Perspectives on Global Healthcare.

Healthcare is organic. This fundamental aspect of healthcare was slowly recognized and acknowledged over my years of teaching a Global Health course and traveling abroadwith students. After interacting with nurses, medical personnel, and the general public in various countries, it became evident that a nation’s healthcare system is not just a static entity. Healthcare is created, then grows, develops, and changes according to the needs of anation and the culture, history, andpersonality of its citizens. Beginning in the late 1970s, a Public Broadcasting System documentary series entitled Connections (An Alternate View of Change) looked at science and inventions from both an interdisciplinary perspective and as a largely unintentional interaction of discrete events. As creator and science historian James Burke noted, the development of anything in our world cannot be viewed as a singular event, but rather as a network of interrelated events, with each of those events occurring for various individual reasons with no awareness of the possible future results. Burke suggested several corollaries to his theory: first, that the modern world has no ideawhere today’s ‘‘isolated’’ eventswill lead, second that the probable increase in both speed and complexity of these connections will impact individual freedom and privacy, and third, the probable consequences to the entire system in case of a breakup or collapse of one of the interconnected networks. In many ways, healthcare systems mimic Burke’s theory on how the world interconnects. Healthcare does not occur in isolation; it is developed and changed by people, events, and the connections between them. History, culture, education, politics, and geography all play an integral part in contemporary healthcare; comparisons of these topics add dimension and depth to the learning experienced and insight developed by the students in my Global Health course. What does historical perspective bring to understanding healthcare systems, and what role does a nation’s history play in current-day healthcare? The history of a nation illuminates that nation’s view of individual health and the development of its healthcare system. The aftermath of war, the immediacy of a national trauma, and the realities of public health concerns, such as infectious disease or a widespread disaster, all help determine the role that healthcare plays in the lives of a country’s citizens. Inmany parts of Europe, World War II is not just a distant memory; it is a remembrance that is integral to the national consciousness. With the influx of refugees, the damaged cities, and the necessary rebuilding of a society, systemic programs such as universal health coveragewere both an imperative and a reasonable solution for the postwar problems experienced by many European countries. William Beveridge, one of the creators of Britain’swelfare state, said in 1948 that ‘‘social security and world security were indissolubly linked.’’ Professional nursing has been, and continues to be, shapedbyhistorical events, fromFlorenceNightingale’s response to the needs of the Crimean war soldiers to the experiences of the nurses in Louisiana and Mississippi who worked in nursing homes during Hurricane Katrina. In a medical corollary to James Burke’s theory, presentday healthcare professionals are often so focused on current concerns that the larger, and longer-term, implications may be ignored or overlooked. It would seem to be significant that education on historical perspectives of health is usually taught only tangentially in nursing and medical schools, where very full curriculums are generally focused on current knowledge and practice standards. It is important, at some point, to take the long view and remember that all events experienced by a nation shape and change the long-term view of healthcare goals and inwhatmanner they should be achieved. With that in mind, the following question must be considered: Does the educational preparation of healthcare providers influence the direction of the entire country’s healthcare systemor simply define how an individual practitioner performs? There ismore depth to the education of a healthcare provider than clinical preparation. An interesting Author Affiliation: Clinical Associate Professor, College of Nursing, University of Alabama at Huntsville. The author reports no conflicts of interest. Correspondence: Marlena Seibert Primeau, DNP, FNP-BC, BSHECS, College of Nursing, University of Alabama at Huntsville, NB321, Huntsville, AL 35899 (primeam@uah.edu). DOI: 10.1097/NUR.0000000000000188