Healthy communities require groups of people working together in partnership toward shared goals. Concepts in population health challenge us to apply upstream thinking to build healthier communities. Building healthy communities certainly requires attention to explicit health indicators and also requires attention to many other health correlates. These correlates or determinants of health are readily available on the Healthy People 2020 website. The categories of health determinants listed in Healthy People 2020 include policy making, social factors, health services, individual behaviors, biology and genetics. This list describes a very broad range of factors that affect the health of individuals and communities. Clearly, health is a complex matrix!
The Robert Wood Johnson Foundation is promoting its vision of healthy communities in its Culture of Health framework. The framework focuses on 4 action areas: 1. Making health a shared value; 2. Fostering cross-sector collaboration; 3. Creating healthier, more equitable communities; and 4. Strengthening integration of health services. These 4 action areas and their specific drivers work in combination to achieve “improved population health, well-being and equity.”
A very short list of components of healthy communities include:
- Easy access to healthcare services
- Available public transportation and roadways
- Access to healthy food choices
- Access to quality education
- Access to safe and healthy housing
- Safe parks and outdoor spaces
- Healthy recreation choices
- Access to social support services
- A sense of spirituality
- Freedom from crime
- A healthy natural environment
As nurse leaders, we are aware of these concepts and components as they relate to our patient groups. We know how important these components are in relation to the ability of our patients to be healthy, remain healthy, seek preventive healthcare and healthcare treatment. So how do the concepts of healthy communities relate to nurses’ roles in board governance?
Nurses on boards are in a unique position to focus boardroom discussions and decision making around the determinants of health that lead to and maintain healthier communities and healthier people. Even in organizations that are not specifically focused on healthcare, nurses can have influence over policies, processes, and goals that support health. For example, on youth development boards, nurses can use knowledge of age appropriate activities and health risks to shape decision making for programs. On sports boards, nurses can help frame discussions around risk management policies. Nurses can shape nutrition policies on school boards. Nurses can ensure that transportation committees focus on providing access to vulnerable populations. On community advisory boards, nurses can use their knowledge to promote safe outdoor spaces and access to healthy food choices. In the healthcare environment, nurses can influence governance decision making that places individuals and communities at the center of the mission and goals of the organization. These are but a few examples.
Board leadership for nurses is an extension of nurses’ commitment to health and social justice (Sundean & Polifroni, 2016). Nursing knowledge is a key component of boardrooom discussions and decision making that affect the health of individuals and communities. In combination with board directors from other sectors, nurses help comprise the multi-sector stakeholder board groups that govern on behalf of organizations and communities they serve. Nurses’ board role is to ensure that decisions reflect the best interests of stakeholders that will lead to healthier communities and healthier people who live in those communities.
The concept of nurses on boards, at first glance, seems like a wandering from nursing. However, the metaparadigm of nursing tells us that nursing is essentially about nurse-environment-person-health (Fawcett, 1984). Advocating for programs, policies, processes, and structures that promote healthier communities is unequivocally a leadership role for nurses. It is incumbent on nurses to embrace the leadership role of nurses on boards along the continuum of our core role as health advocates. Nurse board leadership is not about straying from nursing, it is about leading communities toward population health as described by Healthy People 2020 and the Robert Wood Johnson Foundation Culture of Health framework. Advocating for health is a fundamental role for nurses whether at the bedside or in the boardroom. The power of the nursing voice in the boardroom is key for transformational change in healthcare and for building healthier communities.