This year, the United Nations General Assembly (UNGA) was held at the midpoint of the Sustainable Development Goals (SDGs) agenda. The world is not on track, and falling behind, on meeting many of the goals by 2030. The busy summit convened alongside Climate Week NYC and almost marked four years since the first case of COVID-19. Climate change and pandemic prevention, preparedness, and response were at the forefront of the UN’s High-Level Meetings and side events, along with gender equity, digital transformation, and universal health coverage (UHC).
This health-centric theme, I’m told, is unusual at the UNGA. As a nurse who is trained to take a bio-socioeconomic approach to the patient and populations holistically, this surprised me. Good Health and Well-Being (SDG 3) is at the intersection of all of the other goals!
Just months before the UNGA, I completed Sigma’s Global Advocacy Virtual Mini Academy, which focused on learning about the consultative status that Sigma holds with the UN Economic and Social Council (ECOSOC) and how Sigma advocates for health. I collaborated with a group to develop an action plan to directly integrate eight of the 16 SDGs to develop the nursing workforce. If the project was broadened, all 16 SDGs could be integrated—they are all a part of the determinants of health. This sparked my curiosity, and I was motivated to attend the SDG Summit at UNGA to see which individuals and groups were involved, hear what they said, and be where the action was. However, when I was in the room, at a table—if not the table—I asked myself, “Where is the action?”
Most attendees of these summits and High-Level Political Forums are representing an organization and have to get approval for a grounds pass. I didn’t have this opportunity for access. I took the initiative to attend unaffiliated, as a nurse advocating for health. I had to search and discover on my own what events took place on the sidelines and how to access them, and hope that when I showed up at the door, I wouldn’t be asked for additional credentials or worse—turned away.
My goals for the week were to learn, advocate, and network, as I am developing my identity in this realm of global health and where I might find a new role in my career. As a nurse, I have a unique background which gives me keen insight into the effects of the determinants of health headlining the events. But entering each room, the first thing I learned was how few health practitioners were there with me, even with several of Sigma’s United Nations representatives in attendance.
Also, in my opinion, there was a lot of talk about what needs to be done to advance the SDG agenda, but not enough action is being taken for the mountain of necessary change. At one event, Alain Labrique, Director for the Department of Digital Health and Innovation at the World Health Organization, likened this to “entropy,” which is unused, unproductive energy resulting from efforts that outweigh impact and cause a degree of chaos.
Many suggestions throughout the event involved taking leaps to high-tech innovations, but they jumped over basic, affordable steps that can be implemented in the interim and reduce the burden on the individual. For example, at one session about improving kidney health, much of the discussion centered on advances and access to dialysis. But the real transformation is meeting people where they are at and moving toward UHC to focus first on prevention and primary care, with upstream interventions. From my perspective, there are certainly more obvious ways to reach this mountain summit.
If all the talk is about why these things need to be done, and if there are already available and willing private sector partners who have the funds and resources to help make it happen, then the missing link for planning and implementation has to be frontline healthcare workers. We know what potential solutions exist because we know at the individual and population level what is needed and innovate daily to create more efficient care delivery. I know the path forward is difficult and complex, but I think there are existing ways to initiate gradual change. We don’t need to reinvent the wheel, but for some reason, we keep it spinning.
We are also met with daily barriers in health systems and unmet bio-socioeconomic needs of the individual and population. But we are not at the table to make decisions or give insight. Additionally, not all my peers even know how to get to the table, let alone where it is or have the means to do so. I was one of the few present, and I still wasn’t at the table! As Madeleine Ballard of Community Health Impact Coalition said, the decisions are being made “about us, without us.”
We need a pathway to this platform to take action.
As a nurse, I am trained to assess, diagnose, plan, intervene, and evaluate outcomes. This is a foundational and translational skill that provides the acumen to implement health programs and monitor their outcomes. In my career, I have collaborated with other disciplines and departments in root cause analyses and rapid breakthrough improvement sessions to quickly innovate. Nurses are also first-person witnesses, implementing citizen science for data collection at the point of care, everywhere that it is gathered.
Direct investment in advancing the SDGs should start with empowering more nurses and healthcare workers to implement changes they see the need for daily. We’re ready, willing, and able. How do we open up the opportunity?
We need equitable representation in our professional specialties, for our individual demographics, and at all levels in all regions of the world. We have the capacity in our scope and need a platform to practice in its fullest. The reality is governments alone don’t have the capacity to deliver effective and efficient care, and the private sector doesn’t have the expertise. A top-down and bottom-up interdisciplinary approach is required.
Authoritative bodies need to level the playing field and private entities can be our partners in purpose. It didn’t come as a surprise that nursing-centered sponsors, like Jhpiego and Last Mile Health, hosted events that placed nurses’ and healthcare workers’ perspectives at the center of the discussion. It is imperative that existing professional organizations expand their networks, providing more mentorship and development opportunities, and take a more active consultative status like Sigma has, in order to better educate and mobilize the workforce.
Healthcare workers have a wealth of knowledge and skill but need the tools to be at the table and affect impact at the highest levels. Because when we all lead, we all win.
Grace Kistner, BSBA, BSN-RN, CCRN, is a critical care nurse and a member of Sigma’s Phi Gamma Chapter.