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Diagnosing poverty: New stats show people in North End die 16 years earlier

Doctors urged to include patients' financial well-being as warning sign for chronic illness

Life expectancy by Winnipeg neighbourhood, in years

Hey there, time traveller!
This article was published 6/6/2015 (805 days ago), so information in it may no longer be current.

Jessie Howell, 72, warns that an aneurysm 20 years ago sometimes muddies her memory. But the feisty grandmother has no trouble listing off the cost of her monthly pills.

There's $103 for one prescription, about the same for her thyroid condition and $17 for five days' worth of antibiotics she just needed.

Jessie Howell lives on a limited budget, and a significant portion of her income goes to medical expenses such as prescriptions and glasses.  She believes that Aboriginals are treated differently by the medical system, and that unhealthy life choices are influenced by many generations of problems.


Jessie Howell lives on a limited budget, and a significant portion of her income goes to medical expenses such as prescriptions and glasses. She believes that Aboriginals are treated differently by the medical system, and that unhealthy life choices are influenced by many generations of problems.

Portraits of family doctor Anne Durcan, June 5, 2015.


Portraits of family doctor Anne Durcan, June 5, 2015.

"I'm looking at a little over $200 a month," said the retired grandmother, sitting in a sunny office at Mount Carmel Clinic just off Main Street.

"I just had to hand out bucks for these," she added, wiggling off her new bronze-metal eyeglasses.

It doesn't surprise Howell to hear a statistic that should jar most Winnipeggers -- that people in the North End die 16 years earlier than people in the region's wealthiest area of East St. Paul, new data from the Winnipeg Regional Health Authority show.

Talk to Howell or any of the doctors and nurses at Mount Carmel and they'll list off some of the hidden health challenges facing the poor. A patient might not have a phone, so it's hard to reach them to give them the results of blood tests. It's hard to keep track of an appointment with a specialist six months away if you've moved twice in the meantime or if you and your children are trying to escape domestic violence. Travelling to a followup visit costs two bus tickets, often more than the poor can afford.

For the working poor without drug coverage, an $80 prescription for antibiotics might have to wait until payday, by which point the pneumonia is much worse. Even paying a $20 fee for a doctor to fill out a welfare form might break the bank.

"And how do we eat healthy? The things that are cheap, I think are not really good. You can't live on macaroni," Howell said. "And then you turn around and say 'I'll buy some meat,' but you have to buy meat with a lot of fat in it because it's cheaper."

The WRHA recently released its newest community health assessment report, which tabulates everything from cancer rates to breastfeeding statistics, neighbourhood by neighbourhood, including West and East St. Paul.

The statistics bear out what health and poverty experts have known for years: income is among the biggest predictors of good health. Still, some of Winnipeg's new stats are stark.

In East St. Paul, the neighbourhood within the WRHA region with the highest median income, women live on average to 87.5 years and men live until 82.3.

But in the North End, the WRHA neighbourhood with the lowest household income, women only live until 70.9 years and men die on average at 66.7.

That means a man in East St. Paul lives 15.6 years longer than a man in the North End. And that gap is growing. Five years earlier, the life-expectancy gap was 13.4 years.

A new project could help close the health gap between rich and poor by asking family doctors to start diagnosing poverty just as they do high-blood pressure, diabetes or any other chronic illness.

The new tool, still in development by University of Manitoba researchers, asks doctors to pose one simple question to all patients, no matter how wealthy they look: Do you ever have difficulty making ends meet at the end of the month?

If the answer is yes, doctors are asked to take a second look for some common poverty-related illnesses. Knowing a patient is poor might prompt a doctor to order tests for diabetes, heart disease or other illnesses even though the patient otherwise appears low-risk.

"Part of the reason people are really interested in this tool is the evidence for years has been so strong that poverty is a key driver of health," said Noralou Roos, the community health professor with the University of Manitoba's medical school who is quarterbacking the creation of the poverty tool. "Worrying about hypertension and all these other measures physicians do, frankly, become considerably less important than understanding the poverty challenges people face."

The goal of the poverty tool is to get doctors to do something radical: prescribe more money.

The poverty tool comes with a long list of benefits, tax credits and monthly grants doctors can point patients to in a bid to boost their income. A simple one, often first on the list, is checking to see whether patients filed their tax returns. Many poor people don't bother doing it but it's essential for federal and provincial benefits such as the GST credit or the child tax benefit or even a hefty refund.

Doctors can ask patients whether they get welfare, old age security, disability payments, Manitoba's prenatal benefit that helps pregnant women eat better and a host of other programs that can be bureaucratic, hard to suss out and time-consuming to access.

Doctors such as Anne Durcan at the Mount Carmel Clinic, where the poverty tool was tested, already do all this as a matter of course, and can hand off a patient to a social worker who knows the ins and outs of the province's complex social safety net.

But most family doctors in suburban practices, especially those where appointments last just 10 or 15 minutes, don't. The tool is especially meant for those doctors, said family physician Gary Bloch, who helped pioneer the tool at Toronto's St. Michael's Hospital.

If doctors take just the first step -- asking "Can you make ends meet?" -- that's the start of a culture shift in medicine and would trigger a higher level of suspicion about diseases such as diabetes or heart problems, Bloch said. If doctors read up on some of the basic benefits low-income people ought to get and can recommend those to patients, that's another big step forward.

In Ontario, the tool is slowly gaining traction among the hundreds of physicians Bloch has spoken to in recent years. Ontario's tool is taught at University of Toronto medical schools, and it provided the model for Manitoba's version.

Just how the tool will be launched here is still up in the air. Senior staff at the Winnipeg Regional Health Authority say they want to see the tool used as much as possible, as part of the many ways the health authority is trying to close the poverty gap and recognizing that much has to change to fix poverty.

Roos and her colleagues are fine-tuning the tool and trying to figure out how to measure whether it works, whether patient incomes go up after a doctor uses the tool and whether that makes patients healthier in the long run.

And they're trying to figure out how to roll it out, perhaps by piloting it in a handful of access centres where doctors and nurses work with social workers and other experts who can help boost a patient's income. Already, doctors-in-training get schooled on how poverty, poor housing, joblessness, childhood trauma and other factors influence health, and they might be the best way the tool gains currency, Roos said.


-- with files from Inayat Singh


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Updated on Saturday, June 6, 2015 at 11:18 AM CDT: Updated

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