Introduction
The Institute of Medicine, U.S.A, identified global health problems as health concerns that transcend national boundaries. These health issues are influenced by environment prevailing in other nations. Thus, there is a need for cooperative action from countries across the globe to find solutions to these concerns. With the kind of high mobility seen today, an epidemic outbreak in Africa, can readily spread to rest of the globe, if measures to contain its spread are not taken on a global scale. Polio eradication, containment of influenza virus, policies to restrict tobacco use are examples of policies that were instituted to find solution to health concerns that transcend national boundaries. Tobacco use is a risk factor for top ten causes of death, worldwide. Climate change, malnutrition and urbanization are happening on a global scale and this is affecting the health of people across the globe. (IOM, 2007)
Historical perspective on concerns for global health nursing:
The history of nursing in global health, dates back to a very long time ago. With globalization and policies that favor nurses to work outside their nation, the contribution of nurses to global health is high in current times than before. There has always being a need for nursing aid globally. Nurses have crossed national boundaries to become part of a global community that serves the health care need of people outside their nation. WHO is an organization under the United Nation, and is responsible for providing policies and recommendation on global health issues. These policies are constituted based on evidence provided by science. More than 98% of independent countries in the world are members of WHO and are influenced by its policies and recommendation. Nurses from these member country work toward global health care goals set by WHO. However, at present they represent only 1% of the total health care staff. More than 90% of the WHO staff are from medical specialties. In spite of being the largest work force in healthcare, they are underrepresented in both the UN work force and also invisible when it comes to making health care decisions and policies. (Benton, 2016)
Importance of health disparity:
Health disparity refer to the difference in health status and access to health care, between groups in a population. More than half of the deaths caused by heart diseases globally were attributed to preventable risk factors like poor unhygienic diet, high blood pressure, high blood glucose and high blood pressure. The incidence of heart diseases are higher in developed nations when compared to low income countries. Unsafe sex was the leading cause of cervical cancer. The incidence of cervical cancer and mortality associated with it is high among people from poor socio-economic background, when compared to people from high socio-economic background. Mortality rates associated with cervical cancer are relatively high in developing countries. In Africa, cervical cancer is the leading cause of cancer-associated death. Tobacco use accounts for ~5.1 million deaths globally. According to global statistics, 1 in 8 adults over age 30, smoke tobacco. Obesity and overweight were the fifth leading cause of death. The risk associated with obesity is high in high-income countries. In addition to studying global trends of health, WHO also runs health services across that globe that are important in prevention and control of diseases. ("WHO | 10 facts on the state of global health", 2016)
Today, people of color and people from low socio-economic groups are more likely to experience barriers in accessing health care and experiencing poor health outcome. Global health disparity will not only affect the disadvantaged group, but also the overall quality of care provided to a broader population, due to the cost of keeping diseases at bay. Global health disparity is identified by the gaps that exist in the mental and physical wellbeing of people in different sections of the society and different geographical location. While in some countries like Africa, the health disparity is seen in the prevalence of communicable disease; in developed countries, health disparity is seen in the prevalence of communicable diseases. A strong link exists between social inequality and health inequality. Eighty-three percent of the world population live in developing communities where there is relatively poor access to health care facilities. A majority of the people in these countries, live in poor socio-economic condition. Among OCED countries, Japan has the highest life expectancy rate. While, fertility rates are increasing in African countries, in Asian and Latin American countries, the fertility rates have gone down. There is also a need to undertake population-based research to identify and prevent diseases that are specific to a community or geographic region. There is also a need to improve health education for different groups in the population. (IOM, 2007; "United Nations Global Issues", 2016)
Global policies concerning different disciplines can influence global health disparity. The policies concerning legal, social, behavioral, economic, environmental, history, engineering and biomedical sciences can be determinants of global health. For example, economic policies that encourage urbanization and improper town planning can affect the lifestyle and health of people in these communities. Increased stress, dietary changes and lack of opportunity to engage in physical activity will increase the risk of chronic non-communicable diseases. Policies the restrict tobacco use in the community can help in preventing adverse health effects related to smoking. The political stability of a region and civil rights will decide the access to good health care services. The country that is politically unstable, has dysfunctional policies concerning its people’s health. People in these countries are economically unstable. (Choffnes & Mack, 2009)
Healthy people 2020:
