Skip to main content

Strengthening Nursing Education to Address Social Determinants of Health: Systems Leadership

Abstract

As a nation, we are now acknowledging, discussing, and addressing the root causes of inequity found in the social and structural determinants of health. Addressing social, economic, and environmental conditions that impact health is not new to nursing education, but a broader perspective that focuses on (1) systems and structures, (2) policy and politics, (3) historical drivers of inequity, (4) climate change, and (5) structural racism as a root cause of health inequities is new. With this recognition, nursing education must rapidly transform. This transformation will require courageous leadership to change culture, move beyond resistance, and update the curriculum. Cultivating critical consciousness and building structural competency are the new and necessary developmental and curricular underpinnings. In addition, there must be an intensification of the focus on the health and well-being of nurses leading in these new roles to advance health equity. Hope, healing, and finding one’s truth are now essential aspects of health and well-being for nurses leading the transformation of nursing education and healthcare delivery.

Keywords

Future of Nursing 2020–2030: Recommendation 3

By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence-based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity.

Future of Nursing 2020–2030: Recommendation 7

Nursing education programs, including continuing education and accreditors and the National Council of State Boards of Nursing, should ensure that nurses are prepared to address social determinants of health and achieve health equity.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Davis S. The evolving role of social determinants of health to advance health equity. In: Seibert D, Malone B, DeLeon P, editors. Shaping healthcare policy: a view from the inside. 1st ed. New York: Academic; 2022.

    Google Scholar 

  2. National Academies of Sciences, Engineering, and Medicine. The future of nursing 2020–2030: charting a path to achieve health equity. Washington, DC: The National Academies Press; 2021. https://doi.org/10.17226/25982.

    Book  Google Scholar 

  3. Frueh S. Confronting a ‘triple existential threat’—NAM president Victor Dzau discusses how health and medicine can respond to current crises. Washington, DC: National Academies of Sciences, Engineering, Medicine; 2021. https://www.nationalacademies.org/news/2021/10/confronting-a-triple-existential-threat-nam- president-victor-dzau-discusses-how-health-and-medicine-can-respond-to-current-crises.

    Google Scholar 

  4. Davis S, O’Brien A-M. Fast facts about diversity, equity, and inclusion in nursing: building competencies for an antiracism practice. 1st ed. New York: Springer Publishing Company; 2022.

    Book  Google Scholar 

  5. National League for Nursing (NLN). Mission and strategic plan. 2022. https://www.nln.org/about/about/mission-and-strategic-plan.

  6. Malone BL. Managing diversity: a leadership dilemma. Surg Serv Manag. 1996;2(5):14–7.

    Google Scholar 

  7. National League for Nursing (NLN). Core values. 2022. https://www.nln.org/about/about/core-values.

  8. Magnan S. Social determinants of health 101 for health care: five plus five. National Academy of Medicine (NAM) perspectives. Discussion paper. Washington, DC: National Academy of Medicine; 2017. https://doi.org/10.31478/201710c.

  9. Weil A. The social determinants of death. Health affairs. 2021. https://www.healthaffairs.org/do/10.1377/forefront.20200603.831955/.

  10. Olayiwola JN, Joseph JJ, Glover AR, Paz HL, Gray II DM. Making anti-racism a core value in academic medicine. Health Aff. 2020. https://www.healthaffairs.org/do/10.1377/forefront.20200820.931674/full/#:~:text=The%20Miseducation%20On%20%E2%80%9CSocial%20Determinants,root%20causes%20of%20poor%20health.

  11. World Health Organization (WHO). Social determinants of health. 2022. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1.

  12. World Health Organization (WHO). Taking action on the social determinants of health. 2022. https://www.who.int/westernpacific/activities/taking-action-on-the-social-determinants-of-health.

  13. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63. https://doi.org/10.1016/S0140-6736(17)30569-X.

    Article  PubMed  Google Scholar 

  14. Bailey ZD, Feldman JM, Bassett MT. How structural racism works-racist policies as a root cause of U.S. racial health inequities. N Engl J Med. 2021;384(8):768–73. https://doi.org/10.1056/NEJMms2025396.

    Article  PubMed  Google Scholar 

  15. Lavizzo-Mourey RJ, Besser RE, Williams DR. Understanding and mitigating health inequities—past, current, and future directions. N Engl J Med. 2021;384(18):1681–4. https://doi.org/10.1056/NEJMp2008628.

    Article  PubMed  Google Scholar 

  16. Fleming PJ. The importance of teaching history of inequities in public health programs. Pedagogy Health Promot. 2020;6(4):253–6. https://doi.org/10.1177/2373379920915228.

    Article  Google Scholar 

  17. Exworthy M. Policy to tackle the social determinants of health: using conceptual models to understand policy process. Health Policy Plan. 2008;23:318–27. https://doi.org/10.1093/heapol/czn022.

    Article  PubMed  Google Scholar 

  18. Braveman P, Arkin E, Orleans T, Proctor D, Acker J, Plough A. What is health equity? Behav Sci Policy. 2018;4(1):1–14. https://doi.org/10.1353/bsp.2018.0000.

    Article  Google Scholar 

  19. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–45. https://www.jstor.org/stable/45131055.

