Global Nursing and Healthcare Considerations Chronic Noncommunicable disease Global Health Bodies Humanitarian, grassroots global organizations International organizations

1. from the Bush to the Boardroom
Global Healthcare
2013
NURS 483
Issues in Professional
Nursing
Mary Ellen Ciptak RN PsyD
MUSIC by ZAHARA

2. NURS 482
MALSOW’S HEIRARCHY OF NEEDS
Individual, Economic and Societal
• sub-Saharan Africa- maternal death: 1 in 39 births
• sub-Saharan Africa- child deaths: 1 in 9 (under 5 years)
• 800 preventable pregnacy and childbirth deaths daily
Depression: leading cause of years lost due to disability
• the burden is 50% higher for females than for males
Life Expectancy:
• Zambia 37, Malawi 47, Lesotho 48, Afghanistan 48
• Mozambique 49, Sierra Leone 49, Zimbabwe 49, Chad 47
• India 65, Iraq 66, Oman 74, United States 79, Norway 81
• Singapore 82, Israel 82, San Marino 83
THE DANCE BETWEEN HEALTH AND DEVELOPMENT

3. NCDs cause 63% of global deaths, and are largely preventable
NURS 482
Cautionary Chronic
Chronic, noncommunicable disease (NCD): A Global
Crisis
• Low and middle income countries have 80% of deaths.
• By 2015 ~ 2.3 billion adults will be overweight.
• 700 million will be obese.
• Diabetes increased 70% in last 10 years.
• By 2020, estimated 10% of all deaths will be from smoking.
• Elimination of risk factors can prevent 75% of all heart disease, stroke
and type 2 diabetes, with a cancer decrease of 40%.
Health.
ion 2011 Reprinted 2011

4. Global Health Indicators
NURS 482
Millennium Development
Goals.
Built on IMHE’s DAH and GHE.
To achieve by 2015.
• Eradicate extreme poverty
and hunger
• Achieve universal primary
education
• Promote gender equality
• Reduce child mortality
• Combat HIV/AIDS, malaria
and other communicable and
non communicable diseases
• Ensure environmental
sustainability
• Develop global partnership for
development.
MDG 8IMHE
WHO. Disability-adjusted life
years (DALYs). How many
year of life lost through death
and disability.
• Valid, impartial and
consistent estimates of
disease occurrence and
injury for all 21 regions of the
world
• Cause-specific mortality by
region: estimating global
mortality
• Calculate the health state
severity weight (who is
healthier: a blind person or a
chronic pain person?)
• Estimate years lived with
disability (YLD), years of life
lost (YLL)
Burden of Disease
Institute for Health Metrics
and Evaluation
University of Washington. Seattle,
USA
Focus:
• Major world health problems and
disease
• Is society addressing these
issues?
• How best to commit health
resourses to maximize health
improvement?
IMHE: tracks >$200 billion of
private and public contributions
annually
Only 12 of top 20 countries with highest disease burden receive the most
development assistance for health (DAH) and government health
expenditure (GHE). Remaining 8 countries are middle income.
Health Metrics and Evaluation. 2010. IMHE.
Financing Global Health 2012: End of a Golden Age? IMHE.
Millennium Development goals. MDGs. IMHE.

5. Your Logo
Global Health Indicators
• Direct phenomena - death and disease
– Developing countries maintain poor records
• Indirect measures - poverty, education, social cohesion
and stability
• Water and sanitation
• Behavior and lifestyle-alcohol, smoking, diet, exercise
Characteristics for high, medium and low burden of disease

6. NURS 482
Global Health Bodies
Donor governments
National governments
Bilateral development agencies
Multinational governments
Foundations
Non-governmental agencies
Corporations
Academic institutions

7. NURS 482
Continent with majority of poor counties. This region
accounts for 67%-71% deaths in the world.
DAH per US dollar- varies from $1 a day to $75.00 a day,
depending on country, not the disease.
Research and Development
Vaccines
Public Project, Public Goods
Middle East disbursements decreased by 8.1%
($519 million total allocation)
Improved from a loss of 70.8% in 1990. More
transparency, improved reporting and
allocation.
1999-2012
Development Assistance for Health (DAH)
Sub
Unallocated
funds
36.4% annually
Global
$3.5 Billion
Sub-Saharan
Africa 24% DAH
$8.1 Billion.

