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Transcultural Health Care: A Culturally Competent AApppprrooaacchh,, 44tthh EEddiittiioonn
Global Health and Nursing Care
Copyright © 2013 F.A. Davis Company
Larry Purnell, Ph D, RN, FAAN

Effects of Globalization
 Globalization has led to a growing
interdependence of the world’s population.
 Potential for infectious diseases to spread
rapidly in a world with extensive travel.
 Includes food, insects, animals, and other
vectors.

Effects of Globalization
 Bioterrorism necessitates surveillance for
suspicious clusters of symptoms for
populations at a global level.
 Unhealthy populations can destabilize
economies.
 Shift in health conditions from an acute care
focus to chronic care.

Global Context: No boundaries
 Global context of health addresses
circumstances that affect populations
worldwide, such as quantity and nutritional
value of food, air and water quality, exposure
to infectious diseases and environmental
toxins, access to essential medications, and
gender inequalities.

International Context
 International health perspective emphasizes
exchanges between national governments.
 International is border bound.
 We need both the International and Global
contexts

Definition of Global Health:
Institute of Medicine
 Health problems, issues and concerns that
transcend national boundaries, may be
influenced by circumstances or experiences in
other countries, and are best addressed by
cooperative actions and solutions

Alternate Definition of Global
Health
 Global health emphasizes transnational health
issues, determinants, and solutions.
 Involves multiple disciplines collaborating.

Global Nursing
 The adoption of a global health perspective by
nursing professionals interested in seeking
collaborative and sustainable solutions to
health problems irrespective of national
boundaries.
 Requires respect for differences in language,
culture, customs, and health beliefs.

WHO Millennium Declaration
Goals
 Eradicate extreme hunger and poverty
 Achieve universal primary care
 Promote gender equality and empower
women
 Reduce child mortality

WHO Millennium Declaration
Goals
 Improve maternal health
 Combat HIV/AIDS, malaria, and other diseases
 Ensure environmental sustainability
 Develop a global partnership for development

Peace Corps
 U.S. government agency that places
volunteers in 139 countries to work on issues
ranging from AIDS education to information
technology and environmental preservation,
and to foster cultural understanding.

ClickerCheck
The difference between a global and
international context is that international
a. Is between two countries only.
b.Is between low- and high-resource countries.
c. Is between national governments.
d.Emphasizes cultural differences.

Correct Answer
Correct answer: C
International is between 2 or more national
governments of county perspectives.

U.S. Agency for International
Development (USAID)
 U.S. government agency that provides
economic, development and humanitarian
assistance to countries for reasons of poverty,
conflict and natural disaster, and to support
populations engaging in democratic reforms.

Food and Agricultural Organization
 UN agency that provides international
leadership for combating world hunger. FAO
helps countries improve agriculture, forestry
and fisheries practice to ensure good nutrition
for all.

Pan American Health Organization
 UN agency focused on improving the health of
the countries of the Americas. Also serves as
the Regional Office of the Americas for the
World Health Organization.

United Nations Children’s Fund
 UN agency that advocates for children in the
areas of nutrition, environment, education,
gender equity, health, and public policy.

United Nations High Commissioner
for Refugees (UNHCR)
 UN partnership that strives to assure universal
access to services for HIV prevention,
treatment, care and support.

World Bank
 UN-affiliated intergovernmental financial
institution that provides low interest loans,
interest free credits, and grants to developing
countries to invest in areas such as education,
health, infrastructure and resource
management.

World Health Organization
 UN-affiliated intergovernmental agency
responsible for shaping the health research
agenda, setting norms and standards,
articulating evidence-based policy options,
providing technical support to countries, and
monitoring and assessing health trends.

Care International
 Relief and development organization that
identifies underlying causes of global poverty.
Operating in more than 70 countries, CARE
responds to emergencies by delivering aid and
helping people rebuild their lives.

