Poverty, the elephant in the room

As is often referenced, the Institute of Medicine defines quality of care in 6 domains: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. And although we have seen tremendous focus on the first 5 domains in pediatric health care, equity (provision of care that does not vary in quality because of characteristics such as sex, race, ethnicity, or socioeconomic status) is a dimension that we need to continue to address. Efforts to improve population health and promote equity have led to efforts to define and address social determinants of health (SDOH): the conditions in which people are born, grow, live, work, and age. SDOH encompass aspects of well-being, like food security and adequate housing, that are linked to health outcomes.Poverty is a key factor that limits access to food and housing, and poverty is the “elephant in the room” when navigating patient and family factors that affect chronic disease management.