Integrating Social Determinants of Health in Medical Education: Shifting Future Physicians to Population Health-Centric Thinking and Practice

Abstract

Contemporary medical education (ME) curricula are vastly devoid of affirmative integration of the social determinants of health (SDH) despite growing evidence of implications for future physicians’ practice and influence on population health outcomes. Where incorporated, several programs still lack a population health-centric approach in curriculum design. Most publications focus on the academic implications from SDH integration in curricula. Our work extends to a more global perspective, highlighting the impacts of disparities in the integration of SDH on physicians’ readiness and competence to influence population health outcomes. We highlight not just the inequitable integration across countries and ME programs, but also the significance for future physicians’ thinking and approach to practice. From our work, we expect academic administrators to become more aware of the value of population-centric content in ME to address the global high burden of preventable diseases. We also hope to raise awareness among prospective students about the health needs of societies, driven by upstream determinants, and how such needs may reflect downward to patients' conditions. We conclude that affirmative SDH integration in ME is a necessary step to realigning medical practice for better population health outcomes, particularly in developing countries, where poorer health outcomes and socioeconomic conditions are closely interrelated. Our findings underscore the need for improving instructional design and content with a greater focus on global health impact, integrating the community as a learning space and source of co-educators, and realigning institutional policies to enable smoother SDH integration in curricula.

Introduction

Intellectual and practical competence in social determinants of health (SDH) are better entrenched in social education fields while a deep void remains in medical education (ME) curricula. ¹ This gap in curricula is particularly evident in ME education institutions in developing countries, and, where incorporated, several programs face challenges in pedagogical approaches.^1,2 Few publications deep-dive into the contributions of academic institutions to enhance professional competence of future physicians to address complexities giving rise to health inequities.^3,4 Social change aims to reverse undesirable health outcomes through the effective delivery of core services in each pillar of the healthcare system, including workforce development. Trained physicians must understand how to work effectively and contribute to achieving health targets in societies with the greatest needs and highest prevalence of socioeconomic and ecological vulnerabilities. There has been, for many years, a debate about the need to distinguish medical practice from public health. Proponents of distinguishing the concepts inadvertently enable the barriers to incorporating SDH in medical curricula, citing the scope outside of physicians’ responsibilities. ⁵ Furthermore, limited knowledge of SDH content among faculty, lack of resources for education delivery, and underrepresentation of content in certifying examinations are immense hindrances to integration of SDH in ME curricula. ⁵ More and more, in reality, the gap is closing between medical and public health practice and, in higher education institutions, the contents are becoming more homogenous in recognition of the demand for a competent, well-rounded health workforce.^6,7

Addressing SDH is increasingly recognized as impactful for improving health outcomes in an equitable and sustainable manner.^8,9 The belief that “all men are born equal” is blind to the unique circumstances into which individuals are born, grow, live, work, and age. These social contexts, collectively referred to as the SDH, majorly influence health across the life span. ¹⁰ Health condition is determined by physical, mental, and psychological responses to social and ecological pressures. ¹¹ A low capacity to withstand these pressures manifests in an overwhelmed physiological response, deteriorating to dysregulation, and eventual defenselessness to diseases.^12–14

Given the growing evidence of the positive relationship between SDH and population health outcomes, why is contemporary ME curricula still lacking affirmative integration of SDH? In addition to the glaring paucity in SDH in ME, where incorporated, institutions commonly only offer limited content on the subject. ¹⁵ Martinez et al ¹⁶ highlighted the benefits of deliberate integration of SDH teaching materials that have practical applications. Many publications limit focus to the academic output from SDH integration, with little offered on lessons learned and incorporation to enhance the approaches, policies, tools, and delivery methods. ¹⁷ The National Academies of Science, Engineering, and Medicine framework, published in 2016 to educate health professionals on SDH, highlighted the need for competence in awareness, for example in understanding housing instability, transportation barriers, and food insecurity that affect patients; adjustment of clinical care to address social risk factors; assistance to help patients connect with necessary community, government, and other services that meet their needs; alignment of institutions with social service partners; and advocacy to change policies and systems that create health inequities. ¹

