Tune Into New Podcast Series: Conversations About Health Care Delivery in the United States

Tune Into New Podcast Series: Conversations About Health Care Delivery in the United States

Springer Publishing launched a new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music starting on March 7.
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The podcast series is hosted by Jim Knickman, the former Robert Derzon Chair at the NYU Wagner Graduate School of Public Service, and Brian Elbel, MPH, Professor of Population Health and Health Policy at NYU Wagner and the NYU Grossman School of Medicine. The series dives into complex and challenging issues affecting the U.S. health care system, its workforce, and the populations interacting with it, covering topics like health management, public health, health behavior, population health, healthcare quality, and health economics.


Knickman and Elbel engage with guests who are leaders in the health sector, from aging services to health policy, to learn more about the key drivers shaping the health care system, challenges and complexities related to health inequities, and the exciting career opportunities available to future health care professionals and leaders.

The podcast series is a companion to the 13th edition of Jonas and Kovner’s Health Care Delivery in the United States, as each episode has ties to essential concepts, challenges, complexities, and themes in the textbook.

Podcast Episode

How the U.S. Health Care Systems is Preparing for the Demographic Cliff features Ramsey Alwin, President and CEO of the National Council on Aging, and Kathleen Cameron, Senior Director of the National Council on Aging’s Center for Healthy Aging.

The episode offers an in-depth discussion about the demographic shift, how the roles of families and social systems have evolved, federal and state-level programs for seniors, social isolation and inequities in the aging population, healthy aging, and exciting career opportunities in aging services.

The podcast series also features a supplemental instructor guide for anyone using the textbook that provides learning activities, discussion questions, and other guidance to engage with each episode, delivering practical and engaging content to learners and professionals in the health care space.

Health Disparities and Black Communities

Health Disparities and Black Communities

Health disparities have historically impacted multiple populations throughout the U.S. When it comes to health and access to healthcare, consider the plight of Native Americans, undocumented immigrants, people experiencing homelessness and the chronically mentally ill, and rural communities in places like Appalachia, and we see a picture of what’s broken. The undeniable disservice that continues to millions of the most vulnerable is inexcusable, yet this legacy is slow to overcome.health-disparities-and-black-communities

In terms of Black communities and people of color, the disservice is centuries-old. To this day, the legacies of structural racism live on in health disparities that would have no place in 21st-century America if we had already learned our lessons and lived up to the potential outlined in our country’s founding documents.

Nonetheless, disproportionately negative statistics don’t lie. We know beyond the shadow of a doubt that Black Americans have received short shrift in the realms of health and healthcare since the first days of the American colonies, and the work to undo these wrongs is daunting and ongoing.

Distrust, Disparities, and Deceit

The Kaiser Family Foundation website states, “While Black people have made great contributions and achievements in the United States, they continue to face many health and health care disparities that adversely impact their overall health and well-being. These disparities have been exacerbated by the uneven impacts of the COVID pandemic, ongoing racism and discrimination, and police violence against and killings of Black people. Moreover, the long history of inequitable health outcomes among Black people reflects the abuses faced during slavery, segregation, mass incarceration, and their persistent legacies.’

Kaiser’s statistics point out that Black people face more significant financial obstacles to receiving appropriate healthcare and have a higher uninsured rate than white people. And with higher rates of poverty and food insecurity, it’s clear that many factors contribute to this calculus.

The growing gap of health disparities within the American healthcare system is resulting in the unnecessary deaths of people of color and the continued mistrust of the healthcare system,” states Jasmyn Moore, MBA, BSN, RN, co-host of the Distrust and Disparities podcast.

If you take a deep look into most health disparities that plague communities of color,” Ms. Moore continues, “you will see that the root cause is systemic racism. The medical field was built off experimenting on Black bodies.” In this statement, Ms. Moore is referring to a legacy exemplified by the Tuskegee experiments, where Black men were misled by researchers to believe that their syphilis was being treated, but in actuality, the course of the disease could be observed by scientists from the U.S. Public Health Service.

