NR 718 CU Medicaid Expansion to The Rural Areas Discussion Responses

reply to student and to professor:

professor reply 

Thank you Victoria,

Expanding your thoughts to include you as a DNP-leader, what do you think you can do to expand Medicaid expansion to the rural communities?

Dr. B

student reply 

Dr. Bartelt and class,

According to The Commission on Social Determinants of Health (CSDH) by the World Health Organization (WHO) conceptual framework, one example of how health leaders can reduce health inequities is to address social policies from a socioeconomic and political context.  Employing social justice in one’s leadership practice is critical to improving health and quality outcomes (Chamberlain University, 2023).

Social justice principles are fundamental to nursing practice and embedded in our scope of practice. The ANA Code of Ethics provisions identify the role of the nurse in addressing health disparities from the perspective of the root cause of social injustice and, recognize the role of social determinants of health as having a complex role in overall wellness (Hines-Martin & Nash, 2017). Nurse leaders cannot accomplish this by working in silos and are uniquely positioned as the most trusted profession to have a pivotal role in improving community engagement, as well as professional and key stakeholder collaboration.

In a recent national study of adults with obesity (Javed et al., 2022) evidence has shown a proportional relationship between obesity and social disadvantage, in that people with a higher burden of unfavorable social determinants of health (SDOH) also had a higher incidence of obesity.

An example of the effect of health disparities on marginalized populations is in Rural Appalachian Martin County, Kentucky. With 39% of adult Kentucky residents and 44% of children living below the poverty level, 36% are described as physically inactive and over 40% of the population is obese, which is in alignment with Kentucky’s overall rating in the top 10 states with the highest obesity rates in the USA (Kentucky Nutrition Education Program, n.d.).  Three key social determinants of health risk factors identified for this population and the economic instability include poor access to nutritious food, low healthy food spending with high food insecurity, and increasingly sedentary lifestyles.  The University of Kentucky (2019) received a 2.5 million dollar grant from the CDC based on the presented epidemiological data and began implementing a 5-year project to decrease obesity rates. This collaboration among healthcare leadership, community stakeholders, and political policymakers has come together to bring the disparity gap and create an improved physical infrastructure that supports physical activity, community resources to bring nutritious food to the heart of the community, and educational resources to help families make healthier choices to combat obesity (Gustafson et al., 2017).

Pat Mezzina