In a recent article, author Trudy Lieberman describes the work of Dr. Gary Bloch, a family physician at St. Michael's Hospital in Toronto, Ontario. His idea? Treat poverty like a disease, and facilitate the physician led health care team to access the resources that combat it when they are consulted for medical care concerns.
As the article relates, "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." To aid in their work, the team has developed a clinical tool used by primary care practices in Ontario that is based on strong evidence linking poverty to bad health outcomes. This tool notes that "poverty accounts for 24 percent of person years of life lost in Canada (second only to 30 percent for neoplasms)," and makes the claim that in Canada, "higher social and economic status seem to be the most important determinants of health." This relationship has also been demonstrated in the United States.
This is what they do:
1: Screen 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).
2: Think of poverty when making clinical decisions like any other risk factor. For example, a man living in the lowest 25% income level has twice the risk of diabetes as a high income man. Therefore, when a man without other risk factors for diabetes presents for care with very low or no income, doctors should consider a screening test for the disease.
3: Intervene with probing questions. One powerful question is, have you filed a tax return? Those who have not miss out on supplemental benefits to help address their poverty. What is their living situation? Many will hide the fact that they have no permanent home.
Like all family physicians, I have frequently experienced hearing from my patients that they are unable to afford their medicines or the treatments that they need, and this has even been true for people with insurance! What if the family physicians office was the gateway to identifying and treating THAT problem?
