by Rebecca Karb, MD, PhD
It was an honor to attend the Social Emergency Medicine (SEM) Consensus Conference at the American College of Emergency Physician (ACEP) headquarters in Dallas, Texas. What an inspiring experience to get together with such a thoughtful, motivated, and justice-oriented group of EM physicians. The dialogue raised many important questions regarding the priorities for SEM as well as the strategies for pursing our mission. What is the most appropriate and effective strategy for addressing social determinants of health? And where is the most effective space to do so? Addressing SDOH in the ED is, by constraint of necessity, an individual-level intervention. As such, it should certainly be one of the tools that we research and develop as ED physicians; however, it cannot be the only space in which we intervene if we truly wish to address health inequalities.
We must be active and engaged at the community and policy level to change the underlying structures of inequality. For example, we may be able to develop an effective screen for homelessness or housing insecurity in the ED, and as a result provide an individual patient with the resources necessary to obtain secure housing. However, we have not altered the more upstream fundamental causes of disease but rather modified their effect on our individual patient. This is not unimportant and it is what we do as physicians—we treat individual patients. But our SEM mission must extend outside the walls of the ED and into our local communities and government. As ED physicians, we are on the frontlines of healthcare and have a unique window into the health of our communities. We should be systematically gathering information about our communities and using that knowledge in combination with our positions of privilege and power to advocate for fundamental changes at the policy level. I hope that we can continue to build a strong, cohesive movement and that EM can lead the way in the fight to eliminate health disparities.