Georgia Nursing - July 2022

Page 12 • Georgia Nursing July, August, September 2022
Advancing Health Equity in Georgia continued from page 11
Care” describes the disturbing health care experiences
of individuals from underrepresented groups and
the impact of racial, ethnic, and other forms of
discrimination have on quality of health care. Little
sustained change has occurred in reducing health
disparities since this report 19 years ago.
Social, economic, and environmental inequities,
and psychosocial trauma, and residential segregation
have been examined and provide pathways to
understanding the interconnectedness of structural
racism and poor health (Bailey et al, 2017; Yearby,
2020). Although these issues are complex, they
add a contextual framework in understanding the
relationships among these concepts and help to
organize approaches to achieve health equity.
To address health inequities imposed by the
social determinants of health and other barriers it is
important to have some common evidence supported
definitions (see Table 1). Additionally, it is important to
engage people across multiple disciplines and sectors.
One important sector is nursing. Nursing has been
recognized as a key player not only in the health care
workforce, but also for the central role nurses play in
building healthier communities and achieving health
equity where everyone has a fair opportunity for
quality health care (Robert Wood Johnson Foundation,
2020). The National League of Nursing (2019)
highlights the impact Social Determinants of Health
(SDOH) has on health equity, social justice, and health
outcomes, and recommends that SDOH integration in
nursing education curricula is critical to advance the
health of national and global communities. American
Association of Colleges of Nursing’s (AACN) newly
released Essentials for professional nursing education
calls for competencies that reflect an understanding
of the interrelatedness of SDOH, systemic racism, bias,
and health equity (AACN, 2021). AACN acknowledges
how imperative it is for a prepared nursing workforce
to address the persistent and pervasive health
inequities in urban and rural areas where there are
unequal distribution of resources and access to
healthcare services (AACN, 2021).
Although, there are many drivers of health
disparities and the magnitude and complexity of
these problems cannot rely on one discipline alone for
solutions, nursing is key to any organized health system
approach to advance health equity among Georgians.
For 20 consecutive years the Gallup Poll reports
nurses rated highest among a list of professionals in
honesty and ethics (Saad, 2022). The first principle in
the American Nurses Association (ANA) Code of Ethics
for Nurses reads that, “the nurse, in all professional
relationships, practices with compassion and respect
for the inherent dignity, worth, and uniqueness of
every individual unrestricted by consideration of social
or economic status, personal attributes, or the nature
of the health problems.” p.1.
The Healthy People 2020 declaration placed an
emphasis on eliminating health disparities as cited:
Health disparities adversely affect groups of people
who have systematically experienced greater social or
To access electronic copies of
Georgia Nursing, please visit
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Table 1 Socialization to Health Inequity Definitions
Topic Definition Source of Evidence
Health Disparity
Racial/ethnic inequities
Implicit Bias
Racism
Structural Racism
Cultural Racism
Institutional Racism
Social Determinants of
Health (SDOH)
SDOH-from Healthy
People 2030 and
National Academies of
Medicine –Future of
Nursing 2020-2030
An increased burden of an adverse health
outcome or health determinant within a specific
subset of the population
Racial differences in health date back to some of
our earliest health records in the United States
with blacks (or African Americans) having poorer
health than whites across a broad range of health
status indicators.
Cultural stereotypes may not be consciously
endorsed, but their mere existence influences how
information about an individual is processed and
leads to unintended biases in decision-making.
Prejudice (differential assumptions about the
abilities, motives, and intentions of others
according to their race) and discrimination
(differential actions toward others according to
their race
The biased societal approach to housing,
education, employment, healthcare, and criminal
justice.
Is a process whereby people who are strongly
identified with certain ‘language groups, religion,
group habits, norms and customs, including
typical style of dress, behavior, cuisine, music
and literature, are treated in a prejudicial and
discriminatory way based on these characteristics
(Goldberg, 1993, p.70).
