About ICN
ICN Position Statements
ICN on Nursing and DevelopmentPolicy Background Paper
Prepared by the International Council of
Nurses
with the assistance of
Jane Robinson, FRCN, PhD, Emeritus Professor
TABLE OF CONTENTS
___________________________________Introduction
The Wealth of a Nation is its People: The Case for HealthDevelopment and Health
Poverty and Health
Health Inequalities
Women’s Health and Well Being
Children’s Health and Well Being
Interdisciplinary and Inter-Sectoral Collaboration
Protecting the Natural Environment
Infrastructure Development in Nursing and Health
Helping Others to Help Themselves and OthersAppendix - Position statement on Nursing and Development
References
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INTRODUCTION
This background paper expands on the International Council of Nurses (ICN) position on Nursing and Development*. It provides information on how ICN implements this position through its programmes, projects, policies and advocacy work.
ICN’s vision is of a healthy world. In keeping with this vision, we consider health and nursing as key aspects of development in any nation. ICN believes health is a basic human right, and ascribes to the World Health Organization (WHO) definition of health as a dynamic state of being involving mental, emotional, social and spiritual well-being (WHO, 1998).
As an advocate for policies that promote healthy communities and support sustainable development, ICN collaborates with nursing, health care and other organisations to identify health needs of populations at risk. ICN works strategically to assist nurses and others to develop and achieve determined goals for nursing and health care that take into account local needs and inequalities, demography, cultural sensitivity, socio-political and economic conditions and constraints.
In economic terms development is the growth of per capita income. In broader social terms, development is concerned with the distribution of resources, access to opportunities for growth and prosperity, and creation of a climate that promotes and supports the full exercise of rights by every person in society. In essence, it is the process of improving the quality of all aspects of human life (WHO, 1992). There is a complex, though often unacknowledged, inter-relationship between health and development. Health is a pre-requisite for economic development; and development is a necessity for health.
The nursing profession can contribute substantially to development by helping communities achieve better health. In support of this ICN, advances six strategies to guide nursing work in health and development.
1. Increase resources and at the same time provide adequate prosperity to improve health and well being and reduce health inequalities, and provide equitable, cost-effective, access to health care.
2. Strengthen women and children’s capacity to exercise more control over their lives and living conditions.
3. Encourage interdisciplinary and inter-sectoral level collaboration.
4. Protect the environment.
5. Support infrastructure development in nursing and health.
6. Help groups to help themselves and others. ICN appreciates the many national and international agencies that annually make major contributions to policies and programmes for health and development. Ideas, policies and programmes from the World Bank, UNICEF, the United Nations Development Programme (UNDP), the World Health Organization (WHO), and the World Trade Organization (WTO) and many others impact immensely on people’s health and development.
ICN will continue to collaborate with such agencies in pursuing its mission to improve the health of populations.
* See the appendix for the full text of the ICN Position Nursing and Development
THE WEALTH OF A NATION IS ITS PEOPLE:
THE CASE FOR HEALTH
DEVELOPMENT AND HEALTH
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There is close correlation between wealth and health. Yet income alone, in terms of Gross National Product per capita, cannot explain the health outcomes variations observed between countries with the same income levels. Differences in housing, access to clean water and satisfactory sanitation, nutrition, education, income distribution and culture all contribute to this variability, especially in low income countries (The World Bank, 1997).
Health systems also vary, and the effectiveness of a country’s health and social policies can substantially improve, or worsen, health outcomes. The pursuit of wealth alone is insufficient to ensure the health and well being of populations. The Human Development Report 1999 reminds us that:
The wealth of a nation is its people. And the purpose of development is to create an enabling environment for people to enjoy long, healthy and creative lives. This simple but powerful truth is too often forgotten in the pursuit of material and financial wealth’ (UNDP, 1999, page1).
The report notes that the current era of globalisation is creating fresh opportunities for millions of peoples around the world. Increased trade, foreign investments, and expanding media and Internet connections are fuelling economic growth and human advancement. As a result of globalisation we see:
The linking globally of financial markets, old and new.
The introduction of new tools, predominantly electronic.
The involvement of new actors (e.g. the World Trade Organisation, multinational corporations, global networks of NGOs and other organisations that transcend national boundaries).
