Expanding Roles of Nursing in SDGs

Taiwan is a relatively small island with a high population density, limited natural resources, frequent natural disasters, and a unique international status. The urgency for Taiwan to pursue sustainable development is even greater than for other nations. In response to the UN Earth Summit of 1992, Taiwan’s Executive Yuan established the National Council for Sustainable Development (NCSD) in August 1997. It is dedicated to creating a safe, healthy, comfortable, beautiful, and sustainable living environment, while fulfilling its responsibility as a member of the global village and working in coordination with other countries in the pursuit of global sustainable development [1].

On 25 September 2015, the UN General Assembly adopted the 2030 Agenda for Sustainable Development (UN, 2015). At the core of the 2030 Agenda are 17 Sustainable Development Goals (SDGs). The aim of the 17 SDGs (see box .1) is to secure a sustainable, peaceful, prosperous and equitable life on earth for everyone now and in the future. They address a range of social needs including education, health, social protection and job opportunities while tackling climate change and environmental protection. The SDGs address key systemic barriers to sustainable development such as inequality, unsustainable consumption patterns, weak institutional capacity and environmental degradation.

Nurses as one of the irreplaceable health professionals have the inherited responsibility to join the mission to implement the SDGs to reach the target in 2030. Of the 17 SDGs, SDG3, SDG4, are directly related to our professional responsibility. We also have a significant influence on SDG6, SDG14, SDG15, and SDG16. There are several achievements we have accomplished in Taiwan and the works are continued for the better of tomorrow. The purpose of this paper is to present the opinions on the participation of nurses in Taiwan SDGs in the past and the future.

As the largest portion making up the health professional team, and as one of the irreplaceable health professionals, nurses have the inherited responsibility to join the mission to implement the SDGs to reach the target in 2030. In addition, nurses work in a wide variety of settings and provide a continuum of services, the nursing profession has a wide-reaching impact on implementing SDGs.

Of the 17 SDGs, SDG3 is directly related to our professional responsibility. The SDG3 is “Good Health and Well-Being”: Ensure healthy lives and promote well-being for all at all ages. In addition to 13 targets, the United Nations Educational, Scientific and Cultural Organization (UNESCD) organized it into seven topics [2]:

A. Severe communicable and non-communicable diseases

B. Health problems of vulnerable groups and in the most vulnerable regions, and an understanding of how gender inequalities may affect health and well-being

C. Direct strategies to promote health and well-being, e.g. vaccines, healthy food, physical activity, mental health, medical consultation, education, sexual and reproductive health education including education about pregnancy avoidance and safer sex

D. Indirect strategies (public health) to promote health and well-being: e.g. political programs for health insurances, affordable prices of medicine, health services including sexual and reproductive health care services, drug prevention, transfer of knowledge and technology, reduction of pollution and contamination, early warning and risk reduction.

E. Philosophical and ethical conceptions of life quality, well-being and happiness Sexual and reproductive health education including family planning

F. Discriminatory attitudes towards people living with HIV, other illnesses or mental disorders Road traffic accidents

G. Overweight and obesity, insufficient physical activity and unhealthy food

H. Chemicals, pollution and contamination of air, water and soil

Nurses have the knowledge of health, hygiene and well-being and also understanding of the importance of gender in health and well-being. Nurses also aware of the facts and figures about the most severe communicable and non-communicable diseases, and the most vulnerable groups and regions concerning illness, disease and premature death as well as the importance of mental health and how addictions to alcohol, tobacco or other drugs cause harm to health and well-being. In addition to include health-promoting behaviors in their daily routines.

Nurses have to apply relevant prevention strategies to foster positive physical and mental health and well-being, including sexual and reproductive health and information as well as early warning and risk reduction. This effort is only at the individual level but also at institutional, associational, national, and international level.

Nurses also need to understand the socio-political-economic dimensions of health and well- being and knows about the effects of advertising and about strategies to promote health and well-being. As reported by WHO & World Bank [3] that at least 400 million people lacked access to at least one of these services, and that many people were being tipped or pushed further into extreme poverty because they had to pay for health services out of their own pockets. WHO and the World Bank Group [3] also recommend that countries pursuing UHC (SDG3 target 3.8) should aim to achieve a minimum of 80% population coverage of essential health services and that everyone everywhere should be protected from catastrophic and impoverishing health payments. A national health assurance system, as the one implemented in Taiwan government, maybe one of the best solutions to solve the problem of this issue.

Quantity of nurses

Sustainable Development Goal 3 is essential to the achievement of the other SDGs. UHC means not only reaching everyone in need, but also delivering quality health care services that are people-centered. This requires a well-performing health system with a sufficient number of well-trained motivated health workers. However, it is projected that there will be a shortage of 10.1 million skilled health professionals (nurses, midwives and physicians,) by 2030 [4]. The scarcity of qualified health personnel, including nurses, is one of the biggest obstacles to achieving health system effectiveness (Buchan and Aiken 2008) [5].

