Impact of Marginalization On the Social Determinants of Health

Oxford reference defines marginalization as a spatial metaphor for a process of social exclusion in which individuals or groups are relegated to the fringes of a society, being denied economic, political, and/or symbolic power and pushed towards being ‘outsiders’. Marginalized populations experience discrimination and exclusion (social, political and economic) because of unequal power relationships across economic, political, social and cultural dimensions. When you push people to the edge of society by not allowing them a place within it, you marginalize them. Marginalization can result from intentional campaigns that exclude certain people (like ethnic groups) from society. It can also occur unintentionally due to structures that benefit some members of society while making life challenging for others. Those who are at the centre have benefited from globalization, but those who are already marginalized are often left further behind – with the rich becoming richer and the poor becoming poorer.

Another problem is that people born in a marginalized community lack the required social and cultural capital to participate in mainstream development processes. Their social networks are weak and vulnerable. Lack of social capital deprives an individual of access to resources, such as, economic, educational and cultural and other support systems. This creates social isolation and limits their participation in the development process. The World Health Organization defines social determinants of health (SDOH) as “the circumstances in which people are born, live, work and age, and the systems put in place to deal with illness” (2010). The CDC defined the key domains of social determinants of health in Healthy People 2020 as economics, education, social and community context of living, neighborhoods and the built environment, and their relationship to health. This illustrates the fact that health outcomes are affected not only by environment but also by the experience of the individual in that environment (Havranek et al., 2015).

People who are socially marginalized are largely deprived of social opportunities. They may become stigmatized and are often at the receiving end of negative public attitudes. Their opportunities to make social contributions may be limited, and they may develop low self-confidence and self-esteem. Social policies and practices may mean that they have relatively limited access to valued social resources such as education and health services, housing, income, leisure activities, and work. The impact of marginalization, in terms of social exclusion, is similar, whatever the origins and processes of marginalization, irrespective of whether these are located in social attitudes such as, towards impairment, sexuality, ethnicity, and so on or, social circumstance such as closure of workplaces, absence of affordable housing, and so on. Different people will react differently to marginalization depending on the personal and social resources available to them.

One recent example of the intersection of marginalization and social determinants of health has been evident during the COVID-19 pandemic. A study entitled “Multivariate, Transgenerational Associations of the COVID-19 Pandemic Across Minoritized and Marginalized Communities” by Yip et al. demonstrated that social determinants of health, not preexisting medical or psychiatric conditions, were the primary predictors of the multigenerational COVID-19 experience of families. This occurred for families from marginalized communities despite adherence to mitigation factors. Marginalized people don’t necessarily belong to one particular demographic: Marginalization occurs due to ethnicity, gender, sexual orientation, disability status, socioeconomic level, and age. Additionally, the marginalization of certain groups because of ethnicity, race, caste, migrant status, gender, class, or nature and conditions of work, for example, continues to undermine health. In particular, the COVID-19 pandemic has unmasked the inequities and disparities that patients of historically marginalized populations experience. Adverse health outcomes – both physical and mental – resulting from these disparities can be attributed to SDOH.1

Neoliberalism has turned us into competitive individuals. In such a system everyone has to make those choices that turn his life into a professional success or personal happiness; moreover, these choices depend solely on his or her personal efforts. This creates a binary system of winners and losers. As humans are social animals this is a formula for unhappiness. The construction and perpetuation of stereotypes such as abusers of the welfare state, social scroungers, social hammock, is creating strong prejudices in people’s thinking. These ideas are purposely marginalizing the unemployed, the homeless, asylum-seekers, etc. and diverting suspicion from the real culprits. Since the 1980s, the emergence of neoliberalism as a dominant government paradigm has led to increasing instances of accountability failure, resulting in significant challenges to marginalized and lower socioeconomic groups.

Economic marginalization as a process relates to economic structures, in particular, to the structure of markets and their integration. To the extent in the markets that some individuals or groups engage in are segmented from the others in general, these individuals can be said to be marginalized from the rest of the economy. Segmentation and exclusion may, however, have non-economic and non-financial origins, for example in discrimination by gender, caste, or ethnicity. Here, integration takes on a broader meaning. People who are experiencing marginalization are likely to have tenuous involvement in the economy. The evidence indicates that students from low-income families are disadvantaged right through the education system to postsecondary training. The sources of their income will vary. These experiences affect men and women differently and vary with age. Poverty and economic marginalization have both direct and indirect impacts on people’s health and wellbeing.

Poor psychological health can disrupt your ability to think clearly, make healthy decisions, and fight off chronic diseases. Over time, neglecting your mental well-being can lead to feelings of anger, anxiety, fear, depression, self-blame, sadness, stress and isolation. The causes of social marginalization include sexual orientation and gender, religion or ethnicity, geography or history, less representation in political spheres, different cultures or rituals, different language or clothing, caste and class, poverty or race, etc. Impoverished people often don’t have the time or resources to advocate for their interests, either because they live in marginalized communities and lack access to necessary resources or spend excessive time and energy trying to provide for themselves and their families. On a societal level, the marginalization of specific individuals and groups carries a cost for society as a whole. When specific people and groups are shunted to the side and not allowed to make their voices heard, everyone loses out on their perspectives and is poorer for it.

