Healthcare and Medical Tourism

The expansion of primary health care strategies utilizing nurses is required to face the epidemic of noncommunicable diseases (NCDs) in low- and middle-income countries (LMIC). NCDs, also known as chronic diseases, are of immense and growing importance worldwide. The human, social and economic consequences associated with the four major types of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes - are felt by all countries but are particularly devastating in poor and vulnerable populations. As the leading cause of death globally, NCDs were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of them (16million) were premature deaths under age 70 years. Almost three quarters of all NCD deaths (28 million), and the majority of premature deaths (82%), occur in LMIC. These countries also need to deal with a dual burden of disease by addressing increasing amounts of NCDs simultaneously with having to address substantial burdens of communicable diseases. One large challenge for primary health care expansion in LMIC is the limited numbers of doctors. Only 5 of the 49 countries categorized as low-income economies meet the minimum threshold of 23 doctors per 10 000 population. In most countries, nurses account for more than 50% of health-care providers, representing the largest group who can make significant contributions to prevent and treat NCDs. Increasing reference to nurse-led chronic disease management clinics is present within the literature. In high income countries, it has been demonstrated that nurse led clinics provided care that was acceptable, feasible, sustainable and with significant improvements in benchmark goals for hypertension and diabetes at 6 months and 1 year. CHRONIC DISEASE MANAGEMENT: THE ROLE OF THE GLOBAL NURSE 2 The purpose of this presentation is threefold: to describe the NCD epidemic faced by LMIC; the importance of building a sustainable global nurse workforce to tackle this challenge; and the applicability of using a Canadian chronic disease management model which effectively utilizes the role of specialized nurses in optimizing chronic disease management among adults in primary health care.