Blog 3: Marginalized Populations

 Marginalized Populations and Health Equality

    Marginalized populations in the United States experience disproportionately higher risks for chronic disease, substance use, and mental illness due to a complex interaction of social determinants that impede health equity (Chen, 2025).  Health equity is defined as the fair opportunity for everyone to attain their highest level of health; however, systemic barriers continue to prevent this ideal from being achieved among disadvantaged groups (Chen, 2025). Key determinants such as socioeconomic status, access to healthcare, environmental conditions, discrimination, and cultural obstacles collectively contribute to poorer health outcomes in these populations.

                                                                                                    (Chen, 2025)

    Socioeconomic status remains a fundamental determinant affecting marginalized groups. Individuals with lower income and education levels are more vulnerable to chronic illnesses and mental health disorders due to limited resources and increased exposure to stressors (Chen, 2025).  Employment insecurity further exacerbates this vulnerability by restricting access to employer-based health benefits and increasing psychological stress (NIH, 2021).   Moreover, inadequate housing conditions and food insecurity create environments conducive to poor physical and mental health.  For example, living in neighborhoods lacking healthy food options or safe recreational spaces limits opportunities for maintaining good nutrition and physical activity which are both critical factors in preventing chronic diseases (NIH, 2021).

Access to healthcare services is another critical barrier that marginalized populations face.  Disparities in insurance coverage and availability of culturally competent care restrict timely diagnosis and management of chronic diseases as well as treatment for substance use disorders and mental illness (Chen, 2025).  Language differences and cultural misunderstandings between patients and healthcare providers can further hinder effective communication, reducing the quality of care received by ethnic minorities or immigrant communities (Chen, 2025). Such obstacles contribute not only to delayed treatment but also can create mistrust within these communities towards the medical system.

Discrimination and social exclusion significantly impact mental health outcomes among marginalized groups such as ethnic minorities, LGBTQ+ individuals, refugees, asylum seekers, and those living in poverty.  Experiences of racism or stigma elevate chronic stress levels that increase susceptibility to depression or substance use as coping mechanisms (National Institutes of Health, 2024).  Adverse childhood experiences related to discrimination have long-lasting effects on psychological well-being throughout an individual’s lifespan (NIH., 2024). Additionally, isolation caused by lack of social support networks intensifies feelings of hopelessness or anxiety prevalent within these communities.

                                                                                    (Ndugga, Pillai & Artiga, 2024)

    The intersection of veterans, homeless, and incarcerated populations presents a complex dynamic regarding mental illness rates and substance abuse disorders.  Veterans, due to their unique service-related experiences such as exposure to combat stress and trauma, exhibit higher vulnerability to both mental health challenges and substance use disorders (SUD) (Delphin-Rittmon, 2020).  The 2020 National Survey on Drug Use and Health (NSDUH) highlights that nearly three-quarters of veterans with SUD struggle predominantly with alcohol use, while one in three experience serious mental illness (Delphin-Rittmon, 2020). Moreover, approximately 1.1 million veterans report co-occurring SUD and mental illness, underscoring the intertwined nature of these conditions within this population.

Making A Difference

Addressing health disparities experienced by marginalized groups requires a multifaceted approach that integrates clinical care practices, individual social barriers, as well as improving community conditions and policy reforms.  To combat these challenges effectively, healthcare providers and policymakers must adopt strategies that promote equity at multiple levels of the healthcare system (Commonwealth Fund, 2024).  One crucial action involves healthcare professionals critically examining their own practices to identify implicit biases and structural barriers that hinder equitable care delivery. The AMA (2023) advocates for physicians to utilize data on race, ethnicity, and language preferences to tailor interventions that meet the specific needs of minority patients.

Beyond individual practice changes, systemic policy reforms are essential.  Policymakers must rigorously evaluate existing health policies through an equity lens to determine their differential impact across diverse racial and ethnic communities.  The Commonwealth Fund (2024) underscores the importance of expanding insurance coverage for Black, Hispanic, American Indian, and Alaska Native populations as a means of reducing financial barriers that delay care or contribute to medical debt.

 

                                                    (National Academies of Sciences, Engineering, and Medicine, 2021)

Recent Reform

    A recent national intervention aimed at addressing social determinants of health issues experienced by veterans is the Veterans Health Administration’s (VHA) implementation of specialized community-based mental health services.  This initiative aims to respond to complex challenges faced by veterans, including homelessness, justice system involvement, substance use disorders, and functional disabilities related to mental illness (Bhalla et al., 2020).  The origins of this intervention can be traced back to the deinstitutionalization movement from the mid-20th century, which transitioned care from institutional settings to community-based programs.  Recognizing that clinical treatment alone was insufficient for many veterans, the VHA developed comprehensive services that encompass both medical and social support needs in an integrated manner (Bhalla et al., 2020).

    The intervention specifically targets vulnerable veteran populations who often encounter multiple intersecting barriers to health. These include difficulties securing stable housing, employment challenges, and stigma associated with mental illness or criminal justice involvement.  By providing intensive case management and rehabilitation within community settings, the VHA aims to mitigate these social determinants of health that exacerbate mental health conditions such as post-traumatic stress disorder (PTSD) and substance use disorders (Bhalla et al., 2020).  The program’s emphasis on outreach and holistic care represents a significant shift from traditional models focused mostly on symptom management.

    Evaluations of this intervention indicate promising outcomes in terms of engagement with mental health services among marginalized veteran groups.  Data analyzed from over one million veterans receiving specialty mental health care revealed that nearly 20% utilized community-based services designed under this initiative (Bhalla et al., 2020).  These participants were disproportionately those with co-occurring substance use diagnoses or histories involving the criminal justice system, populations traditionally underserved by conventional healthcare approaches (Bhalla et al., 2020).  The increased utilization suggests improved access for individuals facing substantial social obstacles.  However, despite these gains in service reach and integration of supports targeting social determinants of health, challenges remain concerning long-term stability in housing and employment outcomes for many veterans.

References

            American Medical Association. (2023). Reducing disparities in health care. Retrieved from https://www.ama-assn.org/public-health/health-equity/reducing-disparities-health-care

            Bhalla, I. P., Stefanovics, E. A., & Rosenheck, R. A. (2020). Social determinants of mental health care systems: Intensive community-based care in the Veterans Health Administration. BMC Public Health, 20, Article 1311. https://doi.org/10.1186/s12889-020-09402-0

            Chen, A. M. (2025). Barriers to health equity in the United States of America: Can they be … Retrieved from https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-025-02401-w

            Commonwealth Fund. (2024). Advancing racial equity in U.S. health care. Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2024/apr/advancing-racial-equity-us-health-care

            Delphin-Rittmon, M. E. (2025). 2020 National Survey on Drug Use and Health: Veteran adults. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHVeteransSlides072222.pdf

             National Academies of Sciences, Engineering, and Medicine. (2021). Social Determinants of Health and Health Equity. In The Future of Nursing 2020‑2030: Charting a Path to Achieve Health Equity. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK573923/        

             Ndugga, N., Pillai, D., & Artiga, S. (2024) Disparities in health and health care: 5 key questions and answers. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and-health-policy/disparities-in-health-and-health-care-5-key-question-and-answers/