Understanding the Complex Health Risks Faced by Marginalized Populations

PART A

Health risks impact groups differently, with marginalized populations frequently encountering a network of intertwined challenges that heighten their vulnerability to adverse health outcomes. As a family nurse practitioner (FNP) student, grasping these complexities is crucial for delivering compassionate and effective care. This post examines the factors that contribute to health disparities among marginalized groups, particularly what makes these populations more prone to chronic diseases, substance use, and mental illness. It also provides insights on how practitioners can better support these communities.

Community health clinic serving marginalized populations

Determinants that Increase Risk for Chronic Disease, Substance Use, and Mental Illness in Marginalized Populations

As we have reviewed throughout this semester, and I have touched upon in past blog posts, SDOH have direct correlation to the health and well being of marginalized populations. But lets take a second to clearly define 'Marginalized Populations'.

"Marginalized populations refer to groups that experience social, economic, or political inequalities, often leading to exclusion from mainstream society. These groups may face barriers to access resources, opportunities, and basic rights (Fiveable, n.d.).

Its vital for FNP's and practitioners to understand these marginalized populations so that we can give them the most appropriate and effective care.

Here are a few examples of determinants that increase the risk for chronic disease, substance use/abuse, and mental illness.

• Economic instability - poverty, unemployment, housing insecurity. CDC identifies lower socioeconomic status as a major driver of chronic disease and mental illness disparities among racial and ethnic minorities (CDC, 2024).

• Limited access to healthcare - The WHO notes that marginalized groups face barriers to care due to cost, lack of transportation, and discrimination in health systems (WHO, 2023).

• Racism, discrimination and chronic stress - The American Public Health Association shows racism as a determinant that increases chronic disease burden in Black and Indigenous populations (APHA, 2023).

• Trauma exposure - Substance Abuse and Mental Health Services Administration (SAMHSA) reports that trauma are highly prevalent among people who use substances or have mental illness (SAMHSA, 2023).

• Food insecurities - United States Department of Agriculture (USDA) reports food insecurity disproportionately affects low-income and minority populations (USDA, 2024).

Soft White Underbellies

For a couple of years now I have been following Mark Laita and his remarkable YouTube videos. His portrayal of not only addiction, but abuse and mental illness in general could not be more raw and vulnerable. I have been fascinated with people he interviews, sad for the unimaginable stories he captures, and baffled that this is reality for some.

As with many of us, the story of 'Rebecca' has now gained world wide recognition. Our hearts go out to her each and every video. Mark has built this relationship with her, and he clearly wants the best for Rebecca. I find myself searching for updates when there hasn't been a video from her in a while. Every single time hoping she chooses the right path from Mark and his team, sad that she never takes his help and continues to suffer at the hand of addiction and mental illness. Here's the most recent video from Rebecca...

https://www.youtube.com/watch?v=eXDlGeKWh-4&rco=1

Rebecca's videos showcase just how addiction is not just a choice, but a disease that has skewed her reality and her neurological physiology to the point where help is not attainable. Mark seems to never give up, stay tuned...

The Role of Family Nurse Practitioners

At the end of the day, as future family nurse practitioners, we will be on the front lines of care for diverse populations. Our role includes:

• Building trust with patients who may have experienced healthcare discrimination.

• Educating patients about managing chronic conditions within their social context.

• Identifying and addressing barriers to care.

• Promoting health equity through advocacy and community engagement.

  
  

By understanding the complex health risks marginalized populations face, you can tailor your care to be more effective and compassionate. This knowledge also prepares you to be a leader in transforming healthcare systems to better serve all communities.

Nurse practitioner providing personalized care to a marginalized patient

PART B

In 2022 Fine et al. presented staggering statistics regarding 60,000 individuals experiencing homelessness in the greater Boston, Massachusetts area. Focusing their attention to homelessness, addiction, mortality rates and overdoses. Here are some of their statistics that struck me:

• 7130 individuals died by the end of the study period (2003-2018).

• A total of 1727 individuals (24.2%) died of a drug overdose.

• In 2018, synthetic opioids were involved in 96.1% of all opioid-involved deaths compared with 0% in 2004.

• Drug overdose mortality increased 81% between 2004 and 2018.

 Its findings emphasize the need for low-threshold addiction treatment, widespread naloxone distribution, harm-reduction strategies, and supportive housing as essential components of overdose prevention and improved health outcomes for this marginalized population.

References

American Public Health Association. (2023). Racism is a public health crisis. https://www.apha.org

Centers for Disease Control and Prevention. (2024). Social determinants of health: Know what affects health. U.S. Department of Health & Human Services. https://www.cdc.gov

Fine, D. R., Dickins, K. A., Adams, L. D., et al. (2022). Drug overdose mortality among people experiencing homelessness, 2003 to 2018. JAMA Network Open, 5(1), e2142676. https://doi.org/10.1001/jamanetworkopen.2021.42676

Fiveable. (n.d.). Marginalized communities (Intro to Public Health). Retrieved from https://fiveable.me/key-terms/introduction-public-health/marginalized-communities

Substance Abuse and Mental Health Services Administration. (2023). Trauma and violence. U.S. Department of Health & Human Services. https://www.samhsa.gov

United States Department of Agriculture. (2024). Food security status of U.S. households. https://www.usda.gov

World Health Organization. (2023). Social determinants of health. https://www.who.int