The emergence of new rules and multilateral agreements on trade, services and intellectual property. Backed by strong enforcement mechanisms and more binding for national governments, these reduce the scope for national policy (UNDP, 1999, page 1). This is the global reality within which nursing and ICN must function. The opportunities for people everywhere to enjoy improved quality of life and better health lie in our capacity to capitalise on globalisation and development in order to eradicate poverty. The potential to eradicate poverty (and thereby improve the opportunities for health) has never been greater.
While globalisation carries potential benefits, real dangers accompany a movement so strongly driven by economic motives. Nurses are well aware that while market-led expansion may enhance efficiency, it may not have the same impact on equity. This is because the benefits of competitive markets are frequently unequally distributed. For example, some will experience exciting opportunities for the development of innovative, cutting-edge services and new job prospects. Others however, may find that the demands of the health care market, competition, and an erosion of national labour boundaries will increase employment vulnerability, reduce publicly-funded services, and decrease access to health care services for some populations.
Opponents active at the1999 WTO ministerial meeting agenda argued, for example, that the type of free trade being advocated benefits wealthy and large multinational companies; that WTO rules are biased against developing countries; and that trade interests are put before environmental concerns. WTO supporters argued that international trade agreements boost free trade; cut costs; create jobs; and guarantee a free flow of goods, services and ideas, all of which are ultimately beneficial to the development of countries (Marshall, 1999).
What we do know is that many reports identify the deterioration in the material circumstances, including health, of some of the most vulnerable populations, while others continue to receive disproportionate benefits arising from the concentration of wealth and power that results from global economic policies. Resources for public benefits such as free or subsidised access to health care, education, housing and transport systems are squeezed by the demands of the global economy (Robinson 1997). As a result, an even greater inequity may be created for vulnerable groups (such as the young, the old, the poorly educated and those with a low skill base, migrants and refugees). They find themselves unable to compete in an increasingly competitive global labour market, and unable to access basic health care services.
The consequence of health inequities takes many forms. There may be an increased susceptibility to infectious diseases, and/or the diseases of malnutrition, especially among children. Psychiatric disorders, including substance abuse, and an increased propensity for violence, may also grow. Women are often disproportionately affected due to their vulnerability in childbearing and child rearing years. Children may be exploited by demand for cheap labour and the need to raise family income, often working in conditions that are directly harmful to health and normal growth and development.
ICN is a powerful advocate for policies that contribute to the health of populations, to sustainable development, and to the security and just treatment of nurses and health care professionals. ICN will also work with nursing and health care organisations to develop this advocacy role in others.
ICN in action for development
Working to ensure that development of the arrangements and capacity for care, are central to its policies and actions in strengthening NNAs. Positioning itself strategically to enable others to determine and achieve locally defined goals for nursing and health care, helping people take responsibility for creating conditions for local development in improving help and for mutual self help.
POVERTY AND HEALTH
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As clearly stated in the 1999 WHO World Health Report, poverty maintains and intensifies ill health.
Conquering poverty constitutes the central task for development policy at the beginning of the 21st century. Despite rapid economic growth, over a billion humans still exist in absolute, degrading poverty. Because ill health traps people in poverty, sustained investment in the health of the poor could also provide a policy lever for alleviating persistent poverty (WHO 1999, p 7).
Yet while economic growth and good health are increasingly recognised as two sides of the same coin, the Human Development Report 1999 claims that the relentless pressures of global competition are squeezing out care, “the invisible heart of human development ” (UNDP 1999, p 7). This phenomenon is related to the burdens and responsibilities of care, and to the capacity to care. Care is defined by the UNDP Report as a special capability:
…for nurturing human relationships with love, altruism, reciprocity and trust. Without enough care, individuals do not flourish. Without attention and stimulus, babies languish, failing to reach their full potential. And without nurturing from their families, children under-perform in school (UNDP, 1999, p 7).
This report underlines the need to establish new arrangements for care in the face of the global economy. Each society, based on its history and culture, must find new approaches for rewarding care and increasing its supply and quality. Policies and actions that support caring and human development need to be strengthened.
While a disproportionate share of the burden of disease is born by the poor, this is not inevitable. Some countries achieve far better outcomes for their poorest populations than others provided policies are right (WHO, 1999, page 20).
