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Deconstructing Bias logoMerriam-Webster defines margin is as “the part of the page or sheet outside the main body of printed or written matter.” This definition refers to the margins of a book or text where additional notes or ideas can be jotted down. Even after these notes are scribbled onto the page, they’re understood to be separate from the original ideas presented in the main text. Marginalized was used in that context until the 1970s, when the social revolution began to use the term as an analogy to describe the experience of people who live on the fringes of the mainstream of society. In a 1968 article in the Los Angeles Times, the term was used in reference to African Americans mentioning that they were “kept aside, marginalized, thus composing in its large majority the chronically poor.”

Today, the term marginalize is commonly used as a verb meaning “to relegate to an unimportant or powerless position within society or group.” Marginalization, or to marginalize, is used to describe the casting aside of groups that are considered “other” within society. In practice, this can manifest as ignoring the needs of a specific group or failing to provide a group with the same opportunities that are available to other members of society. Much like the notes in the blank edges of a book, marginalized groups are treated as separate from the main body of society. 

The expanded use of marginalization in the medical field was first noted in an article entitled “Marginalization: A guiding concept for valuing diversity in nursing knowledge development” by Hall et al. It identifies vulnerable groups in the health system as those who are “often hidden, stigmatized, lacking access to services, and mistrustful of the research process” (Hall et al., 1994). Since the publication of this article, the composition of these groups has extended beyond women and members of underrepresented ethnic and racial groups. Today, examples of marginalized populations include groups that are excluded due to race, gender identity, sexual orientation, age, physical ability, or language. This intersection between marginalization and health outcomes becomes further evident in the discussion of social determinants of health.  

The World Health Organization defines social determinants of health as “the circumstances in which people are born, live, work and age, and the systems put in place to deal with illness” (2010). The CDC defined the key domains of social determinants of health in Healthy People 2020 as economics, education, social and community context of living, neighborhoods and the built environment, and their relationship to health. This illustrates the fact that health outcomes are affected not only by environment but also by the experience of the individual in that environment (Havranek et al., 2015).

There are three themes that have emerged to demonstrate how marginalization is a process by which certain populations experience social determinants of health that can negatively impact health outcomes (Baah et al. 2018).

  • The first theme addresses how margins are created, defined, maintained, and enforced. They can be intentionally created or developed because of societal structures designed to adversely affect a targeted group. Once they are defined, a power dynamic is created that causes the excluded population to feel less powerful and their access to resources to be restricted. 
  • The second theme addresses the fact that, since the populations are separated from each other, it is difficult for them to meaningfully connect with each other. This reinforces exclusion of the marginalized group.
  • The third theme explains how persons in the excluded group are left vulnerable to poor health outcomes due to structural and social inequities.

All these themes illustrate that marginalized populations have limited access to resources that can promote or support good health outcomes and therefore are at an increased risk of poor outcomes. 

One recent example of the intersection of marginalization and social determinants of health has been evident during the COVID-19 pandemic. A study entitled “Multivariate, Transgenerational Associations of the COVID-19 Pandemic Across Minoritized and Marginalized Communities” by Yip et al. demonstrated that social determinants of health, not preexisting medical or psychiatric conditions, were the primary predictors of the multigenerational COVID-19 experience of families. This occurred for families from marginalized communities despite adherence to mitigation factors.

Social determinants of health and marginalization have a cumulative impact on a population in many complex ways. Marginalization forces a group into a position that impacts their experiences, identity, and environment. The resources that the groups will receive in this position such as education, income, and residence are disproportionately distributed, which can result in adverse life conditions and health outcomes. Understanding how the marginalization of different groups has been established, as well as how it harms the wellbeing of these groups, is the first step we can take toward combating inequality and inequity. Consider taking the following steps to become educated about how to confront and dismantle marginalization and review the resources below:

  1. Familiarize yourself with how different groups are marginalized within society. The Coronavirus pandemic has illuminated the disparity in resources that exist among racial and socioeconomic groups. Becoming educated about the greater health and economic risks faced by marginalized groups is important to understanding the impact of marginalization. Additionally, think critically about the structural and systematic sources of inequality that drive marginalization and how they can be addressed.
  2. Listen to marginalized groups. A lot of research on health and resource disparities is emerging and can help us understand how different groups are marginalized. However, listening to these groups directly as they share their needs can create a better understanding of how they can be supported. Take advantage of opportunities to hear directly from marginalized groups when they speak out about the impact on their families and communities.  
  3. Consider inclusivity in your own work. Individuals who live and partake in society are all valuable parts of that society. Think about how to promote the sharing of resources and opportunities where you work. Additionally, think openly and creatively about how you can play a role in dissolving structural barriers that prevent certain groups from accessing these resources in your community.

Resources