Vulnerable Doesn’t Mean Less Than: Giving Vulnerable Populations the Same Human Standard

The term “vulnerable” comes at a cost. Used to describe “individuals who are at greater risk of poor physical and social health status,” populations are considered vulnerable because they are marginalized and treated unequally. Populations typically seen as vulnerable include people with disabilities, refugees, asylum-seekers, racial minorities, women, children, 2SLGBTQ+ communities, and older people. Categorizing vulnerability can help identify those to whom more attention should be paid, and situations addressed to be made more equal, but this labeling can result in negative social consequences for such individuals, potentially rendering the term more harmful than beneficial. 

The Issue of Vulnerability: Privileging the Physical Over the Social 

I recently watched an interview called “Help Without Borders” on TVP World, a Polish news channel, that explained how Ukrainian refugees who had fled to Poland following the Russian invasion earlier this year were provided with physical safety and provisions, such as food and shelter, but had difficulty connecting with the local Polish community. Feeling socially isolated, many refugees chose to return to Ukraine, where their physical lives would be in danger, but their social needs could be met. To them, social connectedness was more important than their physical safety.  

The interview had me reconsidering what I understood of vulnerability. I had already known that the term “vulnerable” has been problematized, considered controversial, and heavily critiqued, with criticisms including the ambiguity of the term and the “othering” that occurs when people are classified as vulnerable. What I hadn’t fully considered is that efforts to mitigate vulnerabilities and give equal opportunity to people considered vulnerable often prioritize the physical needs of people at the cost of neglecting their social needs. Simply put, when populations are considered vulnerable, their physical needs are considered important while their social needs are not.  

I had found similar attitudes towards people with disabilities while conducting research in Uganda on the lived experience of disability. People without disabilities were so focused on the material needs of people with disabilities that social inclusion was not considered. People believed that as long as the material needs of people with disabilities were met, they should need nor want for nothing more.  

One Ugandan I interviewed told me, “People with disabilities don’t need friends. They need money.” Food, shelter, and money were typically seen as the things people with disabilities needed the most, while social inclusion and connection were glaringly absent. In one case, a neighbor of a man with severe epilepsy whose family refused to give him food due to his epilepsy told me how she would give the man food to eat, but refused to talk to him because of his disability. While this is an extreme example of how the physical and social needs of people with disabilities are seen as completely separate, it was a sentiment that I noticed was widely held, in varying degrees, among the people I interviewed. 

People with disabilities are heavily impacted by this social ostracization. The man whose neighbor refuses to converse with him spends most of his time alone, and his only meaningful connection is one person who is more than 40 years older than him. At the time I interviewed him, he was living in a rural village and expressed how much he disliked where he was, since the people were unfriendly and did not like him. He was hoping to move to a larger city in the future, where he could have a better social life.  

Similarly, another research participant shared how she did not have people she could talk to in her community. She told me, “I feel alone.” Referring to the four times I interviewed her, she said, “When you come and talk to me and we are talking and conversing, that makes me happy.”  

Not all the people with disabilities I interviewed in Uganda had difficulty finding social connection. Some had flourishing social lives with other people with disabilities, and others had robust social connections with both people with and without disabilities. For some, social isolation, or more specifically, solitude, was a choice after multiple negative social interactions with people who discriminated or abused them due to their disabilities. People with disabilities had various social experiences and expectations, but to each person, social connection was an important part of their lives and something they desired, whether or not this was provided by those around them.  

Differing Standards, Significant Consequences 

People in vulnerable categories are often defined only by their physical needs, but when talking about traditionally non-vulnerable populations, social inclusion and connectedness are often considered an important part of well-being. During the beginning of the COVID-19 pandemic, social connection was given the spotlight, as the negative effects of social isolation, especially loneliness, were becoming increasingly impossible to ignore in a lockdown world. Social connection was recognized as integral and necessary to well-being, with numerous studies being published detailing how detrimental social isolation is to mental health.  

People who craved community during lockdown found ways to connect. In Italy, balconies became the new social stage. From opera singers to classically-trained musicians to everyone in between, people in Italy went out onto their balconies and sang or played music to neighbors as a way to connect with others and boost morale. In Spain, people held concerts, played bingo, and even hosted parties on their balconies. In the United Kingdom, when interaction between households was prohibited, the government introduced “support bubbles,” which allowed people who lived alone to join another household so they could have access to the social and mental support only found through social connection. Mental health and well-being became increasingly important topics as people struggled with social isolation.  

At a time when social connection was being increasingly recognized as a basic human need, vulnerable populations were excluded. During the start of the pandemic, regarding people as “vulnerable” became commonplace. Older people, people with disabilities, and people with underlying medical conditions were classified as “vulnerable,” or even “extremely vulnerable,” since their risk of experiencing severe symptoms of COVID-19 are higher than that of other populations. The solution to their vulnerability was social isolation, which protected them from the physical effects of the virus but also simultaneously made them more vulnerable to the psychological harms of social isolation.  

When non-vulnerable populations were given avenues to social connection in a world that necessitated social distancing, vulnerable populations were not given the same access. There were some efforts to protect the social well-being of vulnerable populations through weekly check-in phone calls, but much of the help offered to those who were socially isolating were practical and focused on physical needs, such as neighbors dropping off groceries or delivering medication. Simply put, social connection was overlooked to those who were considered vulnerable. Instead, vulnerable populations were helped physically and left to deal with their social isolation, ironically, alone.  

