Leveraging Data Science & Community-Validated Knowledge

Chronic disease, particularly diabetes, remains a leading cause of morbidity and mortality across the United States. These conditions do not affect all populations equally. Marginalized communities, particularly those impacted by systemic racism, economic disinvestment, and spatial inequality, bear a disproportionate burden of chronic illness (Braveman & Gottlieb, 2014; Hill-Briggs et al., 2021). At the heart of this disparity are the social determinants of health (SDOH) – the non-medical factors that influence health outcomes, including food insecurity, housing instability, limited transportation, and unequal access to care (World Health Organization, 2021; CDC, 2022).