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Chapter 18: Underserved Populations

Chapter Highlights #1

Vulnerable versus underserved populations

Social determinants of health/health disparities

Genomics and underserved populations

Health priorities in rural areas, particularly elders

Health priorities in gay, lesbian, bisexual, and transgender people; in people in correctional institutions; and in people who are homeless

Chapter Highlights #2

Access to quality care

Chronic disease management

Veteran’s health

Human trafficking

Health personnel issues

Risk, prevention, and health promotion in hard‐to‐reach populations

Context of Health Risks

Vulnerability

Social determinants of health and health disparities

Genomics and underserved populations

Question #1

Which of the following are included in the notion of social injustice?

A. Belief of those in power that others are inferior

B. Denial of human rights to certain populations

C. Disparities in access to services, such as healthcare

D. All of the above

Answer to Question #1

D. All of the above

Rationale: Social injustice involves the denial of economic, sociocultural, political, civil, or human rights of certain populations or groups based on the belief of those with power that others are inferior. In healthcare, it manifests as disparity in access.

Vulnerability

Underserved populations

Subgroup of the population

Higher risk of developing health problems

Greater exposure to health risk because of marginalization

Sociocultural status

Access to economic resources

Age

Gender

Social Determinants of Health and Health Disparities

High‐risk mothers

Chronically ill and disabled people

People living with HIV/AIDS

Mentally ill people

Substance abusers

Homeless people

Immigrants and refugees

Rural Populations

Health personnel issues

Morbidity and mortality issues

Elderly people

Occupational and environmental health problems

Question #2

Is the following statement true or false?

Accessibility is insufficient number and diversity of formal services and providers, or lack of acceptable services and human service infrastructure to elders in rural areas.

Answer to Question #2

False

Rationale: Availability—insufficient number and diversity of formal services and providers; lack of acceptable services and human service infrastructure.

Accessibility—shortages of adequate, appropriate, and affordable transportation; cultural and geographic isolation.

Correctional Health: Underserved Populations in Jails and Prisons

All levels of prevention need to be addressed for all people who end up in correctional facilities.

Most inmates are males who are African American or Latino.

The average age of inmates is 37 years.

After release from incarceration, inmates often face social injustices and economic problems.

Gay, Lesbian, Bisexual, Transgender, and Queer Community #1

Four subgroups—gay, lesbian, bisexual, and transgender people—have unique needs.

Few population‐based studies have been conducted in LGBT groups, with the exception of HIV‐related research, particularly in men who have sex with men.

Specific questions on surveys related to sexual orientation are lacking.

Recognition of same‐sex heads of households has not always been included in survey data.

Gay, Lesbian, Bisexual, Transgender, and Queer Community #2

More serious physical and mental health conditions, including interpersonal violence and substance addiction

Particular health concerns from a prevention perspective include obesity, injury, violence, and access to healthcare facilities

Veterans and Health

2 million reintegrated veterans in the civilian sector

1 million veterans suffering from nonvisible or visible trauma

Need for civilian nurses to understand military culture

Human Trafficking

Recruitment and transportation of people for exploitation

Nurse’s role of recognizing victims and responding based on approved protocol

Maintaining safety of victim and healthcare personnel

Homeless Populations #1

Deinstitutionalization efforts of the 1960s to mainstream the mentally ill into society

Unemployment and underemployment

Domestic violence

Abandonment

Natural disasters and fires

Homeless Populations #2

Disability

Substance abuse and addiction

Immigration

Political unrest and wars

Nurses’ Approach to Homeless People

Show respect and use a positive approach, which builds trust.

Support primary (advocacy), secondary (tuberculosis screening), and tertiary (“detox” treatment) prevention to make it easier to cope with difficult, challenging lives.

Key Nursing Considerations

Recognize the biases and prejudices that can be barriers to understanding the needs of populations.

Community and family assessments need to be grounded in trusting approaches.

Allow nurses to do what they do best: heal, and not necessarily fix, healthcare situations