How one doctor is fighting poverty to make people healthier
Without food in the fridge or a place to call home, it’s hard to be healthy—but there is a cure
By Abigail Cukier
Back in 2005, Dr. Gary Bloch stood in front of Queen’s Park and prescribed money to patients.
He was signing forms as part of the Ontario Coalition Against Poverty’s Special Diet Campaign, which aimed to increase an income supplement that helps people on social assistance eat a healthier diet.
“That campaign only lasted eight months, but it carried forward this idea of ‘What if we could get all doctors to care and to make this part of their practice?’” says Dr. Bloch, a family physician at St. Michael’s Hospital. He has been working toward that goal ever since. (His Twitter bio is: A family doctor in Toronto trying to improve health by treating #poverty, #homelessness and other social disease.”)
Dr. Bloch credits his mother, Dr. Susan Comay, with inspiring his mission to make health care about more than addressing physical symptoms. Dr. Comay spent her career at the Pine Free Clinic in Vancouver, which served youth and individuals without health insurance. “I didn’t set out to follow in her footsteps, but I did see her go through decades of enjoying her work and feeling like she was doing good in the world,” Dr. Bloch says. “I developed a picture of the world and my own skills and interests, and I wanted to do something hands-on that could match with that.”
During medical school at the University of British Columbia, Dr. Bloch explored how social factors such as income, education and employment status play pivotal roles in a person’s health.
“When you can’t afford decent food or shelter, it has a very direct impact on health. Your neighbourhood can also affect your health, like having housing and supportive, safe communities,” he says. The stress of not having these things can increase your risk of heart disease, diabetes and chronic illness. “We can deal with individual factors, like quit-smoking programs, but we’re looking at the wrong level,” Dr. Bloch says. “The underlying causes are still inequality, racism, marginalization.”
I see the impact that has on people. They’re happier. They’re more hopeful and more able to focus on their health and improving their lifestyles.
Dr. Bloch is also a member of St. Michael’s Academic Family Health Team where, in addition to flu shots and blood pressure checks, patients might get help applying for the Ontario Disability Support Program or balancing a budget. The Team partnered with Legal Aid Ontario so that a full-time lawyer works with low-income patients on legal issues, while its Reach Out and Read program prescribes books to kids at their annual checkups.
The Team also includes two full-time income security health promoters who help patients access tax benefits, reduce debt or fill out employment insurance forms. Last year, the health promoters saw an average of 30 patients a week and, Dr. Bloch says, they were able to increase patients’ incomes by an average of more than $1,700 a year.
“I see the impact that has on people. They’re happier. They’re more hopeful and more able to focus on their health and improving their lifestyles. Mostly, there is a reduction in stress, and the worry that they can’t feed themselves or pay their rent.”
One of the health promoters on the team, Alyssa Swartz, recently helped a patient who had worked her whole life but had to stop due to illness.
“She didn’t understand the social system because she never needed to use it,” Swartz says. “She was losing her housing through no fault of her own and her health was declining.” Swartz helped the patient access the government resources she desperately needed.
“The predictable outcome is that she would have gone homeless and been in a shelter, which I don’t think she was physically or mentally equipped for,” Swartz says. “And with a history of mental health issues, she was likely to be admitted to hospital—we were able to stem all of that.”
Dr. Bloch says that while organizations such as the Ontario College of Family Physicians and Registered Nurses Association of Ontario have long understood the role providers can take in addressing health inequities, they’ve been slower on the frontline.
“Providers are toiling away, doing their jobs. I’ve spoken to thousands of health-care providers and the common reaction is, ‘We love what you’re saying, but how do we fit it into our day-to-day practice?’”
Despite all the hurdles, it is finally starting to happen. Dr. Bloch co-led a group that designed a core curriculum on addressing poverty that is now taught at the University of Toronto medical school. He also teaches health professionals and community members about these issues, and co-chairs the St. Mike’s Social Determinants of Health Committee, which oversees several projects targeting root causes of health inequity.
To make it easier for doctors on the frontlines, Dr. Bloch developed a clinical tool for primary care providers that includes a poverty screening test, as well as ways to help connect patients to resources. (He started by delivering it to local doctors himself, but the College of Family Physicians of Canada has since produced a country-wide version.)
“We put billions of dollars into a health system that aims to fix problems that could have been prevented—it drives me totally crazy,” Dr. Bloch says. “We’re wasting a lot of resources.” But, he adds, there is hope. “I’m seeing more people coming into medicine who care about these issues and I’m seeing action coming from many corners of the health world. We’ve been doing things the same way for so many years, it’s like trying to turn a massive ocean liner—but that turn is starting to happen.”