Not the Usual Suspects: Addressing Layers of Vulnerability


  • Florencia Luna,

  • Sheryl Vanderpoel

  • Conflict of interest statement: No conflicts declared

Address for correspondence: Florencia Luna, Programa de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Sede Académica de Argentina, Ayacucho 555 (CABA) Argentina. Tel: (54 11) 4806 1042. E-mail:


This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of ‘usual suspects’, focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking.

In the first section, two different approaches to ‘vulnerability’ are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities.