7.2 Social and economic factors contributing to health disparities
11 min read•august 20, 2024
Social and economic factors significantly impact health outcomes, contributing to disparities across populations. These non-medical determinants shape access to resources, healthcare, and opportunities that influence well-being. Understanding these factors is crucial for nurses to provide equitable care and address the root causes of health inequities.
From economic stability to education, , and social context, various elements intersect to create complex health challenges for vulnerable groups. Nurses must consider these broader societal influences when caring for patients and advocating for systemic changes to promote and reduce disparities.
Social determinants of health
Social determinants of health are the conditions in which people are born, grow, live, work and age that shape health outcomes
These non-medical factors influence health risks and outcomes and contribute to wide health disparities across populations
Addressing social determinants is crucial in providing equitable nursing care to vulnerable populations and promoting health equity
Economic stability factors
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, employment, and directly impact access to healthcare, nutrition, housing, and other health-related resources
, poverty, and lack of savings can lead to chronic stress and poor health outcomes
Economic policies, labor markets, and social safety nets play a role in shaping population health
Education access and quality
Higher levels of education are associated with better health outcomes, , and health-promoting behaviors
Early childhood education and development lay the foundation for lifelong learning and health
Disparities in educational opportunities and quality contribute to health inequities
Health care access and quality
Access to affordable, high-quality, and culturally competent healthcare services is essential for maintaining health and managing illnesses
Barriers to healthcare access include lack of insurance, high costs, provider shortages, and linguistic and cultural barriers
Quality of care, including patient-provider communication and trust, impacts health outcomes and adherence to treatment
Neighborhood and built environment
Physical environment, including housing, transportation, safety, and and green spaces, shapes health behaviors and outcomes
Exposure to environmental toxins, pollution, and hazards can lead to adverse health effects and exacerbate existing conditions
Neighborhood segregation and disinvestment contribute to health disparities and "place-based" inequities
Social and community context
Social relationships, support networks, and community engagement are important for mental and physical well-being
, social exclusion, and stigma can lead to chronic stress, mental health issues, and poor health outcomes
Community norms, values, and social capital influence health behaviors and access to resources
Economic factors in health disparities
Economic factors play a significant role in shaping health disparities and access to healthcare services
Nursing care of vulnerable populations must consider the impact of economic stability on health outcomes and tailor interventions accordingly
Addressing economic inequities is crucial for promoting health equity and reducing disparities
Income and wealth inequality
Income inequality, or the gap between the rich and the poor, is associated with worse health outcomes and shorter life expectancy
Wealth inequality, including disparities in assets and generational wealth, perpetuates health inequities across generations
Policies that reduce income and wealth inequality, such as progressive taxation and social welfare programs, can improve population health
Poverty and low socioeconomic status
Poverty and low socioeconomic status are linked to higher rates of , mental health issues, and mortality
Financial strain can lead to chronic stress, poor nutrition, and delayed healthcare seeking
, such as cash transfers and housing assistance, can improve health outcomes for vulnerable populations
Employment and job security
Stable employment with decent wages and benefits is important for maintaining health and accessing healthcare services
Job insecurity, underemployment, and precarious work conditions can lead to stress, poor mental health, and lack of health insurance coverage
Policies that promote fair labor practices, minimum wage, and job training can support health equity
Food insecurity and nutrition
, or lack of consistent access to enough food for an active, healthy life, is associated with poor nutrition and chronic diseases
Low-income communities often have limited access to healthy, affordable food options (food deserts)
Nutrition assistance programs, such as SNAP and WIC, can improve food security and health outcomes for vulnerable populations
Educational factors in health disparities
Education is a key social determinant of health, with far-reaching impacts on health literacy, behaviors, and outcomes
Disparities in educational opportunities and attainment contribute to health inequities across the lifespan
Nurses should consider the role of education in shaping health risks and tailor interventions to enhance health literacy and knowledge
Early childhood education and development
Early childhood experiences and education lay the foundation for lifelong learning, health, and well-being
High-quality early childhood programs, such as Head Start, can improve cognitive development, socio-emotional skills, and health outcomes
Investing in early childhood education can reduce health disparities and promote health equity
High school graduation rates
High school graduation is a strong predictor of health outcomes, with dropouts experiencing higher rates of chronic diseases, mental health issues, and mortality
Disparities in high school graduation rates by race, ethnicity, and socioeconomic status contribute to health inequities
