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”You must form public opinion. The generality of officials will only do what you make them. You, the public, must make them do what you want.”
Florence Nightingale (1893)

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•• Also see Why Nightingale? Why Now? Parts 1 & 2 and Part 3 ••

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As we connect the dots — our NIGH teams remember the 2020 Bicentenary of Florence Nightingale's birth. Her insights still have fresh relevance to a new vision for achieving a healthy world community — through the 17 UN Global Goals for Sustainable Development (SDGs). In fact, Nightingale's life and work anticipated all these SDGs — all as factors in recovering and maintaining health. Today we would call all these factors social and environmental 'Health Determinants.' See each story below.

SDGs #1 and 2 seek to “end poverty in all its forms everywhere” and to “end hunger` and achieve food security and improved nutrition and promote sustainable agriculture.” In the 1860s, Nightingale worked to reform the Liverpool Workhouse Infirmary where 1,200 impoverished and hungry people were crowded into unsafe, unsanitary conditions. Because of this effort — and at Nightingale’s urging — reform of the entire British workhouse system included — for the first time — placing salaried nurses who addressed these conditions in workhouse settings. Improving productivity and access to markets for agricultural businesses like this peanut producer in Lombok creates economic growth and jobs and reduces poverty.

SDG#3 is the one obvious Goal related to Nightingale’s long lifetime of work. Specifically focused on Health & Well-being — this SDG seeks to ‘ensure healthy lives and promote well-being for all, at all ages.’ Of course this Goal is central to Nightingale’s work and to the work of nurses and midwives worldwide. Yet Nightingale saw health through a much wider lens than simply caring for people after they become sick or injured. To the left, a nurse checks the intravenous (IV) fluid infusion for a patient at a treatment centre in the district of Norton in Zimbabwe, during the cholera outbreak in 2008. Many emergencies occur in remote locations and require strong, flexible and multi-sectoral means of response to save lives and treat the critically ill. Nightingale saw that the challenge of improving human health was multi-faceted and holistic. “When we obey all God’s laws as to cleanliness, fresh air, pure water, good habits, good dwellings, good drains, food and drink, work and exercise, health is the result: when we disobey, sickness. 110,000 lives are needlessly sacrificed every year in this kingdom by our disobedience, and 22,000 people are needlessly sick all year round. And why? Because we will not know, will not obey God’s simple Health-laws. No epidemic can resist thorough cleanliness and fresh air.” (1876)

Nightingale passionately noted the key connections between education and health, writing, “oh teach health, teach health, health, health, to the rich, and poor, to educated and, if there be any uneducated, oh teach it all the more — to women especially— to young mothers, to young mothers especially!” This perspective is much in keeping with SDG #4 — to “ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.” To the left, Pakistani girls go to school with support from the Central Asian Institute.

An Amerindian woman and child in the Sacred Valley, Andes, Peru.
Nightingale's ideas — to support and encourage young women and women of all ages — anticipated SDG #5 —to “achieve gender equality and empower all women and girls.” In her own time, Nightingale's entire effort — to develop a nursing education curriculum — focused on improving the earning-capacities and living conditions of young women by providing them the means to join a profession that was becoming well-respected because of Nightingale's own example. She deeply pondered the experience of being a woman in a time where gender equality was mostly non-existent. “Women dream till they no longer have the strength to dream: those dreams against which they so struggle — so honestly, so vigorously and conscientiously, and so in vain — yet which are their life.” (1860)

SDG #6 — to “ensure availability and sustainable management of Water & Sanitation for all” — was as anticipated by Nightingale who clearly saw this Goal as essential to health. She said "pure water is more generally introduced into houses than it used to be, thanks to the exertions of the sanitary reformers. Within the last few years, a large part of London was in the daily habit of using water polluted by the drainage of its sewers and water closets. This has happily been remedied. But, in many parts of the country, well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.” (1860)

Although Nightingale did not specifically anticipate SDG #7, Renewable Energy, to “ensure access to affordable, reliable, sustainable and clean energy for all.” To the right, a group of people march for the Clean Energy Revolution in Philadelphia on July 25, 2016. Nightingale often called for observing and following the ‘laws of nature’ and using these ‘laws’ to improve the quality of life. “In dwelling upon the vital importance of sound observation, it must never be lost sight of what observation is for. It is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort.” (1860) It is also interesting to note that she used an energy-related metaphor in one of her most famous quotes, “Health is not only to be well, but to use well, every power we have.” (1893) .

