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'Global health' and 'global nursing': Proposed definitions from The Global
Advisory Panel on the Future of Nursing

Article  in  Journal of Advanced Nursing · April 2016

DOI: 10.1111/jan.12973

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DISCUSSION PAPER

‘Global health’ and ‘global nursing’: proposed definitions from The

Global Advisory Panel on the Future of Nursing
Lynda Wilson, Isabel Amelia Costa Mendes, Hester Klopper, Cathy Catrambone, Rowaida Al-Maaitah,
Mary E. Norton & Martha Hill

Accepted for publication 8 March 2016

Correspondence to L. Wilson:
e-mail: lyndawilson@uab.edu
Lynda Wilson PhD RN
Retired Professor
School of Nursing, University of Alabama at
Birmingham, Alabama, USA
Isabel Amelia Costa Mendes PhD RN
Full Professor and Director
PAHO/WHO Collaborating Center for
Nursing Research Development, University
of S~
ao Paulo at Ribeirao Preto College of
Nursing, Brazil
Hester Klopper PhD FAAN RN
Professor
University of the Western Cape and
INSINQ Research Unit, North-West
University (Potchefstroom Campus),
Bellville, South Africa
Cathy Catrambone PhD FAAN RN
Associate Professor
Rush University College of Nursing,
Chicago, Illinois, USA
Rowaida Al-Maaitah DrPH RN
Professor/Chairperson of the Health Policy
Research-Based Forum
Faculty of Nursing, Jordan University of
Science and Technology, Irbid, Jordan
WILSON L., MENDES I.A.C., KLOPPER H., CATRAMBONE C., AL-MAAITAH R., NORTON M.E. &
HILL M. (2016)‘Global health’ and ‘global nursing’: proposed definitions from The
Global Advisory Panel on the Future of Nursing. Journal of Advanced Nursing 00
(0), 000–000. doi: 10.1111/jan.12973
Abstract
Aims. To propose definitions of global health and global nursing that reflect the
new paradigm that integrates domestic and international health.
Background. Increased globalization has led to expanded awareness of the
importance of global health and global nursing among students and faculty in the
health professions and among policymakers and practitioners.
Design. Discussion paper that includes a discussion and review of the literature
related to global health and global nursing.
Data sources. A task force searched for and reviewed articles published in
English, Spanish or Portuguese between 2005-2015, developed summaries, listed
key elements, identified prevalent themes and developed consensus definitions.
Implications for nursing. The definitions will be used by the Global Advisory
Panel on the Future of Nursing to guide promoting a voice and vision for nursing that
will contribute to the advancement of the profession’s contribution to global health.
Conclusions. Definitions of global health and global nursing were developed
based on main themes and concepts identified in the literature review to guide
contributions of nursing to global health.
Keywords: definition, global health, global nursing

Mary E. Norton RN EdD APN

Professor and Executive Director
The Center for Global Academic Initiatives,
Felician University, The Franciscan
University of New Jersey, Lodi, New Jersey,
USA

Martha Hill PhD FAAN RN

Dean Emerita/Professor Nursing, Medicine
and Public Health
School of Nursing, Johns Hopkins
University, Baltimore, Maryland, USA

