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Ending unequal treatment: Strategies to achieve equitable health care and optimal health for all
On June 26, 2024, the National Academies of Science, Engineering, and Medicine (NASEM) released a new report examining health care inequities that persist in the U.S. titled "Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All." Flaws in our health system disproportionately affect members of marginalized communities, including stark racial and ethnic inequities in life expectancy, maternal and infant mortality, and many chronic diseases.
This new report reviews the major drivers of health care disparities, provides insight into successful and unsuccessful interventions, identifies gaps in the evidence base, and makes recommendations to advance health equity.
Academic nursing has a pivotal role to play in stemming unequal treatment and preparing an equity-minded workforce. Collectively, we have the power to change direction and move toward the desired state where all people have a fair and just opportunity to attain optimal health regardless of race, ethnicity, or other factors (personal, social, economic, environmental) that impact individual and population health. Three specific pathways we can take include:
Education
Developed to outline the core competency expectations for all professional nurses, AACN's 2021 Essentials features a strong emphasis on preparing nurses to lead initiatives that address structural racism, systemic inequity, and discrimination with the understanding that "equitable health care better serves the needs of all individuals, populations, and communities" (p. 7). Faculty can help to achieve this outcome by:
- Integrating content on the social determinants of health and health equity throughout students' curriculum.
- Expanding education beyond the classroom to provide experiential learning opportunities in underserved communities and with marginalized populations.
- Cultivating inclusive learning environments that acknowledge and challenge racism in all aspects of nursing education and practice.
School administrators can lead in advancing change by recruiting, supporting, and mentoring both students and faculty from diverse backgrounds to ensure that the next generation of nurses reflects the communities we serve. Together, we should strive to create environments that recognize the value of diversity, equity, inclusion, and belonging to achieving excellence in teaching, learning, scholarship, and service.
Research
Uncovering the full impact of unequal treatment on patients and health systems is critical to building momentum for change. One of the five recommendations in the new NASEM report calls for investing in research and evidence generation to better identify and widely implement interventions that eliminate health care inequities. The authors call on federal and private funders to expand support for research on health disparities, structural racism, and health-related social needs, as well as to explore various approaches, strategies, and policies needed to eliminate inequities.
Nurse researchers have played a pivotal role in building the nation's evidence base around health equity, but there is much more work to be done. Many research-intensive nursing schools have launched centers specifically focused on reducing health disparities, including the University of California San Francisco, University of Maryland, University of Texas at Austin, and University of Wisconsin Madison among others. We encourage schools to maintain a strong focus on addressing health inequities and unraveling the social determinants of health as key components of their research enterprise.
Advocacy
According to a recent study in Nursing Outlook, a policy pathway to achieving health equity is feasible as long as it "leverages nursing science, research, education, and practice in order to promote social justice within health and health care and to uphold health care as a human right" (Nickitas et al, 2022). Nurses collectively can influence the public discourse on health equity and help to advance legislation on Capitol Hill that serves the greater good.
With the understanding that data drives change, a key component of AACN's Federal Policy Agenda is to shape public policy by pursuing transformative research that investigates methods to improve public health and reduce health disparities. AACN is committed to providing the information, resources, and opportunities needed to engage nurse educators, students, and advocates in efforts to advance legislation and policy focused on health equity.
We encourage all nurses to use their position as a trusted health care providers and patient advocates to call for an end to unequal treatment. By joining voices with other nurses and interprofessional colleagues spanning education, research, practice, and policy, we can make a real difference in ensuring that our health care system provides just and equitable care for all.
