Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health—An integrative review

Abstract

Scientific advances in healthcare have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest risk of poor health outcomes. Social determinants are thought to influence healthcare delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article is to integrate the literature on marginalization and situate the concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio-environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups.

Marginalisation, Ebola and Health for All: From Outbreak to Lessons Learned

“…Furthermore, each discipline has its own conceptual map and scholarly genealogy of this notion. For example, in the nursing science literature, marginalisation was proposed as a nursing theory by Hall et al in 1994 [8,9,10]. It then underwent a progressive transformation which led to the inclusion of additional elements, such as Eurocentrism [11] and then went through a series of expansions integrating scholarship on globalisation, privilege and intersectionality [12].…”

Exploring the promise of intersectionality for promoting justice-involved women’s health research and policy

“…Last, research has indicated that limited access to affordable housing is the most acute problem for women, because it forces them to return to living environments in which they are at risk of violence (Bunn, 2018 ; Owen et al, 2017 ). This demonstrates the role of structural factors in partial reentry services, in which women are exposed to an unprotected environment where the interaction of sociopolitical, economic, structural, cultural, and interpersonal circumstances put them at physiological and psychological risk (Baah et al, 2019 ). In an exploratory study of the effects of such health-damaging environments conducted among 204 women in Kansas City jails, Ramaswamy, Kelly, Koblitz, Kimminau, and Engelman ( 2011 ) revealed an association between experiences of violence and incarcerated women’s self-reports of cervical cancer screening and cancer history and treatment.…”

“…For example, a newly diagnosed low income cancer patient may spend his/her few life savings on treatments. This process can limit his ability to benefit from treatments and will push the individual further to a marginalized geographical location with limited access to health care services and basic needs (e.g., affordable housing) (Baah, Teitelman, & Riegel, 2019). Crenshaw (1991) charted three foci of intersection as analytical guides for assessment of this interplay.…”

“…These occur not only through deliberate political and structural oppression, but in a subtle, representational discriminatory fashion, as well (Hankivsky & Christoffersen, 2008 ). For example, guided by intersectionality theory, Baah et al ( 2019 ) invoked the concept of marginalization as a process through which certain population groups experience multiple social determinants that concurrently limit their access to health-promoting resources and increase their risk for poor health. The authors first discussed health disparities and inequity in access to resources, due to an uneven distribution of political and socioeconomic resources across gender, race, sexual orientation, culture, and geographic regions that resulted in limited employment and educational opportunities, as well as affordable health care services.…”

Structural Barriers to Health-provider Training Programmes for Ethnic Minorities: The Case of the Katu and Diabetes Management in Vietnam

“…Tailoring a programme to local cultural, health, and belief systems remains a challenge for nongovernmental organisations (NGOs) [8,18,19]. Most broadly, peoples' diverse socioeconomic contexts influence their behaviours, and this diversity needs to be accounted for if public health programmes are to provide agency for patients and improve the impact of interventions [20][21][22]. These challenges are compounded in the low-resource settings of rural areas in developing countries where there is sometimes divergent knowledge about health between participants, and where populations are dispersed and use several different indigenous languages [23,24].…”