Diabetes, heart disease, mental illness and trauma — at first glance, these conditions might not appear to have much in common, but a Toronto doctor says one key trait often lies beneath them: poverty.
Dr. Kimberly Wintemute, a physician with the North York Family Health Team, has spent the last year probing the connection.
"We don't always know who they are. People don't come in saying, 'I've got this problem or I'm struggling with finances,'" Wintemute told CBC Toronto's Metro Morning on Tuesday.
What she found is that doctors can in fact screen their patients for poverty, much like they would for medical conditions. It's a project based on the poverty screening tool from the Ontario College of Family Physicians, a questionnaire that tries to identify patients living with poverty and link them with community resources that can help.
"Everyday most primary care providers in Ontario see patients in poverty," OCFP poverty and health committee director Dr. Gary Bloch told CBC Toronto, adding that a version of the tool has just been released for every province and territory in Canada except Quebec, where a local tool is being used.
"There is an incredibly large body of evidence demonstrating the link between poverty and poor health, and poverty and most chronic illnesses and acute illnesses. The relationship is so strong," Bloch said.
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Which patients struggling often not known
But just who is struggling often remains a mystery.
"When you have someone who comes in over and over and over again and you're trying to manage something like diabetes and it's just not getting better, you've got to start digging," said Bloch.
So, Wintemute launched a pilot project at her office to have doctors try to find out just which of their patients might be having trouble making ends meet.
The project uses Statistics Canada data on income levels by postal code and cross-checks it against the profiles of patients. Four physicians at Wintemute's clinic took part in the project and they discovered that 147 of their patients lived in postal codes with the lowest income brackets. Of the 49 people who agreed to be screened, 12 came forward to say they were struggling.
Improving health by improving poverty
Knowing what patients are suffering from poverty is a powerful tool for healthcare providers, Wintemute says, because doctors can then connect struggling patients with a caseworker who can connect them services in their communities that can help reduce that struggle.
One resource that the case worker at Wintemute's clinic connects patients with is a free tax clinic to make sure they qualify for certain benefits.
Another measure doctors can take based on the information is patient advocacy.
"I have some patients who may need medication on an ongoing basis but they can't afford that medication," Wintemute said. "So I can call a pharmaceutical company and say, 'Look, I've got a patient who needs this. Can you supply me with a compassionate supply?'"
Wintemute says she hopes to expand the project to all 76 doctors working with the North York Family Health Team. It's a goal Bloch's team at St. Michael's Hospital, which has been employing the poverty screening tool for the past several years, hopes to achieve as well.
"People are often ashamed to talk about poverty even when they're affected by it and they come in thinking, 'Well, it's not a medical issue,'" Bloch observed.
"When you open that door it can completely change how that patient interacts with you. You're finally understanding what the most powerful pressures are on that patient."