Healthcare professionals should assess the social determinants of health in people with diabetes mellitus to better guide them to the most appropriate resources.
The social determinants of health are the social, cultural, political, economic and environmental conditions in which people are born, grow up, live, work and age, and their access to power, decision making, money and resources that give rise to these conditions of daily life. The social determinants of health influence a person’s opportunity to be healthy, their risk of illness, health behaviours and healthy life expectancy. Health inequities result from the uneven distribution of these social determinants.
In Scotland, there is evidence that socioeconomic deprivation is associated with higher mortality in people with type 1 diabetes, that the effect of deprivation is larger than in the general population and that inequalities appear to be widening over time.
There is also evidence that life expectancy for people with type 1 diabetes in Scotland is significantly lower in those at the lowest socioeconomic quintile than in those at the highest quintile.
It is essential to consider factors that shape our health as part of the routine assessment of individuals living with type 1 diabetes and to tailor patient-centred support and education accordingly. Questionnaires completed before a consultation may be beneficial tools in the assessment.
Given the importance of the social determinants of health and adverse childhood experiences on clinical outcomes, including the lifetime risk of diabetes-related complications, having a social worker embedded in diabetes services is desirable as they have the skills to make an effective assessment of needs and can signpost appropriately for any support that is required.
Diagram adapted by Scottish Government from Booske et al., 2010 and King's Fund – A Vision for Population Health.
The factors which shape our health (or social determinants of health) range from the individual, to the local, to the national, to the international, and include:
- Income and social protection
- Level of education
- Employment issues and unemployment
- Food insecurity
- Housing, basic amenities, and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Access to health services
See an interactive checklist of the social determinants of health here: