From devastating hurricanes to prolonged droughts to scorching heat waves, climate change wreaks havoc on the planet, with more severe impacts to come. As a nurse, you can expect climate change to affect your work if it hasn’t already. “Climate change,” notes the National League for Nursing (NLN), “currently impacts or will impact every aspect of nursing care.”
The NLN’s 15-page vision statement on climate change and health released in September 2022 “believes that the health consequences of climate change are among the most urgent public health and health equity crises of the 21st century. This statement addresses the importance of educating current and future nurses for climate change-informed practice and policy leadership.”
“Knowing that climate has so much to do with the health of the nation, and if we’re nurses who say we care about the nation’s health, then how can we not be about making sure that we understand climate, that our students are learning about the effects of climate,” says Beverly Malone, Ph.D., RN, FAAN, president and CEO of the NLN.
NLN Addresses the Education Gap
“The vision statement is essential because it addresses a gap in nursing education, where the adverse health effects of climate change are not well integrated into the nursing curricula at any educational level,” says Sandra Davis, Ph.D., DPM, ACNP-BC, FAANP, deputy director, NLN/Walden University College of Nursing Institute for Social Determinants of Health and Social Change.
Davis notes that in the climate change vision statement, the NLN wants to “address the importance of educating nurses on climate change-informed practice and educating them for policy leadership.” According to Malone, nursing schools are beginning to incorporate climate change into their curricula.
The vision statement is the most recent of 20 vision statements from the NLN. Each vision statement in the vision series, notes Davis, “is a living document that serves as a roadmap for navigating some of the most critical issues facing our world, facing healthcare and facing nursing education. Climate change in health is one of these critical issues.”
Five Focus Areas
The NLN vision statement discusses recommendations in five areas, with each providing strategic initiatives. They include strategic initiatives for:
National League for Nursing
Deans, directors, and chairs of nursing programs
Faculty
Policy and Advocacy
Nurses in practice
For instance, in the strategic initiative for faculty, “we want faculty to embed learning strategies related to climate change and planetary health into their didactic, clinical, and simulation experiences,” says Davis. Likewise, for practicing nurses, “we want every nurse in practice to become educated about the adverse health consequences of climate change and to be sure that they understand the concepts of mitigation, adaptation, and resilience.”
Aiding the Marginalized
“As with most other healthcare issues, the greatest burden rests on the marginalized communities, communities of color. The issues of diversity, equity, and inclusion raise their interesting head even in climate,” says Malone. “There are still those on the fringes that have worse experiences or a more intense experience than others. And that’s not anything new. But we’ve not talked about it in terms of climate.”
One School’s Start
At the Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, educators are just beginning work to integrate climate change into the curriculum, notes Mary T. Quinn Griffin, Ph.D., RN, FAAN, ANEF, associate dean for global affairs, and May L. Wykle endowed professor. “We are interested in having our faculty learn more about climate change and the effects on health and how we can start integrating that into the curriculum,” she says.
In an article published in the September/October 2022 Journal of Professional Nursing, Quinn Griffin and coauthors offered ways to integrate climate change content into existing Doctor of Nursing Practice (DNP) programs. In addition, the article ties climate change content to the domains in The Essentials: Core Competencies for Professional Nursing Education from the American Association of Colleges of Nursing (AACN).
Recently, Quinn Griffin delivered a presentation on climate change during homecoming. In that presentation, she discussed how “nurses are really on the frontlines of working to mitigate the consequences of climate change every day. And that nurses comprise about 60% of health professionals globally, so their involvement in the education and the response to climate change is critical if we are to mitigate the impact of climate change on health.”
In addressing climate change, Quinn Griffin references the three strategies of adaptation, mitigation, and resilience. First, she notes that adaptation involves assessing the impact of climate change and planning for its effects.
In mitigation, “nurses could take leadership roles in helping and be on committees to create sustainable climate-smart hospitals and health systems,” says Quinn Griffin. In addition, resilience could involve the community and public health nurses helping to strengthen communities.
NLN Says Nursing Plays Unique Role
“The nursing profession is uniquely positioned to offer critical leadership related to climate change and health and to address this complex challenge in partnership with other health professions and policymakers,” concludes the vision statement.
