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Beyond Access – What Healthcare Equity Actually Requires

Bytarasovich

The Wealth Gap Is a Health Gap

Hims & Hers’ 2026 Super Bowl advertisement opened with a striking claim: “Rich people live longer. All that money doesn’t just buy more stuff. It buys more time.”

They’re right. Socioeconomic position is one of the strongest predictors of health outcomes and longevity (Link & Phelan, 1995). Wealth doesn’t just correlate with health; it shapes who gets sick, who recovers, and who lives longer through multiple pathways simultaneously.

The ad’s solution? Democratizing access to concierge medicine through telehealth: diagnostic testing, hormone therapies, weight loss treatments, and early cancer screening: “the same science, the same access, no connections required.”

This raises an important question: Does expanding access to biomedical interventions address health inequity, or does it solve a different problem?

Why Wealthy People Live Longer

Link and Phelan’s fundamental cause theory explains why the wealth-health relationship has remained stable for over a century despite dramatic changes in medical knowledge and disease patterns (Phelan et al., 2010). Socioeconomic status operates as a “fundamental cause” because it:

  • Influences multiple health outcomes, not just specific diseases
  • Operates through multiple mechanisms simultaneously
  • Provides access to resources that help people avoid risks or minimize disease consequences
  • Reproduces health disparities even as diseases and treatments change

When new health interventions emerge, such as vaccines, screening technologies, pharmaceuticals, they initially diffuse along socioeconomic lines. Higher-status groups adopt them first, temporarily widening disparities before broader access develops.

This matters for telehealth platforms. Expanding access to preventative services may initially benefit populations already experiencing better health outcomes, following predictable diffusion patterns rather than disrupting them.

The Social Determinants Framework

Healthcare access is only one pathway through which wealth produces health. The World Health Organization identifies the conditions in which people are born, grow, live, work, and age as primary drivers of health outcomes (WHO, 2008):

Economic stability – Income insecurity and precarious employment create chronic stress that damages health over time (McEwen & Stellar, 1993). Wealth buffers against this exposure.

Built environment – Neighborhood quality, housing stability, environmental exposures, and green space access are stratified by income (Diez Roux & Mair, 2010). Wealthier populations live in healthier environments.

Social context – Social capital, community support, and freedom from discrimination provide both material resources and psychological benefits that protect health (Williams & Mohammed, 2009).

Education – Educational attainment shapes health through cognitive skills, health literacy, employment access, and social networks (Cutler & Lleras-Muney, 2010).

Healthcare access – While healthcare plays an important role in treating disease and preventing early mortality, research consistently shows that social and economic conditions account for substantial variation in population health (McGinnis et al., 2002).

What “Democratizing Healthcare” Actually Means

When Hims & Hers promises to democratize healthcare, several questions emerge:

Who can access “accessible” care?

Direct-to-consumer telehealth requires multiple forms of capital (Bourdieu, 1986):

  • Economic: disposable income for services rarely covered by insurance
  • Cultural: health literacy to interpret results and manage protocols
  • Social: trust in medical systems after previous experiences
  • Temporal: bandwidth to manage care while working and caregiving
  • Digital: reliable internet, devices, and platform navigation skills

Each barrier operates independently and cumulatively. Populations facing multiple constraints remain excluded even as services become nominally “accessible.”

What problems does expanded access solve?

Telehealth genuinely reduces barriers for specific populations: professionals lacking appointment time, rural patients far from specialists, people seeking stigmatized treatments. These are real problems worth solving.

But fundamental cause theory predicts that new health technologies initially diffuse along socioeconomic gradients. Early adopters of GLP-1 medications for weight loss, despite telehealth availability, remain concentrated among higher-income, higher-education populations with insurance (Koroukian et al., 2024).

Expanding access addresses different problems than the structural determinants explaining why wealth predicts longevity.

What does democratization mean operationally?

The term requires clarity. Does it mean:

  • Price reduction for lower-income populations?
  • Insurance integration or coverage expansion?
  • Eliminating gatekeeping (referrals, prior authorizations)?
  • Geographic reach to underserved areas?
  • Cultural accessibility for marginalized communities?

Each definition implies different barriers addressed and populations reached.

Designing for Equity

Healthcare organizations serious about closing health gaps benefit from medical sociology in three ways:

1. Design with social context in mind

User research must account for structural constraints, not just individual preferences:

  • How do shift work, caregiving, and transportation shape when people can engage with services?
  • Where does “non-compliance” actually reflect structural barriers rather than individual choice? (Lutfey & Freese, 2005)
  • Which populations does your innovation genuinely serve versus which remain excluded?

2. Complement access with structural approaches

Effective equity strategies operate at multiple levels (Whitehead, 1991):

  • Addressing root causes through policy (income supports, labor protections, housing)
  • Improving environments (neighborhood investment, environmental protection)
  • Strengthening communities (reducing discrimination, building social cohesion)
  • Expanding healthcare access (including telehealth to remove specific barriers)

Biomedical interventions work best when embedded in strategies addressing upstream determinants.

3. Be honest about what you’re solving

Honest framing acknowledges specific problems solved for specific populations while recognizing limitations. This creates space for complementary solutions addressing different barriers—and builds credibility with populations skeptical of promises that haven’t historically included them.

The Bottom Line

The Hims & Hers ad correctly diagnoses a real problem: wealth is a health determinant. Expanding access to preventative care through telehealth creates genuine value, particularly for populations facing geographic, temporal, or stigma-based barriers.

But closing the wealth-health gap requires addressing multiple mechanisms simultaneously: the chronic stress of economic precarity, neighborhood environments, occupational conditions, and social support—not just access to peptides and screening tests.

Healthcare equity means understanding all the pathways through which socioeconomic position shapes health, then designing interventions that address multiple levels at once. That’s where medical sociology becomes essential for healthcare organizations: identifying where innovation genuinely reduces barriers versus where it might reproduce existing stratification patterns.

The wealth gap is indeed a health gap. Closing it requires more than democratizing access to interventions. It requires addressing why wealth determines health in the first place.

Selected References

Bourdieu, P. (1986). The forms of capital. In J. Richardson (Ed.), Handbook of Theory and Research for the Sociology of Education (pp. 241-258). Greenwood Press.

Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1-28.

Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186(1), 125-145.

Koroukian, S. M., Schiltz, N. K., Warner, D. F., Sun, J., Bakaki, P. M., Smyth, K. A., Stange, K. C., & Given, C. W. (2024). Early patterns of glucagon-like peptide-1 receptor agonist uptake: Socioeconomic and geographic disparities. Obesity, 32(1), 23-32.

Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80-94.

Lutfey, K., & Freese, J. (2005). Toward some fundamentals of fundamental causality: Socioeconomic status and health in the routine clinic visit for diabetes. American Journal of Sociology, 110(5), 1326-1372.

McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093-2101.

McGinnis, J. M., Williams-Russo, P., & Knickman, J. R. (2002). The case for more active policy attention to health promotion. Health Affairs, 21(2), 78-93.

Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(S), S28-S40.

Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217-228.

Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20-47.

World Health Organization. (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. WHO Commission on Social Determinants of Health.

Mercedes Tarasovich, PhD, is the founder of Tarasovich Consulting, where she helps digital health teams design patient-centered products grounded in research. With a background in medical sociology and hands-on experience in managed patient programs, she brings academic rigor to the practical challenges of healthcare UX.