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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

The Impact of Social Determinants of Health on Vaccination Uptake 

Pallav Dave * 

Regulatory Compliance Analyst, Louisville, KY,40223, USA 

Article Info: 
_____________________________________________ 
Article History: 

Received   21 April 2024     
Reviewed  03 June 2024 
Accepted   24 June 2024 
Published 15 July 2024 

_____________________________________________ 
Cite this article as:  

Dave P, The Impact of Social Determinants of Health 
on Vaccination Uptake, Asian Journal of Dental and 
Health Sciences. 2024; 4(2):56-60 

DOI: http://dx.doi.org/10.22270/ajdhs.v4i2.90      

_____________________________________________ 

*Address for Correspondence:   

Pallav Dave, Regulatory Compliance Analyst, 
Louisville, KY,40223, USA 

Abstract 
_________________________________________________________________________________________________________________ 

This review sought to establish the impact of social determinants of health on vaccination uptake. 
The analysis established that the link between SDH and vaccination uptake is multifaceted with 
different factors affecting the uptake rates. For instance, economic stability affected vaccination 
uptake because it affected people’s ability to access insurance coverage or keep up with vaccination 
schedule. Healthcare access was also a key determinant factor to vaccination uptake. Lack of access 
limited individuals’ abilities to access vaccines. Other factors that played a role are education levels, 
social and community context, and built environment. The interaction between these factors 
contributed to disparities, inequities, and lower immunization rates. Addressing the disparities and 
inequities in vaccination uptake is important because it derails efforts that have already been made 
in addressing communicable diseases. It affects herd immunity, leads to strain of healthcare systems, 
and affects resource utilization. Due to these negative effects, it is important to take measures that 
can address the disparities. Collaboration with the community, policy reforms, and community 
interventions are some of the measures that can be used to increase uptake. These measures can 
address the underlying factors that cause disparities and affect vaccination uptake.  

Keywords: Social determinants of health (SDH), vaccination uptake, health outcomes, access, 
economic stability, health disparities  

 

Introduction  

Vaccination is one of the most effective public health 
interventions that plays a crucial role in disease prevention. 
Research has established that vaccinations prevent millions of 
deaths and disabilities across the globe with estimates showing 
vaccination has prevented up to 154 million deaths since 1974.1 
However, despite the availability and proven efficacy of vaccines 
in preventing communicable disease, vaccination rates remain 
low. According to the World Health Organization, vaccine 
disparities still exist especially in poor countries.2 For instance, 
in 2022, 14.3 million infants failed to receive their initial dose 
of diphtheria, tetanus, and pertussis (DTP) despite a 
widespread campaign to ensure no one is left behind.2 Most of 
the infants who did not receive their vaccine were mainly from 
low-income countries in Africa and Asia. The failure of these 
infants to receive their vaccines was attributed to lack of access 
to immunization and health services. The discrepancy between 
vaccine availability and uptake has led to researchers and other 
health organizations to begin research on factors that influence 
vaccine uptake. According to research, there are other factors 
that inform low vaccination uptake beyond the individual 
choices.3 These factors are social determinants of health (SDH). 
Research on how SDH affects vaccination uptake is growing.4 
The research explores how SDH shape vaccination behaviors 
and overall outcomes.  

Social determinants of health are the conditions in 
which people are born, grow, live, work, and age.5 According to 
Healthy People 2030, social determinants are key determinants 
of health outcomes affecting factors such as accessibility and 
availability.6 SDH are shaped by factor such as income levels, 
education, the built environment, insurance coverage, access, 
among other factors. WHO recognizes that SDH contribute to 

health inequities and affect overall health outcomes.5 When it 
comes to vaccination, these social and economic factors can 
significantly influence an individual's or community's 
likelihood of receiving recommended immunizations because 
they influence factors such as access and availability.  

