‘We Have to Be Able to Walk the Talk’.

Despite vast improvements in medical care and overall health of the US, disparities in health and health care persist across many dimensions, including race and ethnicity, socioeconomic status, sexual orientation, geographic location, and immigration status.

Racial and ethnic disparities in health are particularly evident as the coronavirus pandemic continues to disproportionately impact African Americans, especially those who are low-income.

“When addressing these health disparities and advancing health equity, we need to have a multi-pronged approach,” says Antonia Villarruel, Margaret Bond Simon Dean of Nursing at The University of Pennsylvania School of Nursing. “Like many health providers at the point of care, nurses are in a situation where we have to deal with not only the symptoms that patients are presenting, but their symptoms in the context in which they live, work, and play, whether through treatment or prevention.”

On Wednesday, April 29, Villarruel will visit the School of Public Health as the featured speaker for the Public Health Forum, “Working Together to Advance Health Equity” during which she will discuss ways in which health professionals can address the individual and systemic issues that impact the social determinants and exacerbate health inequities.

A nurse-researcher and an alum of Penn Nursing, Villarruel became dean in 2014 after spending 14 years at the University of Michigan School of Nursing as a professor, Nola J. Pender Collegiate Chair, and associate dean for research and global affairs. She designed ¡Cuídate!, an evidence-based program funded by the National Institutes of Health that promotes abstinence and safer sex within the frame of Latino culture. A strong advocate for health equity and diversity within the nursing profession, Villarruel chairs the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities for the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine, among several other positions.

Ahead of the forum, Villarruel spoke about nurses’ unique role in reducing health disparities, the importance of cultural competency among healthcare professionals, and broad policy changes that will advance health equity.

Given the critical roles that nurses play in patient care, how are nurses best suited to recognize and address health disparities, particularly as they remain on the front lines of the COVID-19 response? 

As a provider, we are aware of issues of racial discrimination and implicit bias, and how that affects our interpersonal actions, but also how the context that affects their illness, their conditions, and their recovery. The healthcare system as a whole is just becoming aware of and being sensitive to how it should be addressing these issues, much of it brought on by payment reforms such as value-based care.

Another component that healthcare professionals need to pay attention to are issues of structural racism and understanding the structures that are in place. In terms of COVID, that means who gets testing and who doesn’t get testing, and where the safety nets are. Those are structural barriers and issues that we need to consider, and the actions at each of those levels are different. If you’re talking about interpersonal reactions, [we need to ask], ‘what is it in my behavior and my attitudes that I need to change and shift and be aware of? How do I address social needs of a person who has a chronic illness, and how do I work and interact with other sectors that influence health—such as housing, food security—and how do I address that at the point of care?’

The final component is looking at the policies that we have within institutions, cities, states, and the federal government that we need to be aware of, and advocate for, in order to advance health equity. All of these components are where the attention of nurses, physicians, and public health professionals needs to be.

Can you talk about the importance of creating diversity in the nursing field? How is cultural competency incorporated into the nursing curriculum at Penn?

As a profession, nursing may be a bit more diverse than medicine or dentistry. We can’t be preaching about health equity and inclusivity if we can’t take care of business in our own homes—we have to be able to walk the talk. That gives us credibility and is the right thing to do. Diversity of thought happens when you have a more inclusive environment and diverse perspectives.

At Penn Nursing, we have a holistic approach to diversity and inclusivity. It’s not just about numbers, it’s looking at where and how people are placed. Within my administrative team, I am Latina, I have two vice deans who are African American, a department chair who is Latino, and a head of diversity who is African American. At the leadership level, that’s a lot. But importantly, we’re working on including a diverse faculty, where we’re increasing numbers, as well as with student recruitment, and we’re also making sure that we have the support to help people be successful. Diversity and inclusionare central components our educational offerings, and we have strength in community engagement, and it is reflected in our mission statement and our values. Social justice is a core value to what we do. It’s more than just the numbers—we have to look at threading diversity, inclusivity, social justice, and commitment to vulnerable populations throughout all that we do.

Can you talk about some of your current research and how it informs necessary policy changes?

Most of my involvement in research has been supporting new investigators and new faculty that have similar lines of research [as my own]. Right now, I’m working with a faculty member who is looking at adapting a curriculum that I developed for parents to talk to their kids about safer sex and applying and adapting that to a population of parents who have LGBTQ youth. I’m also involved in work around developing effective interventions and working with communities on the scale-up and spread of evidence-based interventions. Our research flourished at a time when there was attention to comprehensive sexual education that was evidence-based, but that’s not a government priority anymore, so it’s been hard to advance work without federal support and guidelines. Hopefully that will change.

To influence policy, the most effective thing that public health professionals and healthcare providers can do is get people out to vote—that’s the chance that we have to influence policy. You can’t sit back and say ‘it doesn’t matter.’ The biggest thing we have to fight is apathy.

Another effective action we can take is filling out the census materials and working with communities to complete it. To see funding reach those who most are in need, we need to make sure that everybody is counted. The census is the basis for distribution of resources, including health resources, so we have to support our communities and get them to fill it out.

When working with policymakers, we need to look at the goals that we can achieve together and agree in order to work with communities in need. It’s important to start in those areas of agreement, and then together with those communities figure out what the strategies should be going forward.

—Jillian McKoy