Determinants and Dilemmas

Access to neurologic care and neuroscience research is often limited by social determinants of health (SDoH), such as race, ethnicity, socioeconomic status, and education. These factors can affect health outcomes and their inequities. Studies have consistently reported disparities in neurologic health outcomes and overall well-being, with these inequalities distinctly stratified by race, ethnicity, and socioeconomic status, separate from intrapersonal, genetic, or other biological factors. Across the levels of SDoH, there can be significant intersectionality and interactions. Approached to address or moderate SDoH and these inequities requires a multipronged approach that includes advocacy for policy change, efforts to address structural, social status, and intermediate-level determinants and increased access to neurologists within underserved communities. This chapter provides context for a broad view of determinants in health and reviews some of the limitations and gaps in research within the field of neurologic health equity. In the following chapters, our colleagues explore the existing knowledge, initiatives, scope, and recommendations across neurologic specialties and the needs of the communities we serve.