Who Gets Called Vulnerable? Adults With Intellectual Disabilities in a Rural County and the Power of the Label
Student Name
American College of Education
NUR4043: Community Health and Vulnerable Populations
Module 3 Assignment
Instructor Name
May 18, 2026
Defining Vulnerability
The word vulnerable is used so often in health care that it can seem to need no definition. In practice it is used in at least three ways: to describe people at higher risk of poor health, to describe people who have less power to protect their own interests, and, in research regulation, to describe groups who need extra safeguards before they can be enrolled in a study. A paper about a vulnerable population has to say which meaning it intends.
This paper uses the model proposed by Flaskerud and Winslow (1998), which ties the three meanings together. In their model, vulnerable populations are social groups that experience limited resources and consequent high relative risk for morbidity and premature mortality. Resource availability, relative risk and health status interact: a shortage of socioeconomic and environmental resources raises relative risk, higher risk leads to poorer health, and poorer health further reduces resources. The strength of the model is that it locates vulnerability in a group's circumstances rather than in the people themselves, which makes it something that can change.
The Population in Ashford County
Intellectual disability is a condition that begins before adulthood and involves significant limitations in intellectual functioning and in adaptive behavior, the everyday conceptual, social and practical skills people use to manage their lives. People with intellectual disabilities make up roughly 2 percent of the population (Krahn et al., 2006). In Ashford County, this course's invented rural setting, the county developmental disabilities board currently serves 412 adults, of whom about 60 percent live with family members, 25 percent live in small group homes or supported living arrangements, and the rest live on their own with some support. The board's count includes only adults enrolled in its services, so the full population is likely larger.
Applying the Flaskerud and Winslow (1998) model shows why this group meets the definition. On resource availability, most adults served by the board depend on Supplemental Security Income and Medicaid, few are employed, and many rely on a family member or a paid staff person for transportation in a county without public transit. On relative risk, Krahn et al. (2006) describe a cascade of disparities that people with intellectual disabilities experience: a higher prevalence of some health conditions, inadequate attention to their care needs, little focus on health promotion and poorer access to quality care. On health status, local indicators fit that cascade. The two primary care practices in the county report that adults from the group homes are seen mainly for acute problems, and the county health department's cancer screening outreach has never included them.
Who Decides the Label
The adults in this population did not choose to be called vulnerable. The label has been assigned to them by several different parties, each for its own purposes. Federal research regulations treat people with impaired decision-making capacity as needing additional protections. Public health agencies apply the label when they target resources. Service systems use it to establish eligibility. More recently, in 2023, the National Institutes of Health designated people with disabilities as a population with health disparities for research purposes (National Institutes of Health [NIH], 2023), a decision that followed years of argument by researchers such as Krahn et al. (2015), who contended that people with disabilities had been an unrecognized health disparity population.
Those decisions were made by researchers, officials and professionals. The people most affected are often absent from the room where the label is attached, even though the self-advocacy movement among people with intellectual disabilities has argued for decades that decisions about them should not be made without them. In Ashford County, the board's advisory committee has two self-advocate seats, but the health department's planning group that decides screening outreach has none. The question is not whether this group faces higher health risks, which the evidence shows it does, but whether the people who carry the label have any say in what it is used to justify.
What the Label Gives and What It Takes
The label brings real benefits. It directs funding, triggers protections in research and can make a group visible in planning where it would otherwise be missed. The NIH designation, for example, makes studies of disability-related disparities eligible for funding streams that were previously closed to them. In Ashford County, naming adults with intellectual disabilities as a priority group would give the health department a reason to adapt its cancer screening outreach, which currently depends on mailed letters that many group home residents never see or cannot read.
