Social Identity
Social identity influences many aspects of life, including health and well-being.
Factors individuals cannot control about themselves, such as race, ethnicity, disability, gender, and age, all shape a person’s experiences and can create unique challenges.
People whose social identities have been marginalized often face discrimination and negative health impacts.
Here’s what you’ll learn:
How Social and Community Context Impacts Olivia
Meet Olivia—a young artist who has found community through volunteering, joining LGBTQ+ support groups, and sharing her experiences with homelessness on a youth advisory board. After law enforcement encounters and overcoming addiction, Olivia is working on building deeper connections with others and embracing her identity within her chosen family.
Get to Know OliviaHow Social and Community Context Impacts The Jackson Family
Meet Nichelle—a devoted wife and mother who balances caregiving for her mom with her own family responsibilities. Living near a Haitian community helps Nichelle feel connected to her culture. With her sister far away, she leans on her best friend and creative hobbies to find joy in daily life.
Get to Know The Jackson FamilyHow Social and Community Context Impacts The Garcia Family
Meet Elena—certified nurse assistant, National Guard veteran, and single mom. Living far from her support network, she is navigating grief, PTSD, and an invisible disability while raising her two children. Elena is trying to build community and find her way again.
Get to Know The Garcia FamilyHow Social and Community Context Impacts Chris
Meet Chris, a teacher who is blind and who has built a strong community through friends, family, and shared interests. Between hosting karaoke nights, playing Dungeons & Dragons, and spending time with his girlfriend’s family, Chris works to overcome stereotypes while nurturing his social connections.
Get to Know Chris
Terms to Know
Accessibility is when products, services, and facilities are designed so people of all abilities can access and use them.[1]
According to the Americans with Disabilities Act (ADA), [1] a person with a disability is someone who:
- has a physical or mental impairment that substantially limits one or more major life activities,
- has a history or record of such an impairment (such as cancer that is in remission), or
- is perceived by others as having such an impairment (such as a person who has scars from a severe burn).
Ethnicity refers to characterization of groups of people with similar cultural, national, tribal, racial, ancestry, or linguistic origins. [1]
Gender refers to the cultural behaviors, activities, attributes, and roles society expects of people based on their sex.[1] Gender identity refers to an individual’s sense of self and their gender.
Health equity is achieved when all people can reach their full potential for health and well-being. This fundamental human right is determined by the conditions people live in, including structural determinants like political, legal, and economic factors that shape the distribution of power and resources.[1]
This acronym refers to people who identify as lesbian, gay, bisexual, transgender, and queer/questioning.[1] Sexual orientation refers to an individual’s sexual and emotional attraction to another person.
Race is a social construct, or human-invented concept, used to describe and categorize groups of people into different categories based on physical appearance, social factors, and cultural backgrounds.[1] Historically, race has been used to establish a hierarchy where individuals are treated differently based on race. Racial categories change over time, location, and context.
Sex is a person’s biological status assigned at birth based on their anatomy and chromosomes.[1]
Structural racism refers to racism that is deeply embedded in society’s systems, laws, and practices. It leads to unfair treatment and oppression of people of color that affects their health and well-being. Examples include segregation, unfair lending practices, barriers to wealth accumulation and home ownership, environmental injustice, and voter suppression.[1] Systemic and structural racism include historical and ongoing injustices that involve whole systems within the political, legal, economic, health, criminal justice, and educational spheres.
Underserved populations are marginalized or minoritized groups of people who have limited or no access to certain resources.[1] Examples include people with socioeconomic disadvantages, limited English proficiency, geographical isolation, people of color, women, children, seniors, and people with disabilities.
Key
Facts
- Structural and systemic issues across all determinants of health create barriers that impact the health outcomes for groups of people with marginalized social identities.
- Altogether, these disparities and barriers are compounded for people who have two or more intersecting social identities.
Race and Ethnicity
For 250 years, slavery was legal in the U.S., followed by nearly 100 years of Jim Crow laws that restricted African Americans’ rights to vote, work, and get an education.[1] Although civil rights laws in the 1960s made discrimination illegal, these laws have not always been effectively enforced.
