Future of Nursing 2020-2030

Increasing the Focus of Nursing and Health Care on Equity and Discrimination

Jack Needleman, PhD, FAAN


Nurs Econ. 2021;39(4):196-199. 

In This Article

Abstract and Introduction


The Future of Nursing 2020–2030 report responds to the heightened recognition of systemic racism and discrimination based on ethnicity, gender, and class; the impact of these systemic problems on health and access to health services; and the need for the nursing profession to be deeply involved in addressing these problems.


In May 2021, the National Academies of Sciences, Engineering, and Medicine released The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity. This consensus study from the Committee on the Future of Nursing, 2020–2030, co-chaired by Mary Wakefield and David R. Williams, builds on earlier work conducted by the National Academy of Medicine and its predecessor, the Institute of Medicine, to study the potential role of nurses in advancing health and health care and the action needed to realize this potential. The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2011) and 2016 report assessing progress on the 2011 goals (National Academies of Sciences Engineering and Medicine [National Academies], 2016) focused on identifying expanded roles for nurses and the actions needed to build capacity for nurses to become engaged in and prepare for those roles.

The new report asks, "to what end?" and targets activities and roles for nurses in addressing equity in health care and disparities in outcomes, care, and the upstream sources of disparities. The focus on inequality and equity reflects the increasing attention the National Academy of Medicine has given to health equity and social determinants of health (SDOH), and the Robert Wood Johnson Foundation's agenda to create a culture of health that provides everyone a "fair and just opportunity for health and well-being," a plan that has equity at its center (National Academies, 2021, p. 128).

The report embraces a shift from focusing on disparities as circumstances requiring downstream remediation to having causes that require upstream intervention. It identifies inequities in housing, employment, education, and other precursors to health due to systemic racism and discrimination. It flags inequities associated with socioeconomic status, disability, poverty, limited access to health services, and race, attributing all to systemic and structural causes, not simply individual animus. The report embraces a vision for health systems and healthcare providers to move upstream, to consider how to intervene not just with the patient who presents in the waiting room and while they are in the office or facility, but outside the traditional framework of healthcare delivery, both to prevent illness and disease and treat patients with full consideration of their circumstances.