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The Extent To Which Social Determinants Of Health Explain Health Inequalities In Relation To Diabetes Mellitus Type 2 In Indian Adults Assignment
Introduction
The context of “social determinants of health (SDH)" refers to the non-medical factors and conditions in terms of influencing health outcomes and shaping the conditions of daily lives (WHO). These conditions consist of financial systems, policies as well as developing and social agendas norms, and political aspects. The following essay is intended to address the primary context of social determinants and health inequalities along with the extent of these towards the prevalence of “Type 2 Diabetes Mellitus” (T2DM) among the adult population aged 45 to 65 years from low socioeconomic areas and pregnant women. This also includes identifying the target population of the identified disease conditions while addressing three specific social determinants such as job opportunities, financial stability and educational levels for addressing the extent to create health inequalities.
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Discussion
The context of social determinants and health inequalities in India
Public Health Administrations:
Public health policies identified with T2DM in Indian adults' ability involve measures to a degree health instruction campaigns, protect programs, approach to affordable healthcare, and requirements on unhealthful food produce (Yates?Doerr, 2020). The influence of the procedures can change based on determinants in the way that exercise strategies, reach, and the skill to address latent cause of health.
Social Determinants of Health:
Social cause of energy are the environments in which public are innate, evolve, live, work, and age (Nutbeam & Lloyd, 2021). These determinants, in the way that socioeconomic rank, instruction, employment, approach to healthcare, and living environments, play a critical role in doing energy effects, including T2DM.
Fitness Differences and T2DM:
In the circumstances of T2DM in Indian persons, health diversities mention inequalities in disease predominance, approach to healthcare, and strength outcomes established determinants like socioeconomic rank, caste, race, and terrestrial site (Agurs-Collins et al. 2019). Health inequalities can infuriate the burden of T2DM, exceptionally invulnerable populations.
The country has the birth rate of 16.949 along with 2.05 births per woman (Krishna, 2018). While addressing the social economic inequalities in the country approximately 53.9% a population belongs to the richest wealth and urban place residence of 37.9% and individuals from the age group 45 to 65% of 33.3% in the case of non-communicable diseases (Bambra et al. 2020). This is followed by no measurable changes in terms of addressing gender biased participation in governance, labour state alongside less than 25% of the population having no security for job and less than 15% of the population not having any social security (Krishna, 2018). These possess a significant influence on creating anxiety amongst people with disabilities, thereby affects their mental as well as physical well-being while establishing lifestyles illnesses which include diabetes, and it additionally exerts a detrimental effect overall the work performance of afflicted persons despite suffering signs and symptoms of elevated or decreased blood sugar levels (Ataguba & Ataguba, 2020).
As per the explanation by WHO, it was also understandable that social determinants of health (SDH) in the Indian context have a strong influence on health equity and referred to the expense and protection from society alongside educational qualification, rate of unemployment, working life conditions and food accessibility and the availability of housing. This nation's refractive perspective regarding medical services constitutes as a representation of treatment to exchange conduct that describes an abundance of non-discriminatory and socioeconomic inclusionary viewpoints as well as dispute on society organisation that provide affordable high-quality medical care. Following that, when is said that SDH is responsible for approximately 30 as well as 55% of the health effects along with death rates reductions in children under the threshold of five, although contributing 50% of expenditure beyond of the healthcare industry. These have a negative impact on T2DM individuals' availability of health care as well as healthful diets along with treatments.
Identification of three different social determinants that creates health inequalities.
Community health procedures related to T2DM in Indian adults' ability contain calculates in the way that well-being instruction campaigns, protect prioritizes, approach to inexpensive healthcare, in addition organizing on unhealthful food brand. The influence of the managements can change established factors to a degree exercise policies, reach, moreover the capability until address fundamental cause of strength (Neff et al. 2022). According to the National Family Health Survey (NFHS-4) in 2015-16, the baby death rate Infant Mortality Rate (IMR) with girls accompanying no instruction was 47 graves per 1,000 live births, while the IMR for daughters with 12 or more age of instruction was 17 passing per 1,000 live births (Claypool et al. 2020). This focal point the bare distinctness in fitness affects established instruction levels. The Rural Health Statistics report (2019-20) for one Ministry of Health and Family Welfare designated that the doctor-state ratio in country India was 1:10,926, when in fact in city fields, it was 1:2,161 (Claypool et al. 2020). This important dissimilarity in approach to healing artists manifests the country-city healthcare separately.