The World Health Report 1999 cites studies showing that ill health, in the form of disability, contributed to continuing poverty in Côte d’Ivoire and in Ghana. Wages were significantly lower in each country for each day of continuing disability. The report also demonstrates the complex interrelationships between the different pathways to health and income. In an example from Indonesia, the effects of an iron supplement taken by anaemic men were compared with a control group receiving a placebo. The productivity of the treated group increased nearly to the levels of non-anaemic workers, and the productivity gains were large when weighed against the costs of treatment (WHO, 1999, pp 9 – 10). Better adult health increases productivity and reduces absenteeism. The WHO report concludes that:
Economists should never forget the intrinsic value of health – or that today’s health systems have the tools to vastly improve the welfare of the poor at modest cost. But neither should health professionals forget an important message for presidents and finance ministers: investing in health accelerates economic growth and is one of the very few viable approaches to rolling back poverty (WHO, 1999, page 11).
However, it should be noted that while many effective interventions are simple and relatively inexpensive to implement, they do require an infrastructure of community health services with the capacity to reach populations at risk.
ICN in action for development
Advocating policies that give priority to the health needs of poor and at risk groups.
Promoting educational preparation and nursing practice that meets the health needs of poor and at risk populations.
Emphasising in policy statements that improving the health of the poor also contributes to economic growth and development.
Supporting the development of models for local health systems that reach those most in need of health care.
HEALTH INEQUALITIES
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Raising health standards, especially among populations at risk, and decreasing inequities in health, may require that countries evaluate their models for nursing and health care.
WHO (1999) advocates a new universalism that recognises government limits in providing health services, but retains government responsibility for the leadership and finance of health systems. Since health is such an important component of national welfare it therefore requires a combination of universal entitlement and tight control over expenditure (WHO, 1999, p 33). Market-oriented approaches to health services that ration according to the ability to pay are rejected, but so is the idea that governments should provide and finance all health care for everybody.
The new universalism will require open, vigorous debates on which publicly provided health services are affordable and effective. Priorities will need to be set. The World Bank (1993) recommends that priority setting should focus on the introduction of cost-effective clinical intervention packages matched to the public finance resources available.
Whatever approach is decided for priority-setting, public debate and participation in is an integral part of this process. In some countries national nurses’ associations (NNAs) and other nursing groups are already working with governments on activities related to the identification and application of health care priorities. But overall, nursing needs to become more proactive and strengthen its voice in health care decision making.
ICN in action for development
Endorsing policies that enable NNAs to develop appropriate models for local health systems delivery, including nursing systems.
Supporting NNAs in health service development that considers: local needs and health inequalities, demography, cultural sensitivity, economic conditions, socio-political dimensions and constraints, and the wider environment.
Supporting NNAs in identifying basic health needs amongst poor and at risk populations, and encouraging co-operation in the dissemination of clinically effective intervention packages to them.
Working with international organisations and agencies to promote the development of health programmes for migrants, refugees and displaced persons*.
Encouraging NNAs to participate in the evaluation and monitoring of priority setting activities aimed at universal coverage of target populations and disease reduction.
Using information systems, trend analysis, the legitimisation of successful strategies, networking, and advocacy to systematically collect evidence for successful change.
* See ICN Position Statement on Health Services for Migrants, Refugees and Displaced Persons
WOMEN’S HEALTH AND WELL BEING
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Women’s education and health are intimately related to the health of families and to their capacity to contribute to a country’s economic life and prosperity (The World Bank, 1993, UNDP, 1995). Yet women’s education and health needs continue to be neglected. The Human Development Report 1995 provides a wealth of evidence on women’s continuing disadvantage relative to men, stating:
Poverty has a woman’s face – of 1.3 billion people in poverty, 70% are women. The increasing poverty among women has been linked to their unequal situation in the labour market, their treatment under social welfare systems and their status and power in the family (UNDP, 1995, p 4).
Lack of access to qualified birth attendants, pre and post-natal care, emergency intra-partum care, under-nutrition and long-term complications from childbirth are leading causes of chronic ill health and premature mortality in women. In fact the World Health Report 1999, places maternal conditions together with HIV/AIDS and tuberculosis as the three major causes of disease burden in the developing regions of the world (WHO, 1999, p 20).
By 1999 UNDP reported some progress in women’s global situation. Between 1990 and 1997 the net secondary school enrolment ratio for girls increased from 36% to 61%, and women’s economic activity rate rose from 34% to 40%. However, on an adverse note, nearly 340 million women are not expected to survive to age 40, and between a quarter and a half of all women have suffered physical abuse by an intimate partner (UNDP, 1999, p 22).
