Global challenges in health and health care for nurses and midwives everywhere.

The next decade is likely to produce any number of global challenges that will affect health and health care, including pan-national infections such as the new coronavirus COVID-19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges.

The third decade of the 21st century looks set to be as full of geopolitical and environmental challenges as the last one was, if not more so.

It is always difficult to prepare for the unknown, but at least nursing has started the decade on the right path, thanks to the World Health Organization’s (WHO) designation of 2020 as the International Year of the Nurse and Midwife. That decision, taken by WHO’s governing body, the World Health Assembly, marks a commitment from governments around the world to make nursing a priority this year (WHO 2020a).

As I have said before, we need to make the most of the attention the Year of the Nurse and Midwife is going to afford us. We need to make sure we raise the profile of the profession and get politicians to make the commitments that are needed to grow and support the profession to avoid the alarming staff shortages that WHO is predicting by 2030 if nothing is done.

Every nurse has a story to tell, and it is important to tell yours to anyone who will listen. Telling people about your day as a nurse will help to raise the profile of the profession and help to encourage a new generation into the nursing family.

It was gratifying to hear Pope Francis praise nurses and midwives in a sermon in January (ICN 2020). And I hope other world leaders, heads of states and religious leaders will step forward and publicly recognize the great work that nurses do 24 h a day, 365 days a year.

The International Council of Nurses (ICN) has a large number of events planned for this year, and I know that our National Nursing Associations, healthcare organisations, hospitals and individual nurses have their own events in mind around the world to mark this important celebration of our profession.

Wherever nurses are working, they provide a unique service that no other professionals can equal, albeit in a calm and quiet manner, and often away from the public’s gaze. And of course, they do this in whatever circumstances they find themselves, even when those circumstances look set to change.

Climate change is the greatest threat the world is facing, yet its actual and potential effects on health and health care are rarely brought to the public’s attention. A recent report, The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate (Watts 2019), has laid bare the realities of global warming and the calamitous effects it will have if it continues on its current path. We will all be affected by it in many walks of our lives, but of course children will be most severely affected, and they will have to live with its consequences when we are long gone.

In short, The Lancet reports highlights extensive damage to health as a result of global warming, including:

An increased burden of malnutrition as crop yields fall and food prices rise

Increased rates of infectious diseases

Higher rates of respiratory disease because of air pollution

Increased traumatic injury and subsequent hardship as a result of more frequent extreme weather events.

The Lancet’s prescription for dealing with these potentially catastrophic consequences includes phasing out coal power worldwide, ensuring wealthy countries keep to their financial promises to help low‐income countries, increasing access to efficient, active transport systems based around walking and cycling, and making major investments in adapting health systems to reduce the impact of climate change.

Politicians must do the big things to reduce greenhouse gases and prevent or minimize further global warming, but we can all do something in our day‐to‐day lives to help prevent the lives of children born today being defined by the effects of global warming.

ICN is making sure the voices of nurses on this issue are being heard loud and clear in the circles where healthcare policymaking takes place. Our own position statement on Nurses, Climate Change and Health (ICN 2018) anticipated much of the Lancet report’s findings and calls on governments to take immediate action.

We are currently running disaster competency workshops in Sri Lanka and the Bahamas, and we have updated our Core Competences in Disaster Nursing to better equip nurses for the challenges they might increasingly have to face (ICN 2019).

Given recent global climate events, no rational person, and certainly no one in government anywhere in the world, should have any doubt about the reality and potential consequences of global warming. The science is settled, and so should be the global response.

The inevitable health impacts of global warming around the world make addressing the potential nursing shortages even more critical. In past months, we have seen widespread climatic events, including serious fires in Australia and severe flooding in Indonesia. Nurses are responding to these events, even though they too are potential victims, just like their neighbours.

At the time of writing this, the WHO has just declared a Public Health Emergency of International Concern (WHO 2020b). In China, the unfolding emergency caused by the novel coronavirus or COVID‐19 in Wuhan city is putting nursing services under intense pressure as thousands of people become infected with an uncertain but potentially fatal respiratory infection, and the infection spreads across China and other countries.

ICN is in close contact with the Chinese Nursing Association and the WHO about this developing situation, and we are emphasizing the importance of nurses keeping themselves as safe as possible through their actions and their use of personal protective equipment. Nurses on the front line in this event are showing the commitment and compassion that nurses do everywhere, but the truth is they are putting their lives at risk in the course of their duties, and we need to acknowledge that and praise them for their selflessness.

In previous similar events, such as the SARS (Serious Acute Respiratory Syndrome) event of 2002/2003, nurses died in the course of their duty. I hope all the nurses involved in the current crisis stay safe and that their courageous actions will be properly recognized and rewarded once the situation has resolved.

If governments act appropriately this year and make the massive investments required to deal with the upcoming nurse shortages, we will look back on 2020 as a success. But we cannot leave that to chance: we have to make sure that the legacy in 2020 is not just being able to look back on a batch of fond memories. The year 2020 must be a catalyst for lasting change that raises the profile of nursing in the eyes of an educated public that understands what nurses can do, provided they are properly resourced and rewarded for the outstanding contributions they make to societies around the globe.

My challenge to all nurses, and I know they are all busy and preoccupied with their everyday work and their family lives, is to make sure that what they do is not going unnoticed.

If people see the commitment and compassion that goes into nursing, more of them will appreciate what we do, and more of them will want to join us in what is the most rewarding job on earth.