Intended for healthcare professionals

Rapid response to:


If social determinants of health are so important, shouldn’t we ask patients about them?

BMJ 2020; 371 doi: (Published 24 November 2020) Cite this as: BMJ 2020;371:m4150

Rapid Response:

Re: What happens to knowledge of social determinants in primary care?

Very grateful for the response of Jonathon Tomlinson to our paper. Quite rightly he challenges our claim that “Social determinants are not routinely asked about, documented, or coded in clinical settings. The health service is, in effect, blind to those social determinants of health and healthcare.”

Dr Tomlinson describes his own social enquiries of his patients and these sound informative and empathetic. I have encountered other doctors making social enquiries. Practices vary, but the routine care provided by exceptional individuals is by no means routine practice for the profession as a whole. Moreover, as Dr Tomlinson points out, clinical systems are simply not set up to collect and code the outcome of socioeconomic enquiries. But they could be. The fact that they are not suggests disinterest both in the information that might be obtained and in the role that it might have in auditing health service use and outcomes. Again, individual exceptions to this professional disinterest exist. But social determinants will not get solved by individuals, and health inequalities cannot get meaningfully ‘tackled’ by health care providers.

As I see it, our profession has two important responsibilities: 1) ensuring and monitoring fair health service access and outcomes - this after all was the founding ethos of the NHS; 2) recording and reporting health outcomes in a way that enables unfair health and social polices to be challenged ‘upstream’. If we do not collect socioeconomic data routinely and record it purposefully, then we cannot meet these responsibilities.

Competing interests: No competing interests

28 November 2020
andrew moscrop
Luther Street Medical Centre, Oxford