The use of the concept of vulnerability in public health

  • Vulnerability is a concept widely used by public health actors to designate the groups or individuals affected by a measure or intervention. However, this concept is broad and can have several meanings. 
  • Designating a vulnerable group within a population with the aim of protecting it from one or more dangers runs the risk of assigning its members an identity or situation that does not always correspond to their experience. This can have negative consequences for these groups, especially in terms of stigmatization and even discrimination. 
  • The definition of vulnerability varies and depends on how it is used. 
  • An exploration of the plurality of definitions and uses of the concept reveals that vulnerability is a complex assembly of context-specific dispositions. It leads to a deconstruction of what lies beneath the label “vulnerable,” thus avoiding the potential instrumentalization of the term. 
  • The use of the concept of vulnerability in the context of the COVID-19 pandemic is an example of how to explore the range of experiences it covers. Faced with the need to control outbreaks, the public health measures put in place to protect the most vulnerable sometimes struggled to achieve their intended objectives. They may have even amplified certain inequities or contributed to the emergence of new ones. 
  • When planning a public health measure, it is advisable to reflect on the definition of vulnerability in the precise context of its use. For the actors involved, this means taking a concrete look at its various facets, to determine what “being vulnerable” means for this group, in this context. This also means highlighting the values on which public health intervention is based, and how these match those of the groups concerned. 
  • To help guide this reflection, a practical tool based on an accelerated ethical review process is proposed. It is based on a four-part analysis, each comprising questions to guide reflection and deliberation with the various parties involved in a decision or intervention.
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