Running head: VULNERABLE POPULATIONS Vulnerable Populations Karin Mogren-Kuzma Ferris State University 1 VULNERABLE POPULATIONS 2 Abstract The purpose of this paper is for the author to assess and analyze health disparities and her own attitudes and bias in regards to vulnerable populations. Vulnerable population demographics are identified in addition to the etiology of vulnerability. Included is an analysis of how personal bias and bias in the healthcare system may reflect delivery of care. Vulnerable populations are defined as individuals, in various categories, whom tend to have a poor health status as compared to the general population and are at a greater risk of having poor physical, psychological, and social health outcomes. The demographics include the uninsured, the economically disadvantaged, racial and ethnic minorities, low income children, those with human immunodeficiency virus (HIV), the elderly, the gay, lesbian, bisexual and transgender people (GLBT), mental illness, immigrants and refugees, drug abusers and residents of rural areas with barriers to healthcare access. The etiology of health disparity is believed to be the result of complex environmental interactions and a longstanding history of discrimination (AJMC, 2006). Negative stereotyping is fairly common in the healthcare setting. Being aware of how bias can affect care is important to understand as a professional. After conducting scholarly research of vulnerable populations, the author has gained a better understanding of the implications and the various groups’ susceptibility for vulnerability and how it relates to health and wellbeing. In order to improve health outcomes for this population, biases must be eliminated and healthcare providers must adopt nonjudgmental attitudes. Keywords: Vulnerable populations, healthcare disparity, bias, stereotypes VULNERABLE POPULATIONS 3 Vulnerable Populations Vulnerability or the susceptibility to harm is a risk to all individuals. However, vulnerable populations are diverse social groups, with an increased risk for poor health outcomes due to certain specific factors. The purpose of this paper is to explore the etiology of vulnerable populations and determinants of health care disparities. The discussion includes identifying aspects of vulnerability such as poverty, race and related issues of stigma and discrimination. Additionally, an analysis of stereotyping amongst vulnerable populations, in the healthcare field and how bias affects delivery of care, is provided. Who They Are In regards to healthcare, vulnerable populations are defined as individuals, in various categories, whom tend to have a poor health status as compared to the general population and are at a greater risk of having poor physical, psychological, and social health outcomes. According to the American Journal of Managed Care (AJMC), vulnerable populations include the economically disadvantaged, the uninsured, the homeless, racial and ethnic minorities, low income children, those with human immunodeficiency virus (HIV), the elderly, the gay, lesbian, bisexual and transgender people (GLBT), and those with chronic health conditions, including severe mental illness. Additionally, incarcerated men and women, immigrants and refugees, drug abusers and residents of rural settings who encounter barriers accessing healthcare services are also considered vulnerable populations (AJMC, 2006). The etiology of health disparities and vulnerability are believed to be the result of complex interactions among environmental factors, personal health behaviors, social factors and genetic variations. Specifically, socioeconomic factors, language, discrimination, race, ethnicity, age, sex, low income, lack of insurance, and cultural barriers is factors identified to cause or VULNERABLE POPULATIONS 4 enhance vulnerability. As an illustration, cultural beliefs and practices may determine when and if an individual seeks medical care (AJMC, 2006). I personally describe vulnerable populations as groups of people, which due to various life circumstances, are disadvantaged economically or socially and are frequently faced with unjustified, preconceived attitudes and bias. I believe that generalizations or stereotypes held by the general public regarding particular social groups are more common than we like to admit; especially in the healthcare field. Stereotyping does not usually reflect reality or facts correctly. I believe the reason for this is because stereotypes infrequently change, and we often accept stereotypes from other people. Unfortunately, negative stereotyping is commonly encountered and as a nurse caring for diverse patient populations, it is important to recognize personal bias to ensure it does not affect the care I am providing. Demographics As mentioned previously, vulnerable