Concepts of Health & Global Health • Compare and contrast various definitions of health • Describe historical approaches to health and influence on health discourse • Define global health • Define health disparity and healthcare disparity Learning Outcomes • Understand the transition from the Millenium Development Goals to the Sustainable Development goals and describe the sustainable development goals • Identify nursing organizations with resources related to global health such as: College of Nursing website page on Global Health/Canadian Nurses Association/International Council of Nurses • Give two examples of where nurses may experience the impact of global health in their daily work • Explore the role of the registered nurse as a global citizen What is Health? Discus with your peers how you describe ‘health’. Has this definition changed during your life? What influences your concept of ‘health’? Health Meanings Vary • “from every perspective, and even for every individual, health may mean something different” (van Druten, et al, 2022, p. 1) • General Population themes: • multi-sided, self-management, participation, and subjective. • Health Care Worker themes: • multi-sided, subjective, adapting to change, satisfying life, wellbeing/complete wellbeing and functioning. (van Druten et al., 2022) Health as a Negative Construct • Health as the absence of disease • A continuum Health (Potter & Perry, 2024,7th Canadian Edition, Chapter 1) Death Health as a Positive Construct Health, Illness, Disease, & Wellness have relationships to one another • Health as Stability • Health as Actualization • Health as Stability and Actualization • Health as Resource • Health as Unity • Health as Empowerment Health is defined as the maintenance of physiological, functional, and social norms, and encompasses views of health as a state, as a process, as adaptation, and as homeostasis. Health is defined as the actualization of human potential 1986) and includes capacities to fulfill roles, meet demands, and engage in the activities of everyday living (Mikkonen & Raphael, “reflecting the whole person as process and is synonymous with self-transcendence” (Potter & Perry, 2024, 7th Canadian Edition, Chapter 1) Disease is an objective state of ill health, the pathological process of which can be detected by medical science. Illness is a subjective experience of loss of health. Health is an objective process characterized by functional stability, balance, and integrity, Wellness is a subjective experience. WHO Defintion Health is: ““the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical and psychological capacities” (p.3)” (WHO, 1984, as quoted in Potter & Perry, 2024, 7th Canadian Edition, p.3) Labonte’s Conceptualization of Health • Holistic • Multidimensional • Relational • Includes health as stability and as actualization (Potter & Perry, 2024, fig. 1.2, p. 3) A Venn diagram shows the intersection of three circles representing physical, social, and mental health. The circle at the top marked as physical represents vitality, and energy. The circle at the bottom-right marked as social represents connectedness and community. The circle at the bottom-left marked as mental represents meaning, and purpose. The intersection of the circles marked as physical and social health represents enjoyment of good social relations. The intersection of the circles marked as social and mental health represents feeling of control over life, and living conditions. The intersection of the circles marked as health of mental and physical health represents ability to do things one enjoys. The intersection of all three circles represent well-being. • Having a feeling of control over one’s life and living conditions • Being able to do things that one enjoys • Having a sense of purpose • Feeling connected to community. Defining Health for the 21st Century • Positive • Comprehensive • Includes the mental health dimension • Includes the quality of life and spiritual dimension (Potter & Perry, 2024) Historical Approaches to Health Medical Approach: focus on physiology, pathology, treating diseases Behavioral Approach: focus on lifestyle Socioenvironmental Approach: focus on the social context of health (Labonte, 1993, as cited in Potter & Perry, 2024) Health Discourse • Medical system view of health (bio-medical) • Health care system view • Lay perspectives influence health discourse • Global health perspective • “Health is political because its social determinants are amenable to political action or inaction” (Bambra et al, p. 187) (Bambra et al., 2005) Globalization • It is the increased interconnectedness and interdependence of people and countries. (Holtz, 2022) • Globalization has positive and negative impacts on global health (CNA, 2009) Global Health • “an area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.” (Holtz, 2022, p. 3) • “Is the optimal well-being of all humans from the individual and collective perspective” (CNA, 2009, p1). • Global health is a fundamental human right • Good health for one improves the health of all (CNA, 2009) Global Health • Global health refers to any health issue that concerns • Global health refers to any solutions (ex: polio eradication, distribution of covid vaccines) (Breakey, Corless, Meedzan & Nicholas, 2015) • Global health refers to transnational issues and local issues (Koplan et al., 2009) Major Global Health Issues • Communicable and Noncommunicable Disease • Life expectancy at birth • Demographic