Global Citizens for Health.
1. To discuss the concept of the ‘global citizen’
2. To discuss the implications for the curricula and student experience.
3. To develop plans for further work.
Health is founded upon on social and environmental factors that often transcend national boundaries. This is not to ignore biological influences (such as genetic diseases) but rather to focus activities on those factors that health workers may influence in individuals and populations. Therefore, as the determinants for health are social and often global, one way of addressing the issue is through developing a sense of global citizenship. Global citizenship, as we define it and argue below, has to have sustainability at its core because sustainability and global health are inextricably linked (Goodman and Richardson 2010).
In addition to the health focus, other drivers for global citizenship are clear and many of the most pressing issues facing us must be addressed internationally. The policy context includes the WHO Millennium Development Goals, the G8 Gleneagles Communiqué on Africa (2005) and the COP 15 Accord (2009). In addition to these policy statements which sets out the context, there are global threats to well being from a wide range of economic, environmental and political issues:
• climate change and its concomitants e.g. ocean acidification, climate migration.
• unsustainable practice such as deforestation, soil erosion, overfishing.
• water, food and energy shortages (peak oil).
• mineral and other resource depletion.
• population growth.
• toxic chemical and nuclear waste disposal.
• international terrorism.
• shifts in the power base of the global economy (Rosling 2009).
• unsustainable GDP growth as a policy objective (Jackson 2010).
• post (?) ‘Washington Consensus’ economics (Rodrik 2006)
• inequalities in health and wealth.
• alcohol and substance abuse.
……and of course ‘globalisation‘ in its various guises.
Climate change has been identified as the biggest threat to global health of the 21st century (Costello et al 2009) and health workers have been urged to take action (BMA 2008). International nursing organisations have highlighted this as an imperative (ICN 2009, CNA 2009, 2010, AAN 2008).
Global citizenship can be seen as an emergent concept in this context.
Graduates from UK universities will not be insulated from these global trends. However there are opportunities as well as threats. Adopting global perspectives also offers opportunities for large-scale beneficial change. For example, the transition to a low carbon economy provides new opportunities for innovation and creativity in energy use, production and distribution. For health, the message is that a low carbon lifestyle is also good for health.
Graduates from UoP must be encouraged to think as widely as possible about the future world they are going to inherit and eventually help shape. Sustainable development (or contraction) and the limits to growth as currently defined (Meadows and Meadows 1972, Jackson 2009) may be the defining context for the coming graduate generation. If so, an insular inward looking mindset will not serve us well.
Having an idea of what it is to be a global citizen, living in world where prosperity is meaningless when 80% of humanity live on less than $10 a day (Chen and Ravallion 2008), may be a necessary first step to foster a global consciousness and willingness to engage with these challenges.
Higher Education Institutions have a responsibility to encourage graduates to think about their roles and responsibilities as global citizens in the world they will help to shape.
In this presentation, we will address the following issues in relation to students in the Faculty of Health:
1. What is global citizenship?
2. How can we encourage students to develop their identities as global citizens?
3. Existing good practice in the curricula and student experience
4. Future opportunities.
A note on the challenge in HEI funding:
According to Paul Marshall, chief executive of the small research intensive universities group, there has been an announcement of a £135 million cut and a drive £180 million in efficiency savings. Lord Mandelson’s announcement (Dec 2009) of further budget restraint mean HEFC’s annual budget would fall from £7.291 billion in 2010-11 to £6.376 billion in 2012-13. This would be a 12.5% cut in its annual funding over three years. The December (2009) pre budget report had already announced £600 million in cuts. Therefore any initiative will need to come within existing and reducing funding.
Therefore to address the third aim we will need to be very creative.
What is global citizenship?
Global citizenship (GC) applies the concept of citizenship to a global level. Citizenship entails rights and responsibilities in civil society, is active as well as passive. GC can be defined as a moral and ethical orientation which can guide the understanding of individuals or groups of local and global contexts. As an ethical endeavour it reminds us of our responsibilities within and to various communities.