© 2016 John Wiley & Sons Ltd 1

L. Wilson et al.
Why is this review needed?
 Increased globalization has led to expanded awareness of
the importance of global health among students and fac-
ulty in the health professions and also among policymakers
and practitioners.
 The Global Advisory Panel on the Future of Nursing was
established by Sigma Theta Tau International to create a
voice and vision for the future of nursing and midwifery
that will advance global health.
 To support the mission of the Global Advisory Panel on
the Future of Nursing, it is important to have consensus
on the definition of global health and global nursing.
What are the key findings?
 Based on a review of the literature the authors proposed defi-
nitions of global health and global nursing to guide the work
of the Global Advisory Panel on the Future of Nursing.
The authors suggest that Global health refers to an area for
practice, study and research that places a priority on improv-
ing health, achieving equity in health for all people and ensur-
ing health-promoting and sustainable sociocultural, political
and economic systems. Global health implies planetary health
which equals human, animal, environmental and ecosystem
health and it emphasizes transnational health issues, determi-
nants and solutions; involves many disciplines within and
beyond the health sciences and promotes interdependence and
interdisciplinary collaboration; and is a synthesis of popula-
tion-based prevention with individual holistic care.
 The authors suggest that Global nursing is the use of evi-
dence-based nursing process to promote sustainable plane-
tary health and equity for all people. Global nursing
considers social determinants of health, includes individual
and population-level care, research, education, leadership,
advocacy and policy initiatives. Global nurses engage in eth-
ical practice and demonstrate respect for human dignity,
human rights and cultural diversity. Global nurses engage in
a spirit of deliberation and reflection in interdependent part-
nership with communities and other healthcare providers.
How should the findings be used to influence policy/
practice/education?
 The definitions can be used by policy makers, researchers, clin-
icians and educators to guide the identification of global health
st
competencies needed by 21 century nursing professionals.
Introduction
Increases in globalization have led to expanded awareness
of the importance of global health among students and fac-
ulty in the health professions and also among policymakers
2 © 2016 John Wiley & Sons Ltd
and practitioners. Nurses and the individuals they supervise
are major contributors to global health care. Their voice
will be critical to achieve global health goals and contribute
to the grand convergence in global health that has been pre-
dicted to occur by 2035 (Jamison et al. 2013). Several
World Health Assembly resolutions have recognized the
important contributions of nurses and midwives to global
health, including a resolution passed in 2006 related to the
strengthening of nursing and midwifery ‘as a means of
achieving better health for all communities’ (World Health
Organization 2006).
In November 2013, the Honor Society of Nursing, Sigma
Theta Tau International (STTI), announced the creation of
the Global Advisory Panel on the Future of Nursing (GAP-
FON) to establish a voice and vision for the future of nurs-
ing and midwifery that will advance global health (Klopper
& Hill 2015). An inaugural panel of 17 members from nine
countries in different regions of the world was appointed in
March 2014, selected to bring diverse perspectives of global
nursing leaders from different regions of the world to
address the GAPFON purpose. At the initial meeting they
identified key issues needed for reform, advocacy and inno-
vations in leadership, policy, education and work environ-
ments (Klopper & Hill 2015). It became clear that one of
the first steps needed was the development of a consensus
definition of global health and global nursing to guide the
panel’s work and to provide a framework to guide subse-
quent discussion with stakeholders within global regions.
Thus, a task force of seven GAPFON members was con-
vened to review the literature related to global nursing and
global health and to propose a definition of these two terms
to the GAPFON members. The definitions were shared with
members during a conference call in July 2014 and during
the second face-to-face GAPFON meeting held in December
2014. This discussion paper summarizes the key elements
identified during the literature review and during multiple
conference calls among task force members and presents
the final definitions proposed for global health and global
nursing.
Background
Several authors have described the historical development
and evolution of the concept of global health, which has
evolved from the concept of international health. Rowson
et al. (2012) suggested that a focus on international health
began in the colonial era of the 19th century. Frenk et al.
(2014) suggested that the concept of international health
emerged in the early 20th century, around the time when
the International Health Commission was created by the
JAN: DISCUSSION PAPER
Rockefeller Foundation. In the early years, international
health focused on control of global epidemics and unilat-
eral programmes addressing health needs of low resource
countries, or of indigenous populations of higher resource
countries. Bozorgmehr et al. (2011) described the evolution
of the view of global health from a focus on addressing
health issues (primarily infectious diseases) through devel-
opmental aid or charitable missions to a focus on interna-
tional interdependency and a valuing of health as a
universal human right. Although global health and public
health are often perceived as health that focuses on needs
of poor or disadvantaged people (Harrar 2008), there is
increasing consensus that global health refers to universal
health for all (Janes & Corbett 2009, Campbell et al.
2012).
The literature review indicated that although there has
been increasing interest in conceptualizing and defining the
concept of global health, there is still no universally
accepted definition of this term (Carlton et al. 2007,
Bozorgmehr 2010, Aluttis et al. 2014). Some have even
questioned the value of trying to define global health. For
example, Engebretsen and Heggen (2015) suggested that
‘global health does not only allude to supranational depen-
dency in the health field but refers to a norm or vision for
health with global ambitions. It implies a homogenization
of a world view of health with someone in the role as Cos-
motheros (world viewer). . .(that) involves a limitation of
possibilities’ (p. 115). Rowson et al. (2012) suggested that
the definition of global health depends on the ‘definer’, and
is likely to change over time. Other authors, however, have
advocated for the need for a common definition of global
health, to guide development of global health educational
programmes and integrated global health programmes
(Koplan et al. 2009, Bozorgmehr 2010, Aluttis et al.
2014).
Nurses are key players in providing health care and
ensuring universal access to health care and they have the
potential to make significant contributions to global health
and to the Sustainable Development Goals as advocates,
managers and leaders and care providers, educators and
researchers. In recognition of the need for a voice and
vision for nursing to advance this agenda and the parallel
mission of Sigma Theta Tau, International (STTI), GAP-
FON was established to promote greater global nursing col-
laboration and to mobilize nursing’s contributions to
improving global health. Nurses’ contributions to global
health will be enhanced by a clearer understanding of the
concept of global health and global nursing. Such under-
standing will provide a platform for nursing practice, edu-
cation, research and leadership to advance and sustain
© 2016 John Wiley & Sons Ltd
Global health and global nursing
actions and solutions for an ambitious post-2015 develop-
ment agenda.
Data sources
The task force began its work by searching PubMed,
CINAHL, SCIELO and LILACS databases for articles pub-
lished in English, Spanish or Portuguese between 2005–2014
using key words ‘global health definition’, and ‘global nurs-
ing definition’. A second search was conducted in April 2015
to expand the timeline from 2005–2015. The search was lim-
ited to papers published during the past 10 years so that the
proposed definitions would reflect more recent conceptual-
izations of the concepts of global health and global nursing.
The search for articles related to ‘global health definition’
yielded a total of 753 articles from PubMed, 128 articles
from CINAHL, 43 articles from SCIELO and 0 articles from
LILACS. The search for articles related to ‘global nursing
definition’ yielded a total of 77 articles from PubMed, 17
from CINAHL, two from SCIELO and two from LILACS. In
addition, resources identified in the reference lists were
reviewed which resulted in the inclusion of one book related
to global nursing (Upvall et al. 2014) and two web-based
resources related to global health (HM Government 2008,
The European Commission 2010). The criteria for inclusion
in the review were that the article included a specific discus-
sion on the concepts of global health or global nursing.
Exclusion criteria included publication prior to 2005 and
lack of specific discussion on the concept of global health or
global nursing. A total of 21 references related to definitions
of global health and 6 related to definitions of global nursing
met the criteria for inclusion in our review (Boxes 1 and 2).
Task Force members shared responsibility for reviewing
the articles and developing summaries of the content related
to the definitions of global health and global nursing.. The
NVivo (Version 10) qualitative software program was used
to identify key concepts that were incorporated in the papers
that were reviewed. Following multiple conference calls dis-
cussing the article summaries, the seven task force members
incorporated the key concepts and their personal experiences
to come to a consensus definition for the terms ‘global
health’, and ‘global nursing’. A report summarizing the work
was shared with all 17 GAPFON members and consensus
was reached to use the proposed definitions. To facilitate a
synthesis of the literature for the present publication the orig-
inal summaries were further analysed using the NVIVO (Ver-
sion 10) © qualitative analysis software program. The
program facilitated the organization of the summaries
according to the key concepts that were used to organize the
literature review for this report (Figures 1 & 2).
3
L. Wilson et al.

