Medicine or Tax refunds for health

What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food or income

By Trudy Lieberman

Expert Advisor EvidenceNetwork.ca

Troy Media Columnist

What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food or income benefit programs 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 per cent of person years of life lost in Canada (second only to 30 per cent 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 per cent (the ability to predict the number of people with the disease) and a specificity of 64 per cent (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.

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.

Put all this in the current American political context, which calls for cutting food stamps, making seniors pay more for their Medicare benefits, changing the calculation of the Social Security cost-of-living formula, and the lack of focus on early education and affordable housing. Contrast the latter with all the media hype about affordable healthcare. In the end, affordable housing may trump affordable healthcare if the objective is really better health.

Trudy Lieberman, a journalist for more than 40 years, writes regularly for the Prepared Patient Blog. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of healthcare, Social Security and retirement.

 

Just Posted

Ponoka’s Caleb Shimwell arrested after pursuit

Police allege that Shimwell rammed a police cruiser

Ponoka looking for ways to fix splash park issues

Council hears report on challenges last summer, will have to wait on costs

Survey of Ponoka residents state recreation as top budget priority

A total of 122 survey responses also note need for increased bylaw enforcement

Ponoka will save $430,000 with change to new waste contractor

Transition to take place with CanPak for Jan. 1, contract includes two bins

Crime rate slowly falling in Ponoka County

Ponoka RCMP stats show crime figures down from same nine month period in 2017

VIDEO: Shoppers like self-checkout lanes at the grocery store, survey suggests

Grocery Experience National Survey Report suggests most grocery shoppers spend 32 minutes per visit

South Korean named Interpol president in blow to Russia

South Korea’s Kim Jong Yang was elected as Interpol’s president edging out a longtime veteran of Russia’s security services.

E. coli outbreak linked to romaine lettuce sickens 18 people in Ontario, Quebec

The Canadian Food Inspection Agency says it’s working with U.S. authorities to determine the source of the romaine lettuce those who got ill were exposed to.

Trump defies calls to punish crown prince for writer’s death

The U.S. earlier sanctioned 17 Saudi officials suspected of being responsible for or complicit in the Oct. 2 killing, but members of Congress have called for harsher actions, including cancelling arms sales.

British, EU leaders to meet as Brexit deadline looms

The U.K. and the European Union agreed last week on a 585-page document sealing the terms of Britain’s departure.

Richard Oland was killed ‘in a rage,’ prosecutor tells son’s murder trial

The verdict from Oland’s 2015 murder trial was set aside on appeal in 2016. Richard Oland, 69, was found dead in his Saint John office on July 7, 2011.

Former NHL player and coach Dan Maloney dies at 68

Maloney coached the Toronto Maple Leafs and Winnipeg Jets

Ex-MSU president charged with lying to police about Nassar

Lou Anna Simon was charged Tuesday with lying to police during an investigation

Police looking into two more incidents at private Toronto all-boys’ school

Police and the school have said two of the prior incidents involved an alleged sexual assault

Most Read