The Public Health Nursing Series is a 20-blog collection, written by William (Billy) Rosa, author of the forthcoming title, Nurses as Leaders: Evolutionary Visions of Leadership (June 2016), that sparks a dialogue about each and every nurse's role in advancing and creating the future of global health. With a focus on cultural considerations and the current status of healthcare in nations worldwide, nurses will learn how they are called to contribute to each of the United Nations' 17 Sustainable Development Goals, an international initiative that seeks to end poverty, protect the planet, and ensure prosperity for all over the next 15 years.This series makes the case that every nurse, regardless of title, position, or credential, is a public health leader.

Sustainable Development Goal #1: No Poverty (Part 4)

With the recent creation and ongoing implementation of the Sustainable Development Goals (SDGs), public health nurse leaders play a vital role assisting the United Nations Development Programme (UNDP; 2016a) in “addressing the root causes of poverty and the universal need for development that works for all people.” The SDGs advocate to further address the worldwide anti-poverty work initiated by the Millennium Development Goals (MDGs) and improve quality of life for the global community by 2030 (UNDP, 2016b). In short, the 17 SDGs aim to:

  • End poverty, hunger, and inequality
  • Take action on climate change and the environment
  • Improve access to health and education
  • Build strong institutions and partnerships
  • Address climate change and the importance of environmental stewardship
  • Promote peace and justice for all human beings.

Public health nurses must seek out information about the SDGs and the work being done so they can create opportunities to translate their nursing scope and expertise to each of the goals. The next posts in this blog series address how the contributions of public health nurse leaders are essential components of realizing the SDGs by 2030.

The first SDG is “No poverty.” To be clear, it does not simply look to mitigate the poverty experienced by much of the world’s population – it seeks to eliminate it. In fact, it is determined to “End poverty in all its forms everywhere” (UNDP, 2016c). Extreme poverty throughout the world has been cut in half, from 1.9 billion in 1990 to 836 million in 2015 (UNDP, 2016c). This means that over 800 million people continue to live on just over $1.00 per day and have insurmountable barriers to adequate sanitation, clean water, or enough food. Clearly, we are not there yet.

If we are to facilitate poverty reduction and end extreme poverty, we need to have all the information (World Bank, n.d.), i.e.: Who are the poor? Where do they live? Where is poverty the deepest? Global Finance (2015) shows that of the 25 poorest countries in the world, 21 of them are in Africa, with the poorest nation being the Central African Republic (CAR). With a population of 4.6 million, the country has experienced political instability since its freedom from France in 1960, and in 2013 experienced extreme turmoil as Muslim rebels sought to overthrow the Christian government. Currently, the CAR is under international supervision and being assisted by a UN peacekeeping force while a constitutional referendum and elections hope to stabilize its political status (BBC, 2016).

The link between the political scenario and poverty status in the CAR and the work of every public health nurse leader is clear. Nurses know that health is a human right. But do they realize that the alleviation of economic influences that threaten health – such as poverty - is also a human right (Upvall, Leffers, & Mitchell, 2014)? Poverty and health are intimately related; it becomes an ethical priority of social justice to strive for the identification and eradication of health disparities wherever they may occur (Nickitas, 2016). Nurses must learn how to articulate the injustices they observe, address the inequities and inefficiencies of health care infrastructures, and clearly delineate how human rights violations, such as extreme poverty and barriers to health care access and delivery are intertwined (Nickitas, 2008).

Public health nurse leaders must be powerful and informed advocates for equality in health care and understand what it means: “equal care to all populations with no stratification of its delivery” (Fitzgerald, 2016). In low-income countries and resource-limited settings, this can be quite challenging to ensure. Nurses in the CAR may be the only provider available throughout rural village areas - the difference between life and death for many – and often go without wages for weeks or months at a time (Jones, 2014). Public health nurses must use the power of their voice to hold NGOs and program implementation leaders accountable for the appropriate use of funds in improving health care services and investing in sustainable resources (Lindgren, Rankin, & Schell, 2015).

In low-income countries, nurses are the agents of change that bridge the ideals of health promotion to the doorsteps of those who need care (Manjrekar, 2016). The power of the public health nurse as advocate-leader-practitioner cannot be overlooked, particularly when striving to eradicate poverty in the name of social justice and health equity. So if you can’t go work in the CAR to improve systems, use your voice. If the timing is not right to travel to Africa and create programs that uproot the virus of poverty, take a trip to the resource-constrained areas of your hometown and assess how your skills are needed. Global health – public health – health care: all interconnected and all more closely related than we might think at first glance. If I am a global citizen and a public health nurse leader, I need not look far to see how my knowledge base and skill set can be aptly utilized.

