Emergency physicians are natural advocates, interfacing with all parts of the medical system, and are eyewitnesses to the health effects of social inequalities. As advocates, emergency physicians can use their clinical knowledge and experience to inform and influence not only hospital initiatives but also social and economic policy. Although emergency physicians already advocate for their patients daily, there are opportunities for them to be advocates at other levels beyond the emergency department (ED). At Inventing Social Emergency Medicine, we discussed examples of and opportunities for advocacy by emergency physicians in a variety of arenas (Figure ), ranging from the individual and interpersonal to health systems, community partnerships, and national policies.
An estimated 100 million people globally suffer from absolute homelessness. The estimated number of people who are homeless in the United States at any given point in time is about 550,000. Mortality and disease severity of people who are homeless far exceed those of the general population because of extreme poverty, delays in seeking medical care, nonadherence to therapy, substance use disorders, and psychological impairment. Many of their health problems, such as infections due to crowded living conditions in shelters, hypothermia from exposure to extreme cold, and malnutrition due to limited access to food and cooking facilities are a direct result of homelessness. This chapter addresses in detail infectious diseases, substance abuse, obesity, mental health problems, and causes of death in this population. It also addresses access to and use of healthcare services. It addresses the roots of and underlying issues related to these problems. Finally, it addresses what needs to be done.
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