Biases: Why we all need to think about health equity

This summer, when I was responding to the Health Equity Staff Survey we were all asked to complete, I had to pause when I hit question 5, "In your own words, what does health equity mean?" I could certainly repeat the key phrases like "all people should have the opportunity to reach their full health potential" or  "people should not be  disadvantaged from attaining good health due to social and economic status, racism or other socially determined circumstance" . . .   But in my own words, what does health equity mean to me, personally, and as a nurse? I think that is something we all need to stop and reflect on.

Health equity, promoting conditions in which every person can achieve their full health potential, is now a stated value in our new WRHA Strategic Plan. Although health care providers have always valued equity, promoting equity is now an explicit Regional priority. It's something we need to be deliberate about - every day - in our work. Operational planning to address Regional strategic priorities will require keeping equity in full focus.

The nursing profession certainly has a solid foundation in relationship-based, person-centred care, trauma-informed practice, dignity and respect, recognizing the role of family and community - all the things that together accrue to promoting equity in health at the bedside and in planning health services. But at the same time, real change requires us to honestly reflect on how biases, racism and uneven power dynamics are also at play within some of our processes and traditions.

I thought back to the many roles I have played and how equity has been part of my practice even before we were using the term. At the bedside, I can recall a particularly angry young man who wasn't being cooperative with the care I was trying to provide. Although in a hurry and getting flustered, I paused to consider the circumstances and possible traumas that led to his reaction. I said something like, "I see this is really frustrating for you - what can I do differently to make this better?" That simple question and genuine listening altered the power imbalance and we started over. Was that health equity in action? Yes!

Later, as a manager, I noted that some of our services and approaches may not be appropriate or welcoming for some of the clients we were trying to serve. I heard my staff make comments about "non-compliant patients" or someone being a "no show again" in less than friendly tones. I wondered what barriers existed for these clients, like poverty, limited transportation options, and lack of childcare. What could we be doing differently to remove barriers and avoid assumptions? Reframing this with staff led to positive team brainstorming and changes to our services and approach. Was this health equity in action? Yes!

Now as a health care leader in a VP role I have similar responsibilities at a different level. I still ask myself the same kinds of questions when making decisions and considering options:  Are there assumptions and biases that I am bringing to this issue? How is this issue affecting people across the social and economic spectrum, particularly those most disadvantaged? How will our decisions affect the health gap? Health equity is part of my thinking and informs my work every day.

I am convinced that there is a lot we each can do to contribute towards closing the health gap no matter where we work in the health care system. The 2014 Community Health Assessment shows us we still have a long way to go. The observed health gaps are strongly tied to poverty, discrimination, racism, and oppression - topics often not easily discussed. Yet, without bringing to light issues that affect the health and wellbeing outcomes of clients, we can perpetuate the status quo and uneven power relations.

We will never stop learning about health equity, cultural safety, and reconciliation.  But we must strive every day to listen a little deeper and provide the best care possible in new ways to meet real needs. As nurses, we can make a difference.

What does health equity mean to you?

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