The Public Health Nursing Series is a 20-blog collection, written by William (Billy) Rosa, author of the recently released 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 #11 – Sustainable Cities & Communities

With roughly half of the world’s population – 3.5 billion people – living in cities and over 828 million people living in slums, cities across the world account for about 3% of the Earth, but account for up to 80% of all energy consumption and 75% of carbon emissions (United Nations Sustainable Development [UNSD], 2016). As developing nations focus their industry and innovation efforts on the modernization of their cities, their respective communities must continue to have access to safe housing, clean water, effective sanitation mechanisms, and adequate healthcare delivery. As urbanization continues to be the priority for many countries seeking economic advancement, quality of life for all metropolis inhabitants should be enhanced along with the city’s progress.

Sustainable Development Goal (SDG) #11 has been designed to ensure that all cities worldwide are inclusive, safe, resilient, and sustainable by 2030. This requires not only an environmental consciousness, but also a commitment to promoting health for all global citizens regarding the preservation of national culture, accessible transportation, and reliable infrastructure. According to UNSD (2016), Some of the targets for SDG #11 include:

  • Access for all to adequate, safe, and affordable housing options and the upgrading of slums
  • Access to safe and affordable transport for all through improvement in public transportation services, with attention to the needs of the vulnerable and disabled
  • Protection of the all cultural and natural heritage sites
  • Ensure environmental well-being through attention to air quality, waste management, the use of clean energy, and lessening the climate change burden
  • Support low-income countries to construct buildings that are both sustainable and resilient

Through deliberate planning and the creation of efficient cross-cultural partnerships, cities have the potential to push the global development envelope while remaining cognizant and responsive to the diverse needs of their people.

Using a holistic wellness model, public health nurses can help to identify community strengths and nurture resilience throughout the change process of urbanization. Clark (2002a) calls for nurses to assess for and further develop physiological, psychological, social, and spiritual community strengths, such as education, coping skills, support systems, and problem-solving abilities. In this way, we become advocates who strengthen positive community characteristics and foster a sense of resilience within cities and populations.

Public health nurses may use a community development approach in helping implement SDG #11. This approach “views health and wellness within the broader context of social and economic improvement, and it views resident empowerment as a vital element in achieving health and wellness” (Clark, 2002b, p. 35). In continuing to assess the health and wellness of developing cities and communities, several in-depth considerations need to be given. However, Clark (2002b) suggests starting with these reflections:

  • Whom do I work with to collect needed information?
  • How can I work most effectively with the identified community representatives?
  • How can I understand the processes that affect health and wellness in this community?

A fundamental understanding of available resources is needed to successfully proceed with a community assessment and respond with meaningful and contextually appropriate solutions.

The public health nurse will need to consider key aspects of the community, from geographical composition and vital statistics regarding births and deaths, to morbidity and mortality and communicable disease rates, to available education, employment opportunities, marriages, divorces, accessible health services, and police reports (Benjamin, 2012). It is vital to understand the community’s history and the progress they have made toward their goals to date in order to acknowledge accomplishments and strategically plan for the future. Furthermore, it is essential to assess the readiness of individuals and larger cities for the radical transformation indicative of urban development. By doing so, we will be better able to support them as they move through the fluctuations inherent to any change process.

Jeffreys and Antoine (2016) urge us to consider the “cultural revolution” in healthcare by availing ourselves to the concerns and challenges experienced by clients worldwide, from their perspective and context. At the heart of this process, we are required to become attuned to our own cultural arrogance, surrender ways of being that are fixed and culturally insensitive, and embrace strategies that are both inclusive and humble (Soulé, 2016). By maintaining this sensibility and remaining open and available, we can come to understand our role in procuring safe and inclusive cities that promote health and well-being for all by 2030.

Benjamin, B.B. (2012). Building relationships and engaging communities through collaboration. In AL. Cupp Curley & P.A. Vitale (Eds.), Population-based nursing: Concepts and competencies for advanced practice (pp. 211-237). New York, NY: Springer.

Clark, C.C. (2002a). A model for health and wellness promotion in communities. In C.C. Clark (Ed.), Health promotion in communities: Holistic and wellness approaches (pp. 3-14). New York, NY: Springer.

Clark, C.C. (2002b). Community self-assessment. In C.C. Clark (Ed.), Health promotion in communities: Holistic and wellness approaches (pp. 35-45). New York, NY: Springer.

Jeffreys, M.R. & Antoine, K. (2016). Overview of key issues and concerns. In M.R. Jeffreys (Ed.), Teaching cultural competence in nursing health care: Inquiry, action, and innovation (3rd ed.) (pp. 3-39). New York, NY: Springer.

Soulé, I. (2016). Flexible and responsive: Applying the wisdom of “It depends.” In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership (pp. 417-430). New York, NY: Springer.

United Nations Sustainable Development (UNSD). (2016). Goal 11: Make cities inclusive, safe, resilient, and sustainable. Retrieved from cities/

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, was recently published by Springer Publishing 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 15 - Sustainable Development Goal #12 - Responsible Consumption and Production