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Posts from the ‘Policy’ Category

Sep 6

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health


Lukoye Atwoli, editor in chief, East African Medical Journal; Abdullah H. Baqui, editor in chief, Journal of Health, Population and Nutrition; Thomas Benfield, editor in chief, Danish Medical Journal; Raffaella Bosurgi, editor in chief, PLOS Medicine; Fiona Godlee, editor in chief, The BMJ; Stephen Hancocks, editor in chief, British Dental Journal; Richard Horton, editor in chief, The Lancet; Laurie Laybourn-Langton, senior adviser, UK Health Alliance on Climate Change; Carlos Augusto Monteiro, editor in chief, Revista de Saúde Pública; Ian Norman, editor in chief, International Journal of Nursing Studies; Kirsten Patrick, interim editor in chief, CMAJ; Nigel Praities, executive editor, Pharmaceutical Journal; Marcel GM Olde Rikkert, editor in chief, Dutch Journal of Medicine; Eric J. Rubin, editor in chief, NEJM; Peush Sahni, editor in chief, National Medical Journal of India; Richard Smith, chair, UK Health Alliance on Climate Change; Nick Talley, editor in chief, Medical Journal of Australia; Sue Turale, editor in chief, International Nursing Review; Damián Vázquez, editor in chief, Pan American Journal of Public Health.

Corresponding email: laurie.laybourn@ukhealthalliance.org

Wealthy nations must do much more, much faster

The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with covid-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.

Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.

The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including among children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.2 4

Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8-5.6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition.4 Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.3 7 8

The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the covid-19 pandemic, we are globally as strong as our weakest member.

Rises above 1.5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.9 10

Global targets are not enough

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world’s land and oceans by 2030.11

These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short and longer term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations.12 Concern is growing that temperature rises above 1.5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.13 Relatedly, current strategies for reducing emissions to net zero by the middle of the century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.14 15

This insufficient action means that temperature increases are likely to be well in excess of 2°C,16 a catastrophic outcome for health and environmental stability. Critically, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed.17 This is an overall environmental crisis.18

Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.19 1

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed20 21 and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.

Many governments met the threat of the covid-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.22

These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the covid-19 pandemic.23 But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.

Cooperation hinges on wealthy nations doing more

In particular, countries that have disproportionately created the environmental crisis must do more to support low and middle income countries to build cleaner, healthier, and more resilient societies. High income countries must meet and go beyond their outstanding commitment to provide $100bn a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.

Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42bn of assets from fossil fuels; others should join them.4

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1.5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.

Competing interests: We have read and understood BMJ policy on declaration of interests and FG serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. RS is the chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet Commission of the Value of Death. None further declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

This editorial is being published simultaneously in many international journals. Please see the full list here: https://www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial-september-2021

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

References:

1          In support of a health recovery. https://healthyrecovery.net

2          Intergovernmental Panel on Climate Change. Summary for policymakers. In: Global warming of 1.5°C. An IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. https://www.ipcc.ch/sr15/

3          Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Summary for policymakers: the global assessment report on biodiversity and ecosystem services. 2019. https://ipbes.net/sites/default/files/2020-02/ipbes_global_assessment_report_summary_for_policymakers_en.pdf

4          Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021;397:129-70. PubMed PubMed

5          Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of climate change: an overview of systematic reviews. BMJ Open 2021;11:e046333. PubMeddoi:10.1136/bmjopen-2020-046333 PubMed

6          Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med 2019;380:263-73. PubMed

7          United Nations Environment Programme and International Livestock Research Institute. Preventing the next pandemic: zoonotic diseases and how to break the chain of transmission. 2020.https://72d37324-5089-459c-8f70-271d19427cf2.filesusr.com/ugd/056cf4_b5b2fc067f094dd3b2250cda15c47acd.pdf

8          IPCC. 2019: Summary for policymakers. In: Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Forthcoming.

9          Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points—too risky to bet against. Nature 2019;575:592-5. PubMed

10        Wunderling N, Donges JF, Kurths J, Winkelmann R. Interacting tipping elements increase risk of climate domino effects under global warming. Earth System Dynamics Discussions, 2020: 1-21.

