Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of different races.
One patient has private health insurance; the other is on Medicaid. One patient recovers quickly
while the other languishes. What can be surmised from the differences in the two patients?
Thinking on this and asking the right questions allows health care providers to create patient
care plans that better meet each patient's needs. Providing better health care to all patients
requires awareness of environmental factors that may prohibit timely recovery and put the
patient at risk for secondary and repeat infections.
Environmental factors such as finances, family, and education all affect a person's vulnerability,
or risk level. Understanding statistical data on vulnerable populations will help you interpret
patient information. This allows easier identification of those who are at risk, so that providers
may plan care accordingly. Addressing the needs of at-risk populations leads to faster patient
recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole country.
Nonprofit organizati1.1 Social Theory and Public Policy in Health Care
Courtesy of iStockphoto/Thinkstock
Prohibiting smoking in public places exemplifies the social theory of the common good, because
the mandate is meant to benefit everyone.
Health is both an individual consideration and a community concern. In other words, an
individual makes decisions that directly affect him or herself, and a society makes decisions that
affect and manage the society itself. For example, a person may choose to smoke cigarettes,
thereby damaging his or her own lungs. However, this action also has an impact on those
around the smoker because secondhand smoke has been shown to be a valid health concern.
Thus, society may create public policy, or laws, that outlaw smoking in public places with the
intent of ensuring that one person's decision to smoke does not harm others.
A law that bans smoking in public places is based on the social theory of the common good,
meaning it is intended to help everybody. The concept of the common good focuses on creating
a benefit for the most members of a community. Sometimes the common good is juxtaposed
with the social theory of individual rights, which is based on protecting personal freedoms.
Public controversy often ensues when the common good is perceived to infringe on such
individual rights. For example, social theory centered on the common good led to the creation of
public policy in the form of a law banning smoking in public places, which results in heated
debate among lawmakers and citizens. One side argues that such laws are necessary to protect
society; the opposition argues that personal freedom should not be inhibited by the collective
citizenry. The United States Bill of Rights is the primary protector of individual liberties in the
United States. The argument that personal freedom should not be inhibited by the collective
citizenry is primarily based on three amendments:
The Ninth Amendment states, "The enumeration in the Constitution, of certain rights, shall not
be construed to deny or disparage others retained by the people."
The Tenth Amendment further protects individual liberties by stating, "The powers not delegated
to the United States by the Constitution, nor prohibited by it to the States, are reserved to the
States respectively, or to the people."
The Fourteenth Amendment states, "All persons born or naturalized in the United States, and
subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they
reside. No State shall make or enforce any law which shall abridge the privileges or immunities
of citizens of the United States; nor shall any State deprive any person of life, liberty, or
property, without due process of law; nor deny to any person within its jurisdiction the equal
protection of the laws."
However, the argument in favor of passing legislation to promote the common good is based
directly on the preamble to the Constitution:
"We the People of the United States, in Order to form a more perfect Union, establish Justice,
insure domestic Tranquility, provide for the common defence, promote the general Welfare, and
secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this
Constitution for the United States of America" (Constitution of the United States of America and
the Bill of Rights, 1787).
Courtesy of bbbar/Fotolia
Pareto's principle explains why the common good and individual fairness often conflict. In many
cases, a small group of people do most of the work, which the majority then benefits from.
The Constitution and amendments then go on to describe Congress's power to legislate.
Which option is the fair choice? That question plagues American health policy. America
dogmatically strives for justice and fairness for all citizens. Social theorists and policymakers
alike refer to the Pareto principle when the common good and individual rights are directly at
odds. The Pareto principle is the theory that 80% of the outcome is caused by 20% of the effort
(Juran, 1994). This is often seen in community involvement situations wherein a handful of
people do most of the work while the majority does very little. In social theory, the Pareto
principle is often translated to mean that fairness for all does not necessarily create fairness for
every individual and that some instances occur wherein fairness for all has negative effects on
the common good (Kaplow & Shavell, 2000). Take the case of a communist society wherein all
resources are combined then doled out equally among people, regardless of how much each
person contributed. Ensuring food for all citizens benefits the common good, but a farmer who
worked hard all year to fill the pantry may end up without enough to feed his family for the winter
because others were less industrious, so his equal share becomes less than what he worked
for.
