This is the first Global Health and Nursing column I'm writing for MCN, and I'm thrilled to be starting this ongoing column, as suggested by MCN's Editor. One of my favorite Disney songs is "It's a Small, Small World." Although written a long time ago, I realize now how true these lyrics really are. The world is becoming more and more a global community as we understand the sobering concerns about the health of women and children, as well as the increasing disparities in health outcomes between the developed and developing world. For example, although life expectancy is improving in the developed world, in the poorest countries in recent years life expectancy is decreasing (Benatar, Daar, & Singer, 2005). Did you know that 35% of women in developing countries do not have prenatal care, 50% give birth without a skilled birth attendant, and 70% receive no postpartum care (International Council of Nurses [ICN], 2005a)? This is a major contributor to maternal mortality from postpartum hemorrhage (Callister, 2005). And it is not only maternal health in other countries that should concern us; it is estimated that during 2005, almost 11 million children under 5 years of age died, with nearly 4 million babies dying during the first year of life (World Health Organization, 2005). The majority of the burden of illness in the developing world is borne by women and children.

Why should U.S. nurses care about global health? Because the delivery of healthcare to women and children globally has implications for clinical practice in the United States. Immigration of women and children from all parts of the world to the United States has been rapidly increasing, and nurses in every corner of the United States will soon be taking care of women and children from countries with entirely different healthcare systems and many unmet health needs. Are you equipped to do so? To be ready for this challenge, we must all know much more about what is happening globally in healthcare for women and children.

For example, HIV/AIDS is a growing and dominant public health concern, now reaching epidemic proportions in Sub-Saharan Africa and in Eastern Europe, with maternal/child transmission of particular concern (ICN, 2005b). As a nurse working with women and children, do you know the countries with the highest rates of HIV/AIDS, hepatitis B or C, or tuberculosis? Do you have procedures in place for screening women from high-risk regions? Do you have policies for protection of yourself and your staff?

There are many areas of the world with sobering maternal/child health outcomes. Do you know what the public policy in those countries is for how to reverse their problems? The Pan American Health Organization and World Health Organization recently developed goals for maternal and perinatal care in Latin America and the Caribbean (Belizan, Cafferata, Belizan, Tomasso, & Chalmers, 2005). Some of these goals include involving women in the process of care, making healthcare family-centered instead of physician-centered, basing practices on the best evidence available, and assisting women to attain their best re-productive health status. Sound familiar? These goals could be the same for women in the United States.

There are other important global issues that nurses should understand. How about the ethics of recruiting nurses from developing countries to work in the United States, when there is a global shortage of nurses (Muula, Mfutso-Bengo, Makoza, & Chatip-wa, 2003)? Another global nursing issue is the high ratio of nurse:patient staffing recently being seen in countries such as Australia (ICN, 2005c).

It is essential that as nurses we develop a global state of mind, establishing linkages with nurses throughout the world to improve the health and well-being of women and children. I plan to write about many different issues in this column and will value your input about the content. Please submit your suggestions for topics to me at [email protected]. It may be a small, small world, but I'll try, in this column, to make it easier for us to understand!!

References