Declared a public health crisis in cities and states across the country, racism "saps the strength of the whole society through the waste of human resources."1 As the nation's largest and most trusted group of health care professionals, nurses are bound by a code of ethics that includes promoting, advocating for, and protecting the rights, health, and safety of all patients.2 It's therefore imperative for nurses and nursing to dismantle racism in all its forms to provide quality care that is accessible and equitable to all, regardless of race. But what gets in the way of this noble and worthy cause?
Have you ever raised yourself up by disparaging someone else? If so, you're not alone. The zero-sum bias-a belief that for you to gain, someone else must lose-continues to influence people's thoughts and behaviors. Zero-sum thinking stymies antiracism work when one group falsely believes they will lose when another group is provided for, demonstrating an inability to see how our fate as humans is inextricably linked.
Racism's deleterious effects on Black, Indigenous, and other people of color have been well documented, but racism makes all people sick and unhealthy. The psychological effort required to discriminate can raise cortisol levels, blood pressure, and the risk of heart attacks and strokes.3 Not many would claim to subscribe to overt racism, but passive racism or doing nothing to resist racism (that is, acquiescence) harms more than just people of color. In The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together, Heather McGhee uses the Oak Park swimming pool in Montgomery, Alabama, to illustrate the point of the aptly named chapter, "Racism Drained the Pool."4 After a federal court stipulated the integration of the previously segregated pool, the backlash was swift. Rather than share the all-White swimming pool with the local Black citizens, the city decided to just drain the pool. So, while Black children did not get to enjoy the benefits of swimming in the Oak Park pool, neither did the White children, especially those whose families could not afford to build residential swimming pools.
Structural racism continues to drain pools across the country-pools of talent, opportunity, and promise. We are intimately familiar with the drained pools of health care and education. Current legislation that seeks to abolish intentional efforts to strengthen diversity, equity, and inclusion (DEI) is antithetical to nursing's value of social justice.2, 5 Both the American Association of Colleges of Nursing's The Essentials and the National Academy of Medicine's Future of Nursing 2020-2030 report clearly articulate the need for nurses and nursing schools to include education and efforts to address structural racism.6, 7 The harmful effects of anti-DEI legislation could contribute to the inability of colleges to maintain accreditation-in the case of nursing, leading to potential nursing program closures, exacerbated nursing shortages, substandard health care, poor health outcomes, decreased funding, and financial ruin for health care systems. Truly a "draining of the pool." To avoid this, it's up to all of us to educate ourselves and share why health care must be reenvisioned through a DEI lens, as recommended by professional nursing and health care organizations.
The theory of interest convergence-which argues that a majority group tolerates advances for a minority group only when it suits its interests to do so-begs us to see our shared fate as humans, regardless of race or ethnicity.8 Structural racism is a machine that's larger than one race or one discipline. How can we look more closely at issues to see where our interests converge? When we design systems and programs with the most marginalized in mind, a rising tide truly does lift all boats. Closed captioning helps more than just those with impaired hearing, curb cuts help more than those who use wheelchairs. Similarly, the Alliance for Innovation on Maternal Health's patient safety bundles can help mothers and babies of all races and ethnicities.9 Putting effort, energy, and resources into undoing structural racism can unleash human potential and lead to new levels of health and human flourishing for everyone. It requires us to recognize and eliminate zero-sum thinking and start recognizing that we are all in this together.
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