Philosophy & Technology

, Volume 32, Issue 1, pp 57–68 | Cite as

Social Justice, Equality and Primary Care: (How) Can ‘Big Data’ Help?

  • Kristin VoigtEmail author
Research Article


A growing body of research emphasises the role of ‘social determinants of health’ in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that ‘big data’ might play in allowing primary care providers to respond to the social determinants that affect individual patients’ health. The general idea has been proposed and endorsed by the Institute of Medicine, and the idea has been developed in more detail by Bazemore et al. (2016). In Bazemore et al.’s proposal, patients’ addresses are used to generate information about the patients’ neighbourhood; this information is then included in patients’ health care records and made available to providers. This allows primary care providers to take this information into account when interacting with, and providing care to, patients. I explore three issues arising from this proposal. First, while questions of privacy have been central to discussions about big data, Bazemore et al.’s proposal also allows us to see that there might be costs to not making certain information available. Second, I consider some of the questions arising for primary care from the influence of social factors on health outcomes: given that we know these factors to be significant contributors to social inequalities in health, what precisely should be done about this in the primary care context? Finally, I address problems arising from the use of population level data when dealing with individuals.


Equality Equity Health inequality Social determinants of health Big data 



This paper was written while I was a Senior Researcher at the Ethox Centre, University of Oxford. An earlier version of this paper was presented at the Brocher Foundation workshop, ‘Ethical Risk Assessment in Biomedical Big Data’, March 2016; I am grateful to the audience for their comments and suggestions. I would also like to thank two anonymous reviewers of this journal for their input.


