Vulnerable populations

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Despite efforts and goals in the United States to reduce or eliminate disparities in healthcare by 2010, significant disparities, including risk factors, access to healthcare, morbidity, and mortality, continues in vulnerable populations. For example, studies find that Americans living in poverty are much more likely to be in fair or poor health and have disabling conditions, and are less likely to have used many types of healthcare. I believe that more effort should be made to bring affordable healthcare to vulnerable population

Vulnerable populations are groups who are not well integrated into the healthcare system because of ethnic, cultural, economic, and geographic or health characteristics (WHO).

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This isolation puts members of these groups at risk for not obtaining necessary medical care, and thus constitutes a potential threat to their health. Commonly cited examples of vulnerable populations include racial and ethnic minorities, the rural and urban poor undocumented immigrants, and people with disabilities or multiple chronic conditions. The reasons for disparities are varied.

For example, in access to health care, racial and ethnic minorities may lag behind non-Hispanic whites because patterns of residential segregation separate minorities from the supply of providers, because of language and cultural barriers between doctors and patients, or because of differences in employment patterns that lead to lower rates of employer-based insurance coverage for some groups.

Vulnerability results from developmental problems, personal incapacities, disadvantaged social status, inadequacy of interpersonal networks and supports, degraded neighborhoods and environments, and the complex interactions of these factors over the life course. The priority given to varying vulnerabilities, or their neglect, reflects social values.

Vulnerability may arise from individual, community, or larger population challenges and requires different types of policy interventions—from social and economic development of neighborhoods and communities, and educational and income policies, to individual medical interventions. In the past decade or two we have come to understand better that vulnerability is cumulative over the life course. Early-life difficulties and their adverse effects interact with later events in ways that increase the likelihood of poor adult outcomes. The welfare of adolescents, young adults, and the elderly depends greatly on trajectories of personal development, social and economic experiences of one’s family and community, and stressors that may be unique to various age groups or to communities at a particular time. Many businesses small or medium size do not offering health care insurance as a benefit to their employees or decide to decrease the cost.

Other causes such an increase in premium for the employee with a convalescence economy has further complicated the possibility to take advantage of the benefit. Individuals may be vulnerable by virtue of their financial circumstances or geographic location. These factors can present obstacles to obtaining needed health care and can result in increased exposure to health risks. Those who disproportionately experience access problems include those whose income and/or health insurance status place them at increased risk for encountering barriers to accessing needed services and those who live in certain rural or inner-city areas that have a shortage of qualified health care professionals. The estimated 41.6 million Americans who have no health insurance most often face the greatest access barriers (U.S. Census Bureau, 2009). These barriers to access can lead to a lack of continuity, delays in obtaining care, and limited choices about where and from whom care may be received (Newacheck et al., 2009; Lambert and Agger, 2009). These patterns of utilization can contribute to adverse health care outcomes, including higher rates of preventable hospitalizations (Billings et al., 2008).

Poverty and lack of insurance can result not only in decreased access to health care, but also increased risk of poor health. Any of these factors can magnify exposure to environmental risks (such as secondary tobacco smoke, poor sanitation, or lead exposure), safety risks (such as traffic hazards and family violence), social and psychological stressors (such as fear of crime), and lack of infrastructure supports (such as counseling or educational services) that contribute to an increased burden of poor health. Vulnerability can in some cases be attributed to limitations in the ability to communicate with providers and other actors in the health care system. Communication difficulties may be associated with a person's level of education or development, language or cultural differences, health condition, or physical or mental disability. Persons who have difficulty communicating may experience problems in expressing treatment preferences, providing informed consent, obtaining services that are consistent with their cultural norms, finding providers who are sensitive to their particular concerns, getting problems resolved, and understanding or complying with treatment options.

The number of immigrant/refugees in the United States is estimated at 35 million and this amount continues to grow every day. Many of them suffer from cardio vascular disease and nutrition due to a lack of social support and health care services. Poor socioeconomic status is linked to deficiencies in prenatal and early nutrition. This population is segmented due to a various reasons, culture, race, economic, geographic and even health attributes. Fears of being found illegal and or deported that a reason who block this population for seeking and obtaining medical care. One of the biggest health issues of these immigrants is obesity. During the first exam, many of these patients receive medical help for variety of aliments whom are obese, reveal seriously undiagnosed hypertension, diabetes, metabolic syndrome, or dyslipidemia. Payments to health plans and providers should promote quality health care and improved health and functional status for all patients, including vulnerable populations. Adjusting payments for differences in health or functional status is especially important for Medicare, Medicaid, and other payers that have significant enrollment of individuals with chronic illness or disability so that health plans and providers have an incentive for developing innovative models of care that best serve these individuals.

Risk-adjusted payments are also critical to sustaining the safety-net mission of certain providers that provide a disproportionate amount of care to vulnerable populations, such as community health centers, rural health clinics, and academic health centers. The Federal government should convene high-level stakeholders to determine how best to implement risk-adjusted payments for Medicare. Payment systems also can be better aligned with quality care for vulnerable populations by being broadly based across groups of providers and related health care services to encourage multidisciplinary, coordinated care; providing coverage for health care delivery approaches that have been demonstrated to improve outcomes, functional status, and satisfaction; and rewarding quality performance through financial incentives. According to Candib (2007) States “social and economic factors limit them some change without a prior intervention at the community level”.

There is a series of suggestions on the mechanism to be used by patients to fight obesity. Among these suggestions, churches, neighborhood associations outreach programs, or community radio station promotes preventive education that helps immigrant adults to provide information regarding their health system. Candib suggests, “Taking an active part in working for change in nutrition is likely to work against physicians”. There are four reasons that explain consumers and health care professional needs to participate in the national effort. 1)Prevents kids from watching fatty foods advertisement;

2)Facilitate the purchase of fresh fruits and vegetables;
3)Increase the quality of foods geared at kids; that is nutritional and healthy; 4)Facilitates the purchase of standards foods specified by FDA 5)Involved in political action in the United States like Farm policy Despite all the vascular disease due to the obesity, metabolic syndrome, health care practitioners keep dealing with vulnerable patients. To better approach vulnerable population and their families physicians are utilizing the concept of syndetic. This concept allows physicians to isolate the health problems of vulnerable patients throughout the word. The lack of health care resources in these vulnerable populations, primary prevention and promote educational groups play an important factor in those whom receive health care.

The only way to receive treatment is the learning self-care technique which is the only affordable and acceptable way to receive treatment. The treatment is not including medication due to a lack of financial resources that aide in getting medications. The preventive measures on the patient are important due to limited amount spacing and resources at different clinics that serve this population. Many vulnerable communities lack of health care insurance and high out-of pocket costs for diagnostic tests that are necessary place a heavy load upon their patients. To keep victims of abuse, and families’ safe with their cultural beliefs system the idea to organize a domestic violence program for new immigrant is welcome.

Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals—which have long experience in caring for these vulnerable populations—will be included in integrated delivery systems. The considerable increase of immigrants and the complexity of their health situation require the attention of political authorities. The patient Protection and Affordable Care Act of 2010 requires that care be made to all patients by health care providers. A system for emergency treatment must be given to this population to avoid the worst. The forecast shows that the economic crisis may take another five years. A budget should be allocated to them, a prevention programs to help get rid of cardiovascular disease due to stress.

References:
Candib, L.M. “Obesity and Diabetes in Vulnerable Population”. The Annals Of Family Medicine. Vol.5. (2008). Pg.5. annalsoffamilymedicine.org. Web. 14 June 2014. Shi,L.,& Sing, D.A. “ Government, Politic, and