Social Attitudes Versus Individual Choice
The smoking ban example illustrates how social attitudes—which are positive or negative
evaluations of people, places, things, events, and the like, and are shared by a majority of the
community as a whole—and individual choice are not always in agreement. Social attitudes are
the result of generalized, shared ethics in a society. They help shape our overall health
environment. For example, positive social attitudes toward cigarettes viewed smoking in public
spaces to be perfectly acceptable and even doctor recommended in the early 1900s. The
current social attitude toward cigarette smoking has caused the number of cigarette users in the
United States to drop below 20% (see Figure 1.1). This in turn has created a drop in tobaccorelated illness and death. Negative social attitudes about cigarette use, caused by a collective
realization regarding the negative effects of smoke, secondhand smoke, and related illnesses,
have positively affected the nation's health.
Figure 1.1: Percentage of adults in the U.S. who use cigarettes
A line graph depicts the decrease in the percentage of adults who use cigarettes at various
multi-year intervals between 1965 (about 43%) and 2010 (about 20%).Social attitudes toward
cigarette smoking have changed drastically in the last 50 years, causing cigarette use to
decline.
Centers for Disease Control and Prevention (CDC). (2011). Trends in current cigarette smoking
among high school students and adults, United States, 1965–2010. Retrieved January 9, 2012,
from http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/index.htm
Social attitudes are part of the collective, or macro, influences on our health. Other macrolevel
influences include messages from the media, such as commercials for fast food. Health policy is
often created in response to macro influences on our society's health environment, or the
combined collective knowledge created through rigorous study, comprehensive evaluation, and
peer-reviewed publication of facts related to the collective public good.
Considering only the macro view does not consider the individual, or micro, influences or
decisions that we each make about our health. Micro influences on health include whether we
choose to walk, bike, or drive to work or school, and which foods we select at the grocery. A
debate lingers over whether the micro or macro perspective is more useful when considering
health decisions and policy.ons and government agencies work to identify and help at-risk
groups. This activity affects both government and organizational policy among health care
providers.
This text investigates the statistical data and indicators of vulnerable populations in American
health care. It also covers the causes of vulnerability and the prevailing ideologies on dealing
with at-risk populations. We will also discuss what is currently being done through policymaking
and program implementation to address the needs of vulnerable populations and what the
future looks like for at-risk groups. This chapter focuses on identifying vulnerable populations.
The relationship between resource availability and health is an important part of recognizing atrisk groups. Finally, we will look at statistical data concerning the at-risk groups identified in the
book.
1.2 Considerations for Studying Vulnerable Populations
How do we apply social theory to the study of vulnerable populations? First, we must begin by
categorizing the influences that affect the health of these groups. The influences are used to
determine which social groups in our society are defined as vulnerable populations.
Community and Personal Values
Americans largely associate good health with good personal habits and decisions. This means
that culturally, Americans expect each person to take responsibility for his or her health-related
habits and actions. Daily exercise, dietary choices, and other behaviors are not heavily
regulated by public policy or community values. Each person's own values determine his or her
health outcomes.
Of course, we cannot entirely disregard community health values. After all, they do shape public
health policy. Community values also affect the community's investment in resources and
opportunities that impact health, from regulating pollution levels to ensuring the availability of
fresh produce. Community-based health policies help bridge the gap between microlevel
personal choices and macrolevel governmental thinking. Most public policy decisions grow, not
from massive governmental thinking, but from grassroots efforts, like the previously discussed
smoking ban(s). These grassroots efforts are evidence of the power of individuals to affect
public policy.
The Louisville, Kentucky, Farm to Table program offers a good example. Two movements were
simultaneously growing in the Louisville community. One movement, led by local farmers and
entrepreneurs, focused on expanding access to locally farmed foods within the community; the
other movement, led by parents and school cafeteria employees, focused on improving the
nutrition of school lunches. When these two groups combined efforts, the Farm to Table
program was altered, and creating avenues to getting locally farmed foods into school cafeterias
became an important goal throughout the community. As the community at large increased
program participation, the local city government became involved with programs and grants to
increase the scope of the Farm to Table program.
Access to Resources
A photograph of a woman sitting and a man standing near the end of a yacht. Each are dressed
in white and they look at each other as their yacht sails on the sea.
