not treated properly, patients will develop serious health complications, including diabetic ketoacidosis, hyperosmolar coma, cardiovascular disease, chronic renal failure, and diabetic retinopathy. In some low-income countries, life expectancy of children with diabetes is less than one year. The majority of diabetic complications can be prevented through patient education emphasizing the relationship between diabetes and obesity and how exercise and appropriate medications can treat the disease. Such a program will only be effective if population screening, evaluation, and therapy are implemented and supported by the governments of LMICs. Yet, although diabetes accounts for approximately 60% of deaths in these countries, its identification, treatment and prevention are not developmental priorities. Indeed, only 0.9% of the $22 billion in international aid is allocated for health in developing countries. Moreover, the World Health Organization (WHO) has 2,500 people on staff; yet only one person is dedicated to diabetes. Confounding the problem, diabetic medications do not reach the patients who need them most, because many countries still apply tariffs and taxes on essential medicines, which limit their affordability and access.3 Cancer is a group of diseases involving uncontrolled cell growth. The cause of cancer is diverse, complex and not fully understood. It is, however, a major burden for the world’s poor. It accounts for more deaths than tuberculosis, AIDS, and malaria combined.3 It is estimated that 70% of cancer patients are in LMICs and claim 5.3 million lives annually. Many things are known to increase the risk of developing cancer, including tobacco use, poor nutrition, certain infections, radiation exposure, physical inactivity, obesity, and pollutants. Cardiovascular disease (CVD) refers to any disease that affects the cardiovascular system. The primary causes of cardiovascular disease are atherosclerosis and hypertension. CVD is the leading cause of death worldwide;17 million people die annually, with over 80% occurring in LMICs. By 2030, it is estimated that nearly 23.6 million people will die from CVD.3 The contributing factors of CVD include unhealthy diet, tobacco use, inactivity, obesity, hypertension and diabetes. Asthma is a chronic inflammatory disease of the airways, producing a wide variety of symptoms. Asthma affects 300 million people worldwide and has many precipitating causes both genetic and environmental. Asthma is often exacerbated by triggers which often include smoke, air pollution, non-selective beta blockers and sulfite containing foods. Asthma causes moderate to severe disability in 19.4 million people globally (16 million in LMICs). Reflecting on the NCDs, we can see the commonality of risk factors that are interrelated and present in all of the NCDs. The Nurse as Healthcare Educator and Provider Considering the magnitude of the worldwide problem of NCDs, there needs to be a multidisciplinary approach to the solution, an approach which dovetails nicely with the 56
skillset of nurses. Physicians are trained to focus on and manage chronic diseases. In contrast, nurses are trained to think more holistically about the patient who has the disease and even consider his or her family. Nurses can extend the health plan into many rural areas in which there are no physicians and do an excellent job in controlling blood pressure, glucose and lipids. Dating all the way back to the 16th century, nurses have had a role in restoring the sick back to health. Over the last hundreds of years, the role of nursing has changed from just book learning to a combination of medical training and clinical experience. The biggest shift occurred in the 1850’s when the American Methodists, the largest Protestant denomination, engaged in large scale missionary activity in Asia and elsewhere in the world. Around the world, the scope of nursing practice is very diverse as well as its educational requirements. In the periphery of the Israeli community, nurses practice in roles similar to the Advanced Nurse Practitioner (APN). Their practice, however, is very structured and they work under delineated and prescribed medical protocols. Israel has four universities which offer a master’s degree in nursing but only one teaches both theoretical and clinical APN skills in the same program. In Botswana, they have advanced diploma programs that have evolved from one year to 18 months and is now approved for only 4 semesters. In addition, health care protocols are just as diverse throughout the world. For example, in Thailand, there are 3 levels of primary care. The first is a community medical center responsible for 15,000-20,000 people. These facilities are only staffed by one MD, one dentist, one
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