Introduction
In general, Stanhope and Lancaster (2015) define vulnerable populations as large groups of people that are at greater risk due to their poor health status and access to health care. The variety of risks which are involved is considerably wide, and thus it is essential to develop a profound understanding of the approaches to the improvement of the vulnerable populations’ quality of life. For this study, the homeless population is selected. The problem of homelessness is considered widespread in the United States, and it is also possible to state that the chosen group is at greater risk since it is exposed to a set of various health threats that overlap with the ones of other vulnerable populations (Koh & O’Connell, 2016). This study aims to dwell upon the Vulnerable Populations Conceptual Model (VPCM), which was developed by Nyamathi, Koniak-Griffin, and Greengold (2007), because it provides an efficient framework for investigating vulnerable populations. Therefore, the paper is divided into three sections that reflect the principal aspects of the VPCM: health status, relative risk, and resource availability.
Health Status of the Identified Population
First of all, it is essential to state that “vulnerable populations experience limited resources and, consequently, high relative risk for morbidity and premature mortality” (Nyamathi et al., 2007, p. 7). This statement is particularly accurate in the context of the homeless population group since homeless people are exposed to a wide variety of risks. As it is mentioned by Koh and O’Connell (2016), the most recent US Department of Housing and Urban Development report on homelessness reveals that estimately 564 000 individuals in the United States are not settled to a distinct place of habitation (p. 2586). Therefore, it is evident that a large community in America is the subject to disease incidence, prevalence, as well as morbidity and mortality, which are primary indicators of the health status component of the VPCM (Nyamathi et al., 2007).
Concerning the morbidity rates, it is possible to state that HIV is among the most prevalent chronic diseases that have a significantly negative effect on the selected population group (Mignone et al., 2015). According to the study by Korthuis et al. (2015), in which the authors have followed up a large sample of HIV-infected individuals, “a total of 902 participants died (29.8%) during 24 805 person-years of follow-up” (p. 236). Thus, it could be suggested that HIV-related deaths contribute to the overall morbidity and mortality rates among the homeless population. The article by Baggett et al. (2015) as well as the suggestions from Korthuis et al. (2015) indicate that alcohol and illicit drug abuse considerably influence the increase of the mortality rates among HIV-infected homeless individuals. Also, the study by Pesantes et al. (2015) argues that hypertension and type-2 diabetes are chronic conditions which have a negative potential when they are developed in homeless people since they are significantly more difficult to handle within the chosen population. In overall, it should be stated that the health status of the chosen vulnerable population group is adversely affected by numerous factors that translate into significantly higher morbidity and mortality rates. In the article by Nyamathi et al. (2007) it is mentioned that “factors other than lifestyle and behaviors, such as the availability of economic and health resources, alone or in combination with genetic predispositions, may be influencing the difference” (p. 8). The following two sections will investigate relative risk and resource availability factors as they have a direct impact on the current health status of the chosen population.
Discussion of the Relative Risk
Nyamathi et al. (2007) identify the relative risk as “differential vulnerability of different groups to poor health in that negative or stressful life events harm some people more than others”, and also the authors state that there are two principal areas of concern within this area of concern: behavioral risk factors (lifestyle behaviors and choices, utilization of health screening, health promotion services, etc.) and biological risk factors (physiologic and genetic susceptibility) (p. 8). Concerning the chosen population group, it is possible to suggest that behavioral factors appear to be the most influential in terms of exposure to various risks since the overall lifestyle and behavioral patterns among this group can be significantly destructive.
For example, it could be stated with certainty that habitation in the streets exposes homeless people to such behavioral patterns as crime, violence, drug and alcohol abuse (Bonevski et al., 2014). It should be also mentioned that the vast majority of the homeless population group have a lower level of education compared to the average level of education in the United States, and thus they are less informed and concerned about various health practices, including such basic skills as personal hygiene or disease prevention (Bonevski et al., 2014). Another factor that largely influences the increased exposure to risk is the prejudice towards individuals from the homeless population group as they perceived as marginals and criminal by the society, and thus it is more difficult for people from the chosen population group to maintain healthy behavioral practices and to connect with rest of the society in order to return to the normal life.
