American Diabetes Association (ADA), the nation’s leading organization for all people living with diabetes, published a scientific review addressing social determinants of health (SDOH) and diabetes. Toward the goal of understanding and improving the health of people with diabetes through addressing SDOH, a writing committee—convened by the ADA—reviewed past evidence and research on diabetes risk and outcomes, as well as the impacts of interventions in these determinants.
“People living with diabetes face many challenges. Some of these relate to the disease itself, but increasingly we recognize the importance of many social determinants,” said Robert A. Gabbay, Chief Scientific and Medical Officer for the ADA. “The scientific review not only defines these issues but shines a bright light on the resulting health disparities and articulates an important research agenda to address these issues. The release of this important scientific review underlines the American Diabetes Association’s commitment for #HealthEquityNow.”
As defined by the World Health Organization (WHO), social determinants of health are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries. The COVID-19 pandemic has further exposed unequal vulnerabilities that impact racial and ethnic minority groups and disadvantaged communities. Understanding and mitigating the impact of SDOH for people with diabetes are priorities due to disease prevalence, economic costs, and disproportionate population burden.
The ADA committee summarized the following recommendations from international and U.S. national committees that have convened to provide guidance on SDOH intervention approaches:
- establish consensus core SDOH definitions and metrics,
- examine specificities in SDOH pathways and impacts among different populations with diabetes,
- prioritize a next generation of research that targets SDOH as the root cause of diabetes inequities,
- use dissemination and implementation science to ensure SDOH considerations are embedded within diabetes research and evaluation studies, and
- train researchers in methodological and experimental techniques for multisector and next generation SDOH intervention studies.
“This is a critical time in our nation’s history. As researchers and providers, we have the opportunity to advance solutions to the longstanding inequities that impact diabetes and other health conditions,” said Dr. Felicia Hill-Briggs, past ADA President of Health Care and Education and Chair of the SDOH writing committee. “Through this SDOH review, the American Diabetes Association is taking an important step toward acknowledging and setting the stage for the important research, policy, and implementation work that must be done in order to change the trajectory of inequity.”
The paper begins with a general outline of key definitions and SDOH frameworks and includes a literature review that focuses primarily on U.S.-based studies of adults with diabetes and on five aspects of SDOH: socioeconomic status (education, income, occupation); neighborhood and physical environment (housing, built environment, toxic environmental exposures); food environment (food insecurity, food access); health care (access, affordability, quality); and social context (social cohesion, social capital, social support). The paper concludes with recommendations for linkages across health care and community sectors, diabetes research, and research to inform practice.