When it comes to global health, there is no ‘them’, only ‘us’

Global Health Council

---

This blog is a representaiton of an ePortfolio assignment for the course Health and Healing: Global Context of Nursing. The purpose of this ePortfolio is to display information related to global health promotion concepts as well as personal reflections in relation to topics discussed throughout the course.

Taylor Peppin
York University
BScN Program
Professor: Sandra Peniston

Introduction

Welcome! My name is Taylor Peppin. I am currently a 4^th year BScN student attending York University. I was born and raised in Georgina, Ontario, Canada. I have been fortunate enough to have the opportunity to travel with friends and family and have witnessed some of the health issues that exist in other countries. This has helped to open my eyes and show me the realities of the health issues that are occurring in developing countries, as well as common health issues that exist all over the world.

Global health does not define health inequities in the developing world, but health issues that occur throughout the global population. Nursing should be a global profession because it gives nurses the opportunity to not only become culturally sensitive, but to be collaborative and integrative. Global health nurses have the opportunity to be international leaders and make a difference around the world, and also locally. Global nursing is a chance to address health inequity across the world and health disparities within local communities. Global health nursing can provide nurses with the opportunity to educate globally as well as develop sustainable and safe quality care in developing countries as well as being assets in under-resourced healthcare settings. 

Course Learning Outcomes

Learning Outcome #1

Understand the social, political, economic and environmental challenges that hinder improved health status on a global scale (P.G. 2 & 3)

Learning Outcome #2

Analyze selected international health issues such as communicable and non-communicable diseases/mental health; child and woman/reproductive health; nutrition, water and sanitation; unintentional injuries; and, complex humanitarian disasters (P.G. 2,3 & 7)

Learning Outcome #3

Gain an appreciation of upstream approaches including policies and programs aimed at reducing global health disparities and promoting global health (P.G. 2,3 & 7)

Learning Outcome #4

Critically evaluate the role of nurses and nursing in contributing to global health (P.G. 2,3,6 & 7)

Learning Outcome #5

Critique extant nursing theories for their ability to address and provide guidance in relation to expanded concepts of health and well-being (P.G. 2,3,6,7 & 8)

Learning Outcome #6

Develop individual and professional strategies and/or actions that may be taken to promote global health (P.G. 2,3,4,6,7 & 8)

“The essence of global health equity is the idea that something so precious as health might be viewed as a right.”

Paul Farmer

Reflections

Learning Outcome #1: Understand the social, political, economic and environmental challenges that hinder improved health status on a global scale (P.G. 2 & 3)

During week one of the course, we were introduced to the topic of global health. We were further introduced to the main priorities of global health and the Sustainable Development Goals. These were created by the United Nations Development Programme (UNDP) who are aiming to achieve these specific goals in order to address major global health concerns by 2030. This is related to this learning outcome because the SDG’s determine all of the main health concerns globally due to social, political, economic and environmental challenges worldwide. In week 1 we also discussed the difference between health equality and health equity. These topics are all relative to the learning outcome as they display some of the root causes for a lacking global health status. Individuals around the world are not granted to same resources and accommodations as everyone else, therefore instead of focusing on health equality and health inequity, global health must aim to remove the systemic barriers. Another topic that is relatable to this learning outcome is the concept of social justice which was introduced in week two. According to Nemetchek (2019), nurses have a responsibility to define assumptions and inequalities that affect health care and health care delivery, and to implement social justice into their practice to address social determinants of health. Social justice is an important concept related to global health nursing and it is fundamental in nursing practice. This is also related to the social, economic and environmental challenges that individuals face on a global scale and demonstrate the need to social justice in order to address the wide variety of health inequities. 
Reference: 
Nemetchek, B. (2019). A concept analysis of social justice in global health. Nursing Outlook, 67(3), 244–251. 

Evidence #1:
The University of Toronto has created an Institute for Global Health Equity and Innovation (IGHEI). Their mission is to utilize the strengths and expertise of their members and partners to find and implement sustainable community-driven innovations (University of Toronto, 2019). Their overall goal is to use previous knowledge and resources to improve health status and correct inequities. This is a photo of all of the values that represent their institute and their initiatives. This relates to the course learning outcome because it is an institution put into place to address the need for improved health status based on health inequities due to social determinants of health.

 Evidence #2:

This is a motion graphic video that discusses and demonstrates the different factors that are associated with health inequities and the various social, environmental, political and economic challenges that result in a poor health status, globally and locally. This relates directly to the course learning outcome #1 by illustrating and breaking down certain social determinants of health that have poor outcomes for an individual’s health. This video shows that health inequities can also have an impact on health disparities. This means that different elements of social, environmental and economic factors that occur can ultimately have an effect on the differences in health among various groups of people. 

