Figure 2-1 shows that, in multiple racial groups, women, especially white women, have been more affected than men by rising rates of drug poisoning. People use health care services to diagnose, cure, or improve an illness or injury; to improve or maintain their functioning; or even to obtain information about their health status and prognosis. Many factors influence the utilization of health services, including need. The need for services affects the differential use of health care for specific populations.
Ideally, need is the primary determinant of healthcare utilization, but it's clear that other factors have an impact. They include poverty and its correlates, geographic area of residence, race and ethnicity, sex, age, spoken language, and disability status. The ability to access health care, even if it is available, is timely, convenient and affordable, affects the utilization of health care. For vulnerable populations, their health and health care problems may be aggravated by social factors.
These are just 5 vulnerable populations that experience greater risk factors, worse access to care, and increased morbidity and mortality compared to the general population. In the United States, there are significant disparities in health care for vulnerable populations. There are several groups that consider themselves vulnerable populations, including racial and ethnic minorities, economically disadvantaged people, and people with chronic health problems. People with chronic diseases are at risk of poor health outcomes and obviously spend more money on healthcare than healthy people. Chronically ill people are twice as likely to report days of poor health than the general population.
Disabled people, like the chronically ill, often have many interactions with the health system, but because of their disability, they may have difficulty accessing care. The chronically ill and the disabled may face special difficulties in obtaining services. In general, low-income people are more likely to have chronic diseases, and the impact of those diseases can be more severe. Low-income people are also disproportionately racial and ethnic minorities.
Being low-income, they may be less likely to have coverage and, as a result, have less interaction with the health system, explained Pamela Riley, MD, MPH, vice president of service delivery system reform at The Commonwealth Fund. People with lower incomes are also more likely to have co-occurring conditions, meaning they may have behavioral health problems, such as depression or substance use problems, in addition to chronic medical conditions such as obesity or diabetes. Americans who live in rural areas tend to have worse health than the general population. The reason for this disparity is that rural populations experience geographical isolation, have a lower socioeconomic status, have limited employment opportunities, and tend to be older.
Native Americans who live on reservations are also vulnerable. The Indian Health Service has noted that “American Indians and Alaska Natives have long had a lower health status than other Americans. They have a lower life expectancy (5.5 years shorter than the population of all races) and their inadequate education, higher poverty rates and cultural differences have also caused a disproportionate burden of disease. Native Americans also have problems accessing care, partly because their health programs are underfunded, but also because a quarter of Native Americans have reported experiencing discrimination when they go to a doctor or a health clinic, NPR reported.
Nearly 1 in 5 members of the LGBTQ community has avoided seeking health care because they have experienced discrimination or fear facing it. Within the LGBTQ community, there are also significant racial differences. For example, black transgender women bear a disproportionate burden for HIV. A recent study found that people who present themselves as transgender or gender non-conforming before their 18th birthday have a higher prevalence of mental health conditions, such as anxiety, depression and attention deficit disorders, compared to their cisgender counterparts.
The American Public Health Association has focused on how climate change affects vulnerable populations, such as children, who have developing organs, low immunity, spend more time outdoors, breathe more air and drink more water per body weight than adults. In addition, there has been a lack of adequate pediatric research and testing of medical interventions in pediatric populations. Children respond differently to medications and interventions than adults and cannot simply be considered “young adults” in the healthcare setting. Likewise, older adults are more vulnerable to health problems, as they also have low immunity and often numerous medical conditions. A RAND study found that older people don't always get the care that's recommended for them, such as preventive care.
Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, worship and they age. These conditions include a broad set of forces and systems that shape daily life, such as economic policies and systems, development agendas, social norms, social policies, and political systems. The CDC has adapted this definition from the World Health Organization.
