Social Determinants of Health: A Missing Link in Emergency Medicine Training

Abstract

The health of a population depends upon several factors, including disease, public health initiatives, and the social determinants of health (SDH). These factors often converge in the emergency department (ED) where the impact of social conditions such as homelessness, low-literacy, and poverty lead to recidivism and may contribute to provider burnout. Inclusion of SDH topics in EM residency curricula can provide needed background information and effective strategies for coping with these patients in the clinical setting. Exercises that simulate poverty, the development of and familiarity with meaningful community partnerships, and inclusion of SDH topics in standard ED conferences (e.g., mortality and morbidity conference) can promote understanding and outline a detailed plan for treating patients facing these challenges. By incorporating educational interventions aimed at identifying and intervening on issues of SDH in the ED we may be able to better serve those patients who need us the most.

Biodiversity and Health in the Face of Climate Change: Implications for Public Health

“…Salutogensis focuses on factors that support human health and well-being, rather than on those that cause disease (i.e. pathogenesis) (Antonovsky 1979). Predicated on the paradigm that health is a positive state of well-being rather than just "being well" and deterring ill health, salutogenesis originated through Antonovsky's (1979) asset-based approach, which endorses the skills, attributes and resources of individuals and communities to develop resilience and a sense of purpose.…”

“…pathogenesis) (Antonovsky 1979). Predicated on the paradigm that health is a positive state of well-being rather than just "being well" and deterring ill health, salutogenesis originated through Antonovsky's (1979) asset-based approach, which endorses the skills, attributes and resources of individuals and communities to develop resilience and a sense of purpose. Hence, a salutogenic approach has influenced the move away from more medical, pathogenic models to provide a sense of coherence between health and illness.…”

“…The traditional approach to preventing disease -that is, counselling to reduce unhealthy behaviours -does not effectively address this phenomenon, because social and physical environments and circumstances mitigate behaviour change. Such inequalities are high on the political agenda (Marmot 2010(Marmot , 2013Marmot et al 2008;Stringhini et al 2017), and addressing the social determinants of health is an important and emerging area of clinical and public health practice (Axelson et al 2018;Andermann 2016).…”

Poverty Simulation: An Experiential Learning Tool for Teaching Social Determinants of Health

“…Social determinants are not part of the EM core curriculum . However, EDs bear a disproportionate burden in caring for patients who are un‐ or underinsured.…”

Toward Structural Competency in Emergency Medical Education

“…Attention to health inequities is not new to emergency medicine (EM). Since the Institute of Medicine’s landmark report on health disparities, EPs have paid greater attention to the ways in which implicit bias and stereotyping along with access‐related factors (e.g., insurance and income) contribute to health inequalities among patients. The Accreditation Council on Graduate Medical Education (ACGME) created six core competencies to “define the foundational skills that every practicing physician should possess” and as a way “to shape and evaluate the education of residents.” For example, the systems‐based practice milestone requires that residents demonstrate an awareness of and responsiveness to the larger context and system of health care .…”