Activism, as the translation of this theoretical understanding of the world into actual practice, and appears to be a core idea.
Thomas Paine (1727- 1809) in the ‘Rights of Man’ could be thought to be an early exponent of global citizenship:
“My country is the world, all mankind are my brethren, to do good is my religion”
So GC could mean:
• Respect for all human beings regardless of race, religion or creed (that does not mean respect for their ideas).
• Reaching beyond national barriers to act on inequalities, ecological degradation and the promotion of well being.
Therefore GC has both and an ethical and an action dimension. One follows from the other. It involves both rights and responsibilities.
Falk (1994) identifies five potential categories of global citizens. He describes these as:
“a series of overlapping images of what it might mean to be a global citizen at this stage in history.”(p132).
According to Lagos (2002), except for the example of elite global business people, the majority of Falk’s categories
“have grassroots activism at their core”(p6).
Falk’s five categories are:
1. Global reformers
“[A]n individual that intellectually perceives a better way of life of the planet and favours a utopian scheme that is presented as a practical mechanism.”(p 132).
This may entail some form of centralised world government or organisation in order to avoid global turmoil and maintain some form of unity.There may be a tendency for reformers to filter their visions through the cultural and political outlook of their own “political community” (p 133), and thereby impose their framework on the rest of the world.
This ‘centralised world government’ of course could be interpreted as dictatorship. Stalin and Hitler may have had their own ideas for global reform that went beyond their own borders. In their own terms they may have thought of themselves a ‘reformers’ ushering in a ‘new world order’ (be it a Thousand Year Reich or a Communist utopia). The ‘Washington consensus’ could be seen in this manner – a new world order based on neoliberal capitalism and the dominance of US foreign policy.
Falk summarises the global reformers’ “spirit of global citizenship”(p132) with the statement:
“It is not a matter of being a loyal participant who belongs to a particular political community, whether city or state, but feeling, thinking and acting for the sake of the human species, and above all for those most vulnerable and disadvantaged.”(p132).
It may be the focus on the ‘disadvantaged and vulnerable’ (with a nod to the universal declaration of human rights to help identify who that group is) that makes GC objectively different from national socialist dictatorship. This is still problematic. The definition of who is disadvantaged and vulnerable may seem self evident but a moments thought suggests subjective definitions alter membership of that group. In Palestine today who thinks of themselves as disadvantaged – jew or arab, who is oppressed and who oppressor? Islamists and Jihadists may also have a wish to create a global muslim brotherhood based on sharia law. The muslim brotherhood transcends national boundaries and could be seen as a way of establishing a new global order. Global citizenship for Islam may have its own meaning.
2. A man or woman of transnational affairs.
This category of global citizens could also be described as elite global business people.Falk also points out that the vast majority of these people are men. He writes:
“This second understanding of global citizenship focuses upon the impact on identity of globalization of economic forces. Its guiding image is that the world is becoming unified around a common business elite, an elite that shares interests and experiences, comes to have more in common with each other than it does with the more rooted, ethnically distinct members of its own particular civil society: the result seems to be a denationalized global elite that at the same time lacks any global civic sense of responsibility”(p 134).
This description is similar to those that inhabit ‘Richistan’ a term coined by Frank (2007) in a book of the same name who argued:
“The wealthy weren’t just getting wealthier — they were forming their own virtual country. They were wealthier than most nations, with the top 1% controlling $17 trillion in wealth. And they were increasingly building a self-contained world, with its own health-care system (concierge doctors), travel system (private jets, destination clubs) and language. (”Who’s your household manager?”) They had created their own breakaway republic — one I called Richistan.”
The difference is that Richistan’s elite may see themselves as apart from other citizens and not members of global citizenry, although their actions are self justified on the basis that their actions are good for the world.
