Hill Jacqueline, Nielsen Marcia, Fox Michael H
Department of Radiology, University of Kansas Medical Center in Kansas City, USA.
Perm J. 2013 Spring;17(2):67-72. doi: 10.7812/TPP/12-099.
Social determinants of health are the conditions in which individuals are born, grow, live, work, and age. Increasingly, they are being recognized for their relationship to the soaring incidence of Type 2 diabetes in the US, as well as the opportunities they present for us to counter it. Many current Type 2 diabetes interventions focus on biologic and behavioral factors, such as symptoms, diet, and physical activity. However, it is equally important to address the influence of physical and social environments, which may include low income, employment insecurity, low educational attainment, and poor living conditions, on health outcomes. Section 4302 of the Patient Protection and Affordable Care Act of 2010 offers an opportunity to improve data collection and policy development to more effectively identify populations at high risk for developing Type 2 diabetes and to proactively refer them to appropriate social support services that may ultimately support reduction of health disparities. Expanding the scope of this legislation to include data that incorporate social determinants would improve the ability of clinicians and health systems to engage and to treat patients with chronic conditions, such as Type 2 diabetes, while expanding policymakers' ability to conform to the legislation's intent of shaping efforts to reduce chronic conditions nationwide.
健康的社会决定因素是个人出生、成长、生活、工作和衰老的环境。它们与美国2型糖尿病发病率的飙升之间的关系日益受到认可，同时也为我们应对这一问题提供了机遇。当前许多2型糖尿病干预措施侧重于生物和行为因素，如症状、饮食和体育活动。然而，同样重要的是要关注物理和社会环境对健康结果的影响，这些环境可能包括低收入、就业不稳定、低教育水平和恶劣的生活条件。2010年《患者保护与平价医疗法案》第4302条提供了一个机会，可改善数据收集和政策制定，以便更有效地识别有患2型糖尿病高风险的人群，并主动将他们转介到适当的社会支持服务，这些服务最终可能有助于减少健康差距。扩大该立法的范围，纳入包含社会决定因素的数据，将提高临床医生和卫生系统参与并治疗慢性病患者（如2型糖尿病患者）的能力，同时增强政策制定者按照该立法意图开展工作的能力，即在全国范围内努力减少慢性病。
