1. The Ottawa Charter Twenty Years On – an International Nursing Student Exchange Program Perspective 19th IUHPE World Conference Vancouver 2007

2. Inequalities in health and access to health care for rural communities – an EU/Canada funded student exchange program Inequalities in health and access to health care for rural communities – an EU/Canada funded student exchange program

3. International Partners Canada Canada Mount Royal College Calgary – Pam Nordstrom, Maureen Mitchell Mount Royal College Calgary – Pam Nordstrom, Maureen Mitchell Universite de Moncton – France Marquis and France Chasse Universite de Moncton – France Marquis and France Chasse University of Prince Edward Island – Kimberley Critchley and Barb Campbell University of Prince Edward Island – Kimberley Critchley and Barb Campbell

4. International Partners EU EU England, Bournemouth University – Ann Hemingway and Eileen Richardson England, Bournemouth University – Ann Hemingway and Eileen Richardson Sweden, University of Uppsala – Clara Aarts and Eva Bergknut Sweden, University of Uppsala – Clara Aarts and Eva Bergknut Finland, University of Applied Sciences Savonia – Liisa Koskinen Finland, University of Applied Sciences Savonia – Liisa Koskinen Estonia, Tallinn Health College – Tiina Juhansoo Estonia, Tallinn Health College – Tiina Juhansoo

6. The focus of the student exchange To enable students to experience public health focused practice in another country, specifically focusing on rural inequalities in health and access to health care. To enable students to experience public health focused practice in another country, specifically focusing on rural inequalities in health and access to health care. To enable students to undertake a meaningful exchange program enabling them to gain insights into, and experience of another culture. To enable students to undertake a meaningful exchange program enabling them to gain insights into, and experience of another culture.

7. This presentation will cover how the students used the Ottawa Charter to try to better understand inequalities. This presentation will cover how the students used the Ottawa Charter to try to better understand inequalities.

8. Duration and extent of the project From Oct 2004 to Sept 2007 From Oct 2004 to Sept 2007 A total of 24 EU students and 40 Canadian students will undertake an exchange A total of 24 EU students and 40 Canadian students will undertake an exchange Each exchange visit lasts approx. 12 weeks Each exchange visit lasts approx. 12 weeks

9. While the students were away they were expected to: Write an academic assignment focusing on one of the Ottawa Charter areas. Write an academic assignment focusing on one of the Ottawa Charter areas. The area the student chose from the charter then acted as a framework for them to consider inequalities in access to health care and health improvement work. The area the student chose from the charter then acted as a framework for them to consider inequalities in access to health care and health improvement work.

10. Developing personal skills (n=11) Changing of attitudes, empowerment skills. Re-orienting health services (n=11) Consideration of the social determinants of health e.g. the importance of cultural issues to the health of native people, collaborative working. Strengthening community action (n=10). Enabling people to choose healthy lifestyles, improving the infrastructure: bicycle tracks, footpaths, sidewalks, evening light along walk tracks. Creating supportive environments (n=6) Supportive caring environments for staff and patients. Building healthy public policy (n=3) Parental leave, lack of access to contraceptives, abortion or medicines. Areas Chosen from Ottawa Charter

11. Munich Declaration Nurses and Midwives: A Force for Health (2000) Islamabad Declaration on Strengthening Nursing and Midwifery (2007) Nurse education needs to enable nurses to “contribute to decision making at all policy levels (development and implementation) and to be active in public health and community development”, particularly in relation to the development of positive practice environments. Nurse education needs to enable nurses to “contribute to decision making at all policy levels (development and implementation) and to be active in public health and community development”, particularly in relation to the development of positive practice environments.

12. Did students not address building healthy public policy and practice environments in their assignments because what they saw in practice was health education? Did students not address building healthy public policy and practice environments in their assignments because what they saw in practice was health education? Or Or Was it because the nurse education system prepared them to focus on health education not policy development within their undergraduate programmes? Was it because the nurse education system prepared them to focus on health education not policy development within their undergraduate programmes?

13. Inequalities/inequities This area was poorly developed in the student assignments with no definitions given. This area was poorly developed in the student assignments with no definitions given. Examples given: the health of Aboriginal populations, less access to medical doctors in rural areas, and inequalities between economic classes, genders, and age groups. Examples given: the health of Aboriginal populations, less access to medical doctors in rural areas, and inequalities between economic classes, genders, and age groups.

14. Students view RN’s as part of an interdisciplinary team that improves community health Students view RN’s as part of an interdisciplinary team that improves community health They did not articulate a unique role for RN’s in primary healthcare or tackling inequalities (at odds with Munich Declaration 2000, and Islamabad Declaration 2007) They did not articulate a unique role for RN’s in primary healthcare or tackling inequalities (at odds with Munich Declaration 2000, and Islamabad Declaration 2007) They considered RN roles in other countries and were beginning to analyse and compare one health system to another They considered RN roles in other countries and were beginning to analyse and compare one health system to another Implications for Nursing

15. Students were so overwhelmed with culture, language, and being ambassadors for the institutions, etc. that they didn’t always grasp the nuances of the assignments related to the exchange. Students were so overwhelmed with culture, language, and being ambassadors for the institutions, etc. that they didn’t always grasp the nuances of the assignments related to the exchange. Students need to be introduced to international policy relevant to their roles and responsibilities as a global practitioner. Students need to be introduced to international policy relevant to their roles and responsibilities as a global practitioner. Implications for Nursing Education

16. Implications (con’t) The presence of faculty at the visiting site who understood primary care, and health inequalities helped to facilitate the students’ learning during their exchange to another country. The presence of faculty at the visiting site who understood primary care, and health inequalities helped to facilitate the students’ learning during their exchange to another country. Faculty need to work diligently at understanding the intentions of colleagues at other institutions. While we might use similar language we don’t always mean the same thing! Faculty need to work diligently at understanding the intentions of colleagues at other institutions. While we might use similar language we don’t always mean the same thing!

17. Conclusion Enabling health students to gain practical placements in public health focusing on health inequalities during their initial education does not happen universally. Enabling health students to gain practical placements in public health focusing on health inequalities during their initial education does not happen universally. Students don´t see the application of health promotion theory to practice within our ´sickness´ based health services currently. They don`t see themselves as having a role in policy development to improve health either within the health service or elsewhere. Students don´t see the application of health promotion theory to practice within our ´sickness´ based health services currently. They don`t see themselves as having a role in policy development to improve health either within the health service or elsewhere. Giving students this opportunity (not necessarily overseas) supported by formal assessed educational input would help to ensure that future health professionals see tackling inequalities in health as a key part of their role and have both the experience and insight to underpin their responsibilities in this area. Giving students this opportunity (not necessarily overseas) supported by formal assessed educational input would help to ensure that future health professionals see tackling inequalities in health as a key part of their role and have both the experience and insight to underpin their responsibilities in this area.

18. I missed my bicycle I missed my car I missed my boyfriend

19. The Ottawa Charter Twenty Years On – an International Nursing Students Exchange Program Perspective 19 th IUHPE World Conference Vancouver 2007