I am honored to provide a guest editorial for this esteemed Journal. Much of my content has been taken from a speech I delivered in Orlando, the topic of which was “Responding Globally to the World’s Children.” My objective then and now is to outline what I believe to be the primary threats to women and children in the world today and to encourage nurse practitioners to consider volunteering their time and skills to help those who are most in need.
The issues to be discussed are transnational in nature, and thus the volunteerism I advocate also is global in nature. In a continually shrinking world, it is imperative that we resist the urge to take a regional or national view of issues, for increasingly these divisions are meaningless.
It was some 43 years ago that Loretta Ford and Henry Silver sparked an idea that has grown into a global movement. The combination of Dr. Ford’s public health nursing experience and Dr. Silver’s pediatric experience led to a program advocating the expansion and empowerment of the nurse’s role in health care delivery. In this, the United Nations Decade of the Health Worker, nurse practitioners have reason to be proud of their contributions in the United States and many other countries around the world.
Childhood means more than just the time between birth and the attainment of adulthood. It refers to the state and condition of a child’s life—to the quality of those years.
The convention on the rights of the child, adopted by the General Assembly of the United Nations in 1989, represents a global consensus on the terms of reference as applied to childhood. In the past 18 years advances have been made in the fulfillment of children’s rights to survival, health, and education. However, in several regions and countries, some of these gains are in danger of reversal from four key threats: poverty, armed conflict, HIV/AIDS, and gender equality. These threats not only reduce a child’s chances of survival and development in the early years of life, but for the children who do survive, they cause damage that lingers long after childhood and increase the chances that the next generation will be affected by the same threats.
Children living in poverty are denied many of their basic rights: survival, health and nutrition, education, and protection from harm, exploitation, and discrimination. According to UNICEF’s data, more than 1 billion children are severely deprived of at least one of the essential goods and services they require to survive, grow, and develop. Millions of children are severely deprived of nutrition, water, sanitation facilities, access to basic health care services, adequate shelter, education, and information. Of the 11 million children younger than 5 years who die every year, almost half die in the first month, and three fourths of those die in the first week of life. In our world today, newborns are among the most disadvantaged people in the health care system; one might say an endangered species. Even in countries where deprivation is low, relative deprivation in terms of family income and wealth implies unequal opportunity for children, especially for female children.
Our response to protecting children from poverty is a global as well as a national responsibility. Severe deprivations that deny children the right to grow, develop, and participate are concentrated heavily in lower-income countries, which have fewer resources to confront these challenges.
For these and many other reasons, the elimination or at least the reduction of poverty poses serious political, economic, social, and cultural challenges—but the world community cannot turn away. In the absence of action, the situation will grow worse, and the world as a whole will pay heavily for inaction.
HIV/AIDS is, of course, linked to poverty, because it is endemic in some of the most poverty-stricken nations of the world. However, it must be considered one of the major threats to childhood in its own right, not only because it can infect children, but also because of the disease’s profound social and economic effects, and most importantly, its ability to lay waste to traditional family structures.
HIV/AIDS is tearing at the very fabric of childhood. In 2006, the estimated number of children younger than 15 years infected with AIDS was 2.3 million. By the end of 2006, 15.2 million children younger than 18 years had been orphaned by the pandemic. Eight out of ten of those children live in sub-Saharan Africa. Unless swift and decisive action is taken to stem the tidal wave of infection and loss, it is estimated that by 2010, more than 18 million African children will have lost one or both parents to HIV/AIDS.
Clearly, the highest priority of all is to limit the spread of HIV/AIDS and therefore reduce the number of children being deprived of their parents. Despite the grim advance of the disease worldwide, there are significant national successes in turning back the tide of the pandemic that can serve as models. Forthright national leadership, widespread public awareness, and intensive prevention efforts, for instance, have made Uganda the pre-eminent example of sustained achievement, while comprehensive action in Thailand averted some 5 million HIV infections during the 1990s. Unfortunately, the nongovernmental agencies involved in HIV/AIDS programs in Thailand are reporting that infection rates are increasing.
Women and children do not start wars, yet they are most vulnerable to its deadly effects. Children rarely grasp the complex causes of armed conflict, yet all too often they are forced to flee their homes, witness atrocities, or even perpetrate war crimes themselves. Children are not responsible for war, yet it robs them of their childhood.
Children are always among the first affected by conflict, which alters their lives in so many ways. Even if they are not killed or injured, they may be orphaned, abducted, raped, or left with deep emotional scars and psychosocial trauma from direct exposure to violence, dislocation, and the loss of loved ones.
Armed groups and, in some cases, government forces use children because they often prove easier than adults to condition into fearless fighters with unthinking obedience. For all children, whether they are forcibly recruited, join in order to escape poverty or hunger, or enlist to actively support a cause, the first loss is their childhood.
My last point is on Millennium Goal Number 3—Promoting Gender Equality and Empowering Women. If we are to reach our Millennium goals, all members of society must participate fully, both men and women. A pivotal factor to human progress that will address the issues—poverty, HIV/AIDS and armed conflict—is gender equality. Gender equality will not only empower women to overcome poverty but also will assist their children, families, and communities as well. As nurse practitioners, educating mothers on the care of their children is one of our most important tasks. Healthy, educated, and empowered women are more likely to have healthy and educated daughters and sons. A world that is fit for children is a world fit for women—they are inseparable and indivisible. One cannot exist without the other.
Childhood is the foundation of the world’s future. And although the future may look bleak at times, we must not despair. Our optimism is rooted in history—the world has shown that it is capable of doing great things when it has the will to achieve them.
We as nurse practitioners have so much to offer the children of the world. It is my belief that we all have a vital role to play in improving global health by educating ourselves and others about the vast unmet needs of some of the world’s neediest children living in the most difficult circumstances. I encourage all of you, at some time in your nursing career, to consider volunteering your time and sharing your expertise. By sharing your knowledge with other nurses in other countries, you will be part of the global movement to increase the total number of trained health workers in high-need areas, thus improving the access to care for the world’s children.
The experience of volunteering is like no other. I myself and so many other nurse volunteers have stated time and again that we come away from the assignment feeling that we have gained more from the experience than we were able to give in return. Many nurses speak of the inspiration they gained from their colleagues in the receiving country, while others mention how they improved their teaching skills and their ability to communicate cross culturally. Accept the challenge!
As pediatric nurse practitioners, let’s move in a new direction where we will confront the harsh realities for today’s children. Undoubtedly this task will be challenging and difficult. There will be many days when we will be concerned about our ability to make a difference in a way we hoped we would in health care. In the end, we have no choice but to move forward, and ultimately, I believe that together we can make this world a better place for our children—for each and every child on this planet.
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