jillumbach Advocacy, Media

As a doctor, I know too well why the minimum wage needs to rise

Gary Bloch is a family physician with St. Michael’s Hospital in Toronto, a founding member of Health Providers Against Poverty, http://www.healthprovidersagainstpoverty.ca and an expert advisor with EvidenceNetwork.ca. 

Almost half a million people, representing 9% of Ontario’s workforce, earn minimum wage that has been frozen at $10.25 per hour for four years.

A recent report by the Canadian Medical Association concluded that poverty is the biggest barrier to good health. 

Individuals at the bottom of the income spectrum experience significantly higher rates of disease and premature mortality than those with higher incomes.

Health Providers Against Poverty held a press conference  on January 14th to ask Premier Kathleen Wynne to raise minimum wage to a minimum of $14 per hour. This is the latest in a province-wide campaign to raise the minimum wage.

GARY BLOCH writes in  The Globe and Mail

Published Monday, Jan. 27 2014, 8:24 AM EST

At some point during almost every day in my office, I feel frustrated and powerless. At that moment, I find myself standing with my patient on the edge of a chasm: ill health lies in the crevice below, good health lies on the other side. And we cannot, between us, build the bridge to get across. We know what that bridge looks like, but we do not have the materials to build it.

I have stood at that edge with Fatima, a single mother with two kids in school, who works at Tim Horton’s full time, for minimum wage, at $10.25 an hour. She suffers from low back pain and arthritis. She can barely pay her rent. She has no time to see a chiropractor, to exercise. She can’t afford medications to treat her pain. She often has trouble feeding her family at the end of the month, and eats less herself to make sure her kids get enough.

What she needs to build her bridge is clear: a higher income. She could build it if the minimum wage was set to bring her over the poverty line. That she has to live in this way with a full-time job, in a wealthy country, is a tragedy. That we set our minimum wage to benefit companies’ bottom lines, and not to ensure low-wage workers are able to stay healthy, and to afford the basics of food, shelter, clothing and other necessities, is both a tragedy and a public health travesty.

The health evidence is clear: Fatima and her children are at extremely high risk of developing health problems such as diabetes, heart disease, cancer and mental illness, all due to their inadequate income. I cannot prescribe drugs to alleviate that risk.

People such as Fatima who live at low income live shorter lives, with more disability. Their work is more precarious, and they tend to have worse working conditions, that place them at higher risk of illness and injury.

And this is where our elected officials can act like doctors, by bringing an evidence-based approach to improving health and wellbeing to the forefront of their decision-making. In societies with less poverty, and with less inequality, the evidence shows that everyone is healthier, even the well off. Our governments can continue to legislate poverty and ill health, or they can build legislative bridges to a healthier life for everyone.

These bridges are made of policies that ensure a liveable income for everyone in Canada, including a minimum wage that brings workers above the poverty line and social-assistance rates that enable people to pay the rent and eat a basic healthy diet. They are also made of policies that allow people to participate in society and protect their health, such as affordable childcare and universal pharmacare.

And this approach makes economic sense: a 2008 study by the Ontario Association of Food Banks estimated poverty adds over $7 billion to Canadian health-care costs every year. The overall cost of poverty in Canada, to the public and private spheres, is estimated at up to $85 billion per year. Analysts have demonstrated that programs to alleviate poverty can pay for themselves through, for example, increased tax revenues, reduced health costs, lower crime and increased productivity.

Policies that pay for themselves, increase economic output and improve health? These are the prescriptions I’d like to see written. And these are the bridges my patients need built.

Gary Bloch is a family physician with St. Michael’s Hospital in Toronto, a founding member of Health Providers Against Poverty, and an expert advisor with EvidenceNetwork.ca.

jillumbach Advocacy, Media

This Doctor Treats Poverty Like a Disease

Trudy Lieberman | November 6, 2013

What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food stamps instead of the usual medicines for high blood pressure or diabetes? You’d probably say the physician was nuts. Tax refunds? Food? What do they have to do with making you healthier?

I just returned from a month long Fulbright fellowship in Canada and met such a physician, Dr. Gary Bloch, who practices family medicine at St. Michael’s Hospital in Toronto. We had a long conversation about what makes people healthy. He wasn’t interested in talking about new drugs to lower cholesterol hyped by the latest drug salesperson to walk through his door.

“We’ve created an advocacy or interventional initiative aimed at changing the conversation about poverty and how doctors think about poverty as a health issue,” Bloch told me. “It’s one of those cultural shift things. My job is to push ideas for physician interventions around poverty.” Bloch showed me a clinical tool used by primary care practices in Ontario that is based on strong evidence linking poverty to bad health outcomes.

The tool, a four-page brochure, is simple in design but powerful in concept. “You come at poverty from every possible angle,” Bloch said. “You start from the evidence and frame the issue in language doctors can understand.”

The evidence: Page one of the tool points out that “poverty accounts for 24 percent of person years of life lost in Canada (second only to 30 percent for neoplasms),” and notes that “higher social and economic status seem to be the most important determinants of health.”

The tool: Three steps to address poverty in primary care practices.

Step 1: Screen everyone by asking, “Do you ever have difficulty making ends meet at the end of the month?” Using the language of clinical tests,  the tool says that this question yields a sensitivity of 98 percent (the ability to predict the number of people with the disease) and a specificity of 64 percent (the ability to predict those without the disease).

Step 2: Factor poverty into clinical decisions like other patient risk factors. The tool provides examples, such as noting that a man living in the lowest quartile of poverty has twice the risk of diabetes as a high income man. Therefore, when a 35-year-old man comes to the office without risk factors for diabetes but has a very low or no income, doctors should consider ordering a screening test for the disease.

Step 3: Intervene by asking questions. Here’s where that prescription to file your tax returns comes in. Bloch suggests asking if older patients have applied for all the supplemental income benefits they’re entitled to or whether all patients have applied for drug benefits they may be eligible for.

While these seem pretty straightforward and useful, I wondered how many primary care docs in the U.S. have thought about asking similar questions. I don’t know how many times I’ve heard physicians say they order prescriptions for expensive meds knowing that even cheap, basic antibiotics are out of reach for their patients. That’s where the conversation ends, and so does care for those who need treatment.

I asked Bloch about the impact of his poverty tool, a simple paper brochure, in an age when the press, the public and the medical profession are focused more on shiny, new technology and drugs than the basics of life. He said this approach is “one of those snowball things that keeps rolling.”

The Ontario Medical Association will soon publish a poverty intervention tool, and the Canadian Medical Association held town hall meetings earlier this year in several Canadian cities. Participants identified four main social determinants of health: income, housing, nutrition and food security, and early childhood development.

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