Healthcare Access, Infectious Disease, and Nursing's Global Role

Healthcare as a Right

The first essay question asks what types and forms of healthcare should be guaranteed as a right to everyone regardless of race, gender, class, or background. Before answering, several important considerations must be addressed. First, the healthcare systems of many countries are severely compromised due to ingrained governmental corruption or entrenched harmful practices among the population. For example, approximately two-thirds of Nigerian workers drink while on the job, a practice that is dangerous and unhealthy on multiple levels. This illustrates how both individual behavior and government failure can undermine public health. Leaders such as Kim Jong Un and Robert Mugabe have prioritized their own health and welfare over that of their populations, while even better-resourced countries like India and much of the Middle East struggle with contaminated drinking water and inadequate sanitation infrastructure, including insufficient access to functional toilets (Heijnen, Rosa, Fuller, Eisenberg & Clasen, 2014).

Human behavior also contributes significantly to health problems in developed nations like the United States. Many diseases prevalent in wealthier countries are induced by poor lifestyle choices made over years or decades rather than acute causes. However, this problem is compounded by food systems where less healthy options are ubiquitous and affordable, while health education for vulnerable populations is sporadic or absent. Even when education is available, parents and caregivers often lack motivation to adopt healthier habits themselves. Genetics also plays a role—some individuals become ill despite strong personal efforts (Collins, Ryan & Truby, 2014).

The situation is further complicated by healthcare costs. Medical expenses and insurance premiums impose substantial barriers to access, particularly for the poor and disadvantaged. While the uninsured population in the United States represents a minority, it still comprises millions of people. The number of bankruptcies, financial hardships, and preventable deaths linked to lack of healthcare access is significant (Zhou, Remsburg, Caufield & Itote, 2012). However, those advocating for dramatically expanded public healthcare must acknowledge that transfer payments already constitute a substantial portion of the U.S. federal budget. Social Security, Medicare, and Medicaid alone represent more than half of the standard federal budget, and the growing number of retirees will intensify fiscal pressures (Gamkhar & Pickerill, 2011).

Nevertheless, a minimum standard of care should be accessible to all at little or no cost. People with health insurance plans typically receive preventative care and screenings—such as physical examinations and checkups—at no additional charge. Similar low-cost or subsidized preventative services should be available to those unable to afford them. Public health campaigns that help people manage and prevent chronic conditions have yielded significant gains in obesity reduction in many communities. Addressing disease prevention proactively is far more effective than treating only those already ill (Schimmel, 2013).

For such a system to function equitably, basic and necessary care must be provided through whatever means necessary without bankrupting the state or its citizens. However, patients and communities also bear responsibility. Government programs depend on taxpayer funding; most recipients of these services contribute little or nothing to the tax base. Both patients and governments have ethical obligations. Patients have the right to access affordable, quality care but also bear responsibility for avoiding self-destructive behaviors. For instance, the Affordable Care Act eliminated waiting periods for preexisting conditions, yet many individuals deliberately remained uninsured until medical crises arose—akin to purchasing homeowners insurance after a house fire begins. This is unfair to those who maintain continuous coverage. The system depends on healthy individuals offsetting the costs of sick individuals. Governments should not enable preventable actions, though withholding care is not appropriate. Rather, the focus should be on accountability and education (Schimmel, 2013).

If one factor stands out in controlling infectious disease, it is cleanliness and sanitation. As noted previously, many regions worldwide lack running water, functioning toilets, and basic sanitation infrastructure. This enables rapid disease transmission and contributes to poor oral health and related complications. Tragically, affected populations have little capacity to remedy this situation, as their governments are unwilling or unable to invest in infrastructure. However, even developed nations including the United States and China experience disease problems linked to inadequate sanitation practices. Professional sports teams are not immune to these risks. The Tampa Bay Buccaneers experienced a significant outbreak of drug-resistant Staphylococcus aureus (MRSA) infections among players, including Carl Nicks, Lawrence Tynes, and Johnathan Banks, who contracted staph infections within two to three months despite the team's access to substantial medical resources and personnel (Carlton, Liang, McDowell, Huazhong, Wei & Remais, 2012).

Infectious Disease Factors

This demonstrates that many countries and employers fail to prevent infectious disease spread through adequate cleanliness and sterilization, while others are simply negligent. Poorer nations should receive assistance from the United Nations and other organizations to upgrade and repair sanitation infrastructure. Rather than providing cash to corrupt officials, upgrades should occur under strict supervision with comprehensive training for domestic healthcare personnel and sanitation workers to establish new standards that protect entire communities (Clasen, Pruss-Ustun, Mathers, Cumming, Cairncross & Colford, 2014).