While India consists of a labour market compared to developed countries due to the presence of rapid changes regarding age distribution of population, the trends and pattern regarding financial growth does not guarantee the escalations in equal job opportunities (Oecd.org, 2023). This is followed by low growth productivity and fragmentation of the labour market in India alongside the presence of institutional and social barriers that have a crucial impact on labour market segmentation. This is one of the significant reasons that creates discrimination and diminishes the advantages of growth for the employees in lowly developed regions, small cities, rural areas and under privileged social financial distributions (Garcia, 2022). Besides, the presence of chronic diseases such as T2DM often hinders individuals being fully productive at the working environment and this impacts on reducing the overall workforces (Oecd.org, 2023). This is followed by the overall scenario of employment and unemployment for the working population declining over the years and reducing the power of unemployment affordability for a specific household. It also includes choosing hide education and frictional unemployment among the educational population and that reflects on the stability and changes in employment rate that affect their capability of affording nutritious food and a healthy lifestyle along with medication to treat disease such as T2DM. This is followed by decreasing social security that covers less than 10% of the total workforce in India and is difficult for an organised worker (Oecd.org, 2023). This results in increasing poverty and lowering the financial stability among the population and leads to undermining poverty.
This is followed by addressing the role of other socioeconomic factors such as educational level to influence the health insurance status and inability to access primary and speciality health care providence that increases the prevalence of chronic illness such as diabetes, hypertension or cardiovascular disease (Dawes, 2020). It also includes unequal distributions of academic resources alongside limitation of school funding and absence of qualified and experienced teachers and access to books and technology for the socially excluded community.
Gender bias is considered another significant recent event that creates inequality in India in terms of accessing education (Nutbeam & Lloyd, 2021) Early education acknowledges children to gain concerning healthful behaviours selections, containing proper nourishment and formal recreational activity. By giving information about the significance of balanced diets and alive behaviors, children can cultivate practices this can assistance forbid T2DM later in history. Combining gender-impressionable and well-being-attracted parts into early education educational programs can assistance structure postures, behaviours, in addition information understood diabetes stop and management. By forwarding gender bias early in life, we can influence more impartial strength outcomes and authorize things to make more active selections that reduce their risk of T2DM (Cdc.gov, 2023). Besides, girls are sent to the government school, while male children are accessible to private school and the ratio of girls and boys regarding the access to higher studies after the intermediate school is poor (Insightsonindia, 2023). Discrimination and bias established by race, nationality, or social rank can bring about different treatment and weaker strength effects for marginalized communities in India. This can influence their strength to control chronic environments like type 2 diabetes efficiently. While particular data on bias in healthcare practice power is not effortlessly available, differing reports and studies focal point the life of prejudicial practices that disproportionately influence sure groups, conceivably leading to incompetent diabetes take care of those afflicted (Govinda and Poornima, 2019). Limited education and strength proficiency can preclude individuals' capability to believe and control their health efficiently, containing forestalling and managing type 2 diabetes. According to the National Family Health Survey (NFHS-4) in 2015-16, about 26% of mothers and 18% of fellows in India had no formal instruction. Limited instruction can bring about challenges in understanding medical demands, making cognizant resolutions about treatment alternatives, and adopting athletic behaviour practices (Govinda and Poornima, 2019).
Apart from that income and financial stability are considered significant factors that have a crucial impact on purchasing insurance of health for T2DM patients, mitigating economic issues, diminishing poverty and increasing the accessibility of medicines from the perspective of a patient. Financial stability is also effective in reducing the financial distress in diabetes and self-management while supporting the care process. The unavailability of financial stability and income impact non conclusive outcome and disease prevalence while limiting the axis of available medication and care strategy also address increasing cost of healthcare and medical care that have a crucial impact on affecting lifestyle management and maintaining patient and care provider communication (Osborn & Egede, 2022). The absence of these can lead to the mismanagement of disease prevention and hampering lifestyle.