  1. Bærøe, K., & Bringedal, B. (2011). Just health: On the conditions for acceptable and unacceptable priority settings with respect to patients’ socioeconomic status. Journal of Medical Ethics, 37(9), 526–529.CrossRefGoogle Scholar
  2. Bazemore, A., Phillips, R. L., & Miyoshi, T. (2011). Harnessing geographic information systems (GIS) to enable community-oriented primary care. Journal of Map & Geography Libraries, 7(1), 71–86.CrossRefGoogle Scholar
  3. Bazemore, A. W., Cottrell, E. K., Gold, R., Hughes, L. S., Phillips, R. L., Angier, H., Burdick, T. E., Carrozza, M. A., et al. (2016). “Community vital signs”: incorporating geocoded social determinants into electronic records to promote patient and population health. Journal of the American Medical Informatics Association: JAMIA, 23(2), 407–412.CrossRefGoogle Scholar
  4. Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annual Review of Public Health, 32, 381–398.CrossRefGoogle Scholar
  5. Burgess, D. J., Fu, S. S., & Van Ryn, M. (2004). Why do providers contribute to disparities and what can be done about it? Journal of General Internal Medicine, 19(11), 1154–1159.CrossRefGoogle Scholar
  6. Comer, K. F., Grannis, S., & Dixon, B. E. (2011). Incorporating geospatial capacity within clinical data systems to address social determinants of health. Public Health Reports, 126, 54–61.CrossRefGoogle Scholar
  7. Fiscella, K., & Epstein, R. (2008). So much to do, so little time: care for the Socially Disadvantaged and the 15-minute visit. Archives of Internal Medicine, 168(17), 1843–1852.CrossRefGoogle Scholar
  8. FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(19), 71.Google Scholar
  9. Furler, J. S., & Palmer, V. J. (2010). The ethics of everyday practice in primary medical care: responding to social health inequities. Philosophy, Ethics, and Humanities in Medicine, 5(1), 6.CrossRefGoogle Scholar
  10. Garg, A., Jack, B., & Zuckerman, B. (2013). Addressing the social determinants of health within the patient-centered medical home: lessons from pediatrics. JAMA: The Journal of the American Medical Association, 309(19), 2001–2002.CrossRefGoogle Scholar
  11. Goddard, M., & Smith, P. (2001). Equity of access to health care services: theory and evidence from the UK. Social Science and Medicine, 53(9), 1149–1162.CrossRefGoogle Scholar
  12. Gwatkin, D. R., & Ergo, A. (2011). Universal health coverage: friend or foe of health equity? The Lancet, 377(9784), 2160–2161.CrossRefGoogle Scholar
  13. Hargittai, E. (2015). Is bigger always better? Potential biases of big data derived from social network sites. The ANNALS of the American Academy of Political and Social Science, 659(1), 63–76.CrossRefGoogle Scholar
  14. Hughes, L. S., Phillips, R. L., DeVoe, J. E., & Bazemore, A. W. (2016). Community vital signs: taking the pulse of the community while caring for patients. The Journal of the American Board of Family Medicine, 29(3), 419–422.CrossRefGoogle Scholar
  15. Hurst, S. A. (2009). Just care: should doctors give priority to patients of low socioeconomic status? Journal of Medical Ethics, 35(1), 7–11.CrossRefGoogle Scholar
  16. Institute of Medicine. (2015a). Capturing social and behavioral domains in electronic health records: Phase 1. Washington, D.C.: National Academies Press.Google Scholar
  17. Institute of Medicine. (2015b). Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, D.C.: National Academies Press.Google Scholar
  18. Katikireddi, S. V., & Valles, S. A. (2015). Coupled ethical–epistemic analysis of public health research and practice: Categorizing variables to improve population health and equity. American Journal of Public Health, 105(1), e36–e42.CrossRefGoogle Scholar
  19. Marmot, M. G., & Kogevinas, M. (1987). Social/economic status and disease. Annual Review of Public Health, 8, 111–135.CrossRefGoogle Scholar
  20. McLoone, P. (2001). Targeting deprived areas within small areas in Scotland: population study. British Medical Journal, 323(7309), 374–375.CrossRefGoogle Scholar
  21. Murdoch, T. B., & Detsky, A. S. (2013). The inevitable application of big data to health care. Journal of the American Medical Association, 309(13), 1351–1352.CrossRefGoogle Scholar
  22. Nuffield Council on Bioethics. (2015). The collection, linking and use of data in biomedical research and health care: ethical issues. London: Nuffield Council on Bioethics.Google Scholar
  23. Rasanathan, K., Montesinos, E. V., Matheson, D., Etienne, C., & Evans, T. (2011). Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health. Journal of Epidemiology and Community Health, 65(8), 656–660.CrossRefGoogle Scholar
  24. Shedd, C. (2015). Unequal City. New York: Russell Sage Foundation.Google Scholar
  25. Sniderman, A. (2015). The role of physicians in the era of predictive analytics. Journal of the American Medical Association, 314(1), 25–26.CrossRefGoogle Scholar
  26. Sreenivasan, G. (2014). Justice, inequality, and health. In E. Zalta (Ed.), The Stanford Encyclopedia of Philosophy
  27. Starfield, B., Gérvas, J., & Mangin, D. (2012). Clinical care and health disparities. Annual Review of Public Health, 33(1), 89–106.CrossRefGoogle Scholar
  28. Stevens, G. D. (2014). Addressing social determinants of health using big data. In K. Marconi & H. Lehmann (Eds.), Big data and health analytics (pp. 105–126). Boca Raton: Taylor & Francis.Google Scholar
  29. Thornton, R. L. J., Powe, N. R., Roter, D., & Cooper, L. A. (2011). Patient-physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Education and Counseling, 85(3), e201–e208.CrossRefGoogle Scholar
  30. Veugelers, P., & Yip, A. (2003). Socioeconomic disparities in health care use: does universal coverage reduce inequalities in health? Journal of Epidemiology and Community Health, 57(6), 424–428.CrossRefGoogle Scholar
  31. Voigt, K., Nicholls, S. G., & Williams, G. (2014). Childhood obesity: ethical and policy issues. New York: Oxford University Press.Google Scholar
  32. Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., & De Maeseneer, J. (2005). Socio-economic status of the patient and doctor–patient communication: does it make a difference? Patient Education and Counseling, 56(2), 139–146.CrossRefGoogle Scholar
  33. Wolff, J. (1998). Fairness, respect, and the egalitarian ethos. Philosophy and Public Affairs, 27(2), 97–122.CrossRefGoogle Scholar
  34. World Health Organization. (2008). Closing the gap in a generation: Hhealth equity through action on the social determinants of health. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Institute for Health and Social Policy & Department of PhilosophyMcGill UniversityMontrealCanada

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