Vulnerability

Vulnerability is the degree to which a population, individual or

organization is unable to anticipate, cope with, resist and
recover from the impacts of disasters. (WHO, 2002)
Vulnerable Populations
• Children, pregnant women, elderly people,
malnourished people, and people who are ill
or immuno-compromised, are particularly
vulnerable when a disaster strikes, and take a
relatively high share of the disease burden
associated with emergencies.
• Poverty – and its common consequences such
as malnutrition, homelessness, poor housing
and destitution – is a major contributor to
vulnerability.
Vulnerability During emergency
• During an emergency, material and physical
resources are stretched thin and, often, the needs
of those who most need help, namely the
vulnerable populations, are left unmet.
• Vulnerable populations can be defined broadly to
include those who are not able to access and use
the standard resources offered in disaster
preparedness and planning, response, and
recovery.
• Age, class, race, poverty, language, and a host of
other social, cultural, economic, and psychological
factors may be relevant depending on the nature
of the emergency.
Vulnerable Populations in US Healthcare
1. Chronically ill and disabled
• People with chronic diseases are at risk of
poor health outcomes and they, obviously,
consume more healthcare dollars than healthy
individuals. The chronically ill are twice as
likely to report poor health days as the
general population.
• Disabled individuals, like the chronically ill,
usually have many interactions with the health
system, but, due to their disability, they may
have difficulty accessing care. The chronically
ill and the disabled may face special
challenges in obtaining services.
Vulnerable Populations in US Healthcare
2. Low-income and/or homeless individuals
• In general, low-income individuals are more likely to
have chronic illnesses, and the impact of those illnesses
can be more severe.
• People with low incomes are also disproportionately
racial and ethnic minorities.
• Being low-income, they may be less likely to have
coverage and, as a result, have less interaction with the
healthcare system.
• People with lower incomes are also more likely to have
co-occurring conditions—meaning they might have
behavioral health issues, such as depression or
substance use problems, as well as chronic medical
conditions like obesity or diabetes.
Vulnerable Populations in US Healthcare
3. Certain geographical communities
• Americans living in rural areas: geographic
isolation, lower socioeconomic status, limited job
opportunities, and tend to be older.
• Native Americans living on reservations: lower life
expectancy (5.5 years less than the all-races
population), inadequate education, higher poverty
rates, and cultural differences.
• Native Americans also have issues accessing care:
underfunded health programs, ¼ of them have
reported experiencing discrimination when they
do go to the doctor or a health clinic.
Vulnerable Populations in US Healthcare
4. LGBTQ+ Population
• Nearly 1 in 5 members of the LGBTQ community has
avoided seeking medical care because they have faced
or fear facing discrimination.
• Within the LGBTQ community, there are also significant
racial differences.
• It is associated with higher rates of psychiatric
disorders, substance abuse, and suicide.
• Some of the social determinants that affect the health
of the LGBTQ community include discrimination in
access to safe housing and a shortage of healthcare
providers who are knowledgeable and culturally
competent in LGBTQ health.
Vulnerable Populations in US Healthcare
5. The very young and very old
• The American Public Health Association has
focused on how climate change affects
vulnerable populations like children, who
have developing organs, low immunity, spend
more time outdoors, and breathe more air
and drink more water per body weight than
adults.
• Similarly, older adults are more vulnerable to
health issues since they also have low
immunity and often numerous medical
conditions.
“At-Risk” Groups Vs Vulnerable Populations

• Risk is defined as “any attribute, characteristic or

exposure of an individual that increases the
likelihood of developing a disease or injury”.
(WHO)
• The difference between “vulnerable” and “at-
risk” populations comes down to the difference
between condition versus status.
• Vulnerability refers to one’s general condition or
state, such as age, gender (or incarceration
status).
• “Risk” refers to specific causes to which one is
exposed.
Community Health Needs Assessment (CHNA)
Definition
• CHNA is a systematic process involving the
community to identify and analyze
community health needs and assets, prioritize
the needs, and implement a plan to address
significant unmet community health needs.
• This process includes reviewing quantitative data
on community health status, soliciting input from
community stakeholders, selecting priority
community health needs and devising strategies
to address the identified priority needs.
Community Health Needs Assessment (CHNA)
Definition

Community Health Assessment and Implementation Pathway

Community Health Needs Assessment (CHNA)
Hospital Benefits from Engaging Patients and Communities

