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Nursing Research, Structural Inequalities, and Health

February 22, 2021

Nurses know people. We care for and get to know our patients and their families during some of their most vulnerable moments. We see our patients not just in traditional healthcare settings, but also in their homes, communities, schools, and workplaces. We know that some of our patients face obstacles to health and wellness that others do not. We know that some of these obstacles are grounded in the legacy of structural racism that persists in the United States.

For instance, historical segregation and redlining in the housing market discouraged investment in communities that were home to people of color. As a result, today 25 percent of Black Americans and Native Americans live in high-poverty communities, compared with just 5 percent of White Americans. 

Stemming directly from this under-investment, those living in high-poverty communities and communities of color now have less access to healthy foods and opportunities for physical activity than do those living in wealthier (and often predominately White) communities. High-poverty communities have fewer grocery stores–and even when local shops carry healthier options, they are often more expensive in than in other communities. These communities also have less park space than other communities–and even available park space often has fewer or lower-quality amenities, less programming, and insufficient funding for upkeep. 

Clearly, there’s a straight line from policies that enforced segregation decades ago to real-world health effects today. Nearly 50 percent of Black adults are obese–a known risk factor for a host of chronic diseases–compared with 44 percent of Hispanic adults and 42 percent of White adults.

Similarly, the disparities in infection, hospitalization, and deaths resulting from the COVID-19 pandemic are sobering–but predictable. Compared to White individuals, Native American individuals are almost twice as likely to be infected with SARS-CoV-2, Hispanic individuals are four times more likely to be hospitalized, and Black individuals are nearly three times more likely to die.

As NINR director, I am committed to supporting nursing research that will identify interventions and policies to remove barriers to health equity. As we develop NINR’s next strategic plan, rest assured that we will examine nursing research’s role in overcoming these structural obstacles to health for everyone–regardless of race, ethnicity, gender, or income.

We’re not waiting until a new strategic plan is completed, though. From March 4–5, NINR is hosting the National Nursing Research Roundtable, along with the Western Institute of Nursing. The theme of this year’s roundtable is “Nursing Research of the Future: Using Clinical Big Data to Explore Health Inequities and Social Determinants of Health.” This meeting will be streamed live to the public. Find out more about the meeting here.

Additionally, NINR is pleased to support the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) program. Launched by the NIH Common Fund, NIH FIRST seeks to build diverse teams of early-career scientists and set them up for long-term success by fostering a culture of inclusive excellence. 

NIH is committed to this issue. At the February 26, 2021 meeting of the NIH Advisory Committee to the Director, NIH leadership will present an update on NIH plans to promote diversity, equity, and inclusion in biomedical research. I encourage everyone reading this message to view this important meeting.

Nurses know people. And we know that without research to support evidence-based policies, health inequities will continue to plague our patients. We know we can do better. We know we must do better.

Shannon N. Zenk, PhD, MPH, RN, FAAN
Director, NINR

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