Health Volunteers Overseas
 A network of health care professionals who
aim to increase health care access in low
resource countries. They work to improve
access through clinical training and education
programs. HVO train, mentor and support
health care providers in more than 25
countries.

Human Rights Watch
 Investigates and exposes human rights
violations and holds oppressors accountable
for their crimes. Dedicated to upholding
freedom and preventing discrimination.

International Medical Corps
 Dedicated to relieving suffering through
health care training, and through relief and
development programs. Builds capacity in
underserved communities.

International Red Cross
 Based primarily on the Geneva Conventions of 1864
& 1949, ensures humanitarian protection and
assistance for victims of war and armed violence and
other emergencies. The goal of ICRC’s Health Unit
activities is to give people affected by conflict access
to basic preventive and curative health care that
meets universally recognized standards.

Médecins Sans Frontières
Doctors Without Borders
 Provides life-saving medical and technical
assistance to people affected by natural or
man-made disasters and armed conflict. Field
staff deliver direct care in more than 60
countries, often in very difficult conditions.

Oxfam International
 Group of 14 international organizations that
work with other local organizations in 98
countries to fight poverty and injustice. Oxfam
objectives are guided by the belief that
respect for human rights is the key to lifting
people from poverty.

Partners in Health
 Strives to create solidarity in health by
partnering with poor communities to combat
disease and poverty by using a comprehensive
and community based approach.
 Projects are ongoing in 12 countries.

Project Hope
 Since 1958, has delivered direct healthcare
services and health education to people in
more than 35 countries, with a goal of
creating sustainable approaches.

World Vision
 Christian humanitarian organization that
serves close to 100 million people in over 100
countries. Support children, families and
communities to help all people reach their full
potential by fighting poverty and injustice.

The Gates Foundation
 Philanthropic foundation created by Bill and
Melinda Gates. Provides key resources to
promote health and education in the United
States and globally through innovative
approaches to pressing problems.

The Rockefeller Foundation
 First U.S. philanthropic foundation with global
perspective, established by John Rockefeller in
1913. Funded the first global initiative to
eradicate malaria and yellow fever in the
1940-1950s.

The Global Fund
 U.S. government initiative to save the lives of
those suffering from HIV/AIDS around the
world. Provides the largest commitment by
any nation to combat a single disease
internationally.

ClickerCheck
What organization provides loans and grants to
countries to improve health infrastructures
a.Pan American Health Organization.
b.U.S. Agency on International Development.
c.World Bank.
d.World Health Organization.

Correct Answer
Correct answer: C
The World Bank provides low interest loans,
interest free credits, and grants to developing
countries to invest in areas such as education,
health, infrastructure and resource
management.

Recommendations for the future
U.S. nursing workforce
 Promote targeted educational investment in foreign
educated nurses in the United States.
 Promote baccalaureate education for entry into
practice in the United States.
 Harmonize nursing curricula.
 Add global health as subject matter to
undergraduate and graduate nursing curricula.

Recommendations for the future
U.S. nursing workforce
 Establish a national system that monitors and tracks
the inflow of foreign nurses, their countries of origin,
the settings in which they work, and their education
and licensure to ensure a proper skill mix for the U.S.
nursing workforce.
 Create an international body to coordinate and
recommend national and international workforce
policies.

Country Income & Health
 No direct relationship between high-income
countries and health.
 US spends more than any other country on
health but ranks in the bottom quartile in
terms of life expectance.
 Inefficiencies and cost control are concerns.

Risk Factors for Health across
Countries are similar
 HIV/AIDS, Alcohol, tobacco, obesity, lack of
physical activity.
 Very low income countries – adequate food,
sanitation, safe drinking water, and vector-bourne
diseases are primary concerns.

Health professionals
 Shortage of health professionals.
 Push factors: low compensation, sociopolitical
instability, etc.
 Pull factors: increase income and quality of
life.
 Brain drain for some countries.

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