Does Economic and Social Factors Influence Patient Health?

Health Equity and Social Determinants of Health: Striving for Fair Outcomes

Not all patients have an equal chance at a healthy life. Two people with the same medical condition can have very different outcomes depending on factors like their income, neighborhood, education, or race. These factors, known as the social determinants of health, play a profound role in shaping health outcomes and contribute to health disparities among different populations. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. Achieving health equity requires removing obstacles to health such as poverty, discrimination, and lack of access to good jobs, quality education, and healthcare. For healthcare professionals, understanding and addressing the social determinants of health is becoming as important as prescribing the right medication. In recent years, there is a growing movement in medicine and public health to recognize these social factors and work toward a more equitable health system where one’s zip code or socioeconomic status does not predetermine one’s health.


An illustration comparing equality (treating everyone the same) versus equity (allocating resources based on need). In healthcare, equity involves providing each patient or community the specific support they require to achieve optimal health, rather than a one-size-fits-all approach.

The Impact of Social Determinants on Health Outcomes

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. They include a wide array of non-medical factors that can significantly influence health. The main categories of social determinants include:

• Economic Stability: Income and financial security affect health profoundly. Individuals in poverty often struggle to afford nutritious food, stable housing, or medications. Unemployment or low-paying jobs can lead to chronic stress and limit access to healthcare services. For instance, a patient without economic stability might delay doctor visits or skip medications because of cost, leading to worsened health in the long run.
• Education Access and Quality: Educational opportunities from early childhood through adulthood shape health literacy and job prospects. People with less education may not have learned critical thinking skills or health knowledge that help in navigating the healthcare system. Lower educational attainment is linked to higher rates of many health problems and shorter life expectancy. Conversely, quality education opens doors to better employment and increases the ability to make informed health decisions.
• Healthcare Access and Quality: This determinant includes whether people have health insurance, can find a healthcare provider, and receive culturally competent care. Even in wealthy countries, there are communities with few clinics or doctors, leading to unmet health needs. If a community lacks primary care services, preventable conditions like hypertension or diabetes may go unmanaged. Quality of care matters too—if providers do not listen to patients or if there is implicit bias, patients from marginalized groups might receive substandard treatment.
• Neighborhood and Physical Environment: The place where one lives can either support health or create health risks. Safe housing, clean air and water, and access to exercise spaces like parks are all important. In contrast, neighborhoods with high crime, pollution, or food deserts (lack of grocery stores with healthy food) contribute to poor health. For example, children growing up in substandard housing with mold or lead paint are at risk for asthma and other illnesses. Long commute times or lack of public transportation can also impact health by causing stress and making it harder to get to medical appointments or buy healthy food.
• Social and Community Context: Support networks and community environment influence health behaviors and stress levels. Having strong family support or community ties can help individuals cope with challenges and adhere to medical advice. On the other hand, facing social isolation, discrimination, or systemic racism takes a toll on mental and physical health. Chronic stress from discrimination (such as racism or sexism) has been linked to issues like hypertension, mental health disorders, and higher infant mortality rates in affected populations.

Research shows that these social determinants can be even more important than medical care in determining health outcomes. Some estimates suggest that clinical care accounts for only 10-20% of the modifiable contributors to healthy outcomes, whereas social, economic, and environmental factors account for the rest. This means that even the best medical treatments may have limited impact if a patient’s life circumstances are continually harming their health. For instance, prescribing a healthy diet and exercise is difficult to follow if a patient lives in a neighborhood without grocery stores or safe sidewalks. Understanding the impact of SDOH reminds healthcare professionals that improving health is not just about writing prescriptions, but also about advocating for healthier living conditions for patients.

Disparities in Healthcare Access and Outcomes for Marginalized Communities

Health disparities refer to preventable differences in health outcomes that are observed between different groups of people. Marginalized communities—such as racial and ethnic minorities, low-income populations, rural residents, and others—often face significant disparities in both health status and healthcare access. These disparities are the visible result of underlying inequities in social determinants and in the healthcare system itself.

