Health Beyond Health Care: Social Determinants of Health

Venkatesan S, Yore MA, Pierre VA. Health Beyond Health Care: Social Determinants of Health. Emergency Medicine Advocacy Handbook. 2023 Apr 28;(6th Edition):Chapter 4, Section 8 of 27.

Why It Matters to EM and ME The ED is the gateway to the health care system, accessible at all times to our country's most vulnerable patients, regardless of their socioeconomic background. Millions of Americans, impacted by social needs, rely on the ED for routine and urgent medical care. For this reason, it is often referred to as a "window into the community," through which emergency medicine providers regularly witness and care for people affected by disparities associated with adverse social determinants of health (SDoH).1 The Centers for Disease Control and Prevention (CDC) defines SDoH as "conditions in the places where people live, learn, work, and play, that affect a wide range of health and quality-of-life-risks and outcomes."2 According to data from the Healthcare Cost and Utilization Project, the high reliance on ED services was largely due to non-health care factors, including education, employment, and poverty concentration that had nearly as strong a relationship with ED utilization as health status.3 Given the complex needs of many ED patients, physicians should strive to address the medical and social needs of each patient we encounter, to give equitable care across the board. During the unprecedented COVID-19 pandemic, emergency medicine played an integral role in meeting the challenges of this crisis. As one of the few specialties with direct patient contact at the time, emergency physicians were uniquely positioned to correct public misconceptions and promote more appropriate social distancing, mask wearing, and other health and hygiene practices. The shift in public perceptions based on current communications in the United States presented EM with a rare outlet to spearhead patient education efforts about the virus.4 While their normal scope of duties is typically limited to engaging with patients to coordinate their immediate care, the COVID-19 pandemic provided the opportunity to have more broad-ranging conversation with the public about a multitude of health topics. The COVID-19 response also led to emergency physician leadership in various levels of government and the private sector, providing an opportunity to advocate for the broad determinants of health impacting our patient population. Since then, there has been greater demand for emergency physicians to take up larger roles in various areas of government and public health spheres, to draft and lead future emergency response plans and guidelines.5