Social Determinants of Health: A Priority for Internal Medicine. Position Statement of the Spanish Society of Internal Medicine (SEMI) and the Portuguese Society of Internal Medicine (SPMI)
DOI:
https://doi.org/10.24950/rspmi.2852Keywords:
Health Equity, Health Promotion, Internal Medicine, Quality Improvement, Portugal, Social Determinants of Health, SpainAbstract
Introduction: Internal medicine, owing to its comprehensive and cross-sectional approach, is uniquely positioned to lead the integration of social determinants of health (SDOH) into clinical practice.
Methods: Based on the Delphi methodology promoted by the Spanish Society of Internal Medicine (SEMI) and the Portuguese Society of Internal Medicine (SPMI), this study explored perceptions, barriers, and strategies for integrating SDOH into hospital care. Experts from both countries participated in a two-round consultation process, followed by a consensus meeting, which resulted in a prioritized roadmap of action.
Results: Our findings show strong agreement on the relevance of SDOH for health outcomes, the need for mandatory and transversal training at all educational levels, and the importance of validated tools for systematic screening. Key barriers include lack of time, insufficient specific training, limited human resources, and the absence of structured SDOH data in electronic health records. Additionally, the results emphasize the importance of interdisciplinary teams, coordination with social services, and adapting care pathways to patients' social contexts. Emerging determinants include population aging, mental health, climate change, and digital transformation, including artificial intelligence.
Conclusion: This decalogue provides a practical and prioritized roadmap to transform Internal Medicine care towards a more equitable, comprehensive, and SDOH-sensitive model, with training, service organization, technological resources, and collaboration as fundamental pillars.
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[1] Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P, Consortium for the European Review of Social Determinants of H, et al. WHO European review of social determinants of health and the health divide. Lancet. 2012;380:1011-29.
[2] Frank J, Abel T, Campostrini S, Cook S, Lin VK, McQueen DV. The Social Determinants of Health: Time to Re-Think? Int J Environ Res Public Health. 2020;17:5856. doi: 10.3390/ijerph17165856.
[3] Chimeno Vinas MM, Perez-Martinez P. Social determinants of health and their impact on internal medicine. Rev Clin Esp. 2024;224:398-9. doi: 10.1016/j.rceng.2024.05.003.
[4] Cocchi C, Zazzara MB, Levati E, Calvani R, Onder G. How to promote healthy aging across the life cycle. Eur J Intern Med. 2025;135:5-13. doi: 10.1016/j.ejim.2025.03.003.
[5] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
[6] Houle J, Proietti M, Raparelli V, Atzema CL, Norris CM, Abrahamowicz M, et al. Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation. Eur J Intern Med. 2025;135:83-90. doi: 10.1016/j.ejim.2025.02.009.
[7] Vohra-Gupta S, Petruzzi L, Cherian A, Chow C, Unzueta M, Joachimi R. A Narrative Review on Shifting Practice and Policy Around Social Determinants of Health (SDOH) Screenings: Expanding the Role of Social Workers in Healthcare Settings in the U.S. Healthcare. 2025;13 :1097. doi: 10.3390/healthcare13101097.
[8] Rangachari P, Thapa A. Impact of hospital and health system initiatives to address Social Determinants of Health (SDOH) in the United States: a scoping review of the peer-reviewed literature. BMC Health Serv Res. 2025;25:342. doi: 10.1186/s12913-025-12494-2.
[9] Gottlieb L, Sandel M, Adler NE. Collecting and applying data on social determinants of health in health care settings. JAMA Intern Med. 2013;173:1017-20.
[10] Ebi KL, Hess JJ. Health risks due to climate change: inequity in causes and consequences. Health Aff. 2020;39:2056-62. doi: 10.1377/hlthaff.2020.01125.
[11] Campbell-Lendrum D, Neville T, Schweizer C, Neira M. Climate change and health: three grand challenges. Nat Med. 2023;29:1631-8. doi: 10.1038/s41591-023-02438-w.