 “We have all heard the negative statistics surrounding the health of Black, Indigenous, and people of color,” Moore states. “Black mothers are three times more likely to die during childbirth. Black infant mortality is twice as high compared to white babies. African Americans are more than twice as likely to die from cancer.

Disturbing statistics are nothing new in the world of racial minorities in the United States. Moore comments that “the life expectancy gap between marginalized ethnic groups continues to widen despite health advancements. We are constantly bombarded with those negative and disheartening statistics. The blame is often placed on individuals and families versus a health care system that was not designed to promote and protect our health and livelihood.”

Moore concludes with the following food for thought: “Behind each of those statistics, racism plays a big factor that is often ignoredA report released by the National Academy of Medicine in 2003 pointed out how, in America, race is a determinant of health quality. Their study detailed how Black people and other ethnic minorities receive lower quality of health care than white people even when age, income, insurance status, and severity of conditions are comparable.”

Heightening the Focus

The COVID-19 pandemic and nationwide racial justice movement over the past several years have heightened the focus on health disparities and their underlying causes and contributed to the increased prioritization of health equity,” states the Kaiser Family Foundation. “These disparities are not new and reflect longstanding structural and systemic inequities rooted in racism and discrimination.”

Aggressively addressing disparities at their root — including police violence against Black citizens, maternal-infant mortality, discriminatory housing policies, income inequality, the impact of climate change on vulnerable populations, and access to care — can lead to us cooperatively working together to find multifaceted and forward-looking solutions.

As the Kaiser Foundation pointed out, these disparities are nothing new; thus, dismantling the structural and societal issues that cause them is an uphill battle. That said, many individuals and organizations have set their sights on these issues, and the 21st-century racial justice movement is an intrinsic part of that process.

Those of us in the healthcare industry must maintain awareness, examine our own biases, and demand that our workplaces do their part in decreasing disparities impacting the populations of color that we serve. We carry that responsibility; stepping up and speaking out is our individual and collective moral obligation.

The Intersection of Minority Identity and Palliative Care Nursing 

The Intersection of Minority Identity and Palliative Care Nursing 

Palliative care can be equally rewarding and challenging. Patients are navigating the emotional and physical turbulence of terminal illness. The right professional can be instrumental in ensuring patients’ needs are met to make their period of care more comfortable.

So much of who people are impacts their experience of the palliative journey. This includes the nuances of their cultural, racial, and socioeconomic identities. It should be no question, then, that minority nurses are an invaluable resource at this time. Yet, the current state of palliative care suggests that the industry doesn’t quite reflect this.

Let’s explore the intersection of minority identity and palliative care nursing. What are the opportunities for minority nurses, and why are they so vital in addressing the challenges related to this sector?

The Opportunities for Minority Nurses 

There’s no question that the medical sector, in general, is in greater need of nurses from various backgrounds. However, it’s also essential to look at the disparities within specializations. The needs of patients taking their palliative care journey suggest that minority nurses can find plenty of opportunities in this field.

The changing demographics of the aging population reflect this. It’s worth noting that there is relatively little research into the racial and ethnic disparities in palliative care staff. Nevertheless, there is some evidence that suggests a need for change. A Journal of Palliative Medicine study reported that over the next 20 years, the population of older minorities is expected to grow by 160%. This is far more than their white counterparts. The same study also cited a bereaved families survey that found “African Americans were less satisfied with the quality of end-of-life care.”

This data tells us there are opportunities for minority nurses to contribute to the specific needs that aren’t being met for the growing population of minority patients who will be seeking palliative care in the future.

