Disclosures: The authors report no relevant financial disclosures.
November 12, 2020
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ADA: Social determinants of health key drivers of diabetes outcomes

Disclosures: The authors report no relevant financial disclosures.
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Social determinants of health are essential intervention targets to achieve health equity among people with diabetes, according to a new scientific review from the American Diabetes Association.

The ADA convened a writing committee to review past evidence and research on diabetes risks and outcomes as they relate to social determinants of health, as well as the effects of interventions on social determinants. The scientific review, published in Diabetes Care, is an update to an earlier review published in 2013.

Felicia Hill-Briggs is a professor of medicine and senior director of population health research and development at Johns Hopkins University and Medicine.

“Diabetes can be used as an exemplar of key challenges that have faced U.S. health care: unsustainable increasing economic costs, suboptimal improvement in disease risks and outcomes at the population level despite significant advances in therapies and devices, and entrenched disparities by socioeconomic status and race/ethnicity,” Felicia Hill-Briggs, PhD, ABPP, professor of medicine and senior director of population health research and development at Johns Hopkins University and Medicine, told Healio. “Understanding the contribution of social determinants of health was deemed essential for ADA’s mapping of research and intervention pathways toward improved diabetes population health and equity.”

Social determinants as ‘root cause’

WHO defines social determinants of health as the conditions in which people are born, grow, live, work and age. These include socioeconomic status, neighborhood and physical environment, food environment, health care and social context.

Since the ADA first published a scientific statement on socioecological determinants of health in 2013, much has changed, Hill-Briggs told Healio. Researchers, practitioners and health organizations are now more boldly acknowledging the role of social determinants and their root causes, such as structural racism and classism, in affecting health risks, exposures and outcomes of populations.

“The ADA 2013 statement focused on socioecological contributors to the dual epidemics of obesity and type 2 diabetes and implications of this for recommended lifestyle change ,” said Hill-Briggs, also the 2018 ADA president for health care and education. “In contrast, the 2020 review focuses on naming and describing social determinants of health as root cause conditions that contribute to adverse diabetes outcomes and the avoidable patterns of socioeconomic and racial inequalities we see in diabetes risks and outcomes in the U.S.”

For the 2020 report, the ADA committee reviewed and summarized research examining the effect of social determinants on diabetes prevalence, incidence and outcomes.

The report provides recommendations to enable design and large-scale implementation of effective interventions that target social determinants directly:

  • Establish consensus core social determinants of health definitions and metrics.
  • Examine specificities in social determinants of health pathways and impacts among different populations with diabetes.
  • Prioritize a next generation of research that targets social determinants of health as the root cause of diabetes inequities.
  • Use dissemination and implementation science to ensure social determinants of health considerations are embedded within diabetes research and evaluation studies.
  • Train researchers in methodological and experimental techniques for multisector and next-generation social determinants of health intervention studies.

“By addressing these critical elements, there is potential for progress to be realized in achieving greater health equity in diabetes and across health outcomes that are socially determined,” the researchers wrote in the review.

Lessons from COVID-19

The ADA review committee was convened before the COVID-19 pandemic, Hill-Briggs noted, which further amplified the links between social determinants of health, diabetes outcomes and COVID-19 outcomes. Hill-Briggs said the timing of the scientific review is now even more urgent.

“What social determinants of health reveal — which COVID-19 highlighted — is that the inequalities that determine health outcomes overwhelmingly occur outside of the health care context,” Hill-Briggs said. “It is factors such as where people live, their job class, whether they make a living wage, whether their neighborhood is zoned for proximity to food and safety resources. Therefore, the solutions must be scaled for impact at a population level and necessitate implementation in settings that include but extend beyond health care. For health outcomes to improve, attention to the human condition — housing, wages, education, job opportunities, and environmental safety — is imperative.

For more information:

Felicia Hill-Briggs, PhD, ABPP, can be reached at fbriggs3@jhmi.edu.