    Article  CAS  PubMed  Google Scholar 

  20. National League for Nursing (NLN). The institute for social determinant of health and social change. 2022. https://www.nlnwaldensdoh.org/.

  21. Jemal A. Critical consciousness: a critique and critical analysis of the literature. Urban Rev. 2017;49(4):602–26. https://doi.org/10.1007/s11256-017-0411-3.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mezirow J. Transformative learning: theory to practice. New directions for adult continuing education. p. 5–12; 1997.

    Google Scholar 

  23. Davis S, O’Brien A-M. Let’s talk about racism: strategies for building structural competency in Nursing. Acad Med. 2020;95:S58–65.

    Article  PubMed  Google Scholar 

  24. Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Prison Policy Initiative. States of incarceration: the global context 2021. 2021. https://www.prisonpolicy.org/global/2021.html.

  26. Equal Justice Initiative. Half of Americans have family members who have been incarcerated. 2018. https://eji.org/news/half-of-americans-have-family-members-who-have-been-incarcerated/.

  27. Gramlich J. Black imprisonment rate in the U.S. has fallen by a third since 2006. Washington, DC: Pew Research Center; 2020. https://www.pewresearch.org/fact-tank/2020/05/06/share-of-black-white-hispanic-americans-in-prison-2018-vs-2006/.

    Google Scholar 

  28. Planas A. Blacks, Latinos and Native Americans disproportionately killed by COVID-19 last year study says. NBC News. 2021. https://www.nbcnews.com/news/us-news/blacks-latinos-native-americans-disproportionally-killed-covid-19-last-year-n1280837.

  29. Shiels MS, Haque AT, Haozous EA, Albert PS, Almeida JS, Garcia-Closas M, Napoles AM, Perez-Stable EJ, Freedman ND, Berrington de Gonzalez A. Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020. Ann Intern Med. 2021;174(12):1693–9.

    Article  PubMed  Google Scholar 

  30. Hill L, Artiga S. COVID-19 cases and deaths by race/ethnicity: current data and changes over time. San Francisco: KFF; 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/.

    Google Scholar 

  31. Johnson SR. U.S. News-Harris poll survey: as America aims for equity, many believe systemic racism doesn’t exist. US News and World Report. 2022. https://www.usnews.com/news/health-news/articles/2022-11-16/poll-many-americans-dont-believe-systemic-racism-exists.

  32. Doty MM, Horstman C, Shah A, Ayo-Vaughan M, Zephyrin L. How discrimination in health care affects older Americans, and what health systems as providers can do. The Commonwealth Fund. 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/how-discrimination-in-health-care-affects-older-americans#1.

  33. Hill L, Artiga S, Ranji U. Racial disparities in maternal and infant health: current status and efforts to address them. San Francisco: KFF; 2022. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/.

    Google Scholar 

  34. Ohman RE, Yang EH, Abel ML. Inequity in cardio-oncology: identifying disparities in cardiotoxicity and links to cardiac and cancer outcomes. J Am Heart Assoc. 2021;10(24):1–18.

    Article  Google Scholar 

  35. Hamel L, Lopes L, Munana C, Artica S, Brodie M. KFF/the undefeated survey on race and health. San Francisco: KFF; 2020. https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/.

    Google Scholar 

  36. Rogers CR. Significant aspects of client-centered therapy. Am Psychol. 1946;1(10):415–22.

    Article  CAS  PubMed  Google Scholar 

  37. Malone B. Without diversity, there is no excellence. Nurs Sci Q. 2020;33(3):226–8.

    Article  PubMed  Google Scholar 

  38. Sullivan HS. The interpersonal theory of psychiatry. New York: W. W. Norton & Company; 1953.

    Google Scholar 

  39. Collins FS, Mansoura MK. The human genome project. Revealing the shared inheritance of all humankind. Cancer. 2021;91(1 Suppl):221–5.

    Google Scholar 

  40. McIntosh P. White privilege: unpacking the invisible knapsack. Peace and Freedom. 1989. https://psychology.umbc.edu/wp-content/uploads/sites/57/2016/10/White-Privilege_McIntosh-1989.pdf.

  41. Waite R, Nardi D. Nursing colonialism in America: implications for nursing leadership. J Prof Nurs. 2017;35:18–25.

    Article  PubMed  Google Scholar 

  42. Wallace DF. This is water: some thoughts, delivered on a significant occasion, about living a compassionate life. Boston: Little, Brown and Company; 2009.

    Google Scholar 

  43. Stephenson W. Are there more Black men in prison or college. BBC News. 2013. https://www.bbc.com/news/magazine-21791038.

  44. Grant E. ANA’s racial reckoning: name it, aim it, claim it. Nursing. 2022;52(9):6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Beverly Malone .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Malone, B., Davis, S. (2023). Strengthening Nursing Education to Address Social Determinants of Health: Systems Leadership. In: Hassmiller, S., Darcy Mahoney, A., Beard, K. (eds) The Future of Nursing 2020-2030: Global Applications to Advance Health Equity. Springer, Cham. https://doi.org/10.1007/978-3-031-29746-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-29746-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-29745-8

  • Online ISBN: 978-3-031-29746-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics