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Invited Commentary
April 2014

Social Determinants of Health: From Bench to Bedside

Author Affiliations
  • 1Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, California
  • 2Department of Emergency Medicine, University of California, San Francisco
  • 3Andrew Levitt Center for Social Emergency Medicine, Berkeley, California
JAMA Intern Med. 2014;174(4):543-545. doi:10.1001/jamainternmed.2013.13302

Poverty is misery. It saps nutrients, because the poor may trade sustenance for cheap calories to stave off hunger. It precludes restorative sleep, given the demands of staying alive in the elements of the streets, the noisy crowded quarters, or the grueling hours of a second job. Poverty challenges the most basic levels of safety, security, hygiene, mental health, and the overall well-being of the lives of the almost 50 million Americans and billions worldwide in its grasp.

The socioeconomic gradient is one of the most pervasive and enduring trends in health. Found in nearly every disease entity, from cardiovascular to autoimmune disease, the gradient exists across and within nations.1 The gradient has confounded generations of physicians, whose training and turn of mind typically stop at the clinic door. After all, how far can physicians go? We cannot ensure that our patients keep the home stocked with nutritious foods or can escape nasty pollutants, much less prevent their future homelessness, can we?