Medicalizing the social determinants of health and the inadvertent reproduction of inequities through social-care program implementation in the United States

Social scientists have long noted the influence of social, economic, and political factors—or the social determinants of health (SDOH)—that influence people's health. Healthcare providers and insurers, hospital administrators, clinicians, government, social services, and research agencies have put great efforts into developing policies that create knowledge and awareness, and promote social-risk screening and social-care programs in the United States. These programs screen patients for risks so health professionals can refer them to resources for help with their health-related social needs (HRSN). Federal policies have constructed the socioeconomic conditions of individuals as health problems—and driven SDOH medicalization. While commendable, such programs have not significantly improved patients' health, and the open questions are how and why this is the case. Our qualitative data help answer these questions and inform arguments about the benefits, limitations, and consequences of SDOH medicalization. In our research, we explore study participants' lived experiences of SDOH medicalization in one social-risk-screening-and-care program—from focus-group discussions with clinic staff, patients, and social service leaders collected in 2020–2021. Data provide empirical evidence that medicalization offered benefits but played a role in some unintended negative consequences, including the reproduction of already existing inequities that limited program effectiveness. Efforts to address the HRSN of individuals will be enhanced by policy and clinical work that tackle the intersecting social, economic, and political forces that create and sustain conditions that are harmful to human lives.