11        High Ambition Coalition. https://www.hacfornatureandpeople.org

12        Global Climate and Health Alliance. Are national climate commitments enough to protect our health? https://climateandhealthalliance.org/initiatives/healthy-ndcs/ndc-scorecards/

13        Climate strikers: Open letter to EU leaders on why their new climate law is ‘surrender.’ Carbon Brief 2020.  https://www.carbonbrief.org/climate-strikers-open-letter-to-eu-leaders-on-why-their-new-climate-law-is-surrender

14        Fajardy M, Köberle A, MacDowell N, Fantuzzi A. “BECCS deployment: a reality check.” Grantham Institute briefing paper 28, 2019. https://www.imperial.ac.uk/media/imperial-college/grantham-institute/public/publications/briefing-papers/BECCS-deployment—a-reality-check.pdf

15        Anderson K, Peters G. The trouble with negative emissions. Science 2016;354:182-3. PubMed

16        Climate action tracker. https://climateactiontracker.org

17        Secretariat of the Convention on Biological Diversity. Global biodiversity outlook 5. 2020. https://www.cbd.int/gbo5

18        Steffen W, Richardson K, Rockström J, et al. Sustainability. Planetary boundaries: guiding human development on a changing planet. Science 2015;347:1259855. doi:10.1126/science.1259855 PubMed

19        UK Health Alliance. Our calls for action. http://www.ukhealthalliance.org/cop26/

20        Climate Action Tracker. Warming projections global update: May 2021. https://climateactiontracker.org/documents/853/CAT_2021-05-04_Briefing_Global-Update_Climate-Summit-Momentum.pdf

21        United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020.

22        Markandya A, Sampedro J, Smith SJ, et al. Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study. Lancet Planet Health 2018;2:e126-33. doi:10.1016/S2542-5196(18)30029-9 PubMed

23        Paremoer L, Nandi S, Serag H, Baum F. Covid-19 pandemic and the social determinants of health. BMJ 2021;372:n129. PubMed

Mar 4

1 Comment

Sexual Assault in the Lives of Ethnic Minority Women


Our current featured article is by the prolific social-justice team from the University of Wisconsin Milwaukee – Ashley Ruiz, BSN, RN; Jeneile Luebke, PhD, RN; Maren Hawkins, BA; Kathryn Klein, BA; Lucy Mkandawire-Valhmu, PhD, RN. This current article is titled “A Historical Analysis of the Impact of Hegemonic Masculinities on Sexual Assault in the Lives of Ethnic Minority Women Informing Nursing Interventions and Health Policy.” The article is available for download at no cost while it is featured. Below is a message from primary author Ashley Ruiz about this work:

In this article, we urge readers to consider how hegemonic masculinities are created, upheld, and sustained, due to intersecting systems of oppressions (the totality of which are also referred to as the matrix of domination).  A dominant ideology that refers to how masculine traits are constructed and idealized, hegemonic masculinities are learned social practices that ultimately lead to justifying the acceptability of violence, such as sexual assault.  In this article, we identify four ways in which hegemonic masculinities are used to justify sexual assault, specifically in the lives of ethnic minority women (social order hierarchies, “othering” dynamics, negative media/mass communication depiction, and economic labor division).  We draw from the literature to demonstrate specific ways in which sexual assault in the lives of ethnic minority women in the States are historically situated specifically in relation to colonization and slavery.  This history, upheld by hegemonic masculinities, demonstrates the past and present justification of sexual assault in ethnic minority women’s lives.  We call for nurses to recognize and understand this history as a basis for their approach to effectively meeting the healthcare needs of ethnic minority women who have experienced sexual assault. Understanding this history can help contribute to the implementation of effective interventions and health policies that disrupt hegemonic masculine ideologies by calling for a cultural shift in US society that no longer tolerates violence against women while ensuring the provision of opportunities for women’s healing.  

