There is one glaring symptom that can lead to chronic health problems, and sometimes the medical community can overlook the signs.
Some refer to it as low socioeconomic status, often measured as a combination of education, income and occupation.
But in layman’s terms, it’s poverty.
And poverty is one of the biggest risk factors for almost all the major conditions that family medicine deals with on a day-to-day basis, says Dr. Lee MacKay, board chair for Kootenay Boundary Division of Family Practice.
Health impacts of poverty are well documented in B.C.: lung, oral and cervical cancer rates are higher in the lower income population; heart disease is 17 per cent higher among the lower income sector compared to the Canadian average; depression is 58 per cent higher in those living below the poverty line; and the incidence of diabetes, is double.
“Certainly if you look at demographics, at least 10 per cent of our population is living under the poverty line,” MacKay said, noting the current housing crisis in Nelson, the city he’s based in. “It’s difficult to afford medications and lifestyle changes if you are just barely making ends meet.”
Dr. MacKay has long championed the inclusion of poverty screening in family practice, simple questions about finances can lead to a better understanding of patients and health problems they present - snippets don’t tell a full story.
“It’s just a way for doctors to recognize and validate for patients,” MacKay said. “Sometimes it’s meaningful that we are looking at the full picture of their health and not just saying, for example, that a patient is anxious and then prescribe medications. We are trying to understand … that may be coming from poverty.”
Since 2015, the Kootenay Boundary division has tackled the matter head on with its Poverty Intervention Tool. By now, patients may have noted a certain question coming up during annual physicals, outside of the usual queries about medication history and habits like smoking or alcohol usage.
“The basic screening tool can be done in any encounter,” says MacKay. “For me, I do it often at periodic health visits. It’s just one of those questions I go through like allergies or changes to family history. (I’ll ask) Are you having difficulty making ends meet at the end of the month?”
So identifying poor financial health is one thing, but what about intervention?
In other words, how can a family doctor help?
“Unfortunately, sometimes the requirements to get benefits (entitlements such as guaranteed income supplement or disability pension) are really challenging for patients,” MacKay said. “Because they do not always have high health literacy or high literacy rates to fill in the forms or to know where to go to navigate the system.”
That’s where collaboration between physicians and community agencies is key - once a doctor is in the know, he or she can suggest local advocacy groups to help with the hurdles.
“The challenge is that if we identify this, I can’t do the paperwork to help them,” MacKay shared. “That’s where we do need to connect with nonprofit societies.”
His clinic did something rather unique, something quite innovative.
They hired a social worker.
“Our experience has been profound,” said MacKay. “The difference was incredible, once we had somebody to do this type of paperwork and assist patients in getting things done when the doc did identify (poverty).”
Addressing poverty and understanding its impacts on health has long been McKay’s passion.
“It’s encapsulating … and it’s nice to advocate for my colleagues to really start paying attention, and give them a tool that’s very easy to use to identify certain things.”
Adding another layer to the doctor’s clipboard, however, is not without critics.
“Many doctors say they are not the ideal people to do this,” noted MacKay. “They would like to see social workers or the government take the lead - but when people come in with health issues we are the ones who deal with it in a publicly funded health care system. So it’s good to not just look at disease, but to look at the whole person, and poverty is a huge (factor).”
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