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Health Providers Against Poverty

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Monika Dutt

on 21 April 2017

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Transcript of Health Providers Against Poverty

Presenter Disclosure

Presenters: Kathy Hardill, Monika Dutt, Katie Dorman

Relationships with commercial interests:
Grants/Research Support:
Speakers Bureaus/Honoraria:
Consulting Fees:
Disclosure of Commercial Support

We approach this work from a privileged position as health care workers. We do
speak on behalf of people living in poverty, we speak as allies to these individuals.
Presenter Disclosure
Income & Health
1. To review the evidence for poverty as a key determinant of health that can be addressed through upstream initiatives, education and policy changes

2. To examine strategies used by a community-based, interdisciplinary, health advocacy organization, with a focus on success, failures, and future directions.

3. To generate new ideas on engaging public health and primary care in advocacy around social determinants of health through an interactive discussion
Health Providers Against Poverty
Lessons Learned from Nine Years of Education, Engagement and Political Advocacy

Kathy Hardill, Monika Dutt, Katie Dorman
Prevent More to Treat Less Conference
June 2014

Part I: Presentation

Poverty in Canada
The Evidence: Income & Health
Health Providers Against Poverty

40 minutes
Part II: Workshop

Breakout sessions
Report Back

50 minutes
What is poverty?
"Poverty Lines" for a Family of Four

Low Income Cut Off (LICO) - $30,945
(community size dependent)

Market Basket Measure (MBM) - $31,939
(community dependent)

Research Paper: Low Income Lines, 2011-2012. Statistics Canada 2012.

1 in 7 children live in poverty in Canada
12% of Ontarians live in poverty
>156,000 Ontario households waiting for affordable, rent-geared-to-income housing
Number of Canadians assisted by food banks increased by 39% between 2002 and 2012
Poverty disproportionately affects children, women, people with disabilities, racialized individuals and Aboriginal individuals.
Income Inequality
Income inequality is growing in Canada
The top 100 CEOs take home 171x the average wage of Canadians
Social assistance in Ontario
OW recipients report having
less than $1 per day
to spend on food
ODSP recipients report having
less than $4 per day
to spend on food
Pinto, A., G. Bloch, J Polsky, T. Svoboda.
Survey. Toronto, Ontario: 2010
Dorman, K et al. Ontario Medical Review. October 2013: 15-19
Statistics Canada (2013), Catalogue No. 82-003-X

Poverty accounts for 24% of person years of life lost in Canada
Income and Health
Age-Standardized Mortality Rates for Selected Causes by Income Quintile Q1-Q5

Wilkins, R, et al. Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Statistics Canada 2002:13;10(supp). Adapted from Dennis Raphael
Infants living in poverty have 60% higher mortality before 1 year of age

Children from low-income families are at higher risk of:
- low birth weight
- learning difficulties and mental health problems
- micronutrient deficiences
- asthma
- injuries and hospitalization

Early childhood exposure to poverty leads to adult chronic disease through epigenetic changes, stress hormone deregulation, and altered brain development

Income & Health
Income is the single most important factor which determines whether someone is healthy or not

- Canadian Population Health Initiative, 2004
Income & Health
Low income single moms
Commonly skip meals to feed their children
Calorie deficient
Do not meet RDAs for folate, vitamin A, B6, B12, C, iron, zinc, calcium
Income & Health
Annual increase of $1000 in income for the poorest twenty percent of Canadians
- 10,000 fewer chronic conditions
- 6,000 fewer disability days every two weeks
Lightman et al. Poverty is Making us Sick: A Comprehensive Survey of Income & Health in Canada, 2008
Health Providers Against Poverty
Multidisciplinary alliance of health care providers

Started in 2005 with the "Special Diet Campaign"

Special Diet clinics Feb to Dec 2005

Initially Toronto-based, now Canada wide connections
HPAP Mission Statement
Poverty represents a serious but reversible threat to the health of people living in Ontario. As health providers, we enjoy privilege and access to power which many others do not. As a high impact health intervention, we will work to eliminate poverty.
HPAP Objectives
1. Ensure income and social security for all
2. Raise awareness about the health impacts of poverty
3. Engage health providers and people with lived experience of poverty in social and political change
HPAP Membership
- Steering Commitee: 15 members
- Email Listserve: 269 members
- Facebook Group: 223 members

Monthly meetings attended by ~6-8 members and decision making by consensus of the steering committee
Strategies - Direct Action
Direct action

Political lobbying


Public education

Health provider education
Special Diet Campaign
- Initiated by Ontario Coalition Against Poverty in Feb 2005
- Part of the provincial "Raise the Rates" campaign
- Extra funds available to people on social assistance for nutritious foods if medical conditions verified by healthcare provider
- Histories taken by volunteer providers and forms completed
- >20 community clinics
Strategies - Direct Action
Strategies - Direct Action
May 2005 - Action at Provincial Minister Sandra Pupatello's office

