Achieving the quadruple aim: Treating patients as people by screening for and addressing the social determinants of health

Health care in the United States has reached a breaking point, with increasing costs, ongoing poor outcomes, and increasing provider burnout. This broken system is set within a context of growing economic inequality; one measure of maldistribution, a ratio called the Gini coefficient, which has values between zero and 1, pins America at a staggering 0.81, highest among 53 high-, middle-, and low-wealth nations ranked by the Allianz Capital Global Wealth Report. At the front line of the health care system, as the interface of medicine with daily life, emergency medicine witnesses the effects of this increasing inequality on the health of ordinary Americans; the ED is where patients come when they have nowhere else to turn. As such, emergency providers see patients in the context of life challenges, such as unemployment, homelessness, hunger, and gang violence. These and other challenges, collectively known as the social determinants of health, play an important role in patients’ health outcomes.

This article is part of a special supplement: Inventing Social Emergency Medicine: A Consensus Conference to Establish the Intellectual Underpinnings of Social Emergency Medicine.