The impact of SDH on vaccination uptake is complex. 
Factors such as education, income, employment, housing, social 
support networks, and access to healthcare services all play 
crucial roles in determining whether individuals and 
communities get the necessary vaccinations to prevent them 
against communicable diseases.7 The correlation between SDH 
and vaccination uptake is complex. For example, individuals 
with high literacy levels are likely to have a higher vaccination 
uptake because they have a better understanding of the 
importance of vaccination on health.8 Income levels are also 
likely to have an impact on vaccination uptake. Individuals in 
the lower income quantile and those living in poverty are likely 
to have lower vaccination uptake because of limited access to 
vaccination programs. The impact of poverty levels on 
vaccination uptake was evident during COVID-19 pandemic 
when low-income countries experienced disparities when it 
came to vaccine access, uptake, and coverage.9,10 Other SDH 
such as individual lifestyle factors, working and living 
conditions, and cultural and environment conditions also play a 
role when it comes to vaccination uptake. For instance, cultural 
beliefs about vaccination may inform individual’s decision 
whether to get the vaccine or not.  

Understanding the impact of SDH on vaccination 
uptake is important because it can help in developing strategies 
and policies that can increase uptake and coverage. Such 
strategies and policies should align with the existing strategies 
such as the WHO Immunization Agenda 2030 that seeks to leave 

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[62]                                                                                                                                                                                                                                              AJDHS.COM 

no one behind when it comes to vaccine coverage.11 Increasing 
vaccination uptake with particular focus on SDH should go 
beyond addressing individual factors that limit uptake to 
addressing the broader social and economic factors that affect 
uptake as well. To achieve success, there is a need for 
collaboration among relevant stakeholders such as healthcare 
professionals, policymakers, community leaders, among others 
who are involved in the vaccination process. Collaboration will 
lead to the development of comprehensive interventions that 
can tackle the root causes of vaccine disparities.  

Therefore, the aim of this review is to examine how 
social determinants of health influence vaccination uptake. The 
review will also explore, how SDH influence health outcomes 
and the impact of poor vaccination uptake on overall health. 
The review will also make recommendations on how to achieve 
equitable and effective immunization programs, ultimately 
leading to better health outcomes for individuals and 
communities worldwide. 

Impact of Social Determinants of Health on 
Overall Health Outcomes 

The social determinants of health are the factors that 
influence medical outcomes and influence health inequities. 
These factors are the ones in which people are born in, grow, 
work, live, and age.6 These factors influence health outcomes 
because they shape the conditions of life. Healthy People 2030 
classify SDH into five categories. They include economic 
stability, education access and quality, health care access and 
quality, social and community context, and neighborhood and 
built environment.6 

Economic Stability 

Economic stability refers to the ability of people to 
afford things like healthy food, healthcare, and housing.6 They 
key factors that determine economic stability are income levels, 
employment, financial security, housing stability among others. 
Economic stability has a significant impact on health outcomes 
because it determines whether an individual is able to afford 
things that influence healthcare such as healthy food and health 
care access. 

Research has determined that income inequality is a 
key determinant of health with individuals who have high 
income inequality being the most affected by health disparities 
and poor outcomes.12,13 Populations that tend to be the most 
affected by poverty and who belong to the low-income quintile 
have poor health outcomes which is as a result of health 
disparities.14 These populations tend to have challenges with 
health care access and affordability. In addition to challenges 
access healthcare, impoverished individuals and communities 
do not have adequate access to resources that are need to 
support good health and well-being. Such resources include 
healthy foods, stable housing, and safe neighborhoods.15 

Poverty also limits access to employment and education 
opportunities which widens the income gap even further. 
Research has shown that poverty increases risk of poor disease 
outcomes including the risk for poor mental health, chronic 
disease, and high mortality rates.16,17,18 The relationship 
between poverty and poor health outcomes begins all the way 
from childhood. For instance, research has documented that 
children who are affected by poverty are likely to have 
developmental delays, increased likelihood of chronic illness, 
nutritional deficits, and even chronic stress.19,20 Childhood 
poverty has also been linked to poverty in adulthood which 
means that such individuals are likely to have poor outcomes.21 

Economic stability also affects housing stability with lack of 
stable housing being associated with poor health outcomes. 
Housing instability leads to poor health outcomes because it 
makes it difficult to have healthcare continuity and receive 

social support.22 Economic instability also contributes to 
delayed healthcare because it makes people forego medical care 
when they need to which leads to severe outcomes.  

