How NPs can work towards achieving health equity

self care isn't selfish

What is health equity?

“Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’ “

– CDC1

I feel so much power and truth behind this statement from the Centers for Disease Control and Prevention (CDC). There are two important parts to the CDC’s statement about achieving health equity: the first is that there is equal opportunity to reach one’s full health potential. The second is that no one is kept from achieving their full health potential based on socially determined circumstances.

All humans should have the opportunity to reach their full potential, be it health or otherwise. And no one should be inhibited towards reaching this potential based on income, education, discrimination, or access to clean air and water.

Health equity isn’t a topic I intentionally gravitated towards when I entered healthcare first as a nurse, then as a nurse practitioner. I’ve just noticed that I feel emotionally charged when I witness health inequity and its injustice.

The gap between the “haves” and the “have nots”

The book, Tightrope: Americans reaching for hope, by Nicholas Kristof and Sheryl WuDunn, does an incredibly beautiful job of displaying how wide the gap is between the “haves” and “have nots” in our society and the vastly different outcomes that misfortunes can have among these two groups2. Typically, when individuals from higher socioeconomic statuses experience missteps and mistakes, there is a wide proverbial path for them to quickly find their footing if they stumble. In contrast, individuals from lower socioeconomic statuses walk on a high tightrope (hence the book’s name). If they fall during a misstep, the outcome can be quite devastating.

Healthcare providers and health equity  

I see patients in my mental health practice who struggle with conditions like depression, anxiety, trauma, addiction and have difficulty recovering. Some of the difficulty recovering is rooted in their social needs not being met.

For example, let’s say a patient presents for treatment of their alcohol use disorder. They are also unemployed, have a 9th-grade education, lack good social support, and live in an unsafe neighborhood. That person will have a tougher time successfully recovering from their alcohol use disorder than someone who is not battling these same social issues.

In our society, there’s a lot of controversy surrounding social issues and whether individuals are responsible for their social position or socially determined circumstances. As healthcare providers, working to eliminate social barriers for patients to achieve full health outcomes makes sense. If the goal is to help patients get better, and we know that social circumstances inhibit improved health outcomes, social determinants of health need to be addressed.

I deeply believe that each person should have the opportunity to reach their full potential, not only health potential but potential in general.  Imagine what our world would look like if every person reached their true potential.

The role of healthcare professionals

This powerful video interview hosted by the Institute for Healthcare Improvement (IHI) between Dr. Berwick and Dr. Williams highlights why health equity matters3. As discussed eloquently by Dr. Williams in his interview with Dr. Berwick, there needs to be a recognition of many issues and a desire to make change because “absence of will to address an unprecedented national tragedy is part of the problem” 3.

Dr. Williams discusses various interventions to address health inequality. For healthcare workers, working on implicit biases is key towards achieving health equity, including realizing we are not above implicit bias affecting us as providers, focusing on individuation instead of categorization, and counter-stereotyping 3.

How do we work to achieve health equity?

Achieving health equity is a complex goal with various solutions at the federal and state level regarding laws and policies, among other solutions. Luckily, the problem can be tackled in less over-arching ways too.

In the interview, Dr. Williams discusses one intervention to achieving health equity, which involves telling the story of health equity that connects with the American population. He went on to say that Americans are generally compassionate but need to hear a narrative that connects with them on a deeper level to mobilize action3.

The power of stories to shift perspective

Stories do a great job of putting a person in another person’s point of view. Humans have been telling stories forever, and influential individuals like Joseph Campbell have illustrated the power of effective storytelling.

As nurse practitioners in practice, we hear stories all the time. All day, every day, each patient we encounter has a story we are hearing, unique to that person. Over time, we are curating a series of stories and opportunities upon which to expand our perspectives. If you’re fortunate enough to see patients for years, you may collect many hundred, or thousands, of stories from different people. Understanding stories help us then cultivate the sense of advocacy needed to help achieve health equity.  Once you see and relate to another person’s perspective, it’s easier to empathize and be truly helpful.

Put more care into healthcare

In addition to hearing individual stories, we need to put more care into healthcare. We can’t just provide healthcare services and not address problems that made individuals sick in the first place (such as environmental factors)—this will not lead to long-term positive health outcomes.

We need to invest in programs that link patients to social services to help them address some of the challenges they face.

Listening to patients share their stories with us, recognizing the biases we carry around, and linking patients with necessary social services all move the needle towards the ultimate goal of achieving health equity.

1 CDC. (2021). Health equity. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). https://www.cdc.gov/chronicdisease/healthequity/index.htm

2 Kristof, N. D. & WuDunn, S. (2020). Tightrope: Americans reaching for hope. Alfred A. Knopf.

3Institute for Healthcare Improvement. (2016). Why health equity matters: A conversation between Donald Berwick, MD and David R. Willians, Ph.D., MPH. [YouTube].

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