Healthcare Policy and Analysis Discussion
Read a selection of your colleagues’ posts. Respond to at least two of your colleagues by supporting or expanding on the ideas identified by your colleague or sharing additional perspectives on the issue described by your colleague.
PEER 1
TF
Nov 27 3:49pm
Manage Discussion by Tiffany Fields
Reply from Tiffany Fields
Initial Post
The allegory of the orchard, as presented by Daniel E. Dawes (Satcher Health Leadership Institute, 2021), illustrates how political determinants of health create structural inequities that impact health outcomes across populations. This metaphor highlights an orchard where some trees thrive in favorable conditions while others struggle under systemic disadvantages. These disparities mirror the challenges faced by many of my patients, particularly underserved populations such as low-income individuals, the mental health population and ethnic minorities.
For instance, many of my patients experience limited access to affordable healthcare, healthy food options, and safe housing—factors shaped by political decisions like zoning laws, funding for social services, and healthcare policies. These political determinants create barriers that perpetuate poor health outcomes, such as increased rates of chronic diseases and preventable hospitalizations. Dawes (2020) emphasizes that these systemic inequities arise from historical and ongoing policy decisions that prioritize certain groups over others, leading to what he describes as a cycle of disadvantage (pp. 56–58).
As a nurse, I am uniquely positioned to address these political determinants of health. Nurses interact directly with patients and witness firsthand the health disparities resulting from structural inequities. This frontline perspective allows us to provide evidence-based insights to policymakers and advocate for equitable health policies. Porche (2023) underscores the importance of nurses as healthcare advocates who can influence policies to improve system-level health outcomes (p. 10). The American Nurses Association (ANA) also identifies advocacy as a core responsibility, aligning with our professional commitment to promote health equity.
Advocacy might involve joining coalitions, attending legislative hearings, or writing to elected officials. For example, advocating for expanded Medicaid coverage or increased funding for community health programs can directly mitigate barriers underserved populations face. Porche (2023) also highlights that understanding healthcare systems (pp. 81–83) empowers nurses to identify leverage points for change. By engaging politically, we can address upstream factors influencing health outcomes, striving for an orchard where all trees can thrive.
The allegory of the orchard challenges us to examine and dismantle the policies and structures perpetuating inequities. As trusted professionals and patient advocates, nurses are vital in ensuring that the systemic conditions contributing to poor health outcomes are addressed at their roots. By stepping into the political arena, we can work toward a more equitable healthcare system that provides all patients with the resources and opportunities to achieve optimal health.