[Practising social accountability: From theory to action].

Screening for poverty. 2,3 Providing health care to uninsured migrants.4 Advocating for a national pharmacare program.5 These are but 3 examples of how family physicians are currently actualizing social accountability in Canada at the individual (micro), community (meso), and system (macro) levels. Social accountability is the social contract that medicine has with society.6 For care to be socially accountable, it must be equitably accessible to everyone and responsive to patient, community, and population health needs. It demands advocacy on the part of physicians to speak out on behalf of marginalized populations about the social conditions that contribute to disease, suffering, and death. It requires collaboration with partners and policy makers to create a truly accountable health care system. It supports primary care research that is responsive to perceived needs and translates into evidence-based practice and high-quality care. It necessitates medical education and training that models and teaches advocacy, community responsiveness, and health care provision that addresses the priority health concerns of the population served.7 As family physicians, the essence of social accountability rests in responding to the health needs of our society with whatever capacity we have and in whatever ways we can. In the case of family physicians and their organizations, this accountability encompasses the actions taken within the primary care setting in individual doctor-patient relationships (micro), the collective interactions of physicians and organizations with the communities they serve (meso), and the interactions of societies with their professions (macro). This article is the first in a series of 4 that explores how social accountability can be put into action at each of these 3 levels. This is a call to action and a raising of awareness of our responsibility to our patients, communities, and society as a whole. Building upon the framework and recommendations released in the Best Advice Guide: Social Determinants of Health,8 this series further explores how to get involved to realize our social accountability mandate. It describes the core activities and the obligation of every family physician and family medicine organization to fulfil our social contract with the patients and populations we serve. The 4 principles as a foundation of social accountability The capacities and roles of family medicine are expressed in the 4 principles and the roles are defined in the CanMEDS–Family Medicine tree (Figure 1).9 The roots and foundation of our opportunities and obligations are grounded in and expressed by the 4 principles. Requiring excellence of practice in a relationship with a patient or a particular population and based in an obligation to community, the 4 principles set the expectation of social accountability. In this context, how could we not know, care about, and respond to the particular needs of our patients, communities, and society? Indeed, social accountability is “at the heart of family medicine.”10