Homeless Women and Healthcare: Access to Health Care, Medication, and Health Facilities Essay (Critical Writing)

Introduction

People who are vulnerable are those populations of diverse groups of individuals who are at greater risk of poor physical, psychological, and social health as well as accessing timely or needed care. They are also called “underserved populations, medically underserved, medically disadvantaged, distressed populations, or American underclass (Shi, 2000).

This includes high-risk mothers, children, the poor, non-English speaking patients, disabled, those with chronic illness, suicide-prone, colored, refugees or immigrants, and those with fewer resources to improve their conditions, specifically in health (Shi, 2000).

This paper will discuss homeless women as vulnerable people and the relevance of the topic to nursing practice. Knowledge of vulnerability is important to nursing and healthcare because those who are vulnerable are more prone to disease or sickness. In understanding their plight, thinking as well as their acquisition of diseases, nurses and healthcare providers will accord proper interaction with focus of assistance on their access to health care, medication and health facilities.

Discussion

Farmer (2005) suggested that the utter disregard to the plight of the marginalized who are most vulnerable in all aspects of social benefits is the “pathologies of power” that are symptoms and signs of structural inequality (p 255).

Structural inequality is seen as something inevitable and in fact acceptable in many societies as mass media and information has conditioned societies about its presence in a way that can no longer be avoided. In healthcare, it is those with premium health insurance who are provided with the best service, facilities and medicines. If one lacks insurance, there is high possibility of neglect. Government-issued health care insurance on the other hand is not sweeping, and the lack of systematized integration to government organizations further risks marginalized persons, if ever they are given attention at all.

Czarina (not her real name) is homeless, and sleeps empty or abandoned old trucks in an inner city neighborhood, or on park bench. She is 43 years old, and had previously been employed as helper for fast food, but the business closed. She has tried to look for work but the crisis left her without possible employment for a long time. She has developed a cough and has not seen a doctor. Her cough which gets worse each day already exists for 3 months. She said that she has lost weight and on days when she cannot get food through garbage rummaging, or begging, she sleeps on an empty, painful stomach. She said that her being homeless is the biggest problem she has. She said that she had been accepted to stay with homes of strangers, but only for a short while. Some helped her get a job but it only took a couple of days and she was booted out again due to closing of business. “I wish first of all to find a home, and then, get a job. It is difficult because being homeless has affected my health. I don’t see a doctor because I don’t have insurance,” she said.

Color and gender are seen as factors of vulnerability, but a study indicated that white women were perceived in the study to be less likely insured, without regular source of care, and more likely to be ill, more likely to be hospitalized, and less access to preventive care as compared to African American. In comparing them with Hispanic women, white women are more likely to have health insurance but obtain fewer outpatient visits and tend to be more ill. White women reported more psychological stress, homelessness severity, more drug and alcohol problem, and older age (Stein, Andersen, and Gelberg, 2007).

Health insurance and regular source of care are considered enabling factors predicting all forms of care for general and homeless populations. People who have less access to care become sicker due to lack of preventive care and tend to ignore health problems that worsen over time. Other problems posed were lack of transportation and financial problems. Women who had greater illness, however, reportedly received less preventive care indicating that greatly ill homeless women of reproductive age treated for their present symptoms miss opportunities to receive standard preventive health care screenings important for women.

It is important for nurses and the general healthcare service providers to be aware of vulnerability due to:

1. greater health risk of vulnerable populations
2. increasing prevalence of vulnerability
3. social forces impact on vulnerability, therefore, societal force should remedy it
4. vulnerability is linked to overall health and resources
5. there is a need to ensure the delivery of health care in a fair and equitable manner (O’Rourke, 2007).

Individuals are placed into vulnerable groups because of :

1. Serious, life-threatening or debilitating needs
2. Require significant medical and non-medical services
3. Increasing demands of medical, public health and service sectors.
4. Complex needs not adequately met through existing services and financing mechanisms
5. Growing awareness and concerns on their challenges (O’Rourke, 2007).

Conclusion

The patient provided here who is a homeless woman is already in need of medical service but lack access to it. Women advocacy groups widely represented in media and in policy groups, surprisingly, are not as prevalent when it comes to homeless, marginalized women. Caucasian women in a distressing situation as presented need immediate attention as much as other issues of vulnerable groups. As already noted by Stein, Andersen, and Gelberg (2007), homeless women of all ethnicities are extremely vulnerable but the white women fared worse in some instances as that of Czarina. While they have recommended that health services must address disparities experienced by homeless women, it is better to have a more sweeping consideration to all vulnerable populations in health care and preventive programs where advocacy groups are much needed.

Caucasian homeless women may have been found in the study to be at a more vulnerable health condition in certain aspects compared to other ethnicities, it does not encompass all aspects of health care vulnerability. For example, more women of other ethnicity or women refugees undergo much more health care prevention challenges starting with gaining access to basic needs that directly impacts on health condition.

Color or ethnicity in the end should not be a factor in considering the healthcare insurance, access to health care or prevention. Policy on vulnerable populations should prioritize those at the bottom without neglect to the whole. Likewise, preventive measures should also be considered to ensure that coverage is widespread and effective. The present status, however of many health institutions both for the poor and the powerful seem to be in dire need of more professionals to address needs. At this instance, many forms of governmental and inter-institutional interventions are needed. Until such time that these are met, healthcare and prevention of health related problems among the vulnerable will remain a mounting problem that will only receive improvement in a trickle-down manner.

Reference

1. Aday, L.A. (2001). At risk in America: The health and health care needs of vulnerable populations in the United States. San Francisco: Jossey-Bass.
2. Farmer, P. (2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley, CA: University of California Press
3. O’Rourke, M. G. (2007). In J. L. Creasia & B. J. Parker (Eds). Conceptual foundations: The bridge to professional nursing practice (pp. 435-453). St. Louis, MO: Mosby Elsevier
4. Shi, Leiyu. “Vulnerable Populations and Health Insurance.” Medical Care Research and Review, 2000; vol. 57: pp. 110 – 134
5. Stein, Judith, Ronald Andersen, and Lillian Gelberg (2007). “Applying the Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services Utilization in Homeless Women.” Journal of Health Psychology, 2007; vol. 12: pp. 791 – 804
6. Shi, L. and Stevens, G.D. (2005). Vulnerable Populations in the United States. San Francisco, Calif: Jossey-Bass