The extent to which social determinants of health lead to health inequalities for T2DM
The context of SDH in terms of health inequalities connects and interacts with the development of origin of health and disease and that influences the trajectory of the identified disease (Hill-Briggs et al. 2021). It includes the communities, access and affordability of nutritious food, generic health risks that are carried from past generations and falling the trap of advertising and a wide presence of junk food and many more (Ataguba & Ataguba, 2020). The role of the built environment is considered a significant factor that is directly correlated to health and part of SDH which affects the ability to be healthy in several ways.
However, diabetes mellitus is thought-out the 6th best cause of demise and affects nearly 25.6 heap things over the age of 20. The basic context of SDH in respects to the labelled affliction refers to the allocations of healthcare money plan of funding and repaying for care process educational stance approaching the general healthcare process. It still causes weighty long-term confusions in the form of sightlessness, CVD, CKD, hypertension, MI and neuropathy, amputation of lower appendage and impulsive babies. Here, SDHs play a important role by focusing on shifts in healthcare for incessant affliction and growing stress on the patient's strength consequences and the profit-located care process that influences the success of health egalitarianism (Mathur and others. 2022). Dispassionate suggestions that are generally directing on the things in terms of reconstructing self-administration consequence and decline of the affliction leading to temporary bettering. However, the SDH determinant depends the social environmental determinants that are harsh for moving fitness. It includes extrinsic or hard on someone cause in the form of support from association and different society parts that conceivably impact the fitness of things (Frier et al. 2020). That society foundation containing conveyance neighbourhood safety and the approach volume of athletic foodstuff are deliberate significant obstacles in conditions of things accompanying diabetes while peeling light on the incompetent approach of possessions. Limited transportations in country areas in India necessary travel outside the local society for achieve basic Health care and healthful food (Sai Ambati and others. 2020). India face issues accompanying transportation on account of dearth of sidewalks, and this spurs things to select walking as the unspecified directing material projects. This is deliberate significant in the case of diabetic cases that help bureaucracy to use insulin efficiently alongside directing a healthful behavior (Mathur and others. 2022). However, it likewise contains lack of neighbourhood safety that impacts on strength difference and extreme rate for cooking and first-contact medical care for diabetic subjects.
Apart from that, financial stability is another significant SDH that demonstrates the primary relationship between socioeconomic status and the availability of health outcomes. This entirely depends on the education level, employment, family income that are capable of affecting the social and financial status of Diabetic patients and therefore, health outcome for the disease (Brady et al. 2021). In this context, Verma et al. (2022) have managed to address the role of inadequate management of blood sugar that can impact the overall health quality that adversely affects the employability skills of an individual and reduces the overall productivity. It impacted the affordability of quality foods and necessary medicines for the diabetic patients that have an impact on reducing health quality of individuals. It also includes access to medical care that causes disparities for the availability of healthcare resources for diabetic patients and is entirely based on socioeconomic status of an individual. It also correlated with improvement of self-management outcome and perceptions of low-level social support that increases the risk of self-management behaviour and thus reduces better health opportunities for diabetic patients (Ncbi.nlm.nih.gov, 2023b).
Prevalence and risk groups of T2DM
While the non-modifiable factor of T2DM for the Indian population refers to the genetic predispositions and family history alongside the age more than 45 years; the modified risk factors include sedentary lifestyle, prone to obesity, unhealthy and unbalanced diet, stress factors altered in the environment, pollutant and inadequate sleep (Ncbi.nlm.nih.gov, 2023a). Approximately 77 million of people in the Indian context above the age of 18 years are suffering from T2DM and approximately 25 million of people are considered three diabetics or at higher risk of developing this disease in near future (Who.int, 2023b). However, 57% of individuals remain undiagnosed and in case of diabetes and is largely influenced by several factors such as physical inactivity, age factors, obese and unbalanced diet and demeanour of food consumption pattern in relation to the genetics (Ncbi.nlm.nih.gov, 2023a). Here, Kashyap & Shivaswamy (2019) have managed to address the silent nature of the disease conditions that affects the individuals without showing any symptoms for years. Besides, improper affordability of non-invasive screening tools and lack of awareness of monitoring blood glucose level led to diagnosis of diabetes in India. This is followed by a fast transition from euglycemia to prediabetes and diabetes. It also includes high mortality and morbidity due to diabetic complications. Approximately 3.1% of all deaths in India are caused by the prevalence of diabetes and the rate is increasing from 1990 to 2020 by 131% (Healthcareradius.in, 2023). Due to increasing urbanisation and changing lifestyle habits, the population is leading towards a sedentary lifestyle and physical inactivity with the consumption of unhealthy and fast foods (Kashyap & Shivaswamy, 2019). This also includes limited access to financial stability and disproportionate population burden which are important here to impact the increasing rate of mortality among diabetic patients.
