CHAPTER 1: THE WORLD AS

COMMUNITY: GLOBALIZATION AND

HEALTH
GLOBAL HEALTH AND GLOBALIZATION

Nurses provide 60-80% of the worlds healthcare

22% of the worlds population live below the poverty line of $1.25 a day
10% of the worlds resources are used to address the health problems that
affect 90% of the worlds population
Health disparity: systematic, plausibly avoidable health differences
according to race, skin color, religion, or nationality; gender, sexual
orientation, age, geography, disability, illness, political affiliation; or other
characteristics associated with discrimination
Globalization: a term used to refer to the increasing economic, political,
social, technological, and intellectual interconnectedness of the world
o Positive effects: diffusion of ideas, technologies, and innovations that
lead to improvements to safe water, medications, and treatments
Emerging global stewardship growing recognition of
common threats
o Negative effects: increased crowding in urban areas, increased
health problems associated with adoption of unhealthy western
lifestyles, and fast transmission of infectious diseases due to increased
global travel microbial hitchhikers
Brain drain: migration from lower resource countries to
higher resource countries

MAJOR GLOBAL HEALTH PROBLEMS

Global Burden of Disease: the disability adjusted life year (DALY) a time
based measure combining years of life lost due to premature mortality and
years of life lost due to time lived in states of less than full health
Greatest disease risks:
o High blood pressure
o Tobacco and alcohol use
o Poor diet
Top 12 Causes of Death in the World
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Ischemic heart disease

Cerebrovascular disease
COPD
Lower respiratory
infections

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Lung cancer
HIV/AIDS
Diarrheal diseases
Road injury
Diabetes

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Tuberculosis
Malaria

Cirrhosis

10 Facts about Global Health

o Around 7 million children under age 5 die each year
o Cardiovascular diseases are leading cause of death in the world
o HIV/AIDS is leading cause of adult death in Africa
o Population ageing is contributing to rise in cancer and heart disease
o Lung cancer is the most common cause of death from cancer
o Complications of pregnancy account for almost 15% of deaths in
women of reproductive age worldwide
o Mental disorders such as depression are among the 20 leading causes
of disability worldwide
o Hearing loss, vision problems, and mental disorders are the most
common causes of disability
o Nearly 3500 people die from road traffic crashes every day
o Under nutrition is the underlying cause of death for at least 1/3 of all
children under 5

CLIMATE CHANGE

Ways
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climate may influence health outcomes:

Changes in intensity of extreme heat waves, floods, and droughts
Changes in air pollutants and allergens
Alterations in ecosystems, water, and food supplies that influence the
incidence of infectious diseases and nutritional status
o Population displacement due to rising sea levels
Potential health effects of climate change:
o Elderly and vulnerable groups at greatest risk for exposure to
catastrophic weather events (hurricanes and extreme heat)
o Increased flooding possible food and water shortages mass
migration
o People affected by disasters and economic problems will be vulnerable
to mental health stresses
o Many vector borne diseases may become more frequent and
widespread

THREATS TO GLOBAL PUBLIC HEALTH SECURITY

Important for nurses to be familiar with plans in the local community for
potential threats to public health security
Global Health Diplomacy: a political change activity that meets the dual
goals of improving global health while maintaining and strengthening
international relations abroad
Important for nurses to engage in critical dialogue about ethical and moral
conflicts providing health care as a humanitarian responsibility

MILLENNIUM DEVELOPMENT GOALS

Millennium Declaration, 2000: a set of eight goals and specific targets

under each goal designed to reduce poverty, reduce global inequalities, and
promote health and social welfare
1. Eradicate extreme poverty
Use of microfinance programs to provide the poor with access to
financial services (savings plans and low-interest loans)
Effective in reducing poverty and may also contribute to
improved health outcomes by increasing knowledge and
access to health care
VPO: village phone operators; sell calls to neighbors and
increase access to the outside world
Beneficial to poor village women earned money to
invest in education, health, and nutrition of their children
and families
Stimulated local businesses
2. Achieve universal primary education
There is a strong correlation between education and health
Only 76% of children in sub-Saharan Africa attend primary
school
3. Promote gender equality and empower women
Women still lag behind men in accessing tertiary education
Equal job access has increased from 35 to 40%
Women are often the major family caregivers and assume
primary responsibility for healthcare decisions
4. Reduce child mortality
Decrease from 97/1,000 to 63/1,000
Target: have a 2/3 reduction in deaths of children under age 5,
but has not yet been met
Closely related to poverty, AIDS, malaria, war, and conflicts
5. Improve maternal health
Only 2/3 of deliveries in the developing world are now attended
by skilled personnel
Key strategies: increased access to prenatal care, skilled birth
attendants, and prevention of teen and unplanned pregnancies
6. Combat HIV/AIDS, malaria, and other diseases
There are 21% fewer cases of HIV infections
Highest rates of HIV are in Saharan Africa and the Caribbean
Presidents Emergency Program for AIDS Relief (PEPFAR):
initiative of the US government that provides funding for
medications, care, and treatment of patients with HIV
Targets 15 countries with the highest rates of HIV
Malaria: most effective prevention strategies is the use of
insecticide-treated bed nets
7. Ensure environmental sustainability
Only 56% of the worlds population has access to basic
sanitation
8. Develop a global partnership for development

Make available the benefits of increased technology and

communication
Provide educational and learning programs
Deliver health care using telenursing
Help to develop interoperable electronic health record systems
to facilitate sharing data and improve decision making
Facilitate knowledge management
Develop collaborative partnerships around the world

GLOBAL NURSING SHORTAGE

How to help with the shortage:

o Advocate for nursing leadership in local, state, US, and world positions
o Support policies for ethical recruitment and retention of nurses from
other countries
o Implement policies to promote safe and just working environments
o Strengthen professional nursing organization
o Partner with health related non-governmental organizations
o Promote standard of education

EIGHT ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE

1. Education for identification and prevention/control of prevailing health

problems
2. Proper food supplies and nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child care, including family planning
5. Immunization against the major infectious disease, prevention, and control of
locally endemic diseases
6. Appropriate treatment of common diseases using appropriate technology
7. Promotion of mental health
8. Provision of essential drugs