NURS 4015 – Public and Global Health Essay

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NURS 4015 – Public and Global Health Essay

NURS 4015 – Public and Global Health Essay 

Major Public Health Issues in the U.S. and Developing Nations

The health of any population relies on the functioning of its healthcare system.Services aimed at controlling preventable diseases and treatment of chronic illnesses will increase quality of life and extend life expectancy.  Global health indicators measure disease and death in relation to availability of resources.  These indicators are shaped by race, economics, education, and access to health care services(Stanhope & Lancaster, 2016, Chapter 46).  The purpose of this paper is to compare the rates of HIV in the United States to that of the similarly developed country of Japan, and the developing country of South Africa, while summarizing what the U.S. can learn from Japan in relation to decreasing the prevalence of HIV, and also describing the workforces available to care for the population of each country. NURS 4015 – Public and Global Health Essay Paper

Comparison of HIV Prevalence

The United States spends more on health care than any other country in the world.  Although the U.S. is renowned for biomedical research, cutting-edge medical technology, hospitals and disease specialists; managing illnesses with ongoing, complex care needs such as HIV, remain weak in comparison to other developed countries.  For example, more than 1.2 million people in the United States are living with HIV infection, and of that population, 1 in 8 are unaware they are even infected.  In comparison, the developed society of Japan has only 8100 people infected with HIV (Holtz, 2013, Chapter 2).

Health spending per capita in the U.S. is also much higher in comparison to other developed countries, with the life expectancy of the population being lower.  Causes of healthcare disparities in the United States can be contributed to unequal and inadequate access to insurance coverage, as this directly affects access to health care across all racial, ethnic and socioeconomic groups (Holtz, 2013, Chapter 2).  In contrast, Japan’s population has the highest life expectancy in the world, and provides universal healthcare coverage to all residents.  General healthcare services and disease screening examinations provide relative equality of access.  As a result, the population has better management of the complex medical regime required for conditions such as HIV.  Access to the needed medications as well as implementation of education and prevention strategies to decrease the risks associated with spread and transmission, contribute to lower rates of HIV among the Japanese population (Holtz, 2013).NURS 4015 – Public and Global Health Essay Paper

In the developing country of South Africa, there are approximately 5 million people currently living with HIV (Holtz, 2013).  Poverty and lack of resources make health care and disease preventionvirtually impossible.  Social bureaucracy, including significant power imbalances between men and women with fixed cultural beliefs, in conjunction with high-risk behavior and low levels of education, contribute to the tremendous impact that HIV has on this population.  The lack of adequate nutrition, clean water, housing and electricity further complicate appropriate HIV treatment.  Poor health infrastructures and the high cost of drugs prevent the vast majority of South Africa’spopulation from having access to appropriate health care(World Health Organization [WHO], 2015).

Impact on Nursing Practice

The health disadvantages in the United States arise from gaps in insurance coverage, access to primary care, and health care coordination.  In the U.S., there are only about 1.2 primary care physicians per 1,000 people, with projections indicating a need for approximately 52,000 more providers to meet the expected needs of the growing population.  Health care in the U.S. is inequitable, overspecialized and neglects primary and preventative care, which results in poorer overall health of the population in comparison to other advanced industrialized nations (DPE, 2014).  As a result, nurses must take on more responsibilities for managing and educating patients regarding care management.  This requires precise assessment skills with interventions aimed at guiding patients towards disease prevention. NURS 4015 – Public and Global Health Essay Paper

South Africa has a shortage of healthcare providers, as well as a problem with maldistribution of resources.  The majority of the country’s trained nurses and other professionals work in the private sector, leaving the general public without skilled personnel.  Though there are a multitude of traditional healers who practice in South Africa, there are no accreditations, credentialing or monitoring of their practice.  Such unequal distribution of resources poses many challenges for this healthcare system that already lacks leadership and management (Holtz, 2013).  Providing nurses in this country with incentives to serve the general public could lead to better disease management and prevention.