Courtesy of 123RF Limited/123RF
Opportunities, rewards, and personal characteristics can be attributed to an individual's social
status.
From a macro perspective, we see that the distribution of resources within a community has a
direct impact on health risk. Resource distribution often correlates with social status, social
capital, and human capital. Though American society tries to equalize the distribution of
resources through social welfare programs, it is no secret that individuals gain or lose access to
opportunities and resources depending on their social status, social ties, and ability to invest in
their own potential.
Social Status
An individual's place in society, called social status, is attributable to personal characteristics,
opportunities, and rewards. Personal characteristics such as age, gender, ethnicity, geographic
location, education level, and income result in social rewards like social power, or a lack thereof.
Age affects a person's wellness (e.g., elderly people are usually more susceptible to chronic
illness than young adults) as well as a person's need to depend on others for his or her wellbeing (e.g., children depend on adults for medical care).
Gender is also an important factor in health and level of health risk. Women are more
susceptible to certain cancers, for example, but are more likely to seek medical care. Men are
more susceptible to work-related health risks, as they traditionally hold more physically
demanding jobs. The emotional differences between men and woman also affect vulnerability.
Statistically, women are more likely to suffer the ill consequences of eating disorders, whereas it
can be said that men are socially trained to eat more red meat and maintain a more robust
physique, decisions which come with their own sets of health risks.
Health Care for the Poor
Ethnicity and race are two of the most studied factors in social status and health risk because
minorities historically have less access to the social rewards that limit risk levels. Lower-class
urban neighborhoods with a high number of minority residents often lack representation in social
politics and suffer for it with higher levels of air and water pollution, which increase the level of
health risk for all residents. Furthermore, poverty can breed crime, and the stress of living in a
high-crime area also negatively affects a person's health. Stress can manifest physically by
presenting as complaints such as headaches. Stress can also increase the likelihood of
negative health behaviors, such as cigarette and alcohol use. Limited access to resources,
including fresh vegetables and medical care, increases the burden. Low-income areas are
commonly populated with fast-food restaurants that serve high-fat foods, whereas more affluent
areas often have more grocery stores and farmers' markets. Additional factors such as migrant
status further increase a person's vulnerability. Risk factors do not stand alone. An elderly
minority female has different risk factors than an elderly Caucasian male.
Social Capital
Social capital is the measurement of personal relationships in an individual's life. The number,
type, and reliability of interpersonal relationships greatly influence a person's vulnerability and
health risk. For example, a single mother is less likely to spend a day in bed, resting and
recovering from an illness, than a mother who has a partner or someone reliable who can care
for the children. Working parents are better able to maintain viable employment if grandparents
and other relations are available to help with child care.
A photo of an older woman, younger woman, and little girl smiling at each other while fresh
produce sits in front of them.
Courtesy of Hemera/Thinkstock
Health risk depends on several factors, including the quantity and quality of a person's
interpersonal relationships.
The ability to work creates opportunities and other social rewards. An upwardly mobile career
path grants access to money and insurance to help pay for doctor visits and medicine. The
opportunity to meet people and grow friendships at work adds to a person's support network. A
strong, healthy support network directly influences psychological and physical well-being,
lessening a person's health risk. Hospitals and rehabilitation facilities have found that patients
who have reliable support systems enjoy faster recovery times and spend less time
recuperating in the medical center in favor of convalescing at home with the assistance of a
robust, developed support system. Reducing the length and frequency of hospital stays reduces
the risk of secondary and recurrent infections.
Human Capital
Human capital is the amount of investment in a person's potential. Low-income individuals often
have low human capital, while higher-income individuals enjoy investment in their potential in
the form of education, opportunities for advancement, and even better access to higher-quality
health care. The more investment made in a person's potential, or future, the more that person
will be able to contribute to society in a positive way.
Data on various subjects including education, wage earnings, and health care access indicates
gaps in human capital based on gender, age, and ethnicity. Poor-performing schools are more
common in low-income neighborhoods, females are sometimes passed over for advanced
training and managerial positions, and minorities often suffer a lack of social resource allocation.
