CGFNS Dec07 Villeneuve

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Building Global Alliances Health, Health Disparities and Migration in an Uneven World Eliminating Health Disparities as Part of the Core Business of Nursing on a Global Level Michael J. Villeneuve, RN MSc busara C O N S U L T A N T S

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If you don't like change, you're going to like irrelevance even less. General Eric Shinseki, Chief of Staff, U.S. Army, retired (2003)

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We must stay in our core business… I think it is important that we have a shared vision, that we can add value and that we can get synergy from all these partnerships… What is important to me is, are we getting the results that matter? Are we doing the right things to make an impact on the health of the populations that we are serving? These questions have to be asked. Dr. Margaret Chen WHO Director-General, 2007

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MDG’s

In the broad church that makes up nursing we have not united on the central image we want to communicate to the public and our professional colleagues. Kitson, 1996: 

In the broad church that makes up nursing we have not united on the central image we want to communicate to the public and our professional colleagues. Kitson, 1996

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We’re in a new place; we’re not on the edge of the old place. We’re not pushing the envelope; we’re in a totally new envelope. So the rules have changed. Every fundamental premise of the old way of thinking no longer applies. Sister Elizabeth M. Davis Chair, Canadian Health Services Research Foundation, 2005

Disparity: 

Disparity dis·par·i·ty  - dɪˈspær ɪ ti/ [di-spar-i-tee] – noun, plural -ties. The condition or fact of being unequal, as in age, rank, or degree; difference: "narrow the economic disparities among regions and industries." Unlikeness; incongruity. [French disparité, from Old French desparite, from Late Latin disparitās : Latin dis-, dis- + Late Latin paritās, equality; see parity1.] The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2006 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

The daunting challenge of resolving worldwide disparities were addressed under a principle of equity in the World Health Organization’s (WHO’s) now nearly-30-year-old Alma Ata Declaration (1978): The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.: 

The daunting challenge of resolving worldwide disparities were addressed under a principle of equity in the World Health Organization’s (WHO’s) now nearly-30-year-old Alma Ata Declaration (1978): The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

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Leading population concerns globally Developing countries… HIV/AIDS High mortality related to infant and child mortality Maternal mortality Large size of the working age population High adolescent fertility Low life expectancy Undesirable pattern of spatial distribution High overall fertility High population growth Developed countries… HIV/AIDS Low fertility Population ageing Small size of the working age population United Nations, 2005

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1. Global disease patterns including HIV/AIDS

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2. Global economics (including the dynamics of poverty, wealth, and income)

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By 2030, 1.2 billion people in developing countries – 15 percent of the world population – will belong to the "global middle class," up from 400 million today. This group will have a purchasing power of between $4,000 and $17,000 per capita, and will enjoy access to international travel, purchase automobiles and other advanced consumer durables, attain international levels of education, and play a major role in shaping policies and institutions in their own countries and the world economy. More than a billion people live on less than US $1 per day. Another billion-plus live on less than US $2 per day. World Bank, 2007, http://web.worldbank.org

Economic clout: 

Economic clout The massive economy of the United States is larger than those of Japan, Germany, China and the United Kingdom combined… more than 10 times that of Canada… more than one thousand times the size of Jordan’s… …and more than ten thousand times as large as that of Sierra Leone. Among the 60 poorest nations, GDP per capita is less than US $1,000 in each of them. (Based on World Bank stats, 2005)

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The world’s two wealthiest people (according to Forbes) together have amassed fortunes valued at about US$100 billion… …roughly equivalent to the collective GDP of the world’s 50 poorest nations (based on World Bank ranking) Economic clout

Domestic divides: 

Domestic divides The story of economic disparities is not restricted to differences between countries. In the United States for example, the top 20% of the population has more than 80% of the wealth; the bottom 20% has nearly none. The top 5% of Americans hold more than 50% of the country’s wealth. Since 1975, “practically all the gains in household income have gone to the top 20% of households.” Central Intelligence Agency, 2007

Domestic divides: 

Domestic divides This pattern has real and immediate impacts for society as a whole. Pascal argues that health outcomes are often better in countries where the divide between rich and poor is narrow and the GDP is low, than in places like the United States and Canada where the GDP is high as is the divide between the rich and poor Pascal, 2005, cited in Villeneuve & MacDonald, 2006

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Health Expenditure and GDP per capita (2000)

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Nurse Density and Health Expenditure per capita (2000)

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3. Global demographics (including shifting global populations and migration)

Global Population, 1700-2100: 

Global Population, 1700-2100 D E M A N D

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Average life expectancy, both genders, by country, 2006. Source: WHO