Alongside the general need for hospice nurses and palliative care nurses, these opportunities may include:

  • Palliative nurse practitioners (NPs): Given the disparities in minority palliative care, there must be greater diversity in care leadership roles. Minority NPs can influence strategic decisions that ensure care plans are more relevant and positive for a broader range of patients.
  • Palliative educators: Palliative care is an emotionally and technically challenging field. Therefore, it requires skilled educators to guide professionals in developing appropriate medical, cultural, and empathic abilities. Nurses from minority backgrounds have invaluable perspectives to provide here.

Certainly, minority nurses themselves can seek the opportunities and talk to one another about them. However, it’s also important to encourage administrators and industry leaders to engage a diverse range of professionals more actively. This should involve pitching palliative care to minority students and nurses looking to shift careers. There must also be more significant financial and psychological support that makes palliative care a practical and attractive option.

Addressing the Challenges 

There are clear opportunities for minority nurses in palliative care. But on a practical level, it’s important to establish what specific challenges these professionals are well-equipped to address. Firstly, this helps nurses better serve patients. But it’s also valuable information that care providers and administrators can use to pitch palliative care to minority nurses who may not have considered specializing in it.

Culturally Relevant Care 

Palliative care deals with the end of life. Naturally, various cultural nuances influence this experience. One recent report outlined a significant variety of cultural differences related to the just treatment of pain during palliative care. People’s ethnicities, religious beliefs, and even generational demographics can influence how pain at the end of life is both perceived and managed.

This means that minority nurses can be better equipped to offer culturally relevant care to patients with similar backgrounds. In effect, these culturally competent nurses are likely to impact patient experiences and outcomes positively.

Actionable Community Knowledge 

Palliative care doesn’t always occur within hospice facilities. Nurses can also treat patients in their own homes. Patients from different cultural and socioeconomic backgrounds can face challenges related to the areas in which they live. Minority nurses can use community knowledge to identify issues and integrate solutions into care processes.

For instance, patients living in heavily industrialized communities may be subjected to poorer air quality. One study found that Black and Hispanic citizens bear 56% and 63% more air pollution, respectively, than they produce. Nurses with greater familiarity with these communities may better understand the signs of air pollution in the home. These may be environmental changes, like unpleasant odors, or additional medical symptoms, such as coughing and congestion. As a result, minority nurses can respond swiftly with preventions and treatments that improve palliative patients’ comfort.

Knowledge of the Practical Barriers 

Let’s face it: Nobody better understands the barriers presented by cultural disparities than those subjected to them. Therefore, minority nurses can be powerful allies in improving the palliative care protocols that give hurdles to both patients and professionals.

A continuous commitment to process improvement is vital in any industry. Regularly assessing protocols reveals inefficiencies, issues with regulatory compliance, and tasks ripe for streamlining. It’s important to involve a greater diversity of nurses in mapping out and analyzing care processes. A team with a broader range of perspectives is more conducive to spotting barriers to good care that a more culturally limited one would miss. This enables a positive collaboration for redesigning processes to meet all patients’ needs.

Conclusion 

Palliative care is one of the most challenging medical specializations. It deals with a particularly turbulent time for patients and their families and all the more reason, then, to ensure that culturally, racially, and socioeconomically diverse professionals are leading the way.

Nevertheless, addressing the growing disparities in care for those of minority identity needs immediate action. This is likely to require meaningful collaboration. Minority nurses can actively pursue palliative care and advocate for the systemic changes that make a genuine difference. However, administrators and industry leaders have a role in ensuring sufficient respect, support, and resources to make this a viable and enriching option for nurses.

Why We Need to Talk About Racial Disparities In Fertility Care

Why We Need to Talk About Racial Disparities In Fertility Care

Black women are almost twice as likely to experience infertility as their white counterparts, but only 8% of Black women seek fertility treatment, compared to 15% of white women. Statistics like these, compounded by the fact that Black women are three times as likely to die from pregnancy-related causes, highlight inequalities in reproductive healthcare that the medical community must address.

