TROY MEDIA COLUMNIST
Last fall when I visited Canada I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. The tool assesses what patients might need other than prescriptions for the newest drugs. Bloch's idea was to zoom in on the social determinants of health - food, housing, transportation - all poverty markers linked to bad health and poor health outcomes.
The tool, a four-page brochure, notes that poverty accounts for 24 per cent of a person's years of life lost in Canada and offers three steps for doctors to address poverty. The first step is to screen every patient by asking them, "Do you ever have difficulty making ends meet at the end of the month?"
The next two steps urge clinicians to factor poverty into clinical decisions like other risk factors and to ask questions about income support by age/family status, such as whether seniors have applied for supplemental income benefits they may be entitled to.
"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 explained. "It's one of those cultural shift things."
I decided to get back in touch with Bloch to see whether a cultural shift in Canada had taken place. Indeed it has. "It's been a wildfire effect," Bloch told me.
Bloch ticked off a laundry list of provinces and organizations that were using or about to use the tool. He described a "pretty amazing" and broad coalition that came together to promote the tool, including public health leaders, pediatric and family doctors, community health centres and regional health authorities. A doctor in British Columbia has developed a version for his region. Manitoba is about to roll out its own adaptation. A public health officer in Nova Scotia is pushing for the tool in that province. The tool is getting attention is Saskatchewan, too.
Physician groups, like the College of Family Physicians Canada and the Registered Nurses' Association of Ontario, have signed on. The Canadian Medical Association (CMA) has developed a continuing education module based on these poverty interventions. On his website, CMA president Dr. Chris Simpson says, "Dr. Gary Bloch is one of those guys who walks the talk and speaks about 'prescribing money' as a way to help patients who are economically disadvantaged."
Simpson told me that Bloch's approach is the first clinically relevant tool to address social determinants of health. To support Bloch's work, the CMA's conversations and advocacy about the tool are heightening awareness among Canadian physicians that they need to address these risk factors. Simpson added that Bloch and his team also conduct trainings to help doctors learn how to use the tool.
In a phone interview last week, Bloch observed that adding the steps in the tool to clinical practice is just a beginning. "It was never an end unto itself. It was a stepping stone to other interventions." Bloch described what his family health group in central Toronto is doing. They hired an income security health promoter who meets with patients about their financial situations and works with them on becoming more financially literate. She works with the rest of the medical team to acquaint doctors with patients' needs. For example, a person with diabetes without adequate housing will have trouble storing healthy food and insulin supplies.
Bloch and his team are beginning to study the tool's impact with a randomized trial and collecting data on the social determinants of health for people in central Toronto. "This will allow doctors, health planners and epidemiologists to draw out data and learn about who they are serving," he said.
Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She is an expert advisor at EvidenceNetwork.ca, and a long-time contributor to the Columbia Journalism Review where she blogs for its website, CJR.org.