A Time to Make America Great: Address Discrimination and Life Expectancy.
"... the wealthiest nation on earth, but far from the healthiest" (Blumenthal, 2018)In 2017, the United States experienced disturbance, disruption, and chaotic efforts sowed by the executive and legislative branches of government to "repeal and replace" the Affordable Care Act (ACA). Suddenly, academics, clinicians, and health policy advocates confronted a wave of realities and ramifications about the fragility of the ACA. Healthcare advocates, including professional nursing associations, began to build coalitions to protect patient care and fight threats to population health, specifically towards communities of color and underserved and marginalized populations. For example, data from an unprecedented survey of 3,453 programs and policies aimed at increasing health equity of African-Americans, Latinos, Asian Americans, Native Americans, non-Hispanic Whites, and LGBTQ adults from the Harvard T.H. Chan School of Public Health (2018), NPR, and Robert Wood Johnson Foundation explored experiences with discrimination as an indicator health status. Every demographic group surveyed felt discrimination against their race or ethnic group existed in the United States including 78% of Latinos, 75% of Native Americans, 61% of Asian Americans, and 55% of non-Hispanic Whites (Williams, 2017). However, 92% of African-Americans surveyed were most likely to agree with this statement. In fact, when African-Americans were asked about their own experiences, the following responses were noted:
* 32% said they have personally experienced racial discrimination when going to a doctor or a health clinic; and
* 22% have avoided seeking medical care out of concern about discrimination (Williams, 2017).
Discrimination and Health Status
The ACA succeeded in protecting most citizens and residents by improving their health coverage, assuring health equity, and seeking to eliminate bias and intolerance. However, many citizens and residents still do not have a robust social safety net that buffers the effects of lack of health insurance, access, job loss, and discrimination. In fact, Williams (2017) notes African-Americans live sicker and die sooner than Whites in America. Heart disease is the leading cause of death in the United States, and middle-aged Black males and females have death rates nearly twice as high as their White counterparts. There are also other chronic conditions that have elevated death rates for Black males and females, including cancer, stroke, diabetes, kidney disease, and maternal death. The health outcomes for persons of color in the United States are startling: every 7 minutes, a Black person dies prematurely (Williams, 2017).
Why Are U.S Health Outcomes Abysmal?
The U.S. healthcare system continues to lag on multiple healthcare outcomes, quality, and value indicators. As the wealthiest nation but by far not the healthiest, the United States is falling behind. David Blumenthal, MD, president of the Commonwealth Fund, reported that "Americans are dying younger living shorter lives than previous generations and dying earlier than their counterparts around the world" (2018, para. 1). Life expectancy in the United States is falling. According to the Centers for Disease Control and Prevention, average U.S. life expectancy fell by 0.1 years to 78.6 in 2016 as compared to other developed countries where life expectancy averages 81.8 years. This leaves the U.S. ranked 26th among the 37 members of the Organizations for Economic Cooperation and Development, representing the most developed nations of the world (Blumenthal, 2018).
The evidence is clear: accessibility to health coverage, quality of healthcare, and health status improved for many since the passage of the ACA. However, when efforts failed to provide access to quality affordable care and discriminate based on race, ethnicity, or gender, America's healthcare system misses the mark on the value-quality equation. Discrimination is an intentional, conscious, or personal act to harm another. Nurses and other health professionals must recognize bias and be accountable to reducing it wherever it is found in the healthcare delivery system. Moreover, discrimination exists and is covertly woven into other institutional policies and practices beyond healthcare including housing, education, criminal justice, etc. This in turn affects neighborhoods, education, access to public transportation and good jobs, etc., which are all linked to health and well-being (McGovern, Miller, & Hughes-Cromwick, 2014).
Nurses Doing Public Good
Nurses must serve society and do public good. We must advance society's health and be a driving force that shapes public policy and contributes to a more equitable, prosperous society where the health of all populations are assured. A significant and growing body of research shows how day-to-day experiences of nurses, specifically advanced practice registered nurses, have contributed to alleviating the shortcomings of quality, access, and cost-effective, patient-centered care (Institute of Medicine, 2010). In this issue, our newly appointed Associate Editor Lusine Poghosyan, PhD, MPH, RN, FAAN, illustrates how the nurse practitioner (NP) workforce is critical in delivering primary care and helping millions of Americans to access high-quality health care (Poghosyan, 2018). Dr. Poghosyan's call to action and comprehensive model demonstrating the interplay of federal, state, and organizational barriers affecting NPs helps to remove the artificial barriers on NP practice and access to care for millions of Americans (Poghosyan, Boyd, & Clarke, 2016).
With courage, advocacy, and conviction, nurses must mobilize collectively to remove barriers that threaten healthcare delivery including efforts to temper health insurance coverage, and discriminatory policies and practices that impede access. Doing public good and upholding the promise to serve all society means nurses must advocate for policies that protect all populations, especially the most vulnerable, against detrimental discrimination. It is time to do public good and seek solutions to root out federal, state, and organizational obstacles to the U.S. healthcare system.
There are no simple answers about which programs and policies are best at increasing health equity and improving outcomes, but the following are urgent priorities that nurses must address in 2018:
* Expose inefficiencies in care delivery that deplete resources and staff allocation.
* Acknowledge that everyday discrimination is embedded in our culture, sickening and killing at-risk and marginalize populations.
* Make a new commitment to work together to make America a healthier place for all.
It is time to make the wealthiest nation on earth the healthiest, where health care is a human right for all, no matter where you live, work, or go to school.
REFERENCES
Blumenthal, D. (2018). Drop in U.S. life expectancy is an 'indictment of the American health care system'. Retrieved from https://www.statnews.com/2018/01/04/life-expectancy-ushealth-care/
Harvard T.H. Chan School of Public Health. (2018). Discrimination in America. Retrieved from https:// www.hsph.harvard.edu/horp/discrimination-in-america
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nation alacademies.org/hmd/Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health.aspx
McGovern, L., Miller, G., & Hughes-Cromwick, P. (2014). Health policy brief: The relative contribution of multiple determinants to health outcomes. Health Affairs. Retrieved from http://www.healthaffairs.org/do/10.1377/hpb20140821.40448 7/full/
Pogosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economic$, 36(1), 43-45.
Pogosyan, L., Boyd, D., & Clark, S.P. (2016). Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model. Nursing Outlook, 64(2), 146-155. doi:10.1016/j.outlook.2015.11.015.
Williams, D.R. (2017). Why discrimination is a health issue. Retrieved from http s:// www.rwjf. org/ en/culture-of-health/ 2017/10/discrimination-is-a-health-issue.html
Donna M. Nickitas, PhD, RN, NEA-BC, CNE, FAAN
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| Title Annotation: | Editorial |
|---|---|
| Author: | Nickitas, Donna M. |
| Publication: | Nursing Economics |
| Article Type: | Report |
| Geographic Code: | 1USA |
| Date: | Jan 1, 2018 |
| Words: | 1205 |
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