# Returning value to communities from the All of Us Research Program through the lens of social determinants of health and ethical, legal, and social implications

## TL;DR

This paper reviews how the All of Us Research Program can better serve underrepresented communities by considering social and ethical factors.

## Contribution

The study provides a scoping review of how social determinants of health and ethical considerations intersect in the All of Us Research Program.

## Key findings

- Addressing economic, educational, and environmental factors alongside ethical considerations can enhance health equity.
- Engaging diverse communities and prioritizing ethical standards is a forward-thinking strategy in research.
- The program's approach exemplifies a model for increasing community return on investment.

## Abstract

This scoping review aims to summarize the importance of community return on investment in the All of Us Research Program, particularly for enhancing the representation of underrepresented communities. It explores previous studies on social determinants of health (SDoH) and discusses the ethical, legal, and social implications (ELSI) associated with past implementations of the program. Furthermore, it discusses encountered challenges and explores strategies.

We conducted a scoping review of relevant literature to examine the intersection of SDoH and ELSI within the All of Us Program. A systematic search of the literature was performed in March 2025, on PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar.

We identified 17 studies that focused on the intersection of the SDoH domains and ELSI. Studies showcased the importance of addressing economic, educational, and environmental factors alongside ethical considerations to enhance health equity. Despite challenges such as data completeness and participant diversity, the program’s approach to engaging with diverse communities and prioritizing ethical standards exemplifies a forward-thinking strategy in research.

Understanding the intersection of SDoH and ELSI is crucial for the success of the All of Us Program. Integrating these factors may enhance the program’s ability to address the needs of underrepresented communities, ultimately increasing community return on investment. By continuing to address the challenges of inclusivity and data comprehensiveness, the program stands to contribute substantially to the reduction of health disparities and the advancement of healthcare for all.

The online version contains supplementary material available at 10.1186/s12939-026-02758-6.