Overview & Summary: Emerging Global Health Concerns: How Nurses Respond

The 20^th century ushered in revolutionary progress in the advancement of medical science. These advancements have led to a decrease in morbidity and mortality rates, increase in average global life expectancy and enhancement of quality of life for individuals living in both developed and developing countries. We have seen even more scientific advances in the 21^st century with the use and expansion of genetics and genomics science to create a path to personalized medicine with promises of using these technologies to identify risk factors for several diseases in which early treatment intervention can commence (Aswini & Varun, 2010; Hamburg & Collins, 2010).

The World Health Organization (WHO) has noted a remarkable increase in global average life expectancy with populations everywhere now living longer (WHO, 2014). For instance, the 2014 World Health Statistics Report suggests that on a global average, a female child born in 2012 is projected to live up to 73 years, while a male child born in 2012 is projected to live up to the age of 68 years. These projections are six years longer than the average global life expectancy for a child born in 1990 (WHO, 2014). Although health disparity gaps persist within and between developed and developing countries, gains in life expectancy were significant among low-income nations, which averaged an increase in life expectancy by 9 years from 1990 to 2012 (WHO, 2014).

Although the reasons for the increase in life expectancy are varied and complex, a primary reason is that globally, infant and under-five mortality rates in many countries have significantly decreased (United Nations Children’s Fund, 2015). Other reasons attributed to the increase in overall life expectancy around the world include advances in medical technology, an increase in literacy rates, improved socioeconomic conditions, and progress in availability of safe water and food safety, good sanitation practices, immunization, and a decrease in deaths from infectious and communicable diseases (Kent & Yin, 2006). Additionally, the discovery and availability of new antibiotics have made it possible to treat some infectious diseases that would otherwise kill populations (Hopkins, 2013).

The world has made great strides in addressing infectious diseases, such as the eradication of smallpox in the 1970s and the near eradication of poliomyelitis. Despite these gains, infectious and communicable diseases persist the world over and many microbes have not been eliminated. Frequently, we have seen epidemics either in the form of bacterial, viral, and/or vector borne diseases raising their ugly heads. These diseases are referred to in the public health literature as ‘emerging’ and ‘remerging’ infections. Other global health concerns of note include human trafficking and maternal-newborn health.

During the last three decades, in an effort to name causative agents of these emerging infections, it seemed scientists have used most of the alphabet. A listing of few includes: Acquired Immunodeficiency Syndrome (AIDS), Avian flu (H7N9), Chikungunya, Dengue Fever, Ebola, H1N1 Flu, Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS) and now Zika Virus. Reasons for the emergence of these conditions are complex. However, what is true is that in the last two decades, we have seen new pathogens emerge globally.

New pathogens (including viruses such as Ebola) have emerged and supposedly made the leap from harboring in animals to infecting humans, creating what Quammen (2012) referred to as the ‘spillover effect’ phenomenon. Weather and climatic conditions have reportedly increased risk factors for these conditions by creating the environment and habitat where many vector borne disease can anchor, breed, and multiply (Dye, 2014). Given the changes in global climatic conditions and environmental degradation of ecosystems, there is likely to be an emergence of infectious diseases which are unknown to frontline healthcare workers. As new microbes surface, the medical community is faced with the daunting challenges of developing remedies, including antibiotics, that can appropriately treat such infections.

It is déjà vu once again. In 2014-2015, we witnessed the Ebola virus disease reaping havoc in the West African countries of Liberia, Sierra Leone, and Guinea (Buseh, Bromberg, Stevens & Kelber, 2015). Again, we saw the Zika Virus transmitted by the Ades genus aegypti mosquito, infecting poor and vulnerable populations in Latin America. Cases of Zika have also been reported in the United States in the Miami, Florida area. Radio, television, and print media carried images of anxious and traumatized mothers from Latin American countries in hospital waiting rooms holding babies with microcephalus. Photographs of these babies leaves a sense of hopelessness and emptiness in the hearts of many of us. Having learned from the Ebola outbreak in West Africa, WHO promptly declared a global emergency for Zika which allowed the international organization to mount all of their resources to address the spread of the Zika virus in globally. The United States (U.S.) Centers for Disease Control and Prevention (CDC) also issued health messages with warnings to the general U.S. population.

