Community/Public Health Nursing 6th Edition by Mary Nies ,Melanie McEwen

Exercise 13

In the United States, inequities in the distribution of resources pose a threat to the common good and a challenge for community and public health nurses. Factors that contribute to wide variations in health disparities include education, income, and occupation. Lack of health insurance is a key factor in this issue and a major rationale for passage of the Patient Protection and Affordable Care Act, as about 20% of nonelderly adults and 25% of children in the United States are uninsured. Lack of insurance is damaging to population health, as low-income, uninsured individuals are much less likely than nonpoor insured individuals to receive timely physical examinations and preventive dental care.
Public health nurses are regularly confronted with the consequences of the fragmented health care delivery system. They diligently work to improve the circumstances for populations who have not had adequate access to resources largely because of who they are and where they live.
Ethical questions commonly encountered in community and public health nursing practice include the following: Should resources (e.g., free or low-cost immunizations) be offered to all, even those who have insurance that will pay for the care Should public health nurses serve anyone who meets financial need guidelines, regardless of medical need Should the health department provide flu shots to persons of all ages or just those most likely to be severely affected by the disease Should illegal aliens or persons working on "green cards" receive the same level of health care services that are available to citizens
Social justice in health care is a goal for all. To this end, community and public health nurses must face the challenges and dilemmas related to these and other questions as they assist individuals, families, and communities dealing with the uneven distribution of health resources.