1. Jairath, Nalini

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A decade ago, the Institute of Medicine defined global health as "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" (Board on International Health, Institute of Medicine, 1997). This definition continues to guide and shape the understanding of the role of nursing in advancing global health. More recently, Bunyavanich and Walkup (2001) identified a paradigm shift in which the concept of global health has replaced international health. The concept of global health acknowledges the interconnectedness of nations and the impact of geopolitical, social, and fiscal considerations on healthcare policy. In contrast, international health creates a distinction based on the border between a specific nation and other nations. Currently, the more inclusive concept of global health acknowledges the necessity of addressing socioeconomic disparities; global patterns of migration; redistribution of the healthcare workforce often to more affluent nations; environmental change; urbanization; and violence, whether related to war, terrorism, or security threats (McGill International Health Initiative, 2007).


Although nurses have been on the frontline in addressing global healthcare problems and issues, relatively little has been documented about the contributions of nurse researchers and nursing research to global healthcare priorities. In delineating an agenda and framework for nursing research regarding global health, researchers may draw upon the overarching goals of the United Nations Millennium Project (2005). Global healthcare priorities are identified, with eight quantifiable goals and benchmarks to be achieved by 2015. The Millennium Project goals must be tempered against regional priorities. For example, goals related to promoting gender equality and empowerment of women may not be supported at the regional level. Thus, nurse researchers interested in advancing global health must be prepared to address the inherent tensions that exist between the regional and global priorities.


As nurse researchers collectively delineate priorities for nursing research, it is important to reflect upon the factors that may adversely affect the advancement of nursing research pertinent to global health. Two broad themes are presented: (a) lack of visibility and (b) limited support for nursing research regarding global health within the larger world of nursing science.



Research conducted to address global health requires use of multidisciplinary and multinational teams. Although nurse economists, health analysts, and epidemiologists may contribute to this research, authorship of reports may be dictated by political and ideological considerations. For example, Dr. Mary Paterson of The Catholic University of America has conducted seminal work on strengthening of health systems in developing nations and in countries where the health system infrastructure has been damaged by war and political unrest (Paterson, Telyukov, Faraq, & Al-Shiakhli, 2003; Telyukov & Paterson, 2004; Telyukov, Paterson, Gotsadze, & Jugeli, 2003). Her research has not been recognized readily as nursing research because it is presented within the context of health policy and analysis as opposed to pure research and because it is published in venues such as technical reports commissioned by the World Bank and other global organizations instead of the nursing journals.


The visibility of nursing research regarding global health is influenced also by the way in which nurse researchers interested in global health are educated and socialized. The traditional academic preparation for a nurse researcher involves master's-level preparation in nursing followed by either doctoral-level studies in nursing or a related discipline and, hopefully, postdoctoral work. However, nurse researchers interested in global health may opt for graduate education in public health, health economics, and health policy because the curricula are more responsive to their career goals. By branching into related areas at the master's level instead of at the doctoral level, these researchers join a different community of scholars. Furthermore, lacking a master's-level degree in nursing, their appropriateness for membership as nursing faculty requires specific justification to certain accrediting bodies and groups. Thus, they may face additional marginalization and devaluation of their contribution to nursing science.


Finally, some ambivalence may exist regarding the boundaries of nursing research. Although the richness of the diverse backgrounds of nurse researchers in the area of global health benefits the understanding of global aspects of nursing, some may also view their research as blurring or diluting the uniqueness of nursing research. Paralleling the discussion regarding the nature of global versus international health is a discussion regarding the nature of nursing research in an increasingly global environment versus global healthcare research of relevance to nursing.


Support for Global Health Research

The role of nursing research in advancing global health is limited also by the existing nursing research infrastructure. As a result, although nursing research has been used to address many health problems with a global component, additional follow-up studies are required to make the transition to a global health perspective. For example, U.S. nurse researchers have made a significant contribution to the understanding of factors influencing the risk of HIV/AIDS transmission and the subsequent development of behavioral interventions for risk reduction. Given the global nature of HIV/AIDS, this body of behavioral research is potentially relevant in regions of the world where HIV/AIDS is endemic. However, to tailor these interventions to specific regions of the world, additional research addressing the efficacy of these interventions within the context of sociocultural and political factors and fiscal constraints is necessary.


In addition, research including subjects from other countries has often been patterned after the multicentered clinical trial model. As a result, homogeneity of study groups regardless of country of origin is a desired attribute, thus blunting the ability of the research to address complexities across nations. Thus, although this research is international, it is not global. Finally, nurse researchers interested in global health must aggressively pursue other funding avenues. Traditional funding sources such as the National Institutes of Health understandably give funding priority to research that addresses national healthcare issues. Similarly, only a small subset of private foundations and agencies funding nursing research, such as the Bill and Melinda Gates Foundation (, promote research related to global health.


In conclusion, it is hoped that, through this initiative between Nursing Research and other journals, the hidden face of nursing research in global health will be appreciated more widely. Whether at the level of individual interventions, community action, or healthcare analysis and policy development, nursing research has an enormous yet unrealized potential to advance the global healthcare agenda. I hope that these statements about the limitations in the nursing research agenda will challenge nurse researchers to expand support of an increasingly global agenda.




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Telyukov, A., Paterson, M., Gotsadze, G., & Jugeli, L. (2003). Situation analysis for a new strategy of technical assistance in the health care sector of Georgia (Technical Paper Order No. TE). Retrieved from PHRplus. [Context Link]


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