Political Determinants of Health: The Allegory of the Orchard
The political determinants of health reflect how different powers, governments, and policies that engulf systematic processes of structuring relationships, distributing resources, and administering power affect the people (Dawes & Gonzalez, 2023). The Allegory of the Orchard demonstrates the inequalities happening in our healthcare system. For instance, the gruesome threats from COVID-19, climate emergency, and mental health that have been ravaging underserved communities have proven that human and planetary health are at significant and growing risk and that public health has failed to find practical, effective, and meaningful responses to these threats (Freudenberg, 2022). Some individuals are regarded as top class and have access to quality care, whereas others are underserved.
Dawes illustrated the political determinants of health that communities encounter and how they affect health outcomes using the allegory of Orchard, an animated story about a farmer. In this story, the farmer represents the government, laws, and medical systems, which do not treat the trees equally or provide them with the same resources. The trees represent the diverse individuals, races, ethnicities, genders, and ages. The story draws attention to community inequalities and the significance of identifying, assessing, and resolving these social and political issues to promote equity and enhance well-being.
Political Determinants of Health: Negative Impact on Veterans
The political determinants of health have long-term adverse effects associated with most racial and ethnic health disparities, such as preventable mortality, mental health disorders, and cardiovascular problems (Velasquez et al., 2022). For the veteran population I serve, political determinants of health influenced by policies and resource allocation negatively affect access to care, economic instability, housing instability, and social support, ultimately leading to disparities in health and well-being in this group (Moler, 2023, November 2). Government policies that lead to cuts to social service programs can impact the availability of resources for veterans (Moler, 2023, November 2). Veterans receiving VHA services have lower socioeconomic resources, more complex medical conditions, and worse physical and mental health functioning (Duan-Porter et al., 2018).
The Role of Nurses in Policy Advocacy
Advocacy is one of the significant roles of nurses and the pillar of nursing (American Association of Colleges of Nursing, 2021). Nurses have the closest proximity to patients, directly experience the effect of these determinants on patients, and are well-equipped to advocate for changes to improve outcomes. Advanced practice nurses need to advocate for these underserved by developing deep knowledge and understanding of the politics of population health management, from a macro- and microlevel, and how this systematic process operates and evolves to the benefit or detriment of population groups (Dawes & Gonzalez, 2023).
In conclusion, the Allegory of the Orchard demonstrates how disparities in opportunities and resources can result in various health outcomes. The underserved population suffers complex health issues and faces a high mortality rate, like the trees that received poor treatment. Therefore, it is crucial that as DNP-prepared nurses, we are involved in policymaking to ensure that political determinants of health are addressed and everyone has equal opportunity to achieve optimal care and services.
References
American Association of Colleges of Nursing (2021). The essentials: Core competencies for professional nursing education. AACN. https://www.
Duan-Porter, W., Martinson, B. C., Greer, N., Taylor, B. C., Ullman, K., McKenzie, L., Rosebush, C., MacDonald, R., Falde, S., & Wilt, T. J. (2018). Evidence review-social determinants of health for veterans. Journal of General Internal Medicine, 33(10), 1785–1795. https://doi.org/10.
Dawes, D. E. (2020). The political determinants of health. Johns Hopkins University Press.
Velasquez, D.E., Figueroa, J.F. & Dawes, D.E. (2022). Health institutions and the political determinants of health. American Journal of Preventive Medicine. 63(5). 861–864. https://doi.org/10.
Dawes, D., & Gonzalez, J. (2023). The politics of population health. The Milbank Quarterly, 101(S1), 224–241. https://doi.
Freudenberg N. (2022). Integrating social, political, and commercial determinants of health frameworks to advance public health in the twenty-first century. International Journal of Social Determinants of Health and Health Services. 53(1):4-10. https://doi.org/
Moler, R. (2023, November 2). VA promotes health equity through partnerships: Addressing social determinants of health. VA News. https://news.va.gov/
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The Allegory of the Orchard: Pain Management
The Allegory of the Orchard by Daniel Dawes showed how structural conditions not inherent differences create disparities in outcomes. Rather than focusing solely on the individual trees (people), the allegory emphasizes the importance of understanding and addressing the systemic inequalities in the environment that affect growth and opportunity. This narrative mirrors the real-world scenario where systemic policies and political decisions result in unequal access to healthcare resources; one particular example is in pain management. Patients from marginalized communities often find themselves in the less nourished parts of the orchard, receiving inadequate pain assessment and treatment due to entrenched biases and policy shortcomings (Dawes, 2020)
Political determinants such as legislation, institutional policies, and funding priorities significantly influence pain management practices. For instance, stringent regulations on opioid prescriptions, while aiming to curb misuse of it, have inadvertently led to the undertreatment of pain in certain populations. Moreover, lack of investment in pain management education and resources in underserved areas exacerbates these disparities. Studies have shown that Black patients are less likely to receive pain medication compared to their White counterparts, a disparity rooted not in clinical differences but in systemic biases and policy-driven resource allocation (Deb & Rodman, 2024).
As a nurse, I am uniquely positioned to address these disparities. Nurses often serve as the primary point of contact for patients, allowing us to observe firsthand the effects of policy decisions on patient care. Our role extends beyond bedside care; we are advocates for our patients, equipped with the knowledge and ethical responsibility to challenge and influence policies that hinder equitable pain management. The American Nurses Association emphasizes the nurse‘s role in advocating for policies that ensure access to effective pain management modalities (ANA, 2019).
Engaging in political advocacy involves participating in policy development, joining professional organizations, and educating policymakers about the real-world implications of their decisions. By sharing patient stories and clinical experiences, nurses can humanize the data, making a compelling case for policy reforms that promote equitable pain management. Furthermore, involvement in research and evidence-based practice initiatives can provide the data necessary to support policy changes.
In conclusion, the disparities in pain management are not merely clinical issues but are deeply rooted in political determinants of health. The Allegory of the Orchard illustrates the profound impact of systemic inequities on health outcomes. As nurses, our proximity to patient experiences and our ethical commitment to equitable care position us as powerful advocates for change. By engaging in political advocacy, we can work towards a healthcare system where all patients, regardless of their background, receive appropriate and effective pain management.
References
American Nurses Association. (2019). The ethical responsibility to manage pain and the suffering it causes [Position statement]. OJIN: The Online Journal of Issues in Nursing, 24(1). https://doi.
Dawes, D. E. (2020). The political determinants of health. Johns Hopkins University Press.
Deb, B., & Rodman, A. (2024). Racial Differences in Pain Assessment and False Beliefs About Race in AI Models. JAMA network open, 7(10), e2437977. https://doi.org/10.
