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While awareness of the importance of social determinants of health (SDOH) has grown over the past 2 centuries, commensurate spending on social care programs has not. Building on the foundational works of Frederich Engels, Rudolf Virchow, W.E.B. Du Bois, and Salvadore Allende, the World Health Organization codified the SDOH framework in their Commission on Social Determinants of Health. Within this framework, important distinctions exist between the intermediary social causes of health and the distribution of these causes, which are driven by the larger structural determinants of health. A focus on the SDOH has recently gained traction within health systems through screening for health-related social needs (HRSNs). There is a strong evidence base supporting this work; however, large gaps remain in our understanding of the implementation challenges across complex health care delivery systems. While screening for and addressing HRSNs is a necessary step for health systems to address the intermediary social causes of health, upstream interventions requiring multi-sectoral policies and approaches are critical to reduce health inequities.

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