populations refer to social groups with increased relative, or susceptibility to health-related problems. According to the Centers for Disease Control and Prevention (CDC), demographic factors of vulnerable populations include race/ethnicity, low socioeconomic status, low education level, old age, rural geographic location, disability, primary language spoken, religion, and risk status related to sex and gender (CDC, 2012). Income status is identified as a powerful variable that explains health disparities. The AJMC explains that chronic illnesses are more prevalent among the uninsured, unemployed, and less educated (AJMC, 2006). Language and cultural barriers is another salient factor that plays a major role in access to healthcare in addition to the physical environment. Sexual preference is also identified as an indicator for health disparities. According to McKirnan, Du Bois, Alvy, and VULNERABLE POPULATIONS 5 Jones (2013), homosexual men appear to have less access to healthcare and experience more barriers to healthcare compared to heterosexual men (McKirnan et al., 2013). Self Reflection After researching and gathering data regarding populations that are considered vulnerable, I realize that vulnerability is prominent in more groups of people than I initially thought. Prior to researching this topic, I portrayed vulnerable populations as mostly ethnic minorities and uneducated individuals living at or below poverty level, in rural areas. However, I have gained a new understanding that health disparities also apply to population groups the opposite of my preconceived view, for example, the GBLT population. McKirnan et al., states that perceived stigma may lead this population group to not seek out medical services, and morbidity can be predicated by nondisclosure of sexual orientation because of implications for treatment and transmission of HIV and other sexually transmitted infections (McKirnan et al., 2013). Understanding that cultural, educational, and geographical barriers are not the only determinants of vulnerability will help me better assess my patient’s needs. The literature demonstrates that healthcare outcomes and disparities are associated with “the existence of unconscious or unintentional bias on the part of healthcare providers” (Aronson, Burgess, Phelan, & Juarez, 2013, p. 50). Bias in healthcare can generate negative relationships between the healthcare provider and patient. Self-awareness of personal bias, while ignoring stereotypical comments regarding patients is important in providing quality care, free of prejudice. I believe that in order to improve health outcomes amongst vulnerable populations, healthcare providers must eliminate their biases and understand the stigma, intolerance, and discrimination that these individuals frequently experience. I believe the unpleasant experience of negative stereotyping directly affects the avoidance of healthcare and therefore, less VULNERABLE POPULATIONS 6 appropriate care. The sooner we can eliminate bias and stereotypes in healthcare, the sooner vulnerable populations will decline in numbers. Conclusion Vulnerable populations are individuals that due to societal and environmental factors are at higher risk for mortality and morbidity, lower life expectancy, reduced access to care, and diminished quality of life. Stereotyping of these social groups is common and adds to their discrimination and disassociation from mainstream society. As a professional, it is important to explore what my personal biases might be and eliminate them in order to give my patients the care and compassion they deserve. To reduce and eventually completely eliminate health disparities, healthcare professionals must examine and put an end to their own prejudice and adopt a nonjudgmental attitude and openly accept the cultural differences and life choices that cause these groups to be discriminated against. VULNERABLE POPULATIONS 7 References Aronson, J., Burgess, D., Phelan, S. M., & Juarez, L. (2013). Unhealthy interactions: The role of stereotype threat in health disparities. American Journal of Public Health, 103(1), 50-56. doi: http://0-dx.doi.org.libcat.ferris.edu/10.2105/AJPH.2012.300828 Centers for Disease and Control Prevention [CDC]. (2012). http://www.cdc.gov/minorityhealth/populations/atrisk.html McKirnan, D. J., Du Bois, S. N., Alvy, L. M., & Jones, K. (2013). Health care access and health behaviors among men who have sex with men the cost of health disparities. Health Education and Behavior, 40(1), 32-41. doi: 10.1177/1090198111436340 The American Journal of Managed Care [AJMC]. (2006). Vulnerable populations: Who are they?. American Journal of Managed Care, 12(13), 348-532. Retrieved from http://www.ajmc.com/publications/supplement/2006/2006-11-vol12-n13Suppl/Nov062390ps348-s352/1