Efforts are steadily increasing to address the social determinants of health (SDH) both within health professions education and health care delivery systems. The Future of Nursing 2020-2030 report emphasizes the urgent need to transform nursing education to address SDH and advance health equity (National Academies of Sciences, Engineering, and Medicine, 2021). The report highlights gaps that must be filled to integrate SDH into programs and curricula and the importance of developing leaders to champion these urgent and unmet needs. Prior to the development of the National League for Nursing (NLN) partnership with the Walden University College of Nursing to create the Institute for Social Determinants of Health and Social Change, opportunities in nursing to cultivate this type of leadership did not exist.
PREPARING LEADERS FOR SOCIAL CHANGE
The NLN/Walden University College of Nursing partnership was formed to prepare interprofessional educators and practitioners to lead in the movement for social change. The collaboration demonstrates the role that nursing education must play not only in teaching SDH but also in developing leaders who are catalysts for social change. This unique type of leader must understand the foundations of inequities and have the knowledge, skills, and courage to navigate complex organizational systems and structures to address the social and structural determinants of health (SSDH) so that all individuals, communities, and populations can live their healthiest lives possible.
SDH are the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life (World Health Organization, 2022). Addressing social conditions that impact health is not new to nursing, but an upstream perspective that focuses on systems and structures, policy and politics, historical drivers of disparities, and structural racism as root causes of health inequities is new (Davis, 2022; National Academies of Sciences, Engineering, and Medicine, 2021).
With a vision of leadership that creates deep, meaningful, and lasting transformation to policies, practices, and structures that promote and uphold systems of inequity, the NLN/Walden University College of Nursing Institute for Social Determinants of Health and Social Change Leadership Academy was inaugurated in August 2022 with its first cohort of 10 participants. The second cohort of 10 participants started in August 2023. The application process for the NLN/Walden leadership academy is competitive.
The year-long program consists of focused activities designed for exploration, discovery, and growth to develop a conceptual understanding of SSDH. Participants explore personal, neuroscientific, historic, contemporary, and sociopolitical contexts to understand the how and why of inequities and foster leadership competencies to develop strategies and solutions for meaningful transformation. Activities include experiential exercises, webinars, interactive group calls, reflection, debriefing, and an intensive leadership retreat.
THE IMPACT
Participants in the leadership academy engage in research and other scholarly activities for broad dissemination. They also develop and implement a hallmark leadership project designed to create change or solve an organizational, educational, or community-based issue or problem. Leadership projects of the inaugural cohort, both funded and nonfunded, are making an impact not only within organizations but also more broadly across organizations and within the community.
Participants in the inaugural cohort have been appointed to leadership positions both on organizational and state levels; moved onto the tenure track with SDH and social change as a research focus; and presented nationally on topics related to diversity, equity, and inclusion and the SSDH. Currently, the inaugural cohort is working on two collective projects: 1) a book that highlights leadership for positive change emphasizing strategic approaches to addressing the SSDH, due for release in spring 2024, and 2) a framework for the integration of SDH and social change into the curriculum.
The concept that health and health inequities are driven by social and structural determinants is increasingly the focus of nursing articles, scholarly projects and research, conferences, courses, vision statements, and toolkits (Davis, 2022). The NLN/Walden University Institute for Social Determinants of Health and Social Change is an innovative national initiative to develop leaders to transform SSDH and social change (Malone & Davis, 2023). Housed in the NLN Center for Transformational Leadership under the leadership of chief program officer Dr. Janice Brewington, this bold association-academic partnership demonstrates that nurses can lead social change but only with a clear understanding of SSDH and its evolving role in advancing health equity and the leadership competencies to integrate social change into programs and curricula and engage in research and scholarly activity with broad dissemination.
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