A country’s health system is made up of all of the public and private organizations and resources whose action is performed with the primary intention of improving health in the population. Globally, 1 billion people still lack access to health care services ("United Nations Global Issues", 2016). Infectious diseases like low respiratory tract infection, AIDS, Malaria, Measles, TB, and diarrhea, still continue to be a major cause of death in many developing countries. Healthy people 2020 is a national agenda that was released in December 2010 and communicates the vision of achieving health equality and improving health in U.S. This agenda has set certain measurable objectives that are to be achieved within a period 10 years. It also provides a strategic framework that will guide diseases prevention and health promotion activities. A network of multidisciplinary stakeholders is engaged in data-driven operations that aim to achieve expected outcomes. The Healthy People 2020 communication also provides guidelines for national and international research and program planning. This increases accountability of researcher in contributing to the Healthy People objectives. Though the healthy people plan is led by the federal government, both national and local stakeholders’ participation is necessary for the success of the plan. Multiple sectors are engaged through this plan in the goal of achieving best research evidence and knowledge that can guide practices in health care system. Healthy people 2020 aims to achieve a high-quality life that is free of preventable diseases, disability, injury and premature death. It aims to create a social and physical environment that promotes a high quality of life. In order to achieve this goal, even sectors outside the health care system like education, housing, environment, transportation, labor, and agriculture are involved in the process. Ensuring access to health care is one of the top priority of Healthy People 2010 objective. ("Global Health | Healthy People 2020", 2016)
Moral issues in global health care:
Quality, access and cost are three moral issues of global health care. It is very unfortunate that people die because they could not afford the cost of getting treated. In addition, unsafe practices in healthcare not only deteoriate quality of healthcare and patient safety, but can affect healthcare sustainability. An organization that is concerned with promoting health cannot participate in activities that deteriorate health. Global health status is usually measured in terms of the cause of death, life expectancy at birth, and maternal mortality rates. The cause of death is known from death certificate. Most countries record the cause of death on the death certificate. Lack of proper coverage of death certificate policy can prevent epidemiologist from getting the correct figures about diseases and cause of death (Choffnes & Mack, 2009). Poor living conditions and lack of access to health care can contribute to high infant and maternal mortality. Ensuring healthcare coverage and access is an important moral responsibility. (WHO, 2015)
Health care production and economic cost:
Currently, the cost spend on health care does not correlate with better outcome. There is extensive variation in the amount of resources each country spends for the same quality of healthcare. Likewise, specialized services can cost more than general health care services. Falling mortality rate have increased longevity but have also increased dependence on healthcare. Every production unit generate output and health is the output of healthcare. However, most of the health care policies are largely focused on reducing cost of health care, rather than achieving 100% global health. The cost of production will be determined by the scale of operation, workforce, technology and efficiency with which resources are utilized to achieve health and reduce disease burden. (Scott, Solomon, & McGowan, 2016)
Availability of health care providers
The shortage of health care provider is the biggest crisis that healthcare is facing today. According to WHO estimates, there is a shortage of 4.3 million health care providers that include doctors, nurses, midwives, and other professionals. This can threaten quality and sustainability of healthcare. Globalization of healthcare market provides opportunity for health workers to seek employment abroad and has led to migration of health workers from low income countries to high income countries, worsening the shortage of staff in low income countries. Work force migration is a major concern for low income countries and global health care. (Aluttis, Bishaw, & Frank, 2014)
Conclusion
WHO predicted global disease burden is likely to decrease for HIV/AIDS, TB, malaria, and diarrheal diseases. Research and preventive measures specific to these diseases have helped to bring down their levels in many countries. On the other hand, the global burden of chronic non-communicable diseases like cardiovascular death, diabetes mellitus, COPD and road traffics are likely to increase in the future. There is enormous variation in the amount of money these countries spend on health care, and this often does not correlate with better health outcomes. International collaboration is required to understand trends in diseases that are globally prevalent, to prevent the spread of emerging diseases, promote health care access, quality and to face other healthcare challenges.
References
Aluttis, C., Bishaw, T., & Frank, M. (2014). The workforce for health in a globalized context – global shortages and international migration. Global Health Action, 7(0). Retrieved 28 August 2016, from http://dx.doi.org/10.3402/gha.v7.23611
Benton, D. (2016). Advocating Globally to Shape Policy and Strengthen Nursing’s Influence. The Online Journal of Issues in Nursing, 17(1). Retrieved 28 August 2016, from http://dx.doi.org/DOI: 10.3912/OJIN.Vol17No01Man05
Choffnes, E. & Mack, A. (2009). Global issues in water, sanitation, and health. Washington, D.C.: National Academies Press.
Global Health | Healthy People 2020. (2016). Healthypeople.gov. Retrieved 28 August 2016, from https://www.healthypeople.gov/2020/topics-objectives/topic/global-health
Scott, D., Solomon, S., & McGowan, J. (2016). Applying Economic Principles to Health Care - Volume 7, Number 2—April 2001 - Emerging Infectious Disease journal - CDC. Wwwnc.cdc.gov. Retrieved 2 September 2016, from http://wwwnc.cdc.gov/eid/article/7/2/70-0282_article
IOM,. (2007). Informing the Future (pp. 47-57). Washington D.C: Institute of Medicine.
United Nations Global Issues. (2016). Un.org. Retrieved 28 August 2016, from http://www.un.org/en/globalissues/health/
WHO,. (2015). GLOBAL HEALTH ETHICS (1st ed., pp. 5-31). Switzerland: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/10665/164576/1/9789240694033
_eng.pdf
WHO | 10 facts on the state of global health. (2016). Who.int. Retrieved 28 August 2016, from http://www.who.int/features/factfiles/global_burden/en/
