If you can heal the symptoms,
but not affect the cause
you can’t heal the symptoms
— Lyric from “Sand” (Anastasio/Lawton/Markellis/Marshall)
For most people — doctors included — poverty is an unfortunate economic condition. But what if doctors started to think of poverty as a disease, with diabetes, hypertension, cancer, mental illness, and chronic lung disease as its symptoms? Trudy Lieberman wonders:
What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food stamps instead of the usual medicines for high blood pressure or diabetes? You’d probably say the physician was nuts. Tax refunds? Food? What do they have to do with making you healthier?
Toronto family doctor Gary Bloch thinks they have a lot to do with good health, and he wants to do something about it:
“We’ve created an advocacy or interventional initiative aimed at changing the conversation about poverty and how doctors think about poverty as a health issue,” Bloch told me. “It’s one of those cultural shift things. My job is to push ideas for physician interventions around poverty.” Bloch showed me a clinical tool used by primary care practices in Ontario that is based on strong evidence linking poverty to bad health outcomes.
The tool, a four-page brochure, is simple in design but powerful in concept. “You come at poverty from every possible angle,” Bloch said. “You start from the evidence and frame the issue in language doctors can understand.”
Dr. Bloch helped put together this tool to basically screen patients for poverty when detecting other diseases, and intervening by providing patients with strategies for improving their impoverished conditions — like helping them find a local food bank, or counseling them on tax rules that might benefit them — thereby improving their medical conditions.
This is especially true in pediatrics, as the brochure explains:
Poverty requires intervention like other major health risks. The evidence shows that socioeconomic status and child health are strongly linked.
Children living in poverty are more likely to experience low birth weight, learning difficulties, mental health problems, iron deficiency anemia, asthma, burns and injuries, obesity and hospitalization than their more affluent peers. Infant mortality is 60% higher in lowest income quintile neighbourhoods.
I’ve emphasized the section above to point out that poverty has real symptoms that pediatricians see every day in practice. Mark Rank might agree with the Phish lyric — that you can’t heal the symptoms (of disease) without affecting the cause (poverty):
The solutions to poverty are to be found in what is important for the health of any family — having a job that pays a decent wage, having the support of good health and child care and having access to a first-rate education. Yet these policies will become a reality only when we begin to truly understand that poverty is an issue of us, rather than an issue of them.
(Back pat: Dr. Abby Lippman, Professor of Epidemiology, Biostatistics, and Occupational Health, McGill University – Montreal)