Public Health Reports
Webinar on
Nursing in 3D: Workforce Diversity,
Health Disparities, and Social
Determinants of Health
February 25th, 2014
1:00 PM – 2:00 PM EDT
Public Health Reports Webinar on
Nursing in 3D: Workforce Diversity, Health
Disparities, and Social Determinants of Health
Mary Beth Bigley, Dr.P.H., M.S.N., A.N.P.
former acting editor of Public Health Reports
Director of the Division of Nursing
in the Bureau of Health Professions at HRSA
Public Health Reports
Meet the Author! Live Webcast
Nursing in 3D: Transformation from
Health Disparities to Health Equity
through Workforce Diversity
Shanita D. Williams, PhD, MPH, APRN
Branch Chief, Nursing Practice and Workforce Development Branch
Department of Health and Human Services
Health Resources and Services Administration (HRSA)
Bureau of Health Professions, Division of Nursing
Moving Towards Health Equity:
A Collective Effort
• The Nursing Workforce Diversity (NWD) Program was legislatively
mandated under Title VIII of the 1989 Public Service Act
• The NWD Program has awarded $160 million in institutional grants
• The nursing community cannot address health disparities and
health equity in isolation
• Achieving health equity requires a collective effort across all
disciplines and all sectors (including outside of health care)
• Cross-disciplinary resource that addresses health disparities and
health equity
Transformation from Health Disparities to
Health Equity
Nursing in 3D: Workforce Diversity, Health
Disparities, and Social Determinants of Health
The summit provided nursing stakeholders and grantee
communities with the intellectual and conceptual tools
necessary to apply the social determinants of health framework
to advance the agenda for nursing workforce diversity and
health equity.
PHR Supplement: Nursing in 3D
The supplement:
• Includes 11 articles authored by content experts in the fields of
nursing workforce diversity, health disparities, and the social
determinants of health
• Highlights relevant work in federal and private sectors
• Presents pathways and partnerships to improve health equity
• Increased understanding of potential impact of linking nursing
workforce diversity, health disparities, and social determinants
• Describes efforts supporting the intersecting goals of:
–
–
–
–
increased workforce diversity
fair and equal access to quality health care and health care resources
elimination of health disparities
achieving health equity
• Provides opportunities to integrate workforce diversity, health
disparities, and the social determinants of health
– stakeholders (including key federal staff)
Nursing in 3D Resources
• Nursing in 3D Journal Supplementhttp://www.publichealthreports.org/issuecontents.cfm?
Volume=129&Issue=8
• Nursing in 3D Summit Recordingshttp://bhpr.hrsa.gov/nursing/summit.html
• Division of Nursing Websitehttp://bhpr.hrsa.gov/nursing/index.html
Public Health Reports
Meet the Author! Live Webcast
Federal Investments to Eliminate
Racial/Ethnic Disparities in Health Care
Ernest Moy, MD, MPH and William Freeman, MPH (presenting)
Staff Service Fellow, Center for Delivery, Organization, and Markets,
U.S. Agency for Healthcare Research and Quality
Presentation Agenda
1. Health Care Disparities, Is there a Problem?
2. HHS Action Plan to Reduce Racial/Ethnic Health Care
Disparities
3. Conceptual Framework:
Workforce Diversity’s Role in Disparities and Social Determinants of Health
(SDH):How SDH Relate to Health and Health Care Disparities,Role of PatientProvider Communication and Health Care Disparities
4. The Pathway to Equity: Improving Workforce Diversity
5. Tracking Workforce Diversity and HHS/AHRQ Efforts to
Improve
6. Implications/Action Items/Prediction for the Future
Is there a Problem?
Comparisons to the Reference Group
Is there a Problem?
Health Care Disparities Over Time
HHS Action Plan to Reduce
Racial and Ethnic Health Disparities
Goals and Strategies
Action Plan Goals:
1. Transform Healthcare
2. Strengthen the health and human services infrastructure and
workforce
3. Advance the health, well being and safety of the American People
4. Advance scientific knowledge and innovation
5. Increase efficiency, transparency, and accountability of HHS
programs
Application of the plan is alignment in initiatives, research grants and
contracts, special programs, and creation of tools and partnerships to
reduce disparities through each arm strive towards goals.