The label also carries costs. Calling a group vulnerable can shift attention from the circumstances that create risk to the people who bear it, which is the opposite of what the Flaskerud and Winslow (1998) model intends. It can justify protective decisions made on people's behalf rather than with them, such as a group home policy that every resident's medical appointments are scheduled by staff whether or not the resident wants to be involved. And it can become a permanent identity rather than a description of a temporary imbalance between resources and needs. Adults with intellectual disabilities already live with a diagnostic label; a second label, applied without their participation, can deepen the sense that others define them.
Using the Label Responsibly
A community health nurse working with this population can use the vulnerable label for what it secures while limiting what it takes. Three practices follow from the analysis. The first is to name circumstances rather than people: planning documents can describe adults with intellectual disabilities as underserved by screening programs, which points to the program, rather than as a vulnerable group, which points to them. The second is to bring self-advocates into the planning process, starting with a seat on the health department's outreach planning group and an accessible version of every document the group produces. The third is to measure vulnerability as the model defines it, by tracking resource and access indicators, such as the proportion of the board's adults with a cancer screening in the recommended interval, so that the label describes a condition that can improve rather than a permanent trait.
These practices also change what the nurse measures and reports. A progress report that says the county has reduced vulnerability among adults with intellectual disabilities is hard to verify and easy to misread. A report that says the share of the board's adults screened for cervical and colorectal cancer within the recommended interval rose from a baseline measured in the first quarter to a stated figure a year later, with self-advocates reviewing the outreach materials, can be checked, compared and repeated. Krahn et al. (2006) recommend health promotion and access measures that include people with intellectual disabilities in the same surveillance used for everyone else, and following that advice keeps the group visible without singling it out. The label then serves as a temporary flag on a gap in services rather than a lasting verdict on the people it names.
Conclusion
Adults with intellectual disabilities in Ashford County meet every part of a recognized definition of vulnerability: limited resources, higher relative risk and poorer health status. The label is accurate, and it can open doors that have stayed closed. But it was assigned by others, and it can harden into a description of who these adults are rather than what they face. The work of a community health nurse is to use the label to change their circumstances while making sure the people who carry it have a voice in how it is used.
References
Flaskerud, J. H., & Winslow, B. J. (1998). Conceptualizing vulnerable populations health-related research. Nursing Research, 47(2), 69-78. https://doi.org/10.1097/00006199-199803000-00005
Krahn, G. L., Hammond, L., & Turner, A. (2006). A cascade of disparities: Health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 12(1), 70-82. https://doi.org/10.1002/mrdd.20098
Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198-S206. https://doi.org/10.2105/AJPH.2014.302182
National Institutes of Health. (2023, September 26). NIH designates people with disabilities as a population with health disparities [News release]. https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities
How this NUR 4043 Module 3 example is structured
NUR 4043 Module 3 in many sections turns to vulnerability itself and who decides which groups carry that label; your classroom's instructions decide the population and how the analysis is structured. This example defines vulnerability with a named model before applying it, describes the population and its health disparities with sources, and then gives the question of who assigns the label its own section, because that is the part of the prompt most papers pass over. It weighs what the label provides against the harm it can do and ends with how a community health nurse can use the label without letting it define the people it describes.
NUR4043 Module 3 questions, answered
What does NUR4043 Module 3 focus on?
NUR4043 Module 3 in many sections turns to vulnerability itself: what makes a population vulnerable, how that status is defined and who decides which groups receive the label. Students typically analyze one population using a recognized model. Your classroom's instructions decide the population, the model and the length of the analysis.
Which model of vulnerability should I use?
The Flaskerud and Winslow vulnerable populations model is widely used in nursing because it links resource availability, relative risk and health status. Aday's work on at-risk populations is another common choice. Whichever you use, define it with the original source and then apply each of its parts to your population in turn.
How do I discuss who assigns the vulnerable label?
Name the specific parties that apply it, such as research regulators, public health agencies, service systems or funders, and say what each uses it for. Then ask whether the people in the population took part in that decision. Balance the benefits the label brings against the risks of paternalism and stigma, using concrete examples.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.