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Mapping Vulnerability to Improve Health Outcomes for Marginalized Communities

Targeting the root cause of poor health outcomes can be traced to addressing the environmental and social factors that directly impact individual behaviors. Social determinants of health contribute to astronomical consumption of health care services that contribute directly to annual expenses that exceed $3 trillion a year with the United States also leading in the lowest life expectancy at birth, the highest prevalence of infant mortality and incidence of chronic illnesses. Surprisingly only 34% of the national population is covered by Medicare and Medicaid. In Philadelphia, the saying “your zip code determines your health” rings true because of the vast majority of impoverished neighborhoods. Health inequity exists and persists in the absence of disproportionate efforts to address the root causes of poor health outcomes.

This past year, I had the privileged opportunity to intern with Dr. Stephen Linder from the University of Texas and the Academic Lead for Cities Changing Diabetes in the US. Dr. Linder published a population-based vulnerability tool to assess the specific archetypes of people who are vulnerable to developing Type two diabetes and how potential association with place-based risk factors fosters this relation. Dr. Linder’s introduction of the concept of composite vulnerability as a vehicle for population-based assessment consists of incorporating one’s environment/neighborhood, economic standing, and personal health characteristics. Unique undiagnosed subpopulations were examined to individualize and tailor prevention-based strategies to reduce vulnerability. During the internship, a similar place-based community assessment tool was published to be utilized in Cities Changing Diabetes, Philadelphia.

Assessing population-level vulnerability to certain chronic illnesses would prove to effectively demonstrate differences in socio-cultural groups and how these differences contribute directly to poor health outcomes based on behavioral choices, environmental disadvantages, increased chronic illness risk factors, and structural marginalization leading to decreased healthcare access and health literacy profiles. Standardized assessment tools that are initiated before admission into the care continuum fosters successful primary prevention because it identifies at-risk populations to facilitate resourceful interventions. Likewise, when dealing with chronic illness among disparaged communities, screening for increased vulnerability provides a comprehensible method to examine and implicate strategies to mitigate the incidence. Assessing vulnerability focuses on primary prevention that focuses not only on behavioral/lifestyle modification but also considers the complicated relationship between that and the existing barriers. Kim and Bostwick define “vulnerability as shaped by social, economic, political context, and practices; it determines not only risk exposure but also community capacity to deal with, respond to, and recover from natural disasters and hazards”. Vulnerability assessment allows for a closer look into structural inequities that shape social disparities.

Bush, M. Addressing the Root Cause: Rising Health Care Costs and Social Determinants of Health. North Carolina Medical Journal. 2018 January; 79(1): 26-29.

Kim, S.J. and Bostwick, W. Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago. Health Education Behav. 2020 Aug; 47(4): 509-513.

Linder, S., Marko, D., Tian, Y., and Wisniewski, T. A Population-Based Approach to Mapping Vulnerability to Diabetes. Int. J. Environ. Res. Public Health. 2018; 15: 2167.

Linder, S., Volkmann, A.M., […] and Napier, A.D. Understanding Social and Cultural Factors Associated with Composite Vulnerability to Better Inform Community Intervention Strategies: Cities Changing Diabetes in Houston. Int Arch Public Health Community Med. 2018; 2:016.

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identifying and Addressing Gaps in End-of-Life Care

Between our aging population, people living longer lives, and the death toll exacted by the COVID-19 pandemic, palliative care is a hot topic in the world of public and population health. End-of-life care is a critical aspect of medicine, and yet it is an area that is often overlooked in today’s current healthcare environment.

Patients in palliative and hospice care have unique physical, mental, social, and spiritual needs, especially people who are elderly or who have chronic conditions. However, there’s also a significant gap in end-of-life care when it comes to providing support to caregivers and families, who could be tasked with making some of the largest spiritual and ethical decisions of their lives, all in the face of dealing with their own feelings of loss, anger, and grief.

Taking care of a loved one at the end of their life can lead to significant mental and emotional stress, strained finances and personal relationships, and a lower overall quality of life while coping with the emotional toll of impending death. According to a study published by the Journal of Palliative Medicine, 80% of hospice care is delivered by informal or unpaid caregivers, who are often family members. Caregiving is also more likely to fall on women instead of men. Moreover, end-of-life caregiving is estimated to take up to 97 hours of labor per week, and women who are family caregivers are 2.5 times more likely to be living in poverty.

Providing options to help with everyday care — like administering medications, cooking meals, coordinating with providers, and keeping the patient comfortable — could help to reduce the strain put on caregivers, supporting their mental, emotional, and physical health during such a challenging time. Moreover, most patients in end-of-life care wish to spend their final days at home instead of in the hospital, but this can quickly become overwhelming for caregivers due to the emotional toll and lack of resources in the community. Providing more support for end-of-life through Medicare or other public health initiatives could reduce this strain and improve the overall quality of ed-of-life care.

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776565/ (Links to an external site.)
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089741/ (Links to an external site.)
• https://www.caregiver.org/news/27-things-you-may-not-know-about-women-and-caregiving/#:~:text=The%20Gallup%20analysis%20found%3A%20%E2%80%9CWomen,versus%2016%25%2C%20respectively.%E2%80%9D&text=1.,is%20age%2050%20or%20older (Links to an external site.)