Vulnerable populations in healthcare are groups of people who are at risk for experiencing poor health outcomes and health disparities related to their social, economic, and/or health status. These populations often contend with multiple conditions that can exacerbate one another to create complex challenges while navigating the healthcare system and receiving care. For example, a patient who is low income, lives in a rural area, and suffers from depression is grappling with multiple factors that make them vulnerable to poor health outcomes.
Research on vulnerable populations in healthcare emphasizes the systemic nature of many of the root issues. While the nurses serving these patients at the bedside may not be working directly on the policy changes or cultural shifts needed to create health equity, one-on-one actions matter. Nurses and other healthcare workers serve a vital role by acting as trusted allies, providing compassionate care, and connecting individuals to resources.
In this guide, we'll answer your questions about screening, mandatory reporting, care approaches, and more. We'll also discuss five best practices for serving marginalized and at-risk populations.
Use of the Term: Rooted in Bioethics
The term "vulnerable populations" gained traction in the mid 20th century in the research community, as a result of tragic human subject research studies that took advantage of certain groups of people. Bioethicists and medical researchers recognized that members of some groups struggled to protect their own interests, and therefore warranted additional protective measures. The term spread into public health and is now widely used throughout the industry.
Serving Vulnerable and Marginalized Populations: FAQ
We'll answer commonly asked questions about providing care to those who are at a heightened risk for health disparities.
What is a vulnerable population?
These are groups of people that are more susceptible to poor health outcomes and health disparities. A health disparity is a measurable difference between the health outcomes of two population groups. Patterns of disparities become clearer when a large amount of data is analyzed at the population level.
Why are vulnerabilities identified at a population level?
Focusing on populations, rather than individuals, can reveal the underlying structural and societal causes behind vulnerabilities, such as:
- Systemic racism.
- Proximity to pollution.
- Access to education.
- Federal minimum wage.
- Public policy related to the wellness of children.
- Social stigma and discrimination.
These factors are largely out of an individual's control. Groups of people who have been identified as vulnerable are often subjected to life circumstances that create a need for additional support or protective measures.
Do all healthcare providers define 'vulnerable population' the same way?
No. When discussing vulnerable populations, definitions can be quite broad and vary by context. Some experts have criticized the term as being disempowering and imprecise. In clinical settings, thinking in terms of vulnerabilities may help clinicians give due attention to members of society who may need additional protection and resources.
What are common categories of vulnerable and at-risk populations?
Sometimes, populations at a heightened risk for health disparities are grouped by shared characteristics. Common categories include:
- Infants, children, and the elderly.
- Those with low socio-economic status (SES).
- The homeless.
- Justice-involved individuals (such as incarcerated individuals and those engaged in re-entry into communities).
- Military service members and veterans.
- Members of the LGBTQ+ community.
- People who live in rural areas.
- Racial and ethnic minorities.
- People living with a chronic health condition, illness, or disability.
What elements and conditions make a population vulnerable?
Anything that could contribute to a person's diminished autonomy can make them more vulnerable to harm or poor health outcomes. For example, patients with substantial cognitive impairments may have a limited ability to make informed decisions about their own care, advocate for themselves, and express their own needs.
Factors that limit access to care and resources also contribute. For example, populations in remote areas may not have adequate access to healthcare, mental health resources, or addiction prevention and recovery resources.
Conditions affecting a person's reception by others influence the care they receive. Systemic racism, unconscious bias, discrimination, and social stigma have a negative impact on care quality. For example, research shows that clinicians spend less time on average with low SES patients than higher SES patients, creating health education gaps and a lack of rapport.
What types of questions can help to determine if a patient is in a marginalized or at-risk population?
Questions related to the social determinants of health (SDOH) can be very helpful. Clinicians can also focus on learning about the patient's history, values, and the groups they self-identify with.
What are vulnerable populations at risk of?
Risks can range from isolated negative outcomes to significantly shortened lifespans. The World Health Organization (WHO) has found a 33-year life expectancy gap between countries, pointing to the critical nature of structural SDOH such as safe housing, clean water, and the availability of nutritious food. The data on vulnerable populations in healthcare globally also emphasizes higher-than-average under-five mortality rates (U5MR) in countries with service gaps for women, children, and infants.
Providing Nursing Care for At-Risk Populations: Best Practices
Beyond understanding which characteristics describe vulnerable populations, clinicians need to be equipped with practical techniques. Here are five best practices for tailoring care for those who may be more at risk for poor outcomes.
1. Screen for Social Determinants of Health
Standardized tools can help clinicians identify patients who may be experiencing struggles related to problems with their housing, water, food, utilities, or transportation. Screening can help bring issues to light that may otherwise get left unaddressed (while undermining the care plan). Examples of open source SDOH screening tools include:
- The Accountable Health Communities Health-Related Social Needs screening tool.
- Protocol for Responding to and Assessing Patient's Assets, Risks, and Experience (PRAPARE).
2. Practice Holistic, Patient-Centered Care
Vulnerabilities apply to populations, based on aggregated data. Just because a patient is statistically a member of a group with heightened health risks doesn't mean they'll be affected. Work with patients to understand how their life circumstances and identity influence their experience of health and their health goals. Using a person-centered approach can help care teams practice cultural humility rather than imposing their own beliefs onto the situation.
3. Establish Strong Processes for Connecting Patients to Resources
It's common for practitioners to avoid discussing social determinants out of concern that the patient will feel uncomfortable. However, given the research into health inequalities at the population level, broaching these topics is a necessity. Encourage clinicians on your team to not only screen for vulnerabilities, but also act on the information by connecting patients to the appropriate community, state, and/or national resources.
4. Empower Nurses to Advocate for Patients
As frontline care providers, nurses have a professional and ethical duty to advocate for patients who may not be able to do so for themselves. This includes the mandatory reporting of suspected cases of mistreatment, neglect, and abuse of children and adults. This can help individuals with diminished autonomy receive help from state and federal resources.
5. Engage With Care Coordination Models
Working with vulnerable populations in nursing often involves coordinating care among members of the broader team. There are many evidence-based frameworks for improving care coordination efforts. As just one example, the Department of Veterans Affairs advocates for implementation of the Homeless Patient Aligned Care Teams (HPACTs) model, which integrates primary care, mental health services, and social services to help homeless veterans.
Discover Innovative Ways to Improve Patient Outcomes
Serving vulnerable populations in healthcare may involve testing a new screening tool or care delivery model. We know that staying on top of evolving strategies can be challenging. That's why we offer evidence-based healthcare leadership guides designed to help your facility thrive.