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Research Article|Articles in Press, 101913

Promoting health equity with HBCUs: Breaking away from structural racism

Published:January 21, 2023DOI:https://doi.org/10.1016/j.outlook.2022.101913

      Highlights

      • Major disparities in health outcomes persist
      • Structural racism undermines efforts to advance health equity
      • Prioritizing the need for racial and ethnic diversity among nursing leaders
      • Reconciling funding inequities at Historically Black Colleges and Universities
      • Sustainable partnerships that benefit communities that are under-resourced

      Abstract

      Background

      The United States continues to be plagued with pervasive health disparities. Leading health and professional organizations acknowledge structural racism as a contributing factor for the lack of a racially diverse nursing workforce particularly those serving in leadership roles which could help to mitigate health disparities among historically stigmatized populations.

      Purpose

      Purpose Lack of funding for Historically Black Colleges and Universities (HBCUs) and lack of meaningful partnerships, stymie efforts that can be made by nursing programs at HBCUs.

      Discussion

      Discussion This position paper examines collaborative actions that can address upstream factors that perpetuate healthcare disparities through deep engagement between the policymakers, professional associations, industry, and educational institutions.

      Methods

      Faculty representing HBCU's and predominately White institutions, professional organizations, and staff met via videoconference to refine the focus of the paper, determine topic areas for writing teams, and refine details which occurred during weekly meetings.

      Conclusion

      To disengage from structural racism, three critical recommendations are amplified with associated examples.

      Keywords

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      References

        • Adams S.
        • Tucker H.
        For HBCUs cheated out of billions, bomb threats are the latest indignity.
        Forbes. 2022; (Retrieved from)
      1. American Association of Colleges of Nursing. (2019). Enhancing diversity in the nursing workforce. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/Enhancing-Diversity. Access date May 2022.

        • Bailey Z.D.
        • Krieger N.
        • Agénor M.
        • Graves J.
        • Linos N.
        • Bassett M.T.
        Structural racism and health inequities in the USA: Evidence and interventions.
        Lancet. 2017; 389: 1453-1463
        • Barr T.
        • Malloch K.
        • Ackerman M.
        • Raderstorf T.
        • Melnyk B.
        A blueprint for nursing innovation centers.
        Nursing Outlook. 2021; 69: 969-981https://doi.org/10.1016/j.outlook.2021.05.006
        • Beard K.V.
        • Julion W.A.
        Does race still matter in nursing? The narratives of African American nursing faculty members.
        Nursing Outlook,. 2016; 64: 583-596
        • Bracey E.N.
        The significance of historically black colleges and universities (HBCUs) in the 21st century: Will such institutions of higher learning survive?.
        The American Journal of Economics and Sociology. 2017; 76: 670-696https://doi.org/10.1111/ajes.12191
        • Broady K.
        • Perry A.
        • Romer C.
        Underfunding HBCUs leads to an underrepresentation of Black faculty.
        Brookings. 2021; (Retrieved from)
        • Brooks K.J.
        Black colleges were denied state funding for decades. Now they're fighting back.
        CBS News. 2021; (Retrieved from)
        • Broome M.
        • Bowersox S.
        • Relf M.
        A new funding model for nursing education through business development initiatives.
        Journal of Professional Nursing. 2018; 34: 97-102https://doi.org/10.1016/j.profnurs.2017.10.003
      2. Centers for Disease Control and Prevention. (2022). Pregnancy-related deaths in the United States. Retrieved from https://www.cdc.gov/hearher/pregnancy-related-deaths/index.html

        • Clark K.
        Why black colleges might be the best bargains.
        US News and World Report. 2009; (Retrieved from)
      3. Commonwealth of Pennsylvania. (2021). Department of state: Bureau of professional and occupational affairs. Retrieved from https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/DocumentsBoard/20Minutes/072121-State-Board-of-Nursing-Minutes-Final.pdf. Access date May 2022.

