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Editorial: Embracing Diversity to Overcome Health Disparities
A snapshot of the current U.S. population reveals more than 281 million citizens: approximately 51% are female, 75% Caucasian, 12.5% Hispanic/Latino, 12.3% African American, 3.6 % Asian, and the remaining Native Americans and other groups (U.S. Census, 2000). The nursing workforce, on the other hand, is composed of more than 2.3 million registered nurses, of which 94.5 % are female, 87% Caucasian, 2% Hispanic, almost 5% African American, and the remaining of other races (National Sample Survey of Registered Nurses, 2000; U.S. Department of Labor, 2005). Obviously, the general profile of our patients and nurses do not mirror each other in either race or gender.
Unfortunately, a closer look at the data reveals a distinct trend toward health disparities in different subgroups within the United States. Although the life expectancy and overall health of Americans have improved dramatically in recent years, our patients are not benefiting equally. For instance, African Americans are far more likely to develop cancer than other ethnic groups and are twice as likely to develop diabetes as Caucasians (U.S. Department of Health and Human Services, 2004). In addition, more than 40% of African American men and women will suffer from heart disease, compared with 30% of Caucasian men and 24% of Caucasian women. Whereas Hispanics die from heart disease at a lesser rate than Caucasians, Mexican American women are diagnosed with the condition more frequently than Caucasian females, but also have a greater prevalence of obesity, a major contributor to heart disease.
Racial and ethnic health disparities also are apparent in many other ways, such as infant mortality, diabetes, stroke, end-stage kidney disease, and HIV. Today, more than 8 out of 10 children with acute lymphoblast leukemia are cured (Carroll, 2003), yet African American, Hispanic, and Native American children have the worst survival rate for this form of cancer throughout all treatment stages (Kadan-Lottick, Ness, Bhatia, & Gurney, 2003). Overall, racial and ethnic minorities receive inadequate care in many conditions, die younger from treatable diseases, and have low representation in the health professions when compared with Caucasians (Byrd & Clayton, 2002).
Even though we may be disheartened by these statistics, rehabilitation nurses are in a unique position to assume a leadership role in closing these gaps in care. Admittedly, nurses have not mastered the many facets of diversity, but neither have other healthcare disciplines. Given that nurses comprise the largest segment of the healthcare work force, it is important that our profession develop creative strategies to address health disparities in our increasingly multicultural and varied patient populations. Rehabilitation nurses generally operate uniquely to blend their knowledge of family composition, heritage, and preferences with holistic care in the context of the family, community, and the patients’ functional capabilities postinjury or illness. The future of minority health will be determined to large extent by how well individuals and communities work to reduce and eliminate health disparities for minority populations who experience a disproportionate burden of disease, disability, and premature death (CDC, 2005). One of the primary goals of Healthy People 2010 (U.S. Department of Health and Human Services, 2000) is to assist in the elimination of health disparities resulting from differences in gender, race, ethnicity, education, income, disability, geographic location, and sexual orientation.
Many health disparities exist within the rehabilitation patient population. Countless mechanisms contribute to these disparities, such as racial and ethnic lifestyle variances, genetic predispositions, socioeconomic factors, quality of health care received, differences in health beliefs, literacy, environmental conditions, and adherence to prescribed therapies. How can rehabilitation nurses realistically influence this dynamic situation?
Admittedly, health disparities require widespread, dynamic, long-term interventions. What follows are some initial steps rehabilitation nurses can take to address the challenges posed by patients’ health disparities:
Although these initial steps may appear overwhelming, the articles in this issue will assist in their realization. Readers will be reminded of the linkage of learning styles to patient outcomes, pivotal elements in developing cultural competency, and how collaboration between research teams maximizes the collective skills of individuals to advance nursing knowledge development. Another article acknowledges the recurring role effective communication plays in the referral process while an additional author explores the importance of periodically reframing old concepts such as “pain” within a new context. One study reports findings pertaining to the challenge of caring for an adult patient who fails to thrive in spite of all efforts, and another describes how evidence-based interventions can be bundled to improve the care of a mechanically ventilated patient.
Despite focused efforts to address health disparities of patients, solutions will not be simple or immediate. By becoming increasingly mindful that health disparities exist, rehabilitation nurses can serve as leaders in targeting strategies that dramatically affect primary and secondary disease prevention, health maintenance, and restoration of maximal function now and in the future for those with overt and covert health disparities.
Byrd, W., & Clayton, L. (2002). An American health dilemma: Volume II. New York: Routledge.
Carroll, W. (2003). Race and outcome in childhood acute lymphoblastic leukemia. JAMA: The Journal of the American Medical Association, 290, 2061–2063.
Centers for Disease Control and Prevention. Eliminating racial and ethnic health disparities. Retrieved June, 5, 2005, from http://www.cdc.gov/omh/AboutUs/disparities.htm
Kadan-Lottick, N. S., Ness, K. K., Bhatia, S., & Gurney, J. G. (2003). Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. JAMA: The Journal of the American Medical Association, 290, 2008–2014.
National Sample Survey of Registered Nurses (March, 2000). The Registered Nurse Population. Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. Retrieved June 6, 2005 from ftp://ftp.hrsa.gov/bhpr/rnsurvey 2000/rnsurvey00.pdf
U.S. Census Bureau. Overview of race and Hispanic orgin. Retreived June 6, 2005, from http://www.census.gov/prod/2001pubs/c2kbr01-1.pdf
U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health (2nd ed). [Electronic Version].Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services. (2004). HHS Fact Sheet. Retrieved May 1, 2005, from http://www.omhrc.gov/rah/
U.S. Department of Labor, Bureau of Labor Statistics, Registered Nurses.(2005). Retrieved May 1, 2005, from www.bls.gov/oco/ocos083.htm.