Assignment: Institutional Review Boards (IRBs)

Hansen, Palinkas, and Ell 2008; Mendenhall, Seligman, Fernandez, and Jacobs 2010). The extent to which individual action is embedded in contexts external to individual authority and structured by institutionalized relations, environments, and policies is now well-documented in the social determinants literature (CSDH 2008). This has translated into a growing interest in environmental and policy change (e.g., http://www.cdc.gov/prc/about-prc-program/contributions/environment.htm, & http://www.rwjf.org/applications/solicited/ cfp.jsp?ID=20804) and the need to promote “community empowerment” (Brennan Ramirez, Baker, and Metzler 2008) to overcome social determinants as “upstream” strategies for improving diabetes health outcomes. However, understanding of the social dynamics involved in the mechanisms and pathways of chronic disease continues to lag (Potvin, Gendron, Bilodeau, and Chabot 2005; Trickett 2009). It has become clear that curtailing the alarming rise in diabetes will require a more nuanced understanding of the broader social determinants of health if evidence-guided strategies for individuals at high risk for developing the disease are to be effective. Yet, conceptual frameworks from public health theory, while enlightening in many respects, have not sufficiently embraced the true vision of social determinants thinking (Kawachi and Bruce 2006; Marmot and Bell 2009; Syme 2005; Syme and Frohlich 2002). Current approaches tend to be insufficient for revealing the multi-dimensionality of the relationship between social determinants, chronic disease and health disparity (Chaufan, Constantino, and Davis 2011; Coleman 2011, p. 13).