3. Managers of environmental and economic global order.
This perspective focuses more on environmental needs but also looks at economic concerns. This view is exemplified by the Bruntland Commission’s report, which:
“stress[es] the shared destiny on the earth as a whole of the human species … [and] argues that unprecedented forms of cooperation among states and a heightened sense of urgency by states will be required to ensure the sustainability of industrial civilization”(p135).
This perspective is often concerned with:
“making the planet sustainable at current middle-class lifestyles.”(p136)
Key thinkers in this perspective would be Rachel Carson (1962), Aldo Leopold (1949), Eric Schumacher (1979), David Orr (1994) and those involved in the ‘green movement’, sustainability and environmentalism. Environmentalism and green politics however, is not about establishing a global political order rather that the current dominant economic models need revolution to be replaced with a world based on economic localism (Wood and Lucas 2004). Frank’s ‘middle class lifestyles’ in this analysis may not survive the greening of the new world order especially if it is based on current economic models.
There are of course divisions, Bruntland has been criticised as merely greening the status quo (Sinclair 2009) while others argue for more thoroughgoing reform of Sustainability (Sinclair 2009, Selby 2007). This perspective suggests that ‘industrial civilisation’ is not worth saving.
4. Regional political consciousness.
Within Europe, the birthplace of the modern state, “The Euro-federal process is creating a sufficient structure beyond the state so that it becomes necessary, not merely aspirational, to depict a new kind of political community as emergent, although with features that are still far from distinct, and complete.”(p137)
“Can Europe … forge an ideological and normative identity that becomes more than a strategy to gain a bigger piece of the world economic pie? Can Europe become the bearer of values that are directly related to creating a more peaceful and just world?”(p137)
To state that this sort of regional project is not without its critics is self evident to most people in the UK. Eurosceptics in all major parties plus UKIP argue that this movement is undemocratic and dissolves national sovereignty.
5. Trans-national activists.
Amnesty International and Greenpeace are examples of transnational activism, in part because they transcend national boundaries.Falk writes of the emergence of transnational activism:
“the real arena of politics was no longer understood as acting in opposition within a particular state, nor the relation of society and the state, but it consisted more and more of acting to promote a certain kind of political consciousness transnationally that could radiate influence in a variety of directions, including bouncing back to the point of origin.”(p138)
This kind of activism became important to social movements during the 1980’s. Falk also emphasises that:
“this transnational, grassroots surge, is not, by any means, just a Northern phenomenon.”(p138)
Linked with this is the idea of the ‘multitude’. Hart and Negri’s idea is that ‘the multitude’ is a new model for resistance to global capitalism. However this does not imply any organised connectedness between members (except perhaps in the digital world) or a transnational organisation. The idea of the multitude can be traced back to Machiavelli, Hobbes and Spinoza who argued in Tractatus Theologico-Politicus;
‘Every ruler has more to fear from his own citizens […] than from any foreign enemy, and it is this “fear of the masses” […that is] the principal brake on the power of the sovereign or state.’
Global citizenship may take the form of activism at grass roots level using digital technology with individuals forming (online) groups ad hoc around emergent issues. Facebook is a platform may may be used by these ‘global citizens’ to get their message over. Note the response on twitter to comments made by a Daily Mail journalist’s comments on Stephen Gatley’s death. See ‘Twitter and Facebook outrage over Jan Moir’s Stephen Gately … ‘ Though national in nature it demonstrates the potential for activism using digital technologies.
