Social determinants of health (SDHs) are significant and potentially modifiable drivers of neurologic diseases, including childhood epilepsy. Social determinants of health greatly influence the epidemiology, management, and outcomes associated with these conditions. Social determinants of health affect every aspect of a family's journey with epilepsy-from initial diagnosis to accessing effective treatments and ongoing care. Despite notable advancements in understanding the genetic and molecular underpinnings of pediatric epilepsies, there remains a relative lack of knowledge about the nature and impact of SDHs on these disorders. Epilepsy is a symptom of much more profound underlying determinants of health. Addressing the broader context of epilepsy can transform health outcomes. This narrative review appraises some available evidence and explores possible solutions.