Honoring The Contributions of Nurses to the Health of the United States

Featured image for National Nurses Week 2023

Guest post by Vincent Guilamo-Ramos, PhD, MPH, LCSW, ANP-BC, PMHNP-BC, FAAN, Dean and Bessie Baker Distinguished Professor of the Duke University School of Nursing and Vice Chancellor for Nursing Affairs, Duke University.

Every year, we celebrate National Nurses Week (May 6–12) to recognize the contributions of our country’s largest, most trusted, and highly skilled nursing workforce. The impact of nurses on the health and wellbeing of families and communities in our country and across the globe is undeniable. Historically, National Nurses Week has been an opportunity to reflect on the numerous ways in which nurses have made and continue to make invaluable contributions to health care and public health. This year, I’d like to highlight the current state of health in our nation, look ahead to important opportunities for transforming and improving U.S. health care, and honor the indispensable role of the more than 4.3 million nurses who continue to represent the backbone for health promotion and for preventive and restorative care for Americans.

At present, roughly half of adults in the United States have one or more chronic diseases, a number that is projected to increase in the future. Alarmingly, after more than 40 years of increasing longevity, life expectancy in the United States has dropped significantly. At the same time, health inequities in the U.S. continue to be pronounced, and the costs associated with them are projected to raise health care costs to $1 trillion or more per year by 2040. This threatens to overburden a U.S. health care system that is, by international comparison, already unsustainably costly and ineffective. While communities that experience unequal access to and quality of health services bear a disproportionate impact of deteriorating public health, these challenges ultimately affect all of us. Research shows that while the average U.S. citizen faces greater health challenges overall, even the most affluent Americans achieve worse outcomes on key health indicators than average citizens in other high-income countries.

Considering these increases in morbidity and mortality, National Nurses Week provides an opportune moment for those of us in the nursing profession to reflect on the overall health and wellbeing of our nation and our role as nurses in redesigning and improving the traditional models of health services. Given that nurses provide most care both in the United States and worldwide, our insights are key to transforming the currently unsustainable, ineffective, and cost-prohibitive model of U.S. health care.

In moving toward a health care system that delivers better, more equitable outcomes at a sustainable cost, we increasingly recognize the need to address the underlying drivers of health inequities—harmful social determinants of health (SDOH). The nursing profession has long championed the concept of SDOH, but the existing health care system has been largely unsuccessful in adequately mitigating their adverse impacts. We need a new way of thinking.

Many existing practical frameworks for understanding and addressing the impact of SDOH have focused on identifying broad domains of health-related influences (such as income or access to community resources) instead of the dynamic and multifaceted mechanisms that ultimately affect health outcomes and inequities. There has also been little consideration paid to how nurses and other health professionals can effectively mitigate harmful SDOH in clinical practice.

To address this need, the Center for Latino Adolescent and Family Health (CLAFH) at the Duke University School of Nursing (DUSON) developed a new framework to inform the development and application of nurse-led models of care to effectively mitigate health inequities.

The CLAFH Framework of SDOH Mechanisms

Framework for how social determinants of health affect the life course on micro, meso, and macro levels
This framework considers environmental and behavioral exposures as well as biological susceptibility to assess how a community experiences a harmful SDOH and the resulting chances of morbidity and mortality. It examines external and social factors and recognizes that the effects are cumulative and shape health behaviors and outcomes.

CLAFH also developed DUSON Trailblazer, an interactive website that offers frontline nurses, nursing schools, researchers, and policy makers opportunities to explore the framework of SDOH mechanisms and discover its utility as an approach for informing research, programming, and practice. The site has numerous resources that can be widely shared, including an interface to explore key principles that underpin the framework, an animated video that explains the framework and its components, a video recording of a classroom lecture, a set of companion slides that can be used in teaching, and an SDOH quiz designed to “test your SDOH knowledge” that is integrated with social media to invite others to test their own SDOH knowledge. Also available is an open-access, peer-reviewed article recently published in The Milbank Quarterly, which provides the scientific basis for the CLAFH Framework.

National Nurses Week is a time to celebrate our accomplishments and the contributions that we, as nurses, have made to our country’s health. However, our work is not complete; health inequities still persist, and nurses remain the key to the type of change that can transform health toward a future where our nation achieves health equity and the associated benefits for all.

Headshot of Dr. Vincent Guilamo-Ramos

Vincent Guilamo-Ramos, PhD, MPH, LCSW, ANP-BC, PMHNP-BC, FAAN

Dean and Bessie Baker Distinguished Professor of the Duke University School of Nursing and Vice Chancellor for Nursing Affairs, Duke University

Dr. Guilamo-Ramos is also a practicing advanced practice nurse and nurse scientist. Dr. Guilamo-Ramos’ research is focused on the development and evaluation of large-scale, community-based interventions designed to address health inequities. His research has been funded by NIH and other federal agencies for more than 20 years.

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