Health

Nursing Committee Outlines Roadmap to Health Equity

Members of the Committee on the Future of Nursing 2020-2030 called on nurses to lead the charge on health equity during a webinar hosted by the National Academies of Sciences, Engineering, and Medicine on Tuesday.

Committee members including nurses, social scientists, and other academics noted that structural racism has led to poorer health outcomes among Black Americans and other minorities for decades.

“Imagine a fully loaded jumbo jet with 220 passengers and crew crashing today, and the same thing happened tomorrow and every day next week and every day next month,” said David Williams, PhD, chair of the department of social and behavioral sciences at the Harvard T. H. Chan School of Public Health in Boston.

That is how many Black lives would be saved every day if disparities in health in the U.S. could be resolved, but they are “frighteningly persistent,” he added.

In 1950, life expectancy for white Americans was 69.1 years, which was about 8 years longer than for Black Americans. By 2018, the difference in life expectancy rates had narrowed to 4 years, which is “progress,” Williams said, but “it has taken a long time to get there.”

Other disparities still persist. For every dollar that a white household had in 2018, Black households had $0.59 — a “racial gap” in income that has not changed since 1978, he noted.

Residential segregation has also fostered disparities that in turn impact health. Two out of three Black children, 58% of Latino children, and 53% of Native American children live in “very low or low” opportunity neighborhoods, while only one in five white and Asian children live in such areas, he said.

“Statistically, if you could eliminate residential segregation, you will completely erase Black/white differences in income, in education, and in unemployment, and reduce differences in single motherhood by two-thirds,” Williams added.

Individual discrimination and implicit bias also impact health and medical care, he noted.

A 2020 study of 1.8 million hospital births in Florida from 1992 to 2015 found that Black babies were “three times more likely to die” compared to white babies, Williams said.

Williams called on nurses to “take the lead” in combating the multiple mechanisms that perpetuate these disparities and to collaborate with other stakeholders to reform the structural problems that lead to these health inequities in the first place.

Kenya Beard, EdD, associate provost of social mission and academic excellence at Chamberlain University in Chicago, highlighted one of her biggest concerns: the barriers to diversity in nursing.

She described a scenario in which faculty members of a nursing program discussed halting a “holistic admissions” process after finding that Black and Hispanic nursing students were less likely to graduate and had higher failure rates on the National Council Licensure Examination (NCLEX- RN).

While many faculty members viewed stratifying pass rates on the NCLEX-RN and attrition as “normal,” Beard viewed it as an act of racism, an “injustice looking just,” quoting Isabel Wilkerson, an African-American Pulitzer Prize-winning journalist.

Potential barriers for minority students entering nursing schools might include unseen factors that prevented their parents from living in neighborhoods with strong educational resources and opportunities for success, or the possibility that their GPAs may have been considered “not competitive enough” while working full-time jobs, Beard said.

“The root factors that drive these academic achievement gaps, and an erroneous assumption of intellectual inferiority and worthlessness must be uprooted and uncovered,” she added.

Nurses should be consistently asking themselves how racism might be operating and “own up to it,” said Beard, in addition to looking at policies and practices that have “perpetuated disparities” and implementing new norms that advance educational equity.

Angelica Millan, DNP, RN, former nursing director of children’s medical services for the County of Los Angeles Department of Public Health, highlighted other recommendations in the committee’s report, including calling on all national nursing organizations to develop a “shared agenda” for addressing social determinants of health and achieving health equity.

Nursing organizations are being challenged to “do the hard work of self-assessment” in evaluating their own diversity, equity, and inclusion efforts, and to eliminate any policies, regulations, and systems that “perpetuate structural racism,” Millan said.

The report offers a roadmap to equity, not only in healthcare, but also in education, Beard said. “But we can’t do it alone. We need to unite.”

  • Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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