Introduction
The selected policy is Assembly Bill A5679A, first introduced in February 2021 in the New York State Senate. In December 2021, it was signed by the governor, and it became law at the beginning of 2022 (The New York State Senate, 2021). The current bill concerns the global and national issue of racism in healthcare. According to the policy, racism is now declared “a public health crisis” in the state of New York (The New York State Senate, 2021). A working group was created in the Department of Health to research this problem (The New York State Senate, 2021). As a result of these studies, it is expected that the group will provide evidence-based suggestions to healthcare organizations and drive further policy change. Thus, the policy is research-driven and can be considered a stepping stone for meaningful change in eliminating systemic racism from the healthcare industry.
Population
As evident from the policy’s description, the diverse population at the center of the bill is people of color. The history of racism in the United States is long, and its influence can be seen in the healthcare industry today. According to Devakumar et al. (2020), it is not an issue that affects only certain individuals. Racism is a systemic problem, the impact of which can be seen in the entire minority population segment of the nation, including Black, Latinx, Native American, and Indigenous households (Krieger, 2020). In 2018, it was reported that a Black American’s average life expectancy is four years shorter than that of a white American (Centers for Disease Control and Prevention [CDC], 2021). Black patients are less likely to be prescribed analgesics than white people based on false preconceptions about Black people’s pain tolerance levels (Hassen et al., 2021). Black women are less likely to receive timely screenings for cervical and breast cancer (Hassen et al., 2021).
However, problems are not limited to healthcare providers’ negative views of people of color – socioeconomic factors also create barriers to healthcare access. The fear of discrimination stops many people of color from asking for help (Alang, 2019). Financial capabilities and living conditions of people of color are often limited, which also leads to fewer available treatment options, further exacerbating existing health conditions (Mendez et al., 2021; O’Brien et al., 2020). The crisis was further exacerbated during the COVID-19 pandemic. According to Johnson-Agbakwu et al. (2020), Black Americans’ mortality rate from COVID-19 is more than two times higher than that of white Americans. Latino Americans are more than 4.5 times more likely to be hospitalized for COVID-19 than White Americans (Johnson-Agbakwu et al., 2020). Other recent statistics also expose the discrepancy in care – for example, Black women’s pregnancy-related complications lead to a fatal outcome three to four times more often than among white women (Johnson-Agbakwu et al., 2020). There exists a plethora of other issues that people of color face due to the mix of racism-based beliefs and socioeconomic factors.
Policy Design
The problems that affect the diverse population are complex and include various elements of the healthcare industry. The policy’s design focuses on finding the specific factors that lead to such adverse outcomes and creating ways to eliminate them through recommendations and future policy creation. Therefore, the policy does not lead to an immediate change in healthcare organizations or quick solutions. Instead, it lays a foundation for creating equity based on evidence collected from studies, available government information, and expert opinions.
The cost-effectiveness of the policy or its outcomes is not defined in the bill’s description. However, the studies discussing people of color’s access to medical treatment show that the economic barrier to treatment is one of the major problems in the healthcare industry at the moment. Therefore, one may assume that this particular issue will gain recognition in the state due to the policy’s implementation, leading to better access to care. Furthermore, it may improve the cost-effectiveness of services by lowering the rate of untreated diseases and complications that occur due to poor service and fear of accessing treatment (Egede & Walker, 2020).
Financial Aspects
As the policy is focused on researching the current state of racism in the healthcare industry, it does not require any additional funding or other resources for healthcare organizations at the present stage. While this implies the lack of change in practice, it also means that the policy alone does not lead to any financially demanding changes. Another potential sphere where additional expenses could appear is the time and labor of the working group that is created to research the outlined problems. Nevertheless, the policy clearly states that “the members of the working group shall receive no compensation for their services” (The New York State Senate, 2021). This statement demonstrates that the policy is unlikely to financially strain the state or federal government in the short term. At the same time, its future results in the form of research findings and expert recommendations may require financial resources, which are likely to be explained with the help of analyzed data.
The Nursing Perspective
The policy adheres to the nursing principles of nonmaleficence, justice, and beneficence and follows the nursing perspective of caring. First of all, the policy recognizes the existence of racism and its impact on the diverse population, calling for eliminating inequity, which corresponds to the principle of justice (Bennett et al., 2019). Second, the policy’s main goal is to improve access to care and patient outcomes for people of color, which demonstrates nonmaleficence and beneficence. Caring is at the core of nursing, and the policy’s description shows that people of color often encounter a lack of attention to their needs. The discrepancy between the needs and what is provided by the existing system contrasts with the ethics of equitable healthcare.
Ethical, Legal, and Political Factors
Moreover, the policy covers other factors that affect people’s access to care. These include access to and quality of housing, criminal justice, employment, and more (The New York State Senate, 2021). The recognition of these aspects is linked to political issues, and research may result in changing other parts of the legal system to combat racism in the healthcare industry. For example, the policy includes initiatives for equitable hiring and partnerships with other organizations and public offices to eliminate disparities in this and other sectors (The New York State Senate, 2021). Equal hiring opportunities that exist in the national laws are, therefore, accounted for in the policy. Thus, it is an all-encompassing initiative rooted in holistic, patient-centered, equitable care as well as the legal protection of diverse populations.
