Beginning as early as John Snow and Rudolph Virchow, physicians have recognized a link between social circumstances, population dynamics, and disease. 1 Although some social factors have been improved, such as clean drinking water, others such as unsanitary living conditions, crowding, hunger, and homelessness continue to contribute to poor health in the United States. Currently, the social history generally focuses more on health behaviors such as sexual practice, alcohol use, and smoking and less on the social circumstances of patients' lives. New research, however, has helped elucidate the mechanisms by which social circumstances affect health, and new resources have been created to mitigate these factors and thereby improve health. Medical care must evolve to include screening for selective social factors into clinical practice to augment public health and social policy strategies. Consistent with a call from the Institute of Medicine to better incorporate social and behavioral sciences into medical training, 2 we suggest that the primary tool that identifies the social circumstances of the patients, the social history, be revisited. We make the case for improved social history, particularly in children, although similar cases can be made for the elderly or other adults. ### New Research Beginning as early as 1976 with the work of Cassel3 and Syme and Berkman, 4 the field of social epidemiology has demonstrated how social conditions influence the etiology of various diseases by creating or taking advantage of general susceptibility within populations. Over the last decade, there has been a rapid increase in the quantity of biomedical and health services research, which links elements of the social environment to mental and physical well-being. 5 One example is the social determinants of asthma. Various studies have suggested a link between stress, 6 housing conditions, 7 and homelessness8 and a higher prevalence and severity of childhood asthma. Asthma, … Address correspondence to Megan Sandel, MD, MPH, Boston University School of Medicine, 91 E Concord St, Boston, MA 02118. E-mail: megan. sandelatbmc. org
Kenyon et al. (Fri,) studied this question.