The World Health Organization (WHO) has designated 2020 as the International Year of the Nurse and Midwife. The year-long celebration of our professions was acknowledged as important by the WHO, given the critical role that the nursing and midwifery profession plays in supporting the delivery of the Sustainable Development Goals and the ambition for universal healthcare coverage. The timings for these celebrations also coincide with the bicentenary of the birth of Florence Nightingale.
It was not until I started working in public health that I fully appreciated how Nightingale had used statistics to achieve major health reform. Having collected hospital mortality data for 2 years, while out in the Crimea, Nightingale used a then pioneering way to present her findings. Using her rose chart (also known as a polar area diagram), she was able to clearly illustrate that most people were dying from poor sanitation and infection, which was considered largely preventable (Nightingale, 1859). The presentation of data was compelling and later led to significant health reform. So, in 2020, we should celebrate the nurse, statistician and public health leader who challenged the world to consider doing things differently to save and improve lives.
In the 21st century, our access to data has certainly improved since Nightingale's time and I am sure that we are going to find that our access to different types of data will only increase over coming years. However, as nurses, how often do we go beyond looking at individual level data to understand outcomes? How often do we examine data to understand the leading causes of death and ill health for our local, national and global communities? More importantly, how do we use these data to challenge policy and practice as Nightingale did over 150 years ago?
If we did examine these data, we would see that non-communicable diseases, such as heart disease, stroke, cancer and dementia are now leading causes of preventable death and ill health in most middle- and high-income countries. We would also recognise that major behavioural, physiological and environmental risk factors (such as tobacco, dietary risk, obesity, high blood pressure and air pollution) are the main drivers for these diseases (James et al, 2018). These data also reveal unacceptable health inequalities. For example, in 2015-17 the gap in life expectancy between the most and least deprived areas in England was 9 years for males and 7 years for females. The gap for years spent in good health was 19 years for males and females (Figure 1). What is also concerning is that the inequality gap in life expectancy has increased significantly since 2011-13 for both sexes (Public Health England, 2019).
Nightingale was quoted as saying: ‘Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back.’ This leads me to question if we have made sufficient progress in our nursing profession in promoting, preventing and protecting the public's health. I would propose that our health and care system is still very much focused on treating rather than preventing avoidable diseases and this needs to change. As we celebrate the ‘year of the nurse and midwife’ we must use this as an opportunity to reflect on how nurses, midwives and other health and care professionals respond to the challenges that we face in the 21st century, as Nightingale did in the 19th century.
It is important that we access evidence-based information and guidance on the major public health issues affecting our populations. We need to be able to understand the interventions we can scale at a population, community and individual level to address these public health challenges. That is why Public Health England has introduced the All Our Health framework for all health and care professionals. The aim of All Our Health is to support professional colleagues to better understand the critical public health issues of our time and allow them to consider the role that they can play in promoting and delivering evidence-based risk-reduction interventions. There is no question that we need to enhance our contribution to important issues such as providing support around smoking cessation, physical activity, healthy weight, alcohol consumption and safe antibiotic prescribing through to advice on the importance of immunisations or taking up the offer of certain screening programmes. Our framework has been designed to provide all health and care professionals with brief advice and information on these important topics, in an easily accessible and engaging format. This includes useful links to data, national guidelines and a brief knowledge check for those wanting to measure their understanding of key topics. This is also a great way to provide evidence for continued professional development, which nurses and midwives can use for their revalidation.
The All Our Health framework also challenges professionals to consider a place-based approach to improving the public's health. As nurses and midwives, we are in all parts of the community, including schools, the workplace, national and local government and people's homes, in addition to the traditional clinical settings such as hospitals and health centres. It is only by working with people in their communities that we will manage to address health inequalities and improve health outcomes. As nurses, we can act as a force for change in supporting healthy communities and challenging policy and practice for the greater good. As the largest and most trusted professional workforce (Skinner and Clemence, 2018), we have the potential of making change happen.
There are many nurses from across the world and ages who have made significant contributions to our society. This provides a strong foundation and expectation for our profession to continue to make important contributions to improving the health and wellbeing of the communities that we serve. However, to achieve this, we must take time to reflect and develop our nursing model and practice. What more can we do as a profession to address the unacceptable health inequalities and major burden of preventable disease that affect the lives of too many? How can we shift the focus from treatment of disease to working across our communities to focus more on prevention, promotion and protection?
During 2020, Public Health England will be partnering with the British Journal of Nursing to examine key areas of practice included in the All Our Health framework. I would encourage all nurses and midwives to start using the framework today (https://tinyurl.com/y88blj79). By working together, we can be a positive force for change in improving the lives of all, but our focus must be on addressing the unacceptable health inequalities that persist for many groups.