# data[].attributes.headline
What is inequality and inequity in health?

# data[].attributes.subject
What is inequality and inequity in health?

# data[].attributes.body
Health inequities are avoidable, unfair and systematic differences in health between different group of people. Inequalities constitute inequities.

“Inequity and inequality: these terms are sometimes confused, but are not interchangeable, inequity refers to unfair, avoidable differences arising from poor governance, corruption or cultural exclusion while inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources.”

(Source: https://globalhealtheurope.org/values/inequity-and-inequality-in-health/) http://www.healthscotland.scot/health-inequalities/what-are-health-inequalities

# data[].attributes.headline
Give examples of health inequities and inequalities

# data[].attributes.subject
Give examples of health inequities and inequalities

# data[].attributes.body
Socio-economic
Employment: low income leads to poor housing and poor access to healthy food and good care, availability of treatment, quality and experience of care (level of patient satisfaction).
People with lower levels of education have a higher risk of suffering from certain illnesses than those with a high level of education age.
Tuberculosis is known as a disease of poverty.

Geography
People living in deprived areas face the worst health inequalities in relation to health access. It can be regional or whether urban or rural.
People in some countries live longer and are in better health.
Some people will experience high exposure to pollution (air, grime or other environmental problems; and noise) that will affect their health.

Protected people in law for their specific characteristics
LGBT, ethnicity or disability might experience discrimination on the care received.
Life expectancy is in average shorter for different gender or people with learning disabilities.

Socially excluded groups
people experiencing homelessness, travellers...

https://www.who.int/features/factfiles/health_inequities/en/

# data[].attributes.headline
What conditions contribute to inequities and inequalities in health?

# data[].attributes.subject
What conditions contribute to inequities and inequalities in health?

# data[].attributes.body
Poor health and poverty tend to go hand-in-hand.

Health Inequalities

Causes of health inequalities; Work, Education, Good quality housing, Low income, Poor housing, Discrimination, Access to health service

The WHO Health Equity Status Report indicates that 90% of health inequalities can be explained by financial insecurity, poor quality housing and neighborhood environment, social exclusion, and lack of decent work and poor working conditions

Health Inequities

Distribution of health resources between different population groups

Arise from social, economic, environmental, and structural disparities that contribute to inter-group differences in health outcomes both within and between societies. (Baciu, Negussie, Geller et al (2017)

Healthy inequities arise from policy, law, governance, culture, race, ethnicity, gender or gender identity, class, sexual orientation

The lower an individual’s socio-economic position, the higher their risk of poor health.

https://www.who.int/features/factfiles/health_inequities/en/

https://www.ncbi.nlm.nih.gov/books/NBK425845/

# data[].attributes.attachment_link.readable_text
National actions

Nationally, the focus should be on implementing the measures which are most likely to be effective in reducing health inequalities. This means trying to discontinue or modify measures which have been shown to widen, or potentially widen, inequalities.

There is also an important role for national agencies, including public and third sector organisations, to support local delivery through advocacy and evidence building.

We examined what does, and does not, work to reduce health inequalities for the Ministerial Task Force on Health Inequalities in 2012. Our Health Inequalities Policy Review shows that tackling health inequalities requires a combination of action to

undo the fundamental causes

prevent the harmful wider environmental influences

mitigate (make less harmful) the negative impact on individuals.

You can find out more about this in our health inequalities policy review which was written to provide evidence to the 2013 Scottish Ministerial Task Force on Health Inequalities. It reviews the current policy and the evidence about what works to address health inequalities.

Local actions

Locally, public resources need to be allocated according to need so that they do not make inequalities worse, and may make a contribution towards their reduction. Providing universal services with added intensive support for vulnerable groups (known as proportionate universalism) is effective at reaching all of those that need them by ensuring that there are fewer or no barriers in terms of

However, some people continue to experience barriers to accessing services, including

These include people from minority ethnic or LBGTI (Lesbian, Gay, Bisexual, Transgender or Intersex) population groups or people living with poverty, disability or mental health problems. Additional efforts are also required to ensure equality of access to services for those living furthest from service provision.

