Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene

Abstract

Purpose:

To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the profession worldwide.

Design:

Discussion paper.

Methods:

Literature review.

Findings:

Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems.

Conclusions:

Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels.

Clinical Relevance:

Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 agenda on a global scale and raising the profile of their professions.

The World Health Organization (WHO)-declared Year of the Nurse and the Midwife coincides with a decade of action to achieve the 17 United Nations (UN) Sustainable Development Goals (SDGs) by the year 2030 (UN, 2015; UN Department of Economic and Social Affairs, 2020a; see Figure 1). With a holistic focus on people, planet, peace, prosperity, and partnership, the SDGs continue to represent a moral ideal where all populations know the experience of living in a safe, inclusive, and just world where no one is left behind. Although achieving this vision remains possible, strategic action for implementation is needed to judiciously address substantive inequities within and between countries related to the SDGs. The purpose of this discussion article is to highlight ongoing and emergent roles of nurses and midwives in advancing the SDG targets by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the profession worldwide.

Figure 1.

The United Nations 17 Sustainable Development Goals (United Nations Department of Economic and Social Affairs, 2020a). Reprinted with permission from the United Nations (https://www.un.org/sustainabledevelopment/wp-content/uploads/2019/01/SDG_Guidelines_AUG_2019_Final.pdf).

Background and Significance

The World Social Report 2020 showed that some global inequalities have improved according to rudimentary measures and achievements, such as stunting among children, while many disparities based on socioeconomic status, ethnicity, race, gender, and country of residence are widening (UN Department of Economic and Social Affairs, 2020b). Despite advanced infrastructure, more accessible healthcare services, and fiscal independence, a number of high-income countries continue to fall short on their political, socioeconomic, and environmental commitments to the Sustainable Development Agenda, with several demonstrating low global rankings related to target implementation and realization (Bertelsmann Stiftung and Sustainable Development Solutions Network, 2019). In addition, SDG-specific outcomes suggest a widespread and urgent need for increased collaboration across fields, nations, and sectors (UN, 2019b; UN Economic and Social Council, 2019; WHO, 2020a). This is particularly true for substantial action on climate change and other planetary ecosystem and geopolitical stresses, as well as systemic sustainability, which is lagging at present.

Moreover, the Intergovernmental Panel on Climate Change (2018) has pointed out that this same decade of action is crucial for reducing global greenhouse gas emissions to keep the earth’s heating to a no more than 1.5°C increase over pre-industrial levels. Unfortunately, the world—in this Anthropocene epoch—appears to be on track for a 4°C increase in temperature by the end of the century. The impact of this on human health and biodiversity decimation is nearly unimaginable and must serve as a nonnegotiable impetus to action.

Nurses and midwives are first responders worldwide and are crucial to ensuring that health care both operates with a lighter environmental impact (mitigation) as well as delivers healthcare needs in the face of extreme weather, disease vector shifts, pollution, nutrition changes, and displaced populations (adaptation). In addition to being practitioners, nurses and midwives are educators and researchers who are making critical contributions to the larger Sustainable Development Agenda (Osingada & Porta, 2020). These planetary health issues will be the key drivers of human health and societal integrity. Addressing climate change is needed to achieve sustainable development (Otto et al., 2020), and the SDGs offer a framework for action while incorporating a human rights agenda. Nurses and midwives are essential, as they are best placed in the communities they serve to provide immediate care to those most at risk during climate emergencies, and to actively engage in mitigation and adaptation efforts.

The COVID-19 pandemic has increased awareness of social inequities and the need to commit to the SDGs in the short and long term (Heggen, Sandset, & Engebretsen, 2020; Marmot, 2020). The COVID-19 Response Resolution launched during the 73rd World Health Assembly called for an “intensification of cooperation and collaboration (of all affected countries) at all levels to contain, control and mitigate the COVID-19 pandemic” and “sustainable funding to WHO to ensure that it can fully respond to public health needs” at a global level (WHO, 2020b, pp. 3, 5). Despite the perilous state of the global supply of nurses, nurses and midwives have remained committed to key SDG targets, such as achieving universal health coverage (UHC), throughout this humanitarian crisis (International Council of Nurses [ICN], 2020).

Take the field of palliative care, for instance, a foundational aspect of UHC as articulated by SDG target 3.8 per the UN (2019a) political declaration of the high-level meeting on UHC. The global burden of serious health-related suffering has exponentially increased over the past year (Radbruch, Knaul, de Lima, de Joncheere, & Bhadelia, 2020). Throughout COVID-19, palliative nursing experts have recommended leveraging their role to meet population level needs, address palliative care inequities, and engage nurse activism in policy, academia, and clinical practice settings to achieve universal palliative care access as a component of comprehensive UHC across the serious illness care continuum (Downing et al., 2020; Downing & Ling, 2020; Rosa, Gray et al., 2020; Rosa, Krakauer et al., 2020).

