Last spring the news media was filled with reflections on the 50th anniversary of the 1965 marches from Selma to Montgomery, Alabama-milestones in the civil rights movement. Since then, we've seen many positive changes aimed at ending racial discrimination, from the integration of public schools to the elimination of state and federal "Jim Crow" laws. There is greater racial and ethnic diversity among representatives of our government-perhaps most strikingly, we have an African American president-as well as in industry and the arts; and countless communities have become more racially and ethnically mixed. Although some people point to such advances as proof that discrimination based on race or ethnicity will soon be a thing of the past, recent events suggest otherwise.
In July, NBC Nightly News aired footage of a Ku Klux Klan rally at the Columbia, South Carolina, statehouse, reportedly the first such rally there in 27 years. The rally was held to protest lawmakers' vote to remove the Confederate flag from the statehouse, a decision prompted by the killings of nine members of the Emanuel African Methodist Episcopal Church in Charleston. The alleged shooter's Web site showed photos of him posing with the Confederate flag, and he reportedly told investigators that he "wanted to start a race war." A spate of fires in several Southern African American churches followed, several of which were determined to be the work of arsonists. Many people believe the Charleston gunman's act was an instigating factor.
And recently the media has been covering the campaign of Republican presidential candidate Donald Trump, who has achieved notoriety-and in some circles, support-for labeling Mexican immigrants as mostly criminals, drug dealers, and rapists. Such vitriolic views serve only to promote prejudice and encourage acts of violence. Clearly, as a nation we have a long way to go in overcoming racial and ethnic discrimination.
Numerous studies have demonstrated that racial and ethnic minorities are especially vulnerable to health care inequities. In an article in our June issue, "Culturally Competent Care: Using the ESFT Model in Nursing," Kenya Beard and colleagues noted that "even after differences in income and in access to health care and health insurance are controlled for, racial and ethnic minorities still experience a lower quality of health care services." And access to care isn't the only issue. A growing body of research shows that experiencing racism has inherent consequences for health. In a 2009 systematic review funded by the National Institutes of Health, Williams and Mohammed noted that "research continues to document an inverse association between discrimination and health."
Why address these sociopolitical issues in a nursing journal? Well, because elected officials determine which health initiatives get funded and for whom; because many voters haven't really considered the implications of the political rhetoric they're used to hearing; and because what nurses can do at the point of care and for whom they can do it flows from legislation and policy. For example, consider the expansion of Medicaid in conjunction with the Affordable Care Act. This expansion will largely benefit the working poor, who are disproportionately likely to be black or Hispanic, and who make just enough money to be ineligible for federal subsidies and traditional Medicaid, yet can't afford private insurance. The Kaiser Family Foundation has reported that, as of July 20, while 31 states (including the District of Columbia) have or will expand their Medicaid programs, 20 have not.
So what can nurses do? As the largest group of health professionals, we can make a difference at the polls in determining who gets elected and which programs get funded. But we need to pay attention now, during the primary campaigns, as candidates emerge, put forth their positions, and engage in debates that reveal what they know and why they think the way they do. We need to move past the sound bites and the media spin, and check the facts and judge for ourselves. As trusted health professionals, we can encourage others to do the same. We can donate to or volunteer for a particular candidate's campaign, or contribute to a political action group. The health and well-being of too many people are too important to be left to politicians who forget that they're there to serve the public. Let's do everything we can to make sure they remember.