SDG #8 Decent Work & Economic Growth, seeks to "promote sustained, inclusive and sustainable economic growth and full and productive employment and decent work for all.” Nightingale shared her relevant thoughts on how to achieve these goals. “The very essence of all good organizations is, that everybody should do her own work in such a way as to help and not hinder every one else’s work." (1873) and,“let us run the race where all may win: rejoicing in their successes, as our own, and mourning their failures, wherever they are as our own.” (1883)

Throughout her own career, Nightingale embraced innovation and saw the value of innovation. She noted, “if we can transform by a few years of quiet, the habits of centuries, or progress will have been slow, but amazing rapid” (1894). She would have appreciated SDG #9 - Innovation & Infrastructure - to “build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation.” She even help to develop improved infrastructure in her own time and was responsible for the innovative design of the original St Thomas’ Hospital — some of which is still standing on the banks of the river Thames in London. Her innovations included setting windows in such a way as to allowed sunlight to be readily available to patients and the nurses caring for them.
The picture above illustrates the infrastructure innovation called for by SDG # 9. 'High Line' is an elevated old railway line owned by the City of New York. Today it is a 1.45-mile-long linear public park maintained, operated, and programmed by Friends of the High Line, in partnership with the New York City Department of Parks & Recreation. The High Line railway line was opened in 1934 and moved goods to and from Manhattan’s largest industrial district until 1980. The new HIGH Line was launched on September 15, 2015. Now, the High Line's green roof system, with drip irrigation, is designed to allow the planting beds to retain as much water as possible. Because many of the plants are drought-tolerant, they need little supplemental watering. When supplemental watering is needed, hand watering is used so as to tailor the amount of water to the needs of individual species and weather conditions, and to conserve water.
High Line is independently funded from U.S. Department of Agriculture (USDA) Forest Service (USFS). Urban forestry and green spaces are priority areas for USFS. With 80 percent of the nation's population in urban areas, there are strong environmental, social, and economic cases to be made for the conservation of green spaces to guide growth and revitalize city centres and older suburbs. Urban forests broadly include urban parks, street trees, landscaped boulevards, public gardens, river and coastal promenades, greenways, river corridors, wetlands, nature preserves, natural areas, shelter belts of trees and working trees at industrial brownfield sites. Urban forests are dynamic ecosystems that provide needed environmental services by cleaning air and water helping to control storm water, and conserving energy. They add form, structure, beauty and breathing room to urban design, reduce noise, separate incompatible uses, provide places to recreate, strengthen social cohesion, leverage community revitalization, and add economic value to our communities. Urban forests — through planned connections of green spaces — form the green infrastructure system on which communities depend. Green infrastructure works at multiple scales from the neighbourhood to the metro area up to the regional landscape.
This natural life support system sustains clean air and water, biodiversity, habitat, nesting and travel corridors for wildlife, and connects people to nature. Urban forests, through planned connections of green spaces, form the green infrastructure system on which communities depend. Urban and Community Forestry (UCF) is a cooperative program of the US Forest Service that focuses on the stewardship of urban natural resources. UCF provides technical, financial, research and educational services to local government, non-profit organizations community groups, educational institutions, and tribal governments. The program is delivered through its legislative partners, the state forestry agencies in 59 states and US territories. Forest Service cooperative programs are currently being redesigned to make more effective use of federal resources. Programs will be focused on issues and landscapes of national importance and prioritized through state and regional assessments. Over the next five years, an increasing percentage of funding will be focused on landscape scale projects. Three national themes provide a framework for this work: conserve working forest landscapes; protect forests from harm; and enhance benefits associated with trees and forests.

SDG #10 seeks to achieve "Reduced Inequality within and among countries". In the photo on the left, thirty year-old Tizezew works for the NGO called 'Finote Hiwot' and sees the change the programme is making to girls’ lives. “Now the community and the students are leading the conversations,” she says. “People from every part of the community - from religious leaders to schools - are talking. They’re coming up with solutions on the ground. To see the voice of change passing down from 'Finote Hiwot,' to community facilitators to schools, to girls, it makes me feel proud.” Girls and women everywhere have the right to live free from violence and discrimination. Help end child, early and forced marriage in a generation. Nightingale was concerned with the inequalities that arose from cultural intolerance. Serving both British and Turkish soldiers during the Crimean War, she modelled understanding both Christians and Muslims. She is still appreciated widely across Islam for her own commitment to their well-being. The first biographer of Nightingale, Edward T. Cook, quoted her on this: "To know God we must study Him in the Pagan and Jewish dispensations as in the Christian... this gives unity to the whole—one continuous thread of interest to all these pearls.”

Nightingale certainly reflected upon and worked to achieve what is now known as SDG # 11 Sustainable Cities and Communities — to “make cities and human settlements inclusive, safe, resilient and sustainable.” The Panorama of Todi is a town and municipality of the province of Perugia, region of Umbria, in central Italy. It is perched on a tall two-crested hill overlooking the east bank of the river Tiber, commanding distant views in every direction. In the 1990s, Richard S. Levine, a professor of architecture at the University of Kentucky, chose Todi as the 'Model Sustainable City' because of its scale and its ability to reinvent itself over time. After that, the Italian press reported on Todi as the world's most livable city. Nightingale applied this concern directly saying, “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm” (1868). She also saw the connections between the quality of life in a community and the well-being of its peoples, “The health of the unity is the health of the community. Unless you have the health of the unity, you have no community health” (1893).