Worldwide, infectious diseases continue to be a menace to society accounting for major causes of deaths, especially in low income developing countries (WHO, 2014). Reflection on this begs many questions. What are the narratives with all these infectious diseases? What factors are at the core of the problem with these cyclical emerging infectious diseases including the spread of vector borne diseases? How does emerging infections such as Ebola or Zika virus disease fit within the larger puzzle of global pandemics? What are the roles of healthcare workers, specifically nurses and public health workers, to address these epidemics? How can countries (developed and developing) work together to prevent and control these pestilences?

The health and economic well-being of all people around the world are equally important. In the last several decades, we have seen an array of outbreaks; some of which did not reach the United States. Human trafficking is rapidly becoming a greater concern both at home and abroad. Maternal-newborn health is perennially of concern. No country can remain totally isolated from others. The health of people in a remote part of the world may have an impact on the health of U.S. citizens. We must adequately prepare and develop measures aimed at preventing and mitigating these emerging global health concerns.

The series of articles in this OJIN: The Online Journal of Issues in Nursing topic provide important information regarding emerging global health concerns, including the control and prevention of emerging and reemerging infections, human trafficking, and maternal-newborn health, for the discipline of nursing to consider in this 21^st century. Many authors of these articles stress the need for a greater role of the discipline of nursing to address infectious and communicable diseases. Other authors take a broader view of global health concerns to include additional risks. All of these emerging concerns have health, economic, and social ramifications as well as implications for educating nurses. Providers must have adequate preparation to facilitate early identification and management of increasingly complex and myriad global level challenges coming into their clinics.

Outbreaks of infectious diseases test the readiness of healthcare systems around the world. Thus, the discipline of nursing has a stake in preventing the spread of emerging infections and devising durable solutions. The U.S. healthcare system was tested during the Ebola outbreak in West Africa. On October 10, 2014, a nurse who had cared for a man suffering from Ebola in Texas was diagnosed with Ebola. On October 15, 2014, a second nurse who had cared for the same man was diagnosed with the virus. The news sent shock waves across the United States and within the healthcare community. How can nurses working in one of the most advanced tertiary care systems in the world come down with Ebola? A response came later when the National Nurses United (NNU), the largest union representing nurses, released findings of a survey of their membership that suggested nurses were not sufficiently prepared to safely care for Ebola patients (National Nurses United, 2014). As a result, prominent nursing organizations (e.g., American Nurses Association, him National League of Nursing) promptly devised and disseminated educational tools about Ebola.

The opening OJIN article “Consistent Infection Prevention: Vital During Routine and Emerging Infectious Disease Care,” by Rebmann and Carrico provides an outstanding discussion about the need for nurses in healthcare settings to institute and adhere to proper procedures and standard practice of care when caring for patients every day and during complex emergencies (e.g., biological disasters, bioterrorism, natural outbreaks). Competencies in safe practice behaviors are essential to prevent nurses from contracting infectious diseases from patients. This article reviews occupational health risks, and pharmacological and nonpharmacological interventions for nurses who provide care to patients with new or re-emerging infectious diseases. Challenges specific to infectious disease disasters are discussed, as well as the role of microorganisms and nurse education for infection prevention.

The article “Emerging Global Health Issues: A Nurses Role” by Edmonson, McCarthy, Trent-Adams, McCain, and Marshall provides the broadest scope of selected critical global health issues affecting our world today, addressing emerging infectious diseases, human trafficking, and maternal/newborn health. Predicated on the fact that nurses are a critical sector of the healthcare workforce at the frontline, the authors make a persuasive case for global health concerns to be defined as issues that transcend national boundaries. The article introduces to the topic a critical factor to consider in addressing global health conditions—misdistribution of healthcare workforce both here in the United States and in low-income developing countries. Embracing the global health and social justice framework, Edmonson and colleagues issue a call to action for global partnerships and collaboration to plan how best to address complex health emergencies, stressing the need for nurses to become more engaged with other professionals and in the political and policy making process. They argue for nurses to play a pivotal role in how healthcare and social policies are developed aimed at mitigating emerging infectious diseases.

