Adding to poor patients’ incomes works to decrease the health effects of poverty, Canadian doctors are finding.
The Canadian Medical Association is asking people across the country how poverty affects their health as part of its national dialogue tour. The group said that social and economic factors determine 50 per cent of health outcomes.
Dr. Gary Bloch sees poverty as a disease in his family medicine practice in Toronto’s inner city. (CBC) At his inner city family practice at Toronto’s St. Michael’s Hospital, Dr. Gary Bloch puts income information at the top of the medical history he puts on his charts.
“Treating people at low income with a higher income will have at least as big an impact on their health as any other drugs that I could prescribe them,” Bloch said.
To that end, Bloch asks all patients what their income is and where they get it, along with the standard questions about past medical history, surgeries and medications.
“I do see poverty as a disease,” Bloch said.
In his practice, prescribing income could mean assessing whether a patient’s illnesses might qualify for provincial or federal disability supports and employment insurance. He helps fill in applications and connects patients with programs such as basic financial planning.
“I absolutely see the improvement in my patients’ health,” Bloch said. “For patients that we do manage to get on income supports, their lives often really turn around.”
Increasingly, physician groups are recognizing poverty as a disease, not simply from lifestyle factors such as smoking, but also from the toll the stress of being poor can take on the body.
Children bear ‘toxic stress’. For children in particular, the strong and frequent bombardment of “toxic stress” from living in substandard housing with adults who are also stressed can set the stage for lifelong damage, doctors say.
Such high stress stunts healthy development by “disrupting developing brain architecture,” the American Academy of Pediatrics said in a technical report last year.
Dr. Gary Bloch is teaching medical residents how to weave in questions about income when taking a patient’s history.
“Toxic stress can lead to potentially permanent changes in learning, behaviour and physiology,” the U.S. group concluded.
Statistics Canada has reported that growing up in poverty is associated with increased rates of death and illness including diabetes, mental illness, stroke, cardiovascular disease, gastrointestinal disease, central nervous system disease and injuries.
“We do know that our child poverty rates are an embarrassment,” Dr. Richard Stanwick, president of the Canadian Pediatric Society, said from Victoria. “Do we want … a society where a certain group is permanently disadvantaged? Unfortunately, that’s what poverty does.”
If children live in a neighbourhood that is considered unsafe, then parents may feel more comfortable keeping them indoors watching TV rather than playing outside, said Stanwich, who works at the Vancouver Island Health Authority. “That alone is contributing to obesity, is not contributing to the brain development and is probably putting these individuals at a disadvantage.”
A nutritious diet and access to opportunities for recreation could do more for health care than building more hospitals, Stanwich said.
The CMA’s dialogue on poverty wraps up in St. John’s next month.