How do you fix health inequity in the United States? The education and health-care communities as well as policymakers must consider what are known as the social determinants of health as an integral part of solving this dilemma. Additionally, communities need to stop thinking of health care as care only received in a medical environment such as a hospital or clinic. Instead we must consider health-care holistically as a service given in our homes, our schools, our workplaces, our parks and our communities. These services are provided by an array of health-care providers, including nurses, physicians, psychologists, dentists, social workers and many more — over 13 million strong.

Social determinants of health, the conditions in which people live and work, have a profound impact on health status and the prevalence of health inequities in our country. Good health is not just a medical issue. From the cradle to the grave, our health can be negatively affected by lack of social and economic opportunities; homelessness; racial bias; substandard public education; food insecurity; workplace safety; personal relationships; and the cleanliness and accessibility of water, food and air.

{mosads}As we have seen with the ongoing Flint, Michigan, water crisis, water contaminated with lead has affected residents of all ages, especially children, many of whom will face significant lifelong challenges to their mental and physical development, as well as their overall health. No child in America should face a future like this one.

The United States spends more on health care than any other country in the world. In 2017, our nation spent about $3.5 trillion, or 18 percent of GDP, on health expenditures — more than twice the average among developed countries. Despite this investment, the United States continues to lag behind those countries in many important health indicators.    

Health professionals are uniquely positioned to lead the nation in strategies to promote health equity. We should especially consider the role of the 4 million nurses across the country. They are in every emergency room, every doctor’s office – even most pharmacy clinics. They are often the primary caregivers for patients. And once nurses are educationally prepared, they tend to stay and live in their own communities, especially rural and minority nurses.

Health professional education must include training in the social determinants of health to provide students with the skills they need to practice in rural and underserved communities after graduation, to refer patients to social service resources to improve their health and to advocate for changes to reduce health-care inequities. Nurses are well-placed to take on these challenges, though many more nurses are needed as the demand for health care in our communities increases.

Unfortunately, social determinants of health have not traditionally been integrated throughout most health professional education curricula and this has prevented health professionals from acquiring the knowledge necessary to assess and address the key drivers of health. These include, but are not limited to, an understanding of the more complex and less obvious factors such as neighborhood safety, discrimination based on sexual orientation and gender identity and job security.

Policymakers at all levels of government, including Congress and federal agencies, are also uniquely positioned to address health inequities by taking a more holistic view of health care through legislation and regulation. While health care is critically important, policymakers must consider the impact on our citizens’ health of the quality of schools, affordability and stability of housing, access to good jobs with fair pay and clean air and water.

Even something as simple as transportation can make a big difference in the lives of our citizens. If people don’t have access to a car or public transportation, then they may not have access to quality health care.

Additionally, food deserts in urban areas, where it is difficult for residents to find affordable and good-quality fresh food, can have a significantly negative impact on health. Diet-related health problems tend to be disproportionately higher in food deserts than in areas served by modern grocers. Low quality foods have been linked to chronic illnesses, cancer, cardiovascular disease, diabetes, hypertension and even premature death.

The growing awareness by policymakers of their role in influencing health and health status will present opportunities for innovation in public policy and resources to address the social determinants of health. Policymakers must prioritize addressing these issues through resources, legislation and regulatory action.  

Health, wellness and disease start in the places where we live, work, play, pray and age. Our path to health starts from the moment we are born. Failure to assess social determinants of health and intervene to lessen their impact is contrary to the role of health professionals in our health-care system.

Until health professionals and policymakers incorporate social determinants of health into education, training and practice, our nation will continue to suffer from health inequity and rising health-care costs. We must address these issues to improve the health of individuals and communities.    

Beverly Malone Ph.D. R.N is the CEO of the National League for Nursing CEO. She has worked in mixed policy, education, administration and clinical practice, including as deputy assistant secretary for health within the U.S. Department of Health and Human Services.