Relation to State, Federal, and Global Health Policies and Goals
The policy is rooted in several federal, state, and global policies and goals. The major change in recognizing racism as a systemic issue and a crisis in the United States came as a result of COVID-19, which exacerbated the existing problems of unequal access to health care (Johnson-Agbakwu et al., 2020). In January 2021, President Biden signed an executive order, declaring that racism is a significant issue and urging for racial equality in services with the federal government’s help (Biden, 2021). Similarly, two of the current administration’s priorities are racial equity and health care, which are directly linked to the chosen policy. Choosing equity as one of the primary objectives is a sign that racism is being recognized nationally as a systemic issue affecting not just individuals but also populations and current processes. The goals of the federal and state governments align as they seek to eliminate racism from the healthcare industry and expand access to care for underserved populations.
Apart from the President, other organizations and scientific communities also support a similar initiative, especially the need to address the healthcare disparities during the COVID-19 pandemic. In particular, the National Institutes of Health recently published an official statement taking a stand against racism in research (Collins, 2021). The challenges brought on by COVID-19 and racism are addressed as significant issues that require investigation and resolution. One of the outcomes is equitable treatment of diverse populations, fully aligning with the principles in the selected policy. Centers for Disease Control and Prevention (2021) issued another statement that supports the New York Senate’s approach. The CDC states that racism endangers public health, leads to worse social determinants of health, and results in a disproportionately negative impact on diverse populations. Finally, the Office of Minority Health (2019) is a significant supporter of policies advocating for equitable care. Therefore, participation with the agencies mentioned above can strengthen the positive outcomes of the selected policy.
Advocacy Strategies
The selected policy outlines several strategies to improve cost-effectiveness and access to care for people of color. First, as noted above, the group advocates for racially equitable hiring for people of color in healthcare. This initiative is likely to introduce and promote employees who have a vested interest in supporting their own community and who do not have negative preconceptions of diverse populations (The New York State Senate, 2021). Second, it is vital to support employment, education, and housing programs for people of color and partner with other organizations to research, plan, finance, and execute these interventions.
Furthermore, as health outcomes depend on the social determinants of health, reviewing and improving them is another way to ensure equitable care (The New York State Senate, 2021). Reversing the previous policies that led to worse access to care is an essential step toward equality – such initiatives included immigrant families’ restrictions of access to care (The New York State Senate, 2021). Improving existing access relies on the reprioritization and use of resources to support change.
Obligations of Master’s Prepared Nurses
Nursing is a caring profession where the quality of services and access to them are linked to such notions as justice, beneficence, and nonmaleficence, among others. The patient’s life and health are of the highest importance to the nurse, and it is vital to support their healing process with the existing evidence and expertise. Master’s prepared nurses are leaders and researchers who can use their position to uplift communities and advocate for meaningful change. Nurses’ moral and professional obligations align with the Christian worldview, where caring for those who cannot do it themselves is the righteous path. Nursing also takes on the shape of servantship through advocacy and promotion of others’ interests. In the case of this policy and the related problem, it is necessary to advocate for people’s access to care. One has to establish a just and equitable system where every human being is treated with the same level of care and attention.
Conclusion
The selected policy was introduced and confirmed in the New York State Senate in 2021. Now, the state recognizes racism as a healthcare crisis that leads to significant disparities in people of color’s access to healthcare services. Systemic racism leads to many long-term problems, and its impact became more apparent during the COVID-19 pandemic. The policy is research-based, and its primary goal is to identify specific issues related to racism in health care and provide suggestions and information for future policies and initiatives. Although the approach may not lead to quick changes, it establishes a foundation for improving health care in the future. Moreover, its goals align with the national and global objectives of eliminating systemic racism from the medical sphere. Overall, the policy’s ideas are in line with nurses’ principles and the Christian perspective.
References
Alang, S. M. (2019). Mental health care among blacks in America: Confronting racism and constructing solutions. Health Services Research, 54(2), 346-355. Web.
Bennett, C., Hamilton, E. K., & Rochani, H. (2019). Exploring race in nursing: Teaching nursing students about racial inequality using the historical lens. OJIN: The Online Journal of Issues in Nursing, 24(2). Web.
Biden, J. R., Jr. (2021). Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. The White House. Web.
Centers for Disease Control and Prevention. (2021). Racism is a serious threat to the public’s health. Web.
Collins, F. S. (2021). NIH stands against structural racism in biomedical research. National Institutes of Health. Web.
Devakumar, D., Selvarajah, S., Shannon, G., Muraya, K., Lasoye, S., Corona, S., Paradies, Y., Abubakar, I., & Achiume, E. T. (2020). Racism, the public health crisis we can no longer ignore. The Lancet, 395(10242), e112-e113. Web.
Egede, L. E., & Walker, R. J. (2020). Structural racism, social risk factors, and Covid-19—a dangerous convergence for Black Americans. New England Journal of Medicine, 383(12), e77. Web.
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Johnson-Agbakwu, C. E., Ali, N. S., Oxford, C. M., Wingo, S., Manin, E., & Coonrod, D. V. (2020). Racism, COVID-19, and health inequity in the USA: A call to action. Journal of Racial and Ethnic Health Disparities, 1-7. Web.
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Mendez, D. D., Scott, J., Adodoadji, L., Toval, C., McNeil, M., & Sindhu, M. (2021). Racism as public health crisis: Assessment and review of municipal declarations and resolutions across the United States. Frontiers in Public Health, 1142. Web.
O’Brien, R., Neman, T., Seltzer, N., Evans, L., & Venkataramani, A. (2020). Structural racism, economic opportunity and racial health disparities: Evidence from US counties. SSM-Population Health, 11, 100564. Web.
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