Social Determinants of Health and Structural Inequities—Root Causes of Diabetes Disparities

Diabetes is the seventh leading cause of death in the U.S. and remains a significant cause of disability and decreased quality of life (1,2). In 2018, over 34 million people in the U.S. had diabetes (1). Historically marginalized groups such as racial and ethnic minorities, as well as those with lower socioeconomic status, bear a disproportionate burden of diabetes and its associated complications: blindness, neuropathy, limb amputations, chronic kidney disease, cardiovascular disease, and death (1,3). Additionally, the economic burden of diabetes amounts to approximately $237 billion in direct medical costs and $90 billion in lost productivity (4). Diabetes is a public health crisis that must be addressed by acknowledging and intervening on contextual factors outside of traditional medical care if we are to truly make an impact on improving outcomes, particularly for our most marginalized communities. While contributors to diabetes outcomes are unequivocally multifactorial, cumulative evidence suggests that certain factors play a larger role than others (5). For example, medical care plays a relatively small part (approximately 10–15%) in shaping individual and population-level health outcomes (5,6). In contrast, social and environmental factors, collectively known as the social determinants of health (SDOH), combined account for 50% to 60% of health outcomes and are a key contributor to health and health care disparities (5,6). The World Health Organization’s definition of SDOH also notes that these social and environmental factors are “shaped by the distribution of money, power and resources at global, national and local levels” and are largely responsible for inequities in health outcomes (7). To achieve health equity, we must address SDOH, and do so at …