Our work extends to a more global focus, highlighting impact of the disparities in the integration of SDH on physicians’ readiness and competence to contribute to social change. We present arguments in support of the need to improve population health outcomes through medical practice and to realize better alignment with Sustainable Development Goal #3—Good health and wellbeing for all, particularly in areas with high burden of socially-influenced diseases. Our arguments were not the major focus in the majority of previous publications, which were mostly grounded in the frequency of SDH integration, variations in program delivery, and impact on students in the learning environment. Our discourse explores health co-benefits beyond the institutional environment to helping academic administrators and students appreciate the potential global impact of SDH integration in ME. Finally, we present recommendations for reform to better position institutions to adopt population health goal-driven curricula in ME. From this work, we expect academic administrators to become more aware of the value of population-centric materials in ME to improve health outcomes, particularly in developing countries and regions with high burden of preventable diseases. We hope to raise awareness among prospective medical students of the health needs of the wider society, how these needs may translate to the condition of patients, and how much ME curricula may prepare them to effectively bridge the gap between medical practice and desired population health outcomes.

Evidence of the Impact of Social Context on Health

The World Health Organization identified factors that constitute SDH, among them, income, social protection and working conditions, education, housing, unemployment and job insecurity, food insecurity, housing, the environment, social inclusion, and access to affordable health services of decent quality. ¹⁰ The World Health Organization's Commission on Social Determinants of Health urged global action to prioritize health equity, emphasizing the need for improving living conditions, distributing resources equitably, and continually measuring health disparities from SDH. ¹⁸ Low socioeconomic status (SES) and poor living conditions increase the risk of chronic diseases. ¹³ Studies also found that low education and income levels were associated with poor glycemic control, high blood pressure, and adverse lipid profiles. ¹³ Individuals with multiple SDH challenges face a higher risk of fatal coronary heart disease and non-fatal myocardial infarction. ¹² In the United Kingdom, low SES, education, and employment correlate with higher cardiovascular disease (CVD) mortality and incidence. ¹⁹ Hypertension was more prevalent among women with low educational attainment and who were unemployed. ¹⁹ Diabetes is another chronic disease that was associated with SDH, specifically food insecurity and poor infrastructure, which has led to poor glycemic control and medication adherence, in turn leading to the worse outcomes. ²⁰ SDH was found to be a strong indicator of vulnerability to communicable diseases, although this linkage remains underrecognized. ²¹ Limited health literacy, financial constraints, and reduced healthcare access exacerbate health disparities, often persisting from childhood into adulthood. ²² Management of many diseases requires addressing and modifying the interface with the SDH.

SDH impacts are not limited to linkage with disease outcomes; indirectly, they also affect access to healthcare providers, services, and products. The COVID-19 pandemic exposed stark health inequities, disproportionately affecting low-income and minority communities. Income loss, housing instability, and healthcare inaccessibility led to increased SARS-CoV-2 exposure risk and higher disease incidence and mortality rates. ²³ In other studies, trauma care and management were linked to SDH, with private insurance associated with the speed of concussion recovery. ²⁴ Individuals experiencing food insecurity or unstable housing were disproportionately affected by medication nonadherence due to financial barriers, logistical challenges with filling prescriptions, and limited healthcare access. ²⁵ Low SES and insufficient social support lead to higher mortality, increased hospital readmissions, and reduced adherence to treatment plans. ²⁶ People in low SES groups may rely on emergency departments as their primary or preventative care facility due to financial limitations, lack of health insurance, or geographic disparities, increasing the emergency services demand. ²⁶ Similar issues, in addition to high prescription costs and transportation barriers, impede treatment efficacy among people in low SES groups. ²⁷

