Health Disparities In Health Care Nursing Care and Health Disparities
Health disparities are a persistent issue in health care, affecting access, quality of care, and health outcomes, particularly among racial and ethnic minority groups. These disparities have complex roots in social, economic, and environmental factors, and they pose significant challenges for health care providers, including nurses. Addressing health disparities requires comprehensive policies, targeted interventions, and the active participation of nursing professionals. This article explores the definition of health disparities, policies aimed at reducing them, the relationship between disparities and nursing care, and the challenges nurses face in addressing these disparities.
What are Health Disparities?
Health disparities refer to the inequalities or differences in health outcomes that exist between different population groups. The term encompasses both “inequalities,” which describe differences in health that may be expected based on biological or natural factors, and “inequities,” which imply that these differences are unjust or unfair. In the context of health care, health disparities are most often linked to inequities, where certain groups experience poorer health outcomes due to social, economic, or environmental disadvantages (Carter-Pokras & Baquet, 2002).
Health disparities can manifest in various ways, including differences in access to care, quality of care received, disease prevalence, and life expectancy. They are influenced by a wide range of factors, including age, gender, income, education, sexual orientation, disability, geographic location, and racial or ethnic minority status. While these categories often overlap, the focus of this discussion is on health disparities affecting racial and ethnic minority groups.
In the 1980s, the U.S. Department of Health and Human Services (DHHS) established the Task Force on Black and Minority Health to address the persistent health inequities faced by minority populations. The task force’s work highlighted the paradox of significant scientific advances in health care alongside persistent health disparities for racial and ethnic minorities. By examining mortality data, the task force identified six leading causes of excess deaths among minority populations: cancer, cardiovascular disease and stroke, cirrhosis (largely attributed to substance abuse), diabetes, homicide and unintentional injuries, and infant mortality (US DHHS, 1985).
These findings underscored the urgency of addressing health disparities and provided a foundation for future health policies aimed at eliminating these inequities.
Policies to Deal With Disparities
In response to the growing recognition of health disparities, various national policy initiatives have been implemented to reduce and eliminate these inequalities. One of the earliest initiatives was Healthy People 2000, which set a goal of reducing health disparities among different population groups. This effort was further expanded in Healthy People 2010, which made the elimination of health disparities among racial and ethnic groups a national priority.
In 1998, President Bill Clinton brought further attention to the issue by focusing on six key health disparities affecting racial and ethnic minorities. These included disparities related to cardiovascular disease, diabetes, cancer, HIV/AIDS, infant mortality, and pneumonia and influenza—issues that closely mirrored those identified by the DHHS Task Force more than a decade earlier.
One of the most significant policy advancements in addressing health disparities was the creation of the National Center for Minority Health and Health Disparities (NCMHD) within the National Institutes of Health (NIH). This center focuses on directing research priorities and resources toward understanding and eliminating health disparities. By prioritizing research on minority health issues, the NCMHD aims to develop evidence-based strategies to reduce the health inequities that disproportionately affect racial and ethnic minorities.
Despite the progress made through these policy initiatives, there is ongoing debate about the root causes of health disparities and the best strategies to eliminate them. Causes of disparities range from individual-level factors, such as genetic predispositions and health behaviors, to broader social determinants, such as hazardous living environments, limited educational opportunities, and barriers to health care access. Additionally, factors such as cultural and linguistic barriers, institutional racism, and discrimination within the health care system contribute to the persistence of health disparities.
Disparities and Nursing Care
Nurses play a critical role in addressing health disparities, as they are often the first point of contact for patients in the health care system. Nursing organizations and coalitions have recognized the importance of addressing health disparities and have contributed to the development of research agendas aimed at reducing these inequities.
For example, the National Coalition of Ethnic Minority Nursing Associations (NCEMNA) partnered with the National Institute of Nursing Research (NINR) to create recommendations for a nursing research agenda focused on minority health. This research agenda emphasizes the need for studies that address the top 10 causes of death among ethnic minority groups. The research areas identified include health promotion, disease management, and the development of culturally and linguistically appropriate interventions.
One of the key areas of focus for nursing research is the development of culturally competent care models that consider the unique needs of diverse populations. This includes understanding the spiritual, cultural, and familial dimensions of health and illness, as well as integrating mental health care with physical health care.
In addition to providing care, nurses are also called upon to advocate for social justice and health equity. NCEMNA’s work emphasizes the need to focus not only on the challenges faced by racial and ethnic minority populations but also on their strengths, including resilience, cultural traditions, and strong family and community support networks. Nursing care must consider the whole individual, taking into account the social and environmental factors that contribute to health disparities across the life span.
Nursing Challenges While Dealing With Disparities
Despite the recognition of the critical role that nurses play in addressing health disparities, there are significant challenges that nurses face when working with minority populations. One of the primary challenges is the lack of nursing research that focuses on racial and ethnic minority populations. This gap in research limits the ability of nurses to develop evidence-based practices that are culturally relevant and effective in reducing disparities.
While the lack of research is not unique to nursing, it is particularly concerning in the context of health disparities. As Zambrana (2001) pointed out, health disparities are often attributed to cultural and linguistic differences because these factors are easier to discuss than the more powerful influences of socioeconomic status, literacy, poverty, and systemic inequality. Without sufficient research to guide culturally competent care, nurses may struggle to address the deeper social determinants of health that contribute to disparities.
Another major challenge is the lack of diversity within the nursing profession itself. The nursing workforce does not yet reflect the racial and ethnic diversity of the populations it serves. This lack of representation can create barriers to effective communication and trust between nurses and patients from minority backgrounds. Additionally, the limited diversity within nursing may prevent the profession from fully understanding and addressing the unique health needs of minority communities.
To overcome these challenges, nurses must take a leadership role in eliminating health disparities. This requires nurses to critically examine the role they play in contributing to disparities, both through individual actions and within the broader health care system. Recognizing the influence of social determinants of health, working to eliminate institutional racism and discrimination in health care settings, and advocating for increased diversity within the nursing workforce are essential steps in reducing disparities.
Nurses must also engage in true partnerships with racial and ethnic minority communities. Building these partnerships involves working collaboratively with community leaders, organizations, and patients to develop health interventions that are culturally appropriate and effective. Nurses can serve as advocates for policies that address the social determinants of health, such as access to education, safe housing, and economic opportunities, which are essential for reducing health disparities.
Conclusion
Health disparities remain a significant challenge in the United States, particularly for racial and ethnic minority populations. These disparities are influenced by a wide range of factors, including individual behaviors, social determinants of health, and systemic inequalities within the health care system. Nurses, as frontline health care providers, have a critical role to play in addressing these disparities and advocating for health equity.
To effectively address health disparities, nurses must engage in research, policy advocacy, and the delivery of culturally competent care. By increasing the diversity of the nursing workforce, building partnerships with minority communities, and addressing the social determinants of health, nurses can contribute to the elimination of health disparities and improve the health outcomes of all populations.
Moving forward, it is essential that nurses continue to advocate for policies that prioritize health equity and work to reduce the barriers that prevent minority populations from accessing high-quality care. Through collaboration, leadership, and a commitment to social justice, the nursing profession can make significant strides in reducing health disparities and ensuring that all individuals have the opportunity to achieve optimal health.