Programs that support high school completion, such as mentoring and tutoring, can improve health outcomes for vulnerable youth
Higher education attainment
Higher levels of education, including college and graduate degrees, are associated with better health outcomes and health-promoting behaviors
College education can provide access to better job opportunities, higher incomes, and social networks that support health
Policies that improve college affordability and completion rates can reduce health disparities
Health literacy and education
Health literacy, or the ability to obtain, understand, and use health information to make informed decisions, is crucial for managing health and navigating the healthcare system
Limited health literacy is associated with worse health outcomes, higher healthcare costs, and lower adherence to treatment
Patient education and communication strategies that are culturally and linguistically appropriate can improve health literacy and outcomes for diverse populations
Healthcare access factors in disparities
Access to affordable, high-quality healthcare services is a critical determinant of health outcomes and disparities
Barriers to healthcare access disproportionately affect vulnerable populations, including low-income, racial/ethnic minorities, and rural communities
Nurses play a key role in identifying and addressing healthcare access barriers to promote equitable care
Insurance coverage and affordability
Lack of health insurance coverage is a major barrier to accessing healthcare services and is associated with worse health outcomes
High out-of-pocket costs, including deductibles and copayments, can deter individuals from seeking necessary care
and subsidies for marketplace coverage can improve access to insurance for low-income populations
Provider availability and quality
Shortages of healthcare providers, particularly in underserved areas, can limit access to timely and appropriate care
Disparities in provider quality, including cultural competence and patient-centered communication, can impact patient trust and engagement in care
Strategies to increase provider diversity, cultural competence training, and team-based care models can improve access and quality for vulnerable populations
Linguistic and cultural barriers
Language barriers and lack of culturally competent care can deter individuals from seeking healthcare and impact quality of care
Limited English proficiency is associated with worse health outcomes, lower patient satisfaction, and higher rates of medical errors
Providing language assistance services, such as interpreters and translated materials, and culturally tailoring interventions can improve access and outcomes for diverse populations
Transportation and geographic barriers
Lack of reliable transportation and long travel distances can be significant barriers to accessing healthcare services, particularly in rural and underserved areas
disproportionately affect low-income, elderly, and disabled populations
Strategies such as mobile clinics, telehealth services, and transportation assistance programs can improve access to care for vulnerable populations
Environmental factors in health disparities
The physical and built environment plays a significant role in shaping health behaviors, exposures, and outcomes
Environmental factors contribute to health disparities, with low-income and minority communities often experiencing disproportionate exposure to health hazards
Nurses should assess environmental risk factors and advocate for policies and interventions that promote healthy environments and health equity
Housing quality and stability
Poor housing conditions, such as overcrowding, inadequate ventilation, and exposure to mold and pests, can lead to respiratory illnesses, injuries, and mental health issues
Housing instability and homelessness are associated with higher rates of chronic diseases, mental health problems, and mortality
Policies that improve access to affordable, safe, and stable housing can promote health equity
Crime and violence exposure
Exposure to community violence and crime can lead to trauma, stress, and mental health issues, particularly among children and youth
Neighborhoods with high rates of violence often have limited access to health-promoting resources, such as safe parks and community centers
Community-based interventions that address root causes of violence, such as poverty and lack of opportunities, can improve health and safety
Environmental pollution and toxins
Exposure to air, water, and soil pollution can lead to respiratory illnesses, cancer, and other chronic diseases
Low-income and minority communities are often disproportionately exposed to environmental toxins, such as lead and industrial emissions
Policies that regulate pollution, enforce environmental justice, and promote clean energy can reduce health disparities
Access to healthy foods and green spaces
Limited access to healthy, affordable food options in low-income neighborhoods (food deserts) can contribute to poor nutrition and chronic diseases
Lack of access to safe, green spaces and recreational facilities can deter physical activity and social interaction
Strategies such as community gardens, farmers markets, and park development can improve access to health-promoting resources in underserved areas
Social and community factors in disparities
Social and community context, including relationships, , and community engagement, shape health behaviors and outcomes
Social factors contribute to health disparities, with marginalized populations often experiencing greater social exclusion and stress
Nurses should assess social determinants and work with communities to promote , resilience, and health equity
Social cohesion and support networks
Strong social relationships and support networks are associated with better mental and physical health outcomes
Social isolation and loneliness can lead to depression, anxiety, and poor self-care behaviors
Interventions that foster social connectedness, such as peer support groups and community events, can improve health and well-being
