Exploring the complexity of homelessness in emergency medicine: Dissecting myths, evidence, and solutions

Emergency departments serve as critical-access points for people experiencing homelessness (PEH). These patients face significant health disparities and are subject to stigmatization and misconceptions, often contributing to suboptimal care and moral distress among providers. Structural competency, a framework that addresses the social, political, and economic determinants of health, is crucial in rethinking the care of PEH in emergency medicine (EM).

This paper is based on the proceedings of the SAEM24 didactic session, which utilized a structural competency framework to address common misconceptions about unhoused patients. The session was developed through comprehensive literature reviews conducted by a multidisciplinary team and focused on integrating structural competency into EM practice.

To confront the bias and stigma surrounding PEH, the didactic session provided evidence throughout four key areas: the diversity and changing demographics of homelessness, understanding the structural and infrastructural drivers of homelessness, identifying the impact of homelessness on health and health care access, and implementing practical interventions aimed at improving health outcomes for unhoused individuals. These areas are critical in educating EM providers on the complexities of caring for unhoused patients and the systemic issues that exacerbate their health crises.

Addressing homelessness within EM through a structural competency framework is imperative for researching and delivering effective health care. Continuous education and policy advocacy are vital to confront the underlying structural determinants of health and enhance emergency care for unhoused populations.