Learning Outcome #2: Analyze selected international health issues such as communicable and non-communicable diseases/mental health; child and woman/reproductive health; nutrition, water and sanitation; unintentional injuries; and, complex humanitarian disasters (P.G. 2,3 & 7)

In week four and ten of the course, we were introduced to the topics of communicable and non-communicable diseases. These topics are important to overall global health, as non-communicable diseases are the leading cause of deaths globally. We watched a YouTube video on NCD’s and how little knowledge people have about them. Non-communicable diseases are not the most typical types of diseases that people would think to be the biggest causes of death around the world. We also reviewed an article about a coach trial and nurse management of non-communicable diseases, like heart disease. This is also important to the health of individuals globally as it affects all ages, all genders, the wealthy and especially the poor. NCD’s and poverty are a constant cycle which ultimately affects a lot of developing countries. This is due to food globalization and urbanization. Another concept that was discussed in week four was health transitions. The one type of transition that relates to this learning outcome is the nutrition transition. Nutrition transition is important because it involves the transition between developing and developed countries. At one point in time, developing countries struggled with proper nutrition and malnourishment. It is more evident that developed countries are now struggling with overnutrition and an obesity crisis. These are important concepts that are relative to the learning outcome #2 because they are analyzed and recognized as the most major threats to global health. As a result of urbanization and globalization, people around the world are adopting unhealthy lifestyles and behaviours.   

Evidence #1:

This is an image that represents the different types of non-communicable disease that effect people globally. This image also displays the different risk factors that contribute to certain non-communicable diseases. Due to individuals moving out of rural areas and into more urbanized areas, people in developing and developed countries are adopting more urbanized lifestyles and habits. This includes an increased alcohol and tobacco intake, as well as adopting a sedentary lifestyle and being exposed to unhealthy diets like fast food restaurants. This image directly relates to learning outcome #2 as it demonstrates an analysis of the leading cause of global deaths, NCD’s and their related risk factors.

Evidence #2:
Callister, L. (2015). WASH. MCN, The American Journal Of Maternal/Child Nursing, 40(6), 398. doi: 10.1097/nmc.0000000000000180. Retrieved from https://insights-ovid-com.ezproxy.library.yorku.ca/crossref?an=00005721-201511000-00012

This is an article that highlights the UNICEF WASH strategies. WASH is an acronym that represents improved water, sanitation and hygiene. There are 46 countries across the world that still have over half of their populations that are without adequate sanitation and clean drinking water. In poorer and low-resource countries, this creates a great health risk for infectious diseases. Services need to be implemented in these countries to help improve the use of clean water sanitation facilities to help prevent the risk of cholera and other sanitation-related diseases. This is related to the course learning outcome #2 as it analyzes the global health issue of water and sanitation issues in developing countries as well as in developing communities.

Learning Outcome #3: Gain an appreciation of upstream approaches including policies and programs aimed at reducing global health disparities and promoting global health (P.G. 2,3 & 7)

In week 2, we were introduced to the topic of the Declaration of Alma-Ata for Primary Health Care, as well as the “Health in All” Policy (HiAP) framework. The Declaration of Alma-ata was adopted in 1978 at the International Conference on Primary Health Care. It suggested to urgent need for the protection and promotion of health for all people around the world. This would need the immediate action by all levels of government, the communities of the world, and all healthcare workers. This declaration highlighted the importance of primary healthcare for individuals globally. The “Health in all” Policy (HiAP) is an approach that will implement the importance of health and health considerations into policymaking across sectors to improve the health of people throughout all communities (CDC, 2019). These topics relate to the course learning outcome #3 as they are policies and programs put into place which aim to tackle global health issues as well as advocating for global health using an upstream approach. An upstream approach to healthcare focuses on prevention, opposed to a downstream approach which focuses on treatment. Another concept that was introduced to us in week 6 was task shifting for nurses. Task shifting is the idea of transferring accountability and responsibility of health-related tasks to less-specialized healthcare workers (WHO, 2007). This is a strategy that has been applied globally due to healthcare worker shortages. For example, with a lack of doctors available in a low-resourced country, a qualified nurse could be delegated the tasks. This concept is also related to the learning course outcome #3 as it demonstrates another upstream approach to address global healthcare shortages and therefore promoting global health. 

