Hegyvary, S. T. (2004).Journal of Nursing Scholarship, 36, 96-101.

We live in a global village where the chief causes of mortality are malaria, AIDS, and tuberculosis. Earlier in 2004, an international nurses' list of grand challenges in improving global health was published (Dickenson-Hazard, 2004). This article consists of nurses' responses to the initial list; as well as a comparison with a list of global challenges compiled by the Bill and Melinda Gates Foundation (http://www.gatesfoundation.org). Readers will be struck by how many of the challenges relate to women and children, key areas of interest to MCN readers.

The JNS working list includes (1) Improving societal conditions affecting health (educational levels of women in poverty, cycles of violence, maternal mortality); (2) Improving child and adolescent health (infant mortality, premature births, childhood precursors of adult illness, mental health); (3) Improving family planning; (4) Reducing substance abuse; (5) Preventing infectious diseases; (6) Managing physical and mental illnesses; and (7) Linking health systems and social processes.

The Gates foundation list focused more specifically on vaccines, nutrition, drug treatment of infectious diseases, controlling insects that transmit diseases like malaria, curing latent and chronic infections, and the measurement of health status lacking in many developing countries.

The two lists are not contradictory; both emphasize the complex challenges in improving global health and the need to focus on conditions that underlie health/illness, as well as the illness/violence/infections themselves. We may differ by worldview and professional perspective on the way we approach these challenges, yet our collective action may lead to positive changes. It will be long and hard, but what a chance!!

Comment by Linda Beth Tiedje

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