Determinants of Inequities in Neurologic Disease, Health, and Well-being

Abstract

A National Institute of Neurological Disorders and Stroke working group developed the Determinants of Inequities in Neurological Disease, Health, and Well-being framework. Our goal was to guide and inspire a new generation of neurologic research that pushes the field to design and test new approaches in pursuit of health equity, population health, and social justice. We seek to expand the lens of those looking to reduce or eliminate racial, socioeconomic status, and other inequities in neurologic disease, health, and well-being to improve our collective ability to create research, programs, and policies that lead to larger, more impactful, and more sustainable change in neurologic disease patterns. In this context, we outline a framework that includes and highlights “upstream” factors in the hopes of enhancing the focus of research, programmatic, and policy efforts to reduce and eliminate inequities in neurologic health and well-being. We explicitly discuss racism and other structural factors to clarify that social determinants are not natural and unchangeable. Populations with a disproportionate burden of neurologic disease are not inherently deficient, despite what some approaches to framing health inequities imply. The framework is presented linearly, but the pathways linking the determinants of neurologic disease, health, and well-being are far more complex than those demonstrated by the arrows included in the figure. The framework highlights the different levels and scale of causation, including the structural and intermediary social determinants and their impact on neurologic health. We offer this framework to refine efforts to contextualize the interpretation of neurologic research findings and suggest new avenues for their application. We illustrate how behavioral and biological factors occur in a social and economic context, factors that have been understudied as points of intervention to reduce inequities in neurologic disease. Considering social and structural determinants of health provides promising new opportunities to achieve neurologic health equity, reach social justice, and improve our science. Extending our work in this fashion is not simply about health equity or social justice but to fundamentally improve the quality of neurologic research by enhancing underlying theory and improving study design and implementation.

The Communication of Scientific Information to Scientists, Clinicians, and the Public

“…Yet both access to information and the ability to make sense of such information are socially patterned in ways that mirror the social patterning of other social goods and tools, often leading to sustained or new inequities, particularly in those populations designated by the NIH to experience health disparities (e.g., racial, ethnic, rural, low socioeconomic status, sexual, and gender minoritized populations). These social determinants of health, which are reviewed and discussed in depth in elsewhere in this special issue, 4,5 are increasingly recognized as important mechanisms for disparities in neurologic outcomes and disease. 6 As such, the information environment both contributes to and reinforces disparities in health outcomes.…”

Advances in the Understanding of Social Determinants of Health in Stroke

“…1 Additionally, addressing more structural and social status determinants will likely have a larger impact than interventions geared toward individual health literacy and behavior change. 1,3 Once efficacious interventions are identified, it will be necessary to evaluate the effectiveness, implementation, and dissemination.…”

“…2 Finally, the article “Determinants of Inequities in Neurologic Disease, Health, and Well-Being: The NINDS Social Determinants of Health Framework” illustrated a model for conceptualizing the impact of SDOH on inequities in neurological disease (Figure). 3 This model, adapted from 3 sources—the World Health Organization Commission on SDOH, 4 the Schulz et al 5 model, and the work of Williams et al 6 —shows the interplay between upstream structural determinants (cultural and social values; structural racism; economic, public, and social policies), social status determinants (socioeconomic position, class, education, occupation, and income), intermediate factors (public health and health care, built environment, and sociocultural environment), intrapersonal determinants (health behaviors and knowledge, psychosocial factors, and disability), biological determinants, and inequities in neurological health.…”

“…AD indicates Alzheimer disease. Reprinted from Griffith et al 3 with permission. Copyright ©2023, Wolters Kluwer Health, Inc.…”