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What are social determinants of health?

Dr Catherine Godbold

Everyone’s experience of MS is different. People have different symptoms. Some have more relapses or their MS progresses faster. Recent research suggests these differences are influenced by more things than we thought.

We don’t fully understand why everyone’s MS is different. But we do know that how someone’s MS behaves, and the impact this has on them, can be affected by many things, including:

Other factors are also important across health and illness. These factors shape how we experience the world, and they influence lots of different conditions.

Social determinants of health

Because they’re relevant to everyone, we call these factors “social determinants of health”. They include:

  • Sexuality
  • Ethnicity
  • Education
  • Employment
  • Ability to access food and social support

These don’t always stay the same and are often impacted by external forces, which individual people might not have much control over. For example, COVID-19 had a big influence on employment and social networks. And new factors are emerging, like confidence using digital systems.

Research shows we can improve health by influencing some of these circumstances, but we don’t yet know exactly how they impact MS.

Social factors and MS

Dr Ruth Dobson and her colleagues recently published a new paper exploring the evidence in MS so far. They believe social factors could play a major role.

Read the full paper on the journal website

Social support

Financial and emotional support comes from family, friends, colleagues, charities, and even pets. But MS can affect all of this, and evidence suggests social isolation caused by MS can worsen mental health and quality of life.

Find out about our befriending service

Education

Several studies have suggested higher education levels may protect against MS progression for some people. But these studies have limitations. They don’t look at the quality of education. Also, experiencing early signs of MS could make it more likely that people leave education, not the other way round.

Employment

Studies show unemployment can affect MS outcomes. One study looked at people with MS who weren’t working 10 years after diagnosis. They had worse physical functioning and said they took part in daily activities less. Another found more stress and less life satisfaction in unemployed people with MS.

Read more about our policies on employment and MS

Socioeconomic status

Socioeconomic status uses things like income, occupation and where we live, to give an overall measure of how privileged or deprived someone is.

Most studies focus on the effect of socioeconomic status and the risk of developing MS, but some research suggests a link between being more deprived when you’re diagnosed with MS, and later disability (like reaching secondary progressive MS faster).

Race and ethnicity

Research suggests people from minoritised racial or ethnic groups may have worse MS outcomes. For example, one study showed Black Americans had faster disability worsening than White Americans.

These differences are likely the result of racism across health and other services. But there are still gaps in our understanding of MS in diverse populations.

Read our response to the Sewell report on race and social care

There are also factors where there’s been no research in MS. For example, more and more households in the UK are struggling with food poverty, but no studies have examined the effect on MS.

It’s also hard to untangle their separate effects. Lots of them are closely linked and having MS can also affect some factors.

Improving health

We think many social determinants have at least part of their effect through changing how people experience healthcare, rather than through direct effects on MS. That doesn’t make it any less important to tackle these where possible.

Being aware of each person’s circumstances is likely to improve care. So we need to help neurology teams recognise people who have social factors that might make their MS and quality of life worse.

If we address some of these factors, alongside using DMTs and symptom management therapies, we could make living with MS easier. We’ve seen this in other health conditions, but urgently need research to help us understand how to do it in MS.

This blog came from an article in our MS Matters magazine. You can explore the full back catalogue of the magazine. 

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