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Notices & Advisories:
The impact of poverty on health and the role of the physician

By Dr. Melanie van Soeren

Family Medicine Resident, Memorial University; Health Providers Against Poverty (HPAP)

 

Low-income Canadians are at risk for a wide range of negative health outcomes.  Poverty has been demonstrated to be a risk factor for diabetes, cardiovascular disease, cancer, depression, mental illness, chronic disease and toxic stress1-7.  To put that risk into numbers, a report looking at data from 1971 to 1996 demonstrated that 24% of all potential years of life lost in Canada were estimated to be attributable directly to poverty, compared with 31% for cancer, and 18% for cardiovascular disease8.

 

Major strides have been made in reducing the impact of poverty in Newfoundland and Labrador over the past decade.  While in 2003 NL was the province with the highest level of poverty in Canada, data from Statistics Canada’s Low Income Cut Offs After Tax (LICO-AT) in 2013 showed the province at that time had the lowest level of poverty in the country.  While progress has been made, poverty remains a major challenge.  Newcomers, youth, aboriginals, LGBTQ+ and single parent families remain at high risk.  Homelessness is an ongoing challenge, particularly in rural areas of the province where services such as shelters and low-income housing are often full or non-existent.  The economic downturn over the past year has put more families in financial risk and the 2015-2016 provincial budge will worsen the impact, with new taxes and fees and loss of or change to benefits such as the Baby Bonus, the Adult Dental Program and changes to over the counter drug coverage from NLPDP.

 

While there are certainly arguments to be made for increasing income assistance rates (an individual in receipt of IA living alone in their own home receives only $534 monthly9) and enhancing programs (dental care being one I am sure we can all agree on), during times of financial restraint a focus simply on ensuring that all those who are eligible for benefits are accessing them can have a substantial impact.  This year, an agency in Manitoba helped 9,000 low-income families secure an additional $21 million in child benefits and tax rebates just by filing their taxes10

 

While discussing finances with patients may not be perceived to be within the traditional jurisdiction of the physician, a patient’s social determinants of health should impact the way we manage their care.  We may be able to have a greater impact on the health and overall wellbeing of a patient by prescribing income than by prescribing a medication.

 

What can we do as physicians?

 

  • Ask ALL patients about their financial situation. Start with the question that has 98% sensitivity for detecting individuals living under the poverty line: “Do you ever have difficulty making ends meet at the end of the month?”11  A positive screen should prompt you to look further into a patient’s social history.  The best first step to addressing income is to encourage all those who have not recently filed their taxes to do so – without this, many income security benefits cannot be accessed.  Use the NL specific Poverty Tool, soon to be released by the Centre for Effective Practice: thewellhealth.ca/poverty
  • Remember that poverty is a risk factor for many health conditions.  An otherwise healthy individual living in poverty may warrant different and often more aggressive screening and investigations, as they have a higher pre-test probability of many illnesses.
  • Become involved in advocacy. Join the group Health Providers Against Poverty (HPAP) Newfoundland and Labrador. Come to our next meeting, on September 26th, 2016 at 6:30pm in Med 2860 (Old Medical School, near lecture theater D and the department of Family Medicine Office).  Contact us at hpagainstpovertynl@gmail.com and find us online at healthprovidersagainstpoverty.ca

 

References

  1. Bierman, A.S., Ahmad, F., Angus, J., Glazier, R.H., Vahabi, M., Damba, C., Dusek, J., Shiller, S.K., Li, Y., Shapiro, G., Manuel, D. (2009). Burden of Illness. In: Bierman, A.S., editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 1: Toronto. 

  2. Lightman, E., Mitchell, A., Wilson, B. (2009). Sick and Tired: The Compromised Health of Social Assistance Recipients and the Working Poor in Ontario. Wellesley Institute.
  3. Bezruchka, S. (2015). Early Life Or Early Death: Support for Child Health Lasts A Lifetime. International Journal of Child, Youth and Family Studies, 6(2): 204-229.
  4. Fryers, T., Melzer, D., & Jenkins, R. (2003). Social inequalities and the common mental disorders: a systematic review of the evidence. Social Psychiatry and Psychiatric Epidemiology, 38, 229–237.
  5. Smith, et. al.  (2007). Gender, Income and Immigration Differences in Depression in Canadian Urban Centres. CJPH, 98(2): 149. 

  6. Lightman, E., Mitchell, A., Wilson, B. (2008). Poverty is making us sick: A comprehensive survey of income and health in 
Canada. Wellesley Institute, p. 12. 

  7. Conway, D.I., Petticrew, M., Marlborough, H., Berthiller, J., Hashibe, M., Macpherson, L.M. (2009). Significant oral cancer risk associated with low socioeconomic status. British Dental Journal, 206(6), 2811-2819.
  8. Wilkins R, Berthelot J-M, Ng E. Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Health Reports 2002. Available from: http://www.statcan.ca/english/freep ub/82-003-SIE/2002001/pdf/82-003-SIE2002007.pdf.
  9. Newfoundland and Labrador Department of Advanced Education Skills: Income Support.  Available from: http://www.aes.gov.nl.ca/income-support/overview.html#monthlyrates
  10. Bloch, G & Silver, J. (2016). Filing tax returns puts $21M in pockets of low-income Winnipeggers. CBC News.  Available from: http://www.cbc.ca/beta/news/canada/manitoba/low-income-tax-returns-canada-1.3728546.  Accessed August 23, 2016.
  11. Brcic, V., Eberdt, C., & Janusz, K. (2011). Development of a Tool to Screen for Poverty in a Family Practice Setting: A Pilot Study.  International Journal of Family Medicine, 2011:812182. Epub 2011 May 26.

 

 










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