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One of the more egregious – and heartbreaking – realities in today’s healthcare environment is the direct link between access to care and positive health outcomes. Officially, the conditions that stand in the way of healthcare access are called social determinants of health (SDOC), and include factors that are hard to control. Things like a person’s race, quality of education, economic security, or whether a person speaks English, or has access to public transportation. As the Centers for Disease Control (CDC) explains, “when people have limited access to resources they need to be healthy, they are more likely to experience health issues.”
Examples are everywhere. Adults who experience food insecurity are 2 to 3 times more likely to have type 2 diabetes. Children were found to be more than 19% more likely to suffer from asthma, and 28% more likely to experience depressive symptoms. The American Heart Association cites studies showing that food insecurity is associated with a range of adverse conditions including obesity, hypertension, diabetes, hyperlipidemia, and cardiovascular disease.
And that’s just food insecurity which according to the U.S. Department of Agriculture affects an estimated 13.5% of U.S. households, or almost 48 million people. Other examples include poor access to transportation, which affects about 15 million U.S. adults, making it difficult to reach doctors’ offices and other healthcare facilities. Another study found that individuals who do not complete high school were at a higher risk for reduced kidney function and cardiovascular disease.
As front-line healthcare providers, pharmacists see the effects of health inequities on a daily basis. Patients unable to afford medications due to sub-optimal insurance coverage, or no coverage at all. Patients with language barriers who can’t easily communicate their questions or concerns. Patients who don’t own a vehicle, and can’t easily travel to a pharmacy to pick up their medications or consult with a pharmacist. Or who can’t make it to the pharmacy during normal hours of operation.
Pharmacists can use their front-line role to help patients address the obstacles that preclude access to care. As members of their communities, pharmacists are attuned to the needs of their patients, and as trusted members of the medical profession, they are able to deliver critical assistance.
The following discussion will detail the many ways in which health disparities affect patient care, and offer insight about how pharmacists can help patients overcome those challenges.
The CDC has identified several factors that disproportionately affect individuals’ ability to access the health-related resources they need. Collectively these factors are called social determinants of health (SDOH) and refer to the conditions in which people are born, raised, live, and work. Inequities in any of the following, the CDC notes, “influence health outcomes and quality of life.”
Social context refers to the human interactions where one lives, works, learns, plays, and worships. Special programs help protect the health and well-being of people who experience disadvantage. Social and community context also includes discrimination (the unfair treatment of people or groups based on their race, gender, age, or sexual orientation). Discrimination – including racism – can be found in many societal systems, including housing, education, criminal justice, and finance.
Expanding on this description, Tulane University’s Weatherhead School of Public Health & Tropical Medicine explains that social context also encompasses:
“People who participate in civic and community activities can make social connections, become more physically fit, and better manage mental health issues like depression,” the Tulane overview notes. “Consider how joining a bi-weekly tai chi or play-reading class at a local community center could improve a senior’s sense of belonging, or how volunteering at a food bank could help a depressed teenager feel a sense of purpose.”
Groups that have been marginalized face multiple barriers to accessing health care. Structural barriers including socioeconomic status, lack of insurance, transportation, childcare, or ability to take time off work to visit a doctor. Barriers to patient-provider interactions and health care quality also include cultural differences and language barriers.
Neighborhood and Physical Environment
Access to public transportation, supermarkets, and healthcare contribute to segregation of American cities. Discriminatory practices limit housing options to neighborhoods with inadequate funding for school districts, higher crime rates, poorly resourced infrastructure, and limited access to nutritious, affordable foods. These conditions can make illnesses, diseases, and injuries more common and severe among discriminated groups.
As an example, analysis by Deloitte cites a study of Los Angeles County, which found Black and Hispanic residents more likely than White people to live in pharmacy deserts. In addition to reduced access to pharmacies, the study found that pharmacies located in poor communities were 24% more likely to be out of stock or to have limited stock for the 13 most-commonly prescribed medications, and to have limited hours of operation.