The injustice in the US is systematic; much like family secrets we do not talk about. Decisions are made by well-intended people, in a society that can be described as having cognitive dissonance. The victims are those who are already suffering the most from one discrimination or another. The more acute the driving force behind securing public health, the more marginalized these individuals become. In short, it is not the individuals, but the system that is unjust. “If you’re in an advantaged position in society, believing the system is fair and that everyone could just get ahead if they tried hard enough doesn’t create any conflict for you … [you] can feel good about how [you] manage it,” said Godfrey. But for those marginalized by the system – economically, racially, ethnically – believing the system is fair puts them in conflict with themselves and can have negative consequences. We need to look in the mirror.

A gaslighter’s statements and accusations are often based on deliberate falsehoods and calculated marginalization. The term gaslighting is derived from the 1944 film Gaslight, where a husband tries to convince his wife that she’s insane by causing her to question herself and her reality. Consider Trump’s statement: “What you’re seeing and what you’re reading is not happening.” It makes victims question their reality, becoming even more dependent on the gaslighter as the only source of true information. In relation to hostile online material, the enthusiasts for chaos have no interest in whether it is true, nor even whether it supports their own ideological position. They will share hostile fake material both for and against their ‘side’, not simply for the devilment but because they see it as making collapse and chaos more likely. Social media has provided a huge proselytizing opportunity to those with destructive intentions. Many of Donald Trump’s tweets qualify.

The idea of canceling began as a tool for marginalized communities to assert their values against public figures who retained power and authority even after committing wrongdoing – but in its current form, we see how warped and imbalanced the power dynamics of the conversation really are. Now conservative elites have harnessed cancel culture to “cancel” anyone whose opinions cause controversy. For example, just as populism undermines democracy, “cancel culture” undoes the tolerance such that as you cancel disagreement, you start seeing it everywhere. Cancel culture’s zero-sum game plays off disadvantaged groups against one another, rather as right-wing populism pits the blue-collar “left behind” against groups that remain marginalized, such as Blacks, LGBTQ, low-income individuals and undocumented immigrants. Amid the left’s Twitter micro-wars, its real enemy – neoliberal hegemony – remains safely out of view. While black, queer, transsexual and feminist folk bicker, powerful white dudes carry on running the world.

For many students and their families who are struggling with inequity and social exclusion, poverty is a common marker of their marginalized social status. Poverty engenders a wide range of daily struggles, and can include the denial of a young person’s primary needs, such as homelessness or insecure housing, or facing the day without adequate clothing or nutrition. Poverty isn’t a learning disability, but when we ignore the needs of poor children, poverty can become disabling. Political and economic agendas that underlie conditions of daily life, and thus SDOH, are structurally rooted in lack of opportunity and inequitable access to resources. However, marginalized people are not responsible for ending their own oppression. It more important for the apologists for neoliberal prejudiced views to step out of their echo chambers and see the marginalized as humans than it is for the oppressed to humanize oppressors.

Social determinants of health (SDOH) and marginalization have a cumulative impact on a population in many complex ways. Marginalization forces a group into a position that impacts their experiences, identity, and environment. The resources that the groups will receive in this position such as education, income, and residence are disproportionately distributed, which can result in adverse life conditions and health outcomes. Social and health inequities aggravate one another, with marginalized groups having higher rates of infection, hospitalization, and mortality. While some may lack accessibility to adequate mental health services, the occupations, living conditions, and structural oppression experienced by marginalized groups increase allostatic load and worsen mental health inequities. Understanding how the marginalization of different groups has been established, as well as how it harms the wellbeing of these groups, is the first step we can take toward combating inequality and inequity.2

1https://science.nichd.nih.gov/confluence/display/newsletter/2022/06/10/Deconstructing+Bias%3A+Marginalization

2 Ashley Pratt and Dr. Triesta Fowler, Deconstructing Bias: Marginalization,  https://science.nichd.nih.gov/

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2 Responses to Impact of Marginalization On the Social Determinants of Health

  1. Bruce Haulley says:

    You make so many declarative statements without any truth to them that it’s obvious you’re writing for yourself, not others.
    • How did Trump lie to get elected? Are you unaware of other politicians’ blatant lies? And his distrust of the commercial media is well founded.
    • You seem to have only two choices: government or anarchy. By posing a false choice, you ignore the many other ideas, such as opposing a growing federal govt and huge spending.
    • Good Democrats and Bad Republicans. You pose as an intellectual, but you are definitely a small minded conservative thinker. Best wishes.

    • greg says:

      I write with the idea of making the reader think.
      Perhaps you only read and accept things that support your confirmation bias.

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