Socioeconomic Determinants of Diabetes and Hypertension: Mechanisms, Health Disparities, and Strategies for Equitable Prevention and Management

Abstract

Diabetes mellitus and hypertension are significant noncommunicable diseases, and are key causes of cardiovascular, renal, neurological, and other chronic complications. While the predisposition to these diseases is an important factor, their distribution and outcome are greatly influenced by socioeconomic factors. Exposure to risk factors, health behaviors, diagnosis, treatment, adherence, and long term outcomes are influenced by income, education, employment, housing, food security, neighborhood environments, social protection and access to affordable health services. This review summarizes the literature about the pathways between socioeconomic disadvantage and diabetes and hypertension and how these pathways relate to health disparities. Low SES can be associated with more exposure to unhealthy food environments, chronic psychosocial stress, environmental hazards, and less access to physical activity, as well as fewer access to preventive services, medicines, monitoring and continuity of care. These factors influence each other over the years, and can perpetuate patterns of disease and economic instability. Beyond individual behaviour change, interventions that promote access to healthy food, primary health care services, affordable medicines, community-level screening, culturally responsive health education, social protection and commercial and environmental determinants of health are necessary to achieve equitable prevention. To minimize preventable disparities in diabetes and hypertension, a multi-sectoral effort is needed, with health systems, communities, education, labor, agriculture, and urban planning playing a critical part.