On the other hand, while addressing SDH in terms of addressing developmental origins, it can be stated that focusing on health outcomes are effective factors that result in nutritional, environmental and social exposure to this disease. This factor is also applicable for gestational diabetes where the living condition of mothers and facing social factors such as racism and inequality impact on them by increasing the risk of pregnancy and developing diabetes which make this population one of the vulnerable groups of diabetes (Hooten et al. 2022). Approximately 1.38 lakhs of pregnant women in India face pregnancy related complications along with improper treatment and living conditions (Pib.gov.in, 2023).
Prevention strategies for T2DM related health inequalities in India
The rising rate of T2DM or associated complications both in urban and rural areas of India alongside the young children are concerning. The specific challenges in regards to the identified disease management or prevention refers to the lack of strong national partnership in terms of employing multisectoral action along with the absence of availability of strong impact and study information on DM (Schroeder et al. 2021). This is followed by lack of awareness among the population and absence of basic prevention processes in the case of primary healthcare settings. This can be incorporated through managing the educational levels of the population along with the implementation of comprehensive diabetes education through different programs (Deepa et al. 2014). This also includes emphasising on diabetes risk factors along with complications, diet control, physical activities, regular check up and screening in order to achieve better control of the disease and reducing the burden by lowering complications. The National program for control of Diabetes is presently used by the Government all over the country with the aim of raising awareness at the national level (Deepa et al. 2014). These are also considered significant reasons that lead to the inability to access affordable medicine and leading to premature deaths (Ranasinghe et al. 2021). Promoting well-being education and lifting knowledge about T2DM risk factors, healthful behaviours, and early discovery can authorize things to create conversant decisions about their fitness. According to a study written in the “Indian Journal of Endocrinology and Metabolism”, fitness instruction attacks developed in upgraded knowledge about diabetes risk determinants and better self-care practices with shareholders (Golden, 2021). Implementing food programs that devote effort to something reconstructing approach to affordable, healthy foodstuff and advancing more healthful digestive clothing can help avoid T2DM. A randomized control trial published in “The New England Journal of Medicine” manifested that a diet rich in whole grains, crops, salads, and legumes considerably diminished the occurrence of T2DM with colleagues. A study published in “The Lancet Diabetes & Endocrinology” emphasizes that charming in consistent entertainment discounted the risk of T2DM by 42%, stressing the significance of staying alive (Reddy et al. 2022). The World Health Organization (WHO) approves common pebbles for diabetes to discover and accomplish the condition early. Early discovery has been proven to upgrade energy effects and lower complexities India (Ranasinghe et al. 2021). This can also be addressed by focusing on nationwide effort by training physicians in India by using "certificate course in evidence-based diabetes management (CCEBDM)" and improving participation of diabetes educators by attending "National diabetes educators' program (NDEP)" to raise awareness (Deepa et al. 2014).
However, prevalence strategy while reducing the exposure of the specific lifestyle for identified disease refers to the promotion of health and improving primary prevention aspect. This also includes early detections of the disease and the providence of timely treatment for the risk group such as aged population between 45-65 along with pregnant women. This is followed by surveillant the trends in T2DM and included risk factors by using high level up dedication and multi-sectoral activities with the aim of reducing the growing burden of T2DM in India.
