Considerations in Studying Data
It is difficult to get definitive data on any given population. Variations in how studies are conducted, the communities in which they are conducted, and the type of respondents all contribute to incomplete and inaccurate data compilation. Add to these hurdles the fact that vulnerable populations overlap, and it is nearly impossible to create a perfect picture of the total number of America’s vulnerable populations, their relative risk profiles, and their needs.
Different data sources, including vital statistics counts of deaths and births, patient perception of illness, health agency records, and clinical diagnoses reports, provide differing estimates of individual needs within groups. It is difficult to compare needs across groups, and studies may be biased. Increases and decreases in some statistics are subjective due to influences of social, or in some cases medical, ethics. For example, a rise in reports of child abuse may not indicate an increase in actual child abuse but instead may indicate a shift in social ethics that has made people more likely to report child abuse incidents.
It is also difficult to compare data across groups because different indicators are used to measure statistics. Resource needs for the chronically ill are often based on clinical records measuring physical limitations. These measurements are based on clinical information, physician recommendations, and patient perceptions of pain and illness. Statistics on family abuse are based on case reports. It is understood that many abuse cases go unreported, but the number of unreported cases is unknown. Needs assessments of other vulnerable populations are based on varying evidence of poor health and functioning. The Public Health Data Standards Consortium promotes standardization of health and community statistical studies and data in an effort to make the data more accessible and meaningful.
Connections Between Vulnerable Groups
The last few decades have seen interesting changes in the population numbers of vulnerable groups. The number of Americans living with HIV and AIDS has risen drastically since the virus was first recognized by the CDC in the 1980s. In fact, the number of people with HIV/AIDS doubled in almost every measured area of residence from 2004 to 2008, as shown in Figure 1.4.
Figure 1.4: Reported number of people living with HIV/AIDS by area of residence
A bar graph shows, in 500-person increments, the reported number of AIDS cases from 2004-2008 and the estimated number of people living with HIV/AIDS in 2008 from 12 geographical areas across the United States and Puerto Rico.
Reported AIDS cases rapidly increased nationwide from 2004 to 2008.
Center for Disease Control and Prevention. (2008a). Reported AIDS cases and persons reported living with AIDS, by area of residence, 2004–2008 and as of December 2008—eligible metropolitan areas and transitional grant areas for the Ryan White HIV/AIDS Treatment Extension Act of 2009. Retrieved from http://www.cdc.gov/hiv/surveillance/resources/reports/2010supp_vol17no1/pdf/2010_hiv_aids_ssr_vol17_n1.pdf#page=8
A photo of a homeless man sitting on a sidewalk against a wall with a Golden Retriever dog laying next to him.
Courtesy of Tony Baggett/iStockphoto
The homeless population is affected by HIV/AIDS at a rate three times greater than the general population.
This data does not include unreported cases, which is a problematic inconsistency in the data measurement. An unknown number of unreported cases complicate resource allocation for this vulnerable population.
HIV/AIDS affects the homeless population at an estimated 3.4%, a higher rate than the general population at 1% (National Coalition for the Homeless [NCH], 2007). Homelessness is difficult to define and track because it is often a transitory situation. The homeless population is measured primarily based on shelter occupancy and street counts, which can vary depending on a range of factors, starting with weather.
Migrants and migrant workers often make up a significant percentage of the homeless population. Statistics on migrants obtaining legal permanent resident status in the United States are easily tracked by the Department of Homeland Security (2010). Unauthorized immigrants are difficult to track because they avoid the immigration system.
This selection of vulnerable populations illustrates how intermingled the groups are. At-risk mothers and infants can be homeless, living with HIV/AIDS or other chronic illnesses, immigrants, or all three. Alcohol and substance abuse is found in all populations, not only vulnerable ones. Chronic illnesses are prevalent among the homeless population and the elderly. Population-specific data better illustrates this point.
Title II of HIPAA (Health Insurance Portability and Accountability Act) has “administrative simplification” provisions and requires national standards for electronic health care transactions. It also sets forth stipulations ensuring privacy and security of health records. Considering how many populations fit in many areas of “at risk,” do you believe HIPAA will help or interfere with research involving these special populations?
1.4 Defining Vulnerable Populations in American Health Care
A person’s vulnerability to negative health outcomes increases as the level of risk exposure increases. Everybody is vulnerable at some point in his life, though some people’s level of vulnerability is rarely very high. Vulnerable populations are those groups of people who are exposed to many risk factors, such as inadequate access to fruits and vegetables, alcohol use, tobacco use, and inadequate housing. The WHO defines risk factors as
any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Some examples of the more important risk factors are underweight, unsafe sex, high blood pressure, tobacco and alcohol consumption, and unsafe water, sanitation and hygiene. (WHO, 2012)
Individuals and communities that lack resources, social status, social capital, and human capital are referred to as “vulnerable populations.” The most prominent vulnerable populations in America are as follows:
vulnerable mothers and children
chronically ill and disabled people
people diagnosed with HIV/AIDS
people diagnosed with mental conditions
suicide- and homicide-liable people
people affected by alcohol and substance abuse
indigent and homeless people
immigrants and refugees
This list represents vulnerable American groups with the highest population numbers and risk factors. These groups appear to be growing quickly and thus putting an increasing strain on America’s resources. The macro perspective social theory of public policy recognizes that mitigating risks for vulnerable populations must include reform at the community level. These interventions include programs that include access to housing, food, and health care by geographically locating such resources where there were previously few. The micro perspective social theory of public policy focuses on reforming the resource delivery system on the individual level. These interventions include programs that educate schoolchildren on proper nutrition and pay for immunizations for Medicaid recipients. Public policy strategists struggle to keep up with increasing demands on both the community and individual levels.
Allocating resources to at-risk groups is complicated by the fact that they do not exist in independent bubbles. The problems of these groups are intertwined. Alcohol and substance abuse can be a factor with abusive individuals and high-risk mothers and infants; suicide is a problem among homeless people; and people living with HIV are chronically ill and so have many of the same resource needs as that group. As at-risk populations grow and their problems become more intertwined, the country struggles to find solutions for a lack of needed resources and resource delivery.
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