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Revista Latino-Americana de Enfermagem

On-line version ISSN 1518-8345

Rev. Latino-Am. Enfermagem vol.16 no.4 Ribeirão Preto Aug. 2008 



Nursing in the era of globalisation: challenges for the 21st century



Alcione Leite da Silva

Post-doctoral degree, Faculty, University of Aveiro, Portugal, e-mail:




The purpose of this paper was to reflect about issues related to the processes of globalization and the global impacts on health, pointing out some challenges for Nursing in the twenty-first century. In this sense, the author outlines the forms and trends of globalization in the contemporary world, and the drastic impacts on human health and environment. To respond to the challenges of the globalized world, some ways are indicated, among which, the strengthening of nursing discipline stands out, together with some guidelines for education, research and Nursing care, in a local and global scope.

Descriptors: health; nursing




Globalization is understood by those who follow a neoliberal ideology as an irreversible process which is intensified and developed according to its own logic and dynamics. To other people(1-2), globalization goes beyond determinism, because it becomes a field of social and political questioning. Some authors also say that globalization is especially economic(3), and it can also be seen as a complex and diverse phenomenon, with economic, social, political, and cultural dimensions, among others(1-2).

With this diversity in the speeches, as of the 80's, globalization took several shapes and tendencies, there are, at times, conflicting. However, the negative impact of globalization on the everyday lives and on the health of people in the global sphere is undeniable, especially of those economically deprived of goods and basic social services such as education, and health care.

Within this context, Nursing is challenged to look for new ways of meeting critically and effectively the demands of these health issues that are put to society. From this setting, the present text develops some reflections on the following issues: What are the health perspectives in the era of globalization? What are the challenges imposed to Nursing in the 21st century?



In times of globalization, in health, it is important to highlight the positive advances in communication and biotechnology. However, the effects of globalization on the health of the world poor population tends to be far more negative than positive, since poverty is closely related to health conditions and expectations. It is worth mentioning that of the worldwide population of 6 billion people, 2.8 billion (almost half) live with less than 2 dollars a day, and 1.2 billion (one fifth) with less than 1 dollar a day, and 44% live in the South of Asia(4).

In this sense, poor countries are accountable for 90% of the diseases of the world, but they do not have over 10% of the resources globally spent in health, which is reflected in the poor economic development of these countries, due to the loss of people at a young and productive age. Children with less than five years old in Africa are 7 times more likely to die than European children, just as people from 15-59 years old in Africa are 4.5 times more likely to die than people in Europe, and maternal mortality rates are 16 times greater in Africa than in Europe(5).

A risk to world health due to globalization is connected with increase in transnational trade, and this is a direct cause of the spread of diseases(6), such as hepatitis B virus, due to the international trade of blood products, diseases related to the intake of food, bovine spongiform encephalopathy, and those related to new variations of Creutzfeldt-Jakob disease in human beings.

Harms to the physical environment, largely caused by unsustainable consumption rates of rich countries, can be seen as a consequence of globalization. The harm to the environment has led to alarming loss of social environmental quality, with a great result in the population health, making it clear that a global future would not be viable without a strategic program on sustainable development.

Risks to global health result, also, from the growing urbanization, encouraged by economic growth and industrial development that bring significant social, economic, and political changes. This outcome has negative impacts on the health of people especially due to the threaten of communicable diseases, as well as the worsening of other problems associated with social disintegration and violence.

We know that good health depends, also, on the quality of health policies and health investments(7), as well as education, ideas, techniques, and technologies. However, poor countries not only invest little in health and education, but also lack financial and human resources that enable an equal participation of these countries in international organizations, where decisions affecting and designing the rules operating international systems are made.

These are only some impacts on health due to the globalization process. Certainly, the impact of globalization on health is a complex process, with different sides, whose dimension is far from the perspective focused here. We have a major challenge, that we must face if we agree with the Declaration of Alma-Ata, 1978, which states that health is a fundamental human right and that attaining the highest possible level of health is a most important world-social goals, whose realization requires the action of many other social and economic sectors in addition to the health sector(8).



Over a little more than a century, Nursing, in different places of the world, has gone through several changes, with undeniable developments, that were seen in the academic field, and that led to the achievement of new places of action(9). However, the shape and trends of the globalization process in the contemporary society, imposes new and great challenges for Nursing, in this 21st century. These challenges are due, mainly, to countless and fast changes in the political, economic, social, and cultural field with drastic effects on the individual and collective health.

Due to the complexity of these processes and challenges, it is essential to strengthen the discipline of Nursing. This strengthening goes through the construction of innovative epistemological bases that are in agreement with the contemporary advances that are consistent and sensible to the human and environmental needs and those of society. These epistemological bases will, in turn, support and direct the professional practice connected with education, research, and care, locally and globally speaking.

In this 21st century, it is essential to combine collaborative efforts in Nursing, in each country and in the different countries to open up and consolidate spaces of effective action regarding: 1) forming competent scientist able to think critically in order to define and prioritize social needs that guide their study object; to assess the vulnerable aspects of their education, and to make decisions to strengthen and consolidate Excellency in capacity-building and scientific production; 2) producing innovative knowledge and with sizeable impact on the social reality and in the health and well being of individuals, families and communities, especially for the poorer population with no access to goods and services; 3) giving opportunity to capacity-building in the use of new theoretical and methodological references and giving training in advanced technological strategies; 4) encouraging development of a "..proactive behavior of Nursing leaders to give attention to opportunities, to create spaces and mechanisms to insert this field of knowledge, and to present the demands using projects that work together with public policies"(10), geared to the social needs. However, this process requires, above all, multicultural domain, sensibility to deal with differences, and ability to build bridges between the different boundaries of human living in a global scope.

The power of research in Nursing must be to consider it as an important space for care, as a political activism, not only to build new theoretical-practical framework but also, and mainly, to perform actions to increase levels of quality of life in society(11).

In the field of formal education in Nursing, we have to search for, obligatorily, an emancipating education, as an important dimension to form professionals with critical ability of thinking about them, thinking globally about the present structures, from their historical roots, and acting locally to solve problems, in a transforming way and with social and ecological responsibility. The education needs to be committed with preparing nurses able to, among other aspects,: 1) know about local and global reality; be aware of the health profile of the population, regionally, nationally and internationally speaking; 2) work in the several levels of complexity of individual and collective health care, with social responsibility and commitment with citizenship; 3) develop a culturally competent practice, that values and respects differences in the scope of gender, sexual orientation, among other aspects; 4) build knowledge as of the educational practice.

In the context of care, some strategies are necessary, focusing essentially on people, guiding them to emancipation and autonomy, making them capable of thinking and acting critically to improve their lives. Likewise, to value and encourage believes and cultural values are essential to perform care culturally competent, favoring building attittudes, and health behaviors.

The intention in this text was to open up space for reflection on some issues related to globalization processes and impacts on global health, pointing out some implications in Nursing. Naturally, the cut we have used reduces significantly this complex and plural reality. Within this context, we have to ask ourselves: where should we go from here? Any path we choose implies collective responsibility and goes through the logic of solidarity, justice and human dignity. The future of Nursing and health will depend on our collective and political choices.



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Recebido em: 3.9.2007
Aprovado em: 15.6.2008

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