Text by Greta Andersén
Health care and health promotion is a complex area, and when targeting vulnerable populations, some additional aspects should be taken into consideration. Good health outcomes aren’t simply a result of health care interventions, but as the World Health Organization (2022) states, social determinants actually account for up to 30-55% of health outcomes. This means, that health and equity is in fact impacted by multiple socio-economic factors such as income, education, access to health care, social protection or discrimination, and food insecurity. According to WHO (2022), lower socio-economic status can be associated with deteriorated health. Often, despite defining vulnerable populations through the social determinants, the health promotion projects may struggle to address these underlying issues.
Incorporating Social Determinants of Health in health promotion intervention has proven to be effective in meeting the health needs of vulnerable populations. For example, in a study done with homeless veterans (O’Toole, Johnson, Aiello, Kane & Pape 2016), it was found that addressing only health and nursing issues was not enough to improve their health significantly and effectively. Addressing issues in housing, hygiene care, transportation and food security resulted in significant decreases in hospitalizations and emergency services amongst homeless veterans. Clearly, in Health Promotion for vulnerable populations, plain clinical health services need to be combined with actions improving social health determinants too, for a holistic and effective outcome.
Reaching the vulnerable populations and providing access to health information is anotherextremely important aspect in health promotion. In a culture-centered approach to health communication, Dutta (2008, 4-6) presents three key concepts: Structure, culture, and agency. The structure covers all the social and physical structures, that facilitate or constrain access to health services. These can be physical access to health care services, but also the way the services are delivered, and opportunities to make health-related choices. According to Dutta, marginalized communities have often limited or deprived access to these health care structures and the communication platforms and information available. Agency is the concept describing how individuals can make health choices, and marginalized groups and vulnerable individuals are often forced in a decision-making scheme of the dominant view population providing the health services (Dutta 2008, 87). In development projects, this might be a risk when planning health promotion interventions, resulting in situations where culturally non-functional programs are imposed on a local population. Limited access to health care and health promotion can also be seen in how patriarchal societies affect women’s health care. When women are deprived from education, it results in less access to health promoting information, but also education of female doctors in societies, where it is considered inappropriate for women to be seen by male physicians. When trying to reach vulnerable populations for health promotion, both access to information and the suitability to the community must be considered.
In the end, there needs to be a strong political will to address the health of vulnerable populations. Donor based health projects need to be sufficiently backed up by governments and supporting infrastructures. This also will avoid the vulnerable populations to be left out of services, after the funding ends and the interventions are over. The key important fact is to engage both the local authorities, and the key populations into maintaining these health structures and services. Institutionalizing and gaining political will to back up the interventions and programs have proved to help with funding and sustainability. Equally important is to remember the community and vulnerable population as a key stakeholder and empower them too. (Rodríguez, Whiteside & Bennett 2017.)
More information from:
Dutta, M. 2008. Communicating Health: A Culture-centered Approach. Cambridge: Polity Press.
O’Toole, T., Johnson, E., Aiello, R., Kane, V. & Pape, L. 2016. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis. 13, E44. doi: 10.5888/pcd13.150567
Rodríguez, DC., Whiteside, A. & Bennett, S. 2017. Political commitment for vulnerable populations during donor transition. Bulletin World Health Organ. 95 (2), 121-127. doi: 10.2471/BLT.16.179861
Social Determinants of Health. WHO website. 2022. Accessed 1. Dec 2022. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Bio of the author:
Greta Andersén is a registered nurse, studying in the Masters in Global Health and Crisis Management program. She has 17 years of experience in nursing, and has worked several years in various countries, in conflict zones and crisis set ups.