A system that categorizes people based on
race, color, ethnicity, and culture to differentially
allocate societal goods and resources in a way
that unfairly disadvantages some, while without
merit, rewards others. As a system, racism has
been institutionalized in a way that permits the
establishment of patterns, procedures, practices,
and policies within organizations that consistently
penalizes and exploits people because of their
race, color, culture or ethnic origin.
The conditions in the environments where people
are born, live, learn, work, play, worship, and age
that affect a wide range of health, functioning,
and quality-of-life outcomes and risks.
Social determinants of health (SDOH) have a
major impact on people’s health, well-being, and
quality of life and contribute to health disparities
and inequities. They affect everyone at some level
or at some time. Examples of SDOH include:
• Safe housing, transportation, and
neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical
activity opportunities
• Polluted air and water
• Language and literacy skills
• Income and wealth
• Public safety
• Transportation
• Social Environment
Wheeler & Bryant (2017) Obstet Gynecol Clin
North Am. Mar;44(1):1-11
Williams, D. & Sternthal, M. (2010).
Understanding Racial/ethnic Disparities in
Health: Sociological Contributions. J Health
Soc Behav.; 51(Suppl): S15–S27.
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3468327/
Chapman, E., Kaatz, A. & Carnes, M. (2013).
Physicians and implicit bias: how doctors may
unwittingly perpetuate health care disparities.
J Gen Intern Med 28(11):1504-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3244674/
https://www.medpagetoday.com/blogs/
kevinmd/84362
Goldberg D (1993) Racist Culture: philosophy
and the politics of meaning. Oxford: Blackwell.
Hamel J (1993) Case Study Methods. Newbury
Park: Sage Publications.
Shepherd,SM, Willis-Esqueda,C, Paradies,
Y., Sivasubramaniam, D., Sherwood, J. &
Brockie, T. (2018). Racial and cultural minority
experiences and perceptions of health
care provision in a mid-western region.
International Journal for Equity in Health
volume 17, Article number: 33.
https://www.aafp.org/about/policies/all/
institutional-racism.html
Williams, D., Lawrence, J & Davis, B. Racism
and Health: Evidence and Needed Research
Annual Rev Public Health. 2019 April
01; 40: 105–125. doi:10.1146/annurevpublhealth-040218-043750
https://health.gov/healthypeople/objectivesand-data/social-determinants-health
https://www.ncbi.nlm.nih.gov/books/
NBK573923/#pz64-2
Bharmal N, Derose KP, Felician M, Weden
MM. Understanding the upstream social
determinants of health. Santa Monica, CA:
RAND Corporation; 2015
NASEM. Vibrant and healthy kids: Aligning
science, practice, and policy to advance
health equity. Washington, DC: The National
Academies Press; 2019b.
Social and Health
Policy Decisions
Economic inequities
Political and Moral
Determinants of
Health
Racism is a fundamental cause of health inequities
and disease, which requires policy solutions
that address this cause directly rather than only
targeting mechanisms.
Wage and employment gaps
Federal poverty level 2021: Annual income
1 person household= $12,880
2 person Household =$17,420
4 person Household =$26,500
Political determinants of health lie even further
upstream than the social determinants of health –
Looking further upstream through the lens of the
political determinants of health, one can see how
the placement of the bus depot and interstate
stemmed from redlining policies, displacement of
minorities, and zoning decisions. If the minority
community had had political power, those
decisions would have been made differently.
The political determinants of health shape the
social drivers of health equity.
Cogburn, CD (2019). Culture, Race, and
Health: Implications for Racial Inequities and
Population Health Milbank Q.97(3):736-761.
Columbia University School of Social Work
US Department Health and Human Services
Poverty Guidelines: Jan 15,2021.
https://aspe.hhs.gov/poverty-guidelines
Dawes DE. Health inequities: a look at the
political determinants of health during the
COVID-19 pandemic. American Journal of
Health Studies. 2020;35 (2):77-82
Berwick DM. The moral determinants of
health. JAMA. 2020;324(3):225-226
Pepin D, Winig BD, Carr D, Jacobson PD.
Collaborating for health: health in all policies
and the law. The Journal of Law, Medicine &
Ethics. 2017;45(1)
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