{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:27:35Z","timestamp":1788848855596,"version":"build-2803163510"},"reference-count":27,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2013,3,1]],"date-time":"2013-03-01T00:00:00Z","timestamp":1362096000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Glob Health Promot"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:p>This paper reviews approaches to vulnerability in public health, introducing a series of 10 papers addressing vulnerability in health in Africa. We understand vulnerability as simultaneously a condition and a process. Social inequalities are manifest in and exacerbate three key dimensions of vulnerability: the initial level of wellbeing, the degree of exposure to risk, and the capacity to manage risk effectively. We stress the dynamic interactions linking material and social deprivation, poverty, powerlessness and ill health: risks or shocks and their health impacts are intimately interconnected and reinforce each other in a cycle which in the absence of effective interventions, increases vulnerability. An inductive process which does not begin with an a priori definition or measurement of \u2018vulnerability\u2019 and which does not assume the existence of fixed \u2018vulnerable groups\u2019 allowed us both to re-affirm core aspects of existing conceptual frameworks, and to engage in new ways with literature specifically addressing vulnerability and resilience at the population level as well as with literature \u2013 for example in ecology, and on the concept of frailty in research on aging \u2013 with which researchers on health and poverty in Africa may not be familiar. We invite conceptual and empirical work on vulnerability in complex systems frameworks. These perspectives emphasize contexts and nonlinear causality thus supporting analyses of vulnerability and resilience as both markers and emergent properties of dynamic interactions. We accept a working definition of vulnerability, and recognize that some definable groups of people are more likely than others to suffer harm from exposure to health risks. But we suggest that the real work \u2013 at both intellectual and policy\/political levels \u2013 lies in understanding and responding to the dynamics, meanings and power relations underlying actual instances and processes of vulnerability and harm.<\/jats:p>","DOI":"10.1177\/1757975912470062","type":"journal-article","created":{"date-parts":[[2013,4,2]],"date-time":"2013-04-02T12:12:14Z","timestamp":1364904734000},"page":"3-9","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":60,"title":["Beyond \u2018vulnerable groups\u2019: contexts and dynamics of vulnerability"],"prefix":"10.1177","volume":"20","author":[{"given":"Christina","family":"Zarowsky","sequence":"first","affiliation":[{"name":"School of Public Health and HIV Research Centre, University of the Western Cape, Belleville, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slim","family":"Haddad","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CRCHUM) & D\u00e9partement de M\u00e9decine Sociale et Pr\u00e9ventive, Universit\u00e9 de Montr\u00e9al, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinh-Kim","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CRCHUM) & D\u00e9partement de M\u00e9decine Sociale et Pr\u00e9ventive, Universit\u00e9 de Montr\u00e9al, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,4,2]]},"reference":[{"key":"bibr1-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462417"},{"key":"bibr2-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462418"},{"key":"bibr3-1757975912470062","doi-asserted-by":"crossref","unstructured":"Chib A, Wilkin H, Hoefman B. Vulnerabilities in mHealth implementation: a Ugandan HIV\/AIDS SMS campaign. Glob Health Promot. 2013; 20 Supp. 1: 26\u201332.","DOI":"10.1177\/1757975912462419"},{"key":"bibr4-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462420"},{"key":"bibr5-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462421"},{"key":"bibr6-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462422"},{"key":"bibr7-1757975912470062","doi-asserted-by":"crossref","unstructured":"Kakudji Kyungu A. Exacerbation of vulnerability in a hospital setting in Lubumbashi (Democratic Republic of Congo). 2013; 20 Supp. 1: 51\u201356.","DOI":"10.1177\/1757975912462423"},{"key":"bibr8-1757975912470062","first-page":"57","volume":"20","author":"Forman L","year":"2013","journal-title":"Exploring the case study of access to antiretrovirals"},{"key":"bibr9-1757975912470062","doi-asserted-by":"crossref","unstructured":"Mohindra KS, Schrecker T. From bulldozing to housing rights: Reducing vulnerability and improving health in African slums. 2013; 20 Supp. 1: 64\u201369.","DOI":"10.1177\/1757975912462425"},{"key":"bibr10-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1177\/1757975912462416"},{"key":"bibr11-1757975912470062","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300268"},{"key":"bibr12-1757975912470062","unstructured":"Alwang J, Siegel PB, Jorgensen SL. Vulnerability: a view from different disciplines. Social Protection Discussion Paper Series 23304. Washington, D.C., USA: The World Bank; 2001"},{"key":"bibr13-1757975912470062","unstructured":"Hoogeveen J, Tesliuc E, Vakis R, Dercon S. A Guide to the Analysis of Risk, Vulnerability and Vulnerable Groups. Washington, D.C., USA: The World Bank; 2004."},{"key":"bibr14-1757975912470062","unstructured":"Duclos J-Y. La vuln\u00e9rabilit\u00e9 et la mesure de la pauvret\u00e9 dans la politique publique. Social Protection Discussion Paper Series 0230. Washington, D.C., USA: The World Bank; 2002."},{"key":"bibr15-1757975912470062","first-page":"1","volume":"9","author":"Criel B","year":"1998","journal-title":"Stud Health Serv Organ"},{"key":"bibr16-1757975912470062","unstructured":"Haddad S. Cadre conceptuel de la vuln\u00e9rabilit\u00e9. Unpublished manuscript; 2006"},{"key":"bibr17-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1017\/S0963180109090203"},{"key":"bibr18-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-S1-S2"},{"key":"bibr19-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7313.625"},{"key":"bibr20-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7315.746"},{"key":"bibr21-1757975912470062","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2005.03638.x"},{"key":"bibr22-1757975912470062","unstructured":"De Savigny D, Adam T (Eds). Systems thinking for health systems strengthening. 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