# data[].attributes.attachment_link.description
What causes health inequalities and how can they be reduced

# data[].attributes.headline
Why should nurses be aware of inequalities or inequities in health

# data[].attributes.subject
Why should nurses be aware of inequalities or inequities in health

# data[].attributes.body
Nurses have an understanding of the health inequalities that can occur, and their causes. This knowledge will enable nurses to address the challenges that health inequalities can create in nursing practice

Nurses can successfully identify and address the health inequalities that they encounter in their practice, thus enabling a holistic approach to patient care

# data[].attributes.attachment_link.readable_text
Agi McFarland Lecturer and programme leader, Master's in Public Health, Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland

Emma MacDonald Lecturer and deputy programme leader, Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland

* To familiarise yourself with health inequalities and social determinants of health

* To understand the role of public policies in addressing health inequalities

* To be aware of how addressing health inequalities can improve health outcomes

This article aims to improve nurses' knowledge and understanding of health inequalities. Health inequalities are responsible for variation in health outcomes observed across different population groups. Therefore, it is essential that nurses have an understanding of the health inequalities that can occur, and their causes. This knowledge will enable nurses to address the challenges that health inequalities can create in nursing practice. This article raises awareness of this important aspect of care, so that nurses can successfully identify and address the health inequalities that they encounter in their practice, thus enabling a holistic approach to patient care.

Nursing Standard. doi: 10.7748/ns.2019.e11341

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

Agi.mcfarland@gcu.ac.uk@AgiMcfarland

Conflict of interest

None declared

McFarland A, MacDonald E (2019) Role of the nurse in identifying and addressing health inequalities. Nursing Standard. doi: 10.7748/ns.2019.e11341

Published online: 21 March 2019

Want to read more?

# data[].attributes.attachment_link.title
Role of the nurse in identifying and addressing health inequalities

# data[].attributes.attachment_link.description
Agi McFarland Lecturer and programme leader, Master's in Public Health, Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland Emma MacDonald Lecturer and deputy programme leader, Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland * To familiarise yourself with health inequalities and social determinants of health * To understand the role of public policies in addressing health inequalities * To be aware of how addressing health inequalities can improve health outcomes This article aims to improve nurses' knowledge and understanding of health inequalities.

# data[].attributes.headline
What can nurses do to reduce inequalities or inequities in health

# data[].attributes.subject
What can nurses do to reduce inequalities or inequities in health

# data[].attributes.body
Dyson and McAllister (2019) advocated that nurses should prepare themselves and the future nurses for vital roles. Such as;

-  Advocating for public health,

-  Early intervention in primary care

-  Monitoring the fairness of healthcare services to reduce inequalities.

Nurses as health educators;

- Need to be equipped with the technical and psychosocial skills as well as political knowledge to engage and advocate on patients behalf (Dyson and McAllister, 2019).

- Nurses should care for people according to their needs, not the care they can afford; therefore, both the rich and poor can receive the care they need to live a long and healthy life (Cookson, 2016).

Cookson R (2016) Health Equity Indicators for the NHS, presented at maximising the impact of the NHS in tackling health inequalities, London, 2016.

Dyson, S. and McAllister, M. (Eds.) (2019) Routledge International Handbook of Nurse Education. Abingdon: Routledge

# data[].attributes.headline
How to support student nurses to address health inequalities or inequities

# data[].attributes.subject
How to support student nurses to address health inequalities or inequities

# data[].attributes.body
The Role of Education

Teaching about the issues, causes, and strategies to identify and tackle health inequalities or inequities

Social and health inequalities to be addressed in the nursing curriculum

Opportunity to learn about the relationship between health and homelessness.

Homeless Health in the Curriculum: improve their curricula and approaches to teaching homeless and inclusion health, which had a demonstrable impact.

