Eight ways speech-language pathologists can contribute to health equity: the case of Black stroke survivors with aphasia

Issue Editor Foreword

Disparities in Vision Health and Eye Care: Where Do We Go from Here?

Partnerships to improve social determinants of health, health equity, and health outcomes: An SNRS whitepaper.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Background: The pursuit of health equity has gained significant attention in recent years, with a focus on eliminating health disparities and addressing social determinants of health. Health equity is crucial in ensuring that everyone has an equal opportunity to attain his/her full potential for well-being and health. Purpose: This paper aimed to conduct a comprehensive analysis of health equity and healthcare disparities, specifically from the perspective of nursing. It also emphasizes the importance of nursing professionals in promoting health equity, addressing health disparities, and advocating for fair and equitable access to healthcare services. Methods: A scoping review was performed to determine applicable international reports and literature published in English. The search was conducted across various electronic databases, including Google Scholar, CINAHL, EBSCO, MEDLINE, and PubMed. Results: The findings revealed that achieving health equity involves addressing the root causes that hinder individuals from attaining optimal health. Social determinants of health play a significant role in shaping health outcomes, and addressing these factors is essential to achieve health equity. Furthermore, the study underscores the need for a community-oriented approach that involves collaboration with community and government sectors to improve social care resources and healthcare delivery. Conclusion: Nurses play multi-faceted roles in promoting health equity through technology, policy, education, research, philosophy and theory context, and disaster response. They have the opportunity to address health disparities and promote health, particularly in underserved communities. Implications for Nursing: Nurses need to be actively involved in advocating for policies and practices that address social determinants of health and promote equity in healthcare delivery. By recognizing the impacts of social, economic, and environmental factors on health outcomes, nurses can play a key role in addressing health disparities and promoting health equity. This involves collaboration with various stakeholders, advocating for resource allocation, and implementing communityoriented approaches to address health inequities Keywords: Health equity, Health disparities, Social determinants, Nursing research, Nursing theories, Nursing policy, Nursing education, Health technology, Disaster response, Jordan.

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism.Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis.Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19.Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

Ten years have passed since the release of the final report of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH),1 a landmark document that provided a global blue‐print for the health promotion community and the stakeholders we work with. Three overarching recommendations were outlined, improving daily living conditions; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action.1 The extent to which progress has been, and continues to be, made is contested. This editorial briefly reflects on what has been achieved over the past decade—in broad terms—about action on the social determinants of health (SDH) in Australia. We deliberately take a balanced view by highlighting the weaknesses and strengths in what has been achieved by governments, non‐government organisations, research institutions, peak bodies and civil society. We also reflect on the ongoing role that the Australian Health Promotion Association (AHPA) has played in advancing our understanding about, and action on, the SDH.

The Future of Nursing 2020–2030: Charting a path to achieve health equity

Cultural Competence: How Qualified Are You?

COVID-19 and Social Determinants of Health in Gastroenterology and Hepatology

Background: Nowadays, there has been a growing emphasis on the topic of health equity, which refers to the fundamental principle of addressing and resolving disparities in health outcomes and the factors that influence them, such as social determinants. The pursuit of health equity entails a dedicated effort towards achieving the utmost level of health and wellbeing for every individual, while also paying particular attention to those who are most vulnerable to experiencing poor health due to their social circumstances. Purpose: This paper aimed to delve deeply into the concepts of health equity and disparities in healthcare from nursing perspectives, exploring various philosophies, theories, and ethical principles. Furthermore, it aimed to highlight the crucial role that nursing professionals play in promoting health equity and eradicating health disparities. Methods: A scoping review was conducted to identify relevant international reports and literature published in English, multiple electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, MEDLINE, Google Scholar, SAGE Journals, and PubMed were searched. Results: Nursing professionals have a significant role in achieving health equity and eliminating health disparities. Therefore, there has been a growing emphasis on the importance of achieving health equity, enhancing caring and healing connections as the core of professional nursing, alongside the use of theory-guided practice approaches, and nursing philosophies. Consequently, professionals in the field are actively seeking more practical methods that incorporate a sense of purpose and significance into their work to achieve equity based on essential nursing philosophies and theories. Conclusion: Nurses have a unique and advantageous role in the healthcare system, as they have the ability to make a substantial impact on addressing the underlying factors that contribute to health disparities. Furthermore, nurses work closely with interdisciplinary teams, harnessing the power of collaboration and teamwork to effectively implement a range of strategies aimed at promoting fair and equal access to healthcare for all individuals. Implications for Nursing: Nursing professionals have a crucial role in promoting and maintaining health equity, which has been increasingly recognized and emphasized. In addition, they are in a unique position to lead the way in patient care and can make a significant impact in addressing the underlying causes of health disparities by understanding and acknowledging the various factors that influence a person's health and overall well-being. Keywords: Nursing philosophy, Nursing theories, Ethic principles, Health equity, Health disparities.