Discrimination and social exclusion
Experiences of discrimination based on race, ethnicity, gender, sexual orientation, and other factors can lead to chronic stress, mental health issues, and poor health outcomes
Social exclusion and marginalization can limit access to health-promoting resources and opportunities
Policies and interventions that address discrimination, promote inclusion, and celebrate diversity can reduce health disparities
Incarceration and criminal justice system
Incarceration is associated with higher rates of chronic diseases, mental health issues, and substance abuse disorders
Formerly incarcerated individuals often face barriers to healthcare access, employment, and housing, which can exacerbate health disparities
Strategies such as diversion programs, re-entry support, and healthcare coordination can improve health outcomes for justice-involved populations
Adverse childhood experiences (ACEs)
ACEs, such as abuse, neglect, and household dysfunction, can have lifelong impacts on health and well-being
Higher ACE scores are associated with increased risk of chronic diseases, mental health problems, and substance abuse
Trauma-informed care and interventions that build resilience and support families can mitigate the impact of ACEs and promote health equity
Intersectionality of social and economic factors
Social and economic factors do not operate in isolation but intersect and interact to shape health outcomes and disparities
Intersectionality recognizes the cumulative impact of multiple marginalized identities and experiences on health and well-being
Nurses should take an intersectional approach to understand and address the complex determinants of health for vulnerable populations
Cumulative impact of multiple disadvantages
Individuals and communities often face multiple, overlapping social and economic disadvantages that compound health risks and disparities
The cumulative impact of poverty, discrimination, limited education, and other factors can create significant barriers to health and well-being
Interventions that address multiple determinants of health, such as housing-healthcare partnerships, can have synergistic effects on health outcomes
Interaction of race, ethnicity, and socioeconomic status
Race, ethnicity, and socioeconomic status intersect to shape health outcomes and access to resources
are disproportionately affected by poverty, which can exacerbate health disparities
Strategies that address both racial and economic inequities, such as targeted investments in minority communities, can promote health equity
Gender and sexual orientation disparities
Gender and sexual orientation can intersect with other social and economic factors to shape health risks and outcomes
Women and LGBTQ+ individuals often face unique barriers to healthcare access, including discrimination and lack of culturally competent care
Interventions that address gender and sexual orientation disparities, such as LGBTQ+ inclusive healthcare environments, can improve health equity
Disability and chronic illness considerations
Individuals with disabilities and chronic illnesses often face multiple social and economic barriers to health and well-being
Disability can intersect with poverty, limited education, and social isolation to exacerbate health disparities
Strategies that promote accessibility, inclusion, and self-management support can improve health outcomes for individuals with disabilities and chronic conditions
Strategies to address social and economic disparities
Addressing social and economic determinants of health requires multi-level, multi-sectoral strategies that engage diverse stakeholders
Nurses play a key role in identifying disparities, advocating for change, and implementing interventions that promote health equity
Effective strategies should be evidence-based, culturally tailored, and grounded in community partnerships and priorities
Policy interventions and social programs
Policies that address upstream determinants of health, such as living wage laws, affordable housing initiatives, and universal healthcare coverage, can have broad impacts on population health
Social programs, such as food assistance, early childhood education, and job training, can mitigate the impact of social and economic disadvantage
Nurses can advocate for policies and programs that promote health equity and support vulnerable populations
Community-based participatory research and interventions
Community-based participatory research (CBPR) engages communities as equal partners in identifying health priorities, designing interventions, and disseminating findings
CBPR can build trust, cultural relevance, and sustainability of interventions to address social and economic disparities
Examples of CBPR interventions include community health worker programs, peer support groups, and community-led health promotion campaigns
Culturally competent care and outreach
Culturally competent care recognizes and respects the diverse values, beliefs, and practices of patients and communities
Culturally tailored interventions, such as language-concordant care and community health education, can improve healthcare access and outcomes for diverse populations
Outreach strategies, such as mobile health clinics and faith-based partnerships, can engage hard-to-reach populations and build trust in the healthcare system
Advocacy and social justice efforts in healthcare
Nurses can use their expertise and influence to advocate for policies and practices that promote health equity and
Advocacy efforts can include testimony at public hearings, op-eds and media engagement, and participation in coalitions and campaigns
Social justice efforts in healthcare can address root causes of disparities, such as racism, discrimination, and structural inequities
Examples of social justice interventions include implicit bias training for healthcare providers, diversifying the healthcare workforce, and investing in community-led health initiatives