Domestically, healthcare providers must reinforce sterilization and cleanliness standards continuously. This does not mean excessive use of antimicrobial products or fear of human contact, but rather that individuals who disregard infection control standards should be held accountable—not through shaming, but through corrective action. Anecdotally, a healthcare worker may decline standard sterilization procedures citing religious beliefs. While such beliefs deserve respect in nearly all contexts, operating room protocols are not negotiable. An individual unwilling to properly sterilize before surgery should not practice medicine in that setting. Standards should be regularly assessed for reasonableness and ethics, but anything that compromises patient safety and is reasonably preventable must be enforced without exception. Policing only obvious rule-breakers—such as nurses stealing pain medications—is insufficient. Best practices must be followed consistently and universally (Clasen, Pruss-Ustun, Mathers, Cumming, Cairncross & Colford, 2014).

The general public can adopt practical daily habits without the stringency required in medical settings. Effective practices include showering regularly, washing hands after toilet use, and keeping food and personal items out of bathrooms. Though seemingly minor, these habits substantially reduce disease transmission over time. Equally important is firmly but politely countering misinformation—particularly false claims that immunizations cause autism or are inherently dangerous. No credible evidence supports these claims. The overwhelming public health benefit of vaccination against measles, mumps, rubella, tetanus, and pertussis far outweighs known and disclosed risks. Without vaccination programs, measles outbreaks—which have occurred with increasing frequency in recent years—would be far more common, and diseases like polio could reemerge (Clasen, Pruss-Ustun, Mathers, Cumming, Cairncross & Colford, 2014).

The Millennium Development Goals, established by the United Nations at the 2000 Millennium Summit, comprise eight objectives:

Nurses can directly contribute to several of these goals, though some fall outside nursing's scope. Regarding HIV/AIDS and malaria control, nurses primarily influence outcomes through patient education about risk behaviors and prevention practices. Malaria presents a particular challenge; it has historically been the deadliest disease globally, and controlling it requires addressing mosquito-borne transmission and improving sanitation infrastructure worldwide—objectives beyond individual nursing practice. Similarly, eliminating global poverty, achieving universal education, and building global partnerships exceed what nurses can accomplish independently.

Millennium Development Goals

However, nurses can meaningfully advance gender equality by treating male and female patients identically, even when governments and colleagues do not. Given that nursing is female-dominated, promoting gender-neutral care standards should encounter less resistance. Although some literature advocates masculine centering or gender-neutrality in nursing, the optimal approach maintains equal care standards while addressing gender-specific health needs (Hollup, 2014).

Reducing child mortality presents a more nuanced opportunity. While many factors contributing to elevated child mortality lie outside nursing's direct control, prompt and competent care in medical settings can prevent deaths from disease and treatable medical conditions. Two measurement tools used in pediatric intensive care units—the Nursing Manpower Use Score (NEMS) and the Therapeutic Intervention Scoring System (TISS-28)—enable assessment of nursing performance in pediatric contexts. A study conducted in Brazil validated both metrics across over 800 pediatric patients and nearly 8,000 clinical events over two years, demonstrating strong correlations between the two approaches (Travi-Canabarro, Stochero-Velozo, Rosária-Eidt, Pedro-Piva & Ramos-Garcia, 2013). Maternal health, closely linked to child mortality outcomes, similarly benefits from skilled nursing care.

Environmental sustainability, while seemingly tangential to nursing, offers clear opportunities for contribution. Nurses can properly dispose of sharps and needles, participate in recycling and reuse programs where ethically appropriate, and eliminate unnecessary waste. In any sustainability framework, nurses must be involved because they perform the detailed work that physicians lack time and inclination to undertake.

This intersection becomes especially important in nationalized and socialized healthcare systems where resources are finite and often declining. Prudent allocation, conservation, and renewable use of resources becomes ethically and legally necessary. Clearly, reusing contaminated items like needles or blood-soaked materials is unacceptable. However, wasteful or negligent resource use by any healthcare worker violates ethical and often legal standards. Overstocking perishable supplies until they spoil wastes resources, particularly when products are scarce. Conversely, maintaining adequate supplies to accomplish work while avoiding excess that consumes space, funds, and attention needed elsewhere represents responsible practice (Higuchi, Downey, Davies, Bajnok & Waggott, 2013).

All the foregoing questions appear to have relatively straightforward answers in principle. In practice, implementation encounters substantial obstacles rooted in political will, fiscal constraints, and deliberate obstruction or misinformation. Universal low-cost healthcare is theoretically sound but requires navigating complex power structures and competing interests.

Conclusion