Diminishing, eliminating, and other types of addressing health disparities is a national goal of many initiatives in the U.S., such as the National Stakeholder Strategy for Achieving Health Equity, Healthy People 2020, HHS Action Plan to Reduce Racial and Ethnic Health Disparities, and the 4th NPS Strategic Direction for Improving Public Health. Notwithstanding the fact that dozens of initiatives have been taken to eliminate health disparities, they still exist. The reasons that explain the existence of the health disparities are multifarious. They include, inter alia, adverse socioeconomic and educational background, lack of health insurance, negative medical history, and patient beliefs. Nurses have a long history of catering to the needs of underserved populations. Eradicating rampant health disparities necessitates the use of behavioral, environmental, and community-based interventions to address adverse issues attending health disparities, including poor education, sordid living conditions, and exposure to violence. The paper discusses how public health nurses can contribute to quelling health disparities in conformity with the recommendations set forth in the 4th NPS Strategic Direction for Improving Public Health. The bottom line is that public health nurses have the necessary expertise to address health disparities under each recommendation.
Review of the 4th NPS Strategic Direction for Improving the Public Health
Judging by the highest standards, the National Prevention Strategy is a blueprint for action that will help maximize the number of American citizens who feel well at every stage of life (Centers for Disease Control and Prevention [CDC], 2014). The overarching goal of the NPS is to improve health outcomes for all Americans irrespective of their age, socioeconomic status, and, what is more important, “the fatness of their wallets” (Stanhope & Lancaster, 2014). One of the most salient features of the NPS is that it acknowledges the importance of stopping diseases before they develop. The NPS also recognizes that the prevention efforts “should be woven into all aspects of our lives, including where and how we live, learn, work, and play” (CDC, 2014). True to its name, the “Elimination of Health Disparities” chapter outlines a roadmap for addressing health disparities between various subgroups of the population. It provides a range of evidence-based recommendations for the eradication of the health disparities including, but not limited to
- Focusing on the most vulnerable and underserved communities;
- Addressing unequal access to high-quality healthcare services;
- Enhancing the capacity of the prevention workforce and individuals in the affected communities to identify and reduce disparities;
- Conducting research aimed at identifying effective interventions to eradicate health disparities; and
- Gleaning data that would help to better identify and address disparities (Stanhope & Lancaster, 2014).
According to the NPS, every single American should play a pivotal role in eradicating the health disparities and creating a healthier nation in general (CDC, 2014). However, the advanced practice of the community/public health nurse must be the linchpin of the elimination efforts. As Butts and Rich (2005) put it, “Eliminating health disparities is a moral issue for public health nurses and servant leaders because communitarian ethics is based on building flourishing communities that support the common good of all community members” (p. 218). Public health nurses have discretion to remove financial, structural, and personal barriers to health care, thereby eliminating any health disparities. Below there is a detailed description of the nurses’ role in each activity.
First and foremost, when dealing with health disparities, nurses need to focus on the most susceptible populations. It should be noted in this context that the term disparities goes beyond ethnic and racial disparities. Apropos of this, Stanhope and Lancaster (2014) assert that health disparities adversely affect all people irrespective of their racial or ethnic background, religion, socioeconomic status, gender, age, mental health, sexual orientation, and other characteristics. It is imperative that nurses should adhere to the tenets and standards of nursing practice in order to engage the representatives of the most vulnerable communities. By focusing on the underserved populations, nurses make a tangible contribution to the cause of overcoming health disparities. Working within the most underserved communities, nurses should discourage people from engaging in unhealthy or risky behaviors, in order to avoid the future health problems (Maurer & Smith, 2014). Health education and health promotion based on participatory action research methods can send effective health messages; moreover, they have the potential to promote healthy behaviors.
It is a matter of conventional wisdom that the American minorities, as well as other underserved groups, lack access to the high-quality healthcare. Similarly, there is no gainsaying that delays in seeking professional care constitute one of the major factors leading to health disparities. Oftentimes, such delays are caused by inadequate insurance coverage or the lack of it. In the absence of funds for a comprehensive health insurance, the public health nurses can mobilize to take a bevy of other measures to reduce health disparities in the underserved communities (Maurer & Smith, 2014). In addition to petitioning for an increase in insurance funding for the previously uncovered representatives of at-risk communities, nurses can conduct health education and health promotion programs. Similarly, they could conduct mass screenings to detect physical and mental health problems in the underserved populations, thereby contributing to the elimination of the health disparities (Stanhope & Lancaster, 2014). It is also necessary to note that public health nurses are in a position to assess healthcare services within a particular community; they should make full use of this power. They also play an important role in planning and evaluating the programs designed to reduce psychosocial and environmental stressors in the underserved communities.
Next, the NPS emphasizes the significance of augmenting the capacity of the prevention workers to detect and decrease disparities (Stanhope & Lancaster, 2014). In other words, it is crucial that the prevention workforce, i.e. all workers engaged in the fight against a particular health disparity within a particular community, should be thoroughly enlightened on the issues and conditions peculiar to that specific community. It is also necessary that the workforce should take preventive measures in concert with other sectors across the community, such as primary care providers, school nurses, neighborhood groups, and other grass-roots organizations (Butts & Rich, 2005). In this context, public health nurses stand out against the background of other prevention workers, because they usually have extensive experience of working with marginalized groups and cooperating with other sectors across different communities. Likewise, with the aim to increase the capacity of individuals in the affected communities to identify and reduce the healthcare disparities, it is necessary to raise the proportion of such individuals in the healthcare professions. Public health nurses have all the necessary prerequisites to take the lead in recruiting students from the underserved communities into nursing. The last but not least, nurses as advocates can exert significant influence on the health policy decision-making (Maurer & Smith, 2014).
Recommendations 4 and 5
It is a matter of fact that prevention interventions geared to the needs of a specific group are the most effective ones. However, there is a paucity of research into the ways to address health disparities associated with some populations. In this context, the public health nurses could make an invaluable contribution to the elimination of the health disparities by closing the sorely felt gap between knowledge and praxis (Ivanov & Blue, 2008, p. 112). Indeed, they can conduct the health impact evaluations to inform the policy-makers on the possible effects of the suggested programs and strategies of addressing the health disparities. For the same reason, the public health nurses could collect statistical data from the inadequately researched populations on rates of illness, chronic conditions, and other health outcomes, to improve their lot. In the same vein, they could help to standardize the garnered data, thereby improving the ability of the healthcare providers to identify and reduce health disparities (Maurer & Smith, 2014).
Discussion of Other Disciplines. Conclusion
The paper has shown that the public health nurses play a key role in meeting each of the five recommendations for eliminating health disparities outlined in the 4th NPS Strategic Direction for Improving Public Health. Yet, the public health nurses are best equipped to improve access of the underserved populations to the quality healthcare services, due to their broad experience of working with marginalized groups and their ability to cooperate with other sectors across different communities. Nevertheless, the role of nurses in meeting other four recommendations should not be downplayed, as well. Overall, nurses should possess a set of qualities to be able to meet the recommendations. Thus, they need to be good psychologists to gain trust of people with whom they are working. Similarly, they need to be culturally and linguistically competent to serve patients with bad command of English. Nurses need all these skills to eradicate the fragmentation of the healthcare services along the socioeconomic lines, thereby improving health outcomes for the underserved populations and contributing to their longevity. After all, it is their role as advanced practice community/public health nurses to provide guidance in quelling the health disparities.