Cardiovascular disease (CVD) is a major cause of mortality and morbidity in the United States.¹ Hypertension and diabetes mellitus are among the leading risk factors for CVD.² Several epidemiologic and clinical studies^3-5 have suggested that there is an excess risk of hypertension and diabetes mellitus among persons with suboptimal intake of vitamin D. Dietary sources of vitamin D are very few and are limited to fatty fish liver and fortified food sources, such as cereals and milk. The synthesis of vitamin D in the skin after exposure to type B UV light remains a major source of vitamin D in humans. The primary circulating form of vitamin D is 25-hydroxyvitamin D (25[OH]D), formed in the liver by the hydroxylation of vitamin D. The active form of the vitamin is 1,25-dihydroxyvitamin D, formed by a second hydroxylation of vitamin D, primarily in the kidneys, and is responsible for the physiologic functions of vitamin D. The nutritional status of vitamin D has always been assessed by the circulating level of 25(OH)D, but the data for the historical reference range for the circulating level of 25(OH)D originated from sun-deprived human populations with suboptimal vitamin D intake and may have underestimated the physiologic demands for vitamin D.^6,7 Recommended optimum levels of vitamin D have been established without accounting for the ubiquitous nature of the vitamin D receptor and the possible salutary affects of vitamin D on other organ systems that may affect CVD.^8,9 Indeed, even the adequacy of present recommendations for vitamin D to prevent osteomalacia has been questioned.¹⁰

The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.