Targets related to SDG 3 (Good Health and Well-Being) are the predominant charge for health and social care professionals (Institute for Health Metrics and Evaluation, 2020). However, we can think of SDG 3 as a starting point for the rest of the agenda. For example, health remains elusive in settings of war, violence, and forced mass displacement (SDG 16); where peace and justice fail, so does health. When women and sexual gender and racial minorities receive unequal pay or treatment, access to and the quality of health care received will suffer (SDGs 5 and 10). And when economic opportunities are lacking for certain groups (SDG 8) and climate or environmental changes impact job or personal safety for others (SDGs 6, 13, 14, and 15), the hierarchy of needs becomes focused on survival over the cultivation of well-being.

In short, we as a healthcare community have much work ahead of us, and it is essential that all of the health disciplines actively and equitably partner in this crucial work. Given that nurses and midwives account for nearly 60% of the healthcare workforce and are consistently considered among the most trusted of professions, they are critical in optimizing the success of the SDGs (Reinhart, 2020; WHO, 2016, 2020c). Here we outline ways in which nurses and midwives can and are collaborating on SDG attainment by ensuring their active engagement in policymaking and decision making, increased leadership, and leveraging their training beyond more traditionally perceived disciplinary expectations. We support the premise that nurses and midwives have the key characteristics and competencies to make crucial contributions in alignment with their professional ethical obligations to society in furthering the SDGs and climate action locally and on a global scale (Rosa, 2017; Rosa & Hassmiller, 2020).

Nursing and Midwifery: Key Actors in Sustainable Development

First, it is important to note that the SDGs reflect the biopsychosocial scope and environmental priorities historically addressed by nurses and midwives (Rosa, Dossey, Watson, Beck, & Upvall, 2019). This past year, 2020, also corresponded with Florence Nightingale’s 200th birth anniversary. Nightingale (1820–1910) is celebrated as the founder of modern nursing. She also contributed venerable academic service as a researcher, statistician, clinician, hospital architect, policy and social justice advocate, and staunch environmentalist (Dossey, Selanders, Beck, & Attewell, 2005). Nightingale is recognized for supporting British representation during ratification of the First Geneva convention, a document that aided in the formation of the League of Nations in 1914 and later the UN in 1945 (Beck, 2017). Excerpts from Nightingale’s over 2,300 letters and 200 books and reports have been highlighted with respect to each of the 17 SDGs, demonstrating inextricable connections between the philosophical and moral premise of the nursing profession and the 2030 agenda (Dossey, Rosa, & Beck, 2019).

Second, nurses and midwives have furthered scholarly discussion of how to integrate awareness of and interventions related to the SDGs and the climate crisis into policy, education, and research settings (Rosa, Kurth, et al., 2019). The 2030 agenda has been described as “the steady horizon we steer towards while attempting to navigate the political currents at work within the . . . healthcare sector” (Miyamoto & Cook, 2019, p. 658). A number of policy statements from professional organizations have harnessed the political will of their memberships toward SDG attainment (International Confederation of Midwives, 2014; ICN, 2019a; Leffers & Butterfield, 2018).

The 17 Global Goals have been successfully integrated into nursing academic curricula to promote social justice and the values of global citizenship (Upvall & Luzincourt, 2019). Nursing and midwifery educators can and do employ the SDGs as a framework to advocate health equity through attention to the social determinants of health and promote what it means to act both globally and locally. For nurse and midwife scientists, emphasis must be placed on research capacity building to strengthen content expertise, methodological rigor, and the creation of trans- and multidisciplinary teams that can define problems and design studies reflective of the 2030 agenda (Nove et al., 2021; Squires, 2019)—a seminal example was The Lancet (2014) Midwifery Series. Nursing- and midwifery-led research has focused on many of the SDGs in the past, but as the health of the planet changes, our science must expand to empirically investigate emerging phenomena of relevance (Squires, Abboud, Ojemeni, & Ridge, 2017).