8. • Zimbabwe, 2009. Most nursing and medical schools suspended programs due to lack
of adequate facilities, support, supplies.
Only dental technician school closed their doors. Little improvement today.
• South African-Cuban Health Cooperation Agreement
Cuba trains S.A. MD’s for rural sector. One in 5 MD’s within 5 years of graduation migrates out of
the country.
• Aid is allocated to specific illnesses rather than general healthcare.
• Two to three healthcare workers/1000
Africa has 24% of global disease burden, and has only 1% of total global health funding.
• Brain drain: RN’s leave for a living wage, better working conditions, better equipment,
and better education.
• Medical Education Partnership Initiative (MEPI). Training and retention.
Healthcare conditions in Africa

9. Interpersonal, educational and societal growth potentials
Why volunteer globally?
Understanding that nurses have the power to change
Greater understanding of vulnerable populations
Learned cultural sensititvies and perspectives
Renewed passion in nursing profession
Exposure to ethics, policy, social justice and politics
Cognitive development
Positive global and local influence on colleagues
NURS 482

10. Chronic, noncommunicable diseases (NCDs):
A nursing perspective
• Representative survey of 1600 nurses in 8 countries.
• 95% said they wanted to use time and knowledge towards
prevention and education of NCDs.
• 98% said that to work load and time pressures prevent them from
devoting more time.
• Work and environment issues need to be addressed so that first line
healthcare providers can maximize their potential.
Decola, P., Benton, D., Peterson, C. & Matebeni, D. (2012) International Nursing Review
NURS 482

11. NURS 482
International Organizations
Nursing, applied research, education
GLOBAL HEALTH COUNCIL
Evidence based approach to global health. Excellent publications and monthly magazine. Funded by Department of
State international Affairs and the Department of Health and Human Services
FOGARTY INTERNATIONAL CENTER (NIH)
• Supports applied research, clinical training through grants and fellowships.
INTERNATIONAL COUNCIL OF NURSES (ICN)
• > 130 national nurses associations worldwide. Largest international healthcare organization.
• 13 million members – seek to advance nursing and positively impact health policy
INTERNATIONAL NETWORK FOR DOCTORAL EDUCATION IN NURSING (INDEN)
• Curriculum development, program evaluation, collaborative research, innovation in doctoral education.
GLOBAL RESEARCH NURSES. Part of Global Health Network.
• Open to all RN’s interested international research.
• Great resources and guidelines on prevention and management of disease
AFRICAN HEALTH OER NETWORK (open educational resources)
• South African Institute for Distance Learning (SAIDE)
• Share video lectures, health information exchange, networking, e-learning, health IT workforce curriculum.

12. NURS 482
Humanitarian, Grassroots Organizations
Volunteer, Immersion and Educational Programs
 Johns Hopkins Centre for Global Health
 Johns Hopkins Center for Clinical Global Health Education
 Medecins Sans Frontieres / Doctors without Borders
 Global Health Immersion Programs. RN’s and MD’s. Excellent resource.
 World association of Non-governmental Organizations
 Peace Corps (Volunteer for 2 years, than eligible for any qualified Federal Job).
 PATH. Global healthcare advocacy, collaboration and education
 Global Volunteer Network-GVN. Charitable trust
 Cross Cultural Solutions
 International Volunteer HQ (IVHQ)
 Child Family Health International (CFHI)
 M.E.D.I.C.O. – Central America
 Mission of Mercy

13. INTERNATIONAL
HEALTHCARE INTERNET RESOURCES
Pitt.edu
Duke.edu
Globalhealthlibrary.net
Fundisaforum.org
NURS 482
FUNDISA
Forum of University Nursing Deans in South
Africa
Provides excellence in nursing practice,
research and education.
AFRICAN HEALTH OER NETWORK
(open educational resources)
• South African Institute for Distance
Learning (SAIDE)
• Share video lectures, health information
exchange, networking, e-learning, health
IT workforce
Global Health Library
Supercourse:
Epidemiology, the Internet and
Global Health
Lectures, videos, publications. Over
56,000 professionals in 174 countries.
Library >5000 lectures in 31 languages.
Exhaustive resource on global health,
disease management, education and
prevention.
Call for a nursing Supercourse. Currently
has small dedicated nursing section.
WHO-NIH-PITT.EDU SUPERCOURSE

