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Ciencia y enfermería

On-line version ISSN 0717-9553

Cienc. enferm. vol.23 no.1 Concepción Apr. 2017 



Lilian Ferrer1 

Melissa Sutherland2 

1Pontificia Universidad Católica de Chile. Chile. E-mail:

2Boston College . Connell School of Nursing. USA. E-mail:

Let's talk about global health. It's the buzz word these days. Students want to have a global health experience, a greater number of researchers conduct global health re search, and educators are teaching global health principles to their students. So what is global health? And how should we be thinking about it? Global Health as defined by Koplan1 is "an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide". Global health is transdisciplinary and collaborative, emphasizes issues that cross national boundaries, focuses on determinants of health and blends individual-focused care with population health. Global health faces many challenges and solutions will re quire transnational collaborations and partnerships, and the work of multiple dis ciplines. The United Nations website2 discusses eighteen global health challenges that we will be facing in the next few decades. An overarching challenge for health care workers specifically is migration; whether than be migration from climate changes, natural disasters, or violence/conflict. In order to address health outcomes from individuals, families, and populations, health care workers will need to address the larger issue of migration in order to provide better care. Specifically, the United Nations2 defines refugees as individuals protected by international law who are often forced outside of their native country secondary to persecution. In contrast, migrants are considered to be individuals and/or families who voluntarily leave a country or location; regardless of leaving home in search for a better life. Nonetheless, the experience of movement to a new country, community or culture has health care implications for both the country/community of origin and the new place for leaving. Migration, as stated by Carlos Van der Laat3, is a determinant of health on its own, and currently a main issue in global health.

Current data support that the largest number of people in history are currently homeless and the global world is witnessing the highest levels of displacement on record. An unprecedented 65.3 million people globally have been forced from home; nearly 21.3 million of these people are refugees and more than half are under the age of 183. Specifically, in Latin America there are large numbers of migrants and refugees, in Chile this has exponentially increased in the past years, with large diversity of countries of origin4.

Presently as practicing nurses and researchers we need to discuss migration (both voluntary and involuntary) in the context of social determinants of health. We know that where people and populations live and work impacts their health. We also know that migrants and refugees experience poorer health outcomes. As nurses and nurse researchers, we are often at the front lines of care and work with migrant and refugee communities. We are pivotal actors in maintaining and sustaining global health. This editorial offers suggestions to work with migrants and refugees.

Clinical nurses are the main providers of care in the health care system. Because of their educational and clinical preparation, they possess skills for counseling, teaching and advocating at both the individual and community level. Historically, nurses have worked with the most vulnerable communities. In considering nursing practice and migrant and refugee health, we need to provide culturally sensitive care and have nurses able to communicate and understand not only western medicine, but also alternative/complementary ways of care.


With regards to teaching the future generation of nurses, we need to teach cultural awareness and reflection. This will require us to be reflective of our own biases and stereotypes as they relate to migrants and refugee. Only through our self-awareness we will be able to teach the next generation of nurses culturally sensitive care. We recommend that nurse educators and educational administrators consider offering all students the opportunity to participate in international programs during their undergraduate training. Such programs provide students with opportunities for cultural exchange and reflection. In developing international exchange programs and experiences, nurse educators need to consider best practices for these. Questions of how best to teach and assist students in intercultural experiences need to be answered as address global health challenges. Finally we need to invest in faculty development focused on acknowledging the value of training global citizens, with the end outcome of providing culturally approach and patient center care.


We suggest a few areas for global health nursing research and migrants and refugee health. Research on stigma as it relates to providing care for migrants and refugees should be prioritizes. Specifically, we need to investigate how health care workers' stigma impacts care and health outcomes among migrant/refugee patients and communities. Nurse researchers need to investigate the meaning of health and health practices as defined by specific groups. It is only through describing and explicating social constructions of health that nurses will be able to provide the high est level of care. As nurse researchers we also need to develop interventions that are culturally appropriate and specific. We need to test interventions in the intended populations and use measures that have been validated in the study population. We caution researchers about adapting instruments and interventions, without rigorous pre-testing and establishing cultural appropriateness and translation. For in stance, an intervention that has worked with a specific group, may not translate to a new setting despite the group being the same. Environment influences health and how groups experience health.

In summary, it is essential to empower nurses in their various roles (practice, education, research) to provide care to migrants and refugees. This goal can only be met when we empower our students and our community. The challenges in global health are an opportunity for nursing research. We are at the door and need to be willing to walk through it with each other to get to the other side


1. Koplan JP, Bond TC, Merson MH, Reddy KS, Rodríguez MH, Sewankambo NK, Wasserheit JN, Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet. 2009; 373(9679): 1993-95. [ Links ]

2. United Nations. Addressing large movements of refuges and migrants [In ternet]. New York: United Nations; 2017 [citado 28 abr 2017]. Disponible en: Disponible en: ]

3. Van der Laat C. La migración como determinante social de la salud. En: Cabieses B, Bernales M, McIntyre AM, editores. La migración internacional como determinante social de la salud en Chile: evidencia y propuestas para políticas públicas. Santiago, Chile: Universidad del Desarrollo; 2017. p. 29-38. [ Links ]

4. Sandoval R. Una política migratoria para un Chile cohesionado. En: Cabieses B, Bernales M, McIntyre AM, editores. La migración internacional como determinante social de la salud en Chile: evidencia y propuestas para políticas públicas. Santiago, Chile: Universidad del Desarrollo; 2017. p. 39-49. [ Links ]

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