The Definition of Vulnerable Populations
There was a great editorial by Costanza Galastri in this month’s NACCHO Preparedness Brief (a monthly newsletter on public health preparedness issues – you can sign up at the bottom of this page). I uploaded a pdf of the editorial here, I hope the good folks at NACCHO are cool with that.
The editorial was on the subject of vulnerable populations, specifically the difficulty of disaster planning for those populations. Ms. Galastri, in my opinion, identified the problem right off–the very definition of vulnerable populations doesn’t lend itself to facilitating planning.
Consider, for a moment, who is a member of a vulnerable population. Picture them in your mind. I’ll bet if you ask anyone else doing this exercise, they’ll have a different picture in their head; some will be black, rural white, in wheelchairs, on dialysis, deaf, blind, old, young, etc. This is problematic because no single plan will address the needs of all of these disparate groups. Indeed, the idea of planning especially for vulnerable populations has come into vogue because it was recognized that no single plan can take into account vulnerable and “non-vulnerable” populations. By that taking that view of the problem, it is disingenuous to think that one plan can accommodate all of the special needs of all vulnerable populations.
There was a time, not too long ago, when I thought I was being clever saying that there really was no vulnerable populations. In a disaster, everyone is vulnerable. Pandemic influenza doesn’t care if you can see or not; chlorine gas sweeps over an entire sleeping town not just the old folks; earthquakes shake all buildings. But, to pull out my old feminist unpacking exercises, a definition like that leads to vacuity. If everyone is vulnerable, then no one truly is. And I never advocated against doing more for people who needed extra help, so I’ve had to abandon that definition. Some people will experience worse outcomes than other folks. It’s not vulnerable versus non-vulnerable; it’s a gradation of vulnerability. In a disaster, everyone is “at risk,” some more than others.
Ms. Galastri’s editorial quotes the PA Department of Health’s definition of vulnerable populations as:
groups whose needs are not addressed by traditional service providers or who feel they cannot comfortably or safely access and use the standard resources offered in disaster preparedness, relief, and recovery.
I felt his definition fails for the same reason as Ms. Galastri–it fails to take into account the nuance and particular needs of the individual demographic groups AND individual disasters. In an evacuation situation, the critically ill, the elderly and the mobility disabled have the potential to experience the worst effects. In a dust situation (building collapse, explosion, volcanic eruption), those will cardio-pulmonary problems will be the most adversely affected. No vulnerable populations plan will plan for all of these things.
The editorial notes that local health departments have experienced a number of difficulties in trying to plan for these contingencies, and recommends working with the communities that these vulnerable populations work and live in–as opposed to working directly with each vulnerable person.
By working with agencies and providers that currently support these vulnerable populations health departments won’t be forced to reinvent the wheel. The vulnerable populations that they’re trying to reach out to already have support networks that help eliminate and alleviate the vulnerabilities they experience in everyday life. They have workers who know where the disabled live, and what types of special care they require. A great example of how robust these support networks can be is found in the dialysis provider community. In disaster situations, competing companies forward medical information and balance case loads so that local patients will always have access to the dialysis they need.
Not every community is as prepared for disaster as the dialysis folks, and maybe they can’t provide long-term support for everyone in their world, but they can act as a critical dissemination point for preparedness information. As it is, they regularly hold seminars and classes, why not offer preparedness talks (in multiple languages, like my good friend @carolarc does in Seattle)?
My point is this: vulnerable populations is a poorly chosen term that unnecessarily lumps disparate peoples and needs together. Weak vocabulary can lead to ill suited planning, which is something that health departments and EMAs are finding out more and more each day. Programs like NACCHO’s APC network encourage working with the existing community to supplement public health planning, and the interests of the community organizations. I constantly harp on the idea that planning and preparedness should be taking place in the community. Regular people (vulnerable and non-vulnerable) have a vested stake in those plans and should, at the very least, know that they exist. Partnering with community organizations is a great way to ensure that your vulnerable populations are integrated into the plan, and that their concerns are properly voiced and understood.
Photo by ChildofAtom