Health Equity, Diversity, and Inclusion

In some neighborhoods around our country, infant mortality rates resemble those of underdeveloped countries and citizens have unequal chances of living to age 65. In the not so distant past, our health care system might have overlooked these discrepancies. However, more and more, the rising costs of health care and transformation into value-based and quality-driven indicators is forcing entities to also identify and improve on social determinants that affect health. The concept of social determinants of health is not new, but it is gaining traction due to health care’s imperative to break with the status quo. Social determinants of health help us answer questions such as the following: How do diabetes patients who lack refrigeration store insulin to be complaint with care? How can low-income people adopt an exercise program if neighborhoods are unsafe for walking? How can people incorporate fruits and vegetables into their diet if they live in a food desert? To answer these broader questions, the imperative is for the traditional health care model to change and expand, adopt interdisciplinary care models of health, and develop integrated health care systems that are more holistic and focus on patient-centered resources and practices. In essence, create a large ecosystem of partners and solutions around the patient to build equity. Another imperative toward improving health care disparities is to increase diversity and inclusion in practice. The nursing profession has just over three million registered nurses in the United States, but Hispanic nurses represent roughly less than 4%. Yet, in contrast, Hispanics in the United States account for 17% of the U.S. population. If health equity is best achieved with a workforce that mirrors communities served, then we should all be working to increase diversity into nursing and other health care professions. Two landmark initiatives commissioned by the W. K. Kellogg Foundation in 2004 documented the need for increased diversity within the health professions: (1) The Nation’s Compelling Interest—Ensuring Diversity in the Health Care Workforce, by the Institute of Medicine; and (2) Missing Persons—Minorities in the Health Professions, by the Sullivan Commission. The Sullivan Commission’s report concluded the following: