Determinants of health exposed: How health disparities start before care begins

maninon0
Jul 23
5 min read

Updated: Jul 24

Imagine a single mother juggling two jobs who must choose between buying groceries for her children or paying for her diabetes medication. Her health isn’t just shaped by the care she receives; it’s influenced by systems and barriers far beyond her control.

This scenario isn’t far-fetched. Similar stories play out millions of times across America every single year, and they highlight a truth that is reshaping how we approach healthcare research: Medical care contributes just 10% to 20% to real-world health outcomes. The rest comes down to social determinants of health (SDOH).

For professionals conducting clinical trials, understanding these important upstream factors isn’t about social awareness, though that’s also very important; it’s about designing studies from the ground-up to reflect the complexities of the real world in order to deliver equitable outcomes for every individual.

What Are Social Determinants of Health (SDOH)?

Social determinants of health include all of the economic and social factors that shape a person’s healthcare journey. Everything from socioeconomic status and education level to physical proximity to clean resources and countless smaller variables impacts an individual’s health outcomes.

As a society, we focus a lot on the quality of medical interventions, but advancements in healthcare alone will never reduce health inequities. Instead, we need to identify and account for the conditions we are born into, live through, and work in, and design clinical trials with those myriad factors in mind.

The Challenge of Tracking Compounding Health Factors

SDOHs don’t exist independently in a vacuum; they compound and multiply, leading to dramatic impacts on health outcomes. A low-income adult in a region with abundant clean air, affordable fresh foods, and easy access to primary care will fare far better than that same low-income adult living in a food desert with poor transportation options and understaffed local clinics.

Race, income, education level, and environment all influence health outcomes in ways that many traditional clinical trials may overlook. Understanding the compounding factors that patients often deal with outside of the trial environment is crucial for developing interventions that benefit a diverse population.

Those living at the intersection of multiple marginalized identities are forced to grapple with certain disadvantages of biased systems. Intersectionality, a framework coined by Kimberlé Crenshaw, explains how overlapping identities such as race, gender, and class can interact to produce uniquely amplified forms of disadvantage.

See how this plays out in real-world trial strategy in Rubix LS’s Intersectionality in Clinical Research.

For example, a Black single mother living in a low-income neighborhood with little access to fresh foods deals with the sum of those realities, systemic racism, parental burden, low income, and lack of access to nutritious foods, all at once in a magnified way. Clinical trials must account for these intersectionalities rather than seeking to tick specific demographic boxes.

Environmental factors, especially pollution and housing conditions, also play a significant role. Learn how Rubix LS incorporates these insights in its Environmental Epidemiology models to better predict disease outcomes.

So, if these factors are so critical, why aren’t they better tracked and accounted for? A few key reasons include..

How Healthcare and Policy Can Help

Addressing SDOH demands a systemic approach that expands on existing clinical trial methodologies and addresses the complexities of each and every possible participant.

Start with Inclusive Trial Planning

Incorporating populations in the margins and those in high-need regions at the earliest opportunity, rather than adding them as an afterthought, ensures that research findings reflect real-world diversity.

Integrate Real-World Data (RWD)

Incorporating RWD and SDOH data early in trial protocols leads to a deeper understanding of how these factors affect treatment outcomes while also quickly identifying barriers to treatment.

See Rubix LS’s Genomic Epidemiology framework to understand how genetics and place interact to shape disease and drive equitable recruitment models.

Engage with Marginalized Groups Early

Planning for the inclusion of marginalized communities from the outset and developing strategies to reduce or eliminate participation hurdles is key. This may also mean providing transportation assistance, offering flexible scheduling, and coordinating with competent care experts to address the needs of each individual.

Continuously Audit for Equity

A plan for including marginalized groups is only beneficial if it’s followed throughout the trial process. Initiate continuous equity auditing throughout the research timeline to ensure all groups are represented. Take measures to ensure no groups are underrepresented in the trial results.

Rubix LS offers tools and real-time monitoring dashboards that support equity-focused auditing. Learn more in our Monitoring Diversity in Clinical Trials article.

Push for Inclusion Incentives through Policy

Support efforts by regulatory agencies to mandate diversity in clinical trial enrollment efforts. The FDA’s draft of diversity action plans from pharma companies was a step in the right direction, but it has since been rolled back. Stronger frameworks for ensuring diverse trial groups would result in more equitable healthcare.

Driving Equity Through Smarter Clinical Trials with Rubix LS

At Rubix LS, we believe innovation in clinical research means nothing if it doesn't include everyone. That’s why we build clinical trials that aren’t just scientifically rigorous, they’re socially conscious, equity-driven, and designed for the complexity of the real world.

We actively work to break down the barriers that keep underserved populations, including rural communities and historically marginalized racial and ethnic groups, from participating in and benefiting from clinical research.

What Makes Our Approach Different?

We design for inclusion from the start. We embed social determinants of health (SDOH) into every phase of trial design. That means accounting for factors like income, geography, housing, and transportation, not after the fact, but as part of the protocol itself.
We tailor trials for real-world complexity. Rubix LS specializes in complexity-ready trials built to reflect the needs of underrepresented and high-risk populations. We don’t retrofit inclusivity; we engineer it in.
We use smarter data. Our trials integrate real-world data (RWD) with deep SDOH insights to better understand how social context affects treatment outcomes. This leads to more accurate, meaningful results across all populations.
We reduce participation friction. Using culturally competent outreach, digital tools, and flexible logistics, we make it easier for people facing socioeconomic or logistical barriers to participate. Think: mobile enrollment, multilingual materials, and transportation support.
We ensure ethical compliance and beyond. Our methods support regulatory success while keeping equity at the core. From IRB protocols to decentralized models, we help sponsors stay compliant while doing the right thing.

By connecting science with social insight, Rubix LS is transforming clinical research into a tool for health justice where trials reflect the world we live in, and everyone has a voice in the future of medicine.

Why We Must Tackle Health Determinants Today

With up to 90% of health outcomes rooted in social determinants rather than medical interventions, clinical trials simply must account for these factors in order to generate valuable insights and, ultimately, lead to the development of treatments that suit a broad and diverse population. Pharmaceutical breakthroughs that work brilliantly in controlled conditions can easily fail for patients who weren’t accounted for in the trial process.

The future of healthcare depends on the ability of clinical research to evolve and address these important upstream factors. Integrating SDOH awareness into clinical trial design from the start puts us closer to addressing the root cause of health disparities.

The path to health equity runs through clinical research equity, and it starts with recognizing that health outcomes are often decided long before a patient ever steps foot inside a clinic.

To learn how Rubix LS can help integrate social context into your research strategy, visit our Contact Us page or get in touch at info@rubixls.com.

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