In all of these examples, failure to invest in people's potential negatively influences their longterm outcomes. Poorly educated children are less likely to attend college, the disenfranchised
female will lose work productivity, and the neighborhood that needs public resources to fix
streetlights will see an increase in crime.
Outside influences are not the only way to invest in human capital. Individuals invest in their
own potential by working hard at school and work and by organizing communities to create the
change they want. Conversely, investment in human capital can be negatively impacted by a
collective lifestyle perspective. The collective lifestyle perspective dictates behavior based on
social constructs, or ideas, about the way people "like me" should behave (Barnes, Hall, &
Taylor, 2010). Middle-class mothers may perceive that smoking is unacceptable among their
peers and so give up smoking. Conversely, adolescents in low-income areas may perceive that
smoking makes them more accepted among their peers and so take up the unhealthy habit.
Critical Thinking
Do you have a support network? Can they help with family needs such as child care or
transportation? Are they supportive of your education goals?
Health Indicators
The World Health Organization (WHO) is an international organization that coordinates healthrelated efforts around the globe. The WHO definition of health goes beyond the mere absence
of illness, proposing that "health is a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity" (World Health Organization [WHO], 2012).
From this definition of health, we can see where values and resources are directly linked to wellbeing. The WHO definition indicates that health exists in varying degrees, based on a number of
recognized indicators. Indicators of physical health are considered the measurements of the
body's wellness, such as bodily illness and disability. Mental health indicators measure
emotional issues such as stress and mental illness. The WHO definition also includes social
well-being, based on indicators such as relationships with others. Figure 1.2 illustrates the
health continuum.
Figure 1.2: The health continuum
A graph illustrating the Health Continuum via a line with arrows on each end. "Perfect Health" is
at one end of the continuum and "Death" is at the other, with "Chronic Illnesses" and "Cold and
Flu" in between.Health is not simply the absence of disease. A person's degree of health exists
on a spectrum, fluctuating throughout life.
Health is measured along a continuum, with great health at one end and death on the opposite
end. Minor ailments fall nearer the perfect health end of the continuum, with more severe needs
nearer the death end.
The WHO definition of health clearly includes physical, mental, and social components. Physical
health deals with the body and bodily functions, mental health includes brain functions such as
thought and emotions, and social health includes interpersonal relationships with others.
Physical health is measured by patient perception, doctor opinion, and clinical testing. Another
way to measure health is based on a patient's abilities to perform activities of daily living (ADLs).
Basic ADLs include personal hygiene and being able to dress oneself, feed oneself, walk with or
without assistance, and use the restroom (Weiner, Hanley, Clark, & Van Nostrand, 1990).
Patient perception of well-being cannot be overlooked when measuring health. An important
part of patient perception of well-being involves the concept that people alter their behavior
when they perceive that they are unwell. Staying in bed and eating chicken soup are two
common "sick role" behaviors. Perception is a key tool in measuring both mental health and
social health, as people interpret stressors and relationships differently.
Patient perception, doctor opinion, and clinical testing are standard ways of measuring
individual health status but do not offer a larger picture of community health status. Community
health status is measured with statistics of the rates of occurrence of illness, disease, and death
within a recognized group. This data, such as that shown in Figure 1.3, is used to influence
public policy and the distribution of public resources.
Figure 1.3: U.S. infant mortality rates per 1,000 live births, by maternal education and race
A bar graph illustrates the U.S. Infant Mortality Rates per 1,000 live births, broken first into
columns based on the mother's education level and then subdivided by the mother's white or
black race. In all five education categories (grades 0-8, 9-11, 12, 13-15, and 16), the infant
mortality rate decreases as the mother's education level increases. In all race-based
subcategories, the infant mortality rate was higher for black women than for white
women.Mortality rates for children born to white mothers is much lower overall than for children
born to black mothers; however, both races see a significant decrease in infant mortality as the
mother's number of years of completed education rises.
Singh, G. K. & Yu, S. M. (1995). Infant mortality in the United States: Trends, differentials, and
projections, 1950 through 2010. American Journal of Public Health, 85(7). Retrieved January
12, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615523/pdf/amjph004450063.pdf
Critical Thinking
Where does your current total health fall on the health continuum? Can you think of a time when
your health measured nearer the negative end?
Do you feel that patient perception is a reliable method of measurement for use in global
decisions regarding heath issues?
