Define the terms vulnerable populations, health disparities, and health equity.
Distinguish among differences in health, health disparities, and health-care disparities.
Understand the relationship between social vulnerability and health disparities, and the pathways mediating this association.
Recognize the ethical and human rights principles underlying efforts to achieve health equity
Identify actions health professionals may take to change the social conditions that create vulnerability and produce health disparities.
“Vulnerable” derives from the Latin word for wounded. Populations can be vulnerable for a variety of reasons. In this chapter, we focus on populations that are wounded by social forces that place them at a disadvantage with respect to their health. Vulnerability is visible in the variation across social groups in levels of resources and social influence and acceptance, as well as in the incidence, prevalence, severity, and consequences of health conditions.
This chapter provides an overview of the concept of vulnerability. It begins by introducing the notion of health disparities, distinguishing it from simple differences in health, and defining the closely related concept of health equity. It describes evidence of health disparities, particularly by socioeconomic status (SES) and race/ethnicity. It then discusses conceptual models for understanding the pathways between social vulnerability and poor health status. It concludes by suggesting that health professionals have a responsibility not only to develop their skills to respond effectively to the health-care needs of vulnerable patients but also to take action to change the fundamental social conditions that produce vulnerability.
WHAT ARE HEALTH AND HEALTH-CARE DISPARITIES?
Webster’s dictionary defines disparity as a difference. “Difference” sounds like a neutral concept. It may seem logical that different people have different states of health, requiring different kinds and quantities of care. For example, elderly people are expected to be less healthy than young adults. People who ski are more likely to suffer leg fractures than people who do not.
Concern for health disparities is not about all differences in health, but rather about a subset of differences that are avoidable and suggest social injustice. Although few readers of this book probably were moved to righteous indignation by the health differences cited in the example of skiers and more frequent broken bones, the following observations are likely to prompt qualitatively different reactions: A baby born to an African-American mother in the United States is more than twice as likely to die before reaching her or his first birthday as is a baby born to a white mother.1 A World Bank study of 56 countries revealed that, overall and within virtually every country, infant and child mortality were highest among the poorest 20% of the population and lowest among the best-off 20% of the population; the disparities were large in absolute as well as relative terms.2