What is the role of nurses to help improve health equity and how can nurses work to minimize bias?

What is Health Equity?
“Our nation’s health and well-being depends in part on the well-being of its communities. Yet many communities are facing the challenges of insufficient access to jobs, healthy food options, safe and affordable housing, parks and open space–the needed conditions to fully thrive. Health equity is when everyone has the opportunity to attain full health potential. Health inequities stem from systematic disadvantage of one social group compared to other groups.”
This is the opening quote in the National Academies “Communities in Action: Pathways to Health Equity” report (2017) that explores the root causes of health inequities and offers promising approaches for promotion of health equity. For everyone to have a fair and just opportunity to be as healthy as possible “requires moving obstacles to health such as poverty and discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care” (County Health Rankings and Roadmaps, 2020, “What is Health”).
IHI President Emeritus and Senior Fellow Donald M. Berwick interviewed David P. Williams, PhD, MPH, Professor of Public Health at the Harvard T. H. Chan School of Public Health. Their discussion about the challenges in achieving health equity is highlighted in this 33-minute video (IHI, 2016a).

Dr. Williams addresses Dr. Berwick’s question, “How can providers reduce unconscious bias? in this next brief video (4:30 minutes) (IHI, 2016b):

Recently, Yale School of Medicine produced a brief video describing health equity and shared how disparities exist in health outcomes and access to treatment for many vulnerable populations. These inequities were laid bare in the context of the COVID-19 pandemic, which resulted in disproportionate illness and deaths among Black and Hispanic population groups. (5 minutes)

Health Equity and COVID-19
In his introduction to the County Health Rankings and Roadmaps COVID-19 Response and Recovery Webinar series, Director Dr. Lawrence Brown highlights the relationship between the pandemic and long-existing health disparities (County Health Rankings and Roadmaps, 2020):
Before the pandemic and now, not everyone has had the same opportunity to live a long and healthy life. Story after story in the news media shows the disproportionate impact of COVID-19 in Black, Latino, and Tribal communities. This pandemic is shining a light on long-standing inequities that exist in this country because of racism, historical trauma, urban apartheid, and rural disinvestment at every level, designed to create barriers to opportunity that we must overcome (0:42).
Watch Dr. Brown’s Introduction here, and consider watching the video series. (2 minutes)

With the COVID-19 pandemic in full swing, and in the immediate shadow of the death of George Floyd after being pinned down by a Minneapolis police officer, the American Public Health Association declared racism as “an ongoing public health crisis that needs our attention now” (APHA, 2020). A growing list of states, cities, and counties have followed their lead, naming racism as a determinant of health. The APHA has compiled a number of resources on Health Equity, including a resource guide on Racism and Health
Scholarly Discussion: Achieving Health Equity
Watch the Don Berwick/David Williams interview (video). Read through chapter 33 in the textbook to learn more about vulnerable populations. Clearly health equity is an issue in itself, but it is magnified in vulnerable populations. Look over the additional resources below and select and explore at least two of them before working on this week’s discussion.
1. How do you see bias (explicit or implicit) exhibited in healthcare in your experience?
2. What is the role of nurses to help improve health equity and how can nurses work to minimize bias? Give concrete suggestions.
3. Explain your understanding of equity versus equality. Give an example in your nursing practice.
4. How does public policy impact equity of health care and how can nurses influence public policy?
Scholarly sources are required but may come from the sources provided in this discussion prompt. Please respond to at least one peer (for full points).
The initial posting is due by Thursday 11:55 pm, and 1 classmate response posting is due Sunday at 11:55 pm EST. Include at least one scholarly source (likely the text or one of the sources in the prompt). Refer to your discussion board grading rubric for what is required for a substantial well presented posting. (Note: response to a minimum of 1 peer will satisfy to earn full participation points).
Options for participation:
1. Type response in the drop box.
2. Video note: create video – Using a computer with a camera and microphone, you can insert a video directly into the message box of the discussion. For instructions on inserting a video note, go to https://mycoursessupport.spcollege.edu/add-a-video-note
American Public Health Association (2020, May 29). Racism is an ongoing public health crisis that needs our attention now [press release]. https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/racism-is-a-public-health-crisis
County Health Rankings and Roadmaps. (2020). COVID-19 Response and Recovery Webinar Series. https://www.countyhealthrankings.org/news-events/introducing-our-special-covid-19-response-and-recovery-webinar-series
Institute for Healthcare Improvement. (2019). Health equity. http://www.ihi.org/Topics/Health-Equity/Pages/default.aspx (Links to an external site.)
Institute for Healthcare Improvement. (2017). What is bias, and what can health professionals do to address it?