Climate change, notes the NLN’s Malone, is part of healthcare. “If you consider yourself a good practitioner, you need to build that into how you view the world and your responsibility as a nurse to that world.”
A month after the U.S. Supreme Court overturned Roe v. Wade, Texas’ two dozen abortion clinics are slowly coming to terms with a future where their work is virtually outlawed.
Some clinics have already announced that they are shutting down operations and moving to New Mexico and other states that are expected to protect abortion access. Others, including Planned Parenthood, say they will stay and continue to provide other sexual and reproductive health services.
But keeping the doors open will likely come at a high cost for these clinics — financially, politically and psychologically — as they absorb more patients with fewer options.
“It’s really hard to find words in the English language that honor what the experience has been like,” said Dr. Bhavik Kumar, medical director of primary and trans care at Planned Parenthood Gulf Coast in Houston. “It’s just devastation.”
Planned Parenthood clinics in Texas have had to turn away patients in dire situations, according to an open letter provided to The Texas Tribune, including minors and a woman who already had children but had been told by her doctor that she could die if she carried another pregnancy to term.
“People are looking at you and asking you, like, ‘Why can’t you help me?’ ‘Can you make an exception?’” Kumar said. “We hear that all the time, and it just feels so inhumane and unethical … to have to do this over and over again.”
Kumar thought years of navigating abortion restrictions in Texas had prepared him for the overturn of Roe v. Wade. But he wasn’t prepared for the fear that his patients are feeling amid this new legal landscape.
He said he saw a patient last week who was worried about the consequences of even mentioning abortion.
“We’re here in a clinic where we’ve provided abortion care for decades. I’m an abortion-providing doctor, and I talk very openly about abortion,” he said. “But she just had so much fear and apprehension, and was uncertain if she could actually say the words out loud and ask for that help.”
Even if Planned Parenthood can’t offer abortion anymore, it’s committed to staying put and helping Texans access an array of other reproductive health services, including birth control, cancer screenings and testing for sexually transmitted diseases.
Its clinics have been dealing with a surge in demand for long-acting reversible contraception, like IUDs, and information about birth control options including vasectomies, all while expanding their education operations.
But keeping the doors open will mean continuing to contend with a Legislature intent on seeing them shut down. Texas elected officials have spent much of the last decade working to defund Planned Parenthood by removing it from Medicaid and other publicly funded programs.
Even as the state halts abortion services entirely in Texas, Planned Parenthood does not anticipate it stopping those attempts to financially hamstring its work.
“The state has been relentless because of who we are and what we stand for, and that’s unapologetic access to comprehensive sexual reproductive health care, which includes abortion,” Kumar said.
Some clinics plan to relocate
Other Texas clinics are shutting down operations entirely and relocating to “haven states” to continue providing abortions.
Whole Woman’s Health, which started in Texas in 2003 and at one point operated six clinics around the state, has announced plans to relocate to New Mexico.
The group has been slowly pivoting its operations in recent years toward states that protect abortion access, building clinics in Maryland and Virginia and a new location near the airport in Minneapolis. It has invested in a program to help patients travel to these states from Texas.
Now, the organization is closing its remaining four Texas clinics and relocating those operations to an as-yet undisclosed location in New Mexico.
“[Whole Woman’s Health] has served Texans for nearly 20 years, and our love for Texans runs deep,” president and CEO Amy Hagstrom Miller said in a statement. “Even when the courts and the politicians have turned their backs on Texans, we never will.”
Alamo Women’s Reproductive Services, an independent abortion provider, has also announced it will close its San Antonio clinic and a sister facility in Tulsa and relocate to Albuquerque, New Mexico, and Carbondale, Illinois.
New Mexico is Texas’ only direct neighbor that is expected to preserve abortion access, although “neighbor” is a relative term — Las Cruces is more than a 10-hour drive from Dallas or Houston.
The clinics that remain in Texas providing non-abortion care are preparing to serve as the conduit to these out-of-state clinics.
“We understand and deeply empathize with providers who have been forced to close their clinics and move out of state,” said Melaney Linton, president and CEO of Planned Parenthood Gulf Coast, in a statement. “We will continue to work closely with them as we help patients navigate their best options.”
But many Texans will not be able to leave the state, due to finances, child care needs or immigration status.