Summer 2005 - Opposition to city bureaucratic changes

September 2005 - TO Board of Health

October 2005 - Massive "hunger clinic" at Queen's Park
- 40 Health Care Providers
- 1100 Clients
Strategies - Direct Action
Repeated attempts to meet Minister rebuffed

Joint action with Raise the Rates group and unions around increasing social assistance rates in provincial budget

"Hunger March" 2006 - attempt to influence provincial budget
October 2006 - Anti-Poverty Rally with RNAO, Queen's Park (Toronto, ON)
March 2012 - March Against Austerity (Toronto, ON)
June 2012 - National Day of Action against federal health cuts to refugee health care coverage (Hamilton, ON)
October 2012 - Anti-poverty march (Hamilton, ON)
February 2013 - "Emergency Shelter" at City Hall
(Toronto, ON)
Sept 2013 - OCAP Rally for Housing and Shelter (Toronto, ON)
Strategies - Political Lobbying

Strategies - Political Lobbying
Strategies - Collaboration
- Ontario Coalition Against Poverty (OCAP)
- Put Food in the Budget (PFIB)
- 25 in 5 Network
- Raise the Rates
- Hamilton Roundtable for Poverty Reduction
- Health For All
- YWCA Hamilton
Strategies - Public Education
Opinion Editorials
Media coverage
Press releases
Health providers Call For 'Livable' Minimum Wage
Press conference - January 14, 2014
Tedx Talk:
If you want to help me, prescribe me money
Strategies - Provider Education
Educational initiatives for health care providers, medical students, and nursing students
- Invited talk for RNAO Board of Directors
- Guest lectures for NP students
- U of T Medical Student Workshops
- Conference Presentations

Ontario Medical Review Series: 2008, 2013

Poverty Clinical Tool for Primary Care
Strategies - Provider Education
Special Diet Campaign
- Millions of dollars directly into low income pockets
- Effects profound at the individual level

Widespread awareness of the special diet allowance
- Although eligibility became stricter, awareness grew

Galvanized health provider focus on poverty and health
- Transformative change in the way some of us saw poverty and health; more than an intellectual construct
Increases in social assistance rates
Increased recognition of link between Poverty and Health

- CMA Report
What Makes Us Sick
(July 2013)
"Poverty is the most important factor and must be addressed"

- Ontario Medical Review (October 2013)
"It is clear poverty represents a serious but modifiable threat to health"

- RNAO Newsroom (August 2013)
"Poverty reduction is one of our biggest priorities"

- Canadian Family Physician (June 2012)
"Further research into how primary care teams can screen for and intervene in our patients' poverty is necessary to understand how best to improve health outcomes."
- Expansion of Network
Success / Challenge
Loss of focus after special diet clinics

Few clear direct action possibilities

Reduced connection with people living in poverty

Limited organizational capacity
College of Physicians and Surgeons of Ontario disciplinary hearing for Dr. Roland Wong

- Then Toronto mayoral candidate Rob Ford
"A doctor is there to be a doctor, not to advocate for the poor, or to be the official opposition in government through taxpayer's money"
- CMAJ, April 2010

- Lodged the complaint with CPSO

- Fined $35K; license suspended for 6 months

"Failed to maintain the standard of practice of the profession"

"Advocacy for a patient...should not trump one's professional integrity"

No patient was harmed - harsh penalty

Dr. Philip Berger, Chief of DFCM, St. Michael's Hospital

"The College is also sending a message...do not bother coming to us if you're poor or on welfare. We're not going to help you. We're just going to punish your doctors who are trying to help you."

Political analysis - Dr. Wong was attacked for confronting the austerity agenda
Note: Dr. Wong is an anti-poverty ally, but he is not a member of Health Providers Against Poverty
How to get media attention
How to identify, agree on, and disseminate timely media responses to ad hoc issues?

How do we create a credible, interdisciplinary advocacy group?
How do we move beyond the silos of our respective disciplines?
Connection: Primary Care & Public Health
HPAP consists of and creates links between primary care & public health

HPAP's actions span all levels of the pyramid
Building partnerships
Brainstorming - Current work
- List poverty-related priorities for your practice/organization (real or an ideal!)
- Note areas of potential overlap in your individual/organizational poverty-related work
Break Out Session

Break Out Session
Brainstorming - Future directions
- List poverty-related priorities as a collective
- List potential activities under each priority that would involve collaboration between primary care, public health, and advocacy groups
Break Out Session
- Write a purpose statement for a team involving primary care, public health and advocacy groups.

- Include:
- What is the value of bringing these groups together?
- What problem is being faced?
- What is the desired outcome?
Poverty in Canada

To join the HPAP email listserve, sign on the sheets provided or email hpagainstpoverty@gmail.com
Current Work
Future Directions
Full transcript