Conceptual Framework:
Health Disparities-Health Care Disparities-Workforce
The Pathway to Equity:
Improving Workforce Diversity to Blunt HC Disparities
How can increasing workforce diversity reduce health care disparities?
• Through better patient-provider communication (better adherence to
optimal treatment) and improving equity in health outcomes/quality of
life
– Examples of AHRQ Tools to Improve Patient-Provider Communication
and Health Literacy: CAHPS cultural competency modules, CLAS
standards, Health Literacy Universal Precautions Toolkit, Pharmacy
Health Literacy Center
• Though example and providing cross-cultural learning to colleagues can
lead to a better understanding and reduce bias, improving patient care.
• Though earning higher wages (improving access to care – access to
health knowledge/literacy) and improving equity in health (more
resources)
AHRQ and HHS efforts to improve workforce diversity
Tracking and HHS/AHRQ Efforts to Improve
Workforce Diversity
• Racial and ethnic composition of nursing workforce
• THE GOAL: match the workforce composition to the general population
Implications for Health and Health Care
• Community Health Worker’s Role
• Action Items
• Predictions
Public Health Reports
Meet the Author! Live Webcast
What is health equity?
And how is it linked with the
social determinants of health?
Paula Braveman, MD, MPH
Professor of Family & Community Medicine
Director, Center on Social Disparities in Health
University of California, San Francisco
What are “health disparities” ?
• Any differences? Health differences between:
– Leg fractures among skiers vs non-skiers?
– The elderly vs young adults?
– Wealthy people in neighborhood A vs neighborhood B?
• Many official U.S. definitions refer only to
differences between unspecified groups
• But we really mean: Health differences that are
unfair (in a particular way)
• M. Whitehead: unfair, avoidable, and unjust
– But ideas of fairness, avoidability, and justice vary
Human rights principles provide guidance
• Social & economic rights, including the right to:
– achieve the highest attainable standard of health
– living standard adequate for health, education, benefits
of progress, participation in society
• Governments should progressively remove people’s
obstacles to fulfilling their rights, especially for
those with more obstacles
• Non-discrimination & equality: prohibits actions
with intent or effect of discrimination & requires
affirmative action
Human rights principles:
Non-discrimination and equality
• Specify vulnerable groups: race or ethnic group,
skin color, religion, language, or nationality; socioeconomic status; gender, sexual orientation or
gender identity; age; disability; geography; political
affiliation
• Implicit criterion: vulnerability due to history of
discrimination, social exclusion or marginalization
– Examples: slavery, genocide, hate crimes, expropriation
of ancestral lands, targeted marketing of harmful goods,
negative media depictions, slurs
Defining health disparity & health equity based
on ethics and human rights: it’s about justice
• Health disparity: a health difference closely linked with
social (including economic) disadvantage
• Health disparities adversely affect groups who have
systematically experienced greater obstacles to health
based on discrimination/exclusion; do not need to
prove causation
• Disparities: the metric to assess progress toward equity
• Health equity: pursuing the highest possible standard of
health for all while focusing on those with the greatest
social/economic obstacles to health
Health equity and the social
(including economic) determinants of health
• Equity in health itself, not only in health care
• Human rights principles call for equality and nondiscrimination regarding all rights, including the
social determinants of health
• Rights to a living standard adequate for health,
education, food, water, participation in society,
benefits of societal progress
How could income affect health?
A body of literature supports:
Income can shape options for:
• Housing
• Neighborhood conditions
• Diet
• Exercise
• Services (e.g., childcare,
transportation, repairs, medical
care…) that can alleviate stress
• Most of above can
affect stress and thus family
stability
Parents’ income shapes the
next generation’s:
• Education
• Work
• Income
Income shapes neighborhood options.
How could a neighborhood affect children’s health?
•
•
•
•
•
Safe places to exercise
Access to healthy food
Ads for harmful substances
Social networks & support
Norms, role models, peer
pressure
• Fear, anxiety, despair, stress
• Quality of schools
• Racial segregation tracks Blacks
& Latinos into poorer
neighborhoods than Whites of
similar income
Image: http://www.seattlemet.com/news-and-profiles/publicola/
articles/some-rich-architects-mansion.
