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2 references each response  Healthcare policy class replies:  Respond to the four colleagues by supporting or expanding on the ideas identified by

2 references each response 

Healthcare policy class replies:

 Respond to the four colleagues by supporting or expanding on the ideas identified by your colleague or sharing additional perspectives on the issue described by your colleague. Include 2 reference each response; APA format


According to Pizzol et al. (2023), individuals with serious mental illness experience a life expectancy that is 10 to 25 years shorter than the general population, mainly due to preventable physical health conditions and disparities in healthcare access. As a mental health nurse, I have observed firsthand how political determinants of health contribute to these disparities, particularly among my patients with serious mental illness. The Allegory of the Orchard illustrates how policies and systemic factors create barriers for underserved populations, such as those with mental illness, exacerbating their health outcomes. Fry (2021) highlights how disparities in Medicaid policies across states directly impact access to mental health services for individuals with serious mental illness. In states with more restrictive Medicaid eligibility criteria, patients are less likely to receive adequate mental health treatment, leading to poorer health outcomes and increased healthcare costs in the long term (Fry, 2021).

Moreover, the lack of integration between mental health and primary care services due to fragmented healthcare policies further perpetuates disparities. Studies have shown that individuals with serious mental illness are more likely to experience chronic physical health conditions such as diabetes and cardiovascular diseases. Yet, they often face challenges accessing coordinated care (Zabeen et al., 2021). This fragmented system not only hinders the management of comorbidities but also contributes to higher rates of preventable hospitalizations and mortality among this population. Addressing these political determinants of health requires advocacy efforts aimed at policy changes that promote equity and access to integrated care. For example, initiatives advocating for Medicaid expansion and integrating mental health services into primary care settings have shown promising results in improving health outcomes for individuals with serious mental illness (Isaacs & Mitchell, 2024). As a mental health nurse, I actively engage in policy advocacy by participating in professional organizations, collaborating with interdisciplinary teams, and advocating for evidence-based policies that prioritize the holistic needs of my patients.

Why are you, as a nurse, the right person to become politically involved in addressing these determinants?

As a nurse, I am the right person to become politically involved in addressing the determinants of health because of my unique position at the frontline of patient care. Through my daily interactions with patients, I witness the direct impact of political decisions on their health outcomes. For example, when a patient with a mental illness cannot afford their medication due to changes in healthcare policies, I see firsthand how this affects their well-being and ability to manage their condition effectively. Additionally, my training equips me with the knowledge and skills to critically analyze healthcare policies and advocate for changes that prioritize patient needs. For instance, during policy discussions, I can provide insights into how specific regulations may impede access to healthcare for vulnerable populations, drawing from my experiences working with diverse patients in various healthcare settings.

Furthermore, as a healthcare team member, I collaborate closely with other professionals to ensure comprehensive and patient-centered care. This interdisciplinary approach allows me to leverage my nursing expertise to advocate for policies that promote health equity and address social determinants of health. For instance, I may work alongside social workers to advocate for affordable housing policies that can improve the living conditions of patients experiencing homelessness, thereby addressing a significant determinant of their health. Additionally, my involvement in professional organizations and community outreach programs provides me with opportunities to amplify the voices of marginalized populations and advocate for policies that address their unique needs.


Homelessness is an increasing issue in our country and around the world. According to Rukmana, 2020 (In 2020, 1.6 billion people worldwide were without access to adequate housing, with global rates of homelessness increasing over the preceding decade). The circumstances leading to homelessness are often complicated, with both structural and individual causes as the identified reasons. Structural factors stem from poverty, incarceration, and insufficient access to secure employment, affordable housing, and income support. In comparison to individual causes which often include chronic physical and mental health problems, substance use, domestic and family violence, childhood trauma, and relationship breakdown. (Chowkwanyun & Reed, 2020).

     There are two main types of city-level homelessness data collection methods (intercity data and intracity data) that state and local entities often use for homelessness studies in the United States, making it harder for municipalities to find effective solutions to address the issues that this population of citizens faces in society. Intercity homelessness data is typically collected through cross-sectional surveys to estimate the number of people experiencing homelessness in each city or metropolitan area, while intracity homelessness data are collected through prior address information reported by people experiencing homelessness within a city’s district. This method can result in underreporting and lack of federal, state, and local funding to support programs to reduce homelessness.

     By comparing data on homelessness between and within cities, we can learn more about the strengths and weaknesses of each data type to find the reasons for homelessness and the factors that increase the risk of homelessness. Data on homelessness in cities look at how policy and institutional variables and community-level variables that change between cities affect how common homelessness is. Data on homelessness within cities look at how the variation of demographic, socioeconomic, housing, and other neighborhood factors within a city that has the same policy, and institutional variables influence how often homelessness occurs. 



 Why are you, as a nurse, the right person to become politically involved in addressing these determinants?

     Nurses have a unique perspective and set of skills that make them well-suited to addressing complex social issues like homelessness. Nurses with advanced degrees, such as a DNP, have the education and training to understand complex healthcare systems, leadership skills and knowledge base to address social change on a frontline level. By leveraging their clinical expertise, understanding of patient needs, and ability to navigate healthcare systems, nurses can play a pivotal role in shaping policies and programs that aim to reduce homelessness and improve the health outcomes of this vulnerable population. Their involvement in political advocacy can help ensure that the voices of the homeless are heard and that practical, compassionate solutions are implemented.

     Nursing organizations and regulators should train and support nurses to be policymakers instead of implementers and fight for the fair representation of nurses at policy making platforms. The main obstacles were power relations within and between professions, the exclusion of nurses from policy making, and specific nursing challenges (Lee, 2019). Those nurses who participate in policy development should focus their efforts on health promotion at the street level to build healthcare service centers with advance practice nurses leading the way meet the unhoused communities where they are, this would empower nurses and the profession as a whole to a larger leadership role in the public health arena. 

