Health equity means that people across all backgrounds, cultures, races, and socioeconomic situations receive access to healthcare and get the treatment that they need. Health equity is defined by the Centers for Disease Control and Prevention as “the state in which everyone has a fair and just opportunity to attain their highest level of health.”
Following this definition may mean that people in poorer health or with a high risk of disease and injury may receive more healthcare services than those who are low risk. Unfortunately, the opposite tends to be true. At-risk populations are often those with fewer opportunities to seek out the care that they need.
Health equity in the United States
Health equity in the United States is most often impacted by social determinants of health. These include social and community context, healthcare access and use, neighborhood and physical environment, workplace conditions, education, and income and wealth gaps.
Another factor contributing to healthcare disparity is race and culture. The 2021 National Healthcare Quality and Disparity Report showed that:
- Black populations received worse care than White populations for 43% of quality measures.
- AI/AN populations received worse care than White populations for 40% of quality measures.
- Hispanic populations received worse care than non-Hispanic White populations for 36% of quality measures.
- Asian and NHPI populations received worse care than White populations for about 30% of quality measures but Asian populations also received better care for about 30% of quality measures.
- American Indian and Alaskan Native people had worse access to care than White people for 50% of access measures.
Maternal health equity
There are significant racial disparities in maternal and infant health outcomes in the United States. Research published by KFF shows that pregnancy-related mortality rates are over three times higher for American Indian and Alaska Native women than White women. In addition, Native Hawaiian, Black, and Pacific Islander women have higher rates of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women.
Young mothers are also at a higher risk of poor outcomes such as low birthweight, premature labor, and low first-minute APGAR scores.
Related: Beyond Delivery: Advocating for Health Equality in Motherhood
Barriers for mothers
Because there are such obvious disparities among women of different ethnicities, backgrounds, and age groups, it is worth exploring barriers that prevent certain groups from seeking or receiving adequate care. Some of the most common barriers include:
Cost
Cost may be the most common reason for delayed or inadequate healthcare. A Gallup survey reported that between 2001 and 2021, nearly 30% of Americans did not seek out care when they needed it because they were worried about high out-of-pocket costs. The average cost of prenatal care and delivery of a baby in the United States is over $18,800, more than many American mothers can afford to pay.
Even if a mother has health insurance, the average out-of-pocket cost is about $3,000 for an uncomplicated delivery.
Transportation
Another barrier that is often unrecognized is lack of transportation. Not owning a vehicle, not having a drivers’ license, having no support system, lack of funds to pay for transportation services, or having little access to public transportation services makes it challenging or even impossible for some women to get to their appointments.
Cultural barriers
Some women face cultural barriers that make it difficult to seek out healthcare. These can include language barriers, a lack of understanding of cultural norms, or even fear of healthcare providers.
Cultural and spiritual beliefs surrounding pregnancy and childbirth vary greatly among different cultures. People from diverse backgrounds and belief systems may avoid clinics and hospitals for fear of being judged, misunderstood, or forced to participate in a care plan that disagrees with their belief system.
Lack of support
Having little to no social support system is another challenge facing many pregnant mothers. Teen mothers may try to hide their pregnancies. Single mothers may have nobody to watch their other children while they attend appointments. Working mothers may have bosses and supervisors who are inflexible about their appointment schedules.
Positive practices in addressing health equity
While healthcare providers cannot change their patient’s income or living situation, there are some things that nurses and other healthcare staff can do to improve healthcare for at risk populations. The Committee on the Future or Nursing offers these recommendations.
Screen all patients for social needs and make referrals to social services when appropriate
Patients may need assistance with transportation, access to food and medicine, shelter, and getting social support. Social services can help patients get these needs met.
Related: Educating Patients: Creating Teaching Moments in Practice
Build a trusting relationship with patients and their families
Nurses often must ask very personal questions. Patients are often hesitant to share their health history and habits with a stranger. Nurses must use good communication skills and active listening to build a trusting relationship with their patients. Patients who feel safe and respected are more likely to ask questions and voice their concerns, leading to better understanding and more positive outcomes.
Complete training on how to provide culturally competent care
Culturally competent care considers a person’s culture and religious beliefs. While nurses do not have to share their patients’ beliefs, they should remain open and respectful. Nurses must understand that health looks different to everyone. The healthcare team should align their goals to match with their patients as often as possible.
Advocate for policy change
Nurses who want to make a change on a larger scale can seek out opportunities to advocate for policy change. Policy change can happen in individual units, whole hospitals, or even on a national level.
Offer a variety of teaching methods and learning tools
Patient education is one of the most important parts of a nurse’s job. Patients cannot follow healthcare instructions that they don’t understand. Asking open ended questions, using the teach-back method, and getting other family members involved in learning can all help to ensure the patient knows how to manage their health condition when they leave the facility.