        • Dobalian A.
        • Bowman C.C.
        • Wyte-Lake T.
        • Pearson M.L.
        • Dougherty M.B.
        • Needleman J.
        The critical elements of effective academic-practice partnerships: A framework derived from the department of veterans affairs nursing academy.
        BMC Nursing. 2014; 13: 1-31https://doi.org/10.1186/s12912-014-0036-8
        • Freeman K.E.
        • Winston-Proctor C.E.
        • Gangloff-Bailey F.
        • Jones J.M.
        Racial identity-rooted academic motivation of first-year African American students majoring in STEM at an HBCU.
        Frontiers in Psychology. 2021; 12 (Retrieved from)
        • Gasman M.
        Giving spare change and love to historically black colleges and universities.
        Forbes. 2021; (Retrieved from)
        • Gasman M.
        • Regla-Vargas A.
        • Sandoval C.
        • Samayoa A.C.
        • Nguyen T.H
        Contributions of historically black colleges and universities to the production of black nurses.
        Journal of Nursing Education. 2020; 59: 76-82https://doi.org/10.3928/01484834-20200122-04
        • Goeppinger J.
        • Shandor Miles M
        • Weaver W.
        • Campbell L.
        • Roland E.J.
        Building nursing research capacity to address health disparities: Engaging minority baccalaureate and master's students.
        Nursing Outlook. 2009; 57: 158-165https://doi.org/10.1016/j.outlook.2009.01.005
        • Gray L.
        • Triplett K.
        • Bowman L.
        • Richardson N.
        • Gray V.
        • Rainey-Brown S.
        • Johnson G.
        Historically black colleges and universities (HBCUs) in the twenty first century: An exploratory case study analysis of their mission.
        Race, Gender & Class. 2017; 24: 44-67
        • Hardeman R.R.
        • Medina E.M.
        • Boyd R.W.
        Stolen breaths.
        New England Journal of Medicine. 2020; 383 (Retrieved from): 197-199
        • Harper D.
        • Moore R.
        • Cleveland C.
        • Miltner R.
        • Froelich K.
        • McGuinness T.
        • Selleck S.
        Transforming veterans health care through academic-practice partnerships.
        Nursing Outlook. 2016; 64: 424-430
        • Hegji A.
        Programs for minority-serving institutions under the higher education act.
        Congressional Research Service. 2017; (Retrieved from)
        • Hine D.C.
        Black women in white: Racial conflict and cooperation in the nursing profession 1890-1950.
        Indiana University Press, Bloomington1989
        • Hoffman K.M.
        • Trawalter S.
        • Axt J.R.
        • Oliver M.N.
        Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.
        PNAS. 2016; 113: 4296-4301
        • Huang N.
        Howard University and NYU form academic partnership.
        Washington Square News, 2021 (Retrieved from)
        • Independence Blue Cross Foundation
        Nurses for Tomorrow. 2022; (Retrieved from)
        • Krisberg K.
        Addressing health equity through state, regional partnerships.
        The Nation's Health. 2018; (Retrieved from): S1-S2
        • Lee J.M.
        • Keys S.W.
        Land-grant but unequal: State one-to-one match funding for 1890 land-grant universities.
        Association of Public Land-Grant Universities. Washington, DC, 2013 (Retrieved from)
      4. Legal Information Institute. (1986). 20 U.S. code § 1060: Findings and purposes. Cornell Law School. Retrieved from https://www.law.cornell.edu/uscode/text/20/1060. Access date May 2022.

        • Nair L.
        • Adetayo O.A.
        Cultural competence and ethnic diversity in healthcare.
        Plastic and Reconstructive Surgery. 2019; 7: e 2219
        • Nardi D.
        • Waite R.
        • Nowak M
        • Hatcher B.
        • Stacciarini J.
        • Hines-Martin V.
        Achieving health equity through eradicating structural racism in the U.S: A call to action for nursing leadership.
        Journal of Nursing Scholarship. 2020; 52: 696-704
        • National Academies of Sciences, Engineering, and Medicine
        The future of nursing 2020-2030. Charting a path to achieve health equity.
        The National Academies Press, 2021https://doi.org/10.17226/25982
      5. National Institutes of Health. (2022). Ending structural racism. Retrieved from https://www.nih.gov/ending-structural-racism

      6. National Institutes of Health. (2021). Historically Black colleges and universities (HBCUs) virtual listening session #1. Retrieved from https://www.nih.gov/ending-structural-racism/historically-black-colleges-universities-hbcus-virtual-listening-session-1. Access date May 2022.

      7. National Institute on Minority Health and Health Disparities. (2022). Structural racism and discrimination: Ending structural racism. Retrieved from https://www.nimhd.nih.gov/resources/understanding-health-disparities/srd.html

      8. National League for Nursing. (2017). Faculty census survey: Disposition of full-time nurse educators by race-ethnicity. Retrieved from http://www.nln.org/docs/default-source/default-document-library/disposition-of-full-time-nurse-educators-by-race-ethnicity-2017.pdf?sfvrsn=0.

      9. National Commission to Address Racism in Nursing. (2022). Racism in nursing. Retrieved from https://www.nursingworld.org/∼49c4d0/globalassets/practiceandpolicy/workforce/commission-to-address-racism/racism-in-nursing-report-series.pdfhttps://www.nursingworld.org/~49c4d0/globalassets/practiceandpolicy/workforce/commission-to-address-racism/racism-in-nursing-report-series.pdf.

