Want to impact health equity? Look in the mirror.

In 2015, the Association of Public Health Nursing wrote a white paper that called public health nurses to speak up and commit to eliminating health inequities. Yet, the struggle for health equity is not only alive and well, but apparently growing. In the wake of numerous national and state policy changes that negatively impact health equity including decreasing access to reproductive planning, exclusions from shelter based on gender identity, and rising health care costs that increasingly impact those who cannot afford it, we seem to be going backward in our work. In health department settings, we frequently use “health equity” language in our goals, missions, visioning, and strategic mapping without giving our workforce concrete, actionable, and lasting steps that can make a difference. And while we own the charge to ensure health equity, we frequently talk about it without translating what that might mean to nurses in all fields, who have as much at stake when it comes to halting health inequities as we in public health do. We need to put the rubber to the road, and we need the help of all nurses, not just public health nurses, to make it happen.

Health equity starts where you are. As public health nurses, we are trained to look at health disparities in our communities, but no matter what kind of nurse you are, you learn to spot them happening in front of you. Do two patients who seem a lot alike in disease process suffer different outcomes? Why might that be? The first place to start is to reflect, honestly, on whether your own biases impact the care you give. You might feel some outrage reading that, but unconscious bias impacts every single one of us. I was raised in Western Nebraska and mostly grew up around white straight kids. Some of them were Hispanic. But none of them were Black, or Asian, and I had one friend who was gay, though he didn’t come out until college. Diversity was not a thing I had much experience with, so as a new nurse, I had quite a learning curve. I’ve been a public health nurse for nearly 18 years and I still find myself facing biases I didn’t know I had. Rather than insisting you couldn’t possibly have a bias, take an honest look. And then, take steps to weed it out. Do you take a laboring Black woman’s pain less seriously than a white woman’s? Do you take care of the middle-class family who appears fresh and washed and inwardly groan about the low-income one who has clearly been in the same clothes for a couple of days? Nurses should pride themselves on caring for anyone who meets the qualification of being a human. Health and Human Services announced a rule change in May that would allow health professionals to decline caring for people based on conscience objections. This sets and extremely dangerous and unethical precedent that can allow health professionals to start down a slippery slope of who deserves care and who does not; it will only drive health inequity to become an even greater problem.

Health equity also has to happen outside your doors. Once they leave your department or your building, your patients return to the environment that is driving their poor health outcomes. That means they may return to you, and growing numbers of people in the same boat may do the same. Why? Your local public health office can help point you toward data that will help you understand what is going on. Better yet, they’d love to have you on their team, partnering to help address the issues head on. In public health, we believe that we can’t possibly change the world alone, and we need you. And, whatever your passion, there is a public health topic and a population with a health disparity that needs you.

Addressing health inequities in our communities takes more than just identifying our biases and translating brochures into another language and putting same-sex couples on posters (although these are a great start). Addressing these inequities requires us to think outside the box consistently and compassionately. One excellent way to do this is to run for election to a board in your community, where your voice can be heard in the sectors that truly matter- the ones that underpin the social determinants of health. This means serving on boards of education, city council, business councils, and others, and then speaking up to ensure that at every consideration, health equity and social justice are taken into account. This speaks to the roots, and not just the leaves, of inequity. Nurses are consistently one of the most trusted professions. We are masters of translating the importance of health to every corner of life, and we need to apply that lens to the policies that are foundational to the environments in which we are all living and working. And while you are in the boardroom, look around and start thinking about creative partnerships that can actually change things. Not only does collaboration mean better pooling of resources, but the synergy of shared brainpower can be unstoppable.

Speaking up against the actual drivers of inequity is hard. It feels scary. You will have to confront yourself, people who are bigger than you, and a system that feels mired in concrete. My favorite author, Brene Brown, likes to say, “Strong back, soft front, wild heart.” We owe it to our patients, our communities, to be brave. Nurses have always had strong backs, and it’s time we use them to lift together. Allowing health inequities to persist goes fundamentally against the pledge we took upon becoming nurses, and it’s time we stop simply talking the talk and start walking the walk.