Education Access and Quality 

Education access and quality is an additional social 
determinant of health that affects health outcomes. Healthy 
People 2030 recognize education as important in determining 
health outcomes with emphasis on increasing education 
opportunities for children and adolescents.23 Education level 
influences health outcomes in a number of ways. First is health 
literacy. Research has documented that health literacy is 
associated with better understanding of health information and 
consequently good health outcomes.24 Individuals who have 
higher education levels are more likely to make informed 
decisions pertaining their health and also navigate the complex 
healthcare systems. Individuals with limited health literacy 
have more risk of misunderstanding health information or 
losing their way in the fragmented healthcare system.25 Several 
researchers associate health literacy with better disease 
prevention and control and overall good health outcomes.26,27,28 

Low literacy is associated with poor disease outcomes because 
it increases the rate of hospitalizations, increases use of 
emergency care, reduces utilization of preventative services, 
affects individuals’ ability to interpret labels and health 
messages, increases mortality, and increases overall costs of 
care.26 Low health literacy also affects shared decision-making 
with individuals who have low literacy finding it difficult to 
engage in their care.  

Education does not only impact health literacy. It also 
affects individuals’ abilities to have access to equal employment 
opportunities. Having higher education levels has been linked 
to access to better paying jobs which is a key determinant of 
health outcomes because it influences one’s ability to access 
care.29 Better paying jobs also have lower occupation hazards 
which expose workers to increased risk of work-related injuries 
and illness.30 Having higher education levels is also linked to 
safer working conditions and better control of work schedules 
which impact health. For instance, having flexible work 
schedules is linked to good mental health while high demanding 
jobs are linked to work-related stress.31 The link between 
flexible work schedules and good mental health outcomes can 
be attributed to work-life balance. A job that has good work-life 
balance is likely to have positive impact on mental health and 
well-being because it is associated with better sleep patterns 
and regular working hours which enables an individual to 
engage in personal activities. Lack of education also increases 
the risk of unemployment which is linked to poor health 
outcomes.  

Healthcare Access and Quality 

Healthcare access and quality is another domain of 
SDH as identified by Healthy People 2030. Access to quality 
healthcare services is a key determinant of health with various 
factors such as insurance coverage, geographic disparities, 
health system navigation, quality of care, and continuity of care 
affecting healthcare outcomes. Access to quality care is a key 
determinant of health because it influences timely use of health 
services and subsequent outcomes.23 Barriers such as lack of 
insurance coverage prevents and limits access to health care 
services when they are needed contributing to health 
disparities and poor outcomes. Lack of insurance coverage still 
remains a significant barrier to access despite numerous efforts 
to increase coverage for all. According to the 2022 National 
Health Interview Survey (NHIS), 12.2% of Americans aged 18 
to 64 did not have health insurance. In total, 27.6 million of the 
population was uninsured.32 The report also established that 
only 22% Americans had public coverage with most (67.8%) 
having private insurance coverage. The lack of insurance 



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coverage means that a large number of people opt for out-of-
pocket medial care which is associated with significant delays 
and foregoing the needed care. Research has established that 
lack of insurance coverage is often associated with poor 
outcomes.33 For instance, uninsured adults are likely to have 
many unmet needs including lack of routine checkups for 
conditions such as diabetes and hypertension.34   

In addition to insurance coverage, geographic 
disparities affect access to quality care. Geographic disparities 
in this case means people who are not near healthcare facilities 
and experience difficulties accessing these facilities. The 
disparities can be as a result of a number of factors including 
being located in rural areas where transportation is unreliable 
or as a result of residential segregation.35 Geographic 
disparities have been linked to poor health outcomes with lack 
of proximity to health facilities being linked to poor disease 
management.36 Residential segregation can also contribute to 
limited access and coverage. This can happen where health 
facilities are available but are overcrowded or have long wait 
outcomes.  

Other factors that affect health care access are 
difficulty navigating healthcare systems, variations in quality of 
care, and fragmented care. Difficulty navigating healthcare 
systems is attributed to complexity more so in individuals who 
have lower health literacy.37 Difficulty in navigating healthcare 
systems leads to uncertainty, disorientation, and suboptimal 
use of the already available systems. Fragmented care can also 
affect access more so when it comes to continuity of care. 
Fragmented care makes coordination difficult leading to poor 
outcomes. Lack of quality care also affects access and leads to 
health disparities.  