Falk’s 5 categories of GC
1. Global reformers
2. A man or woman of transnational affairs.
3. Managers of the environmental and economic global order.
4. Regional political consciousness.
5. Trans-national activists.
Lagos (2002) relates the concept of activism to citizenship:
“Global protest activity is on the rise. Demonstrations in Seattle in 1999, Genoa in 2001 and at dozens of other sites, brought activists together from around the world and localized global issues in unprecedented ways. These and other activities suggest the possibility of an emerging global citizenry. Individuals from a wide variety of nations, both in the North and South, move across boundaries for different activities and reasons. This transnational activity is facilitated by the growing ease of travel and by communication fostered by the Internet and telephony”. (p3)
“A visible expression of global citizenship is the many global activists who debuted spectacularly at The Battle in Seattle (1999). These protests continue at other venues, such as at meetings for the World Bank and the IMF, and most recently at the Summit of America in Quebec City. Other activists fight for environmental protection, human rights to the impoverished and the unrepresented, and for restrictions on the use of nuclear power and nuclear weapons . Freedom from bureaucratic intervention seems to be a hallmark of global citizenship; the lack of a world body to sanction and protect these citizens also means to a certain degree freedom from bureaucratic control”.(p4)
Lagos then elaborates:
“Scholars have already noted the emerging power struggle between corporations and global activists who increasingly see the nexus of de facto governance taking place more and more within the corporate world (and as mediated by communication technologies like the Internet) and not in the halls of representative government. Hence, the tendency on the part of activists to promote rallies and events like the protests at WTO, as more effective means of citizen participation and democratic accountability(p 13).
So clearly from this perspective global citizens not only think about the connectedness of their world transcending national boundaries, but are also spurred to action. There is an echo of Marx (1845, 1888) who argued “the philosophers have hitherto only interpreted the world in various ways; the point is to change it” (11th thesis: Theses on Feuerbach).
Globally Orientated Citizenship
Parekh (2003) advocates what he calls globally oriented citizenship, and states:
“If global citizenship means being a citizen of the world, it is neither practicable nor desirable”(Parekh 2003 p12).
He argues that global citizenship, defined as an actual membership of a type of worldwide government system, is impractical and dislocated from one’s immediate community. He also notes that such a world state would inevitably be:
“remote, bureaucratic, oppressive, and culturally bland.”(Parekh 2003 p12).
Parekh (2003) argues:
“Since the conditions of life of our fellow human beings in distant parts of the world should be a matter of deep moral and political concern to us, our citizenship has an inescapable global dimension, and we should aim to become what I might call a globally oriented citizen.” (p12).
Parekh’s concept of globally oriented citizenship consists of identifying with and strengthening ties towards one’s political regional community (whether in its current state or an improved, revised form), while recognising and acting upon obligations towards others in the rest of the world.
A Multi dimensional concept
Falk’s 5 categories above may illustrate the multi-dimensional nature of GC and the various ways it could be defined. This is supported by Byers (2005 and 2008) who questions the assumption that there is one definition of global citizenship, and suggest that we could unpack aspects of all the various potential definitions. He argued:
“Global citizenship’ remains undefined. What, if anything, does it really mean? Is global citizenship just the latest buzzword?”
Byers notes the existence of stateless persons, whom he remarks ought to be the primary candidates for global citizenship, yet continue to live without access to basic freedoms and citizenship rights. He does not oppose the concept of global citizenship, however he criticizes potential implications of the term depending on one’s definition of it, such as ones that provide support for the:
“ruthlessly capitalist economic system that now dominates the planet.”
An ethical imperative.
An action imperative.
But whose ethics and whose action?
But it may be conservative upholding the current order or radical challenging the current order. Change could be advocated within the system to (make it fairer) or to change the system itself as this is the root of inequity.
Health care workers will need to construct their own ideas for GC based on their understanding of ethics of caring, professional philosophies and the foundations for health.
Implications for Education.
The challenge for HEIs then is to decide if they should take a stance or be neutral and let the students decide. Each discipline may (will) have their own ideological or philosophical underpinnings that guide their educational practice. These may have to articulated more clearly in addressing ideas around GC. For example, an economics course that teaches within the frame of reference of capitalism (e.g. growth as a given) ignoring other political economies would proffer particular solutions to global finance within its own definitions of what it is to be a GC.
