1. Vulnerable Populations

2. Objectives Identify populations considered to be vulnerable Describe health care disparities Define and understand the importance of cultural competency as it relates to self and others

3. In the USA today: As of April 2009,the population is 306,269,974 million people Many are considered to be vulnerable and at risk for health disparities Health disparities are inequalities in health status due to gender, race/ethnicity, education, disability, geographic location or sexual orientation Example: Black infants have higher mortality rates than white infants. Source: Health Resources & Services Administration-2006

4. Health Disparities Why is that? A Look into Health Disparities (Go to You Tube)

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

6. What Social Factors affect the Vulnerable? Poverty- Poverty is defined by family income and the number of people in a family. This determines amount of assistance. Lack of education- Low literacy, lack of communication skills, and minimal understanding of disease prevention and healthy practices. Lack of access- No insurance and/or transportation, isolation.

7. Discussing Specific Vulnerable Populations Refer to Worksheet

8. Understanding Cultural Competency Culture is the shared values, traditions, norms, customs, art, history, folklore, language of a group of people.

9. Culture is made up of many aspects: Race Ethnicity Hometown Religion Experiences Spirituality Talents Abilities Disabilities Languages

10. Avoid stereotyping: Individual-two people may be from the same race but it doesn’t mean they have the same religious beliefs. Always changing-as one goes on to college, they leave the high school culture behind Multi dimensional- a person can be a student, a sports mate, a sister or an immigrant at the same time

11. Language Barriers According to the Census Bureau A total of 215,423,557 people speak English A total of 46,951,595 people speak another language: – 28,101,052 speak Spanish – 2,022,143 speak Chinese – 1,643,838 speak French – 706,242 speak Russian – 614,582 speak Arabic Source: U.S. Census Bureau, Census 2000 Summary File 3, www.census.gov.www.census.gov

12. Language statistics There are more than 100 languages designated as “official” by governments worldwide. The United Nations has six official languages: English-French-Spanish-Russian Chinese & Arabic Did you know? Chinese (Mandarin) -most widely spoken language in the world. English is the second! Source: National Virtual Translation Center; www.NVTR.gov.

13. A culturally competent person: Is aware of his/her own cultural heritage Respects the culture of others, clients and staff Knows that culture is mulitfacted Recognizes barriers such as language differences when communicating Reflects on experiences with people of other cultures Avoids stero-typing individuals

14. Summary There are many different types of vulnerable populations. Poverty, lack of education and lack of access are social factors affecting vulnerable populations. Culture is the shared values, traditions, norms, customs, art, history, folklore, language of a group of people. No one has a single culture.

15. Little or no insurance More than 47 million people in the U.S. are “uninsured” because they don’t have or can’t afford health insurance (15.8% of Americans). More than 25 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. Social Factor-lack of access.

16. Low Income Children There are 28 million low income children. Poverty affects physical/ mental development & school achievement. Social Factor- poverty. Source: National Center for Children in Poverty, 2007 www.nccp.org

17. Aging Population Between 2010 and 2015, those age 65-84 will go from 38.5 million to 43 million! This is an increase of 4.5 million people in just 5 years In the last 10 years the number of centenarians (100+) has doubled Many face day to day challenges with physical & mental ability Many living below the poverty level Social Factor- Poverty, Access Source: 1999 Census Report

18. The Homeless Families make up 41% of the homeless population In 2005 an average of 744,000 experienced homelessness In 2007, it is reported that 1 in 50 children are homeless Almost half are under the age 6 Social Factor-vary Source: The National Center on Family Homelessness, 2007 MSBNC

19. Those 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. Social Factors-vary Source: Commonwealth Fund 2006

20. Rural Americans 20% of Americans live in rural areas but only 10% of doctors practice there. Many have long distances to travel for health care. Results in less visits and less preventive care. Social Factor-Lack of access Source: 2004 National Health Care Disparities Report

21. 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. Suffer from chronic illness, diabetes, asthma, heart disease, and obesity. Have mental health needs due to trauma of relocation & culture shock. Social Factor-Poverty, Lack of access, education Source: Robert Wood Johnson Foundation 2006

22. Migrant Workers 2.5 million persons hired as seasonal and migrant workers. 70% work in crop agriculture. Suffer from muscle and joint problems, depression, and STD’s. Mainly Latino, Mexican, Guatemalan, Puerto Rican, Caribbean, Jamaican. Social Factors-Poverty, Lack of access, education Source: Migrant Clinicians Network, 2009