Nurse Education in Practice 47 (2020) 102849 (Let us be unequivocal about social justice in nursing) https://www.sciencedirect.com/journal/nurse-education-in-practice

# data[].attributes.attachment_link.readable_text
What an honour it is to work with and support community nurses. Highly trusted, skilled, knowledgeable, compassionate and creative, they are at the frontline of care: identifying where the poorest health is, addressing the healthcare needs of some of the most vulnerable people in society.

But community nurses are more than just the help they give - they are active in developing radical solutions to drive better public health, whether this is by leading practice development projects, or by educating student nurses. Their voices are becoming louder in debates, calling for new systems that promote better health for all.

The QNI is working with partner organisations nationally to help improve homelessness and health policy. A major part of this work is a collective effort to turn around the shocking and indecent rise in rough sleeping and family homelessness over the last ten years.

The rising number of people experiencing homelessness, and the severity and impact of homelessness on individual and population health, needs to be addressed urgently. Relevant national and regional policies must all work towards reducing the causes of homelessness, support structures must be collaborative, better research must inform housing and health support providers and low cost accommodation must be championed. Given the impact that homelessness has on health, nurses have a key role to play in all of this work.
The Role of Education
The QNI believes that every student and every registered nurse should have the opportunity to learn about the relationship between health and homelessness. A lack of suitable housing puts people at high risk of poor health as they have no suitable environment to recover from illness. Therefore, a wider understanding of homelessness and its risks is an essential quality for a nurse working in hospital or the community.

Last year, the QNI published a new learning resource, 'Transition to Homeless Health Nursing' to help meet the needs of student nurses seeking to develop their knowledge and practice, as well as registered nurses working in the community.

Transition to Homeless Health Nursing' is an eight chapter, self-guided online resource designed for nurses new to working with people who are homeless. The resource was developed over the course of a year, with input from over 80 specialist community nurses. I was constantly heartened by the willingness and determination of these busy professionals to share their experiences and wisdom. Their commitment to the next generation of nurses and to helping ensure people who are homeless get the best possible healthcare stood out above all else.

As with all nursing, excellent skills in caring for people who are homeless can only develop fully with experience over time. This resource aims to speed up the learning process and help nurses develop the confidence to understand the causes and effects of homelessness, to work collaboratively, know current legislation and get involved in policy. I am sure it will have widespread benefit to student and registered nurses who care about giving the best possible care to people facing some of the most difficult challenges in life, and I'm proud of the nurses in the QNI's Homeless Health Network who helped make the resource possible.
Homeless Health in the Curriculum
When we surveyed nursing course leaders last year, we found many differences in their approaches to teaching homelessness. This included some excellent, innovative methods including modules on inclusion health and the involvement of service user speakers, or case study material focused on homelessness. The more proactive universities identified a series of steps they had taken to improve their curricula and approaches to teaching homeless and inclusion health, which had a demonstrable impact. Not all universities were this proactive however, and less than half offered placements in homeless health.

The QNI encourages universities offering nursing programmes to incorporate the learning in our new learning resource as part of their pre-registration nursing programmes. Educators are very welcome to use the online resource as a course learning material, or get in touch to request a hard copy (limited copies per organisation). By sharing best practice we can help ensure there is more consistency when educating students around homeless health.

The QNI also actively encourages nursing educators and student nurses to join the Homeless Health Network to receive regular updates about consultations and the latest research in homeless health. The Network also enables people to share news, resources, and attend free learning events on clinical subjects in this area.

# data[].attributes.attachment_link.title
Why Student Nurses Should Be Concerned About Health Inequality

# data[].attributes.attachment_link.description
What an honour it is to work with and support community nurses. Highly trusted, skilled, knowledgeable, compassionate and creative, they are at the frontline of care: identifying where the poorest health is, addressing the healthcare needs of some of the most vulnerable people in society.