Services for children with speech and language needs in England and Wales are in a period of change. The context is subject to major systemic pressures deriving from government policies. These include the development of inclusive education and encouragement of multiprofessional collaboration in policy development and practice ('joined up thinking'). In addition, structures at local level are changing with the establishment of unitary authorities and the change from Health Trusts to Primary Care Trusts. Professional practice is also changing with a shift from clinical to community settings for speech and language therapists working with children. The present study reports on a survey sponsored by the Department for Education and Employment, Department of Health and the Welsh Assembly to identify the nature of speech and language therapy (SLT) services provided to education in England and Wales. The sample comprised all SLT service managers (n = 133, response rate 74%). The results indicate that services vary greatly in size and in their SLT: child ratio, with a mean of one SLT to 4257 child population. The caseload was highest for the 5-10 age group, and service delivery was targeted at these children, with low levels of work with secondary aged pupils. Most provision in educational settings was made to mainstream schools, but the provision of SLT time per child was substantially higher in specialist language resources. Apart from the preschool phase, most SLT provision was for children with statements of special educational needs. Prioritization of service delivery was usually by severity of need. The provision of bilingual SLT services was very limited, with only 14.0 full-time equivalents SLTs fluent in a community language, other than Welsh, where proportionately availability was much greater. Most LEAs funded SLT posts, although these were usually employed as part of the SLT service, with only about 10% of LEAs employing SLTs direct. However, 55.5% of SLT managers reported that recruitment and retention were problematic, resulting in gaps in the service. These findings are discussed with respect to changes driven by professional judgements on the nature of optimal service delivery, and government policy, with particular reference to inclusion and equity of service delivery.

Forum Introduction: Promoting Equity in Speech-Language Services With Indigenous Children.

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia. To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs' perspectives on what makes for a positive patient experience. Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment. A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience. This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery. What is already known on the subject There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs' experience of delivering telehealth assessments to PWA. What this paper adds to existing knowledge This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided. What are the potential or actual clinical implications of this work? Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

Twenty-six years ago, Secretary of the U.S. Department of Health and Human Services Margaret M. Heckler called for an end to health disparities among minority populations across the nation.1 Since then, the U.S. government has introduced various initiatives to reduce health disparities among our nation's most marginalized populations. Despite these efforts, health disparities persist. As attempts to reduce health disparities continue, there have been major advances in the theory and research surrounding these challenges. One key development has been the renewed acknowledgment of the larger social context in contributing to the enduring gaps in health seen across vulnerable and disadvantaged groups. This notion is not brand new; in the 19th century, it was understood that the social and physical environment affected health. In 1848, Virchow concluded that poor sanitation, ignorance of basic hygiene, lack of education, and near starvation were the root problems of a typhus epidemic, and in 1855, Snow described the effects of contaminated water on spreading cholera.2,3 As this knowledge has evolved, one approach has emerged: reducing health disparities by addressing the social determinants of health (SDH). The term “social determinants of health” refers to the complex, integrated, and overlapping social structures and economic systems that include social and physical environments and health services. Adequately addressing the social and economic conditions in which people live, work, and play offers renewed hope to reduce health disparities and promote health equity.4 In 2010, the Centers for Disease Control and Prevention (CDC) hosted a symposium entitled “Establishing a Holistic Framework to Reduce Inequities in Human Immunodeficiency Virus (HIV), Viral Hepatitis, Sexually Transmitted Diseases (STDs), and Tuberculosis (TB) in the United States.” The purpose of the symposium was twofold: first, we celebrated the release of a white paper of the same name,5 and second, we offered exciting and engaging discussions with national experts on topics related to addressing SDH in public health practice, policy, and research. The day also included a frank discussion with senior staff members of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and three invited speakers: Paula Braveman, MD, MPH, of the University of California, San Francisco; Scott Burris, JD, of Temple University in Philadelphia, Pennsylvania; and Johnnie “Chip” Allen, MPH, of the Ohio Department of Health in Columbus, Ohio. The discussion focused on how NCHHSTP can further incorporate an SDH approach into its work. At the start of the discussion, a number of questions and challenges were posed: How does NCHHSTP convince others that achieving health equity in the U.S. should be a public health priority? In light of the fact that resources have been declining, how do we adequately address SDH? How do we address SDH in an era with increased negativity toward groups disproportionately impacted by infectious diseases (e.g., men who have sex with men, Hispanic/Latino people, and immigrants)? As NCHHSTP is a leader in infectious disease prevention, what activities should we initiate to address both SDH and their role in HIV, hepatitis, STD, and TB prevention? What changes to our surveillance and data-collection systems should we make to measure, monitor, and collect information on SDH? How do we incorporate laws into public health surveillance research? How does synergy in programs impact the individual? How do laws fit into this? Where do we begin our focus? What is the starting point? What SDH-related variables should be a priority for annual monitoring? These questions were an important starting point to better identify CDC's role in achieving health equity. This session also reiterated the need for CDC to take the lead in reducing health disparities and promoting health equity in the U.S. and abroad.