SDG #12 aims to “ensure Responsible Consumption and production patterns". Recycling and compost bins similar to the ones seen on the Plya de Gijón in Asturias, can be found at various locations around the globe. Although this issue was not yet apparent in Nightingale’s own time, she anticipated valuing health as a priority over economic drivers to produce more money through making and buying things. “People should remember that health is their only capital" (1893).

Although not widely known, Nightingale was herself an ardent environmental activist. She would be appalled at our air pollution and encourage all of us to take action and identify things that impact climate change. Throughout the 1850s to 1880s, she collaborated with a series of leaders based in Calcutta, Bombay and Madras to address environmental concerns affecting the health of the Indian people, including issues related to deforestation resulting in loss of tillable soil during monsoon seasons and acid rain. This work directly anticipated SDG #13, Climate Action, which requires us to “take urgent action to combat climate change and its impact.”

Dolphins play at a favourite whale watching site in Mirissa Beach, off the coast of Sri Lanka. in 2011. SDG #14 Life Below Water aims to “conserve and sustainably use the oceans, seas and marine resources for sustainable development.” Nightingale herself made many sea voyages and remarked about her own love for the ocean. “When I was a child, I remember reading that Sir Isaac Newton said in his last hours: 'I seem to myself like a child who has been playing with a few pebbles on the sea shore — leaving unsearched all the wonders of the great ocean beyond” (1872).

From her work to improve the quality of life in India (ex. SDG#13) Nightingale also anticipated the thrust of SDG #15, Life on Land, to “protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss.” Urban roof gardens, such as the one seen in Seattle, Washington, is increasingly becoming part of the modern architecture emerging in cities worldwide. Nightingale connected the concerns of SDG #15 with the recovery of individuals who are sick. “The effect in sickness of beautiful object, of variety of objects, and especially of brilliancy of colour is hardly at all appreciated... I shall never forget the rapture of fever patients over a bunch of bright-coloured flowers. I remember (in my own case) a nosegay of wild flowers being sent me, and from that moment recovery becoming more rapid... ” (1860)

Two young girls in the Palestine territories.

Building upon her own service to soldiers during the Crimean War and for many years thereafter, Nightingale was keenly awareness of the measures needed to prevent war and to promote peace. With this experience and knowledge, she was called upon to write (anonymously) of the British government’s official text submitted to craft the first Geneva Convention, which later led directly to establishing the League of Nations and the United Nations. Her early insights and passionate commitment to this field of human concern therefore led directly to the establishment of SDG #16 Peace and Justice to “promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.”

Finally, SDG #17, calls for Global Partnerships for the Goals as essential ingredients to achieve all the other SDGs, to “strengthen the means of implementation and revitalize the global partnership for sustainable development.” As a nurse, Nightingale often served the suffering by building collaborative relationships with others of like-mind and heart. From her own wide worldview of caring — with a worldwide network of colleagues from many disciplines — Nightingale took her own stand to courageously advocate for and about the needs of others. She was a change agent who set a culture of caring for others and collaborating with other in motion, still continuing, even now, into the wider possibilities of the 21st century. The photo on the left shows participant ‘’Delegates’ and their assigned nations at the Model World Health Organization Assembly convened in March 2010, at Ryerson University in Toronto, Ontario. Canada, where two NIGH Founders, Deva-Marie Beck and Wayne Kines, participated.

Video recorded in 2019 at 'Deerhaven Lodge' near Riding Mountain National Park in Manitoba, Canada, from NIGH's archives. mage Sources: All SDG Logos are posted using the official UN SDG Guidelines.
Header photo by x-drew. Credit: Getty Images/iStockphoto. SDG's #1&2 photo by Josh Estey. Source Food Security, Indonesia, from Department of Foreign Affairs & Trade. Date 4 May 2009. This file is licensed under the Creative Commons Attribution 2.0 license. SDG#3 photo by Paul Garwood, used with attribution as specified by WHO. Source WHO Media Centre 2008, Zimbabwe. SDG#4 photographer unknown. Source Central Asian Institute, 2009. SDG#5 photo by Quinet, 2006. Source Wikimedia Commons used under the Creative Commons Attribution 2.0 Generic license. SDG#6 photo by 'Mo' in Pakistan, 2007. Source Wikimedia. SDG#7 photo by Becker from Grove City, Ohio. SDG #8 photo by Suzanne Plunkett, 2016. Source Empowering Women for Economic Growth: The Smart Choice for the G20, July 11-12, 2016. SDG #9 photo by Lance Cheung. Source Wikipedia, USDA. SDG #10 photo by Jessica Lea. Source the UK Department for International Development. SDG#11 photo by Livioandronico2013, August 2014. Soure Wikimedia. SDG#12 photo by PC de E. Corvilla under the terms of GNU Free Documentation License. SDG#13 photo by Karendotcom127. Source, Wikimedia Earth Day 2008. SDG#14 photo by Arian Zwegers. Source Wikimedia. SDG#15 photo by Joe Mable, Source: Wikimedia. SDG#16 photo by Justin McIntosh, 2004. Source Wikimedia.