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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.

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Bringing health to poverty a call to action for health providers

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 Providers

  • 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.

The evidence on poverty and health
The Evidence on Poverty and Health Providers

Poverty in Canada

Population Indicators

Chronic Disease

Figure 3 2 percentage of canadians living in poverty 2004
Figure 3.2: Percentage of Canadians Living in Poverty, 2004 Providers

Source: Statistics Canada (2006). Persons in Low Income Before Tax, 2004, CANSIM Tables.

Courtesy of: Dennis Raphael

Life expectancy
Life Expectancy Providers

  • Poorest vs. richest areas:

    • 5 years shorter for men

    • 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
Infant Mortality and LBW Providers

  • Poorest vs. richest areas:

    • Infant Mortality: 61% higher

    • Low Birth Weight: 43% higher

      Wilkins, et. al., 2002.

Diabetes Providers

  • Increase in prevalence among low income vs. high income:

    • Men 40%

    • Women 280%

  • For low vs. high physical activity:

    • Men 40%

    • 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
Mental Health Providers

  • Depression: Overall prevalence 9.17%; among low income 14.52% (10.79% men, 17.09% women)¹

    ¹Katherine 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
Isn’t it Just that Poor Health Causes Poverty? Providers

  • “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
What Can We Do About It? Providers

An Example:

The Special Diet Campaign and Health Providers Against Poverty

Background to the campaign
Background to the Campaign Providers

  • Social assistance in Ontario:

    • 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 parent earns $1653, needs an extra $223/month

  • The Special Diet Supplement: Up to $250/month extra per individual recipient

The campaign
The Campaign Providers

  • Mass assessment clinics

  • Advocacy: government, health organizations, media

  • Alliances with antipoverty groups, health orgs, communities

  • Education and outreach to health providers

The results
The Results Providers

  • 6000+ forms signed … millions of dollars to people living in poverty

  • Awareness raised: government, health providers, health organizations, media/public

  • Mobilization of health providers and new voice in the antipoverty movement

  • Mobilization of low income people

What can we do about it1
What Can We Do About It?? Providers

  • Individual Patient-Provider Interventions

  • Practice Interventions

  • Community Interventions

Individual patient provider
Individual Patient-Provider Providers

  • 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

  • Assess eligibility for income supplements, Ontario Disability Support Program (ODSP), exclusion from forced work/education programs

Practice level interventions
Practice Level Interventions Providers

  • Information on income support programs and supplements

  • 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

  • Information on the health effects of poverty

Community level interventions
Community Level Interventions Providers

  • Direct Health Services for underserved groups

  • 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

  • Participate in public events around decreasing poverty

  • Meet with elected representatives

  • Tell your clients’ stories

  • Conduct and support research into health and poverty

Thank you

THANK-YOU! Providers

Please visit our new website:

Cumulative Patient Profile Forms, as well as Preventive Health Forms can be found there!