The Society of General Internal Medicine (SGIM) represents the world’s leading academic general internists, dedicated to creating a just system of care in which all people can achieve optimal health. SGIM recognizes that to achieve this vision, we must expand our reach beyond the medical office and hospital bedside to identify and address the broader structures and living conditions that influence health—the social determinants of health (SDOH). Centuries of institutionalized oppression in the form of racism, sexism, and other forms of bigotry have created and perpetuated disadvantage. These underlying social values have translated into public policies and structures which affect the distribution of money and power across society. These in turn have shaped living conditions and access to resources, which influence health behaviors and access to care, and ultimately health outcomes. SGIM acknowledges the full spectrum of SDOH including upstream policies, midstream environmental and behavioral factors, and downstream individual and clinical issues. We highlight an important distinction between societal SDOH that require policy and systems-level change, with downstream unmet individual social needs, like homelessness or food insecurity. The entire range of SDOH impacts the work we do, our ability to care for our individual patients, our partnerships with local community organizations, and our impact on population health and equity. SDOH should also be integrated in how we teach future physicians and collaborate with our colleagues in public health, social work, government, research, and partners in non-health sectors.
In this position statement, we draw from medicine, public health, sociology, and ethics to contextualize the daily relevance of upstream SDOH and downstream social risks for SGIM members. We support statements issued by the American College of Physicians, the American Academy of Pediatrics, the National Academy of Medicine, and others.6,7,8 We build upon these to offer a set of positions specifically tailored for the academic general internist. SGIM members are practicing physicians, health system leaders, educators, researchers, and advocates. We articulate strategies for how each of these roles can be leveraged to address SDOH and social needs, and ultimately to improve health and health equity.