It is imperative to refocus and prioritize SDH in the delivery of healthcare. Healthcare is multifaceted, with SDH playing a significant role in health status. Health interventions that are focused solely on behavior change, such as diet programs that target diseases such as hypertension, CVD, diabetes, and obesity, tend to fail when other barriers, such as economic and systemic disadvantages, prevail. ²⁸ Community-based interventions, such as Earned Income Tax Credits and affordable housing initiatives, have led to improved public health outcomes with long-term funding and lower healthcare costs. ²⁸ Strengthening primary care resources can increase patient accessibility while leveraging community partnerships to eliminate healthcare access barriers. ²⁹ Addressing SDH, to achieve social change, will require sustainable funding, collaboration across disciplines and community organizations, and continuing policy development for long-lasting interventions. ³⁰ Physicians, as health experts and service providers, can be influential advocates for social change, such as to improve patient literacy and efficacy, and to support affirmative actions for reducing barriers to healthcare services.

Disparities in the Integration of SDH Content in ME Curricula

Uneven integration of SDH in curricula across countries

SDH play a critical role in shaping patient outcomes, yet its integration into ME curricula remains inconsistent across countries and medical degree programs. ² Ensuring that future physicians are adequately trained and educated in SDH is necessary to improve health equity, enhance patient–physician communication, and support effective clinical decision-making. ¹⁸ Medical schools in developed countries, such as the United States, United Kingdom, and Canada have taken steps to integrate SDH into curricula with institutions successfully incorporating SDH through interprofessional education, community engagement initiatives, and service-learning opportunities. ¹⁵ However, there are differences in delivering SDH education with little standardization, accessibility, and longitudinal competency evaluation. ³¹ Programs vary significantly in their approach too, with some incorporating SDH as electives and others as core subject areas.^15,32 The level of emphasis and approach to SDH integration varies across preclinical and clinical training, with many programs lacking a framework that reinforces SDH knowledge and practical skills-building throughout the education experience. ³³

In contrast, medical programs in developing countries, such as India, some parts of Latin America, and Africa, face considerable challenges in integrating SDH in education. ¹⁵ Resource constraints, insufficient faculty training, and a focus on biomedical sciences rather than social medicine are some of the most pressing challenges that limit the integration of SDH in ME. ¹⁵ A scoping review of SDH education in graduate medical programs found 24 studies from developed countries, of which 22 were from the United States, and only 1 study from a developing country (Kenya). ² This finding highlights the significant gap in implementation and visibility of SDH integration in resource-limited settings. ² Interdisciplinary collaboration, community engagement, cultural competence, innovation, and ethical leadership were among recommendations to transform medical and health science education in developing countries to better align with challenges of the emerging health landscape. ³⁴

Variations in SDH content between Doctor of Medicine and Bachelor of Medicine, Bachelor of Surgery curricula

Disparities in SDH education exist between Doctor of Medicine (MD) programs, which are predominant in North America, and Bachelor of Medicine, Bachelor of Surgery (MBBS) programs, which are more common in Europe, Asia, and Africa. MD programs in countries such as the United States and Canada include SDH as part of elective coursework, interprofessional education and, in some cases, structured community-based learning experiences. ³¹ The extent of SDH integration, however, varies across institutions, mostly lacking mandatory standardized assessments to measure students’ competence in applying SDH concepts in medical practice. ³¹ In contrast, MBBS programs, which are standard in the United Kingdom, Asia, Africa, and Latin America, prioritize biomedical sciences and clinical skills over public health and social medicine. ³¹ When introduced early in medical training, SDH concepts are rarely reinforced in clinical years, limiting students’ ability to apply them in real-world settings. ³¹ Without structured reinforcement, medical graduates enter clinical practice without the necessary skills to address social risk factors that affect patient health outcomes.