Box 1
List of Documents Reviewed for Definition of Global Health

Aluttis C., Krafft,T. & Brand H. (2014) Global health in the European Union - A review from the agenda-setting
perspective. Global Health Action 13, 23610. doi: 10.3402/gha.v7.23610.
Beaglehole R. & Bonita R. (2010) What is global health? Global Health Action 3, 1–2. doi: 10.3402/gha/v3i0.5142.
Bozorgmehr K. (2010) Rethinking the ‘global’ in global health: a dialectic approach. Global Health 6, 19.
doi: 10.1186/1744-8603-6-19.
Bozorgmehr K., Saint V. A., & Tknnemann P. (2011) The ‘global health’ education framework: A conceptual guide
for monitoring, evaluation and practice. Global Health 18(7), 8. doi: 10.1186/1744-8603-7-8.
Brown T. M., Cueto M. & Fee E. (2006) The World Health Organization and the transition from “international”
to “global” public health. American Journal of Public Health 96, 62–72. doi: 10.2105/ajph.2004.050831.
Campbell R. M., Pleic M. & Connolly H. (2012) The importance of a common global health definition: How Canada’s defini-
tion influences its strategic direction in global health. Journal of Global Health 2, 010301. doi: 10.7189/jogh.02.010301.
Fisman D. N. & Laupland K. B. (2010a) The ‘One Health’ paradigm: Time for infectious diseases clinicians to take
note? Canadian Journal of Infectious Diseases & Medical Microbiology 21, 111–114.
Frenk J., Gomez-Dantes O. & Moon S. (2014) From sovereignty to solidarity: a renewed concept of global health for
an era of complex interdependence. Lancet 383, 94–97. doi: 10.1016/s0140-6736(13)62561-1.
Fried L. P., Bentley M. E., Buekens P., Burke D. S., Frenk J. J., Klag M. J. & Spencer H. C. (2010) Global health is
public health. Lancet, 375, 535–537. doi: 10.1016/s0140-6736(10)60203-6.
Global One Health Core Competency Working Group (2013) One Health core competency domains, subdomains,
and competency examples: Global OHCC Working Group: USAID RESPOND initiative. Retrieved from
http://issuu.com/prakitkitsupee/docs/ohcc_domains_final_respond.
HM Government (2008) Health is global: A UK Government strategy 2008–2013. London: COI for the Department
of Health. Retrieved from http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_
consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_088753.pdf.
Horton R., Beaglehole R., Bonita R., Raeburn J., McKee M. & Wall S. (2014) From public to planetary health: a
manifesto. Lancet 383, 847. doi: 10.1016/s0140-6736(14)60409-8.
Kahn L. H., Kaplan B., Monath T., Woodall L, J. & Conti L. (2014) A manifesto for planetary health –
Correspondence. The Lancet 383. doi: 10.1016/S0140-6736(14)60709-1.
Janes C. R. & Corbett K. K. (2009) Anthropology and global health. Annual Reviews of Anthropology 38,
167–183. doi: 10.1146/annurev-anthro-091908-164314.
Jones C. B. & Sherwood G. D. (2014) The globalization of the nursing workforce: Pulling the pieces together.
Nursing Outlook 62, 59–63. doi: 10.1016/j.outlook.2013.12.005.
Koplan, J.P., Bond, T. C., Merson M.H., Reddy K.S., Rodriguez M.H., Sewankambo N. K. & Wasserheit J.N. (2009)
Towards a common definition of global health. Lancet 373, 1993–1995. doi: 10.1016/S0140-6736(09)60332-9.
Khubchandani J. & Simmons R. (2012) Going global: building a foundation for global health promotion research to
practice. Health Promotion Pracicet 13, 293-7. doi: 10.1177/1524839912439063.
Merson M. H., Black R. E. & Mills, A. J. (2006) International Public Health: Diseases, Programs, Systems, and
Policies, 2nd edn. Jones and Bartlett, Sudbury, MA.
Rowson M., Wilcott C., Hugues R., Manini, A., Martin S., Miranda J. J., Pollit V., Smith A., Wake R. & Yudkin
J. S. (2012) Conceptualising global health: Theoretical issues and their relevance for teaching. Globalization and
Health 8. doi: 10.1186/1744-8603-8-36.
The European Commission. (2007) Together for health: A strategic approach for the EU 2008-2013. COM (2007).
630 Final. Retrieved from http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=URISERV:c11579&from=EN.
The European Commission. (2010) Communication from the Commission to the council, the European parliament, the
European economic and social committee and the committee of the regions; the EU role in global health.

