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)