This form of structural racism is embedded in systems, laws, and practices, leading to widespread unfair treatment and oppression of people of color. This results in significant adverse health outcomes. The Centers for Disease Control and Prevention has declared racism a serious public health threat, recognizing racism as the root cause of many health disparities.[2]
For example, Black, Hispanic, and American Indian or Alaska Native people have worse health outcomes compared to white people across the social determinants of health.[3] Racial and ethnic minority groups in the U.S. have higher rates of chronic illnesses like diabetes, hypertension, obesity, asthma, and heart disease. Black Americans have a life expectancy that is four years shorter than white Americans. Racial and ethnic minorities receive inferior health care compared to white people, even when they have similar insurance, income, age, and severity of health conditions.[4]
Disability
Disabilities can affect mobility, cognition, independent living, hearing, visual, and self-care.[1]
Because disability can intersect with all social determinants of health and social identities, people with disabilities face significant health care disparities. They often have limited access to screening and preventive services, cancer diagnosis and treatment, reproductive health care, effective communication with medical providers, and physical and financial access to care. Additionally, they experience higher rates of various health conditions.[2]
While they are more likely to qualify for Medicaid, they also struggle more with medical bills and other financial hardships. As a result, adults with disabilities are more likely to skip or delay necessary health services due to cost.
Gender and Sexual Orientation
Gender
Gender impacts health in many ways due to social norms and power hierarchies. Resources are often allocated differently based on gender, affecting housing quality, neighborhood safety, and access to resources. Gender also influences how people handle stress, form relationships, and engage in healthy or unhealthy behaviors.
Gender roles and expectations, such as masculinity and femininity, shape how people experience risks, behave, access health care, and face biases within health systems. These roles can either help or harm health.[1]
Biological sex, including differences in genes, cells, and hormones, impacts disease risk, progression, and outcomes. Cultural expectations and behaviors linked to gender also influence how people seek care and manage their health.
Sexual Orientation
Individuals who identify as LGBTQ+ are often vulnerable to discrimination, poverty, and incarceration. They are frequently targets of persecution, including violence, alienation, and psychological abuse.[2]
Higher rates of stigmatization and discrimination in employment and education contribute to worse mental health outcomes for LGBTQ+ people.[3] They are at greater risk of suicide, major depressive disorders, generalized anxiety, traumatic stress responses, and substance use. These conditions are made worse by higher rates of illnesses and barriers to accessing health care, such as lack of insurance coverage, care costs, and discrimination from care providers due to stigma.[4]
[2] National Institutes of Health
[3] Measurement of gender as a social determinant of health in epidemiology-A scoping review
Age
The social determinants of health greatly impact physical health and well-being as people age. Older adults with lower incomes are more likely to have disabilities and a shorter lifespan.[1]
Most older adults in the U.S. have at least one chronic health condition, making access to affordable, quality health care essential. As mobility decreases, accessible neighborhoods with nearby grocery stores and safe places to stay active become increasingly important.
Health care is vital for children’s growth and well-being. Particularly from birth to age 5, their brains develop rapidly and are heavily influenced by the environment. Preventive screenings and regular pediatric appointments lead to better health, school performance, emotional well-being, and future work success.
Intersectionality
Intersectionality is the idea that to understand power, privilege, and discrimination, people need to consider all parts of a person’s identity and how they might impact and influence each other.[1] These aspects can include race, ethnicity, sexual orientation, gender identity, religion, and disability.
Intersectionality examines how different aspects of a person’s identity are interconnected and affect their experiences with discrimination and oppression.[2] People can face multiple sources of disadvantage at the same time, such as being a queer woman of color. Intersectionality helps explain the complex layers of inequalities that arise from overlapping systems of marginalization, oppression, and privilege.[3]
[1] Syracuse University Libraries
[3] Measurement of gender as a social determinant of health in epidemiology-A scoping review
Key
Takeaways
- Structural racism leads to widespread unfair treatment and significant negative outcomes for people of color.