The higher incidence of infertility among Black women is due in part to a higher prevalence of uterine fibroids, ovulatory dysfunction, and tubal disease. Studies show that Black women also have higher rates of pregnancy loss, including miscarriages and stillbirths when compared to white women. This is likely because Black women have higher rates of risk factors that are associated with pregnancy loss, such as obesity, diabetes, and low socioeconomic status.

For Black women, the isolation of infertility is compounded by various factors (for example, cultural stigma, socioeconomic barriers, and racial bias) that prevent them from getting the care they need. Those who do end up seeking care often find themselves feeling deeply uncomfortable in the medical space, which is still predominantly white.

Diversity in Healthcare Providers

People of color need to have access to BIPOC (Black, Indigenous, and People of Color) healthcare providers because it provides a sense of comfort and familiarity. This can encourage patients to access available fertility care and can even improve treatment outcomes. BIPOC healthcare providers possess culturally specific knowledge, skills, and experiences that help with communication and health management processes involving people of color.

Diversity in providers also helps reduce barriers to the patient-physician relationship for racial/ethnic and linguistic minority patients. In many situations, seeing someone who looks like you and understands your cultural background offers reassurance.

Many studies have demonstrated better health outcomes when BIPOC providers see patients of color. A result of this is increased trust and communication developed between the patient and provider. The patient may feel more comfortable sharing sensitive information with someone who has an unspoken understanding of what the patient might be going through. Research has shown that Black women who have a provider with a similar cultural history may feel more comfortable speaking up and advocating for themselves.

Many people of color have a (warranted) sense of mistrust when it comes to our healthcare system due to historical practices based on racist ideals. As healthcare providers, we must remain dedicated to bridging the gap to improve outcomes for patients of color.

What Factors Most Impact Black Patients?

Long-held beliefs, stereotypes, cultural stigma, and other issues continue to uphold these racial disparities around fertility and family-building. Here are some examples of the various factors that contribute to widening the gap in care for Black women:

  • Structural racism: This heavily contributes to racial disparities in fertility and maternal healthcare in various ways, as structural racism goes beyond the individual. It refers to inherently racist laws, rules, economic practices, and cultural and societal norms that are embedded in the system itself.
  • Implicit or unconscious bias: This occurs automatically and unintentionally, affecting our judgments, decisions, and behaviors. For example, a white doctor might downplay complaints of pain after surgery from a patient of color due to engrained, inaccurate stereotypes about the strength or pain tolerance of BIPOC people, only to discover the patient is genuinely experiencing discomfort.
  • Accessibility: Many people of color encounter barriers to accessing the healthcare they need due to a lack of insurance or insurance coverage that excludes fertility treatment. Financial roadblocks and accessibility to quality reproductive care are often limited by location (rural or underserved areas may not have fertility clinics nearby) and employment (not everyone can take time off of work to go in for morning monitoring appointments, which are often required during fertility treatment).
  • The myth of hyperfertility: The long-held myth that Black women (and men) are “hyper-fertile” causes considerable harm, leading to a resulting cascade of issues.
  • Religious beliefs: Many people in the Black community are taught to “pray your way” through difficult situations. And while it’s wonderful to have faith, sometimes it’s necessary to seek professional help. Trusting that a higher power will correct infertility leads some people to delay or avoid treatment altogether.
  • Harmful stereotypes: Black women are thought of as being incredibly strong and we are but when we are elevated to “Superwoman” status and need to take off our proverbial capes to ask for help, we are often judged harshly or perceived as weak.
  • Mental health: Shame, guilt, or anxiety about how people in our community may react prevents or delays many women of color from seeking infertility treatment. The stigma of mental illness is also a concern when addressing infertility. Many people coping with infertility experience depression, anxiety, and grief, and cultural norms can discourage people from sharing that they are struggling with their mental health.
  • Isolation: Many people hesitate to talk about their personal experiences with infertility, which often leaves Black women with the impression that they are alone in their struggles or that infertility is a reflection of their character or a personal failing. That’s why sharing fertility stories is so important, especially in communities of color.

