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Claire Betker

Claire Betker, RN, MN, CCHN(C)
Associate Member Representative 2010-2014, Canadian Nurses Association
Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health

Leading the way to health for all

The stories in this series compiled by CNA illustrate nurses fulfilling their mandate to ensure access to health and health care. But more than that, they also paint a picture of nurses working to change the conditions that contribute to the development and sustaining of health inequities (Ruetter & Kushner, 2010). That is primary health care as it was envisioned more than three decades ago.

Close to 35 years ago, the World Health Organization (WHO) articulated the primary health care approach through the Declaration of Alma Ata (WHO, 1978). Primary health care then was described as grounded in a set of core values, and it included a range of approaches to identify and address priority health issues as well as a core set of principles upon which to make decisions about how, where and what health services to provide. Within this approach, nurses were identified as “leading the way” to better health for all (WHO, 1985).

Thirty-years later, the WHO Commission on the Social Determinants of Health (2008) amassed evidence and made a compelling call to close the global health-equity gap. Their report renewed global concern about inequities in health and again championed primary health care as a model to guide action on the underlying social, economic and political causes of ill health. In Canada, leadership was identified by Dr. David Butler-Jones, our Chief Public Health Officer, as a priority area to make a difference in reducing health inequalities. He said “leaders [are needed] at all levels and across all sectors of society to act as champions, helping people to think about the contribution they can make to ensuring that all Canadians have the opportunity to achieve the best possible health” (Butler-Jones, 2008, p. 68).

Nurses work at the “intersection where societal attitudes, government policies and people’s lives meet [and this] creates a moral imperative not only to attend to the health needs of the public, but also, like Nightingale, to work to change the societal conditions contributing to poor health“ (Falk-Rafael, 2005, p. 219).

Indeed, nursing leadership at all levels is required if we are to close the health-equity gap. In these stories, nursing leadership is exquisitely profiled.


Butler-Jones, D. (2008). Chief Public Health Officer’s report on the state of public health in Canada 2008: Addressing the inequalities. Ottawa: Public Health Agency of Canada.

Falk-Rafael, A. (2005). Speaking truth to power: Nursing’s legacy and moral imperative. Advances in Nursing Science, 28(3), 212–223.

Reutter, L., & Kushner, K. (2010). ‘Health equity through action on the social determinants of health’: Taking up the challenge in nursing. Nursing Inquiry, 17(3), 269-280.

World Health Organization. (1978). Alma-Ata 1978: Report of the international conference on primary health care. Geneva: Author.

WHO (1998). Nurses lead the way. WHO features [Newsletter] (27): June 1998.

World Health Organization Commission on the Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: WHO.