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A cross-divisional department spanning

Diversity and Equity Initiatives

Definitions

What are underserved and vulnerable populations? What are they at risk of experiencing?

Definitions can matter. While differences between some definitions may represent stylistic preferences, others can reflect deep divides in values and beliefs that can be used to justify and promote very different policies and practices. Clarity is particularly important in the case of health equity because pursuing equity often involves a long uphill struggle that must strategically engage diverse stakeholders, each with their own agenda. Under those circumstances, if we are unclear about where we are going and why, we can more easily be detoured from a path toward greater equity; our efforts and resources can be co-opted, and we can become lost along the way.

What are underserved and vulnerable populations? What are they at risk of experiencing?

Brief Summary: The US federal agency Centers for Medicare & Medicaid Services (CMS) under the Department of Health and Human Services (HHS) defines underserved and vulnerable populations as populations that face health, financial, educational, and/or housing disparities, such as “facing barriers that make it difficult to get health coverage and basic health care services” [1]. Underserved and vulnerable populations include minority populations such as Hispanic, African American, American Indian and Alaska Native (AIAN) populations [1]. For example, Black, Indigenous, and Hispanic American populations have had more COVID-related deaths (per population size of 100,000) compared to White American populations [2,3]. Black Americans have the highest mortality rate, followed by Hispanic and Indigenous populations [2,3]. These disproportionate outcomes have largely been attributed to the past and current history of institutionalized racism and historical trauma experienced by Black, Hispanic, and Indigenous communities, which has led to these populations experiencing social, financial, and health inequities [2,4-8]. Furthermore, Hispanics, Blacks, and AIAN populations are more likely to face poverty outcomes as well, compared to White Americans [8].

Note: This summary focuses on racial and ethnic groups at risk of health disparities. Additional underserved and vulnerable groups include those with disabilities, individuals living in poverty, etc [1,8].

This article was shared by Dr. Lisa Cooper (MD, MPH Professor of Medicine, Bloomberg Distinguished Professor, Equity in Health and Healthcare) within her Coursera course: Foundations of Health Equity.

Per Dr. Cooper’s Online Coursera Course: Foundations of Health Equity

  • Health disparities (or health inequalities): “Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
  • Health Equity: “When every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

What is Health Equity and What Difference Does a Definition Make?

Helpful Quotes: Brief Examples of Health Equity Definitions/Summaries Pages 2, and 11-14 of [Reference 9]

  • “An 8-second version for general audiences (health equity as a goal or outcome)”
    • “Health equity means that everyone has a fair and just opportunity to be healthy.”
  • “A 30-second definition for general audiences”
    • “Health equity means that everyone has a fair and just opportunity to be healthy. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”
  • Race or Racial Group: “…generally refers to belonging to a group of people who share a common ancestry from a particular region of the globe. Common ancestry is often accompanied by superficial secondary physical characteristics such as skin color, facial features, and hair texture.”
  • Ethnicity or Ethnic Group: “Ethnicity or ethnic group refers to belonging to a group of people who share a common culture (beliefs, values, or practices such as modes of dress, diet, or language).”
  • Health: Physical and mental “health status” and well-being.
  • Social determinants of health: “The social determinants of health are non-medical factors such as employment, income, housing, transportation, child care, education, discrimination, and the quality of the places where people live, work, learn, and play, which influence health.”

References

  1. Serving Vulnerable and Underserved Populations. (n.d.). https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf
  2. Racism and COVID-19 | Hopkins Bloomberg Public Health Magazine. (2020). Hopkins Bloomberg Public Health Magazine. https://magazine.jhsph.edu/2020/racism-and-covid-19
  3. The COVID Racial Data Tracker. (2018). The COVID Tracking Project. https://covidtracking.com/race
  4. GELDENHUYS, O. (1995, March 17th). Housing Segregation: Apartheid in Baltimore. Baltimoresun.Com. https://www.baltimoresun.com/news/bs-xpm-1995-03-17-1995076191-story.html
  5. Jones, R., Crowshoe, L., Reid, P., Calam, B., Curtis, E., Green, M., ... & Milroy, J. (2019). Educating for indigenous health equity: An international consensus statement. Academic Medicine, 94(4), 512.
  6. Brown, L. (2016, June 29th). Two Baltimores: The White L vs. the Black Butterfly. Baltimoresun.Com; Baltimore Sun. https://www.baltimoresun.com/citypaper/bcpnews-two-baltimores-the-white-l-vs-the-black-butterfly-20160628-htmlstory.html
  7. Henderson, C. J. (2018). The reverberating influence of historical trauma on the health of African Americans in Baltimore City. ProQuest Information & Learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 78 (12-) Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-43828-198&site=ehost-live&scope=site
  8. Sauter, M. B. (2018, October 10). Faces of poverty: What racial, social groups are more likely to experience it? USA TODAY; WLST. https://www.usatoday.com/story/money/economy/2018/10/10/faces-poverty-social-racial-factors/37977173/
  9. What is Health Equity. (2017, May). What is Health Equity? RWJF. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html

Arranged by EHE Postdoctoral Fellow, Sharmaine Miller, PhD