Black Maternal Mortality Rates

Many women of color might lack insurance coverage for maternal health or be afraid to advocate for themselves with their doctor. But the starkest evidence of the healthcare system failing people of color is Black maternal mortality rates in the United States, which are alarmingly high.

Studies have shown that Black women are three times more likely to die from pregnancy-related causes than white women. Worse yet, even though multiple factors contribute to this disparity, most are preventable. These factors include access to quality healthcare, underlying chronic illnesses, and two of the most easily preventable: implicit bias and structural racism. As a healthcare system, we need to focus on listening to the concerns of patients of color without allowing unconscious bias to play a role in our treatment decisions.

Responsibility to Patients

In vitro fertilization (IVF) and other fertility treatment options can be very expensive, which makes it exponentially more challenging for individuals with lower median household incomes to afford this path to parenthood. With lower incomes in comparison to white and Asian couples, Black and Hispanic couples may have a hard time affording fertility care if they have to pay out-of-pocket.

Knocking down the roadblock of affordability often goes beyond the scope of the medical community’s responsibility. However, bridging the gap of distrust with people of color and providing culturally competent care does not. One important step hospitals and health systems can take is to increase the diversity of providers within reproductive health specialties. Collectively, we must work to dismantle structural racism, educate ourselves, and listen to people of color. Only then will we start to make progress toward lessening racial disparities in fertility and maternal healthcare.

The Role of Nurses in Countering Environmental Racism

The Role of Nurses in Countering Environmental Racism

Nurses are integral to every community, and not just from the perspective of simply providing critical medical services. Your field experiences have likely made it clear to you that you impact patients’ lives through your empathy, social sensitivity, and hard-earned knowledge.

One of the often overlooked areas in which nurses are influential is helping to address injustice, even environmental racism. Given how urgent and potentially destructive the climate crisis is, it’s important to understand better this issue and how nurses can help counter it.

The Consequences of Climate Change

Environmental racism occurs when Black and other traditionally marginalized communities are disproportionately affected by climate change, pollution, and other environmental issues. This counters the traditional concept of environmentalism, which states that everyone is affected by ecological disasters. However, more evidence indicates that marginalized communities get the brunt of these disasters due to systemic injustices, which may affect the public health of these communities.

For instance, fossil fuel companies primarily tend to set up shops near minority communities, with 68% of African Americans living within 30 miles of a coal-fired power plant. Emissions from these plants can result in community exposure to respiratory and other health issues.

However, such wellness challenges are not limited to the better-known respiratory and cardiovascular risks. The climate can impact vision and eye health, too. People living in neighborhoods exposed to pollution can be more likely to experience glaucoma. Indoor pollution is also an issue, with those who may be unable to invest in adequate filtration systems at risk of experiencing long-term eye damage due to exposure to small particulate matter.

Even with these exacerbated health issues, marginalized communities may not receive proper treatment. One recent Pew Research study reported that 63% of Black Americans polled believe that their diminished access to quality medical is one of the reasons behind poorer health outcomes. Even if specific communities have access to medical care, the plethora of climate change-related health concerns places a greater demand on the healthcare system already underserving these communities.

Community Education and Outreach

The consequences of climate change concerning environmental racism are concerning. Indeed, such systemic issues can feel so large that it’s often difficult to see what individuals can do to help. Yet, as a nurse, you can powerfully impact the communities you serve.

One of the most important forms of assistance you can provide is improvements in relevant health literacy for minority communities. Once community members know the impacts of climate change on their health, they can be more empowered to make informed decisions surrounding their care and day-to-day preventative measures. Therefore, it’s essential to ensure patients have data about local negative environmental influences, the potential impacts, and steps they can take to safeguard their health.

This may involve working with local public health services to find the right literature addressing your community’s concerns. You might also consider engaging with community outreach programs. Spending time at community centers, workplaces, schools, and universities can be helpful to forums for education, where you can answer questions concerning this issue.