Occupational health inequities are avoidable differences in work settings. Physical and mental health outcomes are linked to social, economic and environmental disadvantages. Other workforce factors include temporary work arrangements, socio-demographic characteristics (e.g., age, sex race), and organizational factors (e.g., lack of safety measures, limited or no health insurance).
In addition to lower-quality education, other barriers to good jobs include geographic location, language differences, discrimination, and access to transportation. Redlining (denying mortgages to people of color) also limits home ownership opportunity and ability to build wealth. Financial challenges make it difficult to manage expenses and access affordable quality housing, education, nutritious food, and reliable childcare.
Inequities in access to quality education commonly affect people who have been historically marginalized. Lower-quality education leads to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. Educational barriers limit future job options and lead to lower paying or less stable jobs.
Health inequities put patients at risk for chronic conditions and serious illness. And they also add to the nation’s health spending tab. Analysis by Deloitte estimates that disparities add $320 billion annually to health spending, a figured projected to increase to a shocking $1 trillion or more by 2040. As an example, Deloitte cites the higher propensity for Black adults to be diagnosed with diabetes, and their ensuring experiences. “Racial inequity often contributes to a late diagnosis and comorbidities,” the analysis notes, “which results in $15 billion in unnecessary spending.”
Similarly, the study also found that of the $56 billion spent annually on asthma-related conditions, 4.3%, or $2.4 billion is considered “unnecessary spending associated with disparity.” Among other negative consequences, people at lower-income levels are more likely to receive a late diagnosis, and have trouble accessing needed care and medications.
The effects of health inequities run deep, with dire effects on affected communities. A list of more compelling impacts includes:
Unfortunately, this list is a small sample of the negative effects of health disparities on marginalized groups. A more comprehensive list would certainly continue for several pages and reveal the heartbreaking realities taking place within the U.S. healthcare system.
And while incidences of healthcare disparities are certainly not a new phenomenon, there does seem to be a heightened focus on addressing some of the underlying causes.
While the remedies mentioned above illustrate efforts at the federal level to address health inequities, other initiatives are being implemented across the nation. This includes offerings by state and local elected bodies as well as initiatives undertaken by business interests, community organizations, healthcare entities, and citizen groups. Addressing the multi-tentacled problem of healthcare disparity will require an “all hands-on deck” commitment from a wide swath of stakeholders, each of which can use their expertise to develop meaningful solutions. This includes of course, the nation’s pharmacists.
Patients can be excused for feeling the deck is stacked against them when it comes to healthcare access. This of course heightens the need for pharmacists to take a commanding lead in offering guidance, support, and solutions for the obstacles these patients encounter.
And make no mistake, pharmacists are responding to the challenge. A publication compiled by the Pharmacy Quality Alliance features multiple examples of actions taken by pharmacies nationwide to address SDOH-related issues. A few case study examples include:
As these impressive examples illustrate, pharmacies can – and are – making a difference. Other SDOC-related practices found throughout community pharmacies include:
Medication Accessibility and Affordability. Pharmacists can help patients address cost-related issues that can preclude accessibility to prescribed medications. This is an area in which technology, including the PrimeRx pharmacy management system, can be especially helpful. A few PrimeRx capabilities in this area include:
Patient Engagement. Pharmacists provide valuable assistance to patients by listening to their concerns and identifying social determinants of health during their conversations. As an example, the American Society of Health-System Pharmacists (ASHP) suggests a conversation about why a patient skips meals, exacerbating a diabetes condition, might reveal underlying food securities. The pharmacist can use this information to instruct a patient about care options and to provide referrals to appropriate social or healthcare agencies.
Medication Therapy Management (MTM). ASPHP suggests that MTM programs provide an important opportunity for pharmacists to have a role in health management. “MTM can be used to identify and resolve drug therapy programs,” the ASHP statement explains. “Pharmacists can develop comprehensive individual care plans, identify and meet vaccination needs, and improve health outcomes through adherence and management of chronic diseases.”