Thus GC is a contested space, but one view within nursing is that nursing is an ethical practice orientated towards health and well being. However this view says nothing about the political and social dimension of nursing. nothing about what is ‘ethical’. One may (‘must’ according to the NMC) act ethically towards our patients and clients but this does not automatically mean an international orientation challenging power structures as acting ethically is open to interpretation. So to what degree should students of nursing be orientated towards socio-political and international activism? Does being a GC mean challenging and overturning or (merely?) mitigating the effects of the current global order? Working for an NGO in a health clinic in Africa could be seen to fulfill one’s responsibilities as a GC and for some this will be enough. For others being a GC will mean more radical action.
A starting point could be to outline global disparities in health and well being such as that found on Gapminder.org – For a fact based world view., and poverty such as Poverty Facts and Stats — Global Issues and then to encourage discussion about the remedies (which according to one’s ethical standpoint) may be many and varied. A focus on action needs to stressed if one wants to be a GC, however the nature if that action is debatable. The question arises should and to what degree should lecturers and the HE sector provide leadership in a particular direction?
A response is to argue that given the global crises facing humanity, academia cannot be neutral and objective researching and charting current trends and processes. However each discipline will articulate its own standpoint(s) in response. For health the challenge is to encourage a global outlook within the context of training an NHS workforce. The NHS itself will not look beyond its own borders and the training needs of its own staff.
Biomedicalism and Individualism v GC
Whatever GC may mean in terms of actual action, it is clear that the idea takes one out of narrow contexts bounded by local, regional or national UK boundaries and forces one to think about the health and well being of people living outside of the UK. In this task, we would need to move beyond individualistic bio-medical models of health and illness and draw upon more ecocentric paradigms (Kleffel 1996 and 2004, Goodman and Richardson 2010). We would have to examine current curricula to identify where we are focused on disease and illness in the individual and to where we adopt more a SOCIAL DETERMINANTS OF HEALTH model. A public health (WHO | The public health approach) and a social determinants approach supports and is supported by the concept of GC as both address the environment and human activity as foundations for health.
Current and developing educational practice.
We argue there is a ‘sustainability-climate change-health’ triad (Goodman and Richardson 2010) that GC may assist in addressing:
Sustainability-Climate Change-Health Triad
· Keeping healthy will assist sustainability and climate change.
· Sustainable living mitigates climate change and improves health.
· Unsustainable living causes climate change and poorer health.
· Climate change negatively affects health and sustainability.
This theoretical model needs testing and evidence, but may act as a framework for promoting the idea that good health results from unsustainable living and will be affected by climate change. Thus the payoff of adapting current lifestyles is twofold. Increased health, promoting sustainable living and mitigating climate change.
This task has begun in Faculty of Health modules where the embedding of sustainability has begun. Sustainability is unrelated to GC in terms of defining GC but is a very important policy and philosophical driver not just for developing global citizens but also for the HE sector as a whole (HEA 2009, HEFCE 2009). The Centre for Sustainable Futures has produced guidance for curriculum planners and developers which may prove useful starting points. In addition, the principles underpinning Education for Sustainable Development (ESD) (Sterling 2001) and ecological (Orr 1994) and sustainable literacy (Stibbe 2009) would enhance discussion around global citizenship and its meanings.
For example , Stibbe (2009) emphasises ideas such as the interconnectedness between people and planet and ‘being in the world’ whereby people have the:
“ability to think about the self in interconnection and interdependence with the surrounding world” (Danvers 2009 p185)
and the ‘systems thinking’ ability:
“to recognise and analyse interconnectedness between and within systems” (Strachan 2009 p84).
Both ‘being in the world’ and ‘systems thinking’ are concepts which are congruent with nursing theory which focuses on holistic care.
Comparing concepts embedded in Education for Sustainable development principles and those that may be found in some interpretations of GC indicates some common ground.