Childhood social (including economic)
conditions shape adult health
• Large body of knowledge shows adult health is
shaped by early experiences
– Lasting effects of in-utero/early childhood deprivation
• Early childhood social conditions could have crucial
effects not erased by later circumstances
– Neuroendocrine and immune dysregulation
• Chronic stress/deprivation in childhood  chronic
disease in childhood and adulthood
• Cumulative effects of disadvantage
How could racial discrimination
damage health?
• The legacy of once-legal discrimination: structural
racism
– lower incomes, wealth, education, occupations
• Psychological effects: stress due to economic
hardship and racism-related stress
– Stress  adverse health-related behaviors
– Stress  direct physiologic damage (via HPA axis,
autonomic nervous system, inflammation, immune
response, cellular aging)
– Not only overt incidents, but subtle experiences &
chronic vigilance could damage health
Public Health Reports
Meet the Author! Live Webcast
Increasing Racial/Ethnic Diversity in Nursing to
Reduce Health Disparities and Achieve Health Equity
Janice Phillips MS PhD FAAN RN
Director of Government Affairs
CGFNS International
Why Diversity
• Shifts in demographics minorities- majority by 2043.
• Minorities remain underrepresented in nursing.
• Essential to addressing health disparities and
achieving health equity.
• Minority leadership may shape goals, national
policies and initiatives on health disparities.
Citation: Phillips, J & Malone, B (2014). Increasing racial/ethnic diversity in nursing to reduce health
disparities and achieve health equity. Public Health Reports, 129, 45-50.
Unfinished Business
• What are the contributions of minority nurses in
eliminating health disparities?
• How will increasing the number of minority nurses
with advanced degrees aid in achieving health
equity?
• Where are our minority nurse leaders positioned?
Beyond the Bedside
• Schmeidling, NJ (2000). Minority Nurses in
Leadership Positions: A Call for Action. Nursing
Outlook 48(3), 120-127.
Path to Strengthening Social
Determinents
• Integrate and establish stronger linkages SED in all levels nursing education.
• Support specific training in health equity and
disparities for all levels of nursing including
APRN.
Citation: Phillips, J & Malone, B (2014). Increasing racial/ethnic diversity in nursing to
reduce health disparities and achieve health equity. Public Health Reports, 129, 45-50.
Path to Strengthening Minority
Contribution
• Create stronger metrics that assess minority nurses’
contributions in this arena. Need common language
and common metrics.
• Create national repository to showcase efforts.
• Work with ethnic minority organizations to collect
data on leadership positions and related activities.
Citation Phillips, J & Malone, B (2014). Increasing racial/ethnic diversity in nursing to reduce health
disparities and achieve health equity. Public Health Reports, 129, 45-50.
An Exemplar
• Newly funded Duke University School of Nursing
Health Equity Academy (HRSA Diversity Grant)
• Emphasis on the Social Determinants of Health
View the HEA Informational Webinar
The Duke University School of Nursing announces The Academy for Academic and
Social Enrichment and Leadership Development for Health Equity (Health Equity
Academy). The Health Equity Academy (HEA), a newly funded Health Resources and
Services Administration (HRSA) Nursing Workforce Diversity grant (D19HP25902), is
the next generation of the Making a Difference in Nursing II (MADIN II) program.
MADIN II concludes December 31, 2013.
The Health Equity Academy will focus on Social Determinants of Health (SDH),
health access, health disparities, diversity and health equity in the preparation of
HEA Scholars destined to become the next generation of minority nurse leaders.
Selected Resources
• Doctoral Advancement in Nursing (DAN) Project
• AACN and RWJ Foundation initiative to enhance
minority nurses completing PhD and DNP degrees.
White paper:
http://www.newcareersinnursing.org/resources/da
n-white-paper
• U. S. Department of Health and Human Services,
Health Resources and Services Administration,
Bureau of Health Professions Diversity Grant
Programs http://bhpr.hrsa.gov/grants/diversity
Questions?
Closing
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