“Sometimes we hear that it was difficult for them to even come into the clinic that’s closer to home, maybe within 10 miles of where they actually live, let alone having to travel to another state to get that care,” Kumar said. “So it’s very, very scary for folks.”
Hanging on with ultrasounds
For many of the providers who have been on the front lines of contentious legal fights over abortion access in recent years, the overturn of Roe v. Wade was not a surprise. But now that it’s here, they say the reality is worse than they could have imagined.
Most of the patients who come to Houston Women’s Reproductive Services these days already know they want an abortion — and are willing to travel to out of state to get one. Clinic director Kathy Kleinfeld and her staff are in touch with other clinics around the country, helping patients navigate the various legal requirements, wait times and travel logistics that govern abortion access right now.
“It’s very helpful to have someone to talk this through with, who can say, ‘OK, I know this feels overwhelming right now. But have you ever lived in another state? Do you have any friends or family elsewhere?’” she said. “That gets the wheels turning, and if we’re not here to do that, they’re going to have to figure it out on their own.”
For the last month, Houston Women’s has provided only ultrasounds. Kleinfeld said it has seen a steady trickle of patients and identified ectopic pregnancies, false positives and patients who are actively miscarrying.
“In all those circumstances, women would be wasting precious time and money to travel out of state when in fact they may not need the service,” she said. “So it is important to have those ultrasounds in a medical environment where they receive accurate and compassionate care.”
Kleinfeld worries that if that option isn’t available, more people will turn to crisis pregnancy centers. These religiously affiliated nonprofits often offer ultrasounds, but some use coercive and deceptive practices to discourage clients from pursuing abortions.
Kleinfeld said she’s been encouraged by the support her clinic has received, but they’ve scaled back staff and are being realistic about how long they can remain open without their main source of income.
“We’ll do it as long as we can,” she said. “I’m not gonna sell my house and live under the bridge. I’m not going to go that far, but … I think we’re gonna see a lot of creative thinking here and a lot of innovative ideas from some of the brightest people.”
Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
In El Paso, Texas, men lined up outside the Corner of Hope, a homeless resource center, eyeing free supplies on plastic shelves inside a white van.
Some wanted bags with toiletries or condoms, but others took kits that help them safely use drugs or naloxone, an opioid overdose reversal medicine.
Gilbert Shepherd, an outreach worker for Punto de Partida, a nonprofit that serves people who misuse drugs, gently questioned those who took the drug safety kits. A man wearing sunglasses and a black T-shirt explained that not long ago he took a pill he bought for $1.50 and, within minutes, he passed out for hours. A man in a plaid shirt and khaki pants described seeing someone overdose after taking a blue pill a month before.
Those two overdoses would be added to a new Texas database called Texans Connecting Overdose Prevention Efforts, which aims to improve drug overdose tracking across the nation’s second-largest state.
The University of Texas project, known as TxCOPE, is one attempt to solve a problem exasperating officials nationwide who are trying to lower the record number of drug deaths: getting an instant, accurate picture of both nonfatal and fatal drug overdoses. Community groups are now using TxCOPE’s data dashboards and heat maps to see where overdoses are spiking and then target those hot spots with prevention efforts such as naloxone training and supplies, said Christopher Bailey, project coordinator at Project Vida, a health center in El Paso.
It is one of the few projects in the U.S. pooling crowdsourced overdose data from harm reduction groups in a systematic way, according to Leo Beletsky, a public health law expert at Northeastern University. Such projects compensate for the lack of an accurate picture of the decades-long overdose crisis. “It’s scandalous,” Beletsky said.
No national data
More than 107,000 Americans died of drug overdoses in 2021, according to the Centers for Disease Control and Prevention. But there is no national count of how many people survive drug overdoses. The CDC doesn’t even have a standard method that states can use to count nonfatal overdoses. It aggregates overdose data from emergency room visits based on clinical and billing codes from participating states, but that excludes people who don’t interact with the medical system, said Bradley Stein, director of the Rand Opioid Policy Center. It is a “huge blind spot,” Stein said.
Plus, fatal overdose data is often published weeks or months later, once an official medical examiner’s report or toxicology results show what substances caused the deaths. “We’re looking in the rearview mirror with opioids,” Stein said.
