ORIGINS AND CONTEXT: The concept of 'the social accountability of medical schools' is moving from the peripheral preoccupation of a few to a more central concern of medical schools themselves. Born of concerns about the professionalism and relevance of both the institutions and their graduates, it is seen increasingly as an urgent call to focus the considerable social resources vested in academic health science institutions on addressing the priority health concerns of the societies they serve. For a profession embedded in an ethos of service, this would seem an obvious transition. However, as with any movement towards transformative change, it runs the risk of being more mantra and rhetoric than mandate and responsibility. NEEDED RESPONSE: Proceeding from the assumption that good intentions alone are not enough, this paper seeks to outline the historical development and some current expression of the concept throughout the world. The sadly divergent wealth and health status of modern societies calls for very different actions by medical schools across the spectrum from the least endowed to the wealthiest of schools. In a profession claiming centuries of cohesive commitment to the welfare of others, it is increasingly urgent that the current generation of medical educators converge on a relevant set of principles and coherent activities. TOOLS FOR THE TASK: While recognising that they are closely intertwined, the paper outlines the difference between the social accountability of the institutions themselves and the social accountability of the graduates they produce. It outlines both individual examples and the international initiatives that are fostering and facilitating institutional collaborations to bring both progress and optimism to this daunting task. It provides connections to practical resources for those who are committed to that task. Other papers in this series add further practical insights into the central role that medical educators must play if we are to fulfil the responsibilities we carry with the privilege of our profession.