Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar

Abstract

Purpose of Review To summarize evidence of impact of social determinants of health (SDOH) on diabetes risk, morbidity, and mortality and to illustrate this impact in a population context. Recent Findings Key findings from the American Diabetes Association’s scientific review of five SDOH domains (socioeconomic status, neighborhood and physical environment, food environment, health care, social context) are highlighted. Population-based data on Black/African American adults illustrate persisting diabetes disparities and inequities in the SDOH conditions in which this population is born, grows, lives, and ages, with historical contributors. SDOH recommendations from US national committees largely address a health sector response, including health professional education, SDOH measurement, and patient referral to services for social needs. Fewer recommendations address solutions for systemic racism and socioeconomic discrimination as root causes. Summary SDOH are systemic, population-based, cyclical, and intergenerational, requiring extension beyond health care solutions to multi-sector and multi-policy approaches to achieve future population health improvement.

Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…Five social determinants of health areas have been identified: socioeconomic status (education, income, and occupation), living and working conditions, multisector domains (e.g., housing, education, and criminal justice system), sociocultural context (e.g., shared cultural values, practices, and experiences), and sociopolitical context (e.g., societal and political norms that are root-cause ideologies and policies underlying health disparities) (46). More granularity on social determinants of health as they pertain to diabetes is provided in a recent ADA review (47), with a particular focus on the issues faced in the African American population provided in a subsequent report (48). Environmental, social, behavioral, and emotional factors, known as psychosocial factors, also influence living with diabetes and achieving satisfactory medical outcomes and psychological well-being.…”

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…societal and political norms that are root cause ideologies and policies underlying health disparities) [ 46 ]. More granularity on social determinants of health as they pertain to diabetes is provided in a recent ADA review [ 47 ], with a particular focus on the issues faced in the African American population provided in a subsequent report [ 48 ]. Environmental, social, behavioural and emotional factors, known as psychosocial factors, also influence living with diabetes and achieving satisfactory medical outcomes and psychological well-being.…”

Pandemic Meets Endemic: The Role of Social Inequalities and Failing Public Health Policies as Drivers of Disparities in COVID-19 Mortality among White, Black, and Hispanic Communities in the United States of America

“…Well before the onset of the pandemic, Black Americans suffered disproportionately higher levels of morbidity and excess mortality owing to the types of conditions included under the variable epidemiological factors here [ 27 , 28 ]. The reasons for this have been mainly attributed to social determinants of health that effect numerous dimensions of life for Black Americans and which include challenges such as inadequate health services (see e.g., [ 28 ]), greater exposure to environmental pollutants and hazards (see e.g., [ 29 , 30 , 31 ]), discriminatory practices in education (see e.g., [ 32 ]) and housing (see e.g., [ 33 ]), as well as in policing/imprisonment (see e.g., [ 34 , 35 ]). The common thread amongst all these issues is the role played by systemic racism, which has been referred to as a social determinant in its own right affecting all areas of health and well-being for Black Americans and ultimately contributing to lower life expectancies (by 4 years) compared to Whites [ 34 , 36 , 37 ].…”