Poverty significantly impacts health outcomes and should be considered a critical clinical factor in primary care. Just as providers screen for diet, exercise, substance abuse, and risky sexual behaviors, screening for poverty is equally crucial. Recognizing poverty as a vital determinant of health allows primary care providers to offer more effective and equitable care. This article explores the importance of using a “poverty tool” in primary care settings to identify and support patients facing financial hardship.
A substantial body of research demonstrates the profound link between poverty and adverse health conditions. Patients living in poverty are at a heightened risk for cardiovascular diseases, diabetes, and depression. Children from low-income families face increased vulnerability to low birth weights, mental health challenges, asthma, malnutrition, injuries, and hospitalizations. In Ontario alone, a significant 20% of families, representing 1.57 million individuals, live in poverty, highlighting the widespread nature of this issue. New immigrants, women, Indigenous peoples, and LGBTQ+ individuals are disproportionately affected and face an even greater risk.
The first and most crucial step in addressing poverty’s impact on health is identification. The “Poverty: A Clinical Tool for Primary Care Providers” is designed to facilitate this process across multiple patient visits. This tool enables providers to:
- Screen all patients using a targeted question that effectively predicts poverty.
- Recognize high-risk groups, including new immigrants, women, Indigenous peoples, and LGBTQ+ individuals, who are particularly vulnerable to poverty.
- Understand the elevated health risks associated with poverty, even in patients who may otherwise appear low-risk.
- Intervene, educate, and support patients in accessing crucial tax benefits, government assistance programs, and community resources.
Poverty acts as a major risk factor for numerous chronic diseases, mental illnesses, and even accidents and trauma. Income inequality has been linked to significant premature mortality rates. Studies reveal that individuals living in poverty are more likely to report diabetes, experience higher incidences of lung, oral, and cervical cancers, and face a 17% higher rate of cardiovascular disease compared to the average Canadian. Furthermore, depression rates are 58% higher among those living in poverty, and they also experience elevated risks of hypertension, arthritis, COPD, asthma, and multiple chronic conditions.
Children in low-income families are particularly vulnerable and face a range of health challenges:
- Low birth weight
- Mental health problems
- Micronutrient deficiencies
- Asthma
- Injuries
- Hospitalization
While a universally accepted definition of poverty remains elusive, in Canada, Statistics Canada’s low-income cut-off lines are widely used to understand poverty prevalence. By this measure, approximately 15% of Canadians, including 1 in 7 children, live in poverty. Again, new immigrants, women, Indigenous peoples, and LGBTQ+ individuals are identified as being among the groups at highest risk.
The Centre for Effective Practice (CEP) and the College of Family Physicians of Canada (CFPC) have collaborated to broaden the reach of the Ontario poverty tool, making it accessible to primary care providers across the country. This tool, initially developed for Ontario, has been adapted for use in various provinces and territories. Addressing poverty through screening aligns with the College of Family Physicians of Canada’s strategic plan, emphasizing social accountability and equitable care.
This “Poverty Tool” is a product of the 2014-2017 Knowledge Translation in Primary Care Initiative, a joint effort by the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO), supported by the Ministry of Health and Long-Term Care. This initiative aimed to equip primary care providers with essential clinical tools and health information resources. A Primary Care Needs Assessment conducted by CEP as part of this initiative revealed a significant need for resources to support patients experiencing poverty, directly leading to the development of this crucial tool.
The Poverty Tool was created using CEP’s integrated knowledge translation methods, ensuring continuous engagement of healthcare providers throughout the development process. This user-centered design approach prioritizes usability and practicality from the provider’s perspective.
Clinical Leadership
The development of this tool was expertly guided by Dr. Gary Bloch, a family physician at St. Michael’s Hospital in Toronto and Co-Chair of the OCFP’s Committee on Poverty and Health. Dr. Bloch’s extensive work focuses on the intersection of poverty and health, with a specific emphasis on empowering primary care providers to address poverty as a health issue. His contributions include curriculum development for medical professionals on poverty interventions and involvement in creating and evaluating health team interventions targeting the social determinants of health. Dr. Bloch is a sought-after speaker and his expertise has been featured in prominent media outlets.
Additional Resources
Beyond the Poverty Tool, primary care providers can access other valuable resources to support patient well-being. Tools focused on Adult Mental Health and Youth Mental Health, as well as Chronic Non-Cancer Pain management, offer comprehensive support for a range of patient needs. These resources, alongside the Poverty Tool, empower providers to deliver holistic and patient-centered care.
