Every year on April 7th, the World Health Organization celebrates World Health Day. Nursing's affiliation with the World Health Organization dates back to 1948, when the International Council of Nurses' relationship with the World Health Organization was officially recognized (International Council of Nurses, n.d.). More recently, the World Health Organization designated 2020 as the Year of the Nurse and Midwife in honor of Florence Nightingale's 200th birthday (National Army Museum, n.d.). Commemorating World Health Day is an opportunity for all of us to celebrate improvements in global health and to determine the work that still needs to be done.
As nurse educators and administrators of nursing education, we need to share the message that global health affects all of us. With the rapid pace of air travel today, infectious diseases like Zika, Ebola, or severe acute respiratory syndrome can spread to our own communities within 24 hours. Global health also is affected by climate change through alterations in disease vectors. For example, recent relatively mild winters in the United States have resulted in higher incidences of West Nile virus and Lyme disease (U.S. Centers for Disease Control and Prevention, n.d.). Scientists resolutely affirm the reality of climate change, how it is exacerbated by human activity, and the urgent need to mitigate and adapt to its effects.
Climate change is associated with an increase in severe weather events, resulting in injury and death due to hurricanes, tornadoes, extreme heat, or floods. Long-term health effects due to climate change can include loss of crops due to drought or floods and resultant malnutrition, as well as contaminated water supplies. Families may be displaced following severe weather events, leading to a loss of their homes, jobs, access to health care, and entire communities. Climate change disproportionately affects low-income communities that find it difficult to recover from weather variability and climactic shocks.
Climate change also contributes to diminished air quality, resulting in increased asthma prevalence, incidence, and morbidity. Over recent decades, the prevalence and severity of asthma has risen globally, with the most dramatic increases among minority and impoverished populations (Nunes, Pereira, & Morais-Almeida, 2017).
Although the challenges associated with climate change can create hardships for families in the United States and other wealthy countries, they can be absolutely devastating for communities in low-income countries. In fact, we are starting to see climate refugees—families fleeing their homes and communities due to the effects of climate change. As nurse educators, we need to be mindful and make others aware of our ethical responsibilities regarding climate change. The United States is one of the top emitters of carbon dioxide, which contributes to climate change. Low-income communities in the United States, as well as abroad, experience the worst consequences of climate change and have fewer resources to cope with it. Countries like the United States cause the most harm, but others, especially low-income countries in sub-Saharan Africa, experience the worst effects. Yet, we have an ethical obligation to do no harm.
Another reason we should care about global health is because there is a lot we can learn from other nations to improve health outcomes in our own communities. For example, although the United States spends more on health care than any other country in the world, it does not have the best health outcomes to show for it. The Journal of the American Medical Association compared data among 10 high-income countries between 2013 and 2016 and found that the United States spent twice as much on health care but had the lowest life expectancy in the group and the highest infant mortality rates (Papanicolas, Woskie, & Jha, 2018). More alarmingly, the United States currently has the worst maternal mortality ratio among all developed countries, while spending nearly 18% of our gross domestic product on health care. We can learn from other nations how to improve health outcomes and reduce health care costs.
Global problems can seem overwhelming, but each of us can do our part to improve global health. First, we can educate ourselves and others. As nurse educators and administrators of nursing education, we are in a unique position to learn and teach about global health. We can offer global health content in continuing education courses. The International Council of Nurses ( http://www.icn.ch/), the World Health Organization ( http://www.who.int/), the National Institute for Nursing Research ( http://www.ninr.nih.gov/researchandfunding/globalhealth), the United Nations Sustainable Development Goals ( http://sustainabledevelopment.un.org/sdgs) and other organizations are a good place to start for global health information, policy statements, training opportunities, data, research grants, and more.
