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

Abstract

Scientific advances in health care 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 health care 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 was 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.

Figure 1:. Conceptual model of the link between social determinants of health and marginalization

illustrates social position as the relationship between social determinants of health (SDH) and marginalization. Socio-political, economic, cultural and religious influences accentuate the marginalization of certain individuals. Once marginalized, an individual exists at a position in society with limited access to affordable resources that limits survivability.

Figure 2:. Conceptual framework of social position in relation to mainstream society

Disparities and inequity in health promoting resources increase with increased perceived and objective distance from mainstream society.