Conclusion
The range at which point social causes of fitness explain fitness prejudices concerning Type 2 Diabetes Mellitus among Indian adultss solid. A complex interaction of various public determinants, such as socioeconomic rank, instruction, approach to healthcare, and cultural averages, donates to the disparities noticed in diabetes predominance, management, and consequences. Lower socioeconomic rank often correlates with accompanying restricted access to healthy fare, healthcare aids, and health instruction, all of that is important for preventing and directing Type 2 Diabetes. Additionally, differences in education and energy ability prevent individuals' understanding of the condition, allure risk determinants, and proper self-care methods such as “National Diabetes Prevention and Control Program, Healthy Food Access Initiatives, Employment and Income Equality Policies” and many more.
References
Bmj. 2023., “Trends in incidence of total or type 2 diabetes: systematic review” https://www.bmj.com/content/366/bmj.l5003/rr
Brady, E., Bridges, K., Murray, M., Cheng, H., Liu, B., He, J., & Woodward, J. (2021). Relationship between a comprehensive social determinants of health screening and type 2 diabetes mellitus. Preventive Medicine Reports, 23, 101465.https://www.sciencedirect.com/science/article/pii/S2211335521001558
Dawes, D. E. (2020). The political determinants of health. Johns Hopkins University Press.https://books.google.com/books?hl=en&lr=&id=XijNDwAAQBAJ&oi=fnd&pg=PR7&dq=Identification+of+three+different+social+determinants+that+creates+health+inequalities&ots=can7kuBb5h&sig=Y4bk1wP7c1Btv864PWOhRja8Y-s
Deepa, M., Bhansali, A., Anjana, R. M., Pradeepa, R., Joshi, S. R., Joshi, P. P., ... & Kaur, T. (2014). Knowledge and awareness of diabetes in urban and rural India: the Indian Council of Medical Research India diabetes study (phase I): Indian Council of Medical Research India diabetes 4. Indian journal of endocrinology and metabolism, 18(3), 379.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056139/
Emeny, R. T., Carpenter, D. O., & Lawrence, D. A. (2021). Health disparities: Intracellular consequences of social determinants of health. Toxicology and Applied Pharmacology, 416, 115444.https://www.sciencedirect.com/science/article/pii/S0041008X2100051X
Frier, A., Devine, S., Barnett, F., & Dunning, T. (2020). Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes—a review of the literature. Health & Social Care in the Community, 28(4), 1119-1133.https://onlinelibrary.wiley.com/doi/abs/10.1111/hsc.12932
Garcia, R. (2022). Social determinants of health. A Population Health Approach to Health Disparities for Nurses: Care of Vulnerable Populations.https://books.google.com/books?hl=en&lr=&id=lgOBEAAAQBAJ&oi=fnd&pg=PA107&dq=Identification+of+three+different+social+determinants+that+creates+health+inequalities&ots=o6ptQLhsLP&sig=9SvaqX4Oy5BOx70_Nzg8Ikyak2s
Hardeman, R. R., Homan, P. A., Chantarat, T., Davis, B. A., & Brown, T. H. (2022). Improving the measurement of structural racism to achieve antiracist health policy: Study examines measurement of structural racism to achieve antiracist health policy. Health Affairs, 41(2), 179-186.https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01489
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., ... & Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes care, 44(1), 258-279.https://diabetesjournals.org/care/article-abstract/44/1/258/33180
Hooten, N. N., Pacheco, N. L., Smith, J. T., & Evans, M. K. (2022). The accelerated aging phenotype: The role of race and social determinants of health on aging. Ageing Research Reviews, 73, 101536.