Other projects that count nonfatal overdoses, such as ODMAP, rely on reports from law enforcement or first responders. But many drug users won’t call emergency services or report overdoses for fear of arrest, deportation, or other consequences such as the loss of their children or housing due to drug use, said Traci Green, a professor and the director of the Opioid Policy Research Collaborative at Brandeis University.
“Simply put, current national data systems have not kept up with the scale of the overdose epidemic,” wrote Dr. Rahul Gupta, director of the Office of National Drug Control Policy, in a call for action published June 30 in JAMA. He added that building a better data system is essential and that his agency is convening with other federal agencies to improve the tracking of nonfatal overdose data.
Nationally, Green estimated, about 50% of nonfatal overdoses go unreported, with a higher undercount in places with stricter law enforcement and among communities of color. The missing part of the picture “is a very diverse one,” she said.
In Texas, up to 70% of overdoses, mostly nonfatal, go unreported, estimated Kasey Claborn, lead researcher on the TxCOPE project and an assistant professor at UT’s Dell Medical School and Steve Hicks School of Social Work.
Officially, about 5,000 Texans died of a drug overdose in 2021. Claborn believes that is an undercount, too, because the state has medical examiners’ offices in only 15 of its 254 counties. Most counties have justices of the peace who don’t always request pricey toxicology tests to determine the cause of death. The state recorded nearly 4,000 opioid-related calls to the Texas Poison Control Network last year and nearly 8,000 opioid-related emergency room visits in 2020. Claborn is analyzing how the data TxCOPE collects compares with those official statistics.
“How is that helping in a public health emergency?”
Drug experts are frustrated the U.S. doesn’t treat the overdose epidemic with the urgency it does for covid-19. Drug deaths surged during the pandemic as illegal fentanyl, which is 50 to 100 times more potent than morphine, flooded the nation’s street drug supply and people were cut off from substance abuse support. But while public health authorities based pandemic restrictions on local covid caseloads and death counts, experts and outreach workers have lacked real-time data that would allow them to react with interventions that could save drug users’ lives.
“How is that helping in a public health emergency?” said Daniel Sledge, a paramedic testing TxCOPE in Williamson County, just north of Austin.
That information could help health workers identify which areas to blanket with naloxone or whether they need to educate people about a batch of drugs laced with lethal fentanyl.
TxCOPE, funded by the state’s opioid grant and the federal Substance Abuse and Mental Health Services Administration, started in El Paso in June 2021 and then expanded to Austin, San Antonio, and later Williamson County. An official launch is planned for Sept. 1, with a rollout to the rest of the state in stages.
Before the group started, outreach was more haphazard. “It was catch as catch can,” said Bailey, with Project Vida. Like many harm reduction groups, they would informally track overdoses, which often occurred among an itinerant population. But they didn’t have a way to pool that information with other city groups or generate maps to drive outreach. TxCOPE has helped the group find pockets of at-risk people so they can provide them with overdose prevention, peer support, or treatment referrals. Now “you are able to really home in on those areas with laser-like focus,” he said.
Punto de Partida outreach worker Paulina Hijar, for example, said she routinely meets people who injected their friends with dangerous and ineffective homemade overdose remedies — either milk or a mixture of water and salt — or got naloxone and never called authorities. Because outreach workers have built trust in their communities, they say, they can gather information about overdoses, including when and where they occurred, that would normally be omitted from official statistics.
A hidden problem in Texas
Privacy is a key feature of the TxCOPE project — people need to be able to share overdose information without fear of consequences, Claborn said. Texas passed a law in 2021 intended to shield from arrest people who call emergency services during an overdose, but it’s narrowly tailored. People who have a felony drug conviction, for example, don’t qualify. And someone is protected from arrest only once. TxCOPE has a federal certificate of confidentiality that protects it from court orders, and Claborn doesn’t share raw data with the state.
Claborn wants to use the project, which is being revamped this summer before the launch, to bring more federal dollars to the state. “We’ve had difficulty proving there is an actual problem in Texas because it’s been hidden,” she said.
She has been working on a feature that would allow anyone in the community to report overdoses, an effort to improve counts in parts of the state without harm reduction groups. Eventually, Claborn wants to check the crowdsourced data against toxicology reports.
For now, though, the project relies on anecdotal evidence from drug users and others in the community who report reviving someone with naloxone or seeing someone lose consciousness or suffer other effects of taking too much of a drug.
