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Department: Editor's Memo

Addressing the social determinants of health

Editor(s): Newland, Jamesetta A. PhD, FNP-BC, FAANP, DPNAP, FAAN

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doi: 10.1097/01.NPR.0000798252.52511.96
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Jamesetta A. Newland
Jamesetta A. Newland:
Jamesetta A. Newland

The third report on the future of nursing was released earlier this year, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.1 The report's focus is on preparing nurses to address the social determinants of health (SDOH)—which are grounded in structural and cultural racism—in order to improve access to and quality of healthcare, reduce health disparities, increase health equity, and ultimately improve the health and well-being of all populations, including nurses. To achieve this, Recommendation 4 states, “All organizations, including state and federal entities and employing organizations, should enable nurses to practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value. These barriers include regulatory and public and private payment limitations; restrictive policies and practices; and other legal, professional, and commercial impediments.” The actions proposed in this recommendation are not new, and challenges created within all the current systems mentioned in the statement have persisted for decades despite unwavering efforts from change advocates. In addition to patience, persistence, and perseverance—qualities that exemplify the core of nursing—nurses have displayed extraordinary resilience during the COVID-19 pandemic; one must acknowledge that nothing is impossible when nurses are present.

Health disparities

We are all familiar with the factors that are classified as SDOH, and NPs have traditionally provided services to the vulnerable populations most affected by these determinants—the poor, inner city and rural residents, and people of color. Garcia and Sharif questioned whether SDOH factors are actually euphemisms constructed by a racist system to try to explain what accounts for observed health disparities and poor health outcomes.2 Health disparities, however, should not automatically (systematically) lead to health inequity. Health equity means that every individual has a fair and just opportunity to be healthy. Educating ourselves about how these distinctions evolved; why they have been advantageous to an illness-cure health system; why they have been disadvantageous and discriminatory toward select individuals, populations, and communities; and what actions will change the system are priorities for nursing. Communities in Action: Pathways to Health Equity is a document that addresses these questions generally.3The Future of Nursing 2020-2030 expounds on this content within the context of nursing.

As 2021 draws to a close and we approach nearly 2 years of pandemic existence, the realistic consequences of ongoing health disparities in our healthcare system can no longer be overlooked. More than 725,000 Americans have died from COVID-19, the majority of whom were people of color and persons whose lives could be ascribed to one or more SDOH.

What about nurses?

Nurses represent the largest segment of the global healthcare workforce. The US has approximately 4 million RNs and more than 325,000 NPs. The injustices from within and without endured by nurses during the pandemic could be described as disparities in the allocation of workforce resources. This must change. Nurses deserve respect and caring because the health of a “community” is directly linked to the health and well-being of the nurses in that community. Nurses must also learn to place “me first” and practice self-care behaviors to maintain their personal well-being. Make 2022 the year that you take care of yourself so you can take care of others. A healthy and Happy New Year.

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Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN
Editor-in-Chief [email protected]

REFERENCES

1. National Academies of Sciences, Engineering, and Medicine. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press; 2021.
2. Garcia JJ, Sharif MZ. Black Lives Matter: a commentary on racism and public health. Am J Public Health. 2015;105(8):e27–e30.
3. National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press; 2017.
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