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Public Health Nursing in Japan: Then and Now

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An editorial in The Lancet caught my attention earlier this summer and started me thinking about past visits to Japan and many encounters with Japanese public health nurses. The editorial by Richard Horton –  Offline: Japan’s Hidden Secret – refers to comments made at a global meeting by Dr. Hajime Inoue, an Assistant Minister in the Japanese Ministry of Health, Labour, and Welfare. Speaking at a side-event at the 2024 World Health Assembly, Dr. Inoue pointed out the impressive contributions of the country’s 53,000 public health nurses in achieving positive population health outcomes. I enjoyed reading the description of current public health nursing roles and the recognition given by The Lancet in sharing the successful model from Japan.

Early in my consulting career, I was asked if I would take on a role of coordinating a study tour to British Columbia for a group of nursing leaders from the Japanese Nursing Association (JNA). Their 1994 tour – funded by a grant to JNA by the Ministry of Health and Welfare – had the purpose of learning how health systems in various countries were embarking on health policy reforms. JNA sent groups to other countries during a two-year period and compiled reports from each tour. The study tours explored ways in which nurses were taking on new responsibilities in community health including home care.

Following the 1994 study tour, I received a lovely invitation from the JNA in 1995 to visit Japan to meet with nursing leaders including tour members as they worked on promoting new policies and roles in public health nursing and home care to meet changing demographics. It was a professional highlight and a great honour to serve as a consultant during two trips in 1995 and 1996. Connections made in that period led to further visits by Japanese colleagues to Canada as well as collaboration on documents and one journal publication. 

I was proud to be a co-author with three colleagues on an article published in Public Health Nursing in 1999 (25 years ago!). It was a rewarding collaborative effort to write the paper and to see it in print: Murashima, S., Hatono, Y.,  Whyte, N., & Asahara, K. (1999). Public Health Nursing in Japan: New Opportunities for Health Promotion. Public Health Nursing, 16 (2), 133-139.

As noted in our abstract, we outlined the history, organization, and new opportunities identified at that time:

“Major changes are taking place in public health nursing in Japan. These include significant developments in employment, education, and roles of public health nurses (PHNs). Demographic and economic factors have prompted the Japanese government to focus health service delivery on community-based care, particularly for the growing elderly population. Public health nurses are redefining their roles and are assuming important functions in planning, implementing, and evaluating community health programs for the elderly. Japanese PHNs are using a variety of health promotion strategies to initiate change at the local level. This article presents two case studies to highlight the leadership role of PHNs in creating new services that foster healthy communities” (Murashima et al., 1999, p. 133).

My later involvement involved visits to Japanese universities to conduct seminars with students and faculty and participation in two conferences. I met PHN leaders in their communities where they gave me tours of public health centres and described current successes and challenges.

Visit to a Public Health Centre

Throughout these visits, I remember many interesting informal discussions, wonderful meals, and time to enjoy the beauty of Japan in both rural and urban areas. Above all, I remember the great kindness of the nurses and others in each place I visited.

Dinner with Students at Kochi College of Nursing, 2000.

As Richard Horton notes, “public health nurses evolved to be a unique comparative advantage enjoyed by Japan’s rapidly advancing health system” and asks why we are not sharing national experiences more widely (Horton, 2024, p. 2578). I agree fully and believe we need to continue to learn from policy and practice experiences in other countries.

Kochi Castle

By Nora Whyte – August 25, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Universal Health Coverage: New Political Declaration

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Earlier this year I wrote about Universal Health Coverage (UHC) being on the agenda for 2023 in anticipation of the United Nations High-Level Meeting on UHC. The meeting took place in New York this September during the 78th Session of the United Nations General Assembly (UNGA). The resulting political declaration adopted on September 21 is entitled “Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world.”

The Political Declaration has 109 points beginning with background on past agreements and UNGA resolutions and moving into our current global context including urgent action needed to achieve the Sustainable Development Goals (SDGs).

The World Health Organization issued a media release on September 21 celebrating the approved declaration with its strong focus on primary health care:

“In the Political Declaration, Heads of State and world leaders committed to take key national actions, make essential investments, strengthen international cooperation and global solidarity at the highest political level to accelerate progress towards UHC by 2030, using a primary health care (PHC) approach.