On a recent afternoon, Shepherd and Hijar recognized a man in El Paso’s Houston Park. He told them about a woman who had died alone in her apartment about a week and a half earlier after taking a mixture of drugs. He also mentioned a guy he was able to revive with naloxone about two months earlier. Details were minimal.
Researchers and harm reduction groups say this nebulous data is better than what they’ve had in the past. Even though the project’s anecdotal data isn’t thoroughly vetted, the step toward timeliness is great, Stein said. “We’ve got nothing else right now,” he said.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.
“All across our country, people are hurting. They need help. The good news is that getting that help just got a lot easier… This cross-government effort has been years in the making and comes at a crucial point to help address the mental health crisis in our country, especially for our young people.”
—FCC Chairwoman Jessica Rosenworcel
The Saturday, July 15 launch of the three-digit 988 line—which will provide Americans experiencing mental health crises with access to trained counselors—could be a significant step forward for public health in the US. The product of a three-year joint effort by the U.S. Department of Health and Human Services (HHS), the Federal Communications Commission (FCC), and the U.S. Department of Veterans Affairs (VA), the 988 Suicide & Crisis Lifeline will eventually supersede the 10-digit National Suicide Prevention Lifeline (1-800-273-8255).
The new line offers a more direct, robust, and flexible path for people seeking assistance with mental health issues. John Draper, executive director for the National Suicide Prevention Lifeline, told Yahoo Life this week that 988 is for anyone who is grappling with a debilitating emotional storm (or is worried about a loved one in such a situation) and has much broader applications than the 911 “what is your emergency?” line. As Draper describes it, 988 is a resource anyone can text or call when they feel “so overwhelmed by their experience [and] their feelings that it impairs their ability to get through the day.” It covers virtually any mental health crisis and people are urged to call well before they reach a gun/pills on the table situation.
Health and Human Services Secretary Xavier Becerra sees the new line as an important step in addressing the mental health crisis gripping the country in the wake of the two most stressful years in most Americans’ living memory: “988 is more than a number, it is a message: we’re there for you. Through this and other actions, we are treating mental health as a priority and putting crisis care in reach for more Americans. Thereis still much work to do. But what matters is that we’re launching, 988 will be live. We are looking to every governor and every state in the nation to do their part to make this a long-term success.”
However, it will take time to recover from 13 years of not-very-enthusiastic government support. Many states have not yet allocated funds for the 988 program and only 20 have even partial legislation in the works to implement the line. Draper says they are prepared for this: “In the event that [a local call center] is unable to answer the call because they lack the resources, we are providing at the national level backup services… So in the event that the local centers are unable to take those calls or those chats or texts, somebody will be there to take them. It’s a matter of holding on, maybe for just a little bit longer, and we’ll answer.”
“Recent investments made in the Lifeline have already resulted in more calls, chats, and texts answered even as volume has increased, but we know that too many people are still experiencing a suicidal crisis or mental health-related distress without the support they need,” said Miriam E. Delphin-Rittmon, Ph.D., the HHS Assistant Secretary for Mental Health and Substance Use and leader of SAMHSA. “Over time, the vision for 988 is to have additional crisis services available in communities across the country, much the way emergency medical services work. The success of 988 depends on our continued partnership with states, as the federal government cannot do this alone. We urge states and territories to join us and invest further in answering the call to transform our crisis care response nationwide.”
Vets’ fingers have a shorter walk
VA administers the Veterans Crisis Line through the Lifeline’s national network. Because of VA’s partnership with the Lifeline, the Veterans Crisis Line is affected by this transition to a new number. Veterans and their loved ones can now Dial 988 then Press 1 to reach the Veterans Crisis Line.
“988 has been a long time coming and will serve as a critical resource during a crisis when every second counts. The new, shorter number will help ensure Veterans have easier access to the Veterans Crisis Line,” said VA Secretary Denis McDonough. “This launch is a whole-of-government approach in line with the President’s call to prioritize mental health by strengthening access to crisis services, and preventing Veteran suicide, our top clinical priority.”
A bull market for a mental health crisis line
In 2021, the Lifeline received 3.6 million calls, chats, and texts. That number is expected to at least double within the first full year after the 988 transition.
