In general, a vulnerable population means a disadvantage group of the population that is at a heightened risk due to some feature peculiar for this group and thus its members need utmost care and consideration. Specific groups of people can become vulnerable because of various reasons, for instance, an increased level of poverty, lack of access to quality healthcare, advanced age, gender status, or the lack of stable housing. Persons characterized with the latter aspect re referred to as the homeless, and they probably constitutes one of the most vulnerable populations in the USA in particular and in the world in general. Lack of stable housing impacts on all domains of individuals’ life, thereby having an extremely negative influence on their health, education opportunities, employment, nourishment, socioeconomic status, psychological well-being, and mental health among other things. Therefore, this vulnerable population needs to be studied in more depth, as well as being assessed with application of the Vulnerable Population Conceptual Model in order to determine what risks they face.
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Description of the Population
There exist various definitions of the notion of the homeless, but the current paper will use the one provided by the US Department of Health and Human Services that is the governmental agency funding and launching programs aimed at addressing problems relating to homelessness. Hence, a homeless person is “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g. shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing” (The Public Health Service Act, 42 U.S.C., 254b, 2006). This way, a person may be deemed homeless in case he/she lacks housing, lives on the streets, lives in a motel for an extended period of time, crashes for the night at friends’ or extended relatives’ homes, resides in a vehicle, lives in an abandoned building, and lacks permanent housing in any other way. There are different types of homeless people, including short-term, long-term, chronic, and hidden ones (National Health Care for the Homeless Council, n.d.). Only the first three groups are usually included in official statistics, while a population of the hidden homeless is considered to be the most extensive and the most difficult to detect and count. Sometimes, researchers also distinguish such type of the homeless as the “doubled up” or those who engage in “couch surfing”, consisting of individuals staying at other people’s homes (National Health Care for the Homeless Council, n.d.).
According to the data provided by National Alliance to End Homelessness (2016), there were 564,708 homeless individuals on a single night in January, 2015, and this number includes only those who were spending the night on the street, in an emergency shelter, or in a temporary house provided by the transitional housing program. It is estimated that this figure has remained relatively unchanged during 2015 and 2016, and it is the only official statistics available on the state of homelessness in the USA. Moreover, this figure is much smaller than the real number of the homeless, as it includes only three groups of the homeless and does not take into account hidden homelessness.
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However, official statistics shows that the situation has been improving as the national rate of homelessness in 2015 constituted 17.7 homeless individuals per 10,000 people, while in 2014 it amounted to 18.3 individuals per 10,000 people (National Alliance to End Homelessness, 2016). In general, the mentioned rate has declined by 11 percent since 2007, yet the reality is far from being acceptable (Centers for Disease Control and Prevention, 2015). An especially vulnerable group of the homeless consists of veterans, and the situation with them has been slowly improving as well until reaching the rate of 24.8 homeless veterans per 10,000 veterans (National Alliance to End Homelessness, 2016). However, this is the national average, and some states like D.C. have much worse indicators with 145 homeless veterans per 10,000 (National Alliance to End Homelessness, 2016). Homeless people are considered to be really vulnerable because of their exposure to environmental and health risks, as well as general lack of stable employments, quality nourishment, and inability to satisfy most basic needs. Besides, this group is at a high risk of developing substance abuse problems and mental disorders (National Coalition for the Homeless, 2009).
Application of Vulnerable Population Conceptual Model (VPCM)
VPCM is a population-based framework that was developed by Flaskerud & Winslow (1998) with a view to studying vulnerable populations from the health perspective. It was a product of the authors’ extensive research and clinical experience related to the work with vulnerable populations. The model emphasizes an interrelated relationship between such components as availability of resources, relative risk, and health status, which are discussed in more detail below.
This component of the model envisions consideration of such indicators as health care, education, housing, income, and jobs (Flaskerud & Winslow, 1998), as well as environmental factors. The homeless lack virtually all of these resources, thereby being a highly vulnerable population. Hence, since many of them live on the streets or reside in abandoned and other low-quality dwellings, they are exposed to the environmental impact, which results in a wide range of problems caused by being outdoors, for instance, pneumonia, bronchitis, skin and wound infections, and other health conditions (MedlinePlus, 2015). Virtually all homeless lack access to health care as they have no funds to pay for insurance. As a consequence, 46% of them have poor health, 21% of them suffer from food insufficiency, 19% have chronic bronchitis, 38% have other chronic conditions, 72% suffer from tooth loss, and 25% are diagnosed with severe mental illnesses (National Health Care for the Homeless Council, 2011). These statistics include only officially homeless individuals, which means that real numbers are much higher. Because of having no stable housing, children who constitute 23% of the overall homeless population and other homeless people lack access to education, which results in the loss of employment opportunities (Centers for Disease Control and Prevention, 2015). Thus, they get stuck in this state since early years and have no chance to break out on their own.
Relative risks include lifestyle choices, health-promotion practices, exposure to high-risk activities, and quality of health care (Flaskerud & Winslow, 1998). Lifestyle choices of the homeless do not promote their well-being, as they frequently develop substance abuse problems, eat unhealthy food, and sleep outside. Moreover, they suffer from communicable diseases because of poor living conditions, yet they cannot afford treating them in hospitals. The matter is that 71% of the officially registered homeless are uninsured, which implies poor access to quality health care and low chances of fully recovering from illnesses (National Health Care for the Homeless Council, 2006). Respectively, there is no health promotion among this group of the US population. Furthermore, they are highly exposed to stress caused by the lack of a place to sleep and violence. For instance, National Coalition for the Homeless recorded 472 acts of violence against the homeless in 2005, including 169 murders of the homeless (National Health Care for the Homeless Council, 2006).
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Due to the above mentioned risks and exposures, the health status of the homeless is generally low. The mortality rate for this population is 4 to 9 times higher than for other people with slight variations existing in different states (Centers for Disease Control and Prevention, 2015). The probability of survival to the age of 75 among homeless is 32% for men and 60% for women, which is even lower than that of the lowest income groups of the population (Hwang, Wilkins, Tjepkema, O’Campo, & Runn, 2009). Hence, mortality and morbidity rates for this particular group of the US population are extremely high.
The homeless seem to be one of the most vulnerable population groups in the USA. It is surprising that hundreds of thousands of people have no housing and no opportunity to find one in such a highly developed country. Moreover, virtually all homeless individuals lack access to quality health care, which means that they suffer from a wide range of various illnesses that could have been cured if these people received treatment. As a result of exposure to various risks, the homeless have extremely high mortality and morbidity rates and virtually no chance to survive to an old age. Therefore, urgent measures and effective policies have to be developed to address problems faced by this population with access to health care being among the most significant priorities.