14. NURS 482
Global nursing ethical considerations
• Affordable and sustainable
• Culturally bound: Informed consent is moral and social collective, not an individual
• African Autonomy? UBUNTU. I am because we are.
• Be aware of any “colony” mentality: intimidation, paternalism, exploitation and power imbalance
• Altruism and self interest balance
• Psychological and spiritual distress awareness
• Scarcity of resources: should the poor receive more allocation because of need?
• Cannot ignore political influence and social impact
• Researching on children-special considerations
• Resources:
– Council for International Organizations of Medical Ethics
– World Medical Association
– Integrated Regional Information Networks (IRIN)
Autonomy, non-maleficence, beneficence and distributive justice

15. Conclusion
Nursing in a global economy
Global healthcare is an
ethical, societal, economic, political and
humanitarian force.
Nurses are the greatest number of healthcare
professionals in the world.
Involvement in global theoretical, research-
based and applied clinical health issues adds a
multifaceted prowess and aptitude which
otherwise would be difficult to attain.
The weight and influence in one’s personal and
professional life is potentially boundless.

16. References
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor
clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study, 2010.
Beaglehole, R. et al. (2011). The Lancet. 377(9775) 1438-1447. WHO International: Global status report on
noncommunicable disease.
Carter, B. (2009). International Journal of Nursing Studies. 46(6), 858-864. Tick box for child? The ethical
position of children as vulnerable, researchers as barbarians and reviewers as overly cautious.
Decola, P., Benton, D., Peterson, C. & Matebeni, D. (2012) International Nursing Review 59, 321–330. Nurses'
potential to lead in non-communicable disease global crisis.
Harrowing J.N., Mill J., Spiers J., Kulig J. & Kipp W. (2010). International Nursing Review 57, 70-77.
Cultural, context and community: Ethical considerations for global nursing research.
Health care: an African solution. The Lancet. 26 March 2011. doi:10.1016/S0140-6736(11)60417-0
Human Resources for Health (2009). Zimbabwe Health Workforce Observatory. Country Profile: ZIMBABWE.
Retrieved from http://www.hrh-
observatory.afro.who.int/images/Document_Centre/zimbabwe_hrh_country_profile.pdf
Leach-Kemon, K., Chou, D. P., Schneider, M. T., Tardif, A., Dieleman, J. L., Brooks, B. P. C . . . Murray, C. J. L.
(2012). Health Affairs,31(1), 228-35. The global financial crisis has led to a slowdown in growth of funding to
improve health in many developing countries. Retrieved from
http://ezproxy.loyno.edu/login?url=http://search.proquest.com/docview/916577842
Lim S.S., Vos T., Flaxman A.D., Danaei G., Shibuya K., Adair-Rohani H., Amann M., ... Ezzati M. (2012). The
Lancet, 380(9859), 2224-2260.

17. References
References continued
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. (2012). The Lancet. 380(9859):2197–2223.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for
the Global Burden of Disease
Study 2010. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61689-4/fulltext
Noyes, J. (2011). Global development opportunities for nursing practice. Journal of Advanced Nursing, 67(4), 689.
doi:http://dx.doi.org.ezproxy.loyno.edu/10.1111/j.1365-2648.211.05677
The Lancet. (2012). 380(9859) 2197-2222. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21
regions, 1990—2010: a systematic analysis for the Global Burden of Disease Study 2010.
World Health Organization. 2009. Global Health Risks
Mortality and burden of disease attributable to selected major risks. Retrieved from
http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
World Health Organization. 2012. Mortality and Burden of Disease
WHO International. 2012. Global Health Indicators.
World Health Organization. UNICEF. 2012. Child Mortality Estimates
World Health Organization. 2013. Maternal Mortality