My point is not to negate the importance of protecting the physical health of individuals who are more vulnerable to worse outcomes from COVID-19. There is no doubt that physical distance helps protect individuals who are more at risk of experiencing severe symptoms of COVID-19, but this does not mean that social and mental well-being should be sacrificed or seen as an acceptable loss in exchange for physical well-being. Social well-being is not a payment or trade-off for physical well-being. It is, rather, a basic human need to which everyone should have access. The social well-being of non-vulnerable populations is considered important. The social well-being of individuals falling under the vulnerable category should equally be considered important, not as a privilege or luxury that vulnerable populations cannot afford.  

This is even more important, considering vulnerable populations are often already more socially isolated. People with disabilities report significantly higher rates of loneliness than people without disabilities, with almost two third of people with disabilities in the United Kingdom experiencing “chronic loneliness.” Older adults in the United States have increased risk for loneliness and social isolation, which can lead to dementia and serious medical conditions such as premature death, heart disease, and stroke. The pandemic exacerbated social isolation and loneliness, but little was done to combat this until the damage was already done. A review of 50 research papers published on COVID-19 health impacts highlighted that vulnerable individuals have worse mental health outcomes than non-vulnerable individuals after the emergence of COVID-19. In Wales, many vulnerable individuals who were “shielding,” essentially a friendlier word for socially isolating, developed depression and/or anxiety as a result of such extreme social isolation.  

While the physical health of vulnerable populations have been prioritized over social health, ironically, neglecting social health results in negative physical consequences. Social isolation can cause physical pain in individuals, also known as “social pain.” Social isolation and loneliness can reduce cognitive and physical function and increase mortality, morbidity, and cardiovascular disease. According to the World Health Organization, social isolation and loneliness has comparable effects on mortality as smoking, obesity, and physical inactivity. Social connectedness, alternatively, has powerful, positive health impacts and can develop and maintain cognitive abilities, physical abilities, and health. Social connection can also be a protective factor materially. According to Robert Putnam, social connection leads to social capital, the “features of social organizations such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit,” which then leads to “collective benefits.”  

A Different Approach 

Despite the overwhelming evidence for the importance of social connectedness, somehow the importance of social connection becomes lost when discussing groups labeled as “vulnerable.” Their needs, instead, are reduced to just the material and physical, and they aren’t afforded the same non-physical needs that have been established to be such an important part of the well-being of others’ lives. Instead of sacrificing social connection, perhaps the better approach is to do the opposite of what is currently being done. What if instead of eliminating social connection first, we prioritize social connection? Addressing only physical needs does not result in social well-being and in fact often comes at the price of worse social well-being, but establishing and maintaining social health has shown to result in both positive social and physical effects. It would be logical to ensure the social health of vulnerable populations. 

I studied, work in, and have lived experience in the field of disability, so people often ask me what the most useful thing is that we can do as individuals to break down some of the barriers and discrimination that people with disabilities, a group well-established as “vulnerable,” face. Many times, people who ask me this expect an answer that involves donating to charities, fighting for accessibility or assistive technologies, or giving policy recommendations. While these all can and do work towards creating a more equitable future, we sometimes lose sight of some of the simplest solutions. We gravitate towards large-scale ways to help entire populations, but by doing so, we forget about the individual people who are part of that population, and people become dehumanized in the process. 

My answer is both smaller-scale and more personable. My answer is to have a conversation with someone who has a disability. Talk to them. Be friends with them. Listen to them. Not as an act of charity, but with the goal of genuine connection. Talking to people with disabilities provides opportunities to learn about what people with disabilities need and how they feel. The best way to know how to help people with disabilities is to ask them, since they know their needs the best. In the UK, 49% of people without disabilities reported feeling they did not have anything in common with people with disabilities, and 26% reported avoiding conversations with people with disabilities. This is even more reason to engage in dialogue with people with disabilities. If people aren’t engaging in conversation, commonalities cannot be found and friendships cannot be made. People with disabilities are not fundamentally different from people without disabilities. We are all human, and as humans, we need social connection. It may be easier to donate money to a cause than to engage in conversation with someone who is unfamiliar, but it has the unintended consequence of marginalizing people with disabilities because they are still seen as “others,” foreign, alien. When you talk enough and engage enough, the unfamiliar becomes familiar. The uncomfortable becomes comfortable. People with disabilities become more recognized as simply people, rather than seen only for their disabilities. 

There needs to be a move toward regarding “vulnerable” populations the same way we would non-vulnerable populations. Being in a “vulnerable” category does not mean those who fall into those categories are less than or have less basic needs than other people. Social connection is a basic human need. It is “what it means to be human.” We need to start treating people categorized as vulnerable the same as we do other populations. By not doing so, it is not the vulnerable situations of these populations that make them “vulnerable,” but rather, we are the ones that make them vulnerable by denying them a basic human need that is given to everyone else. Vulnerable populations are not lesser humans; we need to stop treating them as such.  

The views and opinions expressed here are those of the writer, and do not necessarily reflect the official position of SCSC.