Health Equity for All Individuals

 

OVERVIEW

HE is the state in which everyone has a fair and just opportunity to attain their highest level of health. The ability to achieve HE requires focused and continuous efforts to address injustices that create obstacles to health and healthcare. Social factors that determine health, known as the social determinants of health (SDOH), and health disparities must be acknowledged, assessed, and addressed by nurses. This involves acknowledging the history of unethical practices in public health that have led to inequitable health outcomes and addressing racism as a threat to public health now and in the future.

 

BACKGROUND

There is a long history of racism leading to inequitable health and healthcare in the United States. Benjamin Rush originally introduced race into the U.S. medical curricula in 1790 by asserting that blackness was a particular kind of leprosy. In 1857, Josh Nott characterized slaves as a biologically appropriate phenotype for hard labor. In the 1870s, the Jim Crow era of race exclusion from most societal ventures reinforced medical segregation (Ioannidis et al., 2021). These efforts created the underpinnings of inequality in healthcare and laid the groundwork for profound differences in the SDOH. In 1948, the United Nations General Assembly published the Universal Declaration of Human Rights, stating that “[e]veryone has the right to a standard of living adequate for the health and well-being of himself and of his family,” and that “[e]veryone is entitled to all the rights and freedoms set forth in the third Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or another opinion, national or social origin, property, birth or another status.” And yet the U.S. society is still working toward these equalities. The ANA’s Nursing Scope and Standards of Practice (2021) Standard 9 requires the RN to practice with cultural humility and inclusiveness. By implementing DEI nursing strategies in their practice, nurses can align nursing care with cultural and inclusion principles. The National Academy of Medicine (2021) further supports nurses as the change agents to effect equitable health practices. Areas of focus in The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity include:

A. “Role of nurses in improving the health of individuals, families, and communities by addressing SDOH and providing effective, efficient, equitable, and accessible care for all across the care continuum.”

B. “Ability of nurses to serve as change agents in creating systems that bridge the delivery of healthcare and social needs care in the community.”

The attributes of HE include the following:

A. Equity in social and economic circumstances

B. Diverse workforce

C. Nonjudgmental situation with the absence of bias

D. Good health outcomes

NURSING STRATEGIES

A. Nursing care strategies to promote HE include:

  1. Interpreter services
  2. Awareness of unconscious bias during patient encounters
  3. Developing patient trust
  4. Recruitment of diverse staff
  5. Effective communication
  6. Providing cross-cultural education resources to patients
  7. Assessment of SDOH
  8. Referral to community partners to meet needs and address SDOH
  9. Use of cultural competence skills

B. Recognize and minimize risk factors.

  1. Identify and address SDOH as an integral component of caring for patients.
  2. Become an advocate for the patient and speak on behalf of those whose voices are not heard or those patients uninformed about healthcare policies and their own rights.
    • Evaluate patients’ needs, considering their medical backgrounds, personal values, and level of awareness.
    • Identify patients’ goals, including their choice of treatment options.
    • Set an advocacy plan to meet those goals, which may involve working with other members of their healthcare team.
    • Assess the results of their advocacy, considering the satisfaction of the patient, family, and team.
  3. Be aware of the inequities in access to care and to the differing levels of care available to certain marginalized populations.
  4. Align resources with patient needs relative to SDOH that will enhance patient care and health outcomes.
  5. Where possible, ensure cultural responsiveness with the healthcare team.
  6. As a patient advocate, become familiar with the challenges faced by the specific races, ethnicities, and socioeconomic classes under the nurse’s care to improve patient outcomes.

C. Determine existing patient situation.

HE strategies often require an integrated approach to address the associated SDOH. An integrated approach to HE may include consultation with the interdisciplinary team, as well as collaboration with government entities, nonprofit organizations, community groups, and faith-based organizations.

  1. Does the patient have health insurance? If not, understand financial solutions.
  2. Bring in a social worker to assist with solutions necessary for patient care.
  3. Consult with a geriatric specialist if possible.
  4. Provide additional resources to the patient.
  5. Communicate clearly with the patient by providing explanations about needed care.

Example: A nursing care strategy to address the impact of SDOH would be to assess patients for SDOH that influence access to care and clinical outcomes and provide resources to mitigate their effects. For instance, nurses can provide a patient who does not have a car with a transportation voucher to assist them in traveling to their healthcare appointments to maintain compliance with follow-up care.

D. Evaluate expected outcomes.

The nurse can evaluate the outcomes of SDOH care by asking the patient questions to identify the influence of SDOH factors using the Nursing Social Determinants of Health (SDOH) Assessment Tool. The nurse can use the screening tool to obtain preintervention and postintervention SDOH data and compare them to evaluate expected outcomes.

FOLLOW-UP MONITORING

A.  Determine staff responsiveness in recognizing and addressing SDOH in patients.

B.  Document the variety of recommended interventions.

C.  Ensure adherence to certain ethical standards as outlined in the ANA Code of Ethics by demonstrating respect for autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity.

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Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 5, Stamps, D.C. & Brown-DeVeaux, D. (2025) Incorporating Principles of Diversity, Equity, Inclusion, and Access Into Practice

 

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