Disaster can occur in any place. Some places may be more prone to disasters due to geographic location, weather patterns, and living conditions. In many poor countries, it may be difficult to garner resources to address disaster, let alone to plan ahead for potential disaster. Rafferty-Semon, Jarzemnak, and Shanholtzer, in their article “Simulating Complex Disaster Preparedness: Collaboration for Point of Distribution” discuss increasing rates of disasters around the world leading to public health threats. In this article, the authors stress the need for disaster preparedness and collaboration at the local, national, and global levels. They emphasize the need for providing current nurses and future nurses with knowledge and skills necessary to address complex community disasters. Rafferty-Semon et al. describe the need to use preparedness planning that incorporates a point of distribution/dispensation (POD) as a way to improve management and delivery of services during global disasters. Notably, the authors emphasize the need to teach competency for disaster nursing, embedded throughout nursing curricula at both undergraduate and graduate levels. Refferty-Semon and colleagues suggest utilizing an active learning approach in which simulated disaster planning is structured in the activity. An important tool they include to improve disaster management is the Logic Model Framework, an important public health framework that requires an interdisciplinary and collaborative approach to develop, implement, and evaluate health related programs. In my experiences, the Logic Model Framework has been used in many community-based health programs in both developed and developing countries, and is well-suited for disaster planning and management. Finally, the authors stress the need for adequate and sustained funding to conduct disaster drills and simulations.

Mosquitoes are usually active during the summer season in the United States. However, for millions of people around the world, mosquitoes are not merely a recurring irritation; rather, they are agents responsible for spreading various diseases to millions of people, especially in tropical regions. In the earlier part of 2016, the global health community was once again alerted when the Zika virus began to infect populations in Latin American countries. In their article, “The Zika Virus Epidemic: Public Health Roles for Nurses,” Wilson and Nguyen, discuss the public health nursing roles in the context of the Zika epidemic. Zika is not a new disease. As the authors explain, the Zika virus was first isolated in 1947 and the first human cases were documented in 1964 in Uganda, East Africa. Today, Zika has become a critical public health issue to consider, and Wilson and Nguyen support enhancing the roles of public health nurses. The authors stress the key positions of nurses in the healthcare delivery system as a benefit to developing system capacities to address Zika virus around the world.

In their article, “Prevention and Control of World-wide Mosquito-Borne Illnesses: Nurses as Teachers,” Audain and Maher utilize their public health expertise to outline and discuss the prevention and control mosquito-borne diseases globally. The authors call for nurses to serve as teachers in addressing these conditions, in their roles as professionals with influence and education. However, some nurses may not be educated in ecological factors attributed to vector borne diseases, such as transmission and how to clearly identify clinical characteristics of patients presenting with various symptoms. Audain and Maher provide a helpful synopsis about arboviruses. Interestingly, the authors also provide detail via tables and figures generated from varied sources that they have adapted and incorporated to teach lay individuals about vector borne diseases. Customized virtual educational tools are presented as exemplars used by the authors to train youths about vector borne disease prevention before departure for a mission trip to Africa. The authors suggest these educational methods as possibilities for use with other community groups from local to global levels.

Nurses have a long history as first responders to medical crises throughout the world, and this includes those serving in the uniformed forces. Michelle Brown-Stephenson, author of the article, “United States Public Health Service Nurses: Deployment in Global Crisis,” is a member of the U.S. Public Health Service Commissioned Corps. The corps is an elite team of highly qualified public health professionals with extensive training who respond to public health crises both at home and abroad. Author Brown-Stephenson provides a description about responsibilities and roles of nurses during deployments, with information about their duties that many nurses may not know. She provides an exemplar of deployment of the corps to Liberia, West Africa for Ebola response in 2014 that includes discussion of some of their challenges such as controlling the epidemic at its source, mitigating further impact, engaging and coordinating efforts with the global audience, and fortifying global health security. She expands on how the team addressed challenges related to Liberian customs, ensuring provider and patient safety, and establishing and maintaining effective communication. Brown-Stephenson concludes with reflections on her personal experience during the deployment and offers food for thought based on lessons learned.

The journal editors invite you to share your response to this OJIN topic addressing Emerging Global Health Concerns either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Aaron G. Buseh, PhD, MPH, MSN
Email: aaronbg@uwm.edu

United Nations Children’s Fund. (2015). Levels and trends in child mortality. Retrieved from https://www.unicef.org/publications/files/Child_Mortality_Report_2015_Web_9_Sept_15.pdf