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February 2008, Vol 98, No. 2 | American Journal of Public Health 216-221
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.114777

GOVERNMENT, POLITICS, AND LAW

Transcending the Known in Public Health Practice: The Inequality Paradox: The Population Approach and Vulnerable Populations

Katherine L. Frohlich, PhD and Louise Potvin, PhD

The authors are with the Lea Roback Centre for Research on Health Inequalities, Department of Social and Preventive Medicine, University of Montreal, and le Groupe de Recherche Interdisciplinaire en Santé, Montreal, Quebec.

Correspondence: Requests for reprints should be sent to Katherine L. Frohlich, PhD, CP 6128 succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada (e-mail: katherine.frohlich{at}umontreal.ca).

Using the concept of vulnerable populations, we examine how disparities in health may be exacerbated by population-approach interventions.

We show, from an etiologic perspective, how life-course epidemiology, the concentration of risk factors, and the concept of fundamental causes of diseases may explain the differential capacity, throughout the risk-exposure distribution, to transform resources provided through population-approach interventions into health. From an intervention perspective, we argue that population-approach interventions may be compromised by inconsistencies between the social and cultural assumptions of public health practitioners and targeted groups.

We propose some intervention principles to mitigate the health disparities associated with population-approach interventions.




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