Page 570 - Encyclopedia of Nursing Research

VULNERABLE PoPULATIoNS n 537

variables (Lexchin & Grootendorst, 2004). opportunities as well as Healthy People 2010’s
The term is derived from a combination goals (Shi & Stevens, 2005; National Institutes
of Latin words: vulnerare (verb) meaning of Health, 2000; National Institute of Nursing V
“wound” and populatio meaning “wasting Research, 2000; U.S. department of Health
or devastation” as well as populous meaning and Human Services, 2000). The national
“specific members of a region.” Aday (2001) attention was in direct response to the World
referred to VPs as societal subgroups in Health organization’s Health for All and
the position of being hurt, ignored, and/or Millennium Development Goals. The American
helped by others. She claimed all members of Nurses’ Association defended the relevance
human communities are potentially vulner- of VPs for nursing research. The notion of
able. Flaskeraud and Nyamanthi (2002) con- equality and health presents an overlap in
tend that VPs have increased susceptibility defining “health disparities” (among various
to health adversities due to discrimination populations) and “vulnerable populations”
and marginalization. A summary of those as applied to elimination of health dispari-
most at-risk include, but are not limited to, ties using social determinants of health
women, pregnant women, infants, children, (Guthrie, 2005; U.S. department of Health
teenagers and young adults, the economi- and Human Services, 2000). As a result, the
cally or educationally disadvantaged, ethnic Institute of Medicine (2002) report reframed
people of color, immigrants, prisoners, inter- national focus that VPs experience health
national groups living in poverty condi- disparities especially in the unequal receipt
tions, people living in disaster and war-torn of health care, specifically, in the quality
areas, homosexuals, HIV infected, chemi- and access of services (Nyamathi, Koniak-
cally addicted, mentally impaired, homeless, Griffin, & Greengold, 2005). The signing of
elderly, and those living in rural and urban the National Health Care Reform Bill in 2010
settings (Flaskerud & Nyamanthi, 2002; has changed the face of health care receipt.
Flaskerud et al., 2002; Leight, 2003). When The principles of social and distributive jus-
coupled into subgroups, the appellation is tice, as it relates to resource allocation, are of
“doubly” VPs (Liamputtong, 2007; Moore & debate. For example, Frolich and Potvin (2008)
Miller, 1999). The impact on health of being proposed an inequality paradox for decreas-
doubly vulnerable is not well defined, but ing health inequities between socially defined
legal and ethical implications for research groups. They explained an inverse care law:
and intervention are presented (Fleischman those with the most resources at hand dur-
& Wood, 2002). This has been most evident ing crisis adapt more readily and are first to
in studies pertaining to the effect of disas- derive maximum benefit from interventions.
ters on victims (Gershon, Rubin, Qureshi, The end result may lead to positive discrim-
Canton, & Matzner, 2008). An interna- ination, stigmatization, and inefficient public
tional legal definition of VPs is found in the health. The debate has not been entertained by
Safeguarding Vulnerable Populations’ Act leading agencies. In fact, Healthy People 2020’s
of 2006 (Griffith & Tengnah, 2009; Schwehr, national goals have not been released to date.
2010). An interpretation of the United States’ The focus of the National Institutes of Health
legal definition relates to susceptible individ- is on genomics as related to health differences
uals within specific subgroups and has not among various populations (Collins, 2010).
changed since 2003 (Stone, Horton, Pestronk, National Institute of Nursing Research and
& Ransom, 2003). American Nurses Association remain focused
Early in this decade, national attention on the art and science of nursing as it relates to
has focused on VPs, as evidenced by National positively influencing the health of VPs.
Institutes of Health and National Institute of Theoretical perspectives of VPs are
Nursing Research’s missions and funding rooted in the fundamental tenet of defining