The link between ESD and Global Citizens (ESDGC) has been made explicit in Wales (leadership from both Welsh assembly and the HEFCW ) at both secondary school and in higher education. The argument is made:
“The role of Higher Education Institutions within ESDGC is pivotal in that they education a great number of the professionals and leaders of tomorrow’s society. They have a large role to play within the environmental management of their institutions and procurement policies, ensuring that globally aware, ethically sound and environmentally balanced processes are introduced. They also have potential for influencing others outside the university through professional development and training opportunities”.
(Welsh Assembly 2009 and ESDGC 2010)
The Global citizen within Nursing Education and Education for Sustainable Development/Contraction:
Because there is a pending planetary crisis, education (and nurse education) should attempt to challenge and prepare students for a not so brave new world. Selby (2007) suggests 10 Propositions for education:
1. Confront denial by challenging learners’ base assumptions, knowledge and responses. Get them to feel unease at the current situation: Nursing education attempts to develop the personal as well as professional competencies and thus challenges individuals’ world views. Therefore this approach would not be out of place.
2. Given the threat, education needs to address despair, grief, loss. Student nurses have to address loss in personal and individual patient cases: These concepts are already in many curricula (see the work of Kubler Ross for example) but the perspective may have to shift to embrace wider loss and grief issues that flow from climate change.
3. Shift to a holistic dynamic understanding of the relationship between humans and nature is an end in itself not a means to an end: Again this would not be necessarily a radical departure for nursing philosophy in any discussion regarding the value of humanity and the goal of nursing
4.Cultivate a poetic understanding alongside a rational understanding – we need to develop awe, celebration, enchantment, reverence as well as classification, prediction, evaluation and exploitation of nature: This mirrors the ongoing debate within nursing education concerning the art science dichotomy and would provide another useful lens to address the need for scientific competence and artistic appreciation and application in nursing praxis.
5. Marginalised ‘educations’ will be important (e.g. the field of non -violence): Rather more challenging for some fields of nursing such as acute hospital care but may well be core to therapeutic approaches within mental health.
6. Given the heating – sustainable and emergency education need to come together. Social dislocation, hunger, environmental disaster, tribalism etc necessitates an education that can respond (e.g. global citizenship, peace education, conflict resolution, anti discriminatory education etc): Nurses may well be key professionals in dealing with emergencies and disaster management with other healthcare professionals and thus education and training that explicitly addresses these skills may well be valued and developed.
7. Alternative ideas of what ‘the good life’ means need exploring: Again this could be core to nursing philosophy especially within the contexts of mental health and palliative care and living with long term or life limiting conditions.
8. Rethinking notions of democracy, citizenship and sustainability could be part of the professional responsibilities of the registered nurse.
9. Shift from atomistic/reductionist thinking to holistic ways of mediating reality. This is not an unknown concept for nursing, but may require further exploration and development.
10. “Everyone has to understand and come to terms with the fact that we are threatening our own existence. To confront this requires a Copernican revolution in aims, structures, processes of education and perhaps in the loci of learning ... as the heating happens, education and educational institutions ... will be deeply disrupted and if unresponsive to the need for transformation, will disintegrate as people find other more relevant loci for learning what they have to learn”. (Selby 2007).
10 propositions for education
1. confront denial
2. address loss and grief
3. human-nature relationship
4. poetic understanding
5. marginalised education
6. sustainability and emergency education
7. alternative good life
8. democracy and citizenship
9. holistic thinking
10. accept we are threatening our own existence
Flowing from and building upon Selby’s suggestions, we could apply the following principles for a Nurse Education for Sustainable Wellbeing (NESW).
Recognises that human well being depends on foundations of biological, emotional, cognitive, politico-social, and environmental existence which are transient, inter-dynamic and coexistent. This involves understanding that a goal of nursing is to recognise which current state is achievable, acceptable, manageable and desirable by the individual, society and the environment and to support the movement of existence towards wellbeing. Sustainable Wellbeing rests on a relationship between the five but also recognises that the individual’s ultimate existence is non existence.