Regarding the biologic factors, it could be suggested that children are at the highest risk, especially the ones that were born by parents who already live in the streets. In that case, it is possible to predict that these children would be more susceptible to various health risks to which the chosen population group is exposed. However, it is also of high importance to mention that habitation in the streets has negative biological consequences for people of different ages and gender because various inherent genetic problems could be negatively affected by living conditions, and further they would develop into more serious chronic states.
Discussion of the Resource Availability
Income Level and Employment
According to the article by Nyamathi et al. (2007), the factor of resource availability is perceived as “the availability of human capital (income, jobs, education, housing), social status (prestige and power), social connection (integration into society and social networks), and environmental resources” (p. 7). Concerning the income level and employment, it is possible to state that these aspects could be considered as one of the most important negatively contributing factors in the context of the chosen social group. The reason is that homeless individuals are usually unemployed. Therefore, they do not have a stable level of income, and it translates to their inability to access basic human needs such as proper nutrition or medication.
The aspect of unemployment also defines another aspect of the resource availability, namely the problem of housing. It is evident that this problem is also among the most principal issues related to the homeless population group. People become homeless due to various reasons (for example, a person might not be able to pay his or her rent due to their unemployment status, or due to the urgent need for financial expenditures for operations, etc.). However, the result of these various situations is that the person loses a distinct place of habitation, and it becomes considerably difficult for him or her to access proper housing again. As was already mentioned, social connection is considerably limited in the chosen population group since the society at large perceives homeless individuals as outcasts. Environmental resources are usually significantly limited for such individuals as well due to the lack of opportunities to use environmental resources in the chosen vulnerable group.
It is also of high importance to state that the access to healthcare is also among the most adversely contributing factors related to the homeless population. As it is indicated in the article by Chong et al. (2014), more than 30% of the selected population cannot adhere to medications for various chronic diseases (p. 56). For example, visual impairments along with the poor ocular health appear to be very significant problems within the homeless community as people cannot access adequate treatment for these diseases. The issue of insufficient access to healthcare translates into the question of programs that would benefit the selected population. As it is suggested by Bonevski et al. (2014) the development of community-based research programs and the use of media and social marketing could be implemented in order to considerably improve the overall condition of the chosen population.
Conclusion
In conclusion, it should be stated that the homeless population group is exposed to a wide range of risks. These risks derive from numerous factors that are observed in this paper. It is evident that further research on the topic is needed, however, this study summarizes principal factors that should be taken into account when investigating the particular problems related to the chosen population.
References
Bonevski, B., Randell, M., Paul, C., Chapman, K., Twyman, L., Bryant, J.,… Hughes, C. (2014). Reaching the hard-to-reach: A systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Medical Research Methodology, 14(42), 1-29.
Chong, M. T., Yamaki, J., Harwood, M., d’Assalenaux, R., Rosenberg, E., Aruoma, O., & Bishayee, A. (2014). Assessing health conditions and medication use among the homeless community in Long Beach, California. Journal of Research in Pharmacy Practice, 3(2), 56-61.
Korthuis, P. T., McGinnis, K. A., Kraemer, K. L., Gordon, A. J., Skanderson, M., Justice, A. C.,… Fiellin, L. E. (2015). Quality of HIV care and mortality rates in HIV-infected patients. Clinical Infectious Diseases, 62(2), 233-239.
Mignone, J., Migliardi, P., Harvey, C., Davis, J., Madariaga-Vignudo, L., & Pindera, C. (2015). HIV as chronic illness: Caregiving and social networks in a vulnerable population. Journal of the Association of Nurses in AIDS Care, 26(3), 235-245.
Nyamathi, A., Koniak-Griffin, D., & Greengold, B. A. (2007). Development of nursing theory and science in vulnerable populations research. Annual Review of Nursing Research, 25, 3-25.
Stanhope, M. & Lancaster, J. (2015). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.