Sep 15

1 Comment

Critical Cultural Competence


In the current, very timely “Editor’s Pick” article titled “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care, Dr. Adel F. Almutairi and Dr. Patricia Rodney describe the concept of “critical cultural competence” as essential to peace and health.  In their analysis, they view peace as not only a political responsibility of the state, but also a sociocultural concept that is relevant to all human encounters, animated by the ideal of human dignity.  The basis for this perspective is described in the article as follows:

The theoretical underpinnings of the approach to critical  cultural competence that we articulate in this article is an extension of the findings from Almutairi’s doctoral research project, which was a qualitative exploration of the cultural competence of a multicultural nursing workforce in a tertiary hospital in Saudi Arabia.  The nursing workforce in that Saudi tertiary hospital includes nurses from more than 25 nationalities from different parts of the world who provide care to the indigenous people of Saudi Arabia. The findings in Almutairi’s doctoral research project explicated the complex nature of cultural and linguistic diversity during clinical encounters. He found that this diversity poses threats to the physical, psychological, emotional, spiritual, and cultural safety of nurses, patients, families, and their communities. Such threats are caused by the increased potential for cultural clashes, negative attitude, and misunderstandings related to both communication and behavior. (p. 203)

Using evidence from Dr. Almutairi’s research, they present an analysis of the challenges of working in a multicultural environment, as well globe300as insights that can lead to peace in health care delivery.  They conclude:

 In this article, we have argued that because of its foundations in postcolonial theory and cultural safety—as well as its operationalization through critical awareness, critical knowledge, critical skills, and empowerment—critical cultural competence offers an action orientation from which to enact our shared responsibility and address structural injustices. It is our conviction that as a nursing profession we are well positioned to look toward the future and share responsibility locally, nationally, and globally to foster equitable and peaceful heath care. (p. 209)

I hope that ANS readers will find this message relevant, will share this work broadly, and will join the challenge to foster equitable and peaceful health care.  To download your copy of the article at no cost, visit the ANS web site now!

 

May 28

Health & Human Rights: A Vital Connection


As is the tradition of ANS, this current issue of the journal contains articles that will quite likely prompt many interesting

April -June 2012

April-June 2012

discussions! The issue of human rights might seem to be primarily one that belongs in the realm of politics and policy, but as the authors of the articles in this issue of ANS  so aptly demonstrate, human rights are invariably linked to health and well-being.  Falk-Rafael and Betker cite a report that says it best: “Social justice is a matter of life and death.”

The connection goes even further to encompass the matter of health and illness.  The article by Lee titled “Family Homelessness Viewed through the Lens of Health and Human Rights” makes this point very clear – their findings support the conclusion that being treated with dignity and respect is vital to health and well-being.

As nurses we face a fundamental challenge that requires honest reflection on what interests we serve not only in health care, but in the larger society.  Florence Nightingale laid a foundation for western nursing as fundamentally serving the best interests of society. By tending to the needs of those who are ill, at risk for illness, vulnerable, or whose well-being is challenged, we also tend to the needs of society.  But as nurses worldwide recognize, our social obligation goes beyond tending to individuals, to also taking bold steps to improve the social conditions under which people live and work and to shape public policy that creates those conditions.

In many countries around the world, the basic human needs and rights of the most vulnerable individuals have been undermined by the greed and desires of the few.  This is an issue that as nurses we cannot ignore if we take our social duty seriously.  It is time to step up to the challenge that faces our communities and nations, and to use our knowledge and our insights to advocate for social justice for all.  Take a look at the complete Table of Contents of this current issue of ANS.  This is the kind of evidence that nurses provide as a framework from which to build strong arguments that shape strong policies in favor of social justice.  Indeed, it is a matter of life and death, of health and illness.

May 21

4 Comments

Nursing, politics, and the economy


The month of May typically prompts some attention to nursing in most Euro-centric countries, given that May 12th was Florence Nightingale’s birthday, and the second week of the month has been designated as Nurses’ Week in the United States. May is also the month of Mother’s Day in the U.S. — a parallel fact that I see as not altogether accidental.  All too often the attention drawn to mothers and to nurses comes in the form of gratuitous and token recognition of nurses in the “Hallmark card” tradition .. flowers, cards and small gifts that convey appreciation.  I certainly do not question the sincerity of these expressions of appreciation, and in fact believe that such messages are notably absent in places and at times when they could make a huge difference in a relationship.  However, when a culture depends on a designated yearly “day” or “week” to prompt recognition of contributions that are as vital as those of nurses and mothers, and at the same time fails to endow those vital contributes with social and cultural markers of  significant value, something is terribly awry.

