Recognizing and Advocating for Healthcare for Underserved Populations

Nurses are often in the unique position to identify instances when factors beyond physical health are impacting their patients. Poor living conditions, barriers to healthcare, and the inability to afford medication can compound, and sometimes exacerbate, medical conditions. In vulnerable populations, this can lead to challenges in providing healthcare for underserved populations.

In certain U.S. communities, limited access to healthcare persists due to socioeconomic constraints, distant healthcare facilities, and a lack of insurance. Understanding these barriers to care and the burdens they place on the vulnerable and underserved populations allows nurses to make a meaningful impact on their patients’ healthcare journey.

Who are the vulnerable and “underserved” populations?  

The terms vulnerable and underserved are sometimes used interchangeably, but they are two distinct groups. Both have their own risk for poor outcomes, but they can also overlap. A vulnerable individual or group has certain traits that make them more likely to have poor health outcomes. Examples include: 

  • Serious medical conditions (chronic or acute) 
  • Older adults 
  • Disabled individuals 
  • Pregnant women 
  • Homeless individuals 
  • Racial and ethnic risk factors 
  • Refugees 
  • Victims of abuse or neglect 
  • Veterans 

Recommended course: Introduction to Rural Nursing: The Center of Care for 60 Million Americans

Underserved individuals face barriers to having proper medical care. These groups include:  

  • Rural communities 
  • Low income or homeless 
  • Uninsured 
  • Those with physical or intellectual disabilities 
  • Refugees or non-English speaking  
  • Groups that report feared or experienced discrimination from healthcare workers 
  • Racial and ethnic minorities 
  • LGBTQ+ community 
  • Various other groups that face possible discrimination  

Some individuals may be vulnerable, but not underserved. For example, a wealthy person diagnosed with cancer is vulnerable, but has access to high quality healthcare, excluding them from the underserved category. Vulnerable populations may have medical issues that are also exacerbated by socioeconomic factors. 

Examples of vulnerable and underserved populations 

The populations at greatest risk for poor health outcomes are those that fall in both groups. The following are examples: 

  • Homeless and living with a chronic condition such as diabetes, hypertension, or mental illness.  
  • An older adult living alone and in an isolated, rural area with limited transportation. 
  • Non-English-speaking and uninsured and with young children, poor housing, and low food supply. 
  • Transgender (or other LGBTQ+) with a history of discriminatory treatment and contraction of an infectious disease. 
  • An unemployed veteran with undiagnosed mental disorder and development of alcohol or substance abuse disorder. 

Statistics on underserved populations 

Here are just a few statistics on underserved populations. While these numbers are representative, there are many others like it.  

  • More than half a million people experienced homelessness across the United States in 2022. The vast majority were individual adults (72%), but a notable portion were families with children (28%) (NAEH, 2023). 
  • Food insecurity, which is limited or uncertain access to adequate food, affects more than 12.7% of U.S. households (AAMC, 2023). 
  • About 25% of rural children live in poverty (USDA, 2019). 
  • The prevalence of life-threatening conditions such as asthma, diabetes, and heart disease are higher among those is rural areas and those living in poverty (UDSA, 2019) 
  • Approximate 9.6% of those in the U.S. are uninsured (Tolbert & Drake, 2023). 

Recognizing external and internal factors 

Both internal and external factors contribute to barriers to healthcare for underserved populations. Social determinants of health (SDOH), an external factor, have a profound impact on an individual’s health, well-being, and quality of life.  

Examples of SDOH include: 

  • Safe housing and transportation 
  • Education, job opportunities, and income 
  • Access to adequate food 
  • Language and literacy skills 
  • Racism, discrimination, and violence 

Current initiatives to help overcome barriers to healthcare for underserved populations 

There are meaningful initiatives already in action to help bridge gaps in delivery of healthcare to these populations, and nurses have a tremendous opportunity to contribute. Efforts include federal, state, and local programs, organizational initiatives, and independent humanitarian projects. 

In 2020, the U.S. Department of Health and Human Services launched its Healthy People 2030 initiative, a 10-year project aimed at improving health outcomes. A major goal is creating access to quality healthcare services across the nation. 

A few of the strategies to accomplish policy-level changes in health equality are: 

  • Improve social determinates to promote healthy living. The most common health-related social challenges include lack of employment, food and housing insecurity, poor social support, and illiteracy (DHHS, 2021). Improving social determinates of health helps address the root of the problem. 
  • Make health insurance more affordable through healthcare policy. For decades, nurses have played a significant role in advocating for healthcare legislation and reforms. From protecting patients’ rights to providing healthcare for underserved populations to expanding benefits, nurses lead the way in advancing healthcare policy. 
  • Provide access to virtual healthcare. Virtual healthcare provides a bridge to those who have either physical or geographical obstacles to seeking health care. Providers use technology to examine and diagnose patients and perform high-tech monitoring. Virtual healthcare could be used to improve the management of chronic diseases, treat minor illnesses, and support primary care access. 
  • Support and strengthen community healthcare access and humanitarian efforts. Community leaders, faith-based organizations, hospitals, and local authorities often support initiatives that support vulnerable and underserved populations in their own communities.  

A nurse’s role in healthcare policy 

Healthcare policy is a broad term used to describe the plans, evaluations, and actions that deliver healthcare to a community. It encompasses laws, regulations, guidelines, and initiatives that impact patient care and population health. Some general ways that nurses can impact healthcare policy include:

  • Stay informed 
  • Join professional organizations 
  • Educate others 
  • Serve on committees 
  • Advocate or lobby 
  • Engage in research 

How to advocate for underserved populations in healthcare 

Here are eight simple ways for nurses to get involved right away. 

  1. Find a reliable group advocating for underserved or vulnerable individuals on social media. Can’t find one? Consider creating your own. 
  2. Donate money or time to legitimate charitable organizations. 
  3. Volunteer at a clinic providing free vaccinations or medical care. 
  4. Write articles for a local or regional newspaper or establish an awareness-raising initiative within the community. 
  5. Join a professional organization with a substantial platform or serve on a committee (such as American Nurses Association or National League for Nursing). 
  6. Communicate with legislators on current policies or bills. 
  7. Explore career opportunities in humanitarian groups or government agencies at the national, state, or local level that focus on public health. 
  8. Engage in research opportunities.