Content area
Full Text
Values affect how society views the vulnerable-as victims or sinners-and thus whether or not to provide public assistance.
ABSTRACT:
Vulnerability, the susceptibility to harm, results from an interaction between the resources available to individuals and communities and the life challenges they face. Vulnerability results from developmental problems, personal incapacities, disadvantaged social status, inadequacy of interpersonal networks and supports, degraded neighborhoods and environments, and the complex interactions of these factors over the life course. The priority given to varying vulnerabilities, or their neglect, reflects social values. Vulnerability may arise from individual, community, or larger population challenges and requires different types of policy interventions-from social and economic development of neighborhoods and communities, and educational and income policies, to individual medical interventions. [Health Affairs 26, no. 5 (2007): 1220-1230; 10.1377/hlthaff.26.5.1220]
More than twenty years ago Health Af fairs published a special fifth-anniversary issue on health and poverty (Spring 1987). It focused on many population groups that today would be regarded as "vulnerable," consistent with Webster's definitions as "capable of being physically wounded" and "open to attack or damage." But the concept of vulnerability never appears in the issue or even in the index of the prior five years of work. That brings up the question: Are the issues discussed in the present volume the same as those discussed earlier, with new labels, or have fundamental shifts occurred in our perspectives?
* Then. The 1987 publication focused on people who were poor, uninsured, homeless, elderly and frail, and suffering from a range of chronic diseases, or special populations in need such as Native Americans and low-income veterans, a list not much different from one we might arrive at today. But there are some apparent differences. The earlier issue reflected the dominance of health services and focused on health interventions directed to people in need. Analysts appreciate even more now the value of advances in biomedical knowledge and technology for reducing vulnerability, but we also better understand that much more than health care delivery and changing individual lifestyles is required.1 The 1987 journal issue gave litde attention to the long-term determinants of population vulnerabilities-"upstream" factors.
* And now. Much has happened since spring 1987, including the AIDS epidemic, welfare reform, passage of the Americans with Disabilities Act, broad-scale federal...