Deva-Marie Beck (2016), international codirector of the Nightingale Initiative for Global Health (NIGH; 2016), asks and answers a pivotal question for our time… it applies to the soup kitchen in Chicago as much as to the city of Bambari in the CAR:

Global health is accomplished through the application of communications at global levels. It is the worldwide advocacy of the health needs of humanity; the dissemination of care and concern for problems that still need to be solved and the identification of how solutions have been and can be achieved.  What are the tasks and tools of global nursing? We are already accomplished advocates. The task of global advocacy is simply the widening of our scopes to share the value of our perspectives and the effectiveness of our practices with the more expansive world. Our tools are all around us.

“End poverty in all its forms everywhere” – the tools are all around you.

 References

BBC. (2016). Central African Republic country profile. Retrieved from http://www.bbc.com/news/world-africa-13150040

Beck, D.M. (2016). Artistic and scientific: Broadening the scope of our 21st century health advocacy. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Fitzgerald, M.A. (2016). Powerful and beneficent: Seizing opportunity in practice and equality in health care. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Global Finance. (2015). The poorest countries in the world. Retrieved from https://www.gfmag.com/global-data/economic-data/the-poorest-countries-in-the- world?page=2

Jones, P. (2014). Health workers on the frontline. British Journal of Healthcare Assistants, 4(9), 460.

Lindgren, T., Rankin, S., & Schell, E. (2015). Working globally with faith-based organizations. In S. Breakey, I.B. Corless, N.L. Meedzan, & P.K. Nicholas (Eds.), Global health nursing in the 21st century (pp. 453-470). New York, NY: Springer.

Manjrekar, P. (2016). Resourceful and unified: Partnering across cultures and worldviews. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Nickitas, D.M. (2008). Changing the world with words. Nursing Economic$, 26(3), 141.

Nickitas, D.M. (2016). Ethical and economical: Calling the profession to social justice. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Nightingale Initiative for Global Health (NIGH). (2016). About. Retrieved from http://www.nighvision.net/about.html

United Nations Development Programme (UNDP). (2016a). Sustainable Development Goals (SDGs). Retrieved from http://www.undp.org/content/undp/en/home/sdgoverview/post- 2015-development-agenda.html

United Nations Development Programme (UNDP). (2016b). World leaders adopt Sustainable Development Goals. Retrieved from http://www.undp.org/content/undp/en/home/ presscenter/pressreleases/2015/09/24/undp-welcomes-adoption-of-sustainable- development-goals-by-world-leaders.html

United Nations Development Programme (UNDP). (2016c). Goal 1: No poverty. Retrieved from http://www.undp.org/content/undp/en/home/sdgoverview/post-2015-development- agenda/goal-1.html

Upvall, M.J., Leffers, J.M., & Mitchell, E.M. (2014). Introduction and perspectives of global health. In M.J. Upvall & J.M. Leffers (Eds.), Global health nursing: Building and sustaining partnerships (pp. 1-18). New York, NY: Springer.

World Bank. (n.d.). The state of the poor: Where are the poor and where are they poorest? Retrieved from http://www.worldbank.org/content/dam/Worldbank/document/ State_of_the_poor_paper_April17.pdf

More About the Author

William (Billy) Rosa, MS, RN, LMT, AHN-BC, AGPCNP-BC, CCRN-CMC, is currently Visiting Faculty, University of Rwanda and ICU Clinical Educator, Rwanda Military Hospital, Human Resources for Health Program in partnership with the New York University Rory Meyers College of Nursing. He currently has over 65 publications for refereed and non-refereed journals, newspapers, magazines, and national platform blogs and his book, Nurses as Leaders: Evolutionary Visions of Leadership, will be released by Springer in June 2016. Billy currently sits on the US Advisory Board for the Nightingale Initiative for Global Health, and most recently received the American Association of Critical-Care Nurses' 2015 National Circle of Excellence Award and the Association for Nursing Professional Development's 2015 National Change Agent/Team Member Award.

Quick Links

Part 1 -  Understanding the Nurse as a Public Health Leader

Part 5 - Sustainable Development Goal #2 - No Hunger