Community-based participatory research
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Community-based participatory research (CBPR) is a method that integrates research with social action (Masuda, Poland, & Baxter, 2010). It is an effective way to build community capacity, as the method functions to transform power structures to create knowledge and promote actions for social change through community engagement. CBPR has been successfully implemented to expose power inequities in disadvantaged communities. This strategy enables community voices to be heard. Wallerstein and Duran (2010) have identified barriers to implementing CBPR and strategies to address these barriers.
policy advocacy
The socioeconomic and structural gradients in this country and their relationship to differences in health mandate that policies be created to address the social determinants of health inequities (Braverman, Cubbin, Egerter, Williams, & Pamuk, 2010). Canada, England, and Australia are considered leaders in implementing health-promoting public policies through legislation, fiscal measures, taxation, and organizational change (Raphael, 2011b).
Public policies influence the prerequisites of health in three key areas: early childhood development, employment, and income (Raphael, 2011a). Public policies to address these key areas have all been associated with lower rates of poverty and income inequities, Notably, the United States has the second lowest percentage of gross domestic product expenditures allocated in the form of public expenditures and the highest poverty rates in families and children among 21 selected countries (Raphael, 2011a). These rankings point to the need for policy to shift from a focus on individual health risk behaviors to the redistribution of economic resources to promote a healthy society for all.
Nurses and all other health professionals need to become knowledgeable about the political economy of health and public policy analysis to be able to advocate for health policies that promote healthy communities and equitable socioeconomic conditions. In com- munity settings, nurses may become spokespersons for the poor in order for their voices to be heard. At the individual level, strategies to alleviate poverty include helping families obtain available benefits, providing information about available services and how to access them, targeting those in greatest need, teaching skills, and partnering individuals with community agencies to provide additional supports (Cohen & Reutter, 2007). At the community level, empowerment strategies promote community dialogue between community members, CBOs, and persons in positions to influence policies. Nurses can also work with their professional associations to place the elimination of health inequities on their agendas for action. Membership in organizations that promote agendas to reduce health inequities is another avenue for action. Political competence can be developed through courses and dia- logues with knowledgeable others. Working in collaboration with all stakeholders enables nurses to raise awareness of health inequities, advocate for change, and take action, such as lobbying to promote change.
primary Care
Primary care offers an effective mechanism for achieving health equity, as interventions are directed at individuals versus diseases. Primary care was established as a framework for health in the 1960s with the World Health Organization Declaration of Alma-Ata. It includes first contact and continuous, coordinated, decentralized care to address health promotion and disease prevention. Primary care is complex and requires community engagement and respect for individual and family viewpoints. It is an efficient, rational way to provide care for all people.
Investments in a primary care infrastructure have been shown to impact health equity. Pri- mary care services in community health centers can reach socially disadvantaged, racial/ethnic minorities and isolated groups. Nurses are leading primary health care interdisciplinary teams and conducting community-based initiatives to promote community participation in health, provide health care and education, and advocate for communities. Primary care continues to increase in value with the passage of the Affordable Care Act, and nurses play a major role in promoting behavior change as primary care providers.