For health care to be truly universal, it requires a shift from health systems designed around diseases to systems designed for people. PHC, an approach to strengthening health systems centred on people’s needs, is one of the most effective areas for investment to accelerate progress towards UHC.”

Further, as stated in the declaration , political leaders are called to recognize and act upon the health inequities that exist within and among countries. Throughout the document there is a call for greater political commitment along with global solidarity and cooperation to tackle “social, economic, environmental and other determinants of health” and to eliminate barriers to health care access. There are numerous points on Health Human Resources highlighting the need for national governments to invest in their health workforce and to attend to issues of migration.

UHC2030 Coalition

The UHC2030 Coalition continues its excellent advocacy as well as its educational work on UHC. The Action Agenda serves as a clear framework: Action Agenda from the UHC Movement – UHC2030

Credit: UHC2030 Coalition

See also the statement issued on September 26: Statement of the UHC2030 co-chairs on the adoption of the Political Declaration on Universal Health Coverage – UHC2030

International Council of Nurses

The International Council of Nurses (ICN) was represented at the UNGA by President Dr. Pam Cipriano who gave presentations during the High-Level Meetings on Health. It was great to know that ICN brought strong global nursing expertise and presence to the deliberations. ICN had contributed to the Action Agenda as a member of UN High-Level Meeting Task Force. As Dr. Cipriano stated:

“The political declaration gives governments an opportunity to make a clearsighted and enduring change that will make a real difference by giving everyone equitable access to the health care that they need. Governments must not only make these commitments; They must follow through with the necessary investment to make these historic changes a reality that will benefit many millions of people who currently have little or no access to basic health care.”

ICN’s coverage included these media releases:

https://www.icn.ch/news/icn-president-says-universal-health-coverage-will-only-be-achieved-2030-if-there-dramatic

https://www.icn.ch/news/icn-president-calls-resilient-health-systems-un-high-level-meeting-pandemic-prevention

Much more will be written about the UHC movement, the SDGs and the UHC 2030 action agenda. We need to ensure that the momentum is sustained along with the renewed enthusiasm for primary health care.

Credit: World Health Organization

By Nora Whyte – September 27, 2023

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Nurses for Peace

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ICN Campaign: Nurses for Peace

The International Council of Nurses (ICN) has launched a #NursesforPeace social media campaign to join nurses around the world in solidarity with the nurses of Ukraine.

ICN in partnership with the European Federation of Nurses Associations (EFN) and the European Forum of National Nursing and Midwifery Associations (EFNNMA) issued a powerful statement on March 3, 2022. Speaking on behalf of the global nursing community, they condemn the illegal invasion of Ukraine and call for an immediate ceasefire.

ICN is encouraging nurses around the globe to participate in the social media campaign and to add our support by signing the statement.

Thank you to ICN and European partners for your strong leadership at this critical moment and for demonstrating support for the Ukrainian people in this call for humanitarian action. For updates and suggested actions, please visit the ICN website.

#NursesforPeace

By Nora Whyte – March 3, 2022

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Year in Review: 2021

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ICN Congress

A highlight of 2021 was the opportunity to participate in the International Council of Nurses (ICN) Congress, held in a virtual format for the first time. The ICN Board and Staff team along with congress partner Emirates Nursing Association did an outstanding job of hosting the three-day event attended by 5,000 nurses and guests from around the globe. Speakers and participants added to the richness of the discussions on key topics relevant to nursing today and conveyed the sense of urgency on workforce issues and equity in global health. Among the important documents discussed was the Global Strategic Directions for Nursing and Midwifery 2021–2025 released in April 2021 by the World Health Organization. Four focal areas for health systems – education, jobs, leadership and service delivery – were important strategic directions covered in congress sessions.

I enjoyed the daily keynote presentations and the continuity provided by ICN leaders who conveyed the enthusiasm and spirit I had experienced at past congresses. However, I did miss the informal social gatherings and memorable encounters with nurses from other countries at congresses in Singapore (2019), Barcelona (2017) and Durban (2009).

Prior to the congress, I was pleased to continue my collaboration with Patrick Chui and Susan Duncan in planning a presentation delivered by Patrick as a pre-recorded oral concurrent session. The presentation drew on previous work and explored policy advocacy leadership by Canadian nursing organizations using a current example of COVID-19 vaccine equity. We discussed ways in which nursing organizations demonstrate policy advocacy leadership in highly complex and evolving contexts. In our conclusion we proposed areas of research that will be useful in generating knowledge to strengthen nursing organizations’ influence on health systems and policy.