.What Is Bias, and What Can Medical Professionals Do to Address It?
National Academies of Sciences, Engineering, and Medicine. (2017). Communities in action: Pathways to health equity. https://nam.edu/programs/culture-of-health/communities-in-action-pathways-to-health-equity/
Yale School of Medicine (2021). Understanding COVID-19: Health equity

. https: //www.youtube.com/watch?v=gw0-xAmsYNw
Additional Resources: Health Equity
American Public Health Association. (2020). Health Equity (resource guide). https://www.apha.org/topics-and-issues/health-equity
Centers for Disease Control and Prevention (2020). Health equity. [web content]. https://www.cdc.gov/chronicdisease/healthequity/index.htm
Institute for Healthcare Improvement. (2019). Health equity. http://www.ihi.org/Topics/Health-Equity/Pages/default.aspx
Institute for Healthcare Improvement. (2017). What is bias, and what can health professionals do to address it?

.What Is Bias, and What Can Medical Professionals Do to Address It?
Johns Hopkins Center for Health Equity (2020). Health equity action hub. https://www.healthequityhub.com/
National Academies of Sciences, Engineering, and Medicine. (2017). Pathways to health equity [interactive website]. https://webassets.nationalacademies.org/healthequity/
Robert Wood Johnson Foundation (2019). Achieving health equity: Why health matters and what you can do to help give everyone a fair shot at being as healthy as they can be. https://www.rwjf.org/en/library/features/achieving-health-equity.html
Robert Wood Johnson Foundation (2018). Discrimination in America [web series]. https://www.rwjf.org/en/library/research/2017/10/discrimination-in-america–experiences-and-views.html.
Robert Wood Johnson Foundation (2017). What is health equity? And what difference does a definition make? https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf437343
Additional Resources: Health Equity and COVID-19
Centers for Disease Control and Prevention (2021, April 16). Trends in racial and ethnic disparities in COVID-19 hospitalizations, by region–United States, March-December 2020. MMWR 2021; 70, 560565. https://www.cdc.gov/mmwr/volumes/70/wr/mm7015e2.htm?s_cid=mm7015e2_w
Centers for Disease Control and Prevention (2021). COVID-19: Health Equity. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/index.html
Harvard Medical School Office of Diversity, Inclusion, and Community Partnership. (2021). Resources on Health Disparities and COVID-19. https://dicp.hms.harvard.edu/Resources-Health-Disparities-COVID-19
Health Equity Initiative. (2021). COVID-19 and Health Equity Resources. https://www.healthequityinitiative.org/covid-19-and-health-equity-resources.html
Institute for Healthcare Improvement. (2020, May 8). Virtual learning hour special series: Centering equity in the response to COVID-19 [webinar]. http://www.ihi.org/resources/Pages/AudioandVideo/Centering-Equity-in-the-Response-to-COVID-19.aspx
Kaiser Family Foundation. (2021, March 4). THE CONVERSATION: Between us, about us, a new campaign by Black health care workers for Black people about the COVID-19 vaccines. https://www.kff.org/coronavirus-covid-19/press-release/the-conversation-between-us-about-us-a-new-campaign-by-black-health-care-workers-for-black-people-about-the-covid-19-vaccines/
Kaiser Family Foundation. (2021, April 14). Latest data on COVID-19 vaccinations race/ethnicity. Retrieved April 15, 2021 https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/
“When every person has the opportunity to attain their full health potential. We achieve health equity by eliminating avoidable, unfair, or remediable health differences among populations, whether defined socially, economically, demographically, or geographically.”

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