SerpApi.Org
For nearly a decade, the most influential medical journals in the world have been telling medical professionals that almost everything is their business: housing markets, immigration status, climate change, criminal justice, internet access, even colonialism.
The concept driving this expansion is “social determinants of health” (SDOH). The World Health Organization defines the term as “the conditions in which people are born, grow, live, work, and age,” including the health system itself – conditions that the WHO says are “shaped by the distribution of money, power and resources at global, national, and local levels.”
Originally centered on material circumstances, the concept of SDOH has grown far more expansive. It risks drawing healthcare professionals into policy domains in which they have little training and less expertise.
In a new analysis for Do No Harm, I reviewed 1,597 articles mentioning SDOH or related terms in five flagship medical journals – the BMJ, the Lancet, JAMA, the New England Journal of Medicine, and Nature Medicine – finding that the volume of articles invoking SDOH more than tripled between 2016 and 2024, growing from 69 to 216 articles a year. That happened even as the journals’ total output barely budged. In other words, the surge in articles discussing SDOH reflects a deliberate editorial choice to redirect attention toward an ever-expanding definition of what counts as a medical concern.
These aren't obscure academic exercises. The flagship journals set the intellectual agenda for medical education, shape clinical guidelines, and feed directly into the priorities of federal health agencies. What gets emphasized in their pages today tends to show up in medical school curricula, and eventually in the exam room, within a few years.
Interestingly, the count fell to 155 articles in 2025, the first meaningful pullback in years. That dip may be statistical noise, or it may signal the start of a much-needed correction. Either way, it's worth pausing to ask what, exactly, journals have been asking doctors to focus on instead of medicine.
My analysis found the concept metastasizing far beyond its original core. Journals now routinely list as “social determinants of health” race, racism, gender, housing, violence, environment/climate change, and social isolation. The term has even been expanded to include caste systems, colonialism, gang membership, military conscription, internet access, and policing. SDOH-adjacent framings have emerged with names like “commercial determinants of health” and “political determinants of health,” which serve implicit invitations for medical researchers to render judgment on corporate regulation and governance structures, subjects considerably outside the medical school curriculum.
The most politically charged shift involves race and racism. References to racism, structural racism, and racial discrimination as drivers of health surged from just 3 percent of SDOH articles in 2019 to 21 percent in 2020 — the year George Floyd was killed — and peaked at 26 percent in 2022. That figure has since receded to roughly 10 percent, suggesting the most acute phase of that framing may be passing. But mentions of race and ethnicity as demographic descriptors tell a different story: they rose from 11 percent in 2019 to 26 percent in 2020 and stayed elevated through 2024, a more durable shift in how journals describe population health differences generally.
Yet, the fact that a disease tracks along racial lines doesn’t, by itself, identify the cause or point to an effective intervention. When journals treat the mere existence of a disparity as proof of a structural mechanism, they short-circuit the rigorous analysis that good medicine, and good policy, requires. And every claim that doctors are equipped to diagnose society’s structural ills is, implicitly, a claim that medicine knows how to fix them. It usually doesn’t.
When physicians and medical journals weigh in on complex social and economic problems, they may oversimplify dynamics they do not fully understand, confuse correlation with causation, or lend the authority of medicine to policy prescriptions that are neither evidence-based nor practically feasible. There is also a concern that framing health outcomes primarily through the lens of social conditions diminishes the role of personal responsibility and individual behavioral change — factors that remain central to clinical medicine and that patients can act on directly.
This expansive framing hasn’t stayed confined to academic journals, either. The Centers for Disease Control and Prevention, the National Institutes of Health, the Department of Health and Human Services, the Association of American Medical Colleges, and the American Medical Association have all embraced versions of the same broad definition, pulling federal health policy and medical-school curricula along with it.
None of this is an argument for ignoring the conditions that shape patients’ lives. It’s an argument for humility about what medicine can and cannot explain. The further journals venture from measurable clinical factors into the tangled causality of social, economic, and political systems, the less certainty they can honestly claim, and the more they risk lending medicine’s authority to policy prescriptions nobody has actually tested. The modest dip in 2025 is reason for cautious optimism. Medical journals would do well to make it a trend.
