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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The World Health Organization &#40;WHO&#41; defines the social determinants of health as &#8220;the conditions in which people are born&#44; grow&#44; work&#44; live&#44; and age&#8221;&#46; Therefore&#44; the concept of &#8220;health inequalities&#8221; refers to the impact of factors such as wealth&#44; education&#44; occupation&#44; racial or ethnic group&#44; urban or rural residence&#44; and social conditions from the place where one lives or works on the distribution of health and disease in the population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The different health-related opportunities and resources that people have according to their social class&#44; sex&#44; neighborhood&#44; or ethnicity&#44; among other factors&#44; determine a person&#8217;s level of health&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In recent years&#44; it has been shown that these social determinants play an important role in the possible development of chronic noncommunicable diseases by increasing morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These determinants include&#44; among others&#44; economic stability&#44; neighborhood safety&#44; working conditions&#44; environmental hazards &#40;such as air pollution or noise&#41;&#44; level of education&#44; and access to quality health care&#46; A good example of this is cardiovascular diseases&#44; the leading cause of death in Spain&#46; A lower socioeconomic status or having a precarious job is a predictor of greater risk of cardiovascular disease and&#44; along the same lines&#44; recent evidence suggests that having a lower education level is associated with greater inequality in overall cardiovascular mortality in Spain&#44; especially in mortality due to ischemic heart disease and heart failure in young women&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In addition&#44; the structural&#47;socioeconomic&#44; environmental&#44; and psychosocial factors that are most associated with cardiovascular diseases as well as the biological mechanisms that contribute to disease pathogenesis&#8212;such as inflammation&#44; impaired immune function&#44; and cellular aging&#8212;have been defined&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An interesting point for consideration is the impact of the social determinants of health on sick individuals attended by internal medicine specialists&#46; Our specialty entails comprehensive&#44; continuous care and&#44; from this point of view&#44; whatever may happen to the patient is not outside the scope of our activity&#46; This encompasses the implementation of prevention and health promotion measures&#44; the diagnosis and treatment of disease&#44; as well as the psychosocial aspects of their environment in order to improve individuals&#8217; quality of life&#46; At present&#44; aging and the increase in survival has clearly conditioned not only the chronicity of diseases but also their multimorbidity and progressive complexity&#46; Internists do not simply treat diseases in an isolated manner&#44; rather they approach the disease from the individual&#8217;s perspective&#44; both in an inpatient and outpatient setting&#46; From this comprehensive care approach&#44; the social determinants presented by each of the diseases individually are manifested in a more intense and complicated way in these patients and entail exponentially increased difficulty&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Returning to the previous example&#44; a person who only has cardiovascular disease is not the same as a person with cardiovascular disease as well as other comorbidities who lives alone and has a low income&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This highly complex example is clearly influenced by social determinants of health&#46; Similar situations are encountered in internists&#8217; day-to-day work and undoubtedly also occur in generalist specialties&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; each and every one of the social determinants&#44; which directly influence our view of each specific disease&#44; constitute additional factors within the complexity of a pluripathological patient and most of the time have a &#8220;cascade&#8221; effect rather than acting in isolation&#46; Nevertheless&#44; there are a series of social determinants that stand out significantly in internal medicine patients&#58; socioeconomic status&#44; educational level&#44; and lifestyle habits influenced by the patient&#8217;s environment and neighborhood&#44; among others&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Poverty and a low level of education condition the approach to all diseases that internists face on a daily basis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Despite social assistance&#44; there are still many families without resources and they sometimes have no possibility of obtaining them due to a lack of knowledge or lack of initiative and support&#46; Poverty leads to very precarious general living conditions&#58; scarcity or low quality of food&#44; hygiene&#44; treatment access and adherence&#44; etc&#46;&#44; in addition to a greater probability of living in less healthy environments&#44; having a precarious job&#44; etc&#46; On top of such a complex scenario as this is the low level of education and health literacy that these people usually have&#44; which hinders initiatives and strategies to improve these conditions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Population aging has also brought about other pressing problems&#58; lack of family and social support&#44; unwanted loneliness&#44; cognitive impairment&#44; disability&#44; and dependency&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Evidently&#44; higher social classes also have social determinants that condition their health&#58; environments with easy access to alcohol&#44; tobacco&#44; and other types of drugs or an intense social life that leads to excessive calorie consumption and sedentary lifestyles&#44; which predispose them to a greater burden of disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are multiple aspects that can improve health inequalities and are aligned with the goals of the United Nations &#40;UN&#41; 2030 Agenda for Sustainable Development&#44; which pursue equality among people&#44; health and well-being&#44; quality education&#44; protecting the planet&#44; and ensuring prosperity&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> At present&#44; although there are some plans aimed at reducing socioeconomic inequalities in health&#44; there are very few examples of interventions that take them into account&#44; probably due to the scant interest that this problem has sparked among physicians so far&#46; Since the main causes of health disparities lie in the socioeconomic and cultural diversity of population groups&#44; the specialty of internal medicine must lead and implement initiatives that allow for detecting the impact of social determinants in our patients&#44; guaranteeing quality care and a health system without inequities that is sustainable and efficient&#46;</p></span>"
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Editorial
Social determinants of health and their impact on internal medicine
Determinantes sociales de la salud y su impacto en la medicina interna
M. Montserrat Chimeno Viñasa, P. Pérez-Martínezb,c,
Corresponding author
pabloperez@uco.es

Corresponding author.
a Complejo Asistencial de Zamora, Zamora, Spain
b Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
c CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

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