Modeling the healthcare system of Japan could decrease the prevalance of those living with HIV on a global level.By focusing on preventative care to improve health and reduce the financial burdens associated with chronic disease, countries such as Japan, with more effective and equitable health care systems, control costs and protect the vulnerable populations from falling through the cracks.  This is achieved by government regulation of all aspects of the universal public health insurance system which enforces detailed regulations for insurers and providers, with funds allocated by the national government (Matsuda, 2014).

In addition, Japan has more than 4,000 “community comprehensive support centers,” funded by long-term care insurance, that coordinate services for those with long-term conditionssuch as HIV (Matsuda, 2014). A number of preventive measures are publicly provided to those who are considered “at risk,” including screening, health education, and counseling with follow-up care.  A universal mandate for health care coverage eliminates the issue of paying the higher costs of the uninsured due to lack of preventative care (Department for Professional Employees [DPE], 2014).   Though there are only 1.6 physicians per 1,000 individuals of Japan’s population, there is a relatively stable number of other health care professionals including Public Health Nurses, along with Judo, Acupuncture and Moxibustion cultural practitioners. The quality of medical care and patient safety are assessed and certified by The Japan Council for Quality Health Care (JCQHC) for accreditation and monitoring of service (WHO and Ministry of Health, Labour and Welfare, Japan [WHO], 2012).  To further improve the quality of nursing service, the Act on Public Health Nurses has amendments specifying nurses graduate from a 4-year college, with required training to expand their careers in fields of new nursing frameworks (Japanese Nursing Association [JNA], n.d.).NURS 4015 – Public and Global Health Essay Paper


The negative global health and economic impacts of HIV are profound.  Resolving the roadblocks to prevention and the long-term treatment involved in managing such complex conditions can decrease the incidence and provisions needed to care for the effected populations.

Resources, workforce, and funding are necessary for the development and delivery of such health care services.  Changes in population demographics with intense needs surrounding the treatment of long-term illnesses such as HIV, effect health care spending and financing.  Efficient use and equal distribution of health services is necessary to ensure access to appropriate care.  Integrating and funding education and prevention efforts, tailored around the cultural beliefs of developing countries, can improve outcomes and significantly decrease the prevalance of HIV on a global scale.  Nurses play an integral role in accomplishing this goal through education and research that contributes to health system reform.  Well educated nurses are patient-centered, and prepared to tackle the obstacles surrounding major public health issues that influence local communities as well as those impacting populations abroad.


Centers for Disease Control and Prevention. (2015). HIV in the United States: At A Glance. Retrieved from

Holtz, C. (2013). Global health care: Issues and policies (2nd edition). (Second ed.). Sudbury, MA:  Jones & Bartlett.

Japanese Nursing Association. (n.d.). Overview of Japanese Nursing System. Retrieved from

Matsuda, R. (2014). The Japanese Health Care System, 2014. Retrieved from

National Research Council; Institute of Medicine. (2013). Health in International Perspective: Shorter Lives, Poorer Health. Retrieved from

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). Maryland Heights, MO: Elsevier.

The U.S. Health Care System: An International Perspective. Retrieved from

WHO and Ministry of Health, Labour and Welfare, Japan . (2012). Health Service Delivery Profile, Japan 2012. Retrieved from

World Health Organization. (2015). HIV / AIDS. Retrieved from NURS 4015 – Public and Global Health Essay Paper

