Intervening on the social determinants of cardiovascular disease and diabetes.

Heart disease, cerebrovascular diseases, and type 2 diabetes ranked first, third, and sixth, respectively, among the leading causes of death and disability in the United States in 2000. Racial and ethnic communities (i.e., African Americans, Hispanic-Latino Americans, Native Americans and Alaska Natives, and Asian Americans and Pacific Islanders) disproportionately suffer from these chronic conditions. Traditional behavior change strategies have had some positive, but limited effects and will not likely be sufficient to eliminate these health disparities at the population level. In this commentary, the authors argue for greater intervention research directed at the social determinants of cardiovascular disease and diabetes if we are to reverse current trends in chronic disease prevalence in communities of color. The authors also call for new research questions and study designs that will increase our understanding of the social, policy, and historic context in which disparities are created as a necessary first step in developing interventions aimed at social-contextual and psychosocial risk factors. Promising programs supported by the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH 2010) program and the Division of Diabetes Translation are highlighted.