As we close out a year filled with media coverage of patients who were impacted by disasters such as the Camp Fire in California or recent hurricanes, there has been a push to focus on “vulnerable populations.” This is especially true in healthcare and public health, where health disparities can account for varying life expectancies and even survival rates after disasters. While this conversation is very important and should continue to shine a light on those who need support most, I fear that the use of the term “vulnerable populations” is far too broad. Without defining the term, we lose its true meaning as it currently encapsulates just about anyone in the face of a disaster.
First, what does it mean and who is most vulnerable?
To start, the chronically ill and disabled, low-income and/or homeless individuals, certain geographical communities, and the very young or very old are all disproportionately impacted by a disaster or disruptive event. It’s important to note that there are many other populations that would be included, but this is a start. Vulnerability can also include those who are considered medically fragile during certain disasters, such as those with severe chronic diseases or with challenges accessing healthcare.
Within the large swath of populations that are included in the term, not all populations are vulnerable to all threats. Being very clear about which populations would be left most exposed to a hazard enables communities to plan and identify those who should be supported. As an example, snowstorms will impact those with low mobility or transportation challenges, while a pandemic may challenge immune-compromised populations. With the recent hurricane season in mind, populations located in flood-prone areas are also particularly vulnerable to such threats.
The bottom line is that vulnerability does not have a specific face. It can be the person with hypertension and diabetes preparing to weather a hurricane, or an HIV-positive transgender individual concerned about avoiding exposure to the flu. It can be anyone, at any time.
Vulnerability exists across classifications. Many people/communities are vulnerable to several things.
Most individuals fit into multiple categories, so it is not enough to consider an individual or community vulnerable to one threat, without considering the intersections that exist with other threats. Depending on the nature of the community, this may be vital to building true resilience.
Vulnerability is normally determined by outcomes.
Sadly, the most common measures of vulnerability are illness and death before or following an event. While many are certainly working towards developing better outcomes, there is still more to do to pinpoint these communities earlier and support them ahead of disaster.
How should we approach supporting these populations?
There is certainly an opportunity to assess the populations at greatest risk in certain environments or communities. However, it must be done strategically to determine exactly who is vulnerable in various scenarios. It could be a single mother of three children with no car who needs to evacuate from a hurricane, or it could be an elderly person in need of vital medications who is unable to access them during a snowstorm.
Many communities need far more support than they currently receive to be resilient and thrive, or even withstand the threat of local or large-scale disasters. And unless we are intentional about determining how we protect those who need it most, when they need it most, we will continue to leave communities to fend for themselves in times of disaster.
Supporting vulnerable populations in 2019
With these lessons in mind, I encourage all public health and emergency management officials at the state and local levels to determine the needs of the populations they serve, and ensure they are prepared to withstand times of disasters and support them in the aftermath. We have a great opportunity in the year ahead to ensure all Americans are resilient in the face of disaster.