Structural inequalities and chronic disease health outcomes: Type 2 diabetes

The global burden of diabetes is a significant public health concern with prevalence steadily increasing and persistent health disparities by race/ethnicity, socioeconomic status, and geographic residence. The role of social determinants of health on health disparities and health outcomes of adults at risk for or with type 2 diabetes has moved from being largely understudied to having a strong evidence base over the past 15 years. This chapter reviews the last decade of evidence (2014-24) investigating the relationship between social and structural determinants of health and type 2 diabetes, with a focus on prevalence, clinical outcomes, quality of life, and mortality. Evidence is organized by six broad domains of social determinants of health: economic stability, education, community and social context, neighborhood and physical environment, health and healthcare systems, and the food environment, specifying both structural and social factors within each. Possible pathways and mechanisms through which social and structural determinants of health are associated with health outcomes and health disparities cross multiple levels of influence, including the individual, interpersonal, and societal levels. Areas for future research, integration of social and clinical care and policy-based initiatives to address structural inequalities are also discussed. Cross-sector partnerships aimed at delivering effective, multi-level interventions that integrate social and medical care to improve population health and health equity are greatly needed. In addition, a coordinated and targeted movement away from a focus on individual-level determinants to structural factors that drive inequities is critical.