aging in some countries • Maternal and child health • Environmental and ecological threats • War and militarization • Gender equality • Lack of prerequisites for health (ex: water, food, sanitation) • Health inequity • Global workforce migration • Planetary health/climate change (Holtz, 2022; Potter & Perry, 2024) Communicable Diseases of Global Concern Infectious diseases spread by direct or indirect contact • Tuberculosis (TB) • Hepatitis B & C, HIV • Tropical Diseases – cholera, Nipah virus • Sars • Covid-19 • Influenza • West Nile • Ebola • Malaria • Measles (Holtz, 2022; Potter & Perry, 2024 ) Non-Communicable Diseases of Global Concern • The Big Five (70%): • cardiovascular disease, • stroke, • chronic Respiratory disease, • cancer • diabetes • Road Traffic Accidents • Malnutrition and Obesity • Environmental Risks – pollution, unsafe water • Poisoning • Mental health • Opioid epidemic • Violence (Holtz, 2022; Potter & Perry, 2024) Health & Healthcare Disparities • “A health disparity is a statistically significant difference in health indicators that persists over time” (Holtz, 2022, p. 15). ▪ A healthcare disparity is a difference in access to healthcare by group (Holtz, 2022) Indices of Health Disparities ▪ Global burden of disease ▪ Mortality rate ▪ Infant mortality rate ▪ Morbidity ▪ Life expectancy ▪ Birth rate ▪ Total fertility rate ▪ Disability ▪ Nutritional status (Holtz, 2022) Global Health Governance • Brings together leaders from different sectors to deliberate and guide mechanisms toward collaborative resolutions to complex global issues • Millennium Development Goals • United Nations General Assembly (2000) • Address key health and development issues (e.g., reduce poverty) • Sustainable Development Goals • United Nations General Assembly (2015) • 17 universal goals (Potter & Perry, 2024) Objective of the SDG • “…are an urgent call for action by all countries - developed and developing - in a global partnership.” (United Nations, n.d., para 1) • Target Year: 2030 • Goal is to fight inequality to end all forms of poverty and address climate change for all people of the world Sustainable Development Goals: • 1. End poverty in all its forms, everywhere. • 2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. • 3. Ensure healthy lives and promote well-being for all at all ages. • 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. • 5. Achieve gender equality and empower all women and girls. • 6. Ensure availability and sustainable management of water and sanitation for all. • 7. Ensure access to affordable, reliable, sustainable, and modern energy for all. • 8. Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all. • 9. Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation. • 10. Reduce inequality within and among countries. • 11. Make cities and human settlements inclusive, safe, resilient, and sustainable. • 12. Ensure sustainable consumption and production patterns. • 13. Take urgent action to combat climate change and its impacts. • 14. Conserve and sustainably use the oceans, seas, and marine resources for sustainable development. • 15. Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss. • 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels. • 17. Strengthen the means of implementation and revitalize the global partnership for sustainable development. What does all of this have to do with nursing? Canadian Nurses Association (CNA) CNA position statement highlights: • Health is a global issue • Health is a fundamental human right • RN’s have the responsibility and the right to address social inequities International Council of Nurses Global representation of nurses and nursing https://www.icn.ch/who-we-are World Health Organization – State of the World’s Nursing Report, 2020 https://www.who.int/publications/i/item/9789240003279 College of Nursing and Global Health “Through education and research, the College of Nursing strives to develop a nursing workforce and health care system that improves and supports the health of all of its clients, as reflected in the College's central principles of culture, diversity, community, social justice, equity, inclusiveness and respect.” (USASK College of Nursing, n.d.) For more information: Global - College of Nursing | University of Saskatchewan (usask.ca) Nursing is a Political Act • Nurses are called upon to speak out for health • Nurses see the impacts of policy on the health of individuals, communities and populations • Nurses must look upstream and act • Our code of ethics supports this view (CNA, 2005) CNA has many resources for nursing on political action: CNA website on Policy & Advocacy https://www.cna-aiic.ca/en/policy-advocacy/advocacy-priorities Characteristics of Global Citizenship Do I exemplify characteristics of global citizenship? • Awareness of global issues • Respect and value diversity • Contribute to my community locally and globally • Act sustainably • Take responsibility for my actions • Act on social injustice • Learn about and explore the 17 SDG’s. How do they impact my client (patient/family/community/population)? (Potter & Perry, 2024, Dossey et al., 2019) Becoming a Nursing Global Citizen • As a nursing student consider: Looking inward: What do I know of global issues? How can I learn more? Am I committed to good global citizenship and stewardship of the earth? Looking outward: What actions can I take to support local and global health? How can I be an actor and advocate for change? (Potter & Perry, 2024)