ICN in action for development
Affirming women’s fundamental right to attain the highest level of health possible. ICN supports equitable access to services that are sensitive to women’s needs, conform to human rights, ethical standards, and reflect the users’ rights to confidentiality, information and informed consent*.
Supporting NNAs in contributing directly to health policy, service planning, practice development and research in women’s health. ICN urges that a gender approach be incorporated in all aspects of health, including epidemiological studies, research, decision-making, service planning and care.
Urging that gender equity be promoted within the context of responsibility and partnership of women and men in both public and private life.
* See ICN Position Statement on Women's Health
CHILDREN’S HEALTH AND WELL BEING
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Children are a second major vulnerable group in relation to poverty and poor health. The five major childhood conditions – diarrhoea, acute respiratory infections, malaria, measles, and peri-natal conditions – are responsible for 21% of all deaths in low and middle-income countries. Less than 1% occur in high-income countries. All these conditions are susceptible to preventive or curative interventions such as immunisation and oral re-hydration therapy. These interventions should be incorporated into packages of essential health services, including the Integrated Management of the Sick Child (WHO, 1999, p 20).
Children are particularly susceptible to the destabilising effects of war. They must content with loss of human life, disintegration of families, and an increase in mutilation and disability. Their personality development is affected by their frequent participation in these war activities.
Children, particularly those from families that are themselves members of vulnerable groups, are exploited in many ways. Each year, Unicef highlights some aspect of children's vulnerability in its report, The State of the World’s Children. The 1991 report described the commitment of the first World Summit for Children to end child deaths and child malnutrition occurring at the 1990 scale, and to provide basic protection for the normal physical and mental development of all the world’s children. While some progress had been made, the world had not reached many targets by 1999. For example, sixty-seven countries listed in the 1999 Report still have an under age 5 mortality rate above seventy. Forty-nine of these countries have mortality rates above one-hundred deaths of children under 5 years of age per one thousand live births (UNICEF, 1999, p 93).
The 1997 Unicef report focused on child labour, which seriously exploits children by denying them the conditions for healthy development, and access to education and play. Unicef points out that children have rights established in international laws, including the Convention on the Rights of the Child (United Nations 1989), ratified by all but a few countries. Child labour is a complex issue. It is sustained by powerful forces, including some employers, vested interest groups and economists proposing free-markets at all costs. Some traditionalists believe that the caste of certain children removes rights (UNICEF, 1997, p 18). A difficult balance has to be achieved between eliminating the exploitation of child labour while ensuring that measures, such as trade embargoes, do not force families into an even greater poverty, and children into even worse situations.
ICN in action for development
Endorsing the Declaration of the Rights of the Child (United Nations 1959) and the Convention on the Rights of the Child*.
Supporting the role of nurses in the protection of children, particularly from labour exploitation (ICN, 1992), and in ensuring their equitable access to health services.
* See ICN Position Statement on Rights of Children
INTERDISCIPLINARY AND INTER-SECTORAL COLLABORATION
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Emphasis on teamwork has long been a feature of best practice in health care institutions and beyond. WHO recommended the development of a multi-sectoral systems approach to health care delivery and full collaboration of health personnel at all levels in Nursing Beyond 2000: Report of a WHO Study Group (WHO, 1994). WHO further recommended interdisciplinary collaboration in Nursing Practice: Report of a WHO Expert Committee (WHO, 1996).
Many inter-sectoral and interdisciplinary working principles embraced by nurses and other health care professionals, are now found in the statements of United Nation’s agencies in support of development. For example, the World Bank states that policies that contribute to reductions in absolute poverty and to greater equity between peoples increasingly require holistic approaches. The World Bank World Development Report 1999/2000 : Entering the 21st Century puts forth the Comprehensive Development Framework (CDF) for implementation of a holistic approach to development. Certain principles within the framework are relevant to ICN and other nursing organisations in creating strategies and policies for nursing and development:
The country, (NNAs and other nursing groups) should own its development strategy, determining the goals, timing, and sequencing of its development programs.
Partnerships should be built with governments; the private sector; NGOs, assistance agencies, and the organisations of civil society to define development needs and implement programs.
A long term, collective vision of (health and development) needs and solutions should be articulated that would draw sustained national and international support.