Neighborhood and Built Environment 

Neighborhood and built environment are another 
domain of SDH that affects health outcomes. The neighborhood 
and built environment refer to the places where people live and 
work. Some of the factors of the neighborhood and built 
environment that affects health are housing quality, water 
quality, air pollution, neighborhood safety, and the food 
environment. Factors such as air pollution and water quality are 
linked to poor health outcomes because they increase risks of 
diseases such as asthma and water-borne diseases.38 The 
housing quality also matters when it comes to health. People 
who live in poorly built houses that lack proper ventilation or 
are infested with mold and pests are more likely to report 
respiratory issues and allergies.39 This is particularly the case 
for children. The built environment comprising of how the 
neighborhood is built is also instrumental when it comes to 
health. 

Congested and overcrowded neighborhoods are 
linked to poor health outcomes because of the absence of 
sidewalks, parks, bike lanes, and recreational facilities to 
support physical activities.40 Lack of such activities influences 
behavior and increases risk of chronic diseases. Other aspects 
of then neighborhood and built environment that influences 
behavior are safety and violence and food environment. 
Neighborhoods that have high crime rates are known to be 
disproportionately affected by disease.41 High crime rates are 
associated with health disparities because they limit outdoor 
activities and increase the likelihood of mental health problems. 
The food environment refers to the availability of healthy vs. 
unhealthy food outlets and sources. Food environment has 
impact on dietary intake. Areas that have higher numbers of 
food deserts which are areas with limited access to healthy and 
nutritious foods have poor health outcomes including high risk 
of obesity and diabetes.42 Living in such environments 
contributes to poor dietary habits which explains why they are 
associated with poor health outcomes.  

Social and Community Context 

Social and community context is another domain of 
SDH that plays a crucial role in shaping health outcomes. Social 
and community context entails availability of social and 
community support within the community. Having strong 
support or social capital within the community that one lives in 
is associated with better health and well-being.43 Poor social 
relationships and isolation have been linked to poor health 
outcomes more so in older adults.44 Social isolation increases 
the risk of mental health, premature death, and cognitive 
decline. Community cohesion is an additional factor that is 
linked to good health outcomes. Communities that have high 
levels of cohesion tend to report better health outcomes more 
so on their mental health and well-being.45 The reason why 
community cohesion is associated with good health outcomes 
is because it influences behavioral and psychological pathways 
such as the need to eat a healthy diet or engage in healthy 
behaviors. Therefore, social and community cohesion provides 
an avenue for emotional support which is linked to good health 
outcomes and well-being.  

Evidently SDH have an impact on overall health and 
well-being. They affect many aspects of health and well-being 
leading to poor health outcomes and health disparities. SDH can 
also affect other aspects of health such as vaccination uptake. 
These factors can influence rates of vaccine uptake and even 
availability.  

Impact of Social Determinants of Health on 
Vaccination Uptake 

The impact of SDH on vaccination uptake is complex 
and multifaceted with a number of factors affecting the uptake 
rates. The correlation between SDH and vaccination uptake was 
evident during the COVID-19 pandemic.46 During this period, a 
lot of disparities with regard to vaccination uptake were 
experienced with a number of SDH contributing to the low 
uptake. For instance, economic stability is a contributing factor 
when it comes to vaccination uptake. Individuals with low-
income levels and those living in poverty are likely to face a 
number of barriers that may affect vaccination uptake. Areas 
that face deprivation and marginalization are likely to have high 
vaccine hesitancy.47 The high vaccine hesitancy in such regions 
can be attributed to a number of factors including low health 
literacy levels on the importance of vaccination, limitations 
when it comes to transportation costs to healthcare facilities, 
and lack of coverage of vaccinations by health programs. 
Adebowale et al. established a correlation between household 
wealth and vaccination uptake with children from higher 
income households having higher uptake rates than those from 
low-income households.48 

The correlation between economic stability and 
vaccination uptake goes beyond household level. It has been 
established at the country level. The national income can have 
an impact on vaccine rollout, uptake, and hesitancy. This was 
evident during COVID-19 where low- and middle-income 
countries experienced low rollout levels compared to their 
high-income counterparts.49 Economic stability also affects 
vaccination uptake because has an influence on insurance 
coverage. Individuals with low-income levels are likely to be 
uninsured which can limit access to vaccines especially where 
there are no public programs. According to a study by Lu et al., 
vaccination coverage was lower among people who did not have 
health insurance compared to those who had insurance.50 

An additional determinant of health that affects 
vaccination uptake is education level. This includes both 
education attainment and health literacy. Higher education 
attainment has been linked to increased vaccination uptake 
with individuals who have higher education levels being more 



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[64]                                                                                                                                                                                                                                              AJDHS.COM 

likely to go for vaccination.51 Health literacy is an additional 
factor that influences vaccination uptake. Individuals who are 
health literate are more likely to take vaccination because they 
understand the impact of vaccines on health outcomes.52 Health 
literacy also influences a person’s understanding of the risk 
perceptions associated with vaccines. As such, they are likely to 
make informed decisions whether to take vaccines or not.  

