Being vulnerable refers to the capability of incurring physical or emotional harm. For example, illnesses display a person’s physical vulnerability. Similarly, grief and depression reflect emotional hurt. Vulnerability can be described as the state of the physical and emotional well-being at risk of being disturbed due to susceptibility to social and environmental factors (Boldt, 2019). A healthy body is susceptible to harm, muscle loss, and infections in healthcare settings—an individual with a severe medical condition may experience cognitive vulnerability. Vulnerable populations include minority groups, low-income families, and people with diseases or disabilities (Clark & Preto, 2018). This review will focus on African Americans as the vulnerable population. African Americans are susceptible to health risks, mainly cardiovascular diseases, due to racial discrimination, socioeconomic status, negative behaviors like smoking and taking fast food diets, and genetic variation; it is the responsibility of MSN-prepared nurses to reduce health inequities.
Concept Map Overview
African Americans are at the highest risk of contracting diseases. This trend can be traced back to the slavery system, which forced African Americans to live in deplorable physical and social conditions (Bailey et al., 2017). For this reason, African Americans encountered physical, social, and mental challenges. Although African Americans are no longer slaves, their health outcomes have not improved due to systemic discrimination and oppression (Bailey et al., 2017). Currently, most African Americans experience suffering and early death. Compared to other races and ethnicities in the US, African Americans are at higher risk of contracting diseases like HIV, cancer, and coronary heart disease (Lewis & Dyke, 2018). The factors that contribute to this outcome include racial discrimination, health behaviors, socioeconomic status, and lack of access to care.
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Risk Factors
One of the variables that place African Americans’ health at risk is racial discrimination. African American men are likely to experience racial profiling from the police, including excessive force, routine stops, and arrests (Lewis & Dyke, 2018). Similarly, African American women experience double racial discrimination, including expletive comments about their skin and body. According to a recent study, discrimination is associated with increased cortisol levels, resulting in stress activation (Lewis & Dyke, 2018). Indeed, racial discrimination is a risk factor for mental and psychological problems like depression and eating disorders. Socially, racism denies African Americans access to health services and forces them to work in unsafe environments.
Another risk factor is poverty. Most African Americans lack fundamental human needs, such as clean water, education, proper housing, and nutrition (Lewis & Dyke, 2018). Compared to other ethnic groups, African Americans earn the lowest income in the USA. Poverty is linked to adverse health outcomes and increased morbidity and mortality. As a result, conditions such as type 2 diabetes, obesity, high blood pressure, heart diseases, and low birth weight are prevalent in the African American community (Bailey et al., 2017). Although some African Americans are employed in the formal sector, they receive low salaries and are less likely to be promoted than their white counterparts. For this reason, African Americans live in neighborhoods that are close to toxic waste sites, heavy drug use, and violence, which put their health at risk.
The third factor is negative health behaviors among African Americans. Racial discrimination and microaggressions toward African Americans encourage maladaptive coping behaviors such as alcohol consumption and smoking (Bailey et al., 2017). Although racism has a significant impact on African American’s behaviors, neighborhood and environmental influences also play a role. In most African American neighborhoods, older adults who serve as role models influence young people to take drugs like crack. Besides, pop culture praises the use of drugs as a coping mechanism. African Americans from low-income backgrounds are likely to consume fast foods since they have multiple shifts. Most of them do not have time to learn and teach their children about healthy diets.
The most prevalent health-risk among African Americans is cardiovascular diseases. The traditional African American diet comprises fast foods due to a lack of affordable healthy choices (Der Ananian et al., 2018). African Americans consume foods rich in fructose, white flour, and sugar that impair the heart’s functioning. They believe that healthy foods are expensive, while others claim that fast foods are easy to prepare. As a result, African Americans are three times more likely to develop cardiovascular diseases, such as congestive heart failure, coronary heart disease, stroke, and arrhythmias, compared to other races (Der Ananian et al., 2018). Coronary heart disease is among the leading cause of death in the African American community. Since most African Americans do not have a comprehensive health insurance cover, they are unlikely to visit healthcare facilities to check on high blood pressure parameters.
Interrelationship between Risk Factors
Racial discrimination, socioeconomic status, and adverse health behaviors are interrelated in the African American community. The systemic racial discrimination has propagated the stigma of inferiority among African Americans leading to impaired patient-provider relationships (Bailey et al., 2017). Some African Americans experience substandard medical treatment due to racial bias. Besides, low-income in most African American families make it impossible for them to access quality medical care and physical fitness regimens (Der Ananian et al., 2018). Living in poverty, experiencing racial prejudice, and having many commitments causes stress in African Americans. As a result, they smoke and drink to suppress stress and depression.
Implications for Advanced Nursing Practice
MSN-prepared nurses have the role of advocating for African Americans’ rights. At the national level, MSN-prepared nurses should use their knowledge, power, and influence to change the policies that discourage access to health care among African Americans ( Staebler et al., 2017). They need to assess and reshape the policies that promote patient-centered, safe, and effective, and equitable care to African Americans within the healthcare system. For example, they need to advise the health industry leaders to hold seminars and provide advertisements that promote culturally relevant messages about the risks, signs, and prevention of cardiovascular diseases (Der Ananian et al., 2018). Such policy will provide statements that African Americans can understand. One of Healthy People 2020 is to increase access to health services, address mental health, and reduce substance abuse ( Cardiovascular Disease: Interventions Engaging Community Health Workers, n.d. ). These issues are common in the African American community, and MSN-prepared nurses have to address them.
Overall, African Americans are among the most vulnerable populations. Most of the health problems they experience originate from racial bias. Systemic racism has prompted African Americans to have multiple jobs, take unhealthy foods, and live in unsafe neighborhoods. These factors have contributed to negative health behaviors like smoking and drinking. MSN-prepared nurses can address these issues by providing messages that target African Americans’ health problems, such as heart conditions. They can also hold seminars in African Americans neighborhoods to enhance access to care.
References
Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet , 389 (10077), 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X
Boldt, J. (2019). The concept of vulnerability in medical ethics and philosophy. Philosophy, Ethics, and Humanities in Medicine , 14 (1), 1-8. https://doi.org/10.1186/s13010-019-0075-6
Der Ananian, C., Winham, D. M., Thompson, S. V., & Tisue, M. E. (2018). Perceptions of heart-healthy behaviors among African American Adults: A mixed-methods study. International Journal of Environmental Research And Public Health , 15 (11), 2433. https://doi.org/10.3390/ijerph15112433
Cardiovascular disease: Interventions engaging community health workers . (n.d.). Healthy People 2020. https://www.healthypeople.gov/2020/tools-resources/evidence-based-resource/cardiovascular-disease-interventions-engaging-community
Clark, B., & Preto, N. (2018). Exploring the concept of vulnerability in health care. Canadian Medical Association Journal , 190 (11), E308-E309. https://doi.org/10.1503/cmaj.180242
Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the health of African Americans: The potential importance of intersectionalities. Current Directions in Psychological Science , 27 (3), 176-182. https://doi.org/10.1177/0963721418770442
Staebler, S., Campbell, J., Cornelius, P., Fallin-Bennett, A., Fry-Bowers, E., Kung, Y. M., Miller, J., et al. (2017). Policy and political advocacy: Comparison study of nursing faculty to determine current practices, perceptions, and barriers to teaching health policy. Journal of Professional Nursing , 33 (5), 350-355. https://doi.org/10.1016/j.profnurs.2017.04.001