Therefore, more nursing education programs are necessary to provide an adequate amount of nursing workforce to meet needs. Considering that in remote communities and/or in low-middle income countries, as Tomblin Murphy &Rose [6] reported, the primary care delivered at the local level depended upon the expertise of community health workers or nursing assistants. Before adequate registered nurses are available, community health workers and nursing assistant may be considered as the supplement workforce. A good training program is necessary for them.

Quality of nurses

Nurses are educated with a holistic lens so that all facets of a person’s health and well-being are considered when planning and delivering care. The important role of nurses in contributing to population health which has been increasingly acknowledged by governments and recognized by the World Health Organization WHO 2015 [7]. But we would all acknowledge that on top of known health problems, we face emerging global threats such as antimicrobial resistance, new pandemics, emerging infections, natural disasters, global climate change, armed conflicts and migrants. In addition, as Tomblin-Murphy & Rose [6] noted, that there is an increasing focus on the determinants of health, the current models of health delivery still tend to focus primarily on the treatment of illness need to be changed. Therefore, constant and continuous further education is needed to keep knowledge updated and competence adequate for coming health care needs.

As to the professional growth, the knowledge is not limited to healthcare-related only. Shamian et al. [8] stressed the importance of interprofessional education (IPE) and interprofessional collaborative practice (IPCP). Nurses are encouraged to advocate for IPE to be included in core curricula and as a part of health worker training programs. In all of the settings in which they work, nurse leaders have an important role in advancing interprofessional collaboration and ensuring that it is supported by appropriate governance, policies, environments and delivery models [9]. A good example of interprofessional collaborative practice is the long-term care. It requires the collaboration of doctors, nurses. physical therapists, social workers, and more.

The WHO also emphasize the necessity to adopt the knowledge of digital technology. As noted by WHO [10] in their six building blocks for a strong health system, there is a need for well-functioning information systems and nurses must be appropriately resourced in relation to this goal. The connectedness of health care systems and the rapid changes in communication technologies has enabled healthcare innovations to be developed and shared more rapidly than ever before. Adopting new technologies will require nurses to be assertive in their requirements for appropriate technological support. We need to actively participate in the system and promote an understanding that technologies can transform pathways of care and improve patient safety and quality.

The commitment of nurses to SDGs

Nurses play a central role in achieving universal health coverage (UHC) and there are numerous examples of nurses expanding access to essential health services [11]. To make achievement in SDG3, it requires the commitment of nurses. The examples of areas which require nurses to put effort on include: to ensure a strong nursing voice in all health and social system policy development and planning dialogues, to consider the influence of regulation and legislation on the health system and HRH planning issues, to design and improve information infrastructures and data collection to support health system redesign and planning and to participate in research related to HRH and in health systems research and evaluation.

Nurses are taking an essential role in implementing SDG3. The numbers of nurses with qualified education is not adequate, especially in under-developing and developing countries. All well-developed nursing schools and hospitals should consider offering training programs for these countries. Also, we are encountering new health problems and new technology. Nurses have to keep their knowledge and competence updated and be enthusiastic participants in the implementation of SDGs.

Special thanks to Dr. Tsay Shwu-Feng, Director-General, Department of Nursing and Health Care, Ministry of Health and Welfare, Taiwan for her generous offer of the reference material and kindly support.

1. Executive Yuan (2018) Taiwan voluntary national review: The implementation of UN sustainable development goals. Executive Yuan, Taiwan.

2. United Nations Educational (2018) Scientific and cultural organization. Education for Sustainable Development Goals. UNESCO, Paris, France.

3. World Health Organization and World Bank (2015) Tracking universal health coverage: First global monitoring report Joint WHO/World Bank Group report, Geneva, Switzerland.

4. Global Health Workforce Alliance (2015) Synthesis paper of the thematic working groups. Towards a global strategy on human resources for health.

5. Buchan J, Aiken L (2008) Solving nursing shortages: a common priority, Journal of Clinical Nursing 17(24): 3262-3268.

6. Tomblin MG, Rose A (2015) Nursing leadership in primary health care for the achievement of SDGs and HRH Global Strategies Geneva ICN Internal Working Paper.

7. World Health Organization (2018) Realising nurses' full potential, bulletin of the world health organization 93(9):

8. Shamian J (2015) No global health without human resources for health (HRH): The nursing lens, Canadian Journal of Nursing Leadership 28(1):

9. Sullivan M, Kiovksy RD, Mason DJ, Hill CD, Dukes C (2015) Interprofessional collaboration and education. American Journal of Nursing 115(3): 47-54.

10. World Health Organization (2010) Framework for action on interprofessional education & collaborative practice. WHO, Geneva, Switzerland.

11. International Council of Nurses (2015) Nurses a Force for Change: Care Effective, Cost Effective. International Nurses Day toolkit. ICN.