References:
CDC. (2019). Health in All Policies: Ad for Policy and Strategy. Retrieved from https://www.cdc.gov/policy/hiap/index.html
World Health Organization. (2007). Task shifting to tackle health worker shortages [Ebook]. Retrieved from https://www.who.int/healthsystems/task_shifting_booklet.pdf

Evidence #1:
World Health Organization. (2012). Population-based approaches to childhood obesity prevention [Ebook]. Retrieved from https://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf

This is PDF published by the World Health Organization concerning childhood obesity, which is a large threat to global health due to the adoption of unhealthy lifestyles at an early age. This PDF was published to discuss upstream approaches to help prevent and alleviate the risk factors that can contribute to childhood obesity. The upstream approach that aims to prevent childhood obesity addresses the social determinants of health and the social inequities experiences by people all over the globe. The targets associated with childhood obesity are food, physical activity, but also the socio-economic factors that influence such lifestyle behaviours. This PDF is directly related to the learning course outcome #3 as it displays how an upstream approach to a global health issue is beneficial for addressing the root causes.

Evidence #2:

This is a YouTube video about Canada’s first legal supervised injection site. Liz Evans speaks about how she helped launch the centre, and the importance of these sites for harm reduction. The opioid overdose crisis is a massive growing health concern in North America but also all over the world. Harm reduction sites are another perfect example of an upstream approach to health issues globally. Opposed to treatment for health issues, harm reduction can address these problems head on and provide support and safety for individuals involved in this crisis. This topic greatly relates to course learning outcome #3 as it provides another example of an upstream approach that can help improve global health.

Learning Outcome #4: Critically evaluate the role of nurses and nursing in contributing to global health (P.G. 2,3,6 & 7)

In week six we were introduced to the Nursing Now global campaign. We also discussed the topic of globalization of nurses in the workforce. During week two, we also discussed the International Council of Nurses (ICN) and their role within global health. The ICN is an international organization that represents 130 national nursing associations. They work to ensure quality nursing care worldwide as well as ensure complete health policies, and respected and competent nursing profession (ICN, 2019). The WHO estimates that by year 2030, the world will need 9 million more nurses, advocating for the fact that nurses are vital in universal healthcare. The Nursing Now campaign was created in collaboration with the World Health Organization and the International Council of Nurses (Nursing Now, 2019). They aim to spread awareness of the importance and value of nurses in order to improve health globally. This involves encouraging policymakers and our own nurses to represent a global health movement. Globalization of nurses was another topic that was discussed in this course. There are pros and cons to the migration of healthcare workers to other countries. Commonly, nurses and other healthcare professionals will leave their home country in search of better pay in a wealthier country. As this is beneficial for the individual, this creates an additional burden for the poorer countries who are in dire need of healthcare workers. This ultimately gives the thriving countries an abundance of great healthcare and puts poorer countries in a deeper need. All three of these topics are significantly related to learning outcome #4 as they are all ways that nursing is able to impact and contribute to global health.  

Reference:
International Council of Nurses. (2019). Retrieved from https://www.icn.ch
Nursing Now. (2019). Retrieved from https://www.nursingnow.org/join-the-campaign/

Evidence #1:
https://www.nursingnow.org/supporting-community-nursing-in-liberia/

Nursing for All in Liberia
This is a case study from the Nursing Now website. It discusses a small non-profit organization called “Nursing for All” which has been designed to support and empower nurses in low-income countries across the world. This specific case study examines the Nursing for All in Liberia and their recent Ebola epidemic in 2015 that resulted in fatalities of 8% of the countries healthcare workers. Thanks to the Nurse-led Public Health Initiative Program (NLPHIP), Liberian nurses are given their own salary and supplies to run their own public health initiatives in their own communities. This provides healthcare for individuals in communities that others cannot reach. 

Evidence #2:

This is a story of a Vancouver nurse who was away in Liberia volunteering when the Ebola outbreak occurred in 2014. Once she returned home, she was determined to help the struggling country with their poor healthcare system. This nurse has been gathering copious amounts of supplies to eventually ship over to Liberia. This includes hospital beds, IV poles, needles, syringes, wheelchairs, linens, pharmaceuticals and much more useful medical equipment. With the ambulance of medical equipment received, this will greatly improve healthcare delivery in Liberia and ultimately result in hundreds of lives saved. This relates to the course learning outcome #4 because this is an example of how nurses can become involved in global health and proving care for individuals around the world. It does not always have to be hands-on care, but even having the mindset and global health perspective can help make a difference. 