Consider these examples:

• In many countries, including affluent ones, life expectancy differs markedly between the rich and the poor. Within the same city, a wealthy neighborhood might enjoy an average life expectancy a decade longer than a disadvantaged neighborhood just a few miles away. These gaps are due to cumulative factors like differences in education, jobs, exposure to violence or pollution, and access to healthcare and healthy lifestyles.
• Racial and ethnic disparities are well documented. For instance, Black women in the United States are roughly three times more likely to die from pregnancy-related causes than white women, a disparity attributed to a mix of social factors and systemic biases in healthcare. Similarly, infant mortality rates in some minority groups are significantly higher than the national average, reflecting inequities in maternal health, prenatal care, and living conditions.
• Healthcare access is another major disparity. Marginalized groups are more likely to be uninsured or underinsured. In the absence of insurance coverage, people may forgo preventive care and only seek help when illnesses are advanced. Rural communities, on the other hand, might have geographic barriers—there may simply be no doctor or hospital nearby, or specialist care could require traveling great distances. This often leads to delayed diagnoses and treatment.
• Even when accessing care, quality of care can differ. Implicit bias or stereotypes held by healthcare providers can unfortunately influence treatment decisions. Studies have shown that certain groups, such as people of color or non-native language speakers, sometimes receive less pain management, fewer diagnostic tests, or less thorough explanations of their condition. LGBTQ+ patients have reported feeling stigmatized or misunderstood in healthcare settings, leading some to avoid seeking care altogether.
• Social factors can compound over a lifetime. A child growing up in a low-income, under-resourced community may have worse nutrition, attend lower quality schools, and lack consistent healthcare. By adulthood, that individual might face a higher burden of diseases like diabetes, heart disease, or depression compared to peers from more privileged backgrounds. Marginalized communities often endure higher rates of chronic diseases and lower rates of survival for conditions like cancer, reflecting a pattern of cumulative disadvantage.

The consequences of these disparities are far-reaching. Besides the human toll of illness and reduced quality of life, health disparities also carry economic costs (e.g., higher healthcare expenditures for advanced disease, lost productivity due to illness). Addressing disparities is both a moral imperative and a practical one, as improving the health of disadvantaged groups can elevate the overall health of society and reduce healthcare costs.

Strategies for Improving Health Equity

Reducing health disparities and improving health equity require multi-faceted strategies that extend beyond the healthcare sector. Here are some key approaches being pursued:

• Policy Changes and Systemic Reform: Government policies have tremendous power to influence health equity. Expanding health insurance coverage (through mechanisms like universal health coverage or Medicaid expansion in the U.S.) helps remove financial barriers to care. Policies that ensure a living wage, provide housing assistance, or improve education funding can also indirectly boost health by alleviating poverty and related stressors. Public health regulations—like those ensuring clean air and water, or mandating the addition of folic acid in foods to prevent birth defects—benefit everyone, especially the most vulnerable. Another policy approach is integrating “Health in All Policies,” meaning policymakers consider the health impacts of decisions in all sectors (transportation, urban planning, education) to avoid inadvertent harm to communities.
• Community Engagement and Targeted Interventions: Local solutions are critical since health issues often have community-specific nuances. Engaging directly with communities helps identify their most pressing needs. For example, if lack of healthy food is a problem, a targeted intervention might be to support farmers’ markets or community gardens in that area. If a community has many non-English speakers, interventions could include providing multilingual health education and patient navigators. Community health worker programs are a powerful strategy: these are trained laypeople from the community who provide health education, outreach, and help individuals navigate healthcare services. Because they understand the culture and challenges of their neighbors, community health workers can effectively bridge gaps and build trust.
• Improving Healthcare Access and Quality: On the healthcare delivery side, strategies to advance equity include increasing the number of clinics in underserved areas, offering mobile health units that travel to remote or poor neighborhoods, and using telehealth to reach patients who can’t easily travel. Health systems are also working on becoming more culturally competent—training healthcare staff in understanding and respecting diverse backgrounds and addressing their own biases. Another important intervention is incorporating social needs screening into healthcare: for instance, clinics can ask patients if they have trouble affording medications, finding transportation, or securing food. Patients who screen positive can be connected to social services or programs (sometimes called “social prescribing”). This way, a doctor’s office becomes a portal not just for medical care but for getting patients help with the underlying issues affecting their health.
• Education and Workforce Diversity: Ensuring the healthcare workforce itself is diverse and knowledgeable about health equity is a strategy that works from the inside out. Medical and nursing schools are adding curriculum content on social determinants of health, cultural humility, and anti-racism in medicine. The rationale is that new healthcare professionals should be equipped to recognize disparities and feel responsible for addressing them. Additionally, efforts to recruit and support more students from underrepresented communities into healthcare fields will, in time, create a workforce that more closely reflects the populations served. A diverse workforce can improve patient communication and trust, as patients often feel more understood and respected by providers who share or at least appreciate their background. It also helps dismantle biases when colleagues from different backgrounds work together and learn from each other.
• Cross-Sector Collaboration: Health equity cannot be achieved by the healthcare sector alone; it requires collaboration with education systems, housing authorities, urban planners, social services, and more. For example, a hospital might partner with a local housing nonprofit to create a "medical-legal partnership" that helps patients address issues like eviction or utility shutoffs that directly impact their health. Likewise, city planners can work with public health experts to design walkable neighborhoods that encourage physical activity and reduce traffic accidents. In some places, health departments are working closely with schools to ensure children have access to healthy meals and physical education, acknowledging that schools play a key role in children’s health. These partnerships amplify the impact of interventions, ensuring that improvements in one aspect (like housing conditions) support the health gains made in the medical setting.