- Gender roles and expectations shape how people experience risks, behave, access health care, and face biases within health systems.
- People can face multiple sources of disadvantage at the same time, highlighting the importance of understanding how all aspects of identity intersect.
Other Social & Community Topics
Community and Social Supports
Isolation and loneliness harm well-being, while strong social ties help individuals and communities thrive.
Criminal Justice Involvement
Addressing education, economic stability, and community support reduces crime and improves outcomes for those who have interacted with the criminal justice system.
Trauma
Understanding adverse childhood experiences and intimate partner violence helps us prevent trauma and support healing.
Housing stability: LGBTQ+ people are more likely to experience homelessness and face discrimination and harassment that prolongs homelessness. About 20% of homeless youth identify as LGBTQ+.[1]
Disability: Households with a person with a disability face many challenges to achieving financial stability and well-being. These households are twice as likely to have incomes below the federal poverty level.[2]
Economic insecurity: Unemployment rates are higher for people with a disability—specifically those who are also women of color—across all educational attainment groups.[3] Structural and social barriers such as lack of accessible spaces, transportation options, competitive employment opportunities, and discrimination in education and health, all contribute the significant barriers to employment that people with disabilities face.[4]
Discrimination: Black women often experience job segregation, lower pay, and undervaluation
[1] National Alliance to End Homelessness
[2] Prosperity Now
[3] Bureau of Labor Statistics
[4] National Partnership for Women & Families
Access: Students with a disability are 22% less likely to graduate high school on time.[1] Adults with a disability are half as likely to complete a four-year college degree. The factors behind these disparities are systemic and lead to lack of access to adequate resources, trained staff, and wraparound supports for students in need of special education and accommodations.
Quality: Due to historic neighborhood segregation practices, urban school districts with more low-income and racial and ethnic minority students have fewer resources.[2] These students tend to have fewer and lower-quality books, curriculum materials, laboratories, and computers. Teachers in these schools are sometimes less qualified and experienced and teach larger class sizes than well-funded schools.
[1] Prosperity Now
[2] Institute of Medicine (US)
Barriers to care: Lack of insurance coverage and provider availability are among the reasons why LGBTQ+ youth are unable to access mental health services.[1] LGBTQ+ teens are 120% more likely than their peers to experience homelessness or housing instability, [2] primarily because of family conflict or issues at home.[3] For LGBTQ+ teens who are able to access mental health services, concerns about confidentiality or being outed by their therapists can prevent them from getting the care they need.[4]
Challenges for older adults: About 80% of older adults have difficulties with using medical documents like forms or charts, making it harder for them to make informed decisions. Additionally, transitioning from private insurance to Medicare and high out-of-pocket costs further complicate their care.[5]
[1] The Trevor Project
[2] National Coalition For the Homeless
[3] Partnership to End Addiction.
[4] The Trevor Project
[5] Milbank Memorial Fund
Neighborhood support: Working-age adults with disabilities are less likely to find their neighborhoods supportive or cohesive. Accessibility in built environments greatly affects their ability to live, work, and participate in their communities.[1]
Accessibility: As people age and mobility decreases, it’s crucial to have housing. Yet, less than 5% of U.S. housing is accessible for people with moderate mobility difficulties. Less than 1% is accessible to wheelchair users.[2] It is also important for neighborhoods to have easy access to grocery stores and safe places for physical activity.[3]
Impact on pregnancy: Poor-quality built environments increase stress and depression during pregnancy, raising the risk of preterm birth and low birth weight. Additionally, prenatal exposure to air pollutants is linked to low birth weight, preterm birth, stillbirth, and congenital anomalies.[4]
[1] Disability-Based Disparities among Noninstitutionalized Working-Age Adults in the US: Evidence from the 2018 National Health Interview Surveys
[2] Office of Policy Development and Research
[3] U.S Department of Health and Human Services
[4] National Partnership for Women & Families
Social connections: Social isolation and loneliness increase the risk of dementia and other serious health issues in older adults. Positive social relationships can help people live longer, healthier lives.[1]
[1] U.S Department of Health and Human Services