Possible Social Change from SDH Inclusion in ME Curricula

The inclusion of SDH in ME curricula has the potential to drive significant social change and improve outcomes at the individual and population health levels. Although there are limited published studies on the relationship between the integration of SDH and medical services and population health outcomes, observational and cross-sectional studies suggest that this integration can lead to reduced health disparities, enhanced preventive care, and improved health promotion efforts.^2,15,27,35 Studies indicate that integrating SDH into ME and healthcare systems can improve and advance clinical care by incorporating social and economic risk factors into medical decision-making, diagnosis, and treatment. ¹⁵ Given that SDH factors significantly impact access to quality care, equipping physicians with an understanding of these determinants enables practitioners to leverage community partnerships and clinical resources to bridge gaps in care access. ³⁶

Engaging medical students in SDH screening and referral programs has been shown to improve access to healthcare and social services for patients who might otherwise face disruptions due to systemic barriers. ³⁷ By training students to identify social and environmental risks—such as food insecurity, unstable housing, and limited transportation infrastructure and access—healthcare institutions can better connect underserved populations with essential resources, reducing preventable emergency visits and hospitalizations, while promoting continuity of care. Beyond clinical care, integrating SDH into ME empowers communities by fostering collaboration between healthcare providers and local organizations. Community engagement in health initiatives promote positive behavioral shifts and changing public attitudes toward health-related issues. ³⁸ Additionally, studies have found that medical students trained in SDH-focused curricula are more likely to work in underserved communities and feel confident in addressing the needs of marginalized populations. ³⁸ Early exposure to service learning prepares future physicians to approach healthcare with a holistic and equity-driven perspective. The inclusion of SDH in ME was found to be impactful in enhancing community engagements, reducing health disparities, and improving collaboration between the medical programs and stakeholders, such as members of the target community and implementers. ³⁹

Including SDH in ME fosters policy advocacy and systemic change. Physicians trained in SDH not only improve individual patient outcomes through personalized and equity-centered care but can also play a crucial role in shaping public health policies. ² Research suggests that physicians with training in SDH are more likely to advocate for policy changes related to housing, education, and income equality—key determinants of health that influence chronic disease prevalence, infant mortality rates, and overall life expectancy.^2,40 By addressing structural barriers to health, physicians contribute to population-wide health improvements and reduce the burden of preventable diseases.

Examples of the Impact of SDH Content on Medical Curricula

ME systems worldwide are recognizing the benefits for professional practice from the integration of SDH-related content into curricula. Here, we examine how structured SDH curricula have influenced not only clinical competency in treating individual patients but also incorporating and engaging with the ecological upstream factors that influence individual health. The cases show SDH integration in ME can translate into thinking and behaviors that potentially favor equitable healthcare delivery beyond individual disease management.

Medical Education Cooperation With Cuba (MEDICC) ⁴¹

Community health as a priority and the role of social factors in patient care have long underpinned Cuba's ME model. In the 1976 Constitution and 1983 Public Health Law, social and economic developments were enshrined in the healthcare system. Health was cross-cutting with a strong community focus, managed by family doctor and nurse teams.

Driven by the family medicine model, the medical and nursing curricula were overhauled to emphasize holistic health over simply disease management. With the focus on the SDH, Cuba was among the top countries tracking towards major achievements of targets of the Millennium Development Goals. In the MEDICC Review, Cuban medical institutions documented the country's success in developing physicians who are highly skilled in both clinical and community medicine. Medical students were required to complete rotations in underserved areas, where they focused on living standards, including housing, nutrition, and economic stability. This early exposure fostered an appreciation for preventive and equity-focused practice among graduates, which were more likely to incorporate SDH considerations into clinical decision-making. As a result, Cuba achieved one of the lowest physician-to-population ratios in the world during the period, with a healthcare system that prioritized accessibility and preventive medicine. Despite challenges, Cuba's early and continuing focus on SDH, from curriculum to community, have resulted in positive health outcomes for the population.

