From triage to transformation: tackling inequalities in emergency care through a public health lens

Emergency departments (EDs) and NHS ambulance services often serve as the first and only point of contact with healthcare for individuals from deprived communities, marginalised populations and other groups that face inequalities in both access to, and quality of healthcare. These include ethnic minorities, people experiencing homelessness, asylum seekers, sex workers, individuals transitioning from criminal justice settings as well as older adults, children and pregnant women. These populations face disproportionate burdens of disease and systemic barriers to care. Integration of Public Health into Urgent and Emergency Care (UEC) services presents an opportunity to address these challenges.These issues cannot be solved by UEC services alone. EDs and ambulance services, however, are uniquely positioned to identify and address health inequalities by building close relationships with local authorities, primary care, social care and voluntary, community and social enterprises to support preventive efforts, help people before they need to come to ED, reduce repeat attendances and improve patients' experiences and outcomes.Health inequalities cost the NHS billions of pounds each year. Embedding public health in EDs is not just a clinical improvement-it is an economically sound, ethically responsible, equity intervention that addresses the social determinants of health and ensures the most vulnerable receive timely, tailored support.EDs and NHS ambulance services are more than services for time of crisis-they are places of opportunity. By embedding public health principles into emergency care, we can transform emergency care into engines of equity, resilience and prevention. Investing in public health within these settings is not only the right thing to do for patient outcomes and health equity-it is ultimately cost-effective, reducing demand on UEC and improving population health in the long term.