The United States had one death by suicide every 11 minutes in 2020, according to the Centers for Disease Control and Prevention. Suicide was the second leading cause of death for young people aged 10-14 and 25-34. From April 2020 to 2021, more than 100,000 people died from drug overdoses. Studies have shown that after speaking with a trained crisis counselor, most Lifeline callers are significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful.
The 10-digit Lifeline number 1-800-273-TALK (8255) will continue to be operational after July 16 and will route calls to 988 indefinitely. Veterans, service members, and their families can also still reach the Veterans Crisis Line with the current phone number 1-800-273-8255 and Press 1, or by chat or text to 838255.
In 2010, the American Heart Association (AHA) defined “Life’s Simple 7TM,” the seven health behaviors and factors people can improve to help achieve optimal cardiovascular health. And now they’re adding an eighth: sleep.
“Sleep is related to every single one of the other seven elements—it’s closely tied to weight, blood pressure, glucose metabolism, what we choose to eat,” said AHA president Dr. Donald Lloyd-Jones, chair of the department of preventive health at Northwestern University Feinberg School of Medicine. “But sleep is both correlated and also independent. There’s newer research that shows when we take the old seven and add sleep, we can predict cardiovascular disease and stroke even better.”
Now called “Life’s Essential 8TM,” the full list of the AHA’s important health factors includes blood pressure management, cholesterol control, blood sugar reduction, maintaining a healthy weight, increased physical activity, healthier eating, avoiding nicotine in all forms, and now sleep duration.
Although some individuals have a harder time modifying their sleep hygiene, such as those working two jobs or on the night shift, Lloyd-Jones said an important contributor to better cardiovascular health is focusing on ways to get the healthiest amount of sleep (seven to nine hours a night on average) by avoiding caffeine, screens and bright light for several hours before bedtime, putting away your phone and creating a more regular schedule.
A paper on Life’s Essential 8 and the status of cardiovascular health in U.S. adults and children will be published June 29 in Circulation, the flagship journal of the AHA.
“Healthier kids become healthier adults”
A key focus of the re-invigorated list of risk factors is the importance of measuring and monitoring children’s cardiovascular health and learning how to maintain it as they age, Lloyd-Jones said.
“When we create healthier kids, they become healthier adults who then go on to have healthier pregnancies, and the benefits continue with their kids being healthier simply because their parents were healthier,” Lloyd-Jones said. “We get this virtuous cycle of improvement of cardiovascular health generation by generation.”
Additional research published online in Circulation at the same time evaluated the cardiovascular health of U.S. children and adults. Those results showed that as U.S. children ages 2 to 5 grew into the 12- to 19-year-old age group, the healthy diet score fell markedly from 61 to 28 (out of 100 possible points).
“We’re losing a lot of cardiovascular health in the eating patterns as our kids age into later childhood and adolescence,” Lloyd-Jones said. “That doesn’t have to be, but we’re not serving them well…pun intended.”
He said school food programs focused on healthier eating, improving the health of our food supply, helping children choose water over sugary drinks and taxing sugar-sweetened beverages are proven strategies the U.S. can be taking to maintain and improve cardiovascular health in children.
2,500 scientific papers since 2010
The introduction of “Life’s Simple 7” in 2010 was novel, Lloyd-Jones said.
“No one had really tried to quantify health as a concept before that, and it’s been transformative for public health advocacy and for individuals to think about their long-term health,” said Lloyd-Jones, who also is a Northwestern Medicine cardiologist.
Since 2010, more than 2,500 scientific papers have been published about the AHA’s cardiovascular health construct and what it means for improving lifelong health.
“We’ve learned a ton about how important it is to have higher cardiovascular health at every stage of life,” he said. “It affects your risk of stroke, heart attack, cancer, dementia, cognitive functioning, pretty much everything we care about.”
This “cutting-edge research” has paved the way for adding the eighth element of sleep.
More sensitive tools to measure heart health
Also, since 2010 scientists have developed more sensitive tools to determine a person’s cardiovascular health, such as better questionnaires that measure eating patterns in different populations (i.e. the DASH diet versus the Mediterranean diet), Lloyd-Jones said. The new scoring system, he explained, will also better give credit to people who are working to improve their cardiovascular health—something the old scoring system did not do well.