Professional Development Highlights

Webinars were the way to go for professional development this year. I enjoyed sessions organized by the Canadian Nurses Association throughout 2021 and the Annual Marion Woodward Lecture hosted by UBC School of Nursing in November. A stimulating session in December was hosted by the International Collaboration for Community Health Nursing Research (ICCHNR): Dr. Barbara Stilwell delivered the annual Lisbeth Hockey Lecture on The Power of the Nursing Narrative. I liked Barbara Stilwell’s call to nurses: “Let’s power together” as she concluded her lecture. Thank you to the organizers and speakers for contributing to my learning and thinking during the past year.

A New Roadmap

Looking to this new year and beyond, the WHO Regional Office for Europe has published Building Better Together: Roadmap to Guide Implementation of the Global Strategic Directions for Nursing and Midwifery in the European Region.  As noted in the foreword by Hans Kluge, WHO Regional Director for Europe, “…we will work over the next five years to ensure that nurses and midwives have the capacity to contribute to key areas of public health, primary care, long-term care and post-COVID-19 recovery. We will put this into practice through relevant education, improved working conditions, the promotion of leadership opportunities and clear career pathways.” (WHO, 2021, p. v).  Taking into account regional and global policy contexts, it lays out key directions and monitoring mechanisms.  It’s an excellent resource that may serve as a guide for other regions to follow.

I end my year in review comments with a special note of appreciation to all the colleagues who continue to involve me in fascinating projects and who stay in touch through regular email exchanges and on social media. Thank you to my Twitter followers!

By Nora Whyte – January 4, 2022

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Global Nursing Reports: May 2021

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Each year at this time I write a short piece to reflect on National Nursing Week in Canada and follow what others are posting on social media. This year there isn’t much to say that hasn’t been said already by nursing leaders and through Canadian media coverage of nursing during COVID times. I do want to commend leaders in nursing organizations and to thank colleagues for the tremendous work they have been doing under such difficult circumstances. I think about nurses I have known in India, Nepal, and South Africa and wonder how they’re doing. I hear stories about nurses in all parts of Canada who continue to be key to the COVID response and I learn from colleagues in my circle about their recent experiences with the vaccination rollout in British Columbia.

International Council of Nurses May 2021

ICN celebrates International Nurses Day on May 12 each year. This year, it has released an excellent report Nurses: A Voice to Lead – A Vision for Future Healthcare. The report calls for nurses to become the “architects and designers” of health systems, not only the people who deliver care. Among the report’s key recommendations are that governments embrace this new global strategy for nursing and embed its recommendations into their national healthcare strategies.

A graphic that captures the vision for future health care is found on page 7 highlighting the report’s framework and recommendations. It lists six aspects of health care transformation and five ways to support nurses to leverage a better health system. Transformation includes a renewed emphasis on public health nursing, investments in innovation along with greater attention to quality and affordable care. Approaches for supporting nurses focus on safe workplaces, valuing the role of nurses, and better access to education and professional development. This year’s report provided information on a survey of National Nursing Associations on aspects of the COVID response and current issues for evolving the profession. The report is illustrated with country spotlights from the nursing associations and media reports.

Another major report published this month marks the culmination of the global Nursing Now campaign – Agents of Change: the story of the Nursing Now campaign. Although I had followed the campaign since its launch in 2018, I hadn’t been aware of all the impressive accomplishments described in the report. The appraisal of the process and outcomes to date are worth reviewing; it is interesting to know that the reach extended to 729 Nursing Now groups in 126 countries. There’s a strong message to build on the campaign’s momentum as noted on page 14:

“The Nursing Now campaign has generated tremendous energy from nurses and their allies. They have truly come together as agents of change. It is critical at this pivotal moment, as the world turns its attention to rebuilding health systems for the future, that nurses do not lose this momentum.”

Holloway et al. (2021).

A final note for nurses with an interest in global health policy, ICN’s Global Nursing Leadership Institute (GNLI) is worth exploring as a career development step. BC’s Angela Wignall shared her enthusiasm and described her recent experience as a GNLI scholar in a two-part blog for the Nurses and Nurse Practitioners of BC: Part 1 on the ICN Global Nursing Leadership Institute and Part 2 on Nursing Bodies: Learning from Global Examples. To learn more, please see the GNLI program overview with details about the program and the application process.

