Ethics Issues in Nursing: Healthcare Inequality and Access
This paper examines ethical issues in nursing through the lens of healthcare inequality and access to care in underserved communities. Drawing on the work of researchers and physicians such as Dr. Peter Hotez and Dr. Aaron Shirley, the paper explores how poverty drives neglected tropical disease clusters in Gulf Coast states, perpetuates chronic illness in the Mississippi Delta, and reveals systemic failures in preventative and primary care delivery. The paper also considers the fiscal disincentives facing pharmaceutical companies and examines an innovative primary-healthcare model inspired by pre-revolutionary Iran as a potential solution for chronically underserved populations. Together, these cases frame core ethical obligations in nursing and healthcare equity.
- Introduction: Poverty and Healthcare Access: Socioeconomic status shapes healthcare quality and access
- Neglected Tropical Diseases and the Role of Poverty: Poverty drives tropical disease clusters in Gulf Coast states
- Healthcare Failures in the Mississippi Delta: Decades of unresolved chronic illness among poor Mississippians
- Innovative Models for Primary Healthcare Delivery: Iranian primary-care model proposed for Mississippi Delta
- Conclusion: Ethical duties of nurses in underserved communities
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What makes this paper effective
- Uses specific, credentialed expert voices — Hotez, Shirley, Miller — to ground abstract ethical claims in real-world evidence and institutional memory.
- Moves logically from macro-level inequality data (the Gini Coefficient) to granular regional case studies, creating a persuasive escalating argument.
- Employs direct quotation effectively, allowing subject-matter experts to testify in their own words, which strengthens the ethical urgency of the paper's claims.
Key academic technique demonstrated
The paper demonstrates case-based ethical reasoning: rather than invoking abstract ethical principles upfront, it builds its normative argument inductively through documented cases of healthcare failure. Each case — tropical diseases in Texas, chronic illness in Mississippi — adds a layer of ethical weight, making the argument for healthcare equity concrete and difficult to dismiss.
Structure breakdown
The paper opens with a broad framing of socioeconomic disparities in healthcare access, then narrows to two detailed regional case studies. The first focuses on neglected tropical diseases among impoverished Gulf Coast populations, supported by Dr. Hotez's research. The second examines entrenched chronic-disease burdens in the Mississippi Delta through Dr. Shirley's decades of clinical experience. The paper then pivots toward a potential solution — an internationally inspired primary-care model — before concluding. The structure moves from diagnosis of the problem to a tentative prescription, which is appropriate for an applied ethics discussion in nursing.
Introduction: Poverty and Healthcare Access
The quality of healthcare experienced by patients today is radically impacted by the personal resources available to those in need of routine healthcare, preventative healthcare, and medical treatment. Well-to-do patients have always been able to purchase quality medical treatment at a premium, and the opposite has also always been true: patients who are marginalized by society or live in poverty typically forego preventative healthcare and often receive medical treatment for both chronic and acute conditions when it is too late to be effective.
Neglected Tropical Diseases and the Role of Poverty
The poverty analysis statistics provided by the Gini Coefficient ("Measuring Inequality," 2012) paint a grim picture of impoverished people living in the Gulf Coast states who experience levels of inequality equivalent to those experienced by people living in sub-Saharan Africa. Dr. Peter J. Hotez is the dean of the National School of Tropical Medicine at Baylor College of Medicine and the president and director of the Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development. Hotez resides in a poor county in Texas where he has observed the link between poverty and a cluster of tropical diseases that are typically considered to be a problem only in developing countries (Hotez, 2012, p. SR-4).
In addition, Hotez notes that fiscal incentives are weak or nonexistent for pharmaceutical companies to develop new vaccines and treatments for these neglected tropical diseases (Hotez, 2012, p. SR-4). In his words:
"A key impediment to eliminating neglected tropical diseases in the United States is that they frequently go unrecognized because the disenfranchised people they afflict do not or cannot seek out health care. Even when there is a clinic or community health center in an impoverished area, it often lacks the necessary diagnostic tests, and the staff is rarely trained to recognize and manage neglected tropical diseases." (Hotez, 2012, p. SR-4)
With many healthcare fronts today requiring funding and service redesign, tropical diseases may not fare well in the lineup until and unless they impact mainstream populations.
Healthcare Failures in the Mississippi Delta
What about those diseases that are common in the overall population, for which treatments do exist, yet the provision of service is inadequate or ineffective? This is the healthcare issue that receives focused attention from Dr. Aaron Shirley. Dr. Shirley has personal and institutional memory of healthcare in Mississippi: he was the first Black resident at his state's university medical center, served as a physician at the first community health center in the Mississippi Delta in the 1960s, and is a co-founder of the HealthConnect system in Mississippi (Hansen, 2012). In 1993, Dr. Shirley received a MacArthur Foundation "genius" award as a healthcare leader.
Yet, in 2012, Shirley said, "I've been coming here [the Mississippi Delta] for 40 years and nothing has changed" (Hansen, 2012, p. SR-4). The issue is that regardless of Medicaid or health insurance, or access to community clinics or home health services, poor people in Mississippi continue to have serious health problems. As Hansen (2012, p. SR-4) reports: "They don't get better, and the diseases borne of poverty and obesity are not prevented; thousands of people frequent emergency rooms for illnesses that could have been tackled by primary care. They need something more."
Conclusion
The cases examined in this paper — neglected tropical diseases among Gulf Coast populations and entrenched chronic illness in the Mississippi Delta — illuminate the profound ethical obligations that nursing and the broader healthcare system bear toward underserved communities. Structural barriers rooted in poverty, insufficient diagnostic resources, and inadequate primary care infrastructure continue to deny marginalized patients the standard of care they deserve. Addressing these disparities is not merely a policy challenge but a fundamental ethical imperative for nurses and healthcare providers at every level.
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