Introduction to some of the challenges

In this video, Cliona Ni Challaigh introduces some of the challenges that can be faced by both patients and healthcare professionals when a vulnerable patient is seeking health care.

Cliona talks about social exclusion and how this can inform or cause some of the behaviours you might encounter. She explains how significantly poverty affects health, as anybody at any age is twice as likely to die if they are in poverty. Rectifying other socially excluded behaviours such as drug use, alcohol use and smoking is likely to only correct a third of the difference that poverty causes.

Patients in the deep end of poverty (those who are homeless, in prison or inject drugs) often simultaneously experience multiple situations which lead to difficulties in finding housing or jobs. Men who are socially excluded have an 8-fold standard mortality rate and women have an 11-fold standard mortality rate. This magnification of mortality risk due to social exclusion is termed the cliff of inequality.

A personal experience of caring for a socially excluded patient highlights other challenges clinicians may face including difficulty communicating, volatile behaviour, verbal abuse and refusal of scans and treatment.

Cliona highlights some of the challenges faced by clinicians due to socially excluded patients. The following steps look further into the social determinants of health including poverty and homelessness.