Healthcare disparities and inequities

Healthcare Disparity and Inequality in Nursing:

Diversity, Equity, and Inclusion (DEI) and Wellness

Diversity, equity, and inclusion (DEI) initiatives are a critical component of any nursing practice, as nurses strive to be more sensitive and aware of cultural and socio-economic differences and how they impact patient health. One example of this is wellness promotion, as nurses simultaneously are faced with more and more patients suffering from lifestyle-related illnesses, such as type 2 diabetes and heart disease. Although lifestyle-related illnesses are not limited to the socioeconomically disadvantaged, they disproportionately impact the poor and persons of color. Promoting better health is a social justice issue, but nurses must be simultaneously aware of how issues which can impact weight and lifestyle disease may not be fully under a patient’s immediate control.

According to Zare (et al. 2021), according to data compiled for the 1999–2016 National Health and Nutrition Examination Surveys (NHANES), while on average, 35% of the population were classified as being obese in the United States, Black non-Hispanics had a 45.5% rate of obesity, significantly higher than white non-Hispanics. This trend also corresponds with alarming increases in income inequality (Zare et al., 2021). In short, nurses must be aware of issues such as obesity and associated health complaints that may disproportionately impact poorer and non-white populations. Individuals from historically discriminated-against minority populations have lower incomes overall, suffer higher poverty rates, live in neighborhoods with fewer resources (such as grocery stores and green spaces) which can create an obesity-promoting environment (Zare et al., 2021).

Therefore, when dispensing health-related advice, nurses must also be sensitive to the fact that it can be more challenging for less affluent individuals to afford healthy foods, incorporate exercise into their lives, and make lifestyle changes. Such changes may not be impossible, but given even affluent individuals with access to fresh foods at a grocery store, meal services, and gyms struggle with their weight, the difficulty of those patients who lack such resources is compounded. There can also be positive cultural associations with highly caloric food, family, hospitality celebration that can be very important parts of patients’ community life. Food maybe viewed as a source of comfort and entertainment in difficult times. Urging patients to give up favorite foods for health reasons can make patients feel frustrated, as if they must choose between their cultural values and health.

Healthcare providers must strike a balance between the real seriousness of specific health-related demands, such as the need for appropriate monitoring of carbohydrate intake, and, for example, the centrality of rice in many Asian American cultures and corn in Hispanic American cultures. Acknowledging the difficulty of change and honoring the importance of the patient’s culture, while actively working with the patient to create feasible and manageable change strategies that are actionable is critical. The nurse must not simply strive to be correct (for example, the importance of weight loss in reducing the risk of developing diabetes, heart disease, and osteoarthritis) but find a correct way forward for the patient on the path to health.

Providers can also be more sensitive to patients if they engage in self-criticism of their own possible internal biases when dealing with patients, such as frustration when patients do not adhere to a particular diet and exercise regime. Putting one’s self in the patient’s situation imaginatively, rather than simply offering prescriptive advice is critical (Marjadi 2023). For example, patients suffering food insecurity may rely heavily upon high-calorie, low-nutrition, inexpensive foods because they fear not having enough money or food when they are living from paycheck to paycheck. Establishing a meal plan that is affordable and offering suggestions for ways to obtain healthier foods, rather than simply suggesting foods, is critical.

This does not mean that some of the patient’s attitudes and assumptions cannot be challenged (for example, the assumption that being overweight is not a contributor to disease, or that being identified as pre-diabetic is not something to be feared because it can be treated with medication). But the provider and the patient must work together to understand one another’s assumptions and their attitudes to food culture about issues such as eating to satiety, snacking, appropriate foods to eat, how foods are prepared, and create a bridge between the patient’s current behaviors and state of mind to a more positive and health-promoting one that the patient can execute in daily life (Dao et al., 2020). For example, if a patient lacks access to the ability to cook easily, identifying healthy meals that can be made with a minimal amount of preparation may be helpful.