Medical Education Partnership Initiative in sub-Saharan Africa ⁴²

In 2010, Medical Education Partnership Initiative (MEPI) was launched across sub-Saharan African countries with the goal of enhancing medical training and research capacity while integrating SDH into curricula. This initiative aimed at producing physicians who were better equipped to address local health disparities and incorporate interdisciplinary learning. Medical students collaborated with public health professionals and social workers to gain a deeper understanding of how economic and environmental factors influenced disease outcomes. Program evaluations revealed that students who completed SDH-enhanced curricula exhibited improved diagnostic reasoning and greater interest in advocacy for health policy reforms in communities. Retention of workers in the most needed areas increased with improved skills to meet the population health demands.

Case study-based curriculum in the United States ⁴³

A case-study-based curriculum in the United States sought to address gaps in SDH training by incorporating real-world case studies in medical training. One case study focused on a young Haitian patient in need of lifesaving cardiac surgery, using the experience to help American medical students analyze the impact of economic instability, healthcare access, and systemic inequities on patient outcomes. The integration of this case study into ME allowed students to explore the health system challenges specific to Haiti and to identify potential interventions that could mitigate against barriers to care. Outcomes from this educational intervention demonstrated a notable shift in students’ perceptions and clinical approaches. Students reported heightened awareness of non-medical factors influencing health outcomes and an improved ability to incorporate SDH into patient assessments. This approach not only enhanced students’ understanding of healthcare systems but also cultivated critical thinking skills essential for acknowledging the importance of and addressing health disparities in future clinical practice and patient communication.

Flipped classroom experience in University College London Medical School ⁴⁴

This study followed fourth-year medical students through a flipped learning session that included simulated patient interaction. The flipped classroom involved a pre-reading component, followed by in-class discussion, and ending in a simulation exercise. Post-simulation, a questionnaire was completed, and data collected regarding understanding of key SDH concepts. The results show that the flipped classroom style of learning appropriately and adequately increased both clinical skills and person-centered care. Among 289 students responding to the survey, of which 85% (n = 246) completed the online lesson, 3.2 of 4 points was the mean of students agreeing that the session helped their understanding of key concepts, and 3.2 of 4 points was the mean stating the session was enjoyable. Engagement, structure, and attitudes toward SDH were outstanding themes from the evaluation, with students citing increased clinical relevance and understanding of the impact of health inequalities.

Health scholars program at Puentes de Salud, Philadelphia, United States ³⁹

Another example of effective delivery of SDH is shown in a study that followed a group of medical students who completed a health scholars program in partnership with a community health center in Philadelphia, in the United States. The program included lectures, required reading, critical reflections, and community-based service. The community interactive component yielded remarkable results with the expressions that students can better learn about the SDH from interacting with the community and building trust rather than simply reading about the concept. The students offered suggestions on how to improve the delivery of the course. The recommendations included spending less class time on lecture delivery, more time on facilitated group discussions, and providing more hands-on guidance in planning and implementing community-based interventions.

The findings from other institutions that have trialed SDH in ME curricula show that consistency and equal emphasis on SDH in preclinical and clinical years help students build confidence to integrate SDH in medical practice. ¹⁵ Lecture-based teaching was shown to be less effective in SDH curriculum delivery. Rather, small group discussion, direct patient encounters, and inclusion of community-based services were more effective for medical students to gain knowledge and indulge in practice. ² Institutions must set clear goals and objectives in SDH curriculum, ensuring feasibility to deliver and sustain the program within the context of the community and the teaching institution. ⁴⁵

Healthy People 2020

The above cases illustrate how structured SDH integration in ME can significantly influence behavior and thinking of future physicians toward medical practice. In 1990, Healthy People 2000, the first official document that addressed health differences across populations in the United States, was released by the US Department of Health and Human Services. ⁴⁶ This 10-year visionary document focused on reducing health inequity. By 2020, it was evident that addressing the SDH was effective to improve population health outcomes. A significant observation was the difference in health outcomes associated with home health or community partnerships, having a better chance at taking action on SDH, versus hospital and office-based practices. The strength of this evidence on long-term impact from incorporating SDH in healthcare led to visioning the elimination of health disparities by 2010. ⁴⁶ Closing the gap in population health outcomes in the United States offers strong evidence of the potential positive impact of considering SDH in healthcare systems.

