By Dorsey Griffith
Contributing Writer

About a hundred CANP members tuned in Aug. 25 for a Virtual Health Justice Town Hall event on health justice and how providers can advocate for their patients and lead in the creation of systems of care that are inclusive and supportive for all.

The event was organized by the CANP’s Health Justice Committee, the formal forum for the organization’s efforts to advance diversity, equity, inclusion and allyship. It was formed in the wake of social unrest that shined a bright light on racism and inequality in policing and other institutions, including health care.

The meeting featured a slate of diverse voices. They included: 

• Jen Hastings, MD, Assistant Clinical Professor in the Department of Family and Community Medicine and Medical Advisory Board member of the Center for Excellence for Transgender Health at UCSF
• Judy Martin-Holland, PhD, MPA, RN, CNS, FNP, FAAN, Associate Dean, Diversity, Inclusion and Community Outreach at UCSF and a clinical professor in the Department of Physiological Nursing
• Simran K. Tagore, RN, PHN, BA, MSN, FNP-BC, a women’s health NP at Kaiser Greater Southern Alameda County
• Jeffrey D. Vu, DNP, MBA, RN, FNP-BC, Associate Program Director of UC Irvine Health Gender Diversity Program, NP with Providence ExpressCare and VP of Corporate Affairs for CANP

CANP President Patti Gurney opened the forum with an introduction to the Health Justice Committee’s purpose and how it aligns with the CANP’s mission, and the conversation was moderated by CANP President-Elect Cynthia Jovanov, DNP, FNP, NP-BC, an adjunct professor at California Baptist University.

Each panelist brought their own perspectives to the concept of health justice. Hastings, who prefers to be called “Jen” rather than by a specific pronoun, is a nonbinary, gender queer provider. Hastings said health justice is more than health equity.

“It’s about addressing the systemic issues that lead to people not being able to access what they need. It’s about recognizing and removing the barriers standing in the way. It’s about going deep within and recognizing what’s going on within ourselves and stepping up and changing the systems that are around us.” 

Martin-Holland said she thinks of health justice as the ability for everyone to participate in society at their optimal level for functioning, which can only occur if the causes of poor health are addressed through changes in laws, regulations and policies.

“I understand that the work before us to remain steadfast in our commitment, our covenant, to improve the health of our society must be focused on continuous improvement of our practice, pushing to discover, to develop, to learn and implement clinical guidelines that improve health outcomes for everyone, to question any guideline or practice that assumes differences on the basis of skin color, race, beliefs, who people love.” 

Tagore sees the health justice movement as a call to action to begin to dismantle oppressive systems that have existed in one form or another since slavery and that ultimately impact health.

“Health is a fundamental human right, so this is a humanitarian endeavor,” she said. “The institutionalized and ideologic oppression have led to these differences in health care outcomes and disparities. Those are systems that to me have to be torn down. A thriving society is dependent on the health of its people.”

Vu said the first of all nursing ethics is justice and the obligation to understand and practice empathy in responding to patient needs, regardless of race, class, disability or gender.

“I understand the power that I have as a cis(gender) male in the role that I have, as a health care provider, as a teacher, as a human being,” he said. “I need to do more for others, whether they be in direct contact with me or beyond. It’s more about making sure that I use my talent for others.”

Panelists also were asked to talk about how the concepts of privilege and implicit bias show up for them and how they speak to others about them. 

Hastings introduced the term “endosex,” which refers to people whose sex characteristics meet medical and social norms for typically male or female bodies. She said many providers assume that being endosex, cisgender and binary is normal, and anything else as abnormal.

“We know and have learned that most medical providers see transgender as abnormal, and that makes it especially difficult for a transgendered person to navigate the health care system,” Hastings said.

For Martin-Holland, who sits on numerous hiring committees at UCSF, helping colleagues to look at the biases and assumptions that can creep into decision-making and to consider a candidate’s attributes beyond their educational pedigrees.

“We don’t necessarily need to have Yale on a transcript unless that translates into some kind of skill, attribute or ability that they will bring to the position of dean,” she said. “I am looking for creating opportunities for individuals who have not necessarily had a plethora of opportunity.”

Tagore said she tries to recognize her own implicit bias knowing that it can have a direct effect on health outcomes and disparities. She urges everyone to test themselves to learn about their own bias so they can correct it. Harvard University’s Project Implicit offers one such test.

“Bias awareness can be a motivating factor for changing behavior,” she said. “I think it should be part of our nursing education and compliance.”

Similarly, Vu stressed the importance of objective self-reflection.

“Do a self-check in a raw objective way, and open your eyes to something you may not have known.”

He said consideration of privilege is important too to help understand barriers to work, housing, health, and other opportunities only those with privilege can typically enjoy.

“How are we making ourselves available to those people?” he asked. “How do we find our way into those underserved communities?”

When asked what NPs can do to assure health justice, whether with an individual patient or on a larger scale, panelists stressed the importance of getting educated, building relationships and building trust with patients and gaining allies within health care organizations.

Noting that many health systems limit the amount of time providers have with each patient, Holland-Martin said NPs need to find ways in their own practices to be intentional in building relationships with patients and families.

Hastings urged providers to learn more about gender care, committing to anti-racism and changing electronic health systems to ensure that patients’ pronouns are accurate. She suggested NPs attend conferences like Gender Odyssey.

In addition to practicing in a way that acknowledges disparities, Tagore suggested NPs ask their managers if they can give a short presentation on implicit bias or join their organization’s diversity and inclusion committee. 

Vu emphasized the role of health care leadership in creating a culture of inclusivity and support within the organization and, as a practitioner, to accept patients as they are.

To view the entire Health Justice Town Hall, click here. 

What can NPs do in bigger systems such as our work place, it’s larger organization, or our community to promote health justice?

Top Ten List by Judy Martin-Holland

1. Take the time to get to know your patients and their needs. Be intentional and take the time to develop a relationship with your patient.
2. Be reflective in your practice. What’s going smoothly? What is not? What works? What does not? Why?
3. Foster curiosity. Ask questions. Question assumptions. Speak up. 
4. Identify what is needed to improve one or two health outcomes (at the individual, community, or system level). Use formal and build informal coalitions and identify allies in your workplace for change. Start!
5. There is a revised definition of the Social Determinants of Health. It includes racism – individual, structural, and systemic. Learn to identify and remove structural racism as a barrier to health at all three levels.
6. Life-long learning: Stay current in the literature and science.
7. Broaden your own perspectives through readings, community engagement, and group participation (with folks unlike yourself). Broadening perspectives only comes from broadening exposure.
8. Be inclusive. What voices are missing from the conversation? This is especially important in decision-making and policy-making deliberations.
9. Be strong advocates for whatever improves and advances the practice of nursing and the fulfillment of our covenant with society (Nursing’s Social Policy Statement and Nursing’s Code of Ethics).
10. Join your professional, specialty, and special interests organizations (such as AARP, American Lung Association, and similar health-related organizations). 
11. This work needs many hands of dedication to move the needle. Speak up for inclusivity in these organizations, as well!