4 © 2016 John Wiley & Sons Ltd

JAN: DISCUSSION PAPER Global health and global nursing

Box 2
List of documents reviewed for definition of global nursing
Baumann S. L. (2013) Global health nursing: Toward a human science-based approach. Nursing Science Quarterly 26,
365. doi: 10.1177/0894318413500404.
Beck D. M., Dossey B. M. & Rushton C. H. (2013) Building the Nightingale Initiative for Global Health - NIGH - Can
we engage and empower the public voices of nurses worldwide? Nursing Science Quarterly 26, 366–371. doi: 10.1177/
0894318413500403.
Carlton K., Ryan M., Ali N. S. & Kelsey B. (2007) Integration of global health concepts in nursing curricula: a national
study. Nursing Education Perspecives 28, 124–129.
Grootjans J. & Newman S. (2013) The relevance of globalization to nursing: A concept analysis. International Nursing
Review 60, 78–85. doi: 10.1111/j.1466-7657.2012.01022.x.
Macneil J. & Ryan M. (2013) Enacting global health in the nursing classroom. Nurse Education Today 33, 1279–1281.
doi: 10.1016/j.nedt.2013.01.025.
Upvall J.J., Leffers J.M. & Mitchell E.M. (2014) Introduction and perspectives of global health. In: Global Health Nurs-
ing: Building and Sustaining Partnerships (Upvall M.J. & Jeffers J.M., eds), Springer, New York.

Themes Identified for Global Health
One health or planetary health (9)
Transnational (7)
Collaboration (5)
Equity (5)
Health promotion, protection, and disease prevention (5)
Population health or public health (4)
Determinants of health (4)
International health (4)
Global health improvement/health for all (3)
Interdependence (3)
Complex and comprehensive (3)
Individual level health care (2)
Glocal (2)
Note: Numbers in parentheses refer to the number of
references coded under the theme
Figure 1 List of themes identified for definitions of global health.
Discussion
Themes identified related to the definition of global health
Figure 1 illustrates the 13 themes related to definitions of
global health that were identified in the documents
reviewed and Box 1 lists the references that were reviewed
related to global health definitions. The themes are pre-
sented in decreasing order of the number of references that
were coded under each theme. This section presents key
concepts related to each of the themes. The themes were
incorporated either explicitly or implicitly in the proposed
definition of global health which follows the presentation
of the individual themes.
One health or planetary health
Nine references were identified that incorporated concepts
related to ‘One Health’ or ‘Planetary Health’ (Brown et al.
2006, HM Government 2008, Janes & Corbett 2009, Fis-
man & Laupland 2010, Fried et al. 2010, Global One
Health Core Competency Working Group 2013, Aluttis
et al. 2014, Horton et al. 2014, Kahn et al. 2014). The One
Health approach is a collaborative approach that addresses
animal, human and environmental health issues to address
planetary health concerns (Fried et al. 2010, Global One
Health Core Competency Working Group 2013). Fisman
and Laupland (2010)) described the One Health Paradigm
which expands the common concept of global health beyond
a focus only on human health. ‘The mission of the One
Health Initiative. . . includes fostering joint educational
efforts among medical, veterinary and public health
schools,.. joint efforts aimed at clinical care and prevention
and efforts aimed at cross-species surveillance; fostering of
comparative medical research; joint development of diagnos-
tic methodologies; and joint advocacy aimed at educating
leaders and the public ‘ (p. 111). Horton et al.(2014) pub-
lished a manifesto calling for expanding the concept of glo-
bal health to include planetary health:
Planetary health . . .. emphasises people, not diseases and equity,
not the creation of unjust societies. We seek to minimise differences
in health according to wealth, education, gender and place. . . Our

