Learning Objectives
By the end of this section, you will be able to:
- Define health equity and disparities
- Discuss the impact of social determinants of health on patient outcomes
- Explain how nurses can assess and customize care to decrease health disparities
Many factors can impact the way a certain patient receives care. From the fair or equitable distribution of health-care services to the differences with which one may access health care based on belongingness to a certain group, there are lots of reasons why a certain patient may have better or poorer health care. Social determinants of health play a large role in those variances; nurses should strive to provide quality care to all individuals regardless of these circumstances, and they should support equitable access and treatment for all.
Health Equity
The condition in which all individuals in a community have fair opportunities to achieve optimal health and receive appropriate, high-quality care regardless of their social or demographic characteristics is health equity (see Figure 5.2). Achieving health equity requires recognizing and addressing the root causes of health disparities. A health disparity is a difference in health outcomes and access to health care between different population groups (Agency for Healthcare Research and Quality, 2021). Essentially, health disparities are differences in health outcomes and access to health care between different population groups. These disparities are exacerbated by structural barriers such as systemic inequities and social injustices. Certain historically marginalized populations, such as communities of color and people living in underserved or impoverished areas, are disproportionately affected by health disparities and thus face higher rates of disease and health-care costs, lower quality of life, and early death (Collins, 2023). For example, consider the following in the United States (Collins, 2023):
- Non-Hispanic Black people have higher heart disease death rates than people of other racial and ethnic groups.
- Hispanic adults are the most likely to lack health insurance and have unmet needs for medical care.
- Adults with no high school diploma or GED are more than four times as likely to smoke cigarettes than someone with a bachelor’s degree or higher.
Reducing health disparities and promoting health equity are crucial goals for health-care professionals. Nurses are well positioned to be leaders in these efforts, for example, by providing culturally competent care, advocating for at-risk populations, helping patients access all available resources, and collaborating with interdisciplinary teams and local organizations to bring health promotion and disease prevention programs to underserved communities. Through these and other measures, nurses around the world are working toward the day when every individual has a fair opportunity to live their best, healthiest life.
Social Determinants of Health
Health disparities are related to social determinants of health, or the conditions in which individuals are born, live, work, and age (Figure 2.2). These conditions, which play a critical role in shaping health outcomes, encompass a wide range of factors, including social environment, economic stability, and access to quality education, employment, housing, and health care (Healthy People 2030, n.d.). These social factors interact with biological and personal characteristics to influence an individual’s health status and well-being. Recognizing and addressing social determinants of health is essential for nurses and health-care professionals to provide holistic, patient-centered care and promote health equity.
One of the key social determinants of health is socioeconomic status (SES), which measures an individual’s social and financial standing in their community, encompassing factors such as income, education, and perceptions of social class. Individuals with higher SES tend to have better access to health care, education, and employment opportunities; consequently, they have the resources to access and pay for quality health care (Healthy People 2030, n.d.). Lower SES is associated with limited access to health care, increased risk of chronic conditions, and higher rates of mortality. Nurses must understand the influence of SES on health outcomes and advocate for policies and interventions that address socioeconomic disparities, such as increasing access to affordable health care.
The physical and social environments where people live and work are also important social determinants of health. An individual’s health is significantly affected by the quality of their housing, the safety of their neighborhood, and the robustness of their social support networks. Individuals living in a polluted neighborhood with limited access to healthful food and recreational spaces can contribute to stress, poor nutrition, and increased risk of chronic diseases. Nurses can play a role in promoting healthy environments by educating individuals and communities about environmental health risks, advocating for safe and accessible housing, and collaborating with community organizations to improve neighborhood conditions.
Two more social determinants of health to highlight are access to education and employment opportunities. Education is associated with better health literacy, healthier behaviors, and improved access to health care (Healthy People 2030, n.d.). Unemployment and job insecurity can lead to financial strain and increased stress levels as well as limited access to health care. Nurses can help to address these issues by providing education and resources to individuals and communities, advocating for equal educational opportunities, and assisting individuals in accessing employment and social support programs.
Nutrition and Nutritional Deficits
Nurses play a vital role in promoting culturally sensitive nutrition care. By understanding cultural influences on nutrition and dietary practices, nurses can educate individuals and communities about balanced diets that incorporate cultural preferences while meeting nutritional needs. Vegans, for example, do not eat any animal products, which can put them at risk for iron deficiency or folate deficiency anemia. Nurses can help vegans to collaborate with registered dietitians, cultural advisers, and community resources to develop appropriate nutrition plans. Moreover, nurses can advocate for policies that address food disparities, improve access to nutritious foods, and promote health equity. By considering cultural contexts, respecting dietary preferences, and addressing nutritional deficits, nurses can support individuals in achieving optimal health and well-being.
