Table 2.

Brainstorming Themes Regarding Vulnerable Populations, as Discussed at the 2017 Starfield Summit

Theme from Starfield Summit Participants' Discussion on Vulnerable PopulationsRepresentative Statements from Group Discussion Reflecting Theme
Health care should recruit and train providers to understand the needs of their community.“Rural providers often grew up in rural communities; we should be recruiting trainees from these areas to return to these areas.”
“Medical school admissions should systematically choose trainees most likely to serve the needs of populations.”
“Most medical schools have limited curricula addressing vulnerable populations and social determinants of health.”
Systemic injustices are institutional and structural, not just interpersonal.“Empowerment of the individual alone cannot be the only answer—the power of unjust structures often overwhelms individuals.”
“We cannot talk about health disparities without talking about racism. There is a historic systemic inequity society is still trying to overcome.”
“We need to consider oppressive societal forces, as opposed to focusing on vulnerable individuals or populations.”
The elimination of injustice requires the solidarity of the advantaged.“Physician advocacy for health and rights of vulnerable populations is important.”
“What happens to marginalized groups impacts all of society, and if injustices like racism and poverty are to be eradicated, those of us who are privileged need to do our part.”
“There is a lack of knowledge and willingness for physicians to unpack what upholds our privilege, and this perpetuates the -isms.”
Data collection of various social factors helps us better understand health inequity and intersectionality.“There must be recognition that certain vulnerabilities are currently invisible. Patients need to be asked about these.”
“As certain vulnerable groups become more isolated, we must develop new methods for reaching them.”
“When social data is collected, it needs to be correct, useful, and accurate. It's not 'Asian,' but Korean, Vietnamese, Taiwanese, etc.”
“Qualitative data is important for understanding patients and their experiences better. Open ended questions such as 'Who are you?' may provide more useful information.”
Collection of SDH data is insufficient alone; various factors contribute to interpreting data responsibly.“Analysis of a large single subpopulation eliminates the individual challenges faced by those who may fall into multiple vulnerable groups.”
“There is missing or vague data that prevents informed decisions. For example, socioeconomic status is not often systematically queried, and immigration status might not be shared due to stigma and fear.”
“Categories are not necessarily stagnant; for example, sexual orientation or socioeconomic status can change for individuals over time.”
The system may need initial unequal investments to create equity for all.“Academic health centers should make disproportionately higher investments in vulnerable populations they care for.”
“We need to redistribute privilege. Dismantling systemic and historic inequities is a health intervention, just like treating pneumonia.”
“Often, making policies for one subgroup can cause others to feel left out or increasingly marginalized.”
Policies should support a workforce working with vulnerable populations.“Medical education should develop robust training programs in areas of need and these sites should get incentives to do so.”
“The system should develop financial and resource support for smaller clinics and hospitals, which often serve vulnerable patients.”
“Often, it may be beneficial to bring health care to individuals who are vulnerable rather than having them overcome barriers to present at a health care institution.”
  • SDH, social determinant of health.