© 2016 John Wiley & Sons Ltd 5

L. Wilson et al.
Interdependence (3)
Collaboration (2)
Glocal (2)
Advocacy (2)
Caring (1)
Cultural competence (1)
Respect for diversity (1)
Partnerships (1)
Equity (1)
Holistic (1)
Sustainable (1)
*Note: Numbers in parentheses refer to the number of
references coded under the theme
Figure 2 Themes identified for global nursing.
tolerance of neoliberalism and transnational forces dedicated to
ends far removed from the needs of the vast majority of people and
especially the most deprived and vulnerable, is only deepening the
crisis we face. . . (p. 847)
Transnational
Seven references were identified that incorporated transna-
tional collaboration as a component of global health
(Brown et al. 2006, HM Government 2008, Janes & Cor-
bett 2009, Koplan et al. 2009, Beaglehole & Bonita
2010, Bozorgmehr 2010, Jones & Sherwood 2014). The
concept of ‘transnational’ generally refers to issues that
transcend national geo-political borders. For example,
Koplan et al. (2009) defined global health as ‘an area for
study, research and practice that places a priority on
improving health and achieving equity in health for all
people worldwide. Global health emphasizes transnational
health issues, determinants and solutions; involves many
disciplines within and beyond the health sciences and pro-
motes interdisciplinary collaboration; and is a synthesis of
population-based prevention with individual-level clinical
care’ (p. 1995). Bozorgmehr (2010) discussed conflicting
definitions of the term ‘transnational’, and proposed using
the term ‘supraterritorial’, which refers to ‘links between
the social determinants of health anywhere on earth’ (p.
16).
6 © 2016 John Wiley & Sons Ltd
Collaboration
Five references included concepts of interdisciplinary or
interprofessional collaboration or partnerships in their
descriptions of global health (Beaglehole & Bonita 2010,
Fried et al. 2010, Campbell et al. 2012, Khubchandani &
Simmons 2012, Jones & Sherwood 2014). Koplan et al.
(2009), for example, spoke about interdisciplinary collabo-
ration within and beyond the health sciences and Fried
et al. (2010) suggested that ‘global concerns, such as
climate change and cross-disciplinary issues, such as zoono-
tic diseases and human health, involve close collaborations
between medicine, public health, veterinary medicine and
many other disciplines’ (p. 536).
Equity
The concept of equity or social justice was included in
five of the references that were reviewed and was incor-
porated in Koplan et al.’s (2009) global health definition
(Janes & Corbett 2009, Koplan et al. 2009, The Euro-
pean Commission 2010, Campbell et al. 2012, Aluttis
et al. 2014). Equity refers to the elimination of disparities
and promotion of the goal of ‘Health for All’ that has
been promoted since the Alma Ata conference in 1978
(World Health Organization 1978). Janes and Corbett
(2009) offered a definition of global health as it pertains
to anthropology and suggested that ‘the ultimate goal of
anthropological work in and of global health is to reduce
global health inequities and contribute to the development
of sustainable and salutogenic (i.e. factors supporting
human health and well-being versus factors that cause
disease) sociocultural, political and economic systems’ (p.
169).
Health promotion, protection and disease prevention
Five references included discussions of these concepts as
components of a global health definition (The European
Commission 2007, Beaglehole & Bonita 2010, Fried et al.
2010, Khubchandani & Simmons 2012, Frenk et al. 2014).
For example, Fried et al. (2010) suggested that global
health is a ‘scientific approach to health promotion and dis-
ease prevention that examines broad determinants of health
including, but not limited to, delivery of medical care and
creates integrated approaches in clinic, community and gov-
ernment’ (p. 536). Khubchandani and Simmons (2012) pro-
posed a global health promotion ecological framework that
includes physical factors, social and cultural factors, health
policies, demography, ethnography and migration, global
burden of diseases, global economy, technology and health
services, global partnerships for health and environmental
changes.
JAN: DISCUSSION PAPER
Population health and public health
Four references included suggestions that global health is
public health for the world (Koplan et al. 2009, Beaglehole
& Bonita 2010, Fried et al. 2010, Frenk et al. 2014).
Others have suggested that global health includes both pop-
ulation-level and individual-level health interventions
(Koplan et al. 2009, Beaglehole & Bonita 2010). Beaglehole
and Bonita (2010) proposed using the term ‘global health’
instead of ‘global public health’, noting that in many coun-
tries public health is viewed as focusing only on population
health, whereas global health is concerned with ‘all strate-
gies for health improvement’ (p. 1).
Determinants of health
Four references included discussion of the understanding
the multiple and complex determinants of health in describ-
ing and defining global health (Koplan et al. 2009, Fried
et al. 2010, Khubchandani & Simmons 2012, Rowson
et al. 2012). Rowson et al. (2012) noted that ‘ global
health is not simply about health problems. . .it is also about
the underlying determinants of those problems, which are
social, political and economic in nature’ (p. 5).
International health
Four references referred to the concept of international
health when discussing global health. Merson et al. (2006)
described international health as ‘the application of the
principles of public health to problems and challenges that
affect low and middle-income countries and to the complex
array of global and local forces that influence them’ (Mer-
son et al. 2006). Although early views of global health
focused primarily on international health, the concept has
shifted to include a focus on interdependence and transna-
