Vulnerable Populations MODULE ONE: Vulnerable Populations

Describe health care disparities facing vulnerable populations. Objectives Students will: Name 2 populations considered to be vulnerable and at risk for health care disparities. Describe health care disparities facing vulnerable populations. Describe the importance of service and how YHSC volunteers can make a difference in their community.

In the USA today: The population is 280 million people. 50 million people live in rural & urban communities, many are poor, racially and ethnically diverse, and many are with out access to primary health care. These people and others are considered to be vulnerable and at risk for health care disparities. Source: Health Resources & Services Administration-2006

What are Health Care Disparities? Differences or inequalities in health care status due to gender, race/ethnicity, education, disability, geographic location or sexual orientation. Example: African American, Asian, and Hispanics have more chronic disease, cancer & infections. Native Americans are 2.5 times more likely to have diabetes that whites. African American women are more likely to die of breast cancer than any other racial group. Rural residents have more chronic conditions such as diabetes and are more likely to die of heart attacks.

Health Care Disparities cont’d African American infants are 2 times more likely than others to die before the age of one. Native Americans & Alaskans suffer more depression and more substance abuse issues than others. In 2002, fifty percent of those infected with Hepatitis B were Asian and Pacific Islanders. Source: National Health Care Disparities Report- 2003

Who are the Vulnerable? Racial & ethnic minority groups Uninsured Underinsured Low income children Frail older adults Mentally disabled Homeless Physically disabled Rural Americans Immigrants/Migrant Farm workers People with HIV/AIDS

Little or no insurance 45 million people in the U.S. are “uninsured” because they don’t have or can’t afford health insurance. 16 million people in the US are “underinsured” because even though they have insurance they can’t afford the co-pay or other out of pocket expenses.

Low Income Children Poverty affects physical and mental development and school achievement. There are 13 million low income children. 16 % of families with children are hungry.

Low Income Children States with high levels of child poverty: Texas 22% West Virginia 23% Mississippi 24% Louisiana 25% New Mexico 25% Arkansas 30%

Low Income Children 35 % African American 28% Latino 29% American Indian 11% Asian 10% white 26% children of immigrants 20% under age 6 Source: National Center for Children in Poverty Dec. 2006 Report

Frail Older Adults Elderly population age 80-90 is growing. Many have physical & mental health problems. Many live alone, rely on family, and can’t afford to pay for help at home. Medicare doesn’t pay for long-term care. Have little financial reserves. In 2001, the median income for this age group was $14,000 (below poverty level.) Baby boomer population growing. By 2050, those over age 85 will go from 4.3 million to 20.9 million! Source: 2002 Health and Retirement Study

The Homeless In the United States, approximately 3.5 million people experience homelessness each year. Families with children make up 50% of the homeless population. The homeless population is growing. Children under the age of 18 account for 25% of the urban homeless population. 51% of the homeless population are people between the ages of 31 and 50.

The Homeless Approximately 23% homeless adults suffer from some form of severe and persistent mental illness. Addiction disorders, such as drug abuse and alcoholism, affect about 30% of the homeless population. Shelters are overcrowded or filled to capacity. The two most common causes of homelessness are substance abuse and mental illness. The federal and state programs that provide assistance are only short-term solutions.

The Homeless by Race In 2003, the homeless population was: 49% African American 35% Caucasian 13% Hispanic 2% Native American 1% Asian Like the total U.S. Population, the ethnic makeup of the homeless varies according to geographical location. Source: www.Endhomelessness.org

Adults with Disabilities or Special Needs Those disabled due to a progressive illness or a sudden accident. Includes the blind or those with low vision, the deaf or hard of hearing. The medically fragile: unstable conditions & those with HIV/AIDS, Diabetes, or those on life-sustaining medications. Those with physical limitations. Those with mental disabilities. Source: Commonwealth Fund 2006

Rural Americans 20% of Americans live in rural areas but only 9% of doctors practice there. Many have long distances to travel for health care. Results in less visits and less preventive care. Source: 2004 National Health Care Disparities Report

Immigrants / Refugees Immigrants can be invisible in our communities Isolated from health care services. Lack legal status, afraid they will be reported. Need interpreters due to language barriers. Fear discrimination. Lack transportation and insurance. Suffer from chronic illness, diabetes, asthma, heart disease, and obesity. Have mental health needs due to trauma of relocation & culture shock. Source: Robert Wood Johnson Foundation 2006

Migrant Farm Workers 2.5 million persons hired as seasonal and migrant workers. 70% work in crop agriculture. Relatively young and mostly male (sexually active). Single or married but away from family (depression). Mainly Latino , Mexican, Guatemalan, Puerto Rican, Caribbean, Jamaican. Average of 6 years of formal education. Poor (weigh illness against wages). 1/3 are undocumented (fear of accessing care). Source: Connecticut Migrant Health Network

Social Factors affecting the Vulnerable: Poverty Poverty is defined by family income and the number of people in a family. Poverty guidelines help determine financial eligibility for assistance. Example: Children in a family of 4 that has an income of $20,000 or less are considered poor and eligible for some state health care programs. Source: US Dept. Health & Human Services 2006, Poverty Guidelines

Social Factor: Lack of Education Lack of health education & prevention of disease. Low literacy levels- unable to read & understand doctors orders or medication labels. Lack of skills to communicate with the doctor. “Those with the greatest health care needs may have the least ability to read and comprehend information…” AMA Report 1998

Social Factor: Lack of Access Lack of Access to health care - no insurance, job or money to pay for insurance No transportation to get to the doctor Isolation- in some rural areas, no health care close by Examples: Part time worker doesn’t qualify for health care benefits Rural elderly may live over 100 miles from the nearest hospital.

HRSA-Health Resources & Services Administration- U.S. Federal agency Responsible for increasing access to and quality of health care for all especially those who are vulnerable (AHEC’s are part of HRSA). Improving outcomes & quality of health care. Eliminating health disparities. Increase Health Care Response in Public Health Emergencies.

HRSA Workforce Goals Increase the health care workforce by: Recruiting more under-represented people to health careers. Increasing the cultural competency of health care providers. Improving the distribution & retention of the workforce in underserved areas, including rural & border areas.

HRSA Health Disparities Goals Eliminate health disparities by: Increasing the early screening of children for special health care needs. Raising awareness about major health risks through education & outreach to vulnerable populations.

Summary: the Impact of Service-What can YOU do? Volunteer at community sites such as shelters, community centers. Reach out to low income children in after school programs and community settings. Volunteer with professionals to educate about and prevent health problems. Be part of the solution! Volunteer! YOU CAN MAKE A DIFFERENCE!