Running head: VULNERABILITY & MARGINALIZATION FINAL ESSAY 1

Vulnerability & Marginalization Final Essay

Tyler Parsons

The University of Cincinnati

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Over the course of examining how an individual’s health can be severely impacted by

their vulnerability and marginalization has been enlightening. As a nurse, I was aware that there

are patients are at a higher risk of developing certain illnesses or diseases, but through this course

I have explored not only the different types of vulnerability, but also how that can impact a

patient’s health and how we can try to mitigate its impact. This course also shed light on the

groups of people that have been marginalized and that has contributed to poor health outcomes.

Any healthcare professional needs to be aware of both issues so they are empowered to provide

the best possible patient care.

Before this course I thought I was well informed about vulnerability, but I quickly

learned that there were many dynamics that I did not yet know. When I thought of vulnerability,

I thought of patient’s without health insurance and who were of lower socioeconomic status, but

I know now that vulnerability applies to more than just those groups. Their vulnerability seems

obvious, but I didn’t consider at first that children are a vulnerable group, and less obviously, I

wouldn’t have considered prisoners as a vulnerable population. Understanding who is affected

by vulnerability was only a small part of the learning process, equally important was why

vulnerability exists. The complexities of vulnerability require that as healthcare professionals, we

must commit to a lifetime of learning about how our patient’s economic, cultural, ethnic, and

health characteristics can lead to increased vulnerability (Waisel, 2013).

One of the largest misconceptions that I am glad to have corrected during this course was

the assumption that if a patient was just able to obtain health insurance, their vulnerability would

decrease. Unfortunately, it isn’t that simple; there are many dynamics that need consideration. A

patient might have health insurance, but still can’t afford the co-pay to be seen, can’t take the

time off of work to make an appointment, has children and no access to childcare, or has limited
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transportation. These are just a few of the many things that can impede a patient’s ability to

improve their health, even when they have insurance. I think that healthcare professionals can

sometimes forget that patients have complex needs that exist outside of what we may have been

taught as “normal” and that doesn’t empower the provider or the patient. I know that I believed

that if my patients could just get insurance, whether it was public (Medicaid) or private, their

health would improve, and while for some patients this is what happened, it wasn’t realistic to

assume that there was one solution to solve the disparities the patient faced. Affordability is just

one of many obstacles that patients encounter, and as healthcare providers, we have a

responsibility to seeing our patients as more than just their insurance status. By just treating the

symptoms of vulnerability, we avoid addressing the issues causing vulnerability among patients;

this is not something one person or even one group of professionals can accomplish on their

own. Reducing vulnerability will require collaboration and communication, but also a focus on

policy and legislation.

The intersectionalism that can exist between vulnerability and marginalization further

complicates an individual’s ability to have a positive impact on their health. Marginalization

occurs due to an absence of income, mindsets of society, mental illnesses, racial discrimination,

demanding health needs, lack of representation, and cultural barriers (Pottie et al., 2000).

Increasing marginalization hurts the entire healthcare system because it causes an increase in

dependency on expensive acute treatment that will likely have a limited impact on the patient’s

overall health and it forces backwards a system that is trying to turn its focus onto preventative

care (Coster, Turner, Bradbury, & Cantrell, 2017). I see this marginalization nearly every day in

my current practice because I work with patients who often are of low income and have

coexisting mental health conditions that still carry heavy stigmas (substance us disorder,
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depression, and anxiety). I think that this course especially has helped me to understand the

complexity of disparity and has expanded the feelings of how severe the impact it has on

patient’s lives.

It is easy to become frustrated with the systems that are actively working against patients

who have a real desire to act to improve not only their health, but their lives. Sometimes it seems

like no matter how much effort a patient gives to positively influence their health, it makes little

difference if the patients are set up to fail. Healthcare providers all across the country advocate

and fight for their patients, and I know that I will continue to do so for my patients, but I have

definitely sensed a growing feeling of cynicism among those same healthcare providers. Not so

much towards patients, but the entire system that we see consistently fail those who need it the

most. We see women of color forced into survival sex work having their health needs completely

disregarded (Varga & Surratt, 2014), we see the young men and women dying from ketoacidosis

because they couldn’t afford their insulin (Slachta, 2018), we see the veterans suffering from

severe mental illness taking their own lives because money meant to prevent suicide among

veterans goes unused (Rosenkrantz, 2018). These are the realities of our healthcare system and I

don’t think that there’s anyone else better positioned to bring more attention to this issue than the

people who provide healthcare. I want to be more informed about what I can do to decrease the

vulnerability in all patients, not just the ones I care for, and I hope that as we do start to spread

awareness we can do more than just seeing these patients who are being failed by the healthcare

system, we can actually help them. That is how this course has influenced my practice as a nurse.
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References

Coster, J. E., Turner, J. K., Bradbury, D., & Cantrell, A. (2017). Why Do People Choose

Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature

Search and Narrative Synthesis. Academic Emergency Medicine, (9).

Rosenkrantz, H. (2018, December 19). Feds say VA failed to spend millions allocated for suicide

prevention. Retrieved April 24, 2019, from https://www.cbsnews.com/news/feds-say-va-

failed-to-spend-millions-allocated-for-suicide-prevention/

Slachta, A. (2018, September 05). Americans are dying because they can't afford their insulin.

Retrieved April 24, 2019, from https://www.cardiovascularbusiness.com/topics/lipids-

metabolic/americans-dying-because-cant-afford-insulin

Varga, L. M., & Surratt, H. L. (2014). Predicting Health Care Utilization in Marginalized

Populations: Black, Female, Street-Based Sex Workers. Women's Health Issues, (3).

Waisel, D. B. (2013). Vulnerable populations in healthcare. Current Opinion in Anaesthesiology,

(2).