tional causes and solutions to global health problems (Row-
son et al. 2012, Aluttis et al. 2014, Frenk et al. 2014).
Global health improvement/health for all
Three references address the goal of global health improve-
ment or the closely related goal of ‘health for all’ in describing
the focus of global health (The European Commission, 2007,
Koplan et al. 2009, Fried et al. 2010). Koplan et al. (2009)
include this concept in their definition of global health and
The European Commission (2010) suggested that ‘Global
health. . .is about worldwide improvement of health, reduction
of disparities and protection against health threats’ (p. 2).
Interdependence
Three references described interdependence as a key con-
cept to be considered in defining global health (Fried et al.
© 2016 John Wiley & Sons Ltd
Global health and global nursing
2010, Aluttis et al. 2014, Frenk et al. 2014). Aluttis et al.
(2014) noted that some stakeholders perceive the ‘increas-
ing interdependencies and common vulnerabilities that arise
due to globalization as the central theme of global health’
(p.4). Frenk et al. (2014) suggested that ‘global health
should be reconceptualized as the health of the global pop-
ulation, with a focus on the dense relationships of interde-
pendence across nations and sectors that have arisen with
globalization’ (p. 94).
Complex and comprehensive
Three references addressed the complexity of the global
health field and the importance of comprehensive
approaches to solve global health problems (Janes &
Corbett 2009, Khubchandani & Simmons 2012, Frenk
et al. 2014). For example, Janes and Corbett (2009)
noted that ‘global health is an area of research and
practice that endeavours to link health, broadly conceived
as a dynamic state that is an essential resource for life
and well-being, to assemblages of global processes, recog-
nizing that these assemblages are complex, diverse, tem-
porally unstable, contingent and often contested or
resisted at different social scales’ (p. 169). Fried et al.
described global health as ‘comprehensive frameworks for
financing and structuring health policies and services that
support community-based and clinical prevention inte-
grated with healthcare delivery and deployment of a
balanced workforce of physicians, nurses and other
providers’ (p. 536).
Individual-level health care
Two references supported the concept of global health as
including both individual-level health care and population-
level health (Koplan et al. 2009, Beaglehole & Bonita
2010), supporting the notion that global health encom-
passes many strategies to promote ‘health for all.’
Glocal
Two references referred to the interdependence of global
and local health, a term that is sometimes referred to as
‘glocal’ (Janes & Corbett 2009, Fried et al. 2010). Fried
et al. (2010) described the interdependence of populations
and noted that strengthening local populations would ulti-
mately improve the health of the globe. Janes and Corbett
(2009) described the importance of ‘Both theoretically and
methodologically the task is to understand how various
assemblages of global, national and subnational factors
converge on a health issue, problem or outcome in a partic-
ular local context’ (p. 169).
7
L. Wilson et al.
Proposed definition of global health
Based on a synthesis of the literature reviewed and the col-
lective experience of members of the task force, the follow-
ing definition of global health was proposed and endorsed
by GAPFON members:
Global health refers to an area for practice, study and research
that places a priority on improving health, achieving equity in
health for all people (Koplan et al. 2009) and ensuring health-pro-
moting and sustainable sociocultural, political and economic sys-
tems (Janes & Corbett 2009). Global health implies planetary
health which equals human, animal, environmental and ecosystem
health (Kahn et al. 2014) and it emphasizes transnational health
issues, determinants and solutions; involves many disciplines
within and beyond the health sciences and promotes interdepen-
dence and interdisciplinary collaboration; and is a synthesis of
population-based prevention with individual holistic care (Koplan
et al. 2009).
The above definition incorporates all of the themes that
were identified in the literature review either explicitly or
implicitly (see Figure 1). Although the themes of health pro-
motion, protection and disease prevention, glocal and inter-
national health are not explicitly included in the definition,
these concepts are implied within the other concepts that
are included.
Themes identified related to the definition of global
nursing
Eleven themes were identified that related to the definition
of global nursing (Figure 2 & Box 2). Most of the
descriptions involved an integration of general descriptions
of the professional nursing role with descriptions of the
goals of global health. The themes were incorporated
either explicitly or implicitly in the proposed definition of
global nursing which follows the presentation of the
individual themes.
Interdependence
Three references included discussion of the concept of inter-
dependence when defining the concept of global nursing.
(Carlton et al. 2007, Grootjans & Newman 2013, MacNeil
& Ryan 2013). For example, MacNeil and Ryan (2013)
suggested that ‘all nurses, no matter where they practice,
will care for people who have origins in other parts of the
world. To practice in such a context, nurses must not only
be able to deliver care to individuals, but also to place indi-
vidual care within the context of a comprehensive view of
complex societies’ (p. 1279).
8 © 2016 John Wiley & Sons Ltd
Collaboration
Two references made references to the contributions of nurses
as collaborators in contributing to meeting global health goals
(Beck et al. 2013, Upvall et al. 2014). Upvall et al. noted, for