Two elements that affect cardiovascular health are not included in the measurement system: social determinants of health and psychological health characteristics such as optimism, purpose in life, environmental mastery, perceived reward from social roles and resilient coping. Scientists also now know more about how social determinants of health (education, neighborhood environment, community, economic security, access to health care) can affect people’s opportunity for better cardiovascular health. Lloyd-Jones said while policymakers, clinicians and individuals should be mindful of these elements, they’re difficult to quantify and are, therefore, not part of the list of Life’s Essential 8.
“She poured her heart into helping patients and keeping her fellow nurses safe.”
—President Joseph Biden, as he draped a Presidential Medal of Freedom around the neck of Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC.
“Thank you for inspiring us.”
The impact her example had on vaccine-hesitant Americans can’t be measured, but Sandra Lindsay herself has heard directly from people who say that watching the Jamaican-born nurse persuaded them to get their shots. Last year, while on a visit to the Jamaican Embassy, a woman recognized her and thanked her profusely. She and her family had not intended to be vaccinated—until they saw Lindsay getting that first jab on TV. After seeing the nurse’s confident mien, she said, “We all went and made an appointment. So I want to thank you so much for inspiring us.”
That sort of recognition can be a force for good, and Lindsay is surely one of the best-known living nurses in the United States (and in Jamaica, of course!). It’s become a milestone in the history of the pandemic and a powerful symbol of what it means to be a nurse: the image of her serene face wrapped in a pale blue surgical mask, her expressive brown eyes gazing into the distance as she extends her arm to receive the first Covid-19 jab in the US.
Like most people who become symbols, she is not unique. The profession is filled with nurses like Lindsay—nurses who lost family to the pandemic and had no time to grieve; who continued pursuing their education through all of the upheavals; who coped with almost unbearable stress, and scrambled for data when the mRNA vaccines really did emerge at “warp speed” and forced us to rethink everything we thought we knew about vaccine development. But Lindsay’s exceptional poise and sense of responsibility during her frank “I trust the science” spotlight moment have made her representative of the skills, empathy, common sense, and honesty we associate with nursing.
A quiet icon of nurse leadership
While everyone yearned for certainty, Dr. Lindsay never claimed that science is a source of 100% correct, oracular knowledge; she merely said that this is the way that science works—and in effect acted as America’s test pilot for the vaccine.
As she sat down to receive her jab on December 14, 2020, what Lindsay displayed was a nurse’s dedication to evidence-based practice. When she backed this up by not collapsing on the spot or exploding in the weeks following her vaccination, she faded from national headlines and proceeded with her duties at Long Island Jewish Medical Center and worked toward yet another degree. But Lindsay’s persistent lack of rare side effects, her utter failure to cash in on her time in the spotlight, and apparent inability to catch even a mild case of breakthrough Covid made her a quiet icon of nurse leadership during the pandemic.
Millions of mistrustful, frightened people at all levels of society heard her speak with the sane, confident, honest voice of a nurse who has no agenda other than a desire to see her patients well and healthy. Amid rumor-driven panics, false claims based on specious data, and adult mobs throwing tantrums that would be the envy of any 3-year-old, Lindsay’s voice – imbued with a science-based assurance similar to Dr. Fauci’s but without any confrontational edge – resonated. Meanwhile, she has navigated her unasked-for celebrity and public honors with a cool-headed grace and continues to keep her head above water in an era when staffing shortages and burnout are the norm, women’s health care decisions are predicated not on science but on a peculiar blend of metaphysics and politics, and public health officials are driven from office… for doing their jobs.
How about featuring American Nurses on some postage stamps?
Today, after a year and a half of combining full-time work with study, waving from cars during ticker-tape parades, holding a little girl’s hand for her Covid jab, and adding tchotchkes to her diploma and awards wall, Dr. Lindsay is making space for the Presidential Medal of Freedom she received today from President Biden. (He obviously likes standing next to her and handing her things. This is their second rendezvous). As the White House defines the honor, the medal is bestowed on people who have made exemplary contributions to the prosperity, values, or security of the United States.
Lindsay has been a very atypical American celebrity, and there has not been a peep about reality TV deals, an as-told-to book, or even a barrage of media appearances. However, this writer still thinks she belongs on a stamp. While we still have a postal service, we deserve a “nurse” postage stamp of a more recent vintage than 1961—and in fact, it would not be amiss to issue a full series of stamps honoring American Nurses and Nursing.
