Health Issues and Vulnerable Populations
What Are Vulnerable Populations?
Vulnerable populations (VPs) are groups of individuals who are at a higher risk for health problems due to various social, economic, and environmental factors. According to Aday (2001), vulnerable populations are societal subgroups that are in positions where they may be hurt, ignored, or in need of help. These groups are often marginalized or face discrimination, making them more susceptible to adverse health outcomes.
Flaskerud and Nyamathi (2002) identified typical vulnerable populations, including women, children, ethnic minorities, immigrants, LGBTQ+ individuals, people living with HIV, those who are chemically addicted, mentally impaired, homeless, and the elderly. These groups are often exposed to health adversities due to systemic inequalities and limited access to resources and healthcare services. Stone (2003) expanded this definition to include those susceptible to coercive or undue influence, such as children, prisoners, pregnant women, mentally disabled individuals, and those who are economically or educationally disadvantaged.
Economically or educationally disadvantaged individuals are often considered “invisible” vulnerable populations because their vulnerabilities are less obvious but still significant (Stone, 2003). When coupled with other factors like race, gender, or age, these groups become doubly vulnerable (Moore & Miller, 1999).
Data from WHO and Health Issues Record
The World Health Organization (WHO) emphasizes that poverty and limited access to care (ATC) are primary contributors to poor health outcomes among vulnerable populations (Hegavary, 2000). The WHO’s “Health for All” initiative highlights the need to improve health access and reduce disparities to achieve global health equity.
In the United States, the Healthy People 2010 Goals aimed to increase the quality and quantity of healthy years and eliminate health disparities. Improved access to care is identified as a crucial measure for achieving these goals. Similarly, the National Institutes of Health (NIH) focuses on studying disease prevention and health promotion among diverse populations to reduce health disparities and improve access to care.
The National Institute of Nursing Research (NINR) directs its efforts towards eliminating significant health disparities among different segments of the population, including certain ethnic groups. This focus encompasses access to care, incidence of disease, length of life, and mortality rates, recognizing the disproportionate impact of health issues on vulnerable groups.
Key Areas of Health Promotion
The American Nurses Association (ANA) identifies several key areas for promoting health for all people. These include:
- Policy Development: Advocating for policies that promote health equity and access to care.
- Influencing Public Expectations: Raising awareness about the importance of preventive health measures.
- Increasing Consumer Demand for Preventive Health: Encouraging individuals to seek preventive care services.
- Ensuring Equitable Access to Care (ATC): Promoting fairness in the distribution of healthcare resources and services.
These directives underscore the relevance of studying vulnerable populations in nursing research (Edelman & Mandle, 2002). The NIH has targeted studies recognizing certain ethnic groups’ increased risk for diseases, health disparities, lack of access to care, environmental toxins, and obesity.
In-depth and comparative studies are needed to understand better the biological and behavioral factors impacting health among vulnerable populations. Additionally, the NIH seeks longitudinal research that evaluates the effects of interventions on healthy behavioral change over time.
Two researchers, Aday (2001) and Flaskerud (2002), have been instrumental in developing frameworks for researching vulnerable populations. Aday’s Access to Care (ATC) Model identifies predictors of populations at risk, such as demographics and socioeconomic status. Flaskerud’s Vulnerable Populations Conceptual Model postulates interrelationships among resource availability, relative risk, and health status, using empirical indicators to predict the health status of populations.
Privacy Investigation
In 1999, the NINR funded the University of California, Los Angeles (UCLA) School of Nursing (SON) Center for Vulnerable Populations Research (CVPR) to unite scholars focused on health disparities among vulnerable populations. The CVPR includes several primary investigators, such as:
- Deborah Koniak-Griffin, RN, EdD: Director of CVPR, specializing in community-based nursing to reduce risk and promote health among vulnerable populations, particularly teens, young parents, and families.
- Adeline Nyamathi, PhD, ANP: Associate Director of CVPR, focusing on homeless adults at risk for HIV, TB, and hepatitis and vulnerable populations at risk for HIV in international settings.
- Jacquelyn Flaskerud, RN, PhD: Professor Emeritus at UCLA SON, with research interests in cultural beliefs and practices related to the prevention and treatment of AIDS and mental illness, utilization of health services by vulnerable populations, participatory research (PR) methods, and methodological issues in working with culturally diverse populations.
- Nancy Anderson, PhD, RN: Professor Emeritus at UCLA SON, with expertise in qualitative research methods, applications of PR methods, and developing culturally proficient research measures and interventions.
These researchers are advancing knowledge about health disparities and working towards improving health outcomes for vulnerable populations.
Three Cautionary Accounts
Research involving vulnerable populations must be conducted with special ethical considerations, as identified in three cautionary accounts from the literature (Mann, 2003):
- Obtaining Consent: Consent from participants must be obtained following approval from local ethics review boards, particularly because many members of vulnerable populations are minors, have cognitive impairments, or are in government custody.
- Inclusion by Self-Selection and Referral: Inclusion of participants by self-selection or referral may impact the purity of the sample. Self-selected participants might join studies to mitigate their victimization, while referrals could be influenced by similar motivations (Mann; Stone, 2003). Watchirs (2002) provided a comprehensive review of methodologies for measuring human rights, including an analysis of current laws governing the use of vulnerable populations in research.
- Direct Health Benefits: If a health problem is identified during research, an intervention aimed at a positive outcome must be offered to participants (Stone, 2003). This raises an ethical concern about the potential for direct health-related benefits.
Vulnerable Populations as a Social Group
Vulnerable populations are considered social groups with an increased risk of experiencing health problems. Researchers and legal frameworks may define these groups differently, but data is often lacking to substantiate which groups are most at risk. Financial deprivation and limited access to care are significant contributors to vulnerability, evidenced by global trends of lower life expectancy, reduced access to care, and diminished quality of life among these populations.
The UCLA CVPR follows NIH directives to investigate vulnerable populations in terms of health disparities among minorities and those living in poverty. The CVPR’s work aims to advance knowledge about vulnerable populations, including the development of participatory research methods that are ethically sound. Designing research that respects both legal and ethical standards is crucial for influencing global health and improving access to care for all.
Conclusion
Vulnerable populations are at an increased risk for various health problems due to social, economic, and environmental factors. These populations include women, children, ethnic minorities, immigrants, LGBTQ+ individuals, people living with HIV, those who are chemically addicted, mentally impaired, homeless, and the elderly. Systemic inequalities and discrimination contribute to their increased susceptibility to adverse health outcomes.
Efforts to promote health equity must focus on improving access to care, addressing health disparities, and implementing policies that support the well-being of vulnerable populations. The American Nurses Association and other health organizations emphasize the importance of policy development, raising public awareness, and ensuring equitable access to care. Researchers must continue to study the unique challenges faced by vulnerable populations, using ethically sound methods that respect participants’ rights and dignity.
The work of researchers like Aday and Flaskerud has provided valuable frameworks for understanding and addressing the health needs of vulnerable populations. However, more research is needed to identify effective interventions and policies that can reduce health disparities and improve health outcomes for all individuals, regardless of their social or economic status. By advancing our understanding of vulnerable populations and the factors contributing to their health risks, we can work towards a more equitable and just healthcare system that serves the needs of all people.