Structural and social concerns (with health and development) should be treated equally and contemporaneously with macroeconomic and financial concerns (The World Bank, 1999, page 21).
The World Bank emphasises that while the CDF is not exhaustive, the pressing issues of poverty, gender inequality, knowledge/information gaps, and overpopulation are incorporated into virtually all its components. Each country is likely to have unique priorities to be included in a matrix that evolves over time.
Health care professionals risk marginalisation if they continue to adhere to rigid definitions of their roles. Addressing complex health care problems will require interdisciplinary and inter-sectoral partnerships. Nurses can set an example by recognising that the most effective solution for a community health problem may lie outside the traditional definition of nursing care, and be achieved by working with many partners. For example, health may be improved by reducing educational failure and job insecurity. This will require that nurses work differently and with new partners, both within and outside the health sector.
ICN in action for development
Seeking inter-disciplinary and inter-agency working partnerships. ICN supports country and regional multi-disciplinary initiatives to meet local health and development needs.
Encouraging and supporting individual NNAs, using local situation analyses, to strengthen their contribution to health and to health care and to increase their influence on national health policies.
Supporting controlled experimentation in devising new way to achieve goals, working in partnership with a range of institutions
Working to build the capacity and confidence of NNAs to collaborate with other groups at all levels.
Facilitating NNA efforts to work with others.
PROTECTING THE NATURAL ENVIRONMENT
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Sustainable development does not have a single definition (Robinson, 1997). Different inter-national agencies give different emphases to the respective aspects of people and the environment. The World Commission on Environment and Development definition, that current generations should ‘meet their needs without compromising the ability of future generations to meet their own needs’, has become widely accepted (Our Common Future, 1987).
The need to strike a balance between economic growth for the eradication of poverty, and the safeguarding of the natural environment, was a recurring theme in the 1990s (The World Bank, 1992; UNDP, 1993; UN, 1994; WHO, 1994; UNDP, 1996). Phillips and Verhasselt (1994) claim that the people aspects of sustainable development arose as a reaction against economic structural adjustment policies during the1980s. This concerns people and environment-friendly policies for decreasing poverty, reducing unemployment, and enhancing social development through health, education and nutrition programmes.
International sustainable development policies tend to focus on the large-scale environmental problems, for example, the exploitation of non-renewable natural resources, the pollution of the atmosphere and oceans, climate change and global warming. However, nursing and health care are more involved in the local practices that ultimately contribute to the larger global picture of environmental degradation.
In some parts of the world, nurses work locally with the other sectors to improve air and water quality, and promote safe methods for waste and sewage disposal. With the greater usage of sharp instruments and needles, plastics, mercury from calibrated instruments, chemo-therapeutic and other drugs, lasers and their product of electrico-surgical smoke, safe disposal has become a concern for every nurse.
ICN in action for development
Supporting NNAs in negotiations with governments and other agencies to control the production, selection, use and disposal of medical, and other hazardous substances that have potential for immediate and long term harmful effects on both users and the wider population.
Seeking, through education, advocacy and collaboration with other groups, to influence decisions that pose potential threats to health, for example, water stress and pollution, land degradation, and other environmental pollutants.
INFRASTRUCTURE DEVELOPMENT IN NURSING AND HEALTH
_______________________________________________________________________
In many parts of the world, the health and nursing infrastructure cannot cope with present demands and future needs. As the World Health Report 1999 notes, assuring access to effective quality care at an affordable price is a complex process requiring decisions on the health interventions to be made available and delivery channels for these interventions.
As health care providers, nurses need to examine how these choices will affect nursing services, including the range of knowledge and repertoire of competencies required by nurses. Does nursing need to develop new models of practice or revitalise present approaches in meeting health needs? For example ICN believes that the Family Nurse as a community-based practitioner can unleash the tremendous potential of nursing world-wide.
Additionally, nurses will need to determine how to use new technologies to improve health. Although still in early development and application, telenursing promises greater access to healthcare and can be a tool in making health care more available to under-served urban populations and remote areas. Moreover, as the demand for home care and long term monitoring of persons with chronic health problems grow, telenursing can be an indispensable tool for nurses to manage clients between personal visits.
Practising evidence-based care is of growing importance, especially in light of health care restructuring and emphasis on cost-effectiveness. Increasing nursing practice research and applying results to improve practice are critical to an effective infrastructure for nursing and health.