Risk Potential
A photo of two syringes on the floor in the foreground while in the background a young man sits
on the floor near a wall and gives himself an injection with a syringe.
Courtesy of iStockphoto/Thinkstock
In groups exposed to certain risk factors, negative life events can cause more adverse reactions
than in groups not exposed to those same factors.
The data on infant mortality and maternal race and education in Figure 1.3 also illustrates the
concept of relative risk, or risk potential. Relative risk is the potential of imperfect health in
groups exposed to risk factors, such as drug use, in relation to the potential of imperfect health
in groups not exposed to the same risk factors.
The concept of relative risk embodies the differential vulnerability hypothesis, which theorizes
that some people have more adverse reactions than others to negative life events. Studies of
the differential vulnerability hypothesis have found that members of low socioeconomic status
groups experience higher levels of anxiety, stress, and emotional duress when faced with
negative events and information than do persons of higher socioeconomic status. Considering
the factors that contribute to health and well-being (social status, social capital, and human
capital), we can ascertain that a deficiency in these factors is a likely cause of the higher levels
of mental duress in stressful situations experienced by members of low socioeconomic groups.
For example, a wealthy person who receives a speeding ticket is less likely to be concerned
about how he or she will pay the ticket than a person on a fixed income. For the latter, paying a
ticket strains an already tight budget that must pay for food and shelter. Without reasonable
levels of social status, social capital, and human capital, where is the extra money to come
from?
Critical Thinking
Why do you think members of low socioeconomic status groups experience higher levels of
anxiety, stress, and emotional duress when faced with negative events and information than do
persons of higher socioeconomic status?
Public Policy
The World Health Organization works to affect public health policy and practices on a global
scale. In the United States, public health policy is created by local, state, and federal politicians.
Many organizations influence the policies as they are created. Some organizations or groups
that influence public health policy in this country include the following:
Health insurers
Lobbyists
Planned Parenthood of America
Health care providers
The American Public Health Association
The Centers for Disease Control and Prevention
The Public Health Initiative
National Association of Public Boards of Health
Public Health Foundation
The World Health Organization
American Medical Association
The list of groups influencing public health policy in the United States goes on and on, but one
thing is important to note: There is a community of these organizations. Though Americans
primarily take the micro perspective on good health, believing that individuals should be
personally responsible for healthy lifestyle choices, the macro perspective is ever present.
Individuals belong to communities, from the neighborhood level to the international community,
and every group in between. The community perspective of health care policy emphasizes the
creation of a social support system that cares for vulnerable people and populations.
Government regulations control the distribution of resources that can strengthen a vulnerable
community and positively affect the level of vulnerability to at-risk populations.
1.3 Statistical Data on the Population Totals and Growth Trends of Identified Vulnerable
Populations
Public policymakers and health care researchers rely on statistical data from governmental or
academic studies to inform decision makers on necessary changes to resource allocation. Many
organizations perform studies that provide statistics and other data, but the most influential
American organization on the subject of public health is the National Center for Health Statistics
(NCHS) (2012). The NCHS is part of the Centers for Disease Control and Prevention (CDC). It
collaborates with numerous organizational members of the health community in every
community across the nation to survey and identify health problems and vulnerable populations
in the United States. The result of these studies is the national Healthy People objectives list,
which specifies the nation's most pressing health needs and indicates ways to address them
and fund programs for doing so. The Healthy People health objectives list is updated every 10
years.
Considerations in Studying Data
It is difficult to get definitive data on any given population. Variations in how studies are
conducted, the communities in which they are conducted, and the type of respondents all
contribute to incomplete and inaccurate data compilation. Add to these hurdles the fact that
vulnerable populations overlap, and it is nearly impossible to create a perfect picture of the total
number of America's vulnerable populations, their relative risk profiles, and their needs.
Different data sources, including vital statistics counts of deaths and births, patient perception of
illness, health agency records, and clinical diagnoses reports, provide differing estimates of
individual needs within groups. It is difficult to compare needs across groups, and studies may
be biased. Increases and decreases in some statistics are subjective due to influences of social,
or in some cases medical, ethics. For example, a rise in reports of child abuse may not indicate
an increase in actual child abuse but instead may indicate a shift in social ethics that has made
people more likely to report child abuse incidents.
