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

Walk ‘N’ Roll Challenge ending soon

Make sure to log your trips

Rifleman Rodeo coming up

By Robert Greene Publicity Chairman It’s rodeo time again. Riflemans Rodeo that… Continue reading

Wagon rides, petting zoo and more

Ponoka Farmers Market celebrates 43rd year

Hometown Ponoka cowgirl trying one-handed bull riding this weekend

Hometown Ponoka cow rider Seana Rousseau is hoping to prove she can… Continue reading

Ponoka County increases stake in fibre optic expansion to $1.5 million

Rural customers across west side of county will soon benefit from upgrade project

Trudeau to meet with U.K. and Japanese prime ministers ahead of G7 summit

French President Emmanuel Macron, this year’s G7 host, has little expectations of a unified front from the leaders

Ponoka RCMP seeking public assistance in locating missing male

The Ponoka RCMP is seeking the public’s assistance in locating 27 year… Continue reading

PHOTOS: Brazil military begins operations to fight Amazon fires

Amazon fires have become a global issue, escalating tensions between Brazil and European countries

Groups ready campaign to help young voters identify ‘fake news’ in election

The media literacy campaign to focus on identifying misinformation and suspicious sources online

Ethnic media aim to help maintain boost in voting by new Canadians

Statistics Canada says new Canadians made up about one-fifth of the voting population in 2016

Body of 19-year-old drowning victim recovered from Sylvan Lake

RCMP say the body was recovered the evening of Aug. 22.

Black bear ruins Alberta barber’s day

It’s not always a good idea to leave the door open

Conan turns to the Property Brothers for tips on buying Greenland

Jonathan Scott suggests removing glaciers and mountains to bring in ‘more natural light’

Most Read