Running Head: Vulnerable Populations in Homeless Military Veterans 1

Vulnerable Populations in Homeless Military Veterans

Elizabeth Shook

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

April 4, 2017

Honor Code “I pledge.”

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Vulnerable Populations in Homeless Military Veterans

All my life I have heard that soldiers were the reason we have freedom in the United

States. I grew up under the notion that veterans and soldiers were brave selfless warriors with

which no one could compete. It would make since that they would always be treated as such. As

an adult, and as an adult studying health care and medicine, it quickly came to my attention that

this is not always the case. So why is this an important topic and a vulnerable population? This

discussion will show that veterans are more likely to suffer from malnutrition, mental health

disorders, and communicable diseases. I have a sister-in-law who works as a grief and family

counselor, is married to a Marine veteran, and she makes it her life’s work to treat and help those

veterans especially those with mental illness and those who suffer from homelessness. She’s seen

first hand the depth of the issues and disparities that affect these heroes. So why does this mean

health care professionals need to worry? According to Dr. Shi et. al. there are three main reasons

that vulnerable populations are a concern to the United States health care industry: the United

States population health is ranked lower than other developed countries, the number of

vulnerable populations in the US is growing, and the US was founded on the ideals of freedom

and it is logical that freedom should extend to health care (Shi et. al. 2008).

Social Determinants of Health

According to a research article published in the American Journal on Addictions

“Homelessness is associated with an array of deleterious health problems, including

malnutrition, violence, incarceration, diabetes, tuberculosis exposure, substance use, and mental

health diagnoses (Dunne 2015).“ Social determinants of health are defined as “the structural

determinants and conditions in which people are born, grow, live, work and age. They include

factors like socioeconomic status, education, the physical environment, employment, and social
Vulnerable Populations in Homeless Military Veterans 3

support networks, as well as access to health care (Heiman 2015).” For veterans some examples

might include their upbringing, their experience in the military, their jobs during and after the

military, and the environment in which they live. These factors can determine the path to

homelessness. The way veterans can become homeless is well defined in The American Journal

of Public Health. “Combat, wartime trauma, and posttraumatic stress disorder (PTSD) sometimes

contribute to a downward spiral of depression, substance abuse, broken relationships,

unemployment, and isolation—which may lead to homelessness (Donovan 2013).” Also, in a

study about the incidence of homelessness in veterans, “Persons who subsequently became

homeless were disproportionately among those with the lowest pay (72% of the homeless came

from the 44% who had the lowest pay grades) and among those diagnosed with behavioral health

disorders before separation from the military (Metraux 2013).” One of the biggest social

determinants of health care and health disparities include access to health care. A homeless

veteran might not have a job to pay for health care or a place of residence, which can lead to

non-compliance. In addition there might not be a veteran’s hospital or clinic, which specializes in

the physical and mental health disparities commonly seen in homeless veterans, such as PTSD,

amputation, or depression. An example of this is in a study lead by Dr. O’Toole “Homeless

people face multiple barriers to health care including transportation, limited availability and

fragmentation of health care services, difficulty scheduling and keeping appointments, perceived

or actual stigma of homelessness, lack of trust, social isolation, and competing sustenance needs

(O’Toole 2016).”

Evidence-based Interventions Addressing Health Needs

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Intervention and prevention is key in addressing not only the homeless status but also the

health disparities that accompany it. In September 2000, at the Millennium Summit, the United

Nations came up with eight Millennium Development Goals (MDGs) to combat the rising health

disparities around the world. One of the goals is eradicating extreme poverty (Millennium

Project 2002). As formerly noted, poverty is a precursor to homelessness among veterans. One

intervention from the US Departments of Housing and Urban Development and Veteran Affairs

is Housing First, “an emerging, evidence-based best practice for assisting people experiencing

chronic homelessness to obtain and maintain permanent housing. Additionally, the Housing First

model also assists with access to health care, employment, and other supportive services that

promote long-term housing stability, reduce recidivism, and improve quality of life (Donovan

2013).”

