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D espite the numerous medical and public health advancements made in the last century, a social gradient of health continues to exist for Americans. Chetty and colleagues recently found that the gap in life expectancy between the richest 1% and poorest 1% of the population was 14.6 years for men and 10.1 years for women, and that this disparity has only widened since 2001. These gaps cannot be entirely explained by access to and affordability of medical care. A key driving force is a group of factors known as social determinants of health (SDH), defined as the conditions underwhich people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at the global, national, and local levels. Some have estimated that up to 70% of nonmodifiable variation in health outcomes is attributable to these social determinants of health. The U.S. health care system has begun to recognize the need to address patients’ social and environmental circumstances in order to reduce health inequalities. One study demonstrated that incorporating routine screening for SDH at wellchild visits increased maternal employment, childcare, and receipt of fuel assistance, while reducing homelessness. In 2014, the Institute of Medicine (IOM) released recommendations for including social and behavioral domains in the electronic medical record. However, these recommendations have not been systematically incorporated into routine medical care. The Centers for Medicare & Medicaid Services (CMS) recently made available their health-related social needs screener. The IOM’s seminal report, Crossing the Quality Chasm, described the widespread inability in medicine to adopt and implement practice innovations with proven efficacy; prior research suggests that the adoption and incorporation of SDH screening and referral practices will take almost two decades. Given widening socioeconomic health disparities, we believe it is imperative to accelerate the adoption of routine screening and referral interventions for SDH in health care delivery, especially for internal medicine practice, and we therefore provide the following recommendations.

Accelerating the Implementation of Social Determinants of Health Interventions in Internal Medicine