If there's one scene that seems to best represent 2011, it's one of mass protest, and we chose this month's cover image with that in mind (see On the Cover). From the demonstrations and uprisings known as “Arab Spring” that have swept across the Middle East to the Occupy Wall Street movement that started in New York City and continues to spread to cities around the world, people have taken to the streets to make their discontent known. It takes me back to the 1960s, to the civil rights movement and the anti–Vietnam War demonstrations, when protest marches were commonplace in this country. In the Middle East, the ongoing protests are directed primarily at totalitarian regimes that have stifled personal freedoms and trampled on human rights. In Europe, protesters have taken aim at the failed economic policies that led to the current debt crisis. Here in the United States, the protests are also largely fueled by economic issues, such as disparities in the concentration of wealth and, as the affinity group Occupy Wall Street states on its Web site, “the corrosive power of major banks and multinational corporations over the democratic process, and the role of Wall Street in creating an economic collapse that has caused the greatest recession in generations.”
Whether one agrees with the above sentiment or not, I think we'd all agree that the economic recession and slow recovery have profoundly affected most Americans. With the unemployment rate hovering at 9% and mortgage delinquencies and home foreclosures still at record levels, Americans are feeling the strain emotionally and physically. Research published in the American Journal of Public Health last December showed that mortgage delinquency was positively associated with depression, food insecurity, cost-related medication nonadherence, and self-reported declines in health. And an investigation by the National Bureau of Economic Research found that in several states hardest hit by the foreclosure crisis, foreclosures were associated with increased ED visits and hospitalizations for treatment of hypertension, diabetes, anxiety, and other stress-related disorders, especially among African Americans, Hispanics, and people younger than 65 years.
We know that stress can lead to illness. We also know that illness and poor health are often rooted in poverty, in the poor nutrition and limited access to health care associated with being poor. As the current economic conditions push more people into poverty, the number of those facing health problems will likely increase as well.
From its earliest beginnings, nursing has embraced a holistic view of health. What we eat, the environments in which we work and live, our social relationships—all these influence health. Yet, as nurses, many of us shy away from looking at the “big picture”; instead we narrow our focus, addressing only the immediate problems of this patient, this family. It's true that many patients treated in hospitals or outpatient clinics are there only for a short time. But how will such patients and their families fare in the long run if they lack access to public transportation to get to their follow-up appointments? How can patients recover from illness when they must choose between paying the mortgage and filling prescriptions?
And how can nurses work to change this? To really improve the health of our patients, we must address its social determinants—the conditions into which people are born and in which they live, including the areas of education, work, housing, and the environment, and access to health care. Last October, the World Health Organization issued the Rio Political Declaration on Social Determinants of Health (www.who.int/sdhconference/declaration/en), which calls upon all member states to adopt a public health approach that aims to “improve daily living conditions” and “tackle the inequitable distribution of power, money and resources.”
As nurses, we must adopt a similar approach to ensure the public's health. We can take our cue from the protesters and raise our 3 million voices collectively, sending a message to U.S. policymakers to end the economic and social inequities that keep people trapped in poverty. Tell your legislators to support the Rio Declaration.