Healthcare access and quality is a key determinant 
when it comes to vaccination uptake. Factors such as 
geographic disparities, insurance coverage, and availability of 
the healthcare provider determines whether the uptake will be 
high or not. Geographic disparities can affect the ability of the 
individual to keep up with vaccination routine.53 Proximation to 
healthcare facilities is important because it determines 
whether an individual will go for vaccination as required. 
Geographic disparities also affect transport networks with 
people living in remote areas finding it challenging to access 
healthcare facilities for vaccines.54 Shortage of primary care 
providers and lack of insurance coverage can also limit vaccine 
administration and uptake. Individuals that lack insurance are 
less likely to keep up with vaccination schedules.  

Neighborhood and built environment influences 
vaccination uptake in terms of vaccine accessibility. The 
neighborhood and built environment can affect vaccination 
uptake through two main ways. One is presence or absence of 
healthcare facilities or community health centers. Limited 
access to such facilities is likely to lead to lower uptake. Lack of 
reliable public transportation in the neighborhood can also 
make it difficult to access healthcare facilities that provide the 
vaccine.  

Another key domain of SDH that influences 
vaccination uptake is social and community context. Social and 
community context in this case are the social norms that exist 
in a community or religious and cultural beliefs. Cultural and 
religious beliefs influence vaccination uptake with some of 
these beliefs being against vaccination.55 The attitudes that a 
community has towards vaccination can lead to vaccine 
hesitancy on a personal level.  

Increasing vaccination uptake requires broader 
understanding of how social determinants influence individual 
decisions to get vaccinated. It also helps to understand broader 
community factors that influence vaccination uptake. Having a 
good understanding of these factors is important in designing 
targeted interventions that can address the specific barriers 
experienced by individuals and the community. Understanding 
the impact of SDH on vaccination uptake can also influence 
policy changes because policies can be implemented to deal 
with the identified barriers.  

Addressing poor vaccination uptake is important 
because of the impact it has on health outcomes. Vaccination 
can be used as a disease prevention and control strategy more 
so for communicable diseases. Using vaccination as a measure 
to prevent and control the spread of communicable diseases 
reduces strain on healthcare systems and ensures effective 
resource allocation.56 Strain on healthcare systems can have a 
negative effect on health as was witnessed during COVID-19 
pandemic.  

Poor vaccination uptake also leads to increase disease 
incidence. Failing to take vaccination according to vaccination 
schedule increases the incidence and resurgence of preventable 
diseases.57 Some of these diseases are associated with high 
morbidity and mortality rates. Poor vaccination uptake also 
comprises herd community.58 Compromising herd community 
increases the risk of disease spread more so vulnerable 
populations. It also increases the risk of disease outbreaks.  

 

Conclusion 

This review establishes that social determinants of 
health affect vaccination uptake. The analysis determines that 
the relationship between SDH and vaccination uptake is 
multifaceted with different factors influencing the uptake rate. 
The SDH interact in complex ways contributing to disparities, 
inequities, and lower immunization rates. The disparities in 
vaccine uptake derails the efforts that have already been made 
with regard to vaccination and makes it difficult to reach the 
WHOs vision of providing vaccine for all by 2030. Inadequate 
vaccine uptake is associated with negative effects on health 
hence the need for measures that can increase uptake. 
Collaboration, policy reforms, and community interventions are 
some of the measures that can be used to increase uptake. 
These measures can address the underlying factors that affect 
vaccination uptake. It is also important to acknowledge how 
SDH affects vaccination uptake and taking measures to address 
the resulting disparities and inequities. Addressing the 
disparities associated with SDH can lead to improvement in 
vaccination uptake.  

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