     According to Nayna Schwerdtle et al., 2020 (Nurses are the group of healthcare professionals with the closest and most constant proximity to patients and are often exposed to danger and moral dilemmas, facing impossible choices in the context of overwhelming need amid resource constraints.) Nurses are uniquely placed to convene multi-disciplinary health professional teams for patient safety and wellbeing By refocusing attention to political systems organized around and perpetuating inequitable health outcomes, nurses and other health care professionals as well as those whom they serve can concentrate their effort and power to act on political determinants of health in bringing about more equitable health outcomes. 


The Allegory of the Orchard vividly illustrates how political factors influencing health led to disparities in health outcomes. This metaphor highlights the profound impact of systemic neglect and resource disparity on health outcomes. As a nurse, I witness the impact of these political factors, particularly on patients who are experiencing homelessness. This disadvantaged group faces challenges in attaining optimal health due to inadequate housing, healthcare, and social marginalization. Due to our extensive knowledge of patient requirements and the broader health issues inside the system, nurses are in a favorable position to advocate for policy reforms that specifically target these aspects.

Stable housing, a key health factor, is scarce for homeless people. Allegory of the Orchard shows how seeds (people) in poor or rocky soil (inadequate housing) struggle to flourish compared to those un nutrient-rich soil (Dawes, 2020). Homelessness increases stress and instability, which worsens chronic illnesses including diabetes, hypertension, and mental health issues (Roshan Baa, 2024). Lack of a stable address makes healthcare access difficult, delaying treatment and compromising health. Thus, improving homeless health requires addressing housing regulations to guarantee safe and affordable housing.

Political actions and lack of action contribute to the ongoing disparities in health among the homeless population. The farmer’s negligence symbolizes the lack of attention from the government towards underfunded and under supported housing and healthcare facilities for homeless individuals (Dawes, 2020). The exacerbation of these imbalances is caused by inadequate funding for affordable housing and reductions in social services. The act of criminalizing homelessness through the prohibition of sleeping in public or panhandling exacerbates the marginalization of this community and hampers their ability to receive aid (Borras, 2023). As a result, homeless individuals are vulnerable to health emergencies without access to the necessary support for achieving health equity.

Nurses may politically address these variables due to our position. We understand our patients’ health issues and can explain how policies influence them. Nurses must fight for social justice and health equality as a professional and ethical duty, according to the American Nurses Association (ANA, 2020). Nurses may influence legislation that addresses health inequalities by lobbying for affordable housing and homeless healthcare.

Nurses are trusted by the public, hold significant influence as agents of change. Our interactions with patients give us a deep understanding of their challenges, which enhances our influence in policy discussions. Promoting housing-first policies, which prioritize secure housing over other health issues, can improve the health outcomes of homeless individuals (Eide, 2020). Nurses may also advocate for preventive and mental health interventions to address the most crucial health requirements of this demographic.

The conclusion of The Allegory of the Orchard is that health outcomes are significantly influenced by political factors. Like seedlings in unfavorable soil, homeless individuals encounter challenges in attaining optimal health due to inadequate housing policies and healthcare accessibility. Nurses are well-positioned to advocate for legislation that addresses these disparities by leveraging our direct experiences and the public’s trust in us. Nurses’ advocacy for policy may contribute to the establishment of a healthcare system that is more equitable and enables all individuals to achieve their full health potential. 


The broader set of forces and systems shaping the social structures and policies that create an environment that favors some individuals to benefit from quality healthcare and hinders some from accessing quality healthcare and social justice has been in place since the foundation of the United States of America (Dawes, 2020). The allegory of the orchard illustrates the health history of the United States of America, and the impact political forces decisions have on individual health. The metaphor highlights the root cause of health inequities, which the tree represents the people or communities who reached their optimum health level and those who died prematurely or can barely hang on to life.

Through administrative powers and the distribution of resources, the government has created political determinants of health at the local, state, and federal levels that advance health inequities and health equities. This parallels the farmer who failed to recognize the value and potential of all his seeds or understand how his actions lead to the loss of his crops; the government has often failed to take ownership or is complicit in its action, resulting in healthcare disparities we see today. These political determinants have also shaped social drives such as lack of health literacy, inadequate transportation systems, housing instability, broken education, increased crime, and lack of food access, which have plagued our nation, especially the underserved population (Dawes, 2020). As a DNP-prepared nurse, understanding and addressing these political determinants is essential for developing actionable solutions to close the health gap and promote a more equitable future for all populations.

As a nurse, why are you the right person to become politically involved in addressing these determinants?

As a nurse, I am on the front line and have witnessed the adverse effects of these social and political determinants on patients.  As a DNP-prepared nurse with advanced leadership knowledge and extensive clinical skills, I can contribute to shaping policies that foster health equity and better patient outcomes by actively participating in policy decision-making in my workplace (Porche, 2023).

Furthermore, nurses provide direct care to the patient, understand the healthcare system, and have the collective potential to influence healthcare policy. I can join professional organizations in my state to advocate for policies that address critical issues such as access to care, a healthy environment, and equitable distribution of resources (ANA, 2020) and other similar organizations that provide platforms for nurses to engage in advocacy and policy-making that can lead to meaningful changes in the healthcare landscape.

I am committed to my patient’s well-being; my solid professional values, understanding of the holistic view of healthcare, powerful voice, strengths, and opportunities to make a difference in the healthcare system positioned me to be politically involved in addressing the political determinants of health. This can be accomplished by building a solid support network and connecting with my community to understand their needs and concerns, getting nurses involved in politics, and running for elected offices that enact laws that affect healthcare policy.

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