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• W4220846670 abstract "The Residents’ Perspective by Pidgeon et al1Pidgeon H, McKinney D, Tan-Creevy J, Shah M, Ansari S, Gottlieb M. Thinking beyond the emergency department: addressing homelessness in residency education. Ann Emerg Med. Pulished online October 1, 2021. https://doi.org/10.1016/j.annemergmed.2021.07.123Google Scholar was an important contribution to the field of emergency medicine education. Given that the emergency department is often the only place where some homeless patients get any medical care whatsoever, it is imperative that we are well trained in managing their medical and psychosocial issues, especially because they go hand-in-hand. Housing infrastructure is beyond the scope of most medical school curricula and is not asked about in board examinations. Yet, it massively affects the residents of a locale. Pidgeon et al1Pidgeon H, McKinney D, Tan-Creevy J, Shah M, Ansari S, Gottlieb M. Thinking beyond the emergency department: addressing homelessness in residency education. Ann Emerg Med. Pulished online October 1, 2021. https://doi.org/10.1016/j.annemergmed.2021.07.123Google Scholar described how homelessness is related to policy, income, race, and education. It is worth pointing out that these factors also affect health outcomes per se. For example, a higher income is associated with a higher life expectancy.2Chetty R. Stepner M. Abraham S. et al.The association between income and life expectancy in the United States, 2001-2014.JAMA. 2016; 315: 1750-1766Google Scholar Yet, this increase in longevity is not associated with access to health care or income inequality per se.2Chetty R. Stepner M. Abraham S. et al.The association between income and life expectancy in the United States, 2001-2014.JAMA. 2016; 315: 1750-1766Google Scholar,3Akhter M. Assessment of linked associations in predictors of life expectancy inequality.JAMA Intern Med. 2018; 178: 563-564Google Scholar But as Chetty and colleagues2Chetty R. Stepner M. Abraham S. et al.The association between income and life expectancy in the United States, 2001-2014.JAMA. 2016; 315: 1750-1766Google Scholar, 4Opportunity InsightsPolicy Solutions to the American Dream.https://opportunityinsights.org/Date accessed: November 12, 2021Google Scholar have repeatedly shown, access to neighborhoods makes a big difference. Moving to a less impoverished neighborhood leads to significant gains in education, income, and longevity. However, mobility is difficult, and made particularly so by restrictive policies. In fact, residential segregation is rising, interestingly, at almost exactly the same rate as inequality in life expectancy.3Akhter M. Assessment of linked associations in predictors of life expectancy inequality.JAMA Intern Med. 2018; 178: 563-564Google Scholar The state with the biggest homelessness crisis—California—is also the most notorious for its zoning laws.5United States Interagency Council on Homelessness (USICH).https://www.usich.gov/Date accessed: November 12, 2021Google Scholar After years of debate and controversy over its segregationist intent and the effect of these laws, the state has recently passed legislation to end single-family zoning.6California ends single-family zoning. The Economist.https://www.economist.com/united-states/2021/09/23/california-ends-single-family-zoningDate accessed: November 12, 2021Google Scholar The hope is that this will significantly reduce homelessness. Although states and municipalities develop their own solutions to homelessness, emergency physicians will remain at the forefront of providing care for the homeless. Just as managing patients involves more than merely knowing the pathophysiology of their diseases, ensuring good outcomes requires more than a well-written discharge plan. We agree that training our residents on homelessness will involve not just teaching them how to manage the chief complaint–which per se will involve treating biological as well as psychosocial facets–but also informing them of litigation and policies. Advocating for our patients does not solely begin and end at the bedside–even less so for those of our patients who have no beds of their own. In reply:Annals of Emergency MedicineVol. 79Issue 4PreviewWe would like to thank Drs. Winfield and Haamid and Drs. Igoe and Murtaza for their thoughtful replies, with which we largely agree.1 Those with irregular, substandard, and otherwise unstable housing or those living in resource-poor neighborhoods are undoubtedly at risk similar to the risk that those chronically experiencing homelessness face. Moreover, structural racism permeates through the housing system in our society and remains a critically important topic to address. Full-Text PDF Beyond Homelessness: Expounding on Housing Inequality and RacismAnnals of Emergency MedicineVol. 79Issue 4PreviewWe read the article titled “Thinking Beyond the Emergency Department: Addressing Homelessness in Residency Education” by Pidgeon et al1 and agree that education related to housing inequality is vital in emergency medicine training. However, we would like to highlight that by limiting our scope to individuals experiencing homelessness, we are grossly underestimating the housing insecurity faced by our patients. Therefore, we must also consider other elements of housing inequality, including—but not limited to—affordability, housing quality, neighborhood context, and residential instability, because they all affect health outcomes in our patients. Full-Text PDF" @default.
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