Poverty significantly impacts patient health, acting as a critical risk factor in primary care settings. Research consistently demonstrates that individuals living in poverty face a heightened risk of developing cardiovascular diseases, diabetes, and depression. For children in low-income families, the risks are even more pronounced, including low birth weights, mental health challenges, asthma, malnutrition, injuries, and increased hospitalization rates. While primary care providers routinely screen for and address factors like poor diet, lack of exercise, substance abuse, and high-risk sexual behavior, poverty often remains an unaddressed, yet profoundly influential, determinant of health. In Ontario alone, 20% of families, representing 1.57 million people, live in poverty, with new immigrants, women, Indigenous peoples, and LGBTQ+ individuals being disproportionately affected. Recognizing and addressing poverty is a crucial step towards equitable healthcare.
The Poverty: A Clinical Tool for Primary Care Providers is designed to integrate seamlessly into primary care practice and facilitate a structured approach to identifying and supporting patients affected by poverty. This tool, developed for use across multiple patient visits, empowers providers to:
- Screen all patients using a targeted question proven to be a reliable indicator of poverty.
- Recognize high-risk populations, understanding that new immigrants, women, Indigenous peoples, and LGBTQ+ individuals are particularly vulnerable.
- Acknowledge the amplified health risks faced by patients living in poverty, even those who might otherwise be considered low-risk.
- Intervene effectively by educating and assisting patients in accessing crucial tax benefits, government assistance programs, and community resources.
Poverty exacerbates the risk of numerous chronic diseases, mental health conditions, and even accidents and trauma. A Statistics Canada study underscores the severity of this issue, linking income inequality to approximately 40,000 premature deaths annually in Canada. Individuals experiencing poverty are statistically more likely to:
- Report diabetes compared to higher-income counterparts.
- Experience elevated rates of lung, oral, and cervical cancers.
- Suffer from cardiovascular disease at a rate 17% higher than the national average.
- Face a 58% increased risk of depression compared to the average Canadian.
- Exhibit a higher prevalence of hypertension, arthritis, COPD, asthma, and multiple chronic conditions.
Children from low-income families are at an elevated risk for:
- Low birth weight
- Mental health problems
- Micronutrient deficiencies
- Asthma
- Injuries
- Hospitalization
While a universally accepted definition and measurement of poverty remain debated, in Canada, Statistics Canada’s low-income cut-off lines are widely used to understand poverty prevalence. By this metric, approximately 15% of Canadians, including one in seven children, live in poverty, with new immigrants, women, Indigenous peoples, and LGBTQ+ individuals representing particularly vulnerable groups.
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, adapting and disseminating it for primary care providers nationwide. This initiative aligns with the College of Family Physicians of Canada’s strategic plan, which emphasizes social accountability and equitable care, recognizing poverty screening as a vital component in achieving these objectives.
This Poverty: A Clinical Tool for Primary Care is available as a custom form on Telus PS Suite EMR and Ocean platforms, streamlining its integration into existing clinical workflows. It is recommended to utilize the tool on PS Suite EMR v5.2.702 or later for optimal functionality.
This tool emerged from the 2014-2017 Knowledge Translation in Primary Care Initiative, a collaborative effort between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO), funded by the Ministry of Health and Long-Term Care. This initiative was designed 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 highlighted the pressing need for resources to effectively support patients living in poverty, directly informing the development of this crucial tool. The Poverty Tool’s development employed CEP’s integrated knowledge translation methods, ensuring continuous engagement with healthcare providers throughout the process and utilizing user-centered design principles to rigorously test tool usability from a provider’s perspective.
Clinical Leadership
The development of this tool was expertly guided by Dr. Gary Bloch, MD, CCFP, FCFP, 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 clinical, educational, program development, and research work centers on the critical intersection of poverty and health, with a specific focus on empowering primary care providers to effectively address poverty as a health determinant. As an Assistant Professor at the University of Toronto and a founding member of Health Providers Against Poverty and Inner City Health Associates, Dr. Bloch is a recognized leader in this field. He has developed educational curricula on poverty interventions for medical professionals and actively participates in creating and evaluating health team interventions addressing the social factors impacting health. Dr. Bloch is a sought-after speaker on these topics, sharing his expertise with healthcare providers and the public, and his impactful work has been featured in prominent media outlets including the Toronto Star, the Globe and Mail, and CBC.
Additional Resources
To further support primary care providers in comprehensive patient care, consider exploring these related clinical tools:
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