1. McSpedon, Corinne Senior Editor


Fostering dialogue and action on health equity.


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The annual meeting of the American Public Health Association (APHA) took place November 10-14, 2018, in San Diego. Subtitled "Creating the Healthiest Nation: Health Equity Now," the conference featured an opening session in which APHA executive director Georges Benjamin, MD, highlighted the 147-year-old organization's "distinguished record of achievement in public health," including taking on the tobacco industry, battling the HIV epidemic, and helping to establish Medicare and Medicaid, as well as the Affordable Care Act. "None of these achievements were simple or easy but were well worth the fight," he observed, a message that resonated with the estimated 13,000 attendees, who spent the next few days discussing pressing public health challenges, including the opioid epidemic, gun violence, and the needs of vulnerable populations.

Figure. U.S. surgeon... - Click to enlarge in new window U.S. surgeon general Jerome M. Adams, MD, MPH, speaks at the opening session of the APHA's annual meeting on November 11, 2018. Photo (C) EZ Event Photography.

During the meeting, the APHA announced the adoption of 12 policy statements covering a range of topics, including preventing tuberculosis among health care workers, reducing gun-related suicides, and addressing violence-including police violence-as a public health issue.



Also featured in the opening session, U.S. surgeon general Jerome M. Adams, MD, MPH, noted the need to "lift up" those who are most disadvantaged. Failing to do so, he said, is typically recognized as leading to problems like lost productivity, but it's less frequently associated with issues such as safety. "Health and national security-we don't talk about this enough," Adams said. "The healthier our nation is, the safer our nation is." He pointed out that fewer people are now eligible for military service because of poor health and criminal records.


Addressing these and other issues, according to Adams, requires that public health officials seek out nontraditional partners, such as local businesses, law enforcement, and mayors. "At times," he said, "we forget to meet the community[horizontal ellipsis] where they are, engaging the choir but failing to reach others."



Understanding the causes of health disparities is similarly needed, according to speaker Richard Besser, MD, president and chief executive officer of the Robert Wood Johnson Foundation and a pediatrician in Trenton, New Jersey. Personal choices are important, he said, but "the choices people make fundamentally depend on the choices they have." He noted that the life expectancy of a child born in affluent Princeton, New Jersey, is 87 years compared with 73 years for a child born 20 miles away in economically challenged Trenton. These numbers won't change, stated Besser, "until we understand how social conditions and systemic barriers affect our health, and until we change from a sick-based system." There are examples of barriers at every level of society that continue to prevent opportunities for people to prosper, Besser said. These include the "unrelenting stress associated with racism," which he argued must be acknowledged as something many Americans grapple with daily.


Besser also emphasized the need to ensure that health equity isn't looked at separately from other issues, such as the safety of neighborhoods, adequate pay, and access to affordable housing. "Health equity can't sit over there," he said. "It must be a key consideration in everything we do."



Several plenary sessions were dedicated to nursing issues, including discussions focused on school nursing, environmental health, vaccination programs, veterans care, and plans to feature the social determinants of health more prominently in the next Future of Nursing report, which is expected in 2020.


School nursing. Stephen M. Padgett, PhD, RN, assistant professor of nursing at California State University, Monterey Bay, noted that the National Association of School Nurses recommends one school nurse for every 750 students, and the American Academy of Pediatrics has called for at least one full-time RN in every school. Yet staffing levels vary considerably, nationally and within states and counties. The work of school nurses is similarly diverse and frequently poorly understood, even by other RNs, said Padgett.


Caring for a large population of students requires addressing numerous and varied social and physical needs, and new challenges emerge regularly, he observed. In recent years, for instance, school nurses have played an important role in mainstreaming efforts, which focus on the inclusion of children with disabilities in general education classrooms.


Climate change and health. Cara Cook, MS, RN, AHN-BC, of the Alliance of Nurses for Healthy Environments (ANHE), discussed how the group is engaging with its partner nursing organizations to increase awareness among nurses regarding the health effects of climate change and the role nurses can play in mitigating these. When asked how nurses can avoid discussions in which climate change becomes a polarizing issue, Cook suggested neutralizing the topic by "connecting with the person or group you're talking to around a common or shared value." Often, she stated, this can best be achieved by focusing on health messaging: talking about climate change as a health issue that affects everyone, rather than approaching it as a political topic.


The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements makes it clear that social justice and environmental issues "are our ethical responsibilities as nurses," said Barbara Sattler, DrPH, MPH, RN, FAAN, a professor at the University of San Francisco. She recommended that nurses also connect with the media, emphasizing that findings about climate change and its health effects are evidence based. "We are the most trusted source of health information," she said. "Let's use our voices on this."-Corinne McSpedon, senior editor



Nursing as a profession has been shaped and moved forward by many individuals, and some have made especially noteworthy and far-reaching contributions throughout their careers to advance practice, education, and research. The American Academy of Nursing pays tribute to these exceptional people and their extraordinary impact by recognizing them as Living Legends. This year's group joins 119 other notable nurses. The 2018 honorees, shown in the photo from left to right, are Marilyn P. Chow, Beatrice J. Kalisch, Ruth McCorkle, Ada K. Jacox, Sally L. Lusk, Joanne M. Disch, and Jacquelyn C. Campbell. You can read about their accomplishments at

Figure. Photo by Mol... - Click to enlarge in new window Photo by Molly Haley,