It’s April, and I can only imagine the collective sigh of relief heard around the country. Those of us in the Northeast region of the United States—the New England and Middle Atlantic states—can finally be assured that our snowplow and shovel days are over. Clinic closures and school cancellations are unlikely and, thank goodness, the darkest days are behind us. Summer vacations for those of us who reside in the Northern Hemisphere are being planned, and, though we’re a little more than three months deep into the New Year, it actually feels like a new beginning.
April, for me, marks the beginning of planting season. As a gardener, I’m poring through seed catalogs and testing the quality of my soil to determine if it needs a few cups of nitrogen here or there to even out the acid-alkaline imbalance. I’m checking Farmer’s Almanac predictions to get a sense of just how hot and dry the growing season will be. I’m thinking about what I want to eat this summer and whether or not I want to stay on the tried and true path, growing what is familiar to me, or be a bit more bold and ambitious with heirloom seeds and varieties yet untried.
I’m checking my compost—a pile of rich, dark soil filled with worms and their egested casts, perfect for growing. And most importantly, I’m thinking about ways to improve irrigation. With an early start and late finish most days of the week, and hot temperatures sure to come, I can hardly imagine having enough time to make sure each crop row gets thoroughly watered to ensure that all of my hard work pays off with delicious meals composed of my own plantings.
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National Minority Health Month
Spearheaded by the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, the theme of this year’s National Minority Health Month—“30 Years of Advancing Health Equity”— commemorates HHS efforts, mobilized by findings of the Report of the Secretary’s Task Force on Black and Minority Health, commonly referred to as the Heckler Report, to eliminate health disparities among racial and ethnic minorities. Despite significant advances in medical science and disease-awareness campaigns, health disparities continue across racial, ethnic, gender, and socioeconomic lines.
Incidence rates of noncommunicable diseases such as diabetes, hypertension, and kidney failure remain disproportionately higher in African-American and Latino populations, and the United States continues to have an infant mortality rate that is higher than 25 of its wealthy counterparts. According to an alarming report in the Washington Post, in which data from the Centers for Disease Control (CDC) is analyzed, “A baby born in the U.S. is nearly three times as likely to die during her first year of life as one born in Finland or Japan. That same American baby is about twice as likely to die in her first year as a Spanish or Korean one.”
National Public Health Week
While we observe National Minority Health Month, the American Public Health Association (APHA) is marking—this week—National Public Health Week with five days’ worth of shifting themes that also emphasize the importance of addressing health disparities.
Monday kicked off the week with “Raising the Grade,” which, in an attempt to understand the overall state of America’s public health, examined public health data. Tuesday’s focus on the social determinants of health, particularly “zip code” health inequities, opened doors for very necessary conversations about ways in which health care access and services differ from neighborhood to neighborhood, city to city, thus further marginalizing the already marginalized. Wednesday and Thursday offer opportunities to discuss means for building a stronger public-health infrastructure through engaged leadership, interdisciplinary collaboration, and partnerships. And Friday will mark the 20th year of APHA’s National Public Health Week with a celebratory remembrance of major achievements in public health.
Nurses on front lines
No matter the setting in which we find ourselves, nurses are, more often than not, on the front lines of the very health delivery systems that are central to these week- and month-long observances. Nurses are the first and last points of contact for direct and indirect care. We are responsible for educating the largest segment of the health care workforce in the United States. For these reasons—and more—it is our responsibility to not only tune into these observances but to establish a direct relationship between public health and clinical practice.
No matter the setting in which we find ourselves, nurses are, more often than not, on the front lines of the very health delivery systems that are central to these week- and month-long observances. Nurses are the first and last points of contact for direct and indirect care. We are responsible for educating the largest segment of the health care workforce in the United States. For these reasons—and more—it is our responsibility to not only tune into these observances but to establish a direct relationship between public health and clinical practice.
By now, most of us have read the headlines about police shootings, tensions between local police and civilians, and spousal abuse at the hands of prized athletes. Tragedies all, it is time to speak publicly about the psychological toll that violence—particularly structural violence—has on individuals and whole communities. It is time to speak publicly about powerlessness and disengagement as a result of rape, abuse, repeated exposure to violence, and lack of protection and justice for victims of violent crime.
Those of us in clinical practice who know firsthand the financial struggles our patients have paying for medicine, healthy food, and the most basic necessities must give voice to the harsh realities of poverty and the social determinants of health. No more can we remain silent about the existence of food deserts—entire communities bereft of access to quality food markets but with easy access to the cheapest and most nutrient-poor foods one can imagine. No more can we ignore the roles of poor literacy and numeracy, placing blame for nonadherence on our patients without examining our responsibilities as providers to properly identify these deficiencies and to treat them as we would any other obvious health condition.
Now is the time
Knowing that these issues exist—and will continue to exist long past the five days in which we observe National Public Health Week and the 30 days in which we observe National Minority Health Month—underscores the importance of planting ourselves now in the events and discussions that are forthcoming. Now is the time for checking the soil and telling the truth about root causes of health disparities and inequities. Now is the time for collaboration, planting seeds of ideas that are bold and creative and getting out of silos that use outdated methods and theories that won’t solve new and more complex problems.
In the words of Einstein: “You cannot solve problems with the same level of thinking that created them.” Now is the time for improving irrigation, for ceaselessly watering, through advocacy and lobbying for improved and long-overdue health policies, seeds that will germinate into healthy “plants.” There is no better moment than the present to say what needs to be said and to do what needs to be done. Now's the time and the season, because, in the words of a treasured public-health colleague, at the end of the day all policy is health policy and all health is public health.
In late 2014, Angel Shannon was elected to serve on the Maryland Community Research Advisory Board (MD-CRAB) at the University of Maryland Center for Health Equity. “The overarching goal of MD-CRAB is to make a meaningful contribution toward the elimination of racial and ethnic health disparities by building trust between minority communities and health science researchers.” To learn more.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.
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