A Dynamic Hypothesis for Evaluating Diabetes Health Policies in the Presence of Social Determinants Disease Progression

Over the past 10 years, public health researchers have increasingly focused on employing more of a systems perspective when evaluating policies aimed at affecting public health outcomes. The motivation for this approach comes from the recognition that health outcomes emerge from both individual behaviors and from complex interactions among a milieu of social and environmental factors that can play out over many years or even generations. Differences in disease incidence, prevalence, and mortality in diabetes exist across racial/ethnic and socioeconomic groups. The well-documented research in health disparities suggests that factors beyond individual choices are important in affecting the health of individuals and lead to these health disparities. With respect to diabetes, while the health disparities across socioeconomic status are established in the literature, the underlying dynamics contributing to these disparities are not fully understood.

Systems dynamics modeling methods could be applied to guide public policy in addressing the social determinants of health, providing significant new insights for policymakers. The purpose of this research effort is to reframe the discussion of the social determinants of diabetes incidence by synthesizing current understandings, as documented in the literature, into a system dynamics model whose structure and assumptions can be validated against historical data and the literature. Such a model will serve as a useful tool for evaluating public health policies for their potential to reduce health disparities with respect to diabetes.