Social Injustice In Nursing Essay

“There is no social justice without equity in health and no equity in health without social justice”. (Pauly, 2009, pp. 118). “Social injustice is a matter of life and death. It affects people’s way of living and their chances of being ill and their risk of premature death.” (WHO, 2008, pp. 1)’ “The social determinants of health (SDOH) are associated with structural differences such as income, employment and working conditions, housing education, food security, social inclusion, and the environmental conditions.” (CNA, 2016, pp 1).

Raphael, (2012) revealed that stressful experiences arise from coping with conditions of low income, poor quality housing, food insecurity, inadequate working conditions and education. Insecure employment also

increases stress and it results in too many stress-related illnesses. Nurses work at the “intersection where societal attitudes, government policies, and people’s lives meet and creates a moral imperative not only to attend to the health needs of the public but also, like Nightingale, to work to change the societal conditions contributing to poor health.” (Raphael, 2005). Hence, access to SDOH is an important issue for nurses and has a profound impact on health status and the prevalence of health disparities in Canada. Significant improvements in national health indices are not possible without addressing SDOH.
Promoting social justice and health equity fits well with nursing’s historical and philosophical roots. The emergent global agenda of reducing health inequities provides both new opportunities and challenges for the nursing profession. Tackling health inequities is clearly within the nursing mandate, yet this role is underutilized within nursing scope of practice. (Reutter and Kushner 2010). So I strongly argue that nurses as a frontline care giver, patient advocates and patient care experts are ideally positioned to lead the nation in strategies to promote health equity. Hence, Nurses can embrace this leadership role in primary health care, acute care and through policy change level to work to change underlying social conditions that result in and perpetuate health inequities. In the next section of the paper, I will discuss the various ways that nurses can take a leadership role in better integrating a SDOH focus into primary health care of our health care system.
Enhancing social justice and health equity has been a motto of the nursing profession. So it is our professional and moral responsibility to take a leadership for strong advocacy to address the social determinants of health so people can access equitable health care service within our health care system. (CNA, 2012). A primary health care approach is essential to contemporary nursing roles such as practice nursing leadership. Historically nurses have worked with their clients from grass root level and witnessing health disparities so if we can strengthen primary health care (PHC) services then, nurses can take a leadership role in better addressing the SDOH at the primary level.
British Colombia Nurses Union (2015) also argues that nurses are obliged to engage in socio-political activities that improve the social condition of people associated with health inequalities. Nurses can make social justice by engaging in advocacy and addressing those factors, which make people ill, and this is the primary step of making people healthy because only treating the disease is not a long-term solution. The stronger the PHC the better the nurses can address the SDOH at a community level.
Canadian Nurses Association (2015), further emphasized that health-care service should be promoted from the PHC level so we can provide the care in the community and at home. It can only be accessible for all people when we take leadership to address the social, economic, and environmental determinants of health especially poverty, housing, food insecurity, and social exclusion that play such major roles in determining our individual health.
Similarly, the Royal College of Nursing U. K (2012) emphasized that in primary health care level, nurses can take leadership by influencing the health of communities in many ways for e.g. by assessing health needs and ensuring the proper services were provided, supporting community empowerment, making sure that vulnerable groups were prioritized and advocating for change. In this level nurses can better advocate for the social features, which underpin health and wellbeing including housing, poverty and the ability to maintain livelihood of local people.
Mc Murray (2007), argues that addressing SDOH at PHC is the essential foundation of nursing leadership practice.

In the case of primary health care nurse this foundation is pivotal to the evolving role, which across the boundaries of traditional nursing practice. We have to think if health is socially determined or is this where the solution to ill health lie. As a nurse, it is imperative that we closely look for the hidden constraints layers such as social exclusion, economical deprivation and political marginalization which have been constant barriers in accessing health care so we need to peel back those layers and need to move forward to solve the underlying

issues.
I have discussed in previous paragraphs how nurses can take leadership role in primary health care level to address the social determinants of health. In a same way people are vulnerable in acute care setting when getting the appropriate care so I am going to enlighten in the next paragraph on how nurses can take leadership role in acute care setting.
The complexity of modern health care and profit based on neo-liberal ideology also bars accesses to health care for disadvantaged group (poor, elderly etc.) in our current health care system. We have a universal health care coverage for medically necessary services but what if people cannot follow the health care provider’s recommendations due to his poverty as a result of social disparities. So in acute care setting, nurses can address health inequity in many ways for e.g. when patient discharges and we recommend physiotherapy we always have to use our contextual lens through our leadership skills to find out the hidden barriers that if patient can afford the services or not. If not we have to provide community resources available to them. (CNA, 2012).
Pauly& MacKinnon (2009) also argued that biomedical thinking creates artificial separation between health and social issues but nurses should use their knowledge and leadership skills and recognize person’s social location. This social condition may affect their ability to follow medical advice profoundly. We should find out the reason of non- compliance instead of blaming the victim for example someone who is not routinely administering her/his insulin injections. In this situation we should have a need to look for if person has place to store insulin or resources to purchase insulin. So nurses should address contextual background of their clients through nursing leadership.
Paula, B. (2012) further focused on nurse’s role at acute care setting that if the patient is admitted for her/his treatment nurses can find out contextual phenomena of being ill and constraint of being unable to seek care. In this situation nurses should identify the contextual factors of their clients such as poor housing, lack of nutritious food and unemployment etc. For example if patients having recurrent diarrhoea because of lack of clean water, there is no use of treating the patients without supplying the clean water. So nurses can take leadership by taking initiative and collaborating with other concerned organization to supply the clean water resources available to them. If nurses recognized the root cause of illness, they can make an effective treatment plan of care which not only meets recent health need of their clients but also help prevent future recurrence of being ill.
Parker, B.D. (2012), mentioned that, addressing the social conditions of the individual or populations with an illness or disease are fundamental step of nursing leadership. Justice is the duty of nurses to treat all people equally. To take this responsibility in acute care setting nurses should advocate for necessary treatment for those who is in need, even though they may not have the requisite means to pay for the treatment. For example if an elderly poor man loved by his family might choose an expensive transplant procedure even though there is no guarantee of improving or lengthening his life. It is the nurse’s moral responsibility to respect their client’s dignity and protect his right to health care. In this situation nurses can take leadership by collaborating with other health team members and protect the right of clients to nullify poverty as a barrier to get an appropriate health care.
I have discussed in previous paragraphs how nurses can take leadership role in primary health care level and acute care setting to address the social determinants of health. In my next paragraphs I am going to explore how nurses can advocate for their clients in policy change level as without formulating strong policy to address SDOH, we cannot achieve better health for our people. So we have to find out causes of causes (illness) and long-term solution for it.
Reutter &Kushner (2010) highlighted the nurse’s pivotal role at policy change level.

Advocacy includes not only for more equitable health care but also more importantly, for improved living and working conditions. In terms of social inequities, nurses can advocate for living wages, affordable housing, quality childcare and early childhood education, fair employment and universal comprehensive social protection because these are the foundation for good health. For example if we can provide good education for our citizens they can have more chances of being employed and capable of maintaining good health through healthy life style (nutritious food, regular

exercise).
In addition we have to take responsibility in narrowing health inequalities through public policy, such as to take an initiative to reduce poverty and for affordable housing and food security because without addressing the contributing factors of illness we can’t treat the disease effectively. (Nurse One.ca. 2012). Similarly, we can apply quality improvement interventions such as health care providers and consumers education, promotion of self-management and organizational change can also be helpful in reducing inequalities in all health care settings. (McPheeters, 2015). The social determinants of health affect the ability of individuals to assume personal responsibility for adopting and maintaining healthy life styles and minimizing exposure to avoidable health risks. So nurses always have to advocate for those people who are unable to seek health care making continuous effort at policy level.
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Similarly, Registered Nurses Association of Ontario (2013) also argues that nurses as primary care givers of their clients we should advocate for social determinants of health. For e.g., poverty reduction as poverty is not random. Health inequities are a direct reflection of social inequalities, which means that chances for better health and a longer life increase along the socio-economic condition. To reduce poverty, nurses can take leadership by involving actively on Poverty reduction Strategy program such as ongoing campaigns for food security, affordable housing, social assistance reform, increasing minimum wage and safeguarding vulnerable workers etc. So if we put strong effort on these basic strategies we can narrow the health inequity gap and make our citizen healthier.

Lathrop (2013) argued that the influence of the socio economic condition on health status is pervasive and it is extending across the life span. Traditional health care system does not cover the SDOH. Despite modern technology of health care, evidence based practice and patient centred care, health disparities and poor health outcomes will persist unless we better address the SDOH. So nurses can provide the leadership needed to bring national attention to SDOH at policy change level and begin effective strategies to improve the health of nation. The time has come up for urgent call for nursing leadership to address the SDOH.
Cohen and Reutter (2007) also focused on policy advocacy strategies, which are key to reducing inequities. Consciousness rising of the SDOH among the public, policy makers, practitioners, policy makers and health professionals is a first step to policy advocacy. Consciousness rising includes policy analysis that explicates how ideologies of governing parties shape the quality of social determinants of health. So nurses are well positioned to take leadership role to advocate for their clients through awareness raising program in their day-to-day lives at the personal and political basis.
To sum up, after reviewing the literature nursing as a caring and healing profession needs to concentrate more energy on the upstream conditions that perpetuate health inequalities. We should take the challenge to ensure that nurses from the bedside to the boardroom are skilled, knowledgeable, and prepared to fulfill their assigned and desired leadership roles for their clients. We are in an ideal position to take the leadership to address the SDOH in different health care settings such as in primary health care, in acute care and policy change level. A critical perspective of social justice leads nurses to work towards addressing the conditions (poverty, housing, food security, child care, early child education) that impact access to health care. Nurses need to know the social and contextual environments of home community, and work place act as contributing factors in relation to social opposition, which produce vulnerability to illness and injury. It is the time to broaden nursing leadership by providing contextual and relational health care to all particularly for those who are experiencing health inequalities as a result of social determinants of health so we can build a healthy nation.