Third, the international association and campaign support for nursing and midwifery workforces to engage the SDGs has been substantial and sustained. Geopolitical instability and human rights abuses underscore the importance for political engagement. In fact, advocacy is an expected component of our professions. For instance, the American Nurses Association (ANA, 2003) adopted the Precautionary Principle in 2003,

Challeng[ing] nurses to protect those who are most vulnerable, those who are least powerful, and those who are the earth’s future generations who have no power over today’s environmental decisions,” and asking “How can we meet our goals in the least harmful way? How can we protect public health and the environment?” (ANA, 2007, p. 19)

Some additional actions include but are not limited to:

• The ICN first began making environmental policy statements in 1999 and updated their position in 2019 calling for governments, health system leaders, national nursing associations, and nurse leaders to take immediate action to mitigate climate change and to support people and communities around the world to adapt to its impacts (ICN, 2019a). The ICN (2019b) further substantiated this position with the development of core competencies in disaster management. This sentinel work guides the nursing profession to prevent, mitigate, respond to, and recover from disasters, particularly those related to climate emergencies. In 2017, the International Nurses Day publication, Nurses: A Voice to Lead: Achieving the SDGs, showcased to the world nursing’s pivotal and vital role in the achievement of the 17 Global Goals (ICN, 2017).

• The Alliance of Nurses for Healthy Environments (ANHE) and Healthcare without Harm are undertaking the Nurses Climate Challenge to educate 50,000 among the 4 million U.S. nurses as climate champions (ANHE, 2020; Harrington, 2019). The ANHE and Project Drawdown have joined forces to start Nurses Drawdown (2020), a collective action-based initiative to decrease greenhouse gas emissions. Through this forum, nurses can improve the health of individuals and communities by addressing the need for clean energy, gender equity, a commitment to reducing food waste and promoting a more plant-based diet, advocating for more walkable cities and infrastructure, and sustaining nature by planting trees and preventing deforestation.

• The Global Advisory Panel on the Future of Nursing and Midwifery (GAPFON) was formed in 2013 under the auspices of Sigma Theta Tau International Honor Society of Nursing to provide guidance on how nurses and midwives could improve global health. The 2014–2017 GAPFON (Catrambone, Klopper, & Hill, 2017). summary report emphasized that adoption of the SDGs has drawn focus to a new array of health issues and concerns, requiring evolved approaches to collaboration and engagement of nurses and midwives (Sigma Repository, 2017). The recommendations of this report focus on nursing and midwifery capacity building and evidence-based practice to improve global health (Klopper et al., 2020).

• Nursing Now is an international campaign (2018–2021) that seeks to improve health quality globally “by raising the profile and status of nursing, influencing policymakers and advocating for more nursing in leadership positions” (Nursing Now, 2020). Based on the findings of the All-Party Parliamentary Group on Global Health’s (2016) Triple Impact Report, Nursing Now emphasizes nurses’ inextricable roles in advancing multiple SDGs: better health (SDG 3), greater gender equality (SDG 5), and stronger economies (SDG 8).

Lastly, nurses and midwives must extend practice roles beyond traditional (and often externally constrained) scopes and stereotypes. This is an imperative step to optimize our workforces; promote trans- and multidisciplinary, socially responsible care teams; and realize the SDGs by 2030. The SDG Partnership Platform provides a number of current examples of nurses and midwives partnering on the Global Goal targets. For instance, nurses are partnering with medical laboratories and business sector colleagues to deliver affordable clinical education in developing countries (UN, 2020a); supporting capacity building for global disaster reduction frameworks (UN, 2020b); and collaborating in public–private initiatives to significantly reduce maternal and neonatal morbidity and mortality in resource-poor settings through provider- and facility-based interventions (UN, 2020c). The world’s largest health workforce cadre at more than 23 million, nursing and midwifery professionals are being called to action to address planetary health, climate change, and other relevant topics related to the politically and environmentally focused SDGs (Kurth, 2017). Full interprofessional engagement in organizations and networks such as the Consortium for Universities in Global Health and through partnering with institutional members of the Global Alliance for Universities in Climate could further amplify nurses’ and midwives’ contribution to the SDG agenda. Furthermore, nurses and midwives must leverage their skillsets to address climate-exacerbated health emergencies and epidemics, disasters, mass migration, and violence and war. Table S1 outlines the elements of nursing and midwifery practice relevant to SDGs 3 and 13 in particular, in the context of the existential climate crisis in which we now all find ourselves.

The WHO specifically advocates for the delivery of equitable nursing and midwifery care for all in support of universal health coverage and the SDGs (WHO, 2020c). While nurses and midwives have an inherent responsibility to address human rights and the social determinants of health, they are often required to provide care with very limited resources within poor work environments and limited support amid increasing demands and complexity. Nurses and midwives are a vital resource that must be valued and protected if necessary, health and societal benefits are to be fully realized. Ultimately, we need to work across sectors and leverage the abilities of nurses and midwives, in partnership, to promote patient-, family-, and community-centered care with regards to social, economic, and environmental determinants of health. Nurses and midwives have the commitment and professional values to address injustices and inequities. They also have the alliances with communities needed to organize and lead.