It is also difficult to compare data across groups because different indicators are used to
measure statistics. Resource needs for the chronically ill are often based on clinical records
measuring physical limitations. These measurements are based on clinical information,
physician recommendations, and patient perceptions of pain and illness. Statistics on family
abuse are based on case reports. It is understood that many abuse cases go unreported, but
the number of unreported cases is unknown. Needs assessments of other vulnerable
populations are based on varying evidence of poor health and functioning. The Public Health
Data Standards Consortium promotes standardization of health and community statistical
studies and data in an effort to make the data more accessible and meaningful.
Connections Between Vulnerable Groups
The last few decades have seen interesting changes in the population numbers of vulnerable
groups. The number of Americans living with HIV and AIDS has risen drastically since the virus
was first recognized by the CDC in the 1980s. In fact, the number of people with HIV/AIDS
doubled in almost every measured area of residence from 2004 to 2008, as shown in Figure
1.4.
Figure 1.4: Reported number of people living with HIV/AIDS by area of residence
A bar graph shows, in 500-person increments, the reported number of AIDS cases from 20042008 and the estimated number of people living with HIV/AIDS in 2008 from 12 geographical
areas across the United States and Puerto Rico.Reported AIDS cases rapidly increased
nationwide from 2004 to 2008.
Center for Disease Control and Prevention. (2008a). Reported AIDS cases and persons
reported living with AIDS, by area of residence, 2004–2008 and as of December 2008—eligible
metropolitan areas and transitional grant areas for the Ryan White HIV/AIDS Treatment
Extension Act of 2009. Retrieved from
http://www.cdc.gov/hiv/surveillance/resources/reports/2010supp_vol17no1/pdf/2010_hiv_aids_s
sr_vol17_n1.pdf#page=8
A photo of a homeless man sitting on a sidewalk against a wall with a Golden Retriever dog
laying next to him.
Courtesy of Tony Baggett/iStockphoto
The homeless population is affected by HIV/AIDS at a rate three times greater than the general
population.
This data does not include unreported cases, which is a problematic inconsistency in the data
measurement. An unknown number of unreported cases complicate resource allocation for this
vulnerable population.
HIV/AIDS affects the homeless population at an estimated 3.4%, a higher rate than the general
population at 1% (National Coalition for the Homeless [NCH], 2007). Homelessness is difficult to
define and track because it is often a transitory situation. The homeless population is measured
primarily based on shelter occupancy and street counts, which can vary depending on a range
of factors, starting with weather.
1.3 Statistical Data on the Population Totals and Growth Trends of Identified Vulnerable
Populations
Public policymakers and health care researchers rely on statistical data from governmental or
academic studies to inform decision makers on necessary changes to resource allocation. Many
organizations perform studies that provide statistics and other data, but the most influential
American organization on the subject of public health is the National Center for Health Statistics
(NCHS) (2012). The NCHS is part of the Centers for Disease Control and Prevention (CDC). It
collaborates with numerous organizational members of the health community in every
community across the nation to survey and identify health problems and vulnerable populations
in the United States. The result of these studies is the national Healthy People objectives list,
which specifies the nation's most pressing health needs and indicates ways to address them
and fund programs for doing so. The Healthy People health objectives list is updated every 10
years.
Considerations in Studying Data
It is difficult to get definitive data on any given population. Variations in how studies are
conducted, the communities in which they are conducted, and the type of respondents all
contribute to incomplete and inaccurate data compilation. Add to these hurdles the fact that
vulnerable populations overlap, and it is nearly impossible to create a perfect picture of the total
number of America's vulnerable populations, their relative risk profiles, and their needs.
Different data sources, including vital statistics counts of deaths and births, patient perception of
illness, health agency records, and clinical diagnoses reports, provide differing estimates of
individual needs within groups. It is difficult to compare needs across groups, and studies may
be biased. Increases and decreases in some statistics are subjective due to influences of social,
or in some cases medical, ethics. For example, a rise in reports of child abuse may not indicate
an increase in actual child abuse but instead may indicate a shift in social ethics that has made
people more likely to report child abuse incidents.
