The Department of Endocrinology, 
The role of structural racism and geographical inequity in diabetes outcomes.
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: shivani.agarwal@einsteinmed.edu.
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
- Diabetes Unit, KEM Hospital Research Centre, Pune, India.
- Department of Endocrinology, Christian Medical College, Vellore, India.
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Lancet (London, England) Vol. 402 · Issue 10397 · pp. 235-249
PMID 37356447 DOI 10.1016/s0140-6736(23)00909-1
Cite This Article
Shivani Agarwal, Alisha N Wade, Jean Claude Mbanya, Chittaranjan Yajnik, Nihal Thomas, Leonard E Egede, Jennifer A Campbell, Rebekah J Walker, Louise Maple-Brown, Sian Graham. The role of structural racism and geographical inequity in diabetes outcomes. Lancet (London, England). 2023;402(10397):235-249. doi:10.1016/s0140-6736(23)00909-1
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
Keywords
- Humans
- Systemic Racism
- Diabetes Mellitus
- Prevalence
- Social Factors
- Racism
