses need to avoid assumptions about any one person and their gender expression. Even if unintentional, a misguided belief puts patients in an uncomfortable position — at best.
2) Trauma-Informed Care
Trauma is often a hidden affliction. In the case of adverse childhood experiences (ACEs), trauma can linger for years. Adult abuse or rape victims also often live with persistent anguish. Sometimes, the mental and emotional pain manifests in physical form. If no one ever attempts to explore what’s lying underneath the surface, they will never resolve the pain.
To be clear, trauma-informed care is not trauma-specific care. This approach does not propose nurses “heal” the trauma or even address it directly. Rather, nurses and other healthcare professionals can help patients develop resiliency, improve function and optimize well-being.
3) Racial Health Disparities Awareness
The COVID-19 pandemic highlighted disparities among African American, Indigenous and Latinx populations, but racial inequity has far more extensive history. Professor Anna Valdez, Ph.D., RN, CEN, CNE, CFRN, FAEN, FAADN, explains that patients who seek care from someone with a shared background have better outcomes. For example, African American children cared for by African American doctors do better than if they were cared for by a doctor of another race.
Valdez is adamant this must change. “Nursing needs to recognize race as a social construct rather than a biological construct, and I think many nurses don’t understand that yet,” she states. Valdez’s advice is for nurses to look within and recognize how they might be perpetuating systemic racism or other forms of oppression in the workplace.
4) Staff Diversity and Inclusion
Diversity in the nursing profession allows staff to learn from each other — and lean on each other — when different cultural encounters arise. Inclusion is going one step further.
Eileen P. Williamson, MSN, RN, writes that, “Simply put, inclusion is not just being present, but being part of things. Inclusion should be viewed as a celebration of each person’s uniqueness and value and an invitation for them to share their unique gifts with us.” She urges that inclusion not be limited to just staff but also extended to patients, visitors and other professionals within the healthcare realm.
5) Cultural Awareness
Diversity and inclusion go a long way in ensuring patients of differing cultures are not just appropriately cared for but really valued on an equal level. Cultural awareness is the first step towards cultural competence, the willingness and ability to understand and interact with people of different cultural groups — whether rooted in race, gender, sexuality, socioeconomic status, disability, educational background, age or religion.
Health Equity Is Within Reach
All the above practices ensure a more cohesive workplace environment which, in turn, leads to better patient care and improved health outcomes. There’s still much to be done. However, a nurse’s educational training, alongside nursing leadership, can be highly influential in changing long-standing biases in the nursing profession.
“We have to look around and see who should be in the discussion, who should be in the profession and who is underrepresented,” Valdez notes.