The year 2011 recorded a number of significant events that will continue to impact on the lives and health of populations and communities in 2012 and beyond. In the first four months alone some of the worst natural disasters in history occurred. After suffering a decade-long drought, Brisbane, Australia experienced substantial flooding. Other natural disasters, to name but a few, included a 6.3 magnitude earthquake in Christchurch, New Zealand; a 9.0 magnitude earthquake, tsunami and nuclear crisis in Japan; a 6.8 magnitude earthquake in Myanmar; and a series of 137 tornadoes devastating the southern United States of America. In August the worst drought in 60 years was reported in East Africa with millions of individuals suffering famine in Kenya, Ethiopia, Djibouti, Somalia and parts of South Sudan. Each of these events, which devastated individuals, families, communities and populations, caused and continues to cause significant loss of life and human suffering, and will have a long term effect on health and quality of life.

Many of these natural disasters have been blamed on the global weather disruption. Climate changes are taking place in almost every part of the world and pose a serious threat to public health as they affect the fundamental determinants of health – food, air and water. The rise in temperatures will accelerate the proliferation of vector born diseases such as malaria and dengue. Ozone air pollution will increase the prevalence of bronchial asthma and respiratory infections.

This year also witnessed considerable civil unrest within and across many countries. In the first three months of 2011 alone, protests in Bahrain, Egypt, Lebanon, Libya and Tunisia resulted in significant loss of life and numerous casualties. The nursing profession and other health disciplines face the challenge of delivering emergency care at great personal risk in areas of conflict. More recently the riots in the United Kingdom demonstrated how communities could be devastated and intimidated by unforeseen events and emphasised the need to prepare for the unexpected.

Nurses are at the forefront caring for those affected by conflict and disaster, and need to be involved in preparing populations and communities. Preparedness is critical to the delivery of effective response to the short, medium, and long-term health needs of a disaster or conflict-stricken populations. The International Council of Nurses (ICN) promotes strategies that support social justice and equity of access to needed health and social services and calls for support systems that will address the health needs of health workers within conflict areas, relief workers as well as the direct conflict and disaster victims.

In addition to the impact of natural disasters and conflict, health systems continue to be challenged by shortages, imbalances, unemployment and underemployment of nursing personnel. Serious long-term neglect and underinvestment in nursing human resources management and data collection systems have resulted in poor workforce planning, policy formulation and management practices in many countries. Over the past decades, multifaceted demographic, economic, political and social transformations have had a significant impact on the patterns and dynamics of health care delivery. Policies are determined within a complex and changing social and economic context.

Furthermore health systems have been under mounting pressure to balance increasing service demands within the resources available while ensuring patient safety and quality of care. Some of these issues have been on the policy agenda for many years. In recent times, the most significant issue impacting on health care delivery is the global economic downturn. The challenge for the nursing profession is to ensure that the focus is not just on financial issues, but also on subsequent effects on patient care.

In many countries nurses deliver the majority of direct care. Therefore, nursing exerts considerable influence over whether the change advocated by health policy makers actually can be achieved in clinical practice. Evidence demonstrates that qualified nurses make a positive difference to patient outcomes through leadership, policy and practice. ICN has recognised that if nursing practice is to proactively develop to meet patients' health needs and also influence the changing health care context, nursing leadership and involvement in health policy decision-making is essential.

Health care systems around the world are facing great change. Decisions taken under public reform will influence the future of nursing and the care delivered to patients. Therefore, it is imperative that nurses are constructively involved in policy discussions on the future shape of health care. ICN proactively engages with numerous strategies to drive and influence the strategic direction to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce.

Nurses from around the world will gather to discuss the strategic direction of nursing and health policy, and many other topics at the 25th ICN Quadrennial Congress to be held from 18–23 May 2013 in Melbourne, Australia. Focused on the theme of Equity and Access to Health Care, the Congress will highlight the critical role nursing plays in leading the way to healthier nations. The Congress is an excellent chance for nurses to share knowledge and explore ideas and solutions to the challenges facing nursing and health.

Although there are many challenges ahead for the nursing profession, enormous opportunities for the profession also exist. Nurses can develop new models of care delivery focused on population needs and lead the way on preparedness, prevention and promotion strategies. Periods of economic downturn and other crisis can be times of innovation for service delivery and dynamic changes in roles and skill mix. Nursing is in the pole position to give voice to the quality principle and to lead the development of effective and appropriate health care in these challenging times.

Elizabeth Adams RGN, MSc. is a Consultant for Nursing and Health Policy with the International Council of Nurses. In addition, she is an Adjunct Associate Professor with Curtin University of Technology, Western Australia. Previously she served as Deputy Nursing Services Director for the Health Service Executive in Ireland.

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The International Council of Nurses extends warm greetings to its member associations in more than 130 countries. We express deep appreciation to you, the more than 13 million nurses working worldwide, the principal providers of primary health care in many nations. We commend you for your essential role in caring for individuals, families and communities, often in the face of challenging conditions. We applaud and support your advocacy for equitable and accessible health care for all. We hope that you, your families and the people you serve will experience peace and health in 2011.