Recommendations for Integration of SDH in Curricula

ME institutions must recognize social accountability for training students to adequately respond to the health needs of the populations they serve. ⁴⁷ Although most of the published cases indicate positive changes in medical students’ thinking and attitudes, training institutions must not only be satisfied with the positive outlook for future but also feel a sense of responsibility to continue monitoring and providing opportunities to translate this knowledge and skills into healthcare practice. This level of accountability may require institutions to also refocus their values and mission in alignment with promoting communication in ME and medical services, equity, quality and cost-effectiveness of medical services, maintaining relevance in the curricula, focusing on community needs, and ensuring infrastructure to maintain and evaluate accountability in ME. ⁴⁷ SDH integration should be minimally disruptive but acceptable to academic and community stakeholders. ² Consideration should be given to universalization, seamless integration, trainee introspection, competency-based, and faculty development. ² The question remains about aligning SDH with biomedical content that is needed in medical practice.

There are three domains through which change must be achieved for effective SDH integration: education, community, and organization. ³⁹

Education: SDH training and coursework must be embedded in the fundamental core of the curriculum. This framework should include assessments as well as simulations and demonstration of practical knowledge for application in clinical practice. Assessments should measure students’ ability to apply SDH knowledge rather than focusing solely on regurgitating theoretical concepts. There is also a critical role here for licensing board exams to include questions on SDH content to reinforce and motivate learning. The case studies above highlight the value of practice through community service as an effective strategy to help students gain experience and explore concepts. Faculty must be trained to deliver SDH education, for example, in areas of content development, methods of delivery, practical application, assessments, and evaluations. The quality of delivery will depend on who is teaching the content and how well the content is taught.

Community: ME institutions can partner with local communities to afford students firsthand experience of the impacts of socioeconomic and ecological determinants on health. Opportunities should be provided for hands-on community engagement and social awareness training alongside biological content that is already well entrenched in ME curricula. Reflection exercises will help students to mentally process concepts and reflect on relevance to medical practice.

Organization: Institutional commitment, displayed in its values, mission, and curriculum, is necessary for the development and sustainability of SDH integration in ME. Policies and regulations should support appropriate allocation of resources to SDH-related activities to enable the delivery of high-quality programs.

The integration of SDH in ME requires upstream adaptation of population health-centered values. The following recommendations can help in repositioning institutions for SDH integration:

Curricular reforms ⁴⁸

Students undergo rigorous training to develop a strong foundation in biological sciences. Integrating case-based learning, standardized patient encounters that highlight the human aspect of medicine, and interprofessional education can close this gap and expand content in SDH. In a review of 289 articles on SDH coverage in medical curricula, training on social risk screening and other awareness activities (42.6%), helping patients access social care (29.8%), and providing social risk-adjusted health care (28.0%) were most frequently included in lessons. Systems and policy-level activities (14.9%) and advocacy (17.0%) were covered far less. ¹ Curricula reform will not only promote a deeper understanding of the social factors that influence health but also help students connect with patients and communities, from which point they can engage more effectively in addressing challenges. Policy advocacy skills are vital for creating the enabling environments in which social change can thrive.

Clinical training enhancements^35,49

Clinical training enhancement can be achieved through working with standardized patients, structured mentorship, and experiential learning in underserved communities. It was found that, in many institutions, SDH was only integrated at the knowledge level (32.5% in 289 medical programs) and void of practice to identify the source of disease and take steps to address at the upstream level. ¹ These activities provide opportunities for practice in recognizing and addressing SDH in real-world settings. Research indicates that while healthcare providers recognize the impact of SDH on patient outcomes, many feel unprepared to address these factors in practice. This limitation highlights the need for enhanced training for physicians.

Equipping healthcare providers with the necessary tools to assess and act on SDH can lead to more comprehensive and individualized care, fostering better long-term health outcomes.

