Unfortunately, since 1998, little has changed. For many individuals living in impoverished underdeveloped countries, even basic medical care is difficult to obtain. Although international agencies sponsor outreach programs and corporations, and although nonprofit organizations donate goods and services, the level of health care remains far below what is necessary to meet the needs of struggling populations. Polluted water supplies, unsanitary conditions, and poor nutrition only exacerbate the poor health prevalent in these environments. Nurses working in developed nations have many opportunities/advantages that typically are not available to those in underdeveloped countries. What can nurses do to support their international colleagues and advocate for the poor and underserved of the world? 

In this Discussion, you will consider the challenges of providing health care for the world’s neediest citizens, as well as how nurses can advocate for these citizens.

  • Consider the challenges of providing health care in underdeveloped countries.
  • Conduct research in the Walden Library and other reliable resources to determine strategies being used to address these challenges.
  • Using this week’s Learning Resources, note the factors that impact the ability of individuals in underdeveloped nations to obtain adequate health care.
  • Consider strategies nurses can use to advocate for health care at the global level. What can one nurse do to make a difference?

Post a description of at least two challenges related to providing adequate health care in underdeveloped countries. Then, describe two strategies you might use to address those challenges, and explain why. Finally, describe one strategy nurses might use in advocating for health care at the global level, and explain why this would be an effective strategy. 


www.thelancet.com Vol 373 June 6, 2009 1993

Towards a common defi nition of global health
Jeff rey P Koplan, T Christopher Bond, Michael H Merson, K Srinath Reddy, Mario Henry Rodriguez, Nelson K Sewankambo, Judith N Wasserheit,
for the Consortium of Universities for Global Health Executive Board*

Global health is fashionable. It provokes a great deal of
media, student, and faculty interest, has driven the
establishment or restructuring of several academic
programmes, is supported by governments as a crucial
component of foreign policy,1 and has become a major
philanthropic target. Global health is derived from public
health and international health, which, in turn, evolved
from hygiene and tropical medicine. However, although
frequently referenced, global health is rarely defi ned.
When it is, the defi nition varies greatly and is often little
more than a rephrasing of a common defi nition of public
health or a politically correct updating of international
health. Therefore, how should global health be defi ned?

Global health can be thought of as a notion (the current
state of global health), an objective (a world of healthy
people, a condition of global health), or a mix of
scholarship, research, and practice (with many questions,
issues, skills, and competencies). The need for a
commonly used and accepted defi nition extends beyond
semantics. Without an established defi nition, a shorthand
term such as global health might obscure important
diff erences in philosophy, strategies, and priorities for
action between physicians, researchers, funders, the
media, and the general public. Perhaps most importantly,
if we do not clearly defi ne what we mean by global health,
we cannot possibly reach agreement about what we are
trying to achieve, the approaches we must take, the skills
that are needed, and the ways that we should use
resources. In this Viewpoint, we present the reasoning
behind the defi nition of global health, as agreed by a
panel of multidisciplinary and international colleagues.

Public health in the modern sense emerged in the mid-
19th century in several countries (England, continental
Europe, and the USA) as part of both social reform
movements and the growth of biological and medical
knowledge (especially causation and management of
infectious disease).2 Farr, Chadwick, Virchow, Koch,
Pasteur, and Shattuck helped to establish the discipline
on the basis of four factors: (1) decision making based on
data and evidence (vital statistics, surveillance and
outbreak investigations, laboratory science); (2) a focus
on populations rather than individuals; (3) a goal of social
justice and equity; and (4) an emphasis on prevention
rather than curative care. All these elements are
embedded in most defi nitions of public health.

The defi nition of public health that has perhaps best
stood the test o

Advances in Nursing Science

Issue: Volume 32(2), April/June 2009, p E94-E108
Copyright: (C) 2009 Lippincott Williams & Wilkins, Inc.
Publication Type: [Article]
DOI: 10.1097/ANS.0b013e3181a3d754
ISSN: 0161-9268
Accession: 00012272-200904000-00017
Keywords: HIV/AIDS, HIV testing and counseling, nursing education,
qualitative research, Uganda


The Impact of HIV Education on the Lives of Ugandan Nurses and Nurse-Midwives

Harrowing, Jean N. RN, MN

Author Information

Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W,
Lethbridge, Alberta, Canada.

Corresponding Author: Jean N. Harrowing, RN, MN, Faculty of Health Sciences,
University of Lethbridge, 4401 University Dr W, Lethbridge, AB T1K 3M4, Canada
([email protected]).

This work was supported by the Canadian Institutes of Health Research; Faculty
of Nursing, University of Alberta; Alberta Registered Nurses Educational Trust;
Killam Trusts; and Canadian Nurses Foundation. The author thanks the nurses and
nurse-midwives of Uganda; Dr Judy Mill, doctoral supervisor, for her gentle
patience and wise counsel; and Dr david Gregory for his helpful comments and










Reconceptualizing the practice of nursing

Gaining and sharing power

Challenging the image and role of nursing

Systemic challenges






In this ethnography, I explored the impact of an HIV/AIDS education program on
the lives of 24 Ugandan nurses and nurse-midwives. Nurses who previously had
viewed themselves simply as providers of advice and sympathy now saw themselves
as more holistic, collaborative caregivers. They voiced an increased awareness
of their role as leaders and advocates in the community with respect to policy.
The education program had positive and synergistic effects on the nurses’
professional practice, communication and problem-solving skills, confidence, and
engagement in political and social change activities.


IN THE CONTEXT of the devastating HIV/AIDS pandemic in sub-Saharan Africa,
nurses and nurse-midwives face overwhelming challenges. Stigma and discrimination,1-4
inadequate knowledge,5 frustration and stress related to heavy workloads,6,7
negative attitudes,8 and lack of access to basic protective supplies combine to
render nursing staff vulnerable to infection 9,10 and severely constrained in
their attempts to provide competent, safe care. Fu


Barriers to primary care responsiveness to
poverty as a risk factor for health
Gary Bloch1,2*†, Linda Rozmovits3† and Broden Giambrone4


Background: Poverty is widely recognized as a major determinant of poor health, and this link has been
extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what
primary care health providers can do to address their patients’ income as a risk to their health. This qualitative
study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced
jurisdiction with near-universal health care insurance coverage.

Methods: One to one interviews were conducted with twelve experts on poverty and health in primary care in
Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community
workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent

Results: This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to
addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study’s
findings point to a number of areas front line primary care providers could target to address their patients’ poverty.
These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect
adequate data about patients’ social circumstances, and to the development of inappropriate care plans.
Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to
incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can
take to address patients’ poverty.

Conclusions: While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported
existence of significant barriers to addressing income as a health issue within primary care, the findings point to
the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty.
The consistent direction and replicability of these findings point to a refocusing of the research agenda toward an
examination of interventions to decrease the health impacts of poverty.

Poverty is widely recognized as a major determinant of
poor health [1-3]. The powerful link between income
and health has been well documented – people living
on low income consistently have higher rates of morbid-
ity and mortality due to chronic and acute illnesses
[4-7]. This impact is particularly worrisome amongst
children, who exhibit a higher risk of detrimental health
outcomes throughout their life-course regardless of later

socioeconomic status [8]. Nonetheless, there are few stu-
dies o