Globalization is commonly defined as the worldwide integration of economies in the face of substantially increased transborder trade and investment [1]. It is generally addressed in the context of economics and information technologies. Globalization has brought wealth and modernity to many of the world’s peoples. Frequently overlooked in the classroom, unfortunately, are the new vulnerabilities now exposed by globalization, including the spread of natural disease and the use of disease as possible instruments of terror. It is important to understand how globalization may be affecting global public health policies, and what implications that has for global control of infectious diseases.
From a public health point of view, it is imperative that we bear in mind that infectious diseases do not recognize borders, as evidenced by the current HIV/AIDS pandemic. The two main results of globalization have been expanding international travel and increased trade. Increased trade includes the exporting and importing of foodstuffs, which are probable carriers of pathogenic microbes. Some fresh foods may be contaminated during picking, packaging, transport, or delivery [2]. Another factor that may facilitate the international spread of food borne disease is the centralized processing of human and animal foods, followed by widespread distribution. For example, if a component of animal feed is contaminated with a pathogen, a food animal could ingest the pathogen. This food animal could then pass the pathogen to anyone who consumes a part of the animal which could cause a global outbreak.
Increased international travel, a result of globalization, is also a major cause of the spread of disease, and also a major factor in the threat of bioterrorism

There are many definitions for Health. Health means different things to different people, if someone doesn’t drink and smoke then they believe that they are healthy, or if they eat a good balanced diet for example. The main most known definition of health is from the World Health Organization. World Health Organisation states:

‘Health is a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity. Health is a dynamic condition resulting from a body’s constant adjustment and adaptation in response to stresses and changes in the environment for maintaining an inner equilibrium called homeostasis.’ NURS 4015 – Public and Global Health Essay Paper

World Health Organisation (2003)

This definition however has not been amended since 1948.

What is Health Promotion?

Health promotion involves doing things to prevent disease and to improve individual and communities health. Health promotion offers solutions to many of the health problems facing society such as obesity, lack of exercise and smoking though developing skills and knowledge, community action, supportive environments, healthy public policy and health services. Health promotion helps individuals or communities to increase control over and improve their health and wellbeing. Curtin University (2012) states that ‘with a significant proportion of ill-health related to choices about nutrition, exercise, the use of legal and illegal substances, interpersonal relationships and other social behaviours, health promotion can help us make choices that support well-being.’

The features of health promotion are that it is based on a holistic view of health; it uses participatory approaches it focuses on the determinants and addressing of health not just health problems and conditions. These include the social, behavioural, environmental and economic conditions that are the root cause of poor health, wellbeing and illness such as education, income, employment, working conditions, social status. Health promotion builds on existing strengths and assets and it uses multiple, complementary strategies to promote health for the individual, community and population level.  NURS 4015 – Public and Global Health Essay Paper

Why is health promotion needed?

There are fears that the recent generation and their children’s generation will age less successfully than the current older one – no surprise given that, although rates of cigarette smoking are falling, more people are drinking heavily, only a minority of adults exercise often enough to maintain good health and obesity rates have greatly increased over the last 20 years.

Obesity is a main health issue which can lead to other health problems such as diabetes, high cholesterol, hypertension, joint pain, Nursing Times (2009) states that ‘these health issues can be prevented or delayed by lifestyle measures. A health promotion package would enable adults of all ages to lead happier and healthier lives.’

Around two-thirds of the England population are overweight or obese. Obesity has grown by almost 400% in the last 25 years and on present trends will soon surpass smoking as the greatest cause of premature loss of life. (NHS Dudley, 2012)

Obesity is associated with many health problems including coronary heart disease, diabetes, kidney failure, osteoarthritis, back pain and psychological damage. The strong association between obesity and cancer has only recently come to light. (Dodds, 2009)

Dodds (2009) estimates the economic costs of obesity conservatively at £3.3-3.7 billion per year and of obesity plus overweight at £6.6-7.4 billion.

Health promotion for obesity is especially important because it can help lower the risks of many other health conditions which then cuts down the economic costs in the future by educating people about the correct food and exercise and also behaviour change techniques.

Why do we need to Promote Mental Health?

Mental health promotion does remain the most underdeveloped area of health promotion even though there is an increasing recognition that ‘there is no health without mental health’ Christodoul (2009).

Positive mental health involves self-esteem, being able to solve problems and the ability to adapt to stress. The need for positive mental health promotion is beneficial and relevant for everyone. It is important to stress to policy makers and professionals to understand that mental health and mental wellbeing are issues of everyday life. Therefore positive mental health demands the co-ordinated action by all concerned; through the media, the government, local authorities, industry, voluntary organisation and through health and social and economic sectors.

