Identify a specific vulnerable population in the United States or from another country

Topic 5 DQ 1

Identify a specific vulnerable population in the United States or from another country. Explain why the population is considered vulnerable. Include the demographic statistics, access to health care, barriers to care, supporting information, and the challenges to health and wellness. How can the public health nurse advocate and support this vulnerable population?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Vulnerable Population – Sample Answer

A specific vulnerable population in the United States is the homeless population. Individuals experiencing homelessness face multiple vulnerabilities, including limited access to healthcare, increased exposure to illness, and higher rates of chronic diseases, mental health disorders, and substance use. According to the U.S. Department of Housing and Urban Development (HUD), there were approximately 580,000 people experiencing homelessness on a single night in 2020, and nearly 70% were individuals, while 30% were people in families with children (Batko & Culhane, 2023).

Homeless individuals are disproportionately affected by mental health conditions, with about one in four reporting a severe mental illness. Their access to healthcare is significantly limited due to a lack of permanent residence, unemployment, and lack of health insurance, which makes it challenging to receive consistent care for both physical and mental health needs. They also face heightened barriers, such as stigma, poverty, and a lack of transportation, which restricts their ability to seek medical help and manage chronic health conditions effectively.

Public health nurses play a crucial role in advocating for and supporting the health and wellness of homeless individuals. Through outreach programs, nurses can provide essential health services in shelters, community clinics, and street locations, ensuring that homeless individuals have access to basic care, vaccinations, and mental health screenings. Public health nurses can also collaborate with community organizations to address social determinants of health, advocating for housing stability programs and increased funding for mental health resources (Foscarinis & Tars, 2024).

By conducting health education on preventive care and connecting individuals to community resources, nurses can empower homeless individuals to take charge of their health. Furthermore, nurses can support policy changes by raising awareness about the healthcare needs of homeless populations to local governments and health institutions, advocating for funding to create low-barrier healthcare access points and affordable housing programs that contribute to long-term health improvements.

References

Batko, S., & Culhane, D. (2023). Homelessness in the United States. In The Routledge Handbook of Homelessness (pp. 413-422). Routledge.

Foscarinis, M., & Tars, E. S. (2024). Homelessness in the United States of America: Dreams of a Shining City, Realities of Homelessness. The Routledge Handbook of Global Perspectives on Homelessness, Law & Policy, 257-274. https://www.taylorfrancis.com/chapters/edit/10.4324/9781003274056-18/homelessness-united-states-america-maria-foscarinis-eric-tars

Pidgeon, H., McKinney, D., Tan-Creevy, J., Shah, M., Ansari, S., & Gottlieb, M. (2022). Thinking beyond the emergency department: addressing homelessness in residency education. Annals of Emergency Medicine, 79(4), 397-403. https://doi.org/10.1016/j.annemergmed.2021.07.123

Topic 5 DQ 2

For nurses to care for vulnerable populations, it is important to be aware of one’s own cultural awareness and personal biases. Reflect on your own unconscious and conscious biases and how your biases might influence your provision of care. Describe what strategies or best practices can be used to integrate cultural humility in health promotion activities. Identify one or more competencies significant for a public health nurse to be effective in advocating for the vulnerable population.

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Cultural Awareness and Personal Biases – Sample Answer

For nurses to provide effective and compassionate care to vulnerable populations, it is essential to engage in continuous reflection on personal biases, both unconscious and conscious. Recognizing biases is a foundational step in understanding how assumptions and preconceptions might shape the way we interact with diverse patients, impacting the quality of care we deliver. For instance, a nurse may unconsciously attribute certain health behaviors to a patient’s culture or lifestyle, potentially affecting clinical decisions and limiting understanding of the patient’s individual needs.

Conscious biases, too, such as assumptions about socio-economic backgrounds or lifestyle choices, may inadvertently create barriers in patient relationships, reducing trust and hindering open communication (Griffith et al., 2024). Reflecting on these biases allows nurses to recognize and dismantle them, fostering more equitable and empathetic patient care.

Integrating cultural humility into health promotion activities requires an intentional approach that emphasizes learning from the patient rather than assuming knowledge about their culture. Best practices include actively listening to patients’ perspectives, asking open-ended questions, and seeking to understand their health beliefs, traditions, and unique needs (Gottlieb, 2021). This approach encourages nurses to view patients as partners in care and to respect their autonomy.