In addition, PrimeRx pharmacies can access an extensive library of patient education materials through integration with the Elsevier technology solution. Elsevier’s portfolio of solutions includes written handouts, health education videos, and medication/drug information sheets. Materials are available in multiple languages and are written in “user-friendly” format.
Immunizations. As pharmacists can clearly attest, immunizations are powerful tools in protecting patients from major illnesses and have helped eradicate diseases such as polio and measles. But too many members of marginalized communities do not receive their recommended vaccines.
For example, current CDC guidance recommends that children receive vaccinations against 15 major illnesses by age 24 months. According to Northwell Health®, the CDC tracks administration of these vaccines though the “completion of the combined 7-vaccine series, a grouping of vaccines administered during the first two years of life that covers everything from polio and measles to hepatitis B.” However, the analysis notes, children living below the poverty line receive the 7-vaccine series at a significantly lower rate. While 68% of all U.S. children born in 2020 received their vaccines by age two, the completion rate was just 56% for children living below the poverty line. Further, the analysis that completion rates are higher among non-Hispanic White children, those with private insurance, and those living in urban areas.
Similarly, rates of influenza vaccination are significantly lower among low-income and minority communities, with the National Foundation for Infectious Diseases noting that while 54% of White Americans received a flu vaccine during the 2021-2022 flu season, only 42% of Black adults were vaccinated, and 38% of Hispanics.
With more than 90 percent of pharmacies offering some type of immunization services, usually anchored by influenza vaccines, pharmacists are well-qualified to help patients understand the importance of immunization adherence. Examples for improving patient engagement, offered by the CDC include:
Pharmacy eCare plans provide a standard format for pharmacists to use in documenting the precise services provided to patients, and to share that information with doctors, clinicians and other members of a patient’s health care team. With PrimeRx, pharmacists have direct access to this important tool, and an opportunity to further their role as care providers and ensure the highest levels of collaboration in patient care.
In May 2025, the World Health Organization (WHO) released a global report about the impact of social determinants of health on underlying causes of poor health. Among the report’s more alarming findings, was a significant reduction in life expectancy – sometimes by decades – in high-and-low-income countries. Specifically, the report found that people living in the country with the lowest live expectancy will, on average, live 33 fewer years than those born in the country with the highest life expectancy. 33 fewer years!
“Our world is an unequal one,” said WHO Director General Dr. Tedros Adhanom Ghebreyesus in releasing the report. “Where we are born, grow, live work and age significantly influences our health and well-being,”
Indeed, as this discussion has made clear, health inequities prevent millions of American from accessing proper care, often with heartbreaking consequences. Pharmacists though, can be a guiding light in helping people in their communities succeed by offering counsel, expertise and services.
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“ASHP Statement on the Pharmacist’s Role in Public Health,” American Society of Hospital Pharmacies, 2021.
Baumgartner, Jesse C.; Collins, Sara R; and Radley, David C., “Racial and Ethnic Inequities in Health Care Coverage and Access 2013-2019,” Commonwealth Fund, June 9, 2021.
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Yangbo, Sun, MD, PhD; Liu, Buyun, MD, PhD; Rong, Shuang, MD, PhD; Du, Yang, MS; Xu, Guifeng, MD; Snetselaar, Linda G., PhD; Wallace, Robert B., MD; and Bao, Wei, MD, PhD, “Food Insecurity is Associated with Cardiovascular and All-Cause Mortality Among Adults in the United States,” Journal of the American Heart Association, September 25, 2020.
Javed, Zulqarnin, MD, MPH, PhD; Maqsood, Muhammad Haisum, MD; Yahya, Tamer, MD; Amin, Zahir; Acquah, Isaac, MD, MPH; Valero-Elizondo, Javier, MD, MPH; Andrieni, Julia, MD; and Nasir, Khurram, MD, MPH, MSc, “Race, Racism and Cardiovascular Health,” Circulation: Cardiovascular Quality and Outcomes, January 2022.
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