Health Is a Social Outcome: How Social Factors and Poverty Contribute to Health Inequities

Recently enacted and proposed cuts to Medicaid, the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) are deeply troubling and could have devastating consequences for the health of all Americans, especially the poor and vulnerable. These actions threaten to undo much of the slow but steady progress made over the past 50 years toward eliminating health disparities and promoting health equity.

Medicaid provides coverage to more than 80 million low-income people in the United States, including almost 40 million children. It also provides care and resources for low-income pregnant women, people with disabilities, and elderly individuals. Cuts to the NIH and CDC threaten decades of research and public health programs that have significantly improved outcomes for people on the margins of society.

The United States already lags behind other developed nations in key health indicators—infant and maternal mortality, chronic disease rates, and access to care. The U.S. has the highest number of preventable deaths among wealthy nations, despite spending more per capita on healthcare than any other country. Systemic inequities that jeopardize the health of the poor help explain why the U.S. ranks 34th globally in life expectancy. Further reductions in healthcare access will not only harm millions of people today but will also deepen the long-term burden of disease in our society.

As Christians, we must recognize that these issues transcend policy debates; they challenge our moral and spiritual responsibilities. Throughout Scripture, we are commanded to care for the poor, the sick, and the marginalized (Proverbs 31:8-9, Matthew 25:40). Ensuring equitable access to healthcare is not just a matter of public policy but a fundamental issue of justice and compassion.

The social determinants of health

Unlike most other developed nations, the U.S. has never fully embraced what the World Health Organization (WHO) considers essential for a healthy population—Universal Health Care (UHC) and Primary Health Care (PHC). UHC ensures that all people, regardless of income, have access to medical services without financial hardship. PHC integrates healthcare with social services, recognizing that factors such as housing, education, and employment impact health outcomes (1,2).

The importance of addressing health within a social and economic framework was recognized as early as the 19th century. The German physician and social reformer Dr. Rudolph Virchow argued that disease is largely caused by poverty, unemployment, malnutrition, and lack of access to medical care. He famously described medical practitioners as the “natural attorneys for the poor” since they directly witness the effects of inequality on health (3).

Over the past 50 years, the U.S. has made slow but meaningful progress in recognizing the connection between social conditions and health outcomes, particularly in marginalized communities. The establishment of Medicaid and Medicare in 1965 marked a significant step forward. More recently, community health initiatives have combined clinical medicine, public health, and social services to create more comprehensive healthcare models (4,5,6).

However, healthcare alone is not enough. Research shows that medical care accounts for only about 20% of health outcomes, while social and economic factors account for 40%, health behaviors for 30%, and the environment for 10% (7,8). Similarly, health disparities are deeply tied to social determinants such as housing quality, food security, job opportunities, and neighborhood safety.

The impact of chronic stress and poverty

The consequences of inequality extend far beyond access to medical care. Chronic stress from poverty and instability increases the risk of mental health disorders such as depression, while also contributing to weakened immune function and chronic diseases like cancer, heart disease, and diabetes. An individual’s zip code is often a more reliable predictor of health outcomes than their genetic code.

The Affordable Care Act (ACA), passed in 2010, expanded Medicaid coverage, providing more than 41 states and the District of Columbia with additional resources to address social determinants of health (SDOH)—including transitional housing, rental assistance, and nutrition services. However, these advances are now at risk. If Medicaid is cut and public health programs are dismantled, the burden will fall disproportionately on the most vulnerable members of society (9,10,11,12,13).

A call to action for Christians

In a 1966 speech to the Medical Committee on Human Rights, Dr. Martin Luther King Jr. declared, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman,” because it often results in physical death. While some progress has been made since then, the poor remain systematically deprived of equal access to a healthy life and are at increased risk of preventable disease, disability, and premature death.

Christians cannot remain silent in the face of policies that will worsen suffering for millions. Limiting Medicaid and reducing the reach of the NIH and CDC contradicts the Christian virtues of mercy and compassion and undermines our biblical call to love our neighbors as ourselves (Mark 12:31). As people of faith, we must advocate for policies that uphold human dignity, protect the vulnerable, and promote health justice for all.

Here are some ways you can take action:

• Educate your church community about the moral and social impact of healthcare inequities.
• Advocate for policies that protect and expand Medicaid and public health funding.
• Support local organizations working to address the social determinants of health in marginalized communities.
• Engage in community health initiatives that provide holistic care to vulnerable populations.

Faith in action: Transforming communities through vision and partnership

Let me conclude with an example. Early in my career, I joined the board of a non-profit linked to a small inner-city African American church. The pastor had a vision for building affordable housing, while I, as a professor of community medicine, saw an opportunity to improve community health. When I asked about funding, he smiled and said, “Mark, when the Lord gives you a vision, He provides the provision.”

With no initial funds, we spent four years raising nearly $16 million to build a 150-unit low-income housing complex—the first new construction in the area in 70 years. It included a fitness center, a teaching kitchen, community health offices, and garden beds.

This effort sparked a 20-year partnership with the pastor, leading to a coalition of 30+ African American congregations funded by the NIH and CDC. Together, we improved treatment for chronic diseases, increased exercise and weight loss, reduced emergency room visits, and trained a new generation of medical professionals.

Health is not just a personal responsibility—it is a shared social outcome. When we advocate for justice in healthcare, we reflect the love of Christ and help build a society where all people can thrive.