By Nora Whyte – May 22, 2021

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

References:

Holloway, A., Thomson, A., Stilwell, B., Finch, H., Irwin, K., and Crisp, N.(2021). Agents of Change: the story of the Nursing Now campaign. Nursing Now/Burdett Trust for Nursing. London.

International Council of Nurses. (2021). Nurses: A Voice to Lead – A Vision for Future Healthcare. Geneva.

Launching New Projects in the International Year of the Nurse and the Midwife

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Highlights of 2019

Delegates at ICN Congress in Singapore

It was a banner year of professional highlights topped by participating in the International Council of Nurses Congress in Singapore where I presented a poster with Susan Duncan and met other delegates from many countries. Also in Singapore it was a great pleasure to reconnect with the team from the Canadian Nurses Association and other Canadian delegates representing nursing education, unions, professional associations and regulators. Susan Duncan and I wrote post-ICN reflections in blog posts and have appreciated the positive comments in response.

Susan Duncan and Nora Whyte in Singapore – June 2019
UBC Gala – May 2019

Other highlights included celebrating the Centenary of the UBC School of Nursing throughout 2019 by attending a beautiful gala in May and the inaugural Verna Huffman Splane Public Health Nursing Lecture in September. Both events provided opportunities to honour those who have contributed to the profession, to meet colleagues and to build on the legacy of earlier generations of leaders

Looking Ahead

The International Year of the Nurse and the Midwife has launched and will be a focus of global attention and action throughout 2020. Barbara Stilwell, executive director of Nursing Now, has written an excellent overview in Off the Charts – the blog of the American Journal of Nursing – in which she notes the current challenge of a global workforce crisis, the vital role of nurses and midwives in contributing to universal health coverage and new opportunities to raise the visibility of nursing and midwifery during 2020. Read her post here and visit the Nursing Now site for updates.

My own 2020 projects include:

  • Involvement with the Nurses and Nurse Practitioners of BC (NNPBC). I have signed up for NNPBC’s Ambassador Program and look forward to contributing to our professional association in British Columbia through an exciting new phase of activity getting underway this year.
  • Continuation of writing projects with colleagues including blog posts on policy themes.
  • Contract work with the Nuu-chah-nulth Tribal Council Nursing Department to update nursing policies in preparation for accreditation this year.

As we move into the first month of 2020, I remain committed to my local and global involvement and will follow events with interest in what promises to be an outstanding moment for our profession.

By Nora Whyte – January 7, 2020

Twitter: @NoraBWhyte

International Nurses Day 2019

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In advance of International Nurses Day on May 12, the International Council of Nurses (ICN) has produced a new publication for this year’s campaign: Nurses: A Voice to Lead – Health for All. Case studies and photographs from different countries are woven into the document adding rich examples of nursing’s voice to lead in the current era. See the International Nurses Day Resource page to download the full document or to view online.

2019 IND Theme – Credit: ICN

The introductory message from ICN President Annette Kennedy provides inspiration on this year’s theme of Health for All. She describes nursing advocacy for improved health and health services in communities and at the level of the United Nations General Assembly.  She notes that the “time is ripe for nurses to assert their leadership” and concludes by stating “…nursing has vast potential and value if appropriately harnessed to finally achieve the vision of Health for All.” (ICN 2019, p. 4).

The three-part document begins with a section on Health for All outlining the background of the global health for all movement initiated in 1978 at the Alma Ata conference on primary health care. It presents links from Alma Ata to the current push for universal health coverage. The second section – Global Health Challenges Affecting Health for All – offers an in-depth look at six current and future health challenges and ways in which nurses are contributing to solutions.

I found the third and final section on Leadership to be particularly interesting – linking the historical roots of nursing leadership to a renewed political focus. One case study features a parliamentarian in Malawi who draws on her public health nursing background to make a difference in improving her country’s health system.  A second case study highlights the work of the Nurses on Boards Coalition aimed at having more nurses on boards, panels and commissions where they can bring an effective presence on health-related policy initiative.

I recommend this publication as a great resource to be studied and discussed beyond National Nursing Week in Canada (May 6 to 12). See the ICN and Canadian Nurses Association websites for additional content, posters and ideas.

By Nora Whyte – April 26, 2019