Diverse Healthcare Equity Requires Providers and Policymakers to Unite for Change
Systemic racism persists throughout today’s society, presenting barriers to basic human rights and services, including quality health care for millions of people. Overcoming those disparities and achieving social justice require advocacy from all—but especially nurses.
Nurses have seen firsthand this disease’s inequitable impact (https://www.nap.edu/read/25982/chapter/1) on those they serve. They have also experienced firsthand COVID-19’s inequitable impact on the profession. Nurses are more likely to die than are other healthcare professionals, and nurses of color are far more likely to die. The nation cannot achieve true health equity without nurses, which means it must do better for nurses.
Few have the courage to stand by their own convictions as nurses do. In a 2020 statement, the nursing profession’s leading group took a bold stance on racism. Joining forces with the American Medical Association and American Public Health Association, the American Nurses Association wrote (https://www.nursingworld.org/news/news-releases/2020/the-american-academy-of-nursing-and-the-american-nurses-association-call-for-social-justice-to-address-racism-and-health-equity-in-communities-of-color), “For far too long, communities of color have been disproportionally suffering as a result of persistent inequities and biases that exist in society. The current unrest worldwide in response to unjust killings of Black and Brown people, as well as higher rates of COVID-19 within these communities, has emphasized more clearly the need for social justice reform that addresses racism and realigns structures to enable the attainment of better health regardless of race, ethnicity, gender, social group, or geography. The nursing profession, as leader of compassionate care, upholds the highest commitment to achieving health equity and combating discriminatory actions.”
Nurses Have an Ethical Responsibility to Advocate for Equity
Results from the 2021 Gallup public opinion poll demonstrated that for two decades—20 years in a row—nursing has been the most trusted and ethical professional, this year ranking (https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx) 81%. As such, nurses understand their responsibility to speak truth to power, stand up, and call out injustice. In fact, two of the nine provisions in the American Nurses Association’s nursing code of ethics contain (https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only) charges specifically about equity:
- The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
- The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
Racial Inequity Affects Healthcare Outcomes
Using data from the National Vital Statistics System, researchers from the National Center for Health Statistics found that Black and Latino people “experienced a 2.9- and 3-year decline in life expectancy, respectively, in 2020, compared (https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf) with a 1.2-year decline for White people.” The racial divide also exists in cancer outcomes: Black patients with cancer experience higher mortality from breast, cervical, prostate, and other cancers; Latino patients have a higher incidence of cervical and liver cancer; and Native Americans/Alaskan Natives have a higher incidence of liver cancer and death rates from kidney cancer, all compared (https://www.cancer.gov/about-cancer/understanding/disparities) to White patients. For both situations, the evidence points to inequity in access to health insurance and health care.
In a 2021 Centers for Disease Control and Prevention (CDC) blog post, Robert Besser, MD, Robert Wood Johnson Foundation president and chief executive officer, wrote (https://www.cdc.gov/healthequity/racism-disparities/expert-perspectives/besser/index.html) that far from shirking responsibility, society must confront the differences to make real changes. “Addressing systemic racism and dismantling the many barriers to equity will benefit these communities, of course. But doing so will help all people because these systems and structures impact each of us. We must address our nation’s historic failures for the good of everyone.”
Racial inequity is a public health crisis, and decision-makers must confront the issue directly.
Agencies Are Confronting It, but National Policy Must Follow
In response to advocacy work, federal healthcare agencies sought policy change through regulation. The National Institutes of Health (NIH) created (https://www.nih.gov/ending-structural-racism/unite) a program called UNITE to “identify and address structural racism within the NIH-supported and the greater scientific community.” UNITE is capitalizing on opportunities, building strategies, and developing policies for more inclusive and diverse clinical and research programs across NIH.
Similarly, CDC made health equity an institutional priority. “It is important to me to bring my clinical and scientific commitment, passion, and advocacy for health equity to my role as director of the agency charged with protecting the health of all Americans,” CDC Director Rochelle P. Walensky, MD, MPH, said (https://www.cdc.gov/healthequity/racism-disparities/director-commentary.html) in October 2021. Through the CORE Health Equity Science and Intervention Strategy, CDC is shifting its approach to equity from simply reporting on the markers of health inequities to addressing the drivers of disparities.
Finally, the U.S. Food and Drug Administration cited (https://www.fda.gov/consumers/minority-health-and-health-equity/clinical-trial-diversity) the need for clinical trials to reflect the broadest populations. “Ensuring people from diverse backgrounds join clinical trials is key to advancing health equity. Participants in clinical trials should represent the patients that will use the medical products. This is often not the case—people from racial and ethnic minorities and other diverse groups are underrepresented in clinical research. This is a concern because people of different ages, races, and ethnicities may react differently to certain medical products.”
Simply put, ONS condemns racism (https://www.ons.org/ons-condemns-racism), especially as it relates to inequities in cancer care. Nurses and other healthcare providers must join ONS in leading the way for society to recognize the structural and systemic barriers affecting many populations, especially populations of color. “The global pandemic has fundamentally changed society. The overwhelming lack of access to care and treatment for people of color across the United States became immediately apparent. We act without regard to race, religion, gender, sexual orientation or nationality and advocate for those underserved by the healthcare system.”
Join ONS in advocating for equity, in health care, in today’s society, and around the world. Learn more with the resources listed in the sidebar.