Collaboration on Change

Unfortunately, health literacy is unlikely sufficient to counter environmental racism alone. As with so many forms of social injustice, meaningful change happens at a systemic level. Your perspectives and insights as a nurse in minority communities can be a powerful contribution if you collaborate with initiatives that reduce ecological inequality.

This may be most effective on a regional level. You can identify local organizations that are dedicated to taking action to address environmental justice. These actions may involve coordinating efforts to provide qualitative data and testimony as supporting evidence of climate-related illness to present to governmental agencies tasked with assigning public health budgets, planning facilities, and creating healthcare policies.

Alternatively, you can offer insights as a medical professional to organizations dedicated to blocking the local introduction of new hazardous industrial businesses. Grassroots organizations like the Mothers of East L.A. have proven successful here. Your assistance can be invaluable as efficacy tends to rely on research and expert testimony.

This isn’t just effective concerning budget assignment and healthcare policy but also in encouraging the adoption of other resources that directly and indirectly affect the environmental connection to health.

For instance, the rise of the digital age has seen the emergence of inventions that can help combat climate change. If local or state governments adopt ambient carbon capture technology to remove carbon dioxide from the air or invest in distributed energy resources (DERs), there’s a chance to mitigate the health issues that disproportionately impact minority communities. As a nurse, you could play an influential role in representing the medical importance of these tools to local government decision-makers. Advocate for how climate-protecting technology makes a difference in community health and could reduce pressure on care resources.

Conclusion

Nurses may not always think about environmental racism in their daily routines, but it’s a hidden undercurrent in the healthcare system. Nurses have a profound potential to stop this injustice before it worsens.

It’s essential to be mindful of taking everything on your shoulders. Nurses already face a lot of pressure and often unrealistic expectations. When engaging in this social issue, seek support from colleagues, administrators, and community leaders.

Rita And Alex Hillman Foundation Awards Innovation Dissemination Grant to TeamBirth

Rita And Alex Hillman Foundation Awards Innovation Dissemination Grant to TeamBirth

Affirming its commitment to scaling evidence-based, nursing-driven interventions that provide equitable, person-centered, and trustworthy care, The Rita and Alex Hillman Foundation today announced a $200,000 Hillman Innovation Dissemination (HID) grant to TeamBirth.rita-and-alex-hillman-foundation-announce-grant-to-teambirth

“At a time when one in five pregnant people experience mistreatment during childbirth, and up to 40 percent of Black and multiracial patients report discrimination while receiving maternity care, it is imperative that interventions like TeamBirth are made widely available,” says Ahrin Mishan, Executive Director of The Rita and Alex Hillman Foundation. “We are proud to support the expansion of this important intervention.”

Developed by Ariadne Labs – a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard’s T.H. Chan School of Public Health – TeamBirth is a care process innovation that ensures people giving birth and the clinicians who are caring for them have shared input and understanding into decisions during labor and delivery. Using such easy-to-implement components as team huddles and a patient-facing whiteboard, patients and clinicians alike have credited TeamBirth with making the labor and delivery process more person-centered and, most importantly, safer.

After an initial feasibility trial at four sites in 2018, TeamBirth is on track to be integrated into more than 100 U.S. hospitals by the end of this year. Building on this momentum and a growing evidence base, HID funds will enable Ariadne Labs to pursue innovative strategies for maximizing the reach and impact of TeamBirth.

“Funding from The Rita and Alex Hillman Foundation comes at a critical time,” says Amber Weiseth, DNP, MSN, RN, Director of the Ariadne Labs’ Delivery Decisions Initiative and the principal investigator of the HID grant. “This partnership and support will be vital in ensuring that more parents-to-be have access to dignified, equitable, and safe birthing experiences.”

The Hillman Innovation Dissemination program, established in 2017, amplifies the scaling efforts of successful interventions with proven outcomes that target the needs of marginalized populations. See a roster of previous HID grant recipients here.

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