Holiday Observances
Holidays hold deep cultural and religious significance and often involve specific rituals, traditions, and dietary practices. Recognizing and respecting these practices is essential for providing culturally sensitive and patient-centered care. This includes understanding the historical and cultural context as well as the associated customs and practices. For instance, certain holidays may require modifications to the care plan to accommodate dietary restrictions, fasting practices, or specific rituals. Nurses should engage in open and respectful communication with patients and their families, seeking their input on how to incorporate holiday observances into care while maintaining safety and promoting well-being, especially during a hospitalization. Examples could include modifying a hospital menu for a Catholic patient who is fasting during Lent, and reorganizing a treatment schedule for a Muslim patient who wants to observe the five daily calls to prayer while hospitalized.
Educational Beliefs
Educational beliefs and values also differ across cultures and can have a significant impact on health care. In some cultures, for example, education is considered an essential component of health and well-being. Individuals from these cultures may place a strong emphasis on health literacy and view a provider as one of many possible sources of information.
Conversely, certain cultures take a more deferential approach to education and health care. Patients may rely heavily on health-care professionals for guidance and defer their decision-making authority to the health-care provider.
Cultural Groups and Disease Risk
Members of certain cultural and ethnic groups have elevated disease risks, which researchers have documented (Hill et al., 2023) (Table 2.2). Nurses should be aware of these risks to ensure they provide culturally sensitive care and targeted health interventions. At the same time, they must not stereotype. Table 2.2 shows common conditions seen among races at risk.
| Ethnic/Cultural Group | Common Conditions |
|---|---|
| Black or African American | Hypertension, diabetes, obesity, breast, and prostate cancer (CentraState Healthcare System, 2022) |
| Hispanic/Latinx | Obesity, metabolic syndrome, diabetes, cardiovascular disease (Northwestern Medicine, 2024) |
| American Indian/Alaska Natives | Type 1 diabetes, obesity, substance use disorder, alcoholism (Centers for Disease Control and Prevention, 2023) |
| Asian Americans | Chronic hepatitis B, tuberculosis (U.S. Department of Health and Human Services Office of Minority Health, 2023) |
| LGBTQIA+ | Depression, sexually transmitted infections, suicide (Hafeez et al., 2017) |
Link to Learning
Read this article about a 2022 study about COVID-19 that demonstrates how the pandemic disproportionality affected communities of color.
How Nurses Can Customize Care to Decrease Health Disparities
To provide patient-centered care and decrease disparities, it is important to recognize any bias or stereotypical assumptions about patients from culturally diverse backgrounds. These biases can have negative effects on nurse-patient communication and interactions (Oruche & Zapolski, 2020). Nurses can help decrease health disparities on individual, organizational, and policy levels (Oruche & Zapolski, 2020).
On an individual level, nurses can decrease health disparities by providing culturally competent care. Strategies that nurses can use to incorporate culture in their plan of care are as follows:
- Ask the patient about their cultural traditions and preferences. By doing this, the nurse can gain insight into the client’s values and beliefs and incorporate these elements into the plan of care in a way that is respectful and meaningful to the patient.
- Use interpreters. If the patient and the nurse do not speak the same language, using an interpreter can help the nurse understand the patient’s beliefs and preferences. This can help the nurse incorporate these elements into the plan of care.
- Involve family members (when culturally appropriate). Family members can play an essential role in incorporating traditions and personal views into the care plan. Involving family members in discussions about the plan of care can help the nurse understand the patient’s cultural beliefs and preferences.
- Be flexible. Being willing to adapt the plan of care to meet the patient’s needs and preferences is essential. This can involve adjusting the timing of treatments or medications to accommodate the patient’s religious practices or dietary restrictions.
- Use culturally appropriate resources. Educational materials and videos can help the nurse provide respectful and culturally sensitive care.
Interdisciplinary Plan of Care
Plan of Care for an Underserved Patient
For a patient with little to no resources or low SES, a comprehensive interdisciplinary plan of care would be crucial to address patient needs after discharge. The nurse and provider begin by recognizing any needs that the patient may have during a comprehensive admission assessment. After the identification of needs, they would collaborate with the social worker.
Social workers would assess the patient’s social support network, financial resources, and housing stability. They would assist in navigating insurance coverage for medications, accessing community resources for support groups, and addressing any legal or employment concerns.
Pharmacists would collaborate with the provider and patient to ensure proper medication adherence, educate the patient on potential side effects, and monitor for drug interactions. They would also assist in managing medication schedules and addressing any concerns the patient may have about their treatment regimen. If necessary, pharmacists would also counsel the provider about medications, such as generics or combination pills, that could be substituted into the regimen to increase patient compliance.
This interdisciplinary approach ensures that the patient receives comprehensive care addressing social and pharmaceutical aspects of their health. It emphasizes the collaborative effort needed to manage care effectively and improve the patient’s quality of life.
On an organizational level, nurses can assist with creating an inclusive workplace culture, developing policies that foster inclusion and diversity, and providing adequate training and education resources. Supporting weekend clinic hours can increase community access to care. Assisting with improving health-care access through telehealth services and mobile health clinics can also decrease community health disparities (Oruche & Zapolski, 2020).
On a legislative or policy level, nurses have the health-care knowledge to inform policymakers about the health-care needs of disadvantaged populations and advocate for policies that nurture increased patient access (Oruche & Zapolski, 2020). Nurses can push for better accessibility of cultural services, such as interpreter services.