        • Padilla B.
        • Evans-Krieder K.
        The added value of clinical faculty in building effective academic–practice partnerships.
        Journal of the American Association of Nurse Practitioners. 2022; 34: 242-246https://doi.org/10.1097/JXX.0000000000000644
        • Patil V.
        From patriarchy to intersectionality: A transnational feminist assessment of how far we've really come.
        Journal of Women in Culture and Society. 2013; 38: 847-867https://doi.org/10.1086/669560
        • Patterson C.E.
        Health advocacy at historically black colleges and universities as social activism.
        Phylon. 2021; 58 (Retrieved from): 21-38
        • Persaud S.
        Addressing unconscious bias.
        Nursing Administration Quarterly. 2019; 43: 130-137https://doi.org/10.1097/NAQ.0000000000000348
        • Phillips J.M.
        • Malone B.
        Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity.
        Public Health Reports. 2014; 129: 45-50https://doi.org/10.1177/2F00333549141291S209
        • Redd K.E.
        Historically black colleges and universities: Making a comeback.
        New Directions for Higher Education. 1998; 1998: 33-43
        • Robertson B.
        • McDermott C.
        • Star J.
        • Clevenger C.
        The academic-practice partnership.
        Nursing Administration Quarterly. 2021; 45: E1-E11https://doi.org/10.1097/NAQ.0000000000000487
        • Roeder A.
        Zip code better predictor of health than genetic code.
        Harvard T. H. Chan School of Public Health. 2014; (Retrieved from)
        • Russell P.G.
        New Carnegie classifications will elevate colleges promoting equity and social mobility.
        Higher Ed Dive. 2022; (Retrieved from)
      10. Sabin, J.A. (2020). How we fail black patients in pain. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news-insights/how-we-fail-black-patients-pain. Access date May 2022.

      11. Smedley, B.D., Stith, A.Y. & Nelson, A.R. (Eds.). (2003). Unequal treatment: Confrontingracial and ethnic disparities in health care. National Academies Press. Washington, DC. Retrieved from https://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care

        • Smiley R.A.
        • Ruttinger C.
        • Oliveira C.M.
        • Hudson L.R.
        • Allgeyer R.
        • Reneau K.A.
        • Silvestre J.H.
        • Alexander M.
        The 2020 national nursing workforce survey.
        Journal of Nursing Regulation. 2021; 12: S1-S96
      12. Smith, D.A. (2021). Achieving financial equity and justice for HBCUs. The Century Foundation. Retrieved from https://tcf.org/content/report/achieving-financial-equity-justice-hbcus/. Access date May 2022.

      13. Smith, J. (2022). Out-of-state enrollment caps to increase for several North Carolina HBCUs beginning fall 2022. The Chronicle Retrieved from https://www.dukechronicle.com/article/2022/05/out-of-state-enrollment-caps-to-increase-for-several-north-carolina-historically-black-colleges-and-universities-fall-2022-nc-a-t-nccu-elizabeth-city-state#:∼:text=On%20April%207%2C%20they%20voted,will%20go%20up%20to%2050%25. Access date May 2022.

      14. Sullivan Commission. (2004). Missing persons: Minorities in the health professions. Retrieved from https://www.aacnnursing.org/Portals/42/News/Sullivan-Report.pdf. Access date May 2022.

      15. The White House. (2021). Fact sheet: The Biden-Harris administration's historic investments and support for historically black colleges and universities. Retrieved from https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/17/fact-sheet-the-biden-%E2%81%A0harris-administrations-historic-investments-and-support-for-historically-black-colleges-and-universities/. Access date May 2022.

      16. Toldson, I.A. & Pearson, D. (2019). Strategic priorities for historically black colleges and universities with teacher preparation programs. State Higher Education Executive Officers Association. Retrieved from https://files.eric.ed.gov/fulltext/ED603948.pdf. Access date May 2022.

        • Vespa J.
        • Medina L.
        • Armstrong D.M.
        Demographic turning points of the United States: Population projections for 2020 to 2060.
        United States Census Bureau. 2020; (Retrieved from)
        • Waite R.
        • Nardi D.
        Nursing colonialism in America: Implications for nursing leadership.
        Journal of Professional Nursing. 2019; 35: 18-25https://doi.org/10.1016/j.profnurs.2017.12.013
        • Williams K.L.
        • Davis B.L.
        Public and private investments and divestments in historically black colleges and universities.
        American Council on Education, Washington, DC2019 (Retrieved from)
      17. United States Department of Justice. (2002). Case summary: Ayers & United States v. Fordice. DOJ civil rights division case summary. U.S. Dept. of Justice. Washington DC. Retrieved from https://casetext.com/analysis/case-summary-ayers-united-states-v-fordice https://www.justice.gov/crt/case-summaries. Access date December 21, 2022.

      18. Wilkerson, I. (2020). Caste: The origins of our discontents. Random House Books. New York.