Learning Outcome #5: Critique extant nursing theories for their ability to address and provide guidance in relation to expanded concepts of health and well-being (P.G. 2,3,6,7 & 8)

During week two, we read the article Social Justice and Human Caring: A Model of Caring Science as Hopeful Paradigm for Moral Justice for Humanity written by Jean Watson. The theory of Jean Watson and Human Caring relates to the course learning outcome #5 because it is a nursing theory that addresses the concepts of health and well-being. In this article, Watson describes how human caring, social justice and health are the fundamentals of nursing. Watson (2008) stated that “one person’s level of humanity reflects back on the other …we are all connected through our shared humanity”. She reflects on human relationships and that the only way to sustain humanity at this point in human history is to look into the face of the other, not as a different other, but as a reflection of each of us (Watson, 2008). I believe that human caring is vital within the nursing profession, but it is also fundamental when it comes to the concept of global health. In order to make a difference in global health, everyone has to be viewed as a whole. I agree that we are all human and all share the same humanity, and this is how we should be viewed. Without human caring and the theory of Jean Watson, nursing practice would not be therapeutic. Another theory that relates to the concept of health and well-being regarding global health is the upstream approach. This was also discussed during class two and it proves to be vital in the prevention and management of global illnesses and diseases. As the upstream approach focuses on prevention and health promotion, rather than treatment, this is important when tackling certain global health crisis’. 

Reference:
Watson, J. (2018). Social Justice and Human Caring: A Model of Caring Science as a Hopeful Paradigm for Moral Justice for Humanity. Creative Nursing, 24, 54–61. 

Evidence #1:

Florence Nightingale is best known as the founder of modern nursing. She is also the creator of the Nightingale Environment Theory which touches on the concept that nursing is an art and a science. By describing nursing as an art, I think this relates to the art of caring. Caring is an essential part of nursing practice and goes hand in hand with compassion and empathy. I think Florence Nightingale and her theory are also vital components of nursing theories that can also contribute and be applied to the concept of health and well-being which is relative to the course leaning outcome #5. 

Evidence #2:
In week 5 we watch a video of Paul Farmer and his beliefs as healthcare as a human right. We read an article by Paul Farmer titled Structural Violence and Clinical Medicine. Structural violence is defined as social structures such as economic, political, legal, religious, and cultural, that stop individuals, groups, and societies from reaching their full potential (Farmer, 2006). A theory that can be applied to this topic would be Jean Watson’s theory of social justice. Social justice and Paul Farmer’s structural violence concept are closely linked. They both support the belief that health and social equity are fundamental views in healthcare, and this is vastly important for the promotion of well-being and health. These concepts and theories are relative to providing guidance in concept related to health. 

Reference:
Farmer, P., Nizeye, B., Stulac, S., Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Med 3(10): e449. DOI: 10.1371/journal.pmed.0030449 

Learning Outcome #6: Develop individual and professional strategies and/or actions that may be taken to promote global health (P.G. 2,3,4,6,7 & 8)

During the course, we were exposed to a variety of global health concerns and discussed many things that are currently being done to improve healthcare worldwide. During weeks eight and nine of the course, we were to present our and listen to others International Council of Nurses (ICN) presentations. We were asked to present a current global health issue that related to one of the Sustainable Development Goals and suggestion implications for nurses to help achieve this goal. In doing so, this relates back to the course learning outcome #6 as it was a way for us to develop strategies and actions to promote global health. There are multiple policies and strategies put into place, as well as many organizations and initiatives put forth to ultimately positively affect the health of individuals globally. When considering an individual strategy for myself to promote global health, I think education and self-awareness are the first things that come to mind. I believe taking the initiative to educate myself with current global issues and to make the effort to be more globally aware would be beneficial. As for professional strategies and/or actions that could promote global health, I think about travel nursing. Travel nursing has always been something in the back of my mind for my future career. I believe that once experienced enough, it would be valuable to bring my expertise to another country and do whatever I can do to promote global health and provide services and much needed care to healthcare systems in need.

Evidence #1:

Street nursing is a great example of a strategy that is being implemented to promote global health. As homelessness is one of the world’s largest health issues, street nursing is a great resource for providing care for the homeless population. This again not only can provide individuals with treatment, but also includes an upstream approach for preventative care including testing and health promotion. This is a great way to offer supports and services to people who lack permanent housing and who may be exposed to unsafe living environments. I feel like street nursing is an important strategy to address populations that may fall through the cracks. These populations do not always seek the traditional care in healthcare settings, therefore, to have a nurse outreach program to help address and support these populations is vital to global health. 

Evidence #2: Core Nursing Values in Global Health

When considering core values in the nursing profession, I think all of these core values can also relate to the promotion of global health. Certain core values are essential for providing care to your patients. As a nurse you want to deliver inclusive, respectful, compassionate care. As a global health nurse, you want to encompass all of these values, as well as demonstrating courage, leadership and promoting a sense of well-being and social justice. These values relate to the course learning outcome #6 because incorporating these values into your perspective and practice will only benefit the people you provide care to, globally and locally.