One effective strategy is to engage in cultural competence training, which deepens awareness and understanding of diverse backgrounds. Another is to implement the practice of self-reflection as a regular part of clinical work, allowing for adjustments in approach as nurses become more aware of potential biases (Ranjbar et al., 2020). A critical competency for public health nurses in advocating for vulnerable populations is effective communication, as it enables nurses to clearly and respectfully navigate cultural differences, encourage patient engagement, and build trust. By demonstrating empathy, curiosity, and respect, public health nurses can advocate more effectively, leading to better health outcomes and increased patient satisfaction among vulnerable populations.

References

Griffith, D. M., Efird, C. R., Baskin, M. L., Webb Hooper, M., Davis, R. E., & Resnicow, K. (2024). Cultural sensitivity and cultural tailoring: lessons learned and refinements after two decades of incorporating culture in health communication research. Annual Review of Public Health, 45(1), 195-212. https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-060722-031158

Gottlieb, M. (2021). The case for a cultural humility framework in social work practice. Journal of Ethnic & Cultural Diversity in Social Work, 30(6), 463-481. https://doi.org/10.1080/15313204.2020.1753615

Ranjbar, N., Erb, M., Mohammad, O., & Moreno, F. A. (2020). Trauma-informed care and cultural humility in the mental health care of people from minoritized communities. Focus, 18(1), 8-15. https://doi.org/10.1176/appi.focus.20190027

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What Are Social Determinants of Health?

Social determinants of health (SDOH) are the non-medical factors that influence health outcomes and quality of life. These are the conditions in which people are born, grow, work, live, and age, shaped by the distribution of money, power, and resources at global, national, and local levels.

Key Definition Points:

Social determinants of health encompass a wide range of personal, social, economic, and environmental factors that determine individual and population health. Unlike genetic factors or direct medical care, SDOH represent the upstream causes of health disparities that affect entire communities.

According to the World Health Organization, social determinants can outweigh genetic influences or healthcare access in terms of influencing health outcomes, making them critical factors in addressing health equity.

The 5 Key Social Determinants of Health

The 5 social determinants of health framework, established by Healthy People 2030, provides a comprehensive structure for understanding how social factors impact health:

12 Critical SDOH Categories

While the 5-category framework provides structure, researchers have identified 12 social determinants of health that offer more granular insight:

Primary Categories:

1. Income and Social Status
   • Poverty levels
   • Income inequality
   • Social mobility
2. Employment and Working Conditions
   • Job security
   • Workplace safety
   • Work-life balance
3. Education and Literacy
   • Educational attainment
   • Health literacy
   • Digital literacy
4. Childhood Development
   • Early childhood experiences
   • Adverse childhood experiences (ACEs)
   • Developmental support

Secondary Categories:

5. Physical Environment
   • Housing quality
   • Environmental hazards
   • Climate conditions
6. Social Support Networks
   • Family relationships
   • Community connections
   • Social isolation
7. Genetics and Biology
   • Genetic predispositions
   • Age and sex
   • Inherited conditions
8. Personal Health Practices
   • Lifestyle choices
   • Health behaviors
   • Coping skills

Tertiary Categories:

9. Health Services
   • Access to healthcare
   • Quality of services
   • Cultural competency
10. Gender and Race
    • Gender identity
    • Racial discrimination
    • Systemic inequities
11. Culture and Language
    • Cultural practices
    • Language barriers
    • Religious beliefs
12. Political and Policy Context
    • Government policies
    • Healthcare systems
    • Social protection programs

Impact on Families and Communities

Statistical Overview

Family-Level Impacts

Economic Stability Effects:

• Families in poverty experience 2-3x higher rates of chronic diseases
• Children in low-income households show increased developmental delays
• Medical debt affects 1 in 5 American families

Educational Impact:

• Children from low-income families are 5x more likely to drop out of high school
• Educational attainment directly correlates with life expectancy
• Health literacy affects medication adherence and preventive care

Housing and Environment:

• Substandard housing increases asthma rates by 40%
• Neighborhood walkability affects obesity rates
• Environmental hazards disproportionately affect minority communities

Community-Level Impacts

Social Cohesion:

• Communities with strong social networks show 50% lower mortality rates
• Civic participation correlates with better mental health outcomes
• Social isolation increases mortality risk equivalent to smoking 15 cigarettes daily

Infrastructure and Services:

• Food deserts affect 23.5 million Americans
• Transportation barriers prevent 3.6 million Americans from accessing healthcare
• Lack of green spaces correlates with higher stress-related illnesses

Social Determinants of Mental Health

Mental health outcomes are significantly influenced by social determinants, with research showing stronger correlations than traditional medical factors.

Key Mental Health SDOH:

Special Populations

Children and Adolescents:

• Adverse childhood experiences (ACEs) predict adult mental health outcomes
• School-based mental health programs show 40% improvement in outcomes
• Family stability directly correlates with emotional development

Older Adults:

• Social isolation affects 35% of adults over 65
• Ageism and discrimination increase depression rates
• Community programs reduce mental health service utilization by 30%

Statistical Evidence and Research

Recent Research Findings (2024)

Global Health Disparities

• Forcibly displaced people have tripled to 122 million between 2008-2024, with significant health consequences
• WHO’s 2024 framework emphasizes evidence-based policymaking for health equity
• Migration impacts show service inequalities and discrimination affecting physical and mental health

U.S. Health Outcomes

• Geographic variations in health outcomes show 20-year life expectancy differences
• Rural vs. urban disparities continue to widen
• Racial and ethnic minorities experience disproportionate health impacts

Evidence-Based Interventions

Addressing Social Determinants in Practice

Healthcare System Approaches

Clinical Integration:

• SDOH screening tools in primary care
• Community health worker programs
• Social prescribing initiatives

Policy Interventions:

• Medicaid expansion and coverage
• Housing assistance programs
• Transportation services

Community-Based Solutions

Multi-Sector Partnerships:

• Healthcare-housing collaborations
• School-based health programs
• Employer wellness initiatives

Examples of Successful Programs:

1. Pathways Community HUB Model
   • Coordinates care across sectors
   • Reduces healthcare costs by 40%
   • Improves health outcomes in vulnerable populations
2. Housing First Programs
   • Provides stable housing without preconditions
   • Reduces emergency department visits by 60%
   • Improves mental health outcomes
3. Community Schools Initiative
   • Integrates health services in educational settings
   • Increases graduation rates by 25%
   • Reduces childhood obesity rates

Individual and Family Strategies

Health Advocacy:

• Understanding insurance options
• Navigating healthcare systems
• Building health literacy

Community Engagement:

• Participating in local governance
• Volunteering in community organizations
• Supporting neighborhood improvement initiatives

Frequently Asked Questions

Is Race a Social Determinant of Health?

Yes, race is considered a social determinant of health, but not because of biological differences. Race functions as a social determinant through:

• Structural racism in healthcare, education, and employment
• Historical discrimination affecting generational wealth and opportunities
• Implicit bias in healthcare delivery and quality
• Geographic segregation limiting access to resources

What Are Social Determinants of Health Examples?

Common examples include:

• Economic: Poverty, unemployment, debt
• Educational: Lack of high school diploma, limited health literacy
• Environmental: Poor housing conditions, lack of transportation
• Social: Discrimination, social isolation, lack of community support

How Do Social Determinants Affect Health Outcomes?

Social determinants affect health through multiple pathways:

1. Direct effects: Environmental toxins, unsafe housing
2. Behavioral pathways: Stress-related behaviors, limited healthcare access
3. Psychosocial mechanisms: Chronic stress, social isolation
4. Life course effects: Childhood experiences affecting adult health

CDC Social Determinants of Health Initiatives

The CDC’s current priorities include:

• Data collection through the PLACES program
• Policy advocacy for evidence-based interventions
• Partnership development with community organizations
• Research funding for SDOH interventions

Conclusion

Understanding and addressing social determinants of health is crucial for improving health outcomes for families and communities. The evidence clearly demonstrates that social factors contribute more to health outcomes than medical care alone, making SDOH a critical focus for healthcare providers, policymakers, and community leaders.

Key takeaways:

• 80% of health outcomes are determined by social and environmental factors
• Investment in SDOH interventions provides significant returns in health improvement and cost savings
• Multi-sector collaboration is essential for addressing complex social determinants
• Community engagement empowers individuals and families to advocate for better conditions

By recognizing these factors and implementing comprehensive strategies, we can work toward health equity and improved well-being for all communities.

References:

• World Health Organization. (2024). World Report on Social Determinants of Health Equity
• Centers for Disease Control and Prevention. (2024). Social Determinants of Health
• U.S. Department of Health and Human Services. (2024). Healthy People 2030
• Office of the Assistant Secretary for Planning and Evaluation. (2024). Addressing Social Determinants of Health