Global Approach in Addressing “Health for All”

Three of the biggest health concerns for homeless veterans is malnutrition secondary to

extreme poverty, mental illness, and communicable diseases. It is necessary for world

organizations to contribute to and provide programs for health for all. As aforementioned, the

World Summit utilized the MDGs to provide goals for the globe to attain. However the next step

is planning and implementing the programs put in place. The health leaders of tomorrow need to

be properly trained in order to provide equal health for all. One key example is in Rwanda, the

site of terrible genocide. In 2012 the health ministry in Rwanda opened a program that the US

participated in by sending faculty from nursing, medical, and health management schools for

mission trips at teaching hospitals that spanned upwards of a year (Adams 2016). In addition to

training, infrastructure and national and international programs need to be placed in order for
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‘Health for All’ to be obtained. Two global programs are for mental health and poverty. An

example of the mental health treatment and prevention programs instituted by the World Health

Organization (WHO) is one found in Indonesia. “In the province of Aceh in Indonesia, in the

post tsunami period, the Ministry of Health and the World Health Organization set up a

community-based mental health system integrating mental health services within primary

healthcare facilities, with secondary mental care available at the district general hospitals and

tertiary and specialized care provided at the provincial general hospitals level (Trani 2016)”. This

is known as the WHO Mental Health Gap Action Plan. Another example of global help concerns

communicable diseases. Out of the MDGs and their goal to eradicate HIV/AIDS and other

communicable diseases stemmed the Global Fund to Fight AIDS, Tuberculosis, and Malaria

(Nakatani 2016). Its purpose is the reduce infection and reduced life quality by helping to stop

the spread of preventable diseases such as these (Nakatani 2016).

Conclusion

In conclusion, health disparities in homeless veterans include untreated health problems,

extreme poverty, and communicable diseases. It is important for the world and international

organizations to participate in monitoring, identifying, and intervening in health disparities in

homeless veterans. The World Summit MDGs include eradicating extremely poverty and

promoting health for all over the lifespan. This goes hand in hand with the causes behind

homelessness in veterans, and will be instrumental in helping to alleviate the suffering among

this vulnerable population. Future nurses and other health care providers will need to be aware of

the causes and issues in this group in order to be able to provide equal and evidenced based

treatment and care for homeless veterans, especially since we are still in military conflict with

other countries.
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References

Adams, L. V., Wagner, C. M., Nutt, C. T., & Binagwaho, A. (2016). The future of global health
education: training for equity in global health. BMC Medical Education, 16(1), 296.

Donovan, S., & Shinseki, E. K. (2013). Homelessness Is a Public Health Issue. American
Journal Of Public Health, 103(S2), S180.

Dunne, E. M., Burrell, L. E., Diggins, A. D., Whitehead, N. E., Latimer, W. W., &
Burrell, L. 2. (2015). Increased risk for substance use and health-related problems among
homeless veterans. American Journal On Addictions, 24(7), 676-680.
doi:10.1111/ajad.12289

Heiman, H. J., & Artiga, S. (2015, November 4). Beyond Health Care: The Role of Social
Determinants in Promoting Health and Health Equity. Retrieved April 05, 2017, from
http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-
determinants-in-promoting-health-and-health-equity/

Metraux, S., Clegg, L. X., Daigh, J. D., Culhane, D. P., & Kane, V. (2013). Risk Factors for
Becoming Homeless Among a Cohort of Veterans Who Served in the Era of the Iraq and
Afghanistan Conflicts. American Journal Of Public Health, 103(S2), S255-S261.

Nakatani, H. (2016). Global Strategies for the Prevention and Control of Infectious Diseases and
Non-Communicable Diseases. Journal Of Epidemiology, 26(4), 171-178.
doi:10.2188/jea.JE20160010
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O'Toole, T. P., Johnson, E. E., Aiello, R., Kane, V., & Pape, L. (2016). Tailoring Care to
Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans
Health Administration's "Homeless Patient Aligned Care Team" Program. Preventing
Chronic Disease, 13E44. doi:10.5888/pcd13.150567

Shi, L., Dr. PH, MPA, MBA, Stevens, G. D., PhD, MHS, Faed, P., MPH, & Tsai, J., Ed.D.
(2008). Rethinking Vulnerable Populations in the United States: An Introduction to a
General Model of Vulnerability. Harvard Health Policy Review, 9(1), spring 2008, 43-48.
Retrieved April 4, 2017, from http://www.jhsph.edu/research/centers-and-
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Trani, J., Ballard, E., Bakhshi, P., & Hovmand, P. (2016). Community based system dynamic as
an approach for understanding and acting on messy problems: a case study for global
mental health intervention in Afghanistan. Conflict & Health, 101-11.
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UN Millennium Project | About the MDGs. (2002). Retrieved April 06, 2017, from
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