Involves an understanding about the connections and links between all aspects of people’s lives and places at a local and global level, and that decisions taken in one place will affect what happens elsewhere. Nurses should develop an understanding that living things depend on each other and should acquire a sense that all living things have value. This should lead to an understanding that what people do elsewhere affects them, the places they live, other people, and plants and animals. They should become increasingly aware of the global context within which health, trade, industry and consumption operate.
3. Citizenship and stewardship
Recognises that people have rights and responsibilities to participate in decision making and that everyone should have a say in what happens in the future. This involves a willingness to act as responsible global citizens while developing the ability to engage with and manage change at individual and social levels. Nurses are expected to know and understand the connection between personal values, beliefs and behaviour and how the hospital, health centres and community can be managed more sustainably. The choice agenda explicitly recognises this value but may focus too narrowly on choices regarding treatment options rather than choices regarding health inputs (for example – choices around sustainably developed food sources).
4. Needs and rights of future generations
This concept is about learning how we can lead lives that consider the rights and needs of others and recognising that what we do now has implications for what life will be like in the future. This involves nurses in discussing the way they live and the products and services they use, to distinguish between actions and products which are wasteful and those which are sustainable. This should enable nurses to begin to assess the sustainability of their own lifestyle.
This concept is about understanding the importance and value of diversity in people’s lives – culturally, socially, economically and biologically – and realising that all our lives are impoverished without such diversity. Through learning, Nurses should appreciate cultural and biological diversity in the hospital and community and eventually be able to reflect critically on, and engage in, debates and decisions on political, technological and economic changes which impinge on diversity and sustainability. Diversity is recognised as a key concept with the NMC professional code of ethics
6. Quality of life, equity and justice
Recognises that for any development to be sustainable, it must benefit people in an equitable way. It is about improving everybody’s lives. At a basic level this involves understanding the essential difference between needs and wants and developing a sense of fairness. It involves understanding the difference between quality of life and standard of living and seeks a good quality of life for all people, at local, national and global levels and an appreciation of why equity and justice are necessary to a sustainable society. These concepts are addressed in quality healthcare provision frameworks and ought to be part of the nurses’ understanding of the management of quality services. It should challenge the funding of some high tech-high cost (big pharma?) treatment options for the (rich) few .
7. Sustainable change
Promotes an understanding that there are limits to the way in which the world, particularly the richer countries, can develop. The consequences of unmanaged and unsustainable growth in health provision for the rich might include increasing poverty and hardship and the degradation of the environment, to the disadvantage of everyone. This involves nurses in understanding how their hospital and community may be managed more sustainably and beginning to question decisions, practices and processes that affect sustainable development issues. Health care practices and delivery systems which result in inequities on a global scale should be challenged.
8. Uncertainty and precaution
Involves a realisation that because people are learning all the time and that their actions may have unforeseen consequences, they should adopt a cautious approach to the welfare of the planet. This implies understanding that different people want to do things in different ways and are able to listen to arguments and weigh evidence carefully. Nurses should thus be able to think critically, systematically and creatively about sustainable development issues, solutions and alternatives.
(these 8 key concepts are adapted from the Sustainable Development Education Panel 2000).Taking the first step forward towards an education for sustainable development (PDF)
Principles for a Nurse Education for Sustainable Well Being
1. well being
3. citizenship and stewardship.
4. needs and rights of future generations
6. quality of life, equity and justice,
7. sustainable change
8. uncertainty and precaution
The challenges facing humanity in the 21st century require a radical rethink of ‘business as usual’. Education is important, but is not the only game in town. There are other agencies and ideologies shaping the future. However, education is the HEI’s sphere of immediate influence and although it may be morally questionable to ask the next generation to clear up after our own mess we may have little choice. The principles for educational programmes are enunciated above but they may be seen to be mediated through some notion of global citizenship that has to have a moral and political dimension if we are to move civilisation towards moral, economic and environmental sustainability.