Two articles appeared in the last couple of weeks that shed light on the persistent failure of dominant social systems to recognize the actual value of nurses and nursing, despite glaring evidence to the contrary.  The first of these articles, titled “Why Nurses Need More Authority” by John W. Rowe, MD, appeared in The Atlantic on May 7, 2012.  The second, titled “The Power of Nursing” by journalist David Bornstein, appeared on May 16, 2012 in the New York Times. Both articles provide ample evidence, which nurses have known for decades, of the effectiveness of a strong nursing influence and presence in health care.  They both make a strong case for nursing to have a much larger and prominent role in creating the changes that need to happen in health care in the United States.

At the risk of seeming to discount the importance of both of these article, what stood out for me as I read each of them were the many ways that each of these articles also reflected the dynamics that sustain the dominant imbalances of power in health care, and the fundamental issues that keep nursing on the periphery and yes, even in a relatively subservient role in the delivery of health care.  On the surface, it might seem that part of the problem has to do with the fact that both of the authors of these articles are not nurses and certainly that fact does shape the perspective that each author brings to the topic.  But we need strong allies, and each of these articles reflect the intention of both of these authors to come to the table as strong allies of nurses and of nursing.  The markers of sustained attitudes and assumptions that perpetuate the problem lie beneath the fact that the authors are not nurses, and in fact, are attitudes and assumptions that many nurses might also bring to the table.  They are part of the hegemonic climate within which health care in the United States and other western cultures exist.  I will only address a couple of the glaring issues that stood out for me as I read these articles.

In Rowe’s article “Why Nurses Need More Authority” he uses the recent Institute of Medicine (IOM) “Future of Nursing” report in part as a spring-board for making the case that advanced practice nurses should be “allowed” to have an expanded role in health care. He points to the opposition that organized medical groups have launched against the recommendations of the IOM report, and rightfully argues that this opposition makes no sense, and that state laws that restrict APRN practice need to be changed.  The concept of being “allowed” to practice to the full extent of our education (the first recommendation of the IOM report) is the first red flag.  It is true that laws and traditions do place restrictions on nursing practice, but the issue is not one of someone simply “allowing” nurses to practice .. it is an issue of making social change that removes restrictions, a process in which we as nurses are quite capable of being full and equal participants.  The other red flag that stands out for me is that the IOM report recommendations are not limited to advance practice only … the report calls for all nurses at all levels of education to practice at the level they are prepared, and it calls for improvements in the education system that give nurses from all levels of education and practice access to furthering their education.  Advanced practice nurses do have a critical role in providing quality health care in the United States, but so do general practice nurses who have earned associate degrees and baccalaureate degrees.  Yet, at each of these levels of practice, policies and traditions restrict what all nurses contribute.  These are barriers that need to be dismantled, not by having a benevolent “father” figure declaring that we are now “allowed” to practice in a certain way, but by social and political processes, in which nurses play a key role, to shape new policies, practices and laws.

David Bornstein’s article focuses more on the provision of the Affordable Care Act that calls for Maternal, Infant and Early Childhood Home Visiting Programs, and the evidence of the effectiveness of a Nurse-Family Partnership (NFP) program established at the University of Colorado Health Sciences Center by David Olds, MD.  What is not acknowledged in Bornstein’s article is the vital interdisciplinary nature of the program, and the dominant role that nurses have played over the years in the conception, the research, program design and implementation.  Bornstein’s article is a brief opinion piece and is not designed as comprehensive report of the project, and I would not expect to see that kind of coverage in an opinion piece.  The red flag is not in the article itself, rather, it is the reminder of how dominant the realm of medicine is in being credited for an achievement like this, even those that are shaped in vital ways by nurses – nurse researchers, educators and practitioners (as was the Univeristy of Colorado NFP project).  This tradition of granting attribution to the dominant medical discipline is a huge factor that is shaped and sustained not only within the health care system and its practices, but also by the media and the public.  But it is not immutable .. it can change.

Nurses … it is time for us to mobilize the recognize these dynamics, and to claim the power, and the authority that is our!

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