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In the U.S. midterm elections, Lauren Underwood, a 31-year-old African-American nurse and former senior adviser with the U.S. government on public health emergencies was elected to Congress. Paula Risikko, a Finnish nurse, recently became speaker of her country’s parliament. Soon after becoming director-general of the World Health Organization, Tedros Adhanom Ghebreyesus appointed Elizabeth Iro to his leadership team as the chief nursing officer.

Health is a political choice — and nurses need to be where these choices are made. More nurses are ascending to higher political office than ever before, and they are also rising up the ranks of global health policy workers. As a political issue, quality health care is increasingly a vote winner; nurses have credibility in speaking to it.


Achieving universal health coverage — meaning everyone, everywhere has access to the health services they need, when they need them, without suffering financially — is a top priority in global health. According to a new report published by the World Innovation Summit for Health and the UHC Forum 2018, universal health care won’t be attainable without nurses and midwives. Yet policy approaches to universal health care have traditionally neglected the health workforce and the role of nurses. This omission misses two important points:

First, nurses are the single largest contingent of the global health workforce, making up about half of its ranks. They account for about 80 percent of the contacts between patients and health care providers. Given how big a group they are, bringing nurses on board to help implement universal health care could arguably be considered half the battle.

Second, nurses offer more than strength in numbers. They also have the mindset and training to align with what’s needed to achieve universal health care in both prevention and treatment. From a quantity and quality standpoint, countries that empower nurses will be best-placed to rapidly and cost-effectively deliver on the promise of health for all. Investing in nurses will improve services as well as bolster health promotion and disease prevention — both vital levers in the heavy lift of delivering universal health care.


To give a sense of what the world is up against, and why universal health is so badly needed, the latest data released by the WHO show that noncommunicable diseases — cancer, diabetes, heart disease, Alzheimer’s, and the like — killed 41 million people last year and are responsible for 71 percent of all deaths worldwide. These diseases cause suffering, financial catastrophe, and threaten to undermine already fragile health systems straining under the challenges of disease outbreaks and aging populations.

Nurses should be at the forefront of managing the epidemic of noncommunicable diseases within the framework of universal health care. They frequently have close ties to communities and an understanding of local customs and culture. Nurses also have the status and sway to change behaviors that cause noncommunicable diseases. For example, they can support people to exercise more, cut back on drinking alcohol, and quit smoking.

Michael Bloomberg, the former mayor of New York City and a current advocate for global health, has spoken with passion about the essential convening power of government in the fight against noncommunicable diseases. “Governments at all levels must make healthy solutions the default social option. That is, ultimately, government’s highest duty,” he said in a speech before a United Nations summit on noncommunicable diseases.

Who better to hold governments to this overarching obligation than nurses?

More good news stories are in the works as nurses increasingly step up and demand their place at decision-making tables. Nursing Now, a global campaign to raise the profile of nurses launched earlier this year, has inspired nurses in more than 61 countries to take charge and establish their own groups to advocate for more influence for the profession. Electing and appointing more nurses as leaders in health and beyond will be essential for driving forward the universal health coverage agenda.

For too long, nurses have been underutilized and under-resourced. Realizing the huge nursing dividend is the key to delivering on the promise of health for all.

Ilona Kickbusch, Ph.D., is director of the Global Health Center and adjunct professor at the Graduate Institute of International and Development Studies in Geneva. She is also a co-chair of UHC2030 and a member of the WHO Independent High-level Commission on NCDs.

  • Great article, Nurses are really the corner stone of the health care system. They are there when life begins, throughout the continuum of life and of course present for a peaceful death. They understand the life cycle. They are part of meaningful development. Its time for Leaders to recognize, appreciate and reward the role nurses play in the society.

  • Here in the U.S, the nurses were silenced. The media did not cover any nurses strikes or even their demands for better staffing. Provider Industry PR and advertising, replaced factual information released to the public. No local newspapers covered this either. Instead they ran articles carefully crafted to deceived the public. Physicians were silent, or antagonistic towards nurses, and failed to support any of their efforts. In Post Fact America, the impact on patient safety or even the number of excess deaths or hospital acquired infections or adverse events, due to the lack of nurses, or hidden and not reported.

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