• Clearer understanding of the community that the hospital is part of, including
social determinants of health, specific health issues and root causes of those
health issues, and the availability of resources to address them.
• Strengthened bonds between community and hospital, leading to increased
community collaborations around priority issues.
• Greater community buy-in and a sense of shared ownership of and commitment
to community health.
• Relationships with organizations or individuals who are community assets; these
assets can be leveraged during implementation, which will further community
involvement throughout the CHNA process.
• Fostering healthier communities where individuals have access to preventive care
and seek care at the appropriate level, potentially leading to lower costs for the
hospital.
Community Health Needs Assessment (CHNA)
Community and Patient Benefits from CHNA Involvement
• A different perspective of their community.
• Improved communication between community and hospital, contributing to
increased collaboration, mutual respect and understanding.
• Sense of shared ownership and commitment to the CHNA process, providing
impetus and motivation to be invested in the health of the community and
stay involved in the process and any subsequent community coalitions or
collaborative improvement efforts.
• Ability to apply knowledge and experiences to improve the health of the
community.
• Feelings of respect, involvement and investment in the success of the CHNA
process and ready to collaborate in the future
Community Health Needs Assessment (CHNA)
STEP 1: Identify and engage stakeholders
• What role might various stakeholders want to play?
• Do the stakeholders identified reflect the diversity of the population served?
• Is this a new or existing partner? How will the hospital’s approach differ for new and existing
partners?
• Are there any prior interactions with that stakeholder? What was the nature of the relationship?
• What do the identified stakeholders know about the CHNA, and why would the CHNA be
valuable for them?
• How can the hospital and other stakeholders build trust between them? Among the
stakeholders? How does the hospital foster unity to create a cohesive team?
• What power imbalances might affect how the stakeholder relates to the hospital?
• What can be done to alleviate those issues?
• What stakeholders can be involved in the next CHNA that were not engaged in the past?
• Is there a shared understanding of vocabulary among the stakeholders? How can all
stakeholders foster a shared lexicon?
Community Health Needs Assessment (CHNA)
STEP 2: Define the community
• Describe the community. What population does the
hospital serve?
• Who are the most vulnerable members of the
community? Are there community members who
are being overlooked?
• Who would be most affected by community health
improvement plans? Are these people the ones who
are most in need?
• Are there any geographic areas in the region that
are not covered by a hospital’s defined community?
How are the health needs of those geographic
areas being accounted for and who is doing it?
Community Health Needs Assessment (CHNA)
STEP 3: Collect and Analyze Data

• What are the top health needs in the

community?
• What resources are available or seem
unavailable to address those needs?
• What challenges to living a healthy life
are in the community?
Community Health Needs Assessment (CHNA)
STEP 4: Select priority community health issues
• What are the three to five most important needs
for our community?
• Why are these needs the most important?
• What factors may contribute to these community
needs (e.g., housing, transportation, poverty,
disease burden)?
• What resources already exist to address the
identified community needs?
• What resources are still needed to address the
identified community needs?
• Are any of the identified community needs already
being addressed?
Community Health Needs Assessment (CHNA)
STEP 5: Document and communicate results
• How would populations in the community served by
the hospital prefer to have this information presented?
• How can the hospital make the information accessible
to the community? Does the information need to be
customized for different populations? Does the
information need to be translated to another
language? Would an audio version be useful?
• Is there a preferred length of the document that would
encourage community members to read it?
• How would the community prefer to learn about the
information collected (e.g., social media, newsletters,
radio, TV, print advertisements)?
Community Health Needs Assessment (CHNA)
STEP 5: Document and communicate results
• How would populations in the community served by
the hospital prefer to have this information presented?
• How can the hospital make the information accessible
to the community? Does the information need to be
customized for different populations? Does the
information need to be translated to another
language? Would an audio version be useful?
• Is there a preferred length of the document that would
encourage community members to read it?
• How would the community prefer to learn about the
information collected (e.g., social media, newsletters,
radio, TV, print advertisements)?
Community Health Needs Assessment (CHNA)
STEP 6: Plan improvement strategies
• CDC Community Guide
• CDC Community Health Improvement
Navigator
• Community Toolbox
• County Health Rankings and Roadmaps
• Patient-Centered Outcomes Research
Institute
• Practical Playbook
Community Health Needs Assessment (CHNA)
STEP 7: Implement improvement plans
• The entire CHNA process leads to implementing
improvement plans, and the importance of
implementation cannot be overstated.
• Community members and patients can be
involved in a process to customize the
evidencebased interventions identified (see step
6) to meet the unique needs of their community.
• It is also important to discuss what roles
community members and patients want to play
going forward, as there can be ample
opportunity for ongoing involvement.
Community Health Needs Assessment (CHNA)
STEP 8: Evaluate progress

• What are the desired process and

outcomes metrics?
• What tools are available to gather and
synthesize information?
• Who is involved in the evaluation
process?
• What changes do stakeholders hope
to see by the next CHNA?
Vulnerable Populations & Climate Changes
Introduction
• The changing climate is linked to increases in
a wide range of non-communicable and
infectious diseases .
• There are complex ways in which climatic
factors (like temperature, humidity,
precipitation, extreme weather events, and
sea-level rise) can directly or indirectly affect
the prevalence of disease.
• Identification of communities and places
vulnerable to these changes can help health
departments assess and prevent associated
adverse health impacts.
Vulnerable Populations & Climate Changes
Framework Sample

Building Resilience Against Climate Effects (BRACE) framework

Vulnerable Populations & Climate Changes
Framework Sample
1. Determine the scope of the climate vulnerability
assessment
a. Identify the area of interest and the
projected change in climate exposures at
the smallest possible spatial scale.
b. Identify the health outcome(s) associated
with these climate exposures.
2. For these health outcomes, identify the known
risk factors (e.g., socioeconomic factors,
environmental factors, infrastructure, pre-
existing health conditions).
Vulnerable Populations & Climate Changes
Framework Sample
3. Acquire information on health outcomes and
associated risk factors at the smallest possible
administrative unit (e.g., census block group,
census tract, county) in accordance with data
privacy regulations and availability.
4. Assess adaptive capacity in terms of the system’s
(e.g., communities, institutions, public services)
ability to reduce hazardous exposure and cope
with the health consequences resulting from the
exposure.
Vulnerable Populations & Climate Changes
Framework Sample
5. Combine this information in a Geographic
Information System (GIS) to identify
communities and places that are vulnerable to
disease or injury linked to the climaterelated
exposure.

The value of a vulnerability assessment is that it

allows health departments to understand the people
and places in their jurisdiction that are more
susceptible to adverse health impacts
 Thank You

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