ICN in action for development
Continuing its work through programmes, project work and advocacy activities in:
- systems development (international nursing information systems ICNP®);
- human resources development for nursing;
- standard-setting and accreditation programmes;
- leadership development in nursing and health;
- professional regulation;
- socio-economic welfare of nurses (the promotion of safe working
environments, career planning, equitable and just rewards);
- influencing and monitoring international policies that impact on nursing
and health infrastructures.
HELPING OTHERS TO HELP THEMSELVES AND OTHERS
________________________________________________________________
ICN invests its resources to produce the maximum beneficial effect, in health outcomes and the progress of nursing and health care. A key means of this is strengthening national nurses’ associations (NNAs). ICN works with NNAs to enhance their self-reliance, and their capacity to help organisations, groups and individuals nationally and across borders. ICN uses and promotes a ‘cascade effect’ of enabling and capacity building strategies.
Through policies and programmes aimed at building nurses’ capacity to be knowledgeable and confident professionals, ICN helps people to take responsibility for, and act positively to create conditions for local development. Through relevant and timely contributions ICN believes that nurses and nursing can be an effective means for assisting populations towards an improved health status.
ICN remains committed to a framework reflecting the core concepts of primary health care and supporting local, cost-effective approaches to building health systems. By acknowledging self-determination, fostering self-reliance and building on the resources of the community, health care providers can form partnerships to achieve affordable, acceptable health care services.
ICN in action for development
Using approaches that define end goals and the principles underlying the diverse means by which the goals are achieved.
Involving those working at a local level in the clarification and definition of the means to achieving goals.
Helping NNAs to position themselves strategically, enabling them to take responsibility, creating the conditions for local development and its beneficial applications for health, and for mutual self help.
Using an ethical basis in ICN-supported initiatives, involving justice, equity, non-discrimination, transparency and flexibility of means.
CONCLUSION
ICN continues to influence the strategic planning and policies of NNAs, other international organisations and national agencies. ICN continuously reviews, and encourages others to address, the following questions at global, national and local levels:
1. What development initiatives are needed to increase societal resources and prosperity, while protecting the environment?
2. What actions are needed to improve health, particularly for women, children and other vulnerable populations?
3. What strategically needs to be done to advance nursing and health care development?
4. How can ICN best help nurses to help themselves and each other?
ICN recognises that working to achieve a healthy world involves complex inter-relationships between health systems development, poverty reduction, economic growth, the reduction of inequalities, international, inter-sectoral and inter-professional collaboration. Building policies and programmes that account for this complexity demands new ways of working, openness, devolution, and experimentation, while respecting ICN’s basic values of visionary leadership, inclusiveness, flexibility, partnership, and achievement.
ICN will continue to strengthen its ability to meet development challenges and to engage in capacity-building activities with its member NNAs, along with a range of other groups and organisations. Building on its present programmes and experience it will continue to work for health and environments that enable people to enjoy long, healthy, productive lives.
1. International Council of Nurses (1992) The Role of the NNAs in the Protection of Children. Geneva, ICN.
2. Koivusalo M. and Ollila E. (1997) Making a Healthy World: Agencies, Actors & Policies in International Health. London, Zed Books.
3. Marshall A. (1999) Seattle Summit: Castro threatens to join Clinton’s WTO party.
The Independent. Saturday, 27 November, page 17.4. Phillips D.R. and Verhasselt Y. (Eds.) (1994) Health and Development. London, Routledge.
5. Public Services International (ud) Health and Social Services Briefing notes for current debates on public sector issues. Ferney Voltaire, PSI.
6. Robinson, J. (1997) Sustainable Development: Implications for Nursing and Midwifery. Nursing/Midwifery Paper No.1. WHO/HDP/NUR-MID/97.1.
Geneva, World Health Organization.7. Robinson J (1999) ‘The World Bank and the World Health Organization: ‘International sources of ideas for health policy.’ In Robinson, J., Avis, M., Latimer, J & Traynor M. Interdisciplinary Perspectives on Health Policy and Practice: competing interests or complementary interpretations? Edinburgh, Churchill Livingstone.
8. The World Bank (1992) The World Bank World Development Report 1992: The Challenge of Development. New York, Oxford University Press.
9. The World Bank (1993) The World Bank World Development Report 1993: Investing in Health. New York, Oxford University Press.
