Global Healthcare Mary Ellen Ciptak RN, PsyD

from the Bush to the Boardroom

THE DANCE BETWEEN HEALTH AND
DEVELOPMENT
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

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 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.
Cautionary Chronic
• 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%.

NCDs cause 63% of global deaths, and are largely preventable

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Health.
ion 2011 Reprinted 2011
 Global Health Indicators
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.
IMHE MDG 8 Burden of Disease
Institute for Health Metrics and Millennium Development WHO. Disability-adjusted life
Evaluation Goals. years (DALYs). How many year
of life lost through death and
University of Washington. Seattle, Built on IMHE’s DAH and GHE. disability.
USA To achieve by 2015.
• Valid, impartial and consistent
Focus: • Eradicate extreme poverty and estimates of disease occurrence
• Major world health problems and hunger and injury for all 21 regions of
disease • Achieve universal primary the world
• Is society addressing these issues? education • Cause-specific mortality by
• How best to commit health • Promote gender equality region: estimating global
resourses to maximize health • Reduce child mortality mortality
improvement? • Combat HIV/AIDS, malaria and • Calculate the health state
other communicable and non severity weight (who is
IMHE: tracks >$200 billion of private communicable diseases healthier: a blind person or a
and public contributions annually • Ensure environmental chronic pain person?)
sustainability • Estimate years lived with
• Develop global partnership for disability (YLD), years of life
development. lost (YLL)

Health Metrics and Evaluation. 2010. IMHE.

Financing Global Health 2012: End of a Golden Age? IMHE.
Millennium Development goals. MDGs. IMHE.
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Global Health Indicators
Characteristics for high, medium and low burden of disease

• 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

Your Logo
Global Health Bodies

Donor governments
National governments
Bilateral development agencies
Multinational governments
Foundations
Non-governmental agencies
Corporations
Academic institutions

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 Development Assistance for Health (DAH)

1999-2012

Continent with majority of poor counties. This region accounts

Sub-Saharan
Sub for 67%-71% deaths in the world.
Africa 24% DAH
DAH per US dollar- varies from $1 a day to $75.00 a day,
$8.1 Billion.
depending on country, not the disease.

Research and Development

Vaccines
Global
Public Project, Public Goods
$3.5 Billion
Middle East disbursements decreased by 8.1%
($519 million total allocation)

Improved from a loss of 70.8% in 1990. More

Unallocated funds transparency, improved reporting and allocation .
36.4% annually

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Healthcare conditions in Africa

• 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.
 Why volunteer globally?
Interpersonal, educational and societal growth potentials

Understanding that nurses have the power to change

Exposure to ethics, policy, social justice and politics

Learned cultural sensititvies and perspectives

Renewed passion in nursing profession

Cognitive development

Positive global and local influence on colleagues

Greater understanding of vulnerable populations

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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

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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.
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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
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 INTERNATIONAL
HEALTHCARE INTERNET RESOURCES

WHO-NIH-PITT.EDU SUPERCOURSE 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.
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

Pitt.edu
Duke.edu NURS 482
Globalhealthlibrary.net
Fundisaforum.org
Global nursing ethical considerations
Autonomy, non-maleficence, beneficence and distributive justice

• 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)

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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.
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,
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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.
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The Lancet. (2012). 380(9859) 2197-2222. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21
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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