[12] Harish V, Morgado F, Stern AD, Das S. Artificial Intelligence and Clinical Decision Making: The New Nature of Medical Uncertainty. Acad Med. 2021;96:31-6. doi: 10.1097/ACM.0000000000003707.
[13] Novilla MLB, Goates MC, Leffler T, Novilla NKB, Wu CY, Dall A, et al. Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings. Int J Environ Res Public Health. 2023;20:6873. doi: 10.3390/ijerph20196873.
[14] Peretz P, Shapiro A, Santos L, Ogaye K, Deland E, Steel P, et al. Social Determinants of Health Screening and Management: Lessons at a Large, Urban Academic Health System. Jt Comm J Qual Patient Saf. 2023;49:328-32. doi: 10.1016/j.jcjq.2023.04.002.
[15] Smithman MA, Ogundele OJ, Perrier L, Komeiha M, Artyukh I, Kapoor P, et al. Collecting and using social needs data in health settings: a systematic review of the literature on health service utilization and costs. BMC Health Serv Res. 2025;25:1258. doi: 10.1186/s12913-025-13458-2.
[16] Fichtenberg CM, Alley DE, Mistry KB. Improving Social Needs Intervention Research: Key Questions for Advancing the Field. Am J Prev Med. 2019;57:S47-S54. doi: 10.1016/j.amepre.2019.07.018.
[17] Working Group for Monitoring Action on the Social Determinants of H. Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity. Int J Equity Health. 2018;17:136. doi: 10.1186/s12939-018-0836-7.
[18] Schneberk T, Bolshakova M, Sloan K, Chang E, Stal J, Dinalo J, et al. Quality Indicators for High-Need Patients: a Systematic Review. J Gen Intern Med. 2022;37:3147-61. doi: 10.1007/s11606-022-07454-z.
[19] Schickedanz A, Hamity C, Rogers A, Sharp AL, Jackson A. Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System. Med Care. 2019;57 Suppl 6 Suppl 2:S197-S201. doi: 10.1097/MLR.0000000000001051.
[20] Neadley KE, Shoubridge C, Lynch JW, Boyd MA, Poirier BF. Hospital-Based Interventions Addressing Social Needs: A Systematic Narrative Review. Am J Prev Med. 2025;69:107624. doi: 10.1016/j.amepre.2025.03.004.
[21] Kneer K, Zhang E, Harkness T, Lahey T, Lounsbury KM. Integrating social determinants of health principles into the preclinical medical curriculum via student-led pedagogical modalities. BMC Med Educ. 2023;23:210. doi: 10.1186/s12909-023-04152-0.
[22] Daniel H, Bornstein SS, Kane GC, Health, Public Policy Committee of the American College of P, Carney JK, et al. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med. 2018;168:577-8. doi: 10.7326/M17-2441.
[23] Porras-Perez E, Romero-Cabrera JL, Diaz-Caceres A, Serran-Jimenez A, Arenas-Montes J, Pena-Orihuela PJ, et al. Food insecurity and its cardiovascular implications in underresourced communities. J Am Heart Assoc. 2025;14:e037457. doi: 10.1161/JAHA.124.037457.
[24] Campos LS. Climate change, the environment, and health: a call to action. Acta Med Port. 2024;37:579-81. doi: 10.20344/amp.22100.
[25] Campos L, Barreto JV, Bassetti S, Bivol M, Burbridge A, Castellino P, et al. Physicians' responsibility toward environmental degradation and climate change: A position paper of the European Federation of Internal Medicine. Eur J Intern Med. 2022;104:55-8. doi: 10.1016/j.ejim.2022.08.001.
[26] Boesch M, Baty F, Kalra S, Brutsche MH, Rassouli F. Chronicity of disease mandates quality-of-life prioritization - a role for digital health and patient-reported outcome measures. Eur J Intern Med. 2025;135:1-4. doi: 10.1016/j.ejim.2025.03.006.
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