10. The World Bank (1997) Sector Strategy Paper Health, Nutrition and Population. HNP Family, Human Development Network, Washington DC, The World Bank.
11. The World Bank (1999) The World Bank World Development Report 1999/2000 Entering the 21st Century. New York, Oxford University Press.
12. United Nations (1959) The Declaration on the Rights of the Child. New York, United Nations.
13. United Nations (1989) The Convention on the Rights of the Child. New York, United Nations.
14. United Nations (1994) Programme of Action of the 1994 United Nations International Conference on Population and Development. New York, United Nations.
15. United Nations Children’s Fund (1991) The State of the World’s Children 1991. Oxford, Oxford University Press.
16. United Nations Children’s Fund (1997) The State of the World’s Children 1997. Oxford, Oxford University Press.
17. United Nations Children’s Fund (1999) The State of the World’s Children 1999. Oxford, Oxford University Press.
18. United Nations Development Programme (1990) Human Development Report 1990.
New York, Oxford University Press.19. United Nations Development Programme (1993) Human Development Report 1993.
New York, Oxford University Press.20. United Nations Development Programme (1995) Human Development Report 1995.
New York, Oxford University Press.21. United Nations Development Programme (1996) Human Development Report 1996.
New York, Oxford University Press.22. United Nations Development Programme (1999) Human Development Report 1999.
New York, Oxford University Press.23. World Health Organization (1992) Our Planet, Our Health. Report of the WHO Commission on Health and Environment. Geneva, WHO.
24. World Health Organization (1994) Nursing Beyond the Year 2000: Report of a WHO Study Group. Geneva, WHO.
25. World Health Organization (1996) Nursing Practice: Report of a WHO Expert Committee. Geneva, WHO.
26. World Health Organization (1999) The World Health Report 1999 Making a Difference. Geneva, WHO.
27. World Health Organization (1999) Amendments to the Constitution, 52nd World Health Assembly, A52/24, Geneva, WHO.
ICN Position:
As an advocate for healthy communities and sustainable development, ICN collaborates with nursing, health care and other organisations to identify health needs of populations at risk. ICN works strategically to enable nurses and others to develop and achieve goals for nursing and health care that take into account local needs, local socio-political, demographic and economic conditions and constraints, and the local cultural context.
ICN invests its resources to produce the maximum beneficial effect for health outcomes, and the development of nursing and health care. It supports local, cost-effective approaches to health systems development, including the just treatment and security of nurses and health professionals. Within nursing, ICN’s emphasis is on strengthening national nurses’ associations so as to enhance self-reliance and foster their ability to help others.
ICN values the ‘cascade’ approach in development, where the expectation is that, in return for assistance, partners will help others in a like manner. This also involves taking responsibility and creating conditions for local development within a framework that emphasises the principles of justice, equity, non-discrimination, transparency and flexibility.
ICN supports development strategies and policies that:
Increase resources and at the same time provide adequate prosperity to improve health and well being and reduce health inequalities, and provide equitable, cost-effective, access to health care. Strengthen women and children’s capacity to exercise more control over their lives and living conditions. Encourage interdisciplinary and inter-sectoral collaboration. Protect the natural environment. Support infrastructure development in nursing and health. Help groups to help themselves and others. Background:
ICN’s vision is a healthy world where access to health is a basic human right. ICN works with governments, national and international organisations in helping populations to attain a level of health that will permit them to lead a socially and economically productive life.
ICN views development as creating conditions that allow populations to meet the needs of the present without compromising the ability of future generations to meet their needs 1. For us, sustainable development is concerned with providing a framework whereby groups, communities and individuals have access to resources and opportunities, and exercise their rights, using them to create infrastructures that promote healthy communities.
Strengthening the nursing profession is key to improving world health. In fulfilling its mandate to represent nursing world-wide, advance the profession and shape health policy, ICN strives to base its programmes and initiatives on its values of visionary leadership, inclusiveness, flexibility, partnership, and achievement.
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1 Our Common Future. The Report of the Independent Commission on International Development Issues, North and South. Cambridge, Massachusetts, 1987.
Adopted in 2000:
Related ICN Positions:
The International Council of nurses is a federation of more than 120 national nurses’ associations representing the millions of nurses worldwide. Operated by nurses for nurses, ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally.
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