Writing this editorial in the middle of September 1999 one is conscious that it will eventually be published in January 2000 the month which marks the new year, new century and new millennium 2000 (and the 25th anniversary year of the Journal of Advanced Nursing). Greetings and best wishes appear to be in order, and perhaps some attempt at reading a crystal ball. More than 3 months before the event, future-gazing activities in the United Kingdom are muted. Undoubtedly, as 31 December 1999 approaches, all this will change and there will be a surfeit of media presentations on the past and future century and millennium, in addition to the more usual reviews of the past 12 months, and predictions for the next, that take place routinely for any new year.

So, I ask myself, what are the key issues on which one might be expected to prognosticate for nursing and health care? To look even 10 years ahead is a risky business. To try to predict future events for a century or more is usually left to statisticians, soothsayers or magicians. Take demographics and the ageing population. The United Nations ( 1994) review of the sex and age distribution of the world’s population estimated that by 2050 the global population would be 9833 million, a predicted increase of 4541 million, or approaching double the number of people in the world in just 55 years from the mid 1990s. This is a mind-blowing statistic for anyone remotely concerned with health care provision, nutrition, and the provision of clean water, sewage disposal, housing, education or employment.

Yet, on the other hand, a recent article in a British broadsheet newspaper ( The Independent on Sunday, 5 September 1999 ) described in awful detail the impact of the HIV/AIDS epidemic on the populations of the countries of Central and South Africa. It was reported that as a result of the dreadful effects of the epidemic, the hard won years of slow improvements in population health were now in reverse and increases in life expectancy had not only halted, but were in rapid decline. Extrapolating these findings to the rest of the world might lead one to believe that there are indeed pathological checks and balances at work in limiting the apparently inexorable increase in global population. But then, 2 weeks later, a British Channel Four Television news programme (7·00 pm 13 September 1999) described the cautiously optimistic development of an entirely different approach to a vaccine against HIV/AIDS. After so many false starts and major disappointments in this field it is hard to believe that this one will succeed where others failed but, if it does, then population immunity becomes a possibility and another Malthusian prediction could bite the dust. The world, it seems, cannot escape the responsibility of trying to achieve population control by voluntary and humane means.

The lesson I draw from this brief and rather obvious example is that whilst governments must clearly try to ‘second guess’ the future in order to achieve some measure of future planning, there will always be unpredictable events and also unintended consequences, for which we must be prepared. Part of this preparation lies in trying to shake off the ethnocentricity that we adopt when viewing the world outside our limited horizons. This would be my millennium message for JAN readers and authors and my hope for the future development of the journal. The celebration of the millennium is a paradigm example of a developed worldview based on a Christian calendar. Yet even this has not been a fixed entity. Over the centuries the New Year has been changed in many countries, from beginning on Christmas Day, to the feast of the Annunciation of the Blessed Virgin on 25 March, to 1 January when the Gregorian calendar was adopted. The latter change varied in its adoption by different countries between 1582 and 1923. In Great Britain and the Dominions (including the then North American colonies) the change took place in 1752, but in Scotland it was from 1600 (Time measurement & calendars, Whitaker’s Almanac 1999, page 82).

Other religions have completely different calendars for which the millennium 2000 has no relevance except that the potential failure of developed world technology is no respecter either of individuals or social groups. If electricity supplies fail, aircraft are unable to fly or nuclear arsenals self-detonate, the consequences are the same irrespective of the calendar one follows. Nevertheless, members of other cultures will not be celebrating 1 January 2000 as a significant event in time. The Jewish year 5760 began on 11 September 1999, the Muslim year 1420 on 17 April, and the Chinese year of the Rabbit on 16 February, to name but three (Time measurement & calendars, Whitaker’s Almanac 1999, pages 85–86, 88).

It is not only at the millennium but also in many other activities that our own particular worldview seems superordinate. JAN now reaches readers in over 70 countries. But authors (themselves from many different countries) frequently behave as though the health care system of which they are a part is not only readily understood by readers in diverse situations, but also that to write of the differences and idiosyncrasies which exist in their particular situation would be unacceptable in an international journal. Patricia Underwood (1999), one of the Editors-in-Chief of the new journal Nursing and Health Sciences spoke of a tendency for authors in the East to devalue their contribution of position papers, case studies and think pieces for submission to an English language journal, concentrating instead on what they believe will be acceptable — abstract, objective, theoretical knowledge.

Yet, nursing will not be truly international until we can be confident in describing our differences and contextualize each of our respective experiences and stages of progress, or difficulties, within our own socio-economic and cultural milieu. Without this contextualization, it is not only impossible but also inaccurate to begin to talk about possible general, unifying themes across countries. For all the talk of the globalization and convergence of the world economy, it was recently demonstrated that the ratios of nurses to population across 147 countries vary from 1:61 to 1:33 000 population. Seventy per cent of this distribution is associated with the ratios of physicians to population which, in turn, are strongly associated with countries’ wealth in terms of Gross National Product per capita ( Wharrad & Robinson 1999). Therefore, even in the midst of an incredible diversity of nursing provision, there were indicators of the universal drivers for this situation. Once these drivers are identified, one can begin to talk about the possibility (no more) of influencing change, but to do this also requires an incredibly sensitive awareness of cultural variation. Thus, research that presents findings that help to exemplify and to explain how and why nursing and health care vary so much in individual situations is absolutely essential if meaningful progress is to be made in the next century. This would be my hope for JAN ’s development in its 25th year whether or not one sees it as a ‘good millennial resolution’ or simply good publishing policy in order to influence nursing practice.


  1. Top of page
  2. References
  • Independent on Sunday, 5 September (
    1999) Africa: a continent left to die. pp 16.
  • 2
    Whitaker’s Almanac (1999) Time measurement and calendars. The Stationery Office, London, pp. 81–96.
  • 3
    Underwood P. (1999) Editorial, Exchanging Knowledge. Nursing and Health Sciences 1, 1 2.
  • 4
    United Nations (1994) The Sex And Age Distribution Of The World’s Population. United Nations, New York.
  • 5
    Wharrad H. & Robinson J.J.A. (1999) The global distribution of physicians and nurses. Journal of Advanced Nursing 30, 109 120.