Today, Shawn M. Kneipp, PhD, RN, ANP, APHN-BC presented comments during the White House North Carolina Listening Session as part of a panel. Dr. Kneipp was one of two registered nurses on the panel and the only public health nurse.
She was asked to discuss the following:
Based on your experiences caring for patients and/or your work in the area of health equity, what is the most important message you would convey to the White House on equity related issues impacting patients?
Read her full response:
Thank you. It is an honor to be here today and provide my perspective on what the most important areas are for addressing health equity-related issues that impact patients.
First, we must recognize that most patients are really only “patients” – or individuals receiving care within the U.S. healthcare system – for brief, episodic events, or yearly annual visits over the course of their lives. The vast majority of time, patients are simply people who are living, working, and playing in their communities, where social and economic factors outside the healthcare system play a far more powerful role in determining their risk profile for chronic disease, injury, disability, or early mortality. Widely referred to as social determinants of health, these factors include income and wealth, racism, housing, education, employment stability, transportation, neighborhood safety, and the social and physical environment. Over the past 20 years, a large body of research has demonstrated these determinants impact health both directly through stress-related neuroendocrine activation and indirectly through behavioral pathways. As a nation, our efforts to redress health inequities have been focused on interventions to change the lifestyle behaviors of individuals – often leaving the social determinants, as the “root causes” driving health-compromising behaviors, intact. Not surprisingly, this has failed to result in any meaningful closure of the health equity gap at the population level between groups who are socially and/or economically advantaged and those who are disadvantaged (as designated by race/ethnicity, education level, income, wealth, and rural/urban status).
One of the most important conclusions that I believe the public health community has come to from these two decades of work is this: as a nation, we cannot achieve health equity by looking solely to solutions delivered to individual patients through our traditional healthcare system; rather, we must modify the social determinants of health by employing the full weight of, and sufficiently resourcing, our public health system to work in partnership with sectors that regulate or control the social determinants of health in communities.
In 2017, former acting Assistant Secretary for Health Dr. Karen DeSalvo provided a blueprint for how to redirect the work of the public health system to strategically address social determinants through the Public Health 3.0 initiative. Strategies include local public health departments forming “vibrant, structured, cross-sector partnerships designed to develop and guide . . . initiatives and to foster shared funding, services, governance, and collective action.” (DeSalvo et al., 2017).
In summary, the most important message I can deliver to work toward achieving health equity here in North Carolina (and indeed in every other state) is to advance the vision of Public Health 3.0 by sufficiently funding, and incentivizing public health leaders to partner with other sectors at the local, state, and national levels to address the social determinants of health. In so doing, this will help to ensure the conditions where people live, work, and play are designed to allow everyone to be healthy.