Improving health equity is a long-term endeavor. It involves not only implementing new programs but also changing mindsets—recognizing that health disparities are not intractable and that action can make a difference. Encouragingly, many initiatives at local, national, and global levels are beginning to show progress, such as reductions in certain gaps (for example, narrowing differences in colorectal cancer screening rates between racial groups through targeted outreach programs). Every successful strategy provides a model that can be adapted and scaled in other communities.

The Role of Healthcare Professionals in Advancing Equity

Individual healthcare professionals are on the front lines of health equity every day. Beyond providing excellent care to each patient, clinicians have several roles to play in addressing social determinants and advocating for equity:

• Screening and Addressing Social Needs: Doctors, nurses, and other providers can incorporate questions about a patient’s social situation into routine care. Simple queries like, “Do you have any trouble getting your medications?” or “Are you worried about housing or food?” can open the door to crucial information. When a need is identified, healthcare professionals can connect patients with social workers, case managers, or local resources. For instance, if a patient admits they often run out of food, a provider might refer them to a nutrition assistance program or a local food bank.
• Culturally Sensitive Care: Providers must strive to understand the cultural background and personal circumstances of their patients. This involves listening without judgment, being aware of one’s own potential biases, and showing respect for different health beliefs and practices. Something as straightforward as providing translation services for patients with limited English proficiency or ensuring patient education materials reflect the community’s literacy levels and languages can greatly enhance care quality. Culturally sensitive care builds trust, which in turn makes it more likely that patients will follow medical advice and return for follow-ups.
• Advocacy and Leadership: Healthcare professionals carry social authority, and when they speak up, policymakers and the public tend to listen. Many physicians and nurses are using their voices to advocate for policies that promote health equity. This could mean testifying about the health impacts of a proposed law (like those related to clean air, vaccination, or nutrition programs) or writing op-eds and public letters about issues such as gun violence or climate change that affect community health. Clinicians can also lead by example within their institutions, pushing for clinics to adopt practices that reduce disparities (for example, analyzing clinic data to identify if any patient groups are experiencing worse outcomes and developing plans to address those gaps).
• Education and Mentorship: Those in the healthcare field can further health equity by educating peers and trainees. A senior doctor might run workshops on implicit bias for colleagues, or a medical school professor could mentor students from underrepresented backgrounds, fostering an environment of inclusion. Sharing success stories of addressing social determinants (like how a timely referral to a housing program improved a patient’s health) can inspire others in the profession to integrate similar practices. Over time, this builds a healthcare culture that prioritizes equity as part of quality care.
• Community Involvement: Many healthcare providers extend their care beyond clinic walls by getting involved in community organizations or public health initiatives. For example, a pediatrician might volunteer with a local school to implement an asthma prevention program, knowing that childhood asthma is linked to home environmental conditions. Others join health equity task forces or local health boards to work directly on community strategies. By stepping out of the traditional clinical role and working alongside community members, professionals gain a deeper understanding of the challenges people face and can contribute medical expertise to community-driven solutions.

