Vulnerable Populations

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Vulnerable Populations
MODULE ONE
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Objectives

• Students will
• Name 2 populations considered to be vulnerable
  and at risk for health care disparities.
• Describe health care disparities facing
  vulnerable populations.
• Describe the importance of service and how YHSC
  volunteers can make a difference in their
  community.

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In the USA today

• The population is 280 million people.
• 50 million people live in rural urban
  communities, many are poor, racially and
  ethnically diverse, and many are with out access
  to primary health care.
• These people and others are considered to be
  vulnerable and at risk for health care
  disparities.
• Source Health Resources Services
  Administration-2006

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What are Health Care Disparities?

• Differences or inequalities in health care status
  due to gender, race/ethnicity, education,
  disability, geographic location or sexual
  orientation.
• Example African American, Asian, and Hispanics
  have more chronic disease, cancer infections.
• Native Americans are 2.5 times more likely to
  have diabetes that whites.
• African American women are more likely to die of
  breast cancer than any other racial group.
• Rural residents have more chronic conditions such
  as diabetes and are more likely to die of heart
  attacks.

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Health Care Disparities contd

• African American infants are 2 times more likely
  than others to die before the age of one.
• Native Americans Alaskans suffer more
  depression and more substance abuse issues than
  others.
• In 2002, fifty percent of those infected with
  Hepatitis B were Asian and Pacific Islanders.
• Source National Health Care
  Disparities Report- 2003

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Who are the Vulnerable?

• Racial ethnic minority groups
• Uninsured
• Underinsured
• Low income children
• Frail older adults
• Mentally disabled

• Homeless
• Physically disabled
• Rural Americans
• Immigrants/Migrant Farm workers
• People with HIV/AIDS

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Little or no insurance

• 45 million people in the U.S. are uninsured
  because they dont have or cant afford health
  insurance.
• 16 million people in the US are underinsured
  because even though they have insurance they
  cant afford the co-pay or other out of pocket
  expenses.

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Low Income Children

• Poverty affects physical and mental development
  and school achievement.
• There are 13 million low income children.
• 16 of families with children are hungry.

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Low Income Children

• States with high levels of child poverty
• Texas 22
• West Virginia 23
• Mississippi 24
• Louisiana 25
• New Mexico 25
• Arkansas 30

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Low Income Children

• 35 African American
• 28 Latino
• 29 American Indian
• 11 Asian
• 10 white
• 26 children of immigrants
• 20 under age 6
• Source National Center for Children in Poverty
• Dec. 2006 Report

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Frail Older Adults

• Elderly population age 80-90 is growing.
• Many have physical mental health problems.
• Many live alone, rely on family, and cant afford
  to pay for help at home. Medicare doesnt pay for
  long-term care.
• Have little financial reserves. In 2001, the
  median income for this age group was 14,000
  (below poverty level.)
• Baby boomer population growing. By 2050, those
  over age 85 will go from 4.3 million to 20.9
  million!
• Source 2002 Health and Retirement Study

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The Homeless

• In the United States, approximately 3.5 million
  people experience homelessness each year.
• Families with children make up 50 of the
  homeless population.
• The homeless population is growing.
• Children under the age of 18 account for 25 of
  the urban homeless population.
• 51 of the homeless population are people between
  the ages of 31 and 50.

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The Homeless

• Approximately 23 homeless adults suffer from
  some form of severe and persistent mental
  illness.
• Addiction disorders, such as drug abuse and
  alcoholism, affect about 30 of the homeless
  population.
• Shelters are overcrowded or filled to capacity.
• The two most common causes of homelessness are
  substance abuse and mental illness.
• The federal and state programs that provide
  assistance are only short-term solutions.

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The Homeless by Race

• In 2003, the homeless population was
• 49 African American
• 35 Caucasian
• 13 Hispanic
• 2 Native American
• 1 Asian
• Like the total U.S. Population, the ethnic makeup
  of the homeless varies according to geographical
  location.
• Source www.Endhomelessness.org

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Adults with Disabilities orSpecial Needs

• Those disabled due to a progressive illness or a
  sudden accident.
• Includes the blind or those with low vision, the
  deaf or hard of hearing.
• The medically fragile unstable conditions
  those with HIV/AIDS, Diabetes, or those on
  life-sustaining medications.
• Those with physical limitations.
• Those with mental disabilities.
• Source Commonwealth Fund 2006

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Rural Americans

• 20 of Americans live in rural areas but only 9
  of doctors practice there.
• Many have long distances to travel for health
  care.
• Results in less visits and less preventive care.
• Source 2004 National Health Care Disparities
  Report

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Immigrants / Refugees

• Immigrants can be invisible in our communities
• Isolated from health care services.
• Lack legal status, afraid they will be reported.
• Need interpreters due to language barriers.
• Fear discrimination.
• Lack transportation and insurance.
• Suffer from chronic illness, diabetes, asthma,
  heart disease, and obesity.
• Have mental health needs due to trauma of
  relocation culture shock.
• Source Robert Wood Johnson Foundation 2006

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Migrant Farm Workers

• 2.5 million persons hired as seasonal and migrant
  workers.
• 70 work in crop agriculture.
• Relatively young and mostly male (sexually
  active).
• Single or married but away from family
  (depression).
• Mainly Latino , Mexican, Guatemalan, Puerto
  Rican, Caribbean, Jamaican.
• Average of 6 years of formal education.
• Poor (weigh illness against wages).
• 1/3 are undocumented (fear of accessing care).
• Source Connecticut Migrant Health Network

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Social Factors affecting the Vulnerable Poverty

• Poverty is defined by family income and the
  number of people in a family.
• Poverty guidelines help determine financial
  eligibility for assistance.
• Example Children in a family of 4 that has an
  income of 20,000 or less are considered poor and
  eligible for some state health care programs.
• Source US Dept. Health Human Services
  2006, Poverty Guidelines

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Social Factor Lack of Education

• Lack of health education prevention of disease.
• Low literacy levels- unable to read understand
  doctors orders or medication labels.
• Lack of skills to communicate with the doctor.

• Those with the greatest health care needs may
  have the least ability to read and comprehend
  information AMA Report 1998

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Social Factor Lack of Access

• Lack of Access to health care - no insurance,
  job or money to pay for insurance
• No transportation to get to the doctor
• Isolation- in some rural areas, no health care
  close by

• Examples Part time worker doesnt qualify for
  health care benefits
• Rural elderly may live over 100 miles from the
  nearest hospital.

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HRSA-Health Resources Services Administration-
U.S. Federal agency

• Responsible for increasing access to and quality
  of health care for all especially those who are
  vulnerable (AHECs are part of HRSA).
• Improving outcomes quality of health care.
• Eliminating health disparities.
• Increase Health Care Response in Public Health
  Emergencies.

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HRSA Workforce Goals

• Increase the health care workforce by
• Recruiting more under-represented people to
  health careers.
• Increasing the cultural competency of health care
  providers.
• Improving the distribution retention of the
  workforce in underserved areas, including rural
  border areas.

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HRSA Health Disparities Goals

• Eliminate health disparities by
• Increasing the early screening of children for
  special health care needs.
• Raising awareness about major health risks
  through education outreach to vulnerable
  populations.

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Summary the Impact of Service-What can YOU do?

• Volunteer at community sites such as shelters,
  community centers.
• Reach out to low income children in after school
  programs and community settings.
• Volunteer with professionals to educate about and
  prevent health problems.
• Be part of the solution! Volunteer!
• YOU CAN MAKE A DIFFERENCE!