example, that nurses can contribute as global health diplomats
and as primary forces in forging global partnerships.
Glocal
Two references referred to the connection between global
and local health, a concept sometimes referred to as ‘glocal’
(Beck et al. 2013, Grootjans & Newman 2013, Upvall et al.
2014). Beck et al. (2013), for example, challenged nurses
everywhere ‘to think and act both locally and globally, to
raise their voices about the contribution of nursing and to
become authentic advocates, particularly in addressing the
United Nations Millennium Development Goals’ (p. 366).
Advocacy
Two references noted the importance of advocating for
health for all as an important component of a global nurs-
ing role (Beck et al. 2013, Grootjans & Newman 2013).
Grootjans and Newman (2013), for example, suggested that
‘through the provision of care, nurses act as mediators
between a frequently inaccessible treatment regime and the
client’s uniquely personal expectations. It is through actions
locally such as making sure a client understands their diag-
nosis and accordingly does not misuse their antibiotic,
thereby adding to the problem of antibiotic resistance glob-
ally, that we demonstrate our respect and value for the
needs of our clients both locally and globally’ (p. 81).
Caring
The concept of caring is considered by many as central to
the professional nursing role. Beck et al. (2013) alluded to
the centrality of this concept in describing the Nightingale
Initiative for Global Health as ‘a major grassroots-to-global
movement of ‘daring, caring and sharing’ of nursing and
others around the world influenced by the outstanding
legacy of Florence Nightingale’ (p. 366).
Cultural competence
Although cultural competence has received significant
recognition over the past 20 years as a core competency for
professional nursing practice in many countries, only one
reference specified this concept when describing the role of
global nurses. Upvall et al. (2014) defined global nursing as
‘individual and/or population-centred care addressing social
determinants of health with a spirit of cultural humility,
deliberation and reflection in true partnership with commu-
nities and other care providers’ (p. 6).
JAN: DISCUSSION PAPER
Respect for diversity
Closely related to the concept of cultural competence is
respect for diversity and meaningful inclusion. Baumann
(2013) suggested that ‘A human science-based global health
nursing . . . seeks to honour both diversity and that which is
shared by all human beings’. (p. 365).
Partnerships
Baumann (2013) also noted that global health nursing
encourages nurses to offer affiliations and partnerships as
equals, avoiding all semblance of imposition or oppres-
sion. . .(and) seeks to merge respect for human dignity,
human rights and human universality’ (p. 365).
Equity
Although equity was a key concept identified in numerous
definitions of global health, it was identified in only one of
the references reviewed describing concerns of global nurs-
ing. Grootjans and Newman (2013) suggested that a focus
on equity ad social justice for clients and nurses was one of
two broad characteristics of nursing practice in a globalized
world and noted that ‘Nurses have always offered their
services without hesitation to people needing help and
many authors reiterate equity and social justice for clients
to be a cornerstone of the nursing profession and nursing
care’ (p. 80).
Holistic
One reference specifically mentioned the concept of holistic
when describing nurses’ role in global health (Upvall et al.
2014), noting that ‘recognition of the determinants of global
health is a central part of nursing’s holistic practice and nurs-
ing students are taught to assess patients from a cultural,
environmental, social, psychological, economic and spiritual
perspective’ (p. 6).
Sustainable
One reference (Grootjans & Newman 2013) mentioned the
theme of sustainability, which emerged as a major theme in
a concept analysis of the relevance of globalization to
nurses. These authors reviewed literature that addressed not
only sustainability of the planet and ecosystem, but also of
the nursing profession.
Proposed definition of global nursing
Based on a synthesis of the literature reviewed and their
collective experience, the task force members originally pro-
posed the following definition of global nursing:
© 2016 John Wiley & Sons Ltd
Global health and global nursing
Global nursing is the use of evidence-based nursing process to
promote sustainable planetary health and equity for all people
(Grootjans & Newman 2013). Global nursing considers social
determinants of health, includes individual and population-level
care, research, education, leadership, advocacy and policy initia-
tives (Upvall et al. 2014). Global nurses engage in ethical prac-
tice and demonstrate respect for human dignity, human rights
and cultural diversity (Baumann 2013). Global nurses engage in
a spirit of deliberation and reflection in interdependent partner-
ship with communities and other health care providers (Upvall
et al. 2014).
The above definition incorporates all of the themes that
were identified in the literature review either explicitly or
implicitly (Figure 2). Although the themes of glocal, caring
and holistic are not explicitly included in the definition,
these concepts are implied within the other concepts that
are included.
Limitations
There are several limitations to this work that must be
acknowledged. Although an extensive literature review of
articles published in English, Spanish or Portuguese during
the past 10 years was conducted to identify the themes that
others have incorporated in definitions of global health and
global nursing, the review did not include papers published
prior to 2005, papers published in languages other than
English, Spanish or Portuguese, or websites of professional
organizations or institutions. In addition, the review did not