Every action, small or large, contributes to a greater whole in making healthcare more equitable. When providers consistently show concern for the social factors affecting their patients, it reinforces the idea that treating a patient means caring about all aspects of their well-being.

The Future of Health Equity: Prioritizing Equity in 2025 and Beyond

Looking ahead, there is growing momentum to place health equity at the center of health systems’ goals. The COVID-19 pandemic, in particular, threw a spotlight on existing disparities—vulnerable communities saw higher infection and death rates, often due to crowded living conditions, frontline jobs, and less access to care. In the aftermath, many institutions have publicly committed to “build back fairer,” integrating equity into emergency preparedness and healthcare recovery plans.

By 2025 and beyond, we can expect several trends in the pursuit of health equity:

• Data-Driven Equity Initiatives: Health systems are increasingly collecting data on patient outcomes stratified by race, ethnicity, gender, and other factors. This allows for transparency in where gaps exist. With better data, organizations can set concrete targets (for example, eliminating racial disparities in hypertension control rates within a network) and track progress. Technology will aid this effort; predictive analytics might help identify patients at risk of falling through the cracks (such as those likely to miss follow-ups due to transportation issues) so interventions can be offered proactively.
• Investment in Social Programs as Healthcare Strategy: More healthcare organizations are investing in programs that traditionally might be considered outside their scope, because they realize these investments can reduce healthcare utilization and improve outcomes. We might see hospitals funding housing projects for the homeless or partnering with food delivery services to ensure patients have meals after discharge. Such approaches treat social interventions as a form of preventive medicine. Insurers and governments could also shift more funding to upstream preventive measures, recognizing the cost savings when fewer people get seriously ill.
• Telehealth and Digital Inclusion: Telehealth, which expanded greatly in 2020, has the potential to improve access in underserved areas—if done right. Efforts are underway to bridge the “digital divide” by providing broadband access and devices to communities that lack them, ensuring telemedicine isn’t just a convenience for the well-off but a lifeline for rural or underserved patients. In the future, a patient in a remote village could consult a specialist in a city without the burden of travel, receiving timely care that would have been inaccessible before. Maintaining equity means making sure new technologies are accessible to all, not just those with the latest smartphones or high-speed internet.
• Global Health Equity and Collaboration: Globally, there is a push to reduce inequities between countries. Initiatives like the World Health Organization’s drive for Universal Health Coverage aim to have all people obtain the health services they need without suffering financial hardship. We saw during the pandemic that global equity issues (such as unequal access to vaccines) can prolong crises for everyone. Moving forward, international collaboration in health—whether it’s sharing vaccine technology, training healthcare workers in low-income countries, or tackling climate change (which disproportionately affects poorer nations)—will be crucial. Health equity on a global scale means improving the basic health infrastructure in developing regions, combating extreme disparities like the vastly different life expectancies between high-income and low-income countries, and ensuring all nations have a voice in global health decisions.
• Community Power and Leadership: The future of health equity also lies in empowering communities to lead the charge for their own health. We are likely to see more community-led health initiatives, where residents take active roles in designing interventions that work for them. Health systems and governments increasingly recognize that solutions are more sustainable and effective when communities are partners, not just recipients. By 2025 and beyond, community advisory boards might be a standard component of hospital governance, and patients from diverse backgrounds might routinely be involved in designing healthcare services.

In sum, the journey toward health equity is ongoing, but it is gaining traction. Achieving it will require sustained commitment, resources, and innovative thinking across all sectors of society. For healthcare professionals, maintaining a focus on equity means continually asking, “Who might be left behind if we do things this way?” and then working to adjust and include those who are marginalized.

The vision for the future is a healthcare system—and a society—where your health is not predetermined by your social circumstances. This means a world where all children can grow up with the opportunity to be healthy, where every patient can access care that respects their background and meets their needs, and where we measure success not just by overall advances in medicine, but by how those advances reach everyone. Prioritizing health equity is both the right thing to do and the smart thing to do: when more people are healthy, communities thrive and the benefits are shared by all.