It is also difficult to compare data across groups because different indicators are used to
measure statistics. Resource needs for the chronically ill are often based on clinical records
measuring physical limitations. These measurements are based on clinical information,
physician recommendations, and patient perceptions of pain and illness. Statistics on family
abuse are based on case reports. It is understood that many abuse cases go unreported, but
the number of unreported cases is unknown. Needs assessments of other vulnerable
populations are based on varying evidence of poor health and functioning. The Public Health
Data Standards Consortium promotes standardization of health and community statistical
studies and data in an effort to make the data more accessible and meaningful.
Connections Between Vulnerable Groups
The last few decades have seen interesting changes in the population numbers of vulnerable
groups. The number of Americans living with HIV and AIDS has risen drastically since the virus
was first recognized by the CDC in the 1980s. In fact, the number of people with HIV/AIDS
doubled in almost every measured area of residence from 2004 to 2008, as shown in Figure
1.4.
Figure 1.4: Reported number of people living with HIV/AIDS by area of residence
A bar graph shows, in 500-person increments, the reported number of AIDS cases from 20042008 and the estimated number of people living with HIV/AIDS in 2008 from 12 geographical
areas across the United States and Puerto Rico.Reported AIDS cases rapidly increased
nationwide from 2004 to 2008.
Center for Disease Control and Prevention. (2008a). Reported AIDS cases and persons
reported living with AIDS, by area of residence, 2004–2008 and as of December 2008—eligible
metropolitan areas and transitional grant areas for the Ryan White HIV/AIDS Treatment
Extension Act of 2009. Retrieved from
http://www.cdc.gov/hiv/surveillance/resources/reports/2010supp_vol17no1/pdf/2010_hiv_aids_s
sr_vol17_n1.pdf#page=8
A photo of a homeless man sitting on a sidewalk against a wall with a Golden Retriever dog
laying next to him.
Courtesy of Tony Baggett/iStockphoto
The homeless population is affected by HIV/AIDS at a rate three times greater than the general
population.
This data does not include unreported cases, which is a problematic inconsistency in the data
measurement. An unknown number of unreported cases complicate resource allocation for this
vulnerable population.
HIV/AIDS affects the homeless population at an estimated 3.4%, a higher rate than the general
population at 1% (National Coalition for the Homeless [NCH], 2007). Homelessness is difficult to
define and track because it is often a transitory situation. The homeless population is measured
primarily based on shelter occupancy and street counts, which can vary depending on a range
of factors, starting with weather.
Migrants and migrant workers often make up a significant percentage of the homeless
population. Statistics on migrants obtaining legal permanent resident status in the United States
are easily tracked by the Department of Homeland Security (2010). Unauthorized immigrants
are difficult to track because they avoid the immigration system.
This selection of vulnerable populations illustrates how intermingled the groups are. At-risk
mothers and infants can be homeless, living with HIV/AIDS or other chronic illnesses,
immigrants, or all three. Alcohol and substance abuse is found in all populations, not only
vulnerable ones. Chronic illnesses are prevalent among the homeless population and the
elderly. Population-specific data better illustrates this point.
Critical Thinking
Migrants and migrant workers often make up a significant percentage of the homeless
population. Statistics on migrants obtaining legal permanent resident status in the United States
are easily tracked by the Department of Homeland Security (2010). Unauthorized immigrants
are difficult to track because they avoid the immigration system.
This selection of vulnerable populations illustrates how intermingled the groups are. At-risk
mothers and infants can be homeless, living with HIV/AIDS or other chronic illnesses,
immigrants, or all three. Alcohol and substance abuse is found in all populations, not only
vulnerable ones. Chronic illnesses are prevalent among the homeless population and the
elderly. Population-specific data better illustrates this point.
Chapter Summary
Any society that wants to call itself modern must recognize the populations most at risk of
negative outcomes and provide resources to help create positive outcomes for these vulnerable
groups. Doing so adds to the health and economic viability of the community. But an "all for one,
and one for all" model does not always work on a large scale. Resource allocation must be
done thoughtfully to create the most positive outcomes for the most people. Statistical data on
vulnerable populations helps inform public policy decisions that equalize fairness as much as
possible while providing for those in need. At a pivotal point in America's history, following a
recession that saw many people lose health care access, recognizing who is vulnerable and
how to help them is key for improving the chances of positive outcomes for individuals and the
community as a whole.
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