Most of the time when people think of mental health they look at it in a negative way, however it could be argued that this is not the case. NURS 4015 – Public and Global Health Essay Paper

‘Mental health is not just the absence of mental illness. It is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.’

(Mental Health Ireland 2013)

Mental Health is about how people feel about themselves, how they feel about others and how they are able to meet the demands of life.

Mental health promotion is important because mental health contributes to all aspects of human life, it has important, less important and essential values for the individual, society and culture. Mental health has a shared relationship with the wellbeing and productivity of a society and its members. Mental health is essential for the wellbeing and functioning of all individuals.

Mental health is essential for the well-being and functioning of individuals.

Good mental health is an important resource for individuals, families, communities, and nations.

Mental health, as an indivisible part of general health, contributes to the functions of society, and has an effect on overall productivity.

Mental health concerns everyone as it is generated in our everyday lives in homes, schools, workplaces, and in leisure activities.

Positive mental health contributes to the social, human, and economic capital of every society.

Spirituality it can make a significant contribution to mental health promotion and mental health influences spiritual life.

(World Health Organization, p.21 2004)

Mental health can be regarded as an individual resource, which contributes to a person’s quality of life; an aspect of good mental health is the capacity for mutually satisfying and enduring relationships. NURS 4015 – Public and Global Health Essay Paper

The role of Health Promotion.

Health Promotion staff work at numerous different levels from working with groups and communities, face to face contact with individuals, to more strategic work such as policy development. Working as a health promotion specialist is much more than persuading and advising individuals to make lifestyle changes, it also includes the following:

Project management- this involves managing particular health promotion projects to make sure they are delivered to a high standard, effective and that they are ethical.

Personal development – developing personal, emotional and social skills and abilities of everyone to give them the opportunity to maximise their health and build a health promoting attitude to use for those around them.

Community development – encouraging and developing communities to become healthier such as neighbourhoods, cultural communities and communities of interest.

Organisational development – encouraging organisations to become more health promoting such as schools, work places and hospitals.

Partnership development – building partnerships with key people, communities and organisations who can influence health promotion and to help partnerships to be better educated to promote health.

Health information – developing ways of providing the correct information about people’s health, what social and behavioural factors can affect their health and what can be done to improve their health. NURS 4015 – Public and Global Health Essay Paper

Strategy Development – developing a planned approach to improving health and to make sure that local, regional and national polices that could affect the public’s health do so in a health promoting way.

(NHS careers, 2012)

Health promotion specialists also work in a range of different settings and locations such as sport and fitness centres, communities, health centres, local authority buildings, hospitals, offices and schools.

National Health Promotion

National health promotion includes many different programmes and schemes backed by the government the NHS, the Department of Health and some charities. Some are list below:

Change 4 life – this involves eat well, move more, live longer government campaign. This involves a website.

NHS Life Check- this is a free online service from the NHS that asks people a series of questions about their lifestyle and gives them personalised results. NURS 4015 – Public and Global Health Essay Paper

Take on life, one step at a time – this is a website from Healthier Scotland with information about healthy eating and physical activity.

NHS Health – the UKs health improvement agency for improving the health of the nation.

Health at Work Programme from the British Heart Foundation – this involves promoting health and wellbeing in the workplace.

Healthcare Promotions – this is a free service for healthcare professionals which is used to help raise awareness across the UK on a range of health issues.

Alcohol Focus UK – this is a UK national charity that works towards reducing the harm caused by alcohol.

Down Your Drink – this is a website made to help people work out wether they are drinking too much and if so what they can do about it.

Drink Aware – this aims to promote responsible drinking and find innovative ways to challenge the national drinking culture to help reduce alcohol misuse and minimise alcohol-related harm.

Fastforward – Fast Forward is a national voluntary organisation that was created to give young people the skills, education and support to live healthier lives.

Hope UK – Works with communities throughout the UK to prevent drug and alcohol-related harm to children and young people.