Improving the resilience of vulnerable populations

Improving the resilience of vulnerable populations
July 2017
Vulnerable populations in terms of health care disparities include the economically
disadvantaged and uninsured, the elderly, and people with chronic health conditions. Low-
education status compounds the problem and leads to poorer outcomes than in people with the
same disease but higher educational status. Significant disparities include namely risk factors
relating to morbidity and mortality and access to healthcare. In the domain of physical health, the
worst affected are people with chronic health conditions such as respiratory diseases and
metabolic syndrome, including hyperlipidemia and diabetes, and resulting in heart diseases and
hypertension. Vulnerable populations often experience accumulation of problems that are
multiplied by poor health, yet the medical and non-medical needs of these populations are still
underestimated. A significant number of vulnerable people with at least one chronic condition
skip purchasing prescription drugs because of the costs involved. The most relevant risk factors
that result in poor access to health care include low income and uninsured status, in combination
with a lack of regular care. Chronic conditions such as dyslipidemia may not be particularly
apparent now, yet represent a high risk of future disability (“Vulnerable Populations: Who Are
They?”, 2006).
How the principles of vulnerability apply to the chronically ill population
Chronic conditions require regular physician visits and a holistic approach to one’s health,
including optimal nutrition and physical activity. Low economic status makes all aspects of a
healthy lifestyle particularly challenging, often due to long hours spent commuting to work,
isolation in areas with limited access to amenities, and budgetary constraints that limit the
patients’ ability to optimize their lifestyle. Reliance on processed foods with a long shelf life is
often the consequence of efforts to save costs on food and fuel and limit the number of store
visits. This behavior, in turn, leads to a higher intake of saturated fats, sugars, and sodium, and
high-calorie consumption combined with a low intake of essential nutrients. This compensatory
behavior exacerbates the vicious circle of obesity and metabolic syndrome, including
dyslipidemia, insulin resistance, and hypertension. Expenses for health care and medication of
chronic illnesses that do not provide immediate symptomatic relief are a low priority compared to
survival needs that include housing, food, and the ability to maintain employment. Regular doctor
visits add additional time and cost demands on the already overstretched budgets. Chronic
conditions such may remain unaddressed not only due to the costs of care but also because of
frustrations the patients often encounter due to their inability to change their circumstances.
Treatment efforts may then be perceived as futile, adding to frustrations from doctor’s feedback
and lack of progress.
What disparities in health care apply to vulnerable populations?
The most relevant disparities that affect vulnerable populations include access to care and
its utilization and the quality of care received. Non-adherence to treatment regime and long gaps
in care, in addition to moving between providers, often lead to overlooking deterioration or lack
of improvement. Physician’s frustrations with patients’ non-adherence to treatment and irregular
visits often lead to lowering expectations and readjustment of the treatment regimen. Virtual

medical environments may offer a solution that is low cost and ensures regular contact without
placing an additional burden on the patient.
Nurses Roles and functions in the community
The decision to remain at home in the face of a life-limiting illness or to relocate to a care
home or a hospice is a complex one. Boland et al. (2017) analyzed data from 19 systematic
reviews that studied more than 270.000 participants and compared the health outcomes from a
variety of care settings, such as independent living at home and institutional care. The results
show that the health outcomes are generally comparable between different environments, with
mixed results for various attributes. The authors are supportive of the positive impact of home
care providing the elders to remain within their communities where they receive appropriate
support (Boland et al., 2017).
Enrollment in hospice care does not determine the type of patient’s medical care
indefinitely. The real-world care paths differ, and there currently is little evidence about the
length of stay and transfers between hospitals, hospices, and home care. Hospitalization of
terminally ill patients with a high burden of disease and their prolonged treatment in intensive
care units raises a series of ethical and pragmatic questions. Studies using patient-centered data
should be used to evaluate the data objectively (Pathak, Wieten & Djulbegovic, 2014).
Hospices rely on the help of volunteers to provide support to end-of-life patients and
patients with a life-limiting illness. For nurses, the differences in care provided to
institutionalized patients represent different kinds of challenges than care offered to patients in
their homes. In hospices, nurses rarely have to provide care that is outside the domain of nursing
care, and their ability to escalate and delegate responsibility may be better than when the patient
is at home. The roles of caretakers within the community are less clearly defined. In
communities, nurses can provide training that would facilitate correct escalation of patients’ care
needs without overburdening nurses with tasks they can efficiently complete themselves to
ensure the appropriate use of resources.
What is the framework that houses the tenets?
The objective of public health nursing is to promote the health of populations in their
communities utilizing the knowledge and understanding of public health to improve the health
status of the community and reduce the burden of disease and disability. The tenets of public
health nursing have to be based on a comprehensive assessment of the population, development
of appropriate policy, and quality assurance processes. The capacity of the community needs to
be considered to improve the population’s lifestyle practices and optimize environmental factors
that may limit their choices.
What is the value of the tenets from a population health standpoint?
A community where people find it easy and convenient to maintain a healthy lifestyle is
less prone to common civilization ailments such as obesity, metabolic syndrome, and
hypertension. People whose physical mobility is not reduced by chronic illness are more likely to
maintain their independence until advanced age. A safe environment that enables physical
exercise, both outdoors and indoors, is the prerequisite to maintaining population health. A
quality assurance mechanism needs to be implemented to evaluate and improve any measures
undertaken. The assessment of the economic value of any investments in the public health
domain has to be measurable and quantifiable.

References
Vulnerable Populations: Who Are They?. (2006). The American Journal Of Managed Care,
12(13), S348-S352. Retrieved from
http://www.ajmc.com/journals/supplement/2006/2006-11-vol12-n13suppl/nov06-
2390ps348-s352/P-1
Boland, L., Légaré, F., Perez, M., Menear, M., Garvelink, M., & McIsaac, D. et al. (2017).
Impact of home care versus alternative locations of care on elder health outcomes: an
overview of systematic reviews. BMC Geriatrics, 17(1).
http://dx.doi.org/10.1186/s12877-016-0395-y
Pathak, E., Wieten, S., & Djulbegovic, B. (2014). From hospice to hospital: short-term follow-up
study of hospice patient outcomes in a US acute care hospital surveillance system. BMJ
Open, 4(7), e005196-e005196. http://dx.doi.org/10.1136/bmjopen-2014-005196

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