We not only need to stay abreast of what is going on in the world, but we also need to learn to ask critical questions and to broaden our thinking to find creative and effective solutions to world health problems. This could include reading a daily newspaper, watching a national news broadcast on a regular basis, and exposing ourselves to other sources of information. For example, the English-language media outlet Al-Jazeera ( http://www.aljazeera.com/) provides a relatively nonbiased and non-Western perspective on world events, which can help to broaden our views on global issues and give us insight into how other nations regard global events.
We can also learn some geography. For those of us who grew up in the United States, our knowledge of world geography (and even U.S. geography) may be sorely lacking. Geography is important. If I have a client who visited Uganda in the past few months, perhaps I should be concerned given that Uganda borders the Democratic Republic of Congo, which has experienced recent outbreaks of Ebola. Knowing some geography can also increase our cultural competence. If I have a client who recently emigrated from Bolivia, learning about where that is and asking some questions about her homeland may help to make the client feel welcome and more at ease. And with mobile technology, we can learn where a place is located, literally at the touch of a button.
We can also help to improve global health by traveling abroad. This could extend to offering overseas continuing education experiences for practicing nurses. Not only can this augment needed health services in low-income countries, it also gives us the opportunity to learn how nursing is practiced in other places and learn about other cultures, which can enrich our own practices back at home.
We can improve global health by advocating for equitable policies, which impact populations at home and abroad. For example, many U.S. policies affect global health, such as the amount of official development assistance we provide. Official development assistance is aid that high-income countries provide to low-income countries to help level the global playing field. Also, environmental regulations, including the Paris Climate Accords, seek to mitigate the effects of climate change. Staying abreast of world news (as previously suggested) allows us to know when our elected officials are making or changing laws that address these issues. In addition, we can obtain information about current bills under consideration by the U.S. Congress ( http://www.govtrack.us/congress/bills/). We can contact our elected officials and advocate for policies that improve global health.
Relatedly, we can vote! Who we elect into office makes decisions on policies related to global health. Perhaps professional organizations could consider supporting candidates who promote a health and social justice agenda.
Most importantly, we can lead by example. Nurses are viewed as the most trusted profession, so our words and actions carry a lot of weight and can influence others. We can reduce our carbon footprint in order to do our part to mitigate climate change. Most things that are good for the environment are also good for our health—it's a win-win. For example, eating less red meat helps to reduce cardiovascular disease, while also improving the environment. We can replace trips made by car with bicycling or walking. In the United States, 60% of all trips that are 1 mile or less are made by car, truck, or SUV—a distance that most people can easily walk or bike. We can take the stairs instead of the elevator, take shorter showers, avoid wasting food, and avoid using plastic. Relatedly, we can buy energy-efficient vehicles, consume less overall, increase energy efficiency in our homes, and more. The more people see others living in environmentally friendly ways, the more people who will follow suit.
Finally, in recognition of World Health Day, we can celebrate that as nurse educators and administrators of nursing education by teaching nursing ethics, including principles of well-being, beneficence, doing good, equity, justice, and preventing harm—all key tenets of global health.
- International Council of Nurses. (n.d.). ICN and the World Health Organization. Retrieved from https://www.icn.ch/nursing-policy/icn-and-world-health-organization
- National Army Museum. (n.d.). Florence Nightingale: The lady with the lamp. Retrieved from https://www.nam.ac.uk/explore/florence-nightingale-lady-lamp
- Nunes, C., Pereira, A.M. & Morais-Almeida, M. (2017). Asthma costs and social impact. Asthma Research and Practice, 3, 1. doi:10.1186/s40733-016-0029-3 [CrossRef]
- Papanicolas, I., Woskie, L.R. & Jha, A.K. (2018). Health care spending in the United States and other high-income countries. Journal of the American Medical Association, 319, 1024–1039. doi:10.1001/jama.2018.1150 [CrossRef]
- U.S. Centers for Disease Control and Prevention. (n.d.). Climate change increases the number and geographic range of disease-carrying insects and ticks. Retrieved from https://www.cdc.gov/climateandhealth/pubs/vector-borne-disease-final_508.pdf