Conclusions

Realizing the SDGs will require addressing interprofessional hierarchies that constrain nursing and midwifery practice; enabling environments where nurses and midwives can practice to the fullest extent of their scopes of practice; inviting all members of the healthcare team to collaboratively participate in the design, implementation, and evaluation processes of health interventions; advancing nursing and midwifery leadership and policymaking opportunities; capacity building in research and health systems approaches; creating education models that integrate the SDGs; and expanding the professional scope of nurses and midwives to appropriately empower them in the fields of environmental health, climate change mitigation and adaptation, and beyond. It will also take commitment to the unifying belief that every person is worth fighting for and that we—as a healthcare system—are stronger when working together. As we enter this decade of action, we encourage the readership to reconsider how nurses and midwives can advance the SDGs for the betterment of our collective health and well-being and for our survival and the survival of our planet.

Table 1.

Nursing/Midwifery Engagement: SDG 3 Health Targets in Context of Climate Crisis

SDG target*	Nurse/midwife (N/MW) skill engagement	Climate mitigation/adaptation efforts
SDG 3: Good health & well-being
3.1 Reduce materna mortality	• N/MW contraceptive services & unwanted pregnancy termination access; preconceptual, antepartum, safe delivery, post-partum care	• Access to modern contraceptives enhances female-directed control of population growth; capacity-building for N/MW workforce (MW production ROI same as vaccination)
3.2 End preventable newborn & child deaths	• Perinatal/pediatric prevention & care	• Child survival decreases fertility rate
3.3 End epidemics of AIDS, TB, malaria, neglectec tropical diseases; combat hepatitis, water-borne diseases	• Education, stigma reduction, testing, prevention & care delivery	• Reduces vulnerability of populations
3.4 Reduce NCD premature mortality & promote mental health, well-being	• Education, stigma reduction, screening, prevention, treatment	• Plant-based diet has health co-benefits & emissions impact; reduces mental health stresses of climate change-related impact
3.5 Strengthen prevention & treatment of substance abuse	• Education, stigma reduction, screening, prevention, treatment	• Reduces mental health stresses of climate change-related impact
3.6 Halve deaths & injuries from road accidents	• Education, emergency response/care	• Transport changes reduce emissions
3.7 Ensure universal access tc sexual/reproductive health care	• Education, advocacy, delivery of preventive & care services	• Reduces vulnerability & population growth
3.8 Achieve universal health coverage, affordable essential medicines & vaccines for all	• N/MW deliver up to 80% primary care worldwide (per WHO)	• Healthcare, prevention, disease control needed as vectors shift, weather/flooding, & refugee impact
3.9 Reduce deaths & illnesses from hazardous chemicals & air/water/soil pollution	• Environmental health advocacy, education, support of vulnerable populations; anticipate needed services like asthma in EDs	• 8.8 million extra deaths/year from air pollution alone; reducing pollution improves respiratory, cardiovascular, nutritional health
SDG 13: Climate action
13.1 Strengthen resilience & adaptive capacity to climate-related hazards/natural disasters	• Community engagement, education, vulnerability monitoring	• Health systems contribute 5–10% of all emissions, reducing carbon footprint & adaptive capacity of health systems in face of population needs is key
13.2 Integrate climate change measures into national policies, strategies & planning	• Advocate & engage in policy making	• Local, national & transnational efforts required including from the health sector (of which the largest cadre are nurses & midwives)
13.3 Improve education, awareness, human/ institutional capacity on climate change mitigation, adaptation, impact & early warning	• Educate, advocate, surveillance tracking to anticipate patient & population needs	• Health workers/systems are first responders & must maintain service capacity during & after climate-related disasters

^*For SDG target detail see https://sustainabledevelopment.un.org/sdgs

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• Nurses Drawdown: A Project of the Alliance of Nurses for Health Environments and Project Drawdown. https://www.nursesdrawdown.org

• Sigma. United Nations Sustainable Development Goals resource page. https://www.sigmanursing.org/connect-engage/our-global-impact/sigma-and-the-united-nations/sustainable-development-goals

• United Nations Department of Economic and Social Affairs sustainable development platform. https://sdgs.un.org

• United Nations Sustainable Development Goals knowledge platform resources. https://sustainabledevelopment.un.org/resourcelibrary

• United Nations Sustainable Development Goals student resources. https://www.un.org/sustainabledevelopment/student-resources/