Institutional and policy support ⁴⁵

Institutional and policy support should focus on values and arrangements rather than directly on education delivery. Policies should ensure faculty are well-equipped to teach content related to the SDH and that the content meets medical school accreditation standards. A study that involved interviewing 10 faculty members at a medical school in the United States show the faculty often struggled to deliver content due to shortcomings in training as well as structural constraints in the school. ³ During the delivery of content, the faculty experienced unexpected tension in the classroom which prompted rethinking teaching methods. ³ Another study in the United States that looked at the curricular integration of social medicine discussed eliminating the lecture format. ⁵⁰ The researchers stated that it was not sufficient to include hour-long lectures as opposed to providing students with an interactive experience to strengthen and enforce the impact of SDH on populations. ⁵⁰ Established policies and guidelines help create a sustainable and consistent framework that permeates curricula across the institution. As societies become increasingly diverse, healthcare providers have a duty to understand the full spectrum of factors influencing health, beyond biology alone. Institutional support should be directed to prioritizing the integration of SDH in ME.

Limitations of this Paper

This work draws on an extensive search of the literature and including relevant content from peer-reviewed articles and other publications from education authorities. This subject, however, is emerging in many countries and literature on implementation and evaluations is virtually absent for some regions. The studies included in this review lacked substantial input from ME institutions in the Eastern world or from countries that have non-Western medicine education formats. Hence, our study primarily focused on the integration of SDH in ME programs in developed and Westernized countries. No statistical analyses were performed in this review. Our review was limited in reporting quantitative results. Lack of sufficient data from ME systems with diverse populations, such as those that serve indigenous populations, is another limiting factor to understanding how SDH are incorporated into ME globally and the impacts on diverse populations. Despite these limitations, this work is still a valuable eye-opener regarding the need to incorporate SDH in ME curricula and the benefits that can be derived for future medical practice. Further studies can be done to understand the unique challenges and opportunities in specific country or population context.

Conclusion

SDH plays an important role in shaping individual and community well-being. Health disparities are largely driven by varying conditions and factors such as access to health services, neighborhood safety, and food insecurity. In many cases, the most significant contributors to diseases are rooted in the environments and circumstances in which people live. Future physicians must, therefore, be equipped to address prevailing socioeconomic-ecological factors to achieve equitable and patient-centered care.

Integrating SDH in ME was found to enhance clinical decision-making, improve patient communication, and promote health equity. Reformation of ME must be driven by changes in the education focus—that is, content and delivery format; community—including the community environment as a learning space and members as coeducators; and organization—policies that support SDH integration in values and arrangements. SDH integration can help enhance physician–patient communication which is important for building trust, encouraging adherence to treatment plans, and fostering shared decision-making. Physicians who understand the social contexts of their patients’ lives are better equipped to engage in culturally competent discussions, convey empathy, and identify practical interventions. SDH-integrated programs across various medical schools worldwide found that such programs positively boosted students’ confidence in addressing social factors in patient care. Improved communication can lead to increased patient satisfaction and better health outcomes, particularly among marginalized populations who often face systemic barriers to care.

This study has profound implications for advancing global health equity through policy change and advocacy. Medical professionals who are trained to recognize and address social determinants are more likely to advocate for systemic changes that reduce health disparities. This may include participating in policy advocacy, working in underserved communities, or developing institutional initiatives aimed at reducing barriers to care.

Beyond gaining a broader understanding of health disparities, prospective medical students should consider how institutions’ curricula contribute to gaining experience and improving efficacy for addressing upstream determinants to bring about social change in the communities they will serve. These achievements not only deepen commitment to social justice but also enhance physicians’ abilities to respond to emerging health needs effectively. We hope this publication will motivate further work in instructional design, including developing didactic content, presentation formats, assessments, reflection and feedback, and evaluation, differentiating approaches to align with needs across programs. Special attention should be given to ME institutions in developing countries, aiming to improve their contributions to Sustainable Development Goal #3, good health for the population en masse.