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  • Describe the characteristics and distribution of medically vulnerable populations worldwide.

  • Review common challenges faced by health systems globally in assessing and meeting the needs of medically vulnerable populations.

  • Highlight best practices from across the world in how health systems are addressing the needs of medically underserved populations.

  • Identify core competencies for health professionals to promote health equity locally and globally.


Management of health care for medically vulnerable and underserved populations shares a common mission with the growing field of global health. The global health perspective “places a priority on improving health and achieving equity in health for all people worldwide.”1 Addressing the health needs of marginalized populations is fundamental to this orientation.

Care of domestic medically vulnerable populations represents a local facet of global health. The upstream causes of medical vulnerability and the health system challenges in locating those most at risk and providing them with appropriate and affordable health care are common across the world. Many students and health professionals with an interest in global health are also committed to caring for domestic underserved populations.2,3 Framing the care of medically vulnerable and underserved populations in a global context opens opportunities to share solutions applicable to serving vulnerable populations in any country.

In this chapter, we use a global perspective to present unifying themes in addressing the needs of diverse underserved populations. We start by describing the causes, characteristics, and worldwide distribution of medically vulnerable populations. We then review health system challenges in assessing and meeting their needs, and illustrate solutions to some of these challenges from “best practices” from around the world. We conclude by describing competencies for health professionals to promote health equity locally and globally.


Nassoro, 7-year-old boy, lives in rural Tanzania and is undernourished. Because of severe droughts, he only receives one nutritious meal per day through the school program he attends.

Aisha, 9-year-old girl, lives in poor neighborhood of a large US city and is obese. Her family cannot afford to eat balanced meals and relies on a limited range of low-cost foods with high caloric, processed food of low nutritional value.

Several factors render populations vulnerable and result in health inequities, the greatest of which is poverty. For example, poverty results in food insecurity for millions of people across the world. Compounding factors contributing to health inequity globally include unhealthy and unsafe environments, destabilized societies and homelessness, and violation of human rights.


Both under- and overnutrition result from food insecurity—the absence of enough, safe, nutritious, and socially acceptable food. Food insecurity may be chronic, seasonal, or temporary, and may occur at the household, regional, or national level. In low- and middle-income countries, the root causes of food ...

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