By Gary Bloch
University of Toronto
and Sharon Macdonald
University of Manitoba
Can a question asked in a doctor’s office contribute to ending poverty for patients and their families? This is what we asked ourselves 10 years ago, as we set out to convince health providers to tackle poverty.
There were two factors that pushed us into this work: first, the evidence shows us that poverty puts people at risk for almost every chronic disease, acute illness, even accidents and trauma. And for kids, poverty affects them from the time they are in the womb, right through adulthood.
The second push comes from our patients. We hear stories day in and day out, like that of Nico who, at age 42, has diabetes, heart disease and depression. He told us very clearly that he would not be able to get healthy when he has to struggle to eat and pay his rent on the $1,400 a month he earns at minimum wage.
For doctors, the need to tackle poverty as a health issue is obvious – and it is urgent. Health providers told us that they didn’t feel comfortable joining protests or writing policy briefs to government. So we decided to find ways for them to tackle poverty for their patients in their offices.
This is why we created a “Poverty Tool” that lays out a three-step approach for front line doctors, nurses and other health workers to deal with poverty. The steps are simple: ask everyone about their income, learn about how poverty impacts patients’ health and connect patients with key income benefits programs and community resources already available.
The critical message to health providers? Helping our patients reduce their poverty is part of our work as health practitioners.
The impact has been profound. Since we created the Poverty Tool in Ontario, we have taught this approach to thousands of health providers across the country. We now have versions in development in multiple provinces – in BC, Alberta, Saskatchewan, Manitoba and Nova Scotia.
And this is not surprising, because the tool works.
Through simple interventions like asking patients to complete their tax returns, we have supported up to a doubling of incomes for highly vulnerable families: Sarah, a mother of two earning $14,000 per year through part time minimum wage work in Ontario, gained access to $13,500 in extra tax and child benefits. Agnes saw her income increase from $656 to over $1,250 a month when we helped her move from basic social assistance to the Ontario Disability Support Program and related income supplements.
In a sign of the Poverty Tool’s acceptance, Manitoba brought together a powerful coalition of supporting community groups in the development of its Poverty Tool, including government, medical organizations, academics and many civil society groups. The Manitoba clinical poverty tool is now being broadly distributed throughout the province in health settings, libraries, schools and community agencies.
The push for doctors to treat social issues like poverty is starting to change the way we practice medicine and how we work with community agencies and those with expertise in income benefits, food security and poverty law. Many health organizations now are right in the middle of advocacy for better social conditions.
Major medical organizations, including the Canadian Medical Association and the Canadian College of Family Physicians have been vocal in their support for this approach. This demonstrates a real acceptance by the medical mainstream that reducing patients’ poverty is a core part of a doctor’s job.
This shift is exciting and profound. But it is not enough. Health providers can provide a push, and can make a real difference in their individual patients’ lives. But like other important public health issues, like smoking or substance abuse, major change will require significant shifts in public policy. It will require action from government and support from the general public.
Those who live without an adequate income cannot achieve their health goals without basic social foundations – including a liveable income, affordable housing and access to decent well-paid work. As we take real action to help patients and families, together we can all build those foundations.
Gary Bloch is a family physician, assistant professor in the Department of Family and Community Medicine, University of Toronto and co-Chair of the Ontario College of Family Physicians’ Committee on Poverty and Health. Sharon Macdonald is a public doctor in the Department of Community Health Sciences at the University of Manitoba.