Bringing Health to Poverty: A Call to Action for Health Providers Ashley Heaslip, B.A., MHSc (candidate) Canadian Public Health Association Conference June 2, 2008

Objectives To examine poverty as a key determinant of health. To examine poverty as a key determinant of health. To examine specific strategies health providers can employ to alleviate the impact of poverty on their clients’ health. To examine specific strategies health providers can employ to alleviate the impact of poverty on their clients’ health.

The Evidence on Poverty and Health Poverty in Canada Poverty in Canada Population Indicators Population Indicators Chronic Disease Chronic Disease

Figure 3.2: Percentage of Canadians Living in Poverty, 2004 Source: Statistics Canada (2006). Persons in Low Income Before Tax, 2004, CANSIM Tables. Courtesy of: Dennis Raphael

Life Expectancy Poorest vs. richest areas: Poorest vs. richest areas: 5 years shorter for men 5 years shorter for men 1.7 years shorter for women 1.7 years shorter for women R. Wilkins, et. al., “Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996,” Health Reports (Stats Can), 2002: 13(Supplement).

Infant Mortality and LBW Poorest vs. richest areas: Poorest vs. richest areas: Infant Mortality: 61% higher Infant Mortality: 61% higher Low Birth Weight: 43% higher Low Birth Weight: 43% higher Wilkins, et. al., 2002.

Diabetes Increase in prevalence among low income vs. high income: Increase in prevalence among low income vs. high income: Men 40% Men 40% Women 280% Women 280% For low vs. high physical activity: For low vs. high physical activity: Men 40% Men 40% Women 50% Women 50% Douglas G. Manuel & Susan Schulz, “Chapter 4 Diabetes Health Status and Risk Factors,” in J. Hux, G. Booth & A. Laupacis, eds., The ICES Practice Atlas: Diabetes in Ontario, 2002, Institute for Clinical and Evaluative Sciences.

Mental Health Depression: Overall prevalence 9.17%; among low income 14.52% (10.79% men, 17.09% women) ¹ Depression: Overall prevalence 9.17%; among low income 14.52% (10.79% men, 17.09% women) ¹ ¹ “ ¹ Katherine L W Smith, et. al., “ Gender, Income and Immigration Differences in Depression in Canadian Urban Centres,” CJPH, Mar/Apr 2007; 98(2): 149.

Isn’t it Just that Poor Health Causes Poverty? “All [the studies reviewed] conclude that “All [the studies reviewed] conclude that … the main direction of influence is from poverty to poor(er) health.” Shelley Phipps, “The Impact of Poverty on Health: A Scan of the Research Literature,” CIHI, June 2003.

What Can We Do About It? An Example: The Special Diet Campaign and Health Providers Against Poverty The Special Diet Campaign and Health Providers Against Poverty

Background to the Campaign Social assistance in Ontario: Social assistance in Ontario: 22% rate cut 1995, 40% total decrease in real $ now 22% rate cut 1995, 40% total decrease in real $ now Single person on welfare in Toronto earns $569/month, needs an extra $390/month to meet basic needs Single person on welfare in Toronto earns $569/month, needs an extra $390/month to meet basic needs Single parent earns $1653, needs an extra $223/month Single parent earns $1653, needs an extra $223/month The Special Diet Supplement: Up to $250/month extra per individual recipient The Special Diet Supplement: Up to $250/month extra per individual recipient

The Campaign Mass assessment clinics Mass assessment clinics Advocacy: government, health organizations, media Advocacy: government, health organizations, media Alliances with antipoverty groups, health orgs, communities Alliances with antipoverty groups, health orgs, communities Education and outreach to health providers Education and outreach to health providers

The Results forms signed … millions of dollars to people living in poverty forms signed … millions of dollars to people living in poverty Awareness raised: government, health providers, health organizations, media/public Awareness raised: government, health providers, health organizations, media/public Mobilization of health providers and new voice in the antipoverty movement Mobilization of health providers and new voice in the antipoverty movement Mobilization of low income people Mobilization of low income people

What Can We Do About It?? Individual Patient-Provider Interventions Individual Patient-Provider Interventions Practice Interventions Practice Interventions Community Interventions Community Interventions

Individual Patient-Provider See situation from client’s perspective … alter priorities See situation from client’s perspective … alter priorities Limitations poverty places on patient’s ability to adhere to care: time, priorities, hopelessness, demands of social services Limitations poverty places on patient’s ability to adhere to care: time, priorities, hopelessness, demands of social services Assess eligibility for income supplements, Ontario Disability Support Program (ODSP), exclusion from forced work/education programs Assess eligibility for income supplements, Ontario Disability Support Program (ODSP), exclusion from forced work/education programs

Practice Level Interventions Information on income support programs and supplements Information on income support programs and supplements Contact information for welfare and housing offices, social workers, legal aid clinics, and antipoverty/advocacy organizations Contact information for welfare and housing offices, social workers, legal aid clinics, and antipoverty/advocacy organizations Form letters, e.g. to support access to affordable housing, and to appeal rejected income supplement applications Form letters, e.g. to support access to affordable housing, and to appeal rejected income supplement applications Information on the health effects of poverty Information on the health effects of poverty

Community Level Interventions Direct Health Services for underserved groups Direct Health Services for underserved groups Use privileged voice to speak publicly about poverty and health Use privileged voice to speak publicly about poverty and health Educate people living in poverty about health risks to improve their ability to advocate for selves Educate people living in poverty about health risks to improve their ability to advocate for selves Participate in public events around decreasing poverty Participate in public events around decreasing poverty Meet with elected representatives Meet with elected representatives Tell your clients’ stories Tell your clients’ stories Conduct and support research into health and poverty Conduct and support research into health and poverty

THANK-YOU! Please visit our new website: Cumulative Patient Profile Forms, as well as Preventive Health Forms can be found there!