Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting

Abstract

Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations

“… 41 , 43 In this way, ‘vulnerability obeys complexity’ which entails variability and changeability of social situations and acknowledges the presence of multiple types of vulnerabilities, such as socio-economic status, physical and emotional health, social support and networks, and housing. 44 Further acknowledged are the difficulties in assessing vulnerabilities and their diverse interpretations depending on regions of the world, 44 and – one may add – the organisational and structural differences in healthcare systems and provisions.…”

“…Thus, the identification of social vulnerability is based on a ‘social diagnosis’ which establishes, for example, family situation, social, economic and employment status, and linguistic and cultural backgrounds and skills. 44 Layered and flexible, these markers shape professionals’ perceptions of patients’ vulnerability which may also change over time and during the course of cancer care. A social diagnosis may be conducted through a check-list (see Box 3 ) or on the basis of professionals’ experience, their endeavours to meet the needs of all patients and the claim to treat all patients equally regardless of social class, education, income or other social differences such as gender, age or disability.…”

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“…A palimpsest is defined as a manuscript on which older text have been partially erased in order for new text layers to be placed. Over time and over layer application, past writings can still be identified [35]. The term palimpsest has been used as a metaphor on several occasions [36].…”

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