When we reflect on nursing, we don’t always consider the concept of justice.

We may think about patients, patient care, medications, interventions, and hospitals, but justice might seem like the purview of lawyers, legislators, activists, human service agencies, and non-profit organizations. However, nursing and justice are more closely related than we think; thus, linking them in our consciousness is an important consideration.

Social Determinants of Health

In some nursing programs, the concept of social determinants of health (SDOH) is taught from the very early stages of student nurses’ education, and the relationship between SDOHs and justice is quite apparent. This CDC definition is as good as any when it comes to clarifying what constitutes an SDOH:

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems.

Meanwhile, the United Nations’ 17 Sustainable Development Goals (SDGs) offer us another prism through which to view the lives of human beings around the world. The SDGs include broad areas of concern such as good health and well-being, clean water and sanitation, responsible consumption and production, and eradicating poverty and hunger, all of which can be seen as related to justice in the broadest sense.

Regarding the 17 SDGs, the UN asserts that “ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.”

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The ability of citizens around the world to live healthy, productive lives could not be more crucial, and access to healthcare, education, nutritious food, proper housing, and a clean environment are all aspects of achieving such a life. But what do nurses and nursing have to do with such seemingly disparate yet necessary issues regarding justice and equality for all citizens?

Healthcare Doesn’t Happen in a Vacuum

When a patient attends a medical appointment, their presenting issue might be diabetes, hypertension, or asthma. However, we often miss the point when we simplify health and healthcare down to solely the bare bones of a medical diagnosis. For example, a diabetic patient who doesn’t drive may not live in a food desert since they live within walking distance of a bodega or convenience store. Still, they live in a nutrient desert since they lack access to any appreciable nutrient density and quality food.

A child who lives in a part of the city where lead pipes are an incomprehensible reality (e.g., Flint, Michigan) or factory smoke and toxic waste are prevalent (e.g., any number of poor neighborhoods in American cities) may suffer from learning disabilities, asthma, or even cancer that may have otherwise been preventable but for egregious environmental insults.

Is it just that toxic waste is more likely to be stored in poor neighborhoods than in affluent ones? Is there anything but injustice in that an economically disadvantaged child ingests unclean water and air while their wealthy counterparts across town are spared? Is there any reason racial disparities in healthcare delivery are tolerable in our society?

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Patients’ diagnoses and health outcomes can often be directly linked to injustices that are shamefully visited upon certain groups. Nurses and other healthcare professionals are responsible for remaining aware of how multiple factors weigh heavily on the health of myriad communities.

Leveraging Nurse-led Solutions 

As the most trusted professionals in the United States year after year, nurses are uniquely positioned to leverage their influence for the good of the whole. Letters to the editor, podcasts, articles, blog posts, social media, and other means can be utilized by nurses to make their voices heard. Nurses can meet with local, state, and national legislators, lobby for bills geared towards many aspects of justice, be it in the realm of healthcare or otherwise.

Organizations like the Alliance of Nurses for Healthy Environments (ANHE) champion causes that are urgent public health matters. For example, on the legislative side, the non-profit and non-partisan Healing Politics “inspire[s], motivate[s], recruit[s], and train[s] nurses and midwives to run for elected office up and down the ballot while building a culture of civic engagement within the professions.”

The intersectionality of justice, nursing, and healthcare is multifaceted, and nurses can choose to be powerful voices within the chorus of those demanding change. Justice comes in many forms, and nurses can decide how they weigh in on issues that directly impact how justice — or the lack thereof — manifests in this country and the broader world around us.

Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.

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Keith Carlson
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