Bringing Health to Bringing Health to Poverty: A Call to Poverty: A Call to Action for Health Action for Health

ProvidersProvidersAshley Heaslip, B.A., MHSc Ashley Heaslip, B.A., MHSc

(candidate)(candidate)Canadian Public Health Association Canadian Public Health Association

ConferenceConferenceJune 2, 2008June 2, 2008

ObjectivesObjectives

To examine poverty as a key To examine poverty as a key determinant of health. determinant of health.

To examine specific strategies To examine specific strategies health providers can employ to health providers can employ to alleviate the impact of poverty alleviate the impact of poverty on their clients’ health.on their clients’ health.

The Evidence on Poverty The Evidence on Poverty and Healthand Health

Poverty in CanadaPoverty in CanadaPopulation IndicatorsPopulation IndicatorsChronic DiseaseChronic Disease

Figure 3.2: Percentage of Canadians Living in Figure 3.2: Percentage of Canadians Living in Poverty, 2004Poverty, 2004

15.5

17.7

15.114

0

2

4

6

8

10

12

14

16

18

Perc

enta

ge L

ivin

g in P

overt

y

All Persons Under 18 Years ofAge

18-64 years 65 years and over

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

Courtesy of: Dennis Raphael

Life ExpectancyLife Expectancy

Poorest vs. richest areas:Poorest vs. richest areas:

5 years5 years shorter for men shorter for men

1.7 years1.7 years shorter for women shorter for women

R. Wilkins, et. al., “Trends in mortality by neighbourhood R. Wilkins, et. al., “Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996,” income in urban Canada from 1971 to 1996,” Health ReportsHealth Reports (Stats Can), 2002: 13(Supplement).(Stats Can), 2002: 13(Supplement).

Infant Mortality and Infant Mortality and LBWLBW

Poorest vs. richest areas:Poorest vs. richest areas:

Infant Mortality: Infant Mortality: 61% higher61% higher

Low Birth Weight: Low Birth Weight: 43% higher43% higher

Wilkins, et. al., 2002.

DiabetesDiabetes

Increase in prevalence among low Increase in prevalence among low income vs. high income: income vs. high income: Men 40%Men 40% Women 280%Women 280%

For low vs. high physical For low vs. high physical activity:activity: Men 40%Men 40% Women 50%Women 50%

Douglas G. Manuel & Susan Schulz, “Chapter 4 Diabetes Health Status and Risk Factors,” in Douglas G. Manuel & Susan Schulz, “Chapter 4 Diabetes Health Status and Risk Factors,” in J. Hux, G. Booth & A. Laupacis, eds., J. Hux, G. Booth & A. Laupacis, eds., The ICES Practice Atlas: Diabetes in Ontario,The ICES Practice Atlas: Diabetes in Ontario, 2002, Institute for Clinical and Evaluative Sciences.2002, Institute for Clinical and Evaluative Sciences.

Mental HealthMental Health

Depression: Overall prevalence Depression: Overall prevalence 9.17%; among low income 14.52% 9.17%; among low income 14.52% (10.79% men, 17.09% women)(10.79% men, 17.09% women)¹¹

¹¹Katherine 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 Isn’t it Just that Poor Health Causes Poverty?Health Causes Poverty?

““All [the studies reviewed] All [the studies reviewed] conclude that 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 Shelley Phipps, “The Impact of Poverty on Health: A Scan of the Research Literature,” Literature,” CIHICIHI, June 2003., June 2003.

What Can We Do About What Can We Do About It?It?

An Example: An Example:

The Special Diet Campaign and The Special Diet Campaign and Health Providers Against Health Providers Against

PovertyPoverty

Background to the Background to the CampaignCampaign

Social assistance in Ontario:Social assistance in Ontario: 22% rate cut 1995, 40% total 22% rate cut 1995, 40% total decrease in real $ nowdecrease in real $ now

Single person on welfare in Toronto Single person on welfare in Toronto earns $569/month, needs an extra earns $569/month, needs an extra $390/month to meet basic needs$390/month to meet basic needs

Single parent earns $1653, needs an Single parent earns $1653, needs an extra $223/monthextra $223/month

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

The CampaignThe Campaign

Mass assessment clinicsMass assessment clinics

Advocacy: government, health Advocacy: government, health organizations, mediaorganizations, media

Alliances with antipoverty groups, Alliances with antipoverty groups, health orgs, communitieshealth orgs, communities

Education and outreach to health Education and outreach to health providersproviders

The ResultsThe Results

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

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

Mobilization of health providers Mobilization of health providers and new voice in the antipoverty and new voice in the antipoverty movementmovement

Mobilization of low income peopleMobilization of low income people

What Can We Do About What Can We Do About It??It??

Individual Patient-Provider Individual Patient-Provider InterventionsInterventions

Practice InterventionsPractice Interventions

Community InterventionsCommunity Interventions

Individual Patient-Individual Patient-ProviderProvider

See situation from client’s See situation from client’s perspective … alter prioritiesperspective … alter priorities

Limitations poverty places on Limitations poverty places on patient’s ability to adhere to patient’s ability to adhere to care: time, priorities, care: time, priorities, hopelessness, demands of social hopelessness, demands of social servicesservices

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

Practice Level Practice Level InterventionsInterventions

Information on income support programs Information on income support programs and supplementsand supplements

Contact information for welfare and Contact information for welfare and housing offices, social workers, legal housing offices, social workers, legal aid clinics, and antipoverty/advocacy aid clinics, and antipoverty/advocacy organizations organizations

Form letters, e.g. to support access Form letters, e.g. to support access to affordable housing, and to appeal to affordable housing, and to appeal rejected income supplement rejected income supplement applications applications

Information on the health effects of Information on the health effects of poverty poverty

Community Level Community Level InterventionsInterventions

Direct Health Services for underserved groupsDirect Health Services for underserved groups Use privileged voice to speak publicly about Use privileged voice to speak publicly about poverty and healthpoverty and health

Educate people living in poverty about health Educate people living in poverty about health risks to improve their ability to advocate risks to improve their ability to advocate for selvesfor selves

Participate in public events around Participate in public events around decreasing povertydecreasing poverty

Meet with elected representativesMeet with elected representatives Tell your clients’ storiesTell your clients’ stories Conduct and support research into health and Conduct and support research into health and povertypoverty

THANK-YOU!

Please visit our new website:

www.healthprovidersagainstpoverty.ca

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