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The Allegory of the Orchard and the Political Determinants of Health
In Dawe's (2020) article titled The Allegory of the Orchard, he tells the story of a farmer with land that has soil of varying quality. He planted seeds all over the farm. However, he favored the seeds planted in the rich soil. As a result, only the plants in that section of the farm bloomed and flourished. This story depicts how political determinants of health influence the health outcomes of the people. In a nutshell, political determinants of health pertain to policies, decisions, and actions taken by government leaders that, in turn, impact people's health outcomes (Dawes, 2020). Just like the farmer, there are instances when these leaders would make decisions and laws that favor one group over the other, thereby creating a disparity in the allocation of vital health resources. This imbalance often results in poor health outcomes for the unfavored group (Lawson, 2020).
The disparity in Dawe's story is mirrored among patients who belong to the ethnic minority. Certain political decisions and health policies have resulted in a lack of funding and focus on factors that are vital to people's well-being, such as housing and education (Lawson, 2020). For instance, a lack of housing budget can cause homelessness, which puts people at risk of infectious diseases, mental health, and injuries (Garcia et al., 2024). The United States Department of the Treasury (2022) reported that the homeownership rate is higher among Whites (75%) compared to Hispanics (45%) and African Americans (48%). Meanwhile, a lack of education can result in poor awareness and knowledge about critical health information and healthy behaviors. These can prevent people from understanding complicated health information and making informed choices, which, in turn, contribute to poor health outcomes (Coughlin et al., 2020). Data from the National Center for Education Statistics (2024) showed that high school graduation rates are higher among Whites (90%) compared to Hispanics (83%) and African Americans (81%). Similarly, according to the American Council on Education (2022), White adults (52.9%) have greater chances of obtaining an associate or higher degree compared to African Americans (39%) and Hispanics (29.5%).
Aside from the lack of funding, certain political decisions have also been shown to exacerbate the lack of coverage and healthcare access among ethnic minorities. For example, in 2012, the Supreme Court ruled that Medicaid expansion should be optional for the states. This decision puts ethnic minorities at a losing end should their respective states decide not to expand Medicaid coverage to 138% of the federal poverty level (Escarce et al., 2022). This ruling will limit insurance coverage and access to healthcare among ethnic minorities who are experiencing poverty and unemployment (Escarce et al., 2022).
Addressing Political Determinants of Health
There are four reasons why nurses, especially those with a Doctor of Nursing Practice (DNP) degree, are in the best position to address political determinants of health (Haney, 2022). Firstly, DNP-prepared nurses are equipped with the skills and competencies needed to identify the root causes of political health determinants that exist in their communities. They know how to use tools to assess healthcare needs and gaps in the delivery of quality and safe care (Phillips, 2022). Secondly, their education also gives them the knowledge and ability to lead innovations and initiatives that can address the drivers of these political health determinants. They know how to apply various leadership skills in order to bring together key stakeholders that can help resolve the problem (Haney, 2022). DNP-prepared nurses have also been exposed to various healthcare policies as well as the policymaking process during their DNP education. This, in turn, gives them the confidence to lobby and advocate for policies that can help eliminate health disparities caused by political health determinants (Phillips, 2022). Lastly, DNP-prepared nurses were trained to effectively translate evidence into practice and lead quality improvement projects that aim to address health disparities, improve care delivery, and enhance patient outcomes (Tiase et al., 2022).