include an exhaustive review of books related to global
health or global nursing. Another limitation is that there
were only eight references that specifically addressed the
concept of global nursing and thus some of the themes that
were identified were mentioned by only one reference. A
final limitation is that the length of the proposed definitions
of global health and global nursing makes them cumber-
some and may limit their utility. Further work is needed to
achieve consensus about the essential elements of the con-
cepts of global health and global nursing and develop more
succinct, useful definitions.
Implications for nursing
There has been increased recognition about the importance
of global health for all health professionals and the role of
nurses and midwives in contributing to the achievement of
global health goals. Nurses and midwives will need to
assume broader roles to ensure universal health coverage
and achievement of the other targets that have been identi-
9
L. Wilson et al.
fied in the Sustainable Development Goals (SDGs) which
were approved by the members of the United Nations in
2015 (United Nations 2015). SDG goal 3 (ensure healthy
lives and promote well-being for all ages) covers eight tar-
gets including universal health coverage and nurses and
midwives will have significant roles to play to ensure that
these targets are achieved. The World Health Organiza-
tion’s Strategic Directions for Nursing and Midwifery
(2011–2015) provides a framework to guide nurses’ contri-
butions to strengthening health systems to contribute to
meeting global goals and targets (World Health Organiza-
tion 2011). The revision of this document proposed for
2016–2020 aims ‘to ensure that the nursing and midwifery
workforce contributes to Universal Health Coverage and
the Sustainable Development Agenda by ensuring equitable
access to skilled and motivated nursing and midwifery
workforces within performing and responsive health sys-
tems’ (World Health Organization 2015, page 6).
There have also been calls for incorporating global health
content in educational programmes to prepare health pro-
fessionals for an increasingly complex and globalized world.
For example, members of a Global Independent Commis-
sion on Education of Health Professionals for the 21st
Century suggested that ‘redesign of professional health edu-
cation is necessary and timely, in view of the opportunities
for mutual learning and joint solutions offered by global
interdependence due to acceleration of flows of knowledge,
technologies and financing across borders and the migration
of both professionals and patients’ (Frenk et al. 2010). In
the United States, the Essentials for Baccalaureate Educa-
tion document mentions the importance of integrating glo-
bal health content in the curricula, although they do not
identify the specific global health competencies that should
be addressed (American Association of Colleges of Nursing
2008). Efforts to better prepare health professionals for
effective roles in global health require clear definitions of
what global health is. Similarly, to ensure that nurses real-
ize their potential to be key partners in interdisciplinary
teams that advance global health, there is a need to define
the concept of ‘global health nursing’. The authors’ and
GAPFON’s intent is that this paper will contribute to clari-
fying these terms and stimulating discussion and debate
about how all disciplines and professions can collaborate in
effective partnerships to ensure sustainable global health for
all.
Preparing nurse educators, practitioners, researchers and
leaders for the future is essential and requires the develop-
ment of innovative models to enhance nurses’ abilities to
play integral roles in leading change and influencing health
policy to shape the global health agenda.
10
Conclusion
This review of the major themes included in definitions of
global health and descriptions of global nursing can provide
direction to nurses and to other professions working to
advance planetary health and health for all. Educators can
use the proposed definitions to guide development of curric-
ula and to identify concepts that could be integrated into
all nursing courses. Policy makers and researchers can use
the definitions to identify questions to guide future studies
and policies on strategies to promote the ‘grand conver-
gence’ and sustainable development for the future. The pro-
posed definitions support the vision of GAPFON ‘to
establish a voice and vision for the future of nursing and
midwifery that will advance global health’ (Klopper & Hill
2015, p. 3). We invite nurses and midwives across the globe
to grasp the opportunities to promote planetary health
through their roles in education, practice, research, policy
and leadership.
Acknowledgements
The authors acknowledge Sigma Theta Tau International
(STTI) for convening the Global Advisory Panel on the
Future of Nursing (GAPFON). The authors also acknowl-
edge the contributions and feedback from GAPFON mem-
bers who are listed on the website at: http://www.gapfon.
org/panelists.html.
Funding
This research received no specific grant from any funding
agency in the public, commercial or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the author(s).
Impact statement
These definitions of global health and global nursing pro-
vide direction to nurses and other professionals and stu-
dents working to advance planetary health and health for
all through practice, research, education and policy.
Author contributions
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/recommendations/)]:
© 2016 John Wiley & Sons Ltd
JAN: DISCUSSION PAPER
• substantial contributions to conception and design,
acquisition of data or analysis and interpretation of
data;
• drafting the article or revising it critically for important
intellectual content.
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