Where do we live?: 

Where do we live? More than one half of all humans live in China India USA Indonesia Brazil Pakistan, and Russia A third of all humans live in China and India alone

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With the second-largest land mass of all nations, Canada comes 219th in the list of countries by population density. The northern Canadian territory of Nunavut is about the same size in land mass as France, Germany and Spain together – but is home to less than 30,000 people scattered across numerous tiny and remote communities. The challenges in providing equitable, accessible and quality service in that environment are significant. Contrast them with those faced in the relatively small country of Bangladesh, 94th on the list of countries by size. If the population of the entire earth in 2007 was squeezed into the United States, the resulting population density would be less than the present density of Bangladesh.

Socio-economic forces: 

Socio-economic forces The wealthiest nations have been described by some as the “old, dirty, shrinking North” (reflecting their changing demographics and industrial history), and contrasted them with the youth, stamina, vigour, growth and potential of nations in the southern hemisphere and throughout Asia. The World Bank notes that “impressive advances” in China and India alone “have been at the forefront of the reduction in global poverty” (2006).

Urban vs. Rural Challenges: 

Urban vs. Rural Challenges Already, more than 410 million people live in the world’s 25 largest cities

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4. Broad access and outcome disparities

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WHO, 2006

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Critical care 8% of beds 16% of costs >50% of all ER patients could be safely admitted, treated and discharged by RNs without ever seeing an MD 50% of cases are non-urgent Only 1% of cases are actual emergencies

Health depends on nurses: 

Health depends on nurses Canada Population 34,000,000 Nurses 310,000 Ethiopia Population 74,000,000+ Nurses 6-7,000

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Practicing Nurses per Million Population (2000)

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5. The health and safety of women and children

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6. The changing environment

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The Environment

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7. The global influence of technology

For the first time in history, the citizens of some countries will move during the first half of this century from an essentially agrarian culture to a post-technological era that bypasses the industrial revolution nearly entirely. Nearly all of that will happen in the southern hemisphere, in Asia, Africa and remote areas of South America. Those kinds of dynamics will change society as we all understand it – and within that, the place of health, illness and health care. Nurses and midwives need to understand that world and what it will mean for them and for those who seek their services.: 

For the first time in history, the citizens of some countries will move during the first half of this century from an essentially agrarian culture to a post-technological era that bypasses the industrial revolution nearly entirely. Nearly all of that will happen in the southern hemisphere, in Asia, Africa and remote areas of South America. Those kinds of dynamics will change society as we all understand it – and within that, the place of health, illness and health care. Nurses and midwives need to understand that world and what it will mean for them and for those who seek their services.

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We must harness technical solutions to extend our reach.

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“Pearl” “Sister Mary” “Marie”

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A year ago Katsura-ryo became one of the first 100 pioneer companies in Japan to buy Sanyo's new washing machine for people. "Residents say it is really good because they warm their whole body, they can take the bath on their own, they can protect their privacy. As for the staff, it means less burden on their backs. Also, they can save time, because the whole procedure can be done in a very short time."

A call to action: A call to global transformation: 

A call to action: A call to global transformation

You may know the right thing. But do you have the discipline to do the right thing?: 

You may know the right thing. But do you have the discipline to do the right thing? And equally important, to stop doing the wrong things? Collins, Good to Great, 2005

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Many of the sources of pain, misery, sickness and death worldwide are amenable to intervention by nurses and midwives. Nurses and midwives are being called to new levels of practice, including a new and more influential leadership at senior levels of policy development. The days of “taking orders” are over for nursing and midwifery globally. The public trusts nurses and people are expecting us to step up our practice, step forward and lead health systems and health services forward.

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Nurses and midwives largely are not being, and will not be, invited into the highest echelons of public policy development and health legislation. We need to do a better job, collectively, of purposefully and strategically creating points of access for the kinds of knowledge nurses and midwives bring to policy discussions, and be ready to participate meaningfully. We are being called to generate a bold new vision for a future of nursing and midwifery that responds to current and emerging population health needs, to build excitement about a new nursing and midwifery agenda, set benchmarks, model new thinking, innovate, and lead this movement forward.

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History, despite its wrenching pain Cannot be unlived But if faced with courage Need not be lived again. Dr. Maya Angelou On the Pulse of Morning

Thank you! Merci! Gracias!: 

Thank you! Merci! Gracias! Toward 2020: Visions for Nursing may be downloaded free of charge at www.cna-aiic.ca Mike Villeneuve executivedirector@acen.ca busara C O N S U L T A N T S

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