Kashyap, V., & Shivaswamy, M. (2019). Assessment of implementation of the national programme for the prevention and control of cancer, diabetes, cardiovascular diseases, and stroke at subcenters of Belagavi taluka: A cross-sectional study. Indian Journal of Health Sciences and Biomedical Research, 12(1), 21-21.https://go.gale.com/ps/i.do?id=GALE%7CA571317392&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=&p=AONE&sw=w
Krishna, B.M., 2018. Social determinants of health in india: progress and inequities across states. Editorial Board, 7(7), p.45.http://ijmer.s3.amazonaws.com/pdf/volume7/volume7-issue7(1)-2018.pdf#page=53
Mathur, P., Leburu, S., & Kulothungan, V. (2022). Prevalence, awareness, treatment and control of diabetes in India from the countrywide National NCD Monitoring Survey. Frontiers in Public Health, 10, 205.https://www.frontiersin.org/articles/10.3389/fpubh.2022.748157/full
Min, L. Y., Islam, R. B., Gandrakota, N., & Shah, M. K. (2022). The social determinants of health associated with cardiometabolic diseases among Asian American subgroups: a systematic review. BMC Health Services Research, 22(1), 1-16.https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07646-7
Neff, J., Holmes, S. M., Knight, K. R., Strong, S., Thompson-Lastad, A., McGuinness, C., ... & Nelson, N. (2020). Structural competency: curriculum for medical students, residents, and interprofessional teams on the structural factors that produce health disparities. MedEdPORTAL, 16, 10888.https://www.mededportal.org/doi/abs/10.15766/mep_2374-8265.10888
Osborn, C. Y., & Egede, L. E. (2022). The relationship between depressive symptoms and medication nonadherence in type 2 diabetes: the role of social support. General hospital psychiatry, 34(3), 249-253.https://www.sciencedirect.com/science/article/pii/S0163834312000308
Ranasinghe, P., Jayawardena, R., Gamage, N., Sivanandam, N., & Misra, A. (2021). Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults. Annals of epidemiology, 58, 128-148.https://www.sciencedirect.com/science/article/pii/S1047279721000375
Sai Ambati, L., El-Gayar, O. F., & Nawar, N. (2020). Influence of the digital divide and socio-economic factors on prevalence of diabetes.https://scholar.dsu.edu/bispapers/213/
Schillinger, D. (2021). Social determinants, health literacy, and disparities: intersections and controversies. HLRP: Health Literacy Research and Practice, 5(3), e234-e243.https://journals.healio.com/doi/abs/10.3928/24748307-20210712-01
Schroeder, S. M., Adamsen, C., & Besse, R. (2021). The relationship between diabetes and oral health status, and dental visits among American Indian, Alaska Native, and Native Hawaiian elders. The Journal of the American Dental Association, 152(4), 293-301.https://www.sciencedirect.com/science/article/pii/S0002817721000167
Verma, R., Khanna, P., & Mehta, B. (2022). National programme on prevention and control of diabetes in India: Need to focus. The Australasian medical journal, 5(6), 310.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395295/
Claypool, K.T., Chung, M.K., Deonarine, A., Gregg, E.W. and Patel, C.J., 2020. Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015–2016. BMJ Open Diabetes Research and Care, 8(1), p.e000965.
Govinda, R. and Poornima, M. eds., 2019. India's social sector and SDGs: problems and prospects. Taylor & Francis.
Yates?Doerr, E. (2020). Reworking the social determinants of health: Responding to material?semiotic indeterminacy in public health interventions. Medical Anthropology Quarterly, 34(3), 378-397.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73.
Agurs-Collins, T., Persky, S., Paskett, E. D., Barkin, S. L., Meissner, H. I., Nansel, T. R., ... & Farhat, T. (2019). Designing and assessing multilevel interventions to improve minority health and reduce health disparities. American journal of public health, 109(S1), S86-S93.
Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., ... & Trinh-Shevrin, C. (2019). Structural interventions to reduce and eliminate health disparities. American journal of public health, 109(S1), S72-S78.
Ataguba, O. A., & Ataguba, J. E. (2020). Social determinants of health: the role of effective communication in the COVID-19 pandemic in developing countries. Global health action, 13(1), 1788263.
Bambra, C., Riordan, R., Ford, J., & Matthews, F. (2020). The COVID-19 pandemic and health inequalities. J Epidemiol Community Health, 74(11), 964-968.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73.
Golden, S. H. (2021). The contribution of structural racism to metabolic health disparities in the USA. The Lancet Diabetes & Endocrinology, 9(8), 478-480.
Reddy, N. K., Kaushal, V., Kanaya, A. M., Kandula, N. R., Gujral, U. P., & Shah, N. S. (2022). Cardiovascular risk factor profiles in North and South Indian and Pakistani Americans: the MASALA study. American heart journal, 244, 14-18.
