If You Want to Help Me, Prescribe Me Money: Gary Bloch at TEDxStouffville
Summary
TLDRIn this powerful talk, a family doctor shares the stories of marginalized patients, like Sarah, a homeless transgender woman, and others struggling with poverty. He reflects on the deep connection between poverty and health, and his realization that medical treatments alone cannot address the root issues affecting his patients. He advocates for treating poverty as a disease and outlines practical steps doctors can take: asking about finances, prescribing social support, building poverty-focused care teams, and demanding systemic change. The talk ends with a call to action for both the medical profession and the community to address poverty as a critical health issue.
Takeaways
- 🏠 The speaker's children view a homeless transgender woman named Sarah as a neighbor and community member.
- 👨⚕️ The speaker is a family doctor who feels powerless to help homeless and impoverished patients like Sarah.
- 🌆 The doctor works in inner-city Toronto and has witnessed the detrimental health effects of poverty on patients.
- 🏥 Despite standard medical interventions, patients like Sarah do not improve, leading the doctor to question the approach.
- 👩💼 The doctor meets Wanda, a woman living in poverty with multiple sclerosis and heart disease, who faces numerous challenges.
- 👩👧👦 Another patient, Teresa, is a single mother struggling with childcare and unable to find stable employment.
- 💊 The doctor realizes that traditional medical treatments are insufficient and that addressing poverty is crucial.
- 📈 Research shows that poverty is more harmful to health than smoking, high cholesterol, and other common risk factors.
- 🤑 The doctor begins to 'prescribe income' by filling out special diet forms to provide extra money for low-income patients.
- 📋 The Ontario government's changes to the program that provided extra income halted the doctor's efforts.
- 🔍 The doctor explores ways to address poverty within a medical practice, including asking about income and prescribing social cures.
Q & A
What is the main issue the speaker addresses in their talk?
-The speaker addresses the issue of poverty and its direct impact on the health of their patients, emphasizing the need for doctors to treat poverty as a disease.
Why do the speaker's children observe Sarah, the homeless transgender woman?
-The children observe Sarah because they recognize that she is unwell and notice her unusual behaviors, such as speaking to unseen entities and enduring various weather conditions.
What questions do the speaker's children ask about Sarah that they cannot be easily answered?
-The children ask questions like why Sarah has a woman's name and a man's body, why she speaks to people they cannot see, and where she eats. These questions are difficult to answer due to their complexity and the sensitive nature of the issues involved.
What is the speaker's profession and where does he practice?
-The speaker is a family doctor who practices in inner-city Toronto.
Who are Wanda and Teresa, as mentioned in the script?
-Wanda is a 52-year-old woman with multiple sclerosis and heart disease who lives alone in a housing project. Teresa is a young single mother struggling with childcare and welfare, trying to find employment.
What is the connection between poverty and health according to the speaker?
-The speaker states that poverty is intimately connected to health, with low-income patients facing increased risks of various diseases and higher rates of depression, among other health issues.
How does the speaker describe the impact of poverty on the body?
-The speaker describes the impact of poverty on the body as causing a 177% increased risk of heart disease, over 100% increased risk of diabetes, and higher rates of depression and various types of cancer.
What is the 'special diet forms' initiative mentioned in the script?
-The 'special diet forms' initiative is a program where doctors fill out forms to provide people on social assistance with up to $250 extra per month for dietary needs.
What is the average amount left for food per month for someone on basic welfare in Ontario, according to the script?
-The average amount left for food per month for someone on basic welfare in Ontario is less than a dollar per day.
What are the four interventions the speaker suggests doctors can use to treat poverty?
-The four interventions are: 1) Ask and listen to patients' financial situations and stories; 2) Prescribe social cures like income, housing, and social supports; 3) Build a poverty team within the medical practice; and 4) Demand change from government programs and advocate for social change.
How does the speaker feel about the potential of these interventions to eliminate poverty?
-The speaker does not believe that these interventions will systemically eliminate poverty, but they do provide a way for doctors to address their patients' needs and see improvements in their health.
Outlines
🌱 The Impact of Homelessness and Poverty on a Community
The speaker begins by discussing the daily observations of their children regarding a homeless transgender woman named Sarah, who lives in a park near their home. Despite the neighborhood's contentious views on Sarah's presence, the children see her as a neighbor and part of their community. The speaker grapples with their children's questions about Sarah's situation, such as her homelessness and her mental health, which they cannot fully answer. This leads to a reflection on the speaker's role as a family doctor in inner-city Toronto, where they have encountered many patients like Sarah but have felt powerless to help them improve their conditions significantly. The speaker decides to explore new ways to address the root causes of their patients' health issues, such as poverty and social determinants.
📊 The Correlation Between Poverty and Health
The speaker delves into the profound impact of poverty on health, emphasizing that for their low-income patients, poverty is a more significant health risk than traditional factors like smoking or high blood pressure. They highlight the stark realities of living on welfare, such as the meager $600 a month that is supposed to cover all living expenses, leading to extreme deprivation. The speaker shares their experience of participating in clinics that provided additional income through special diet forms, which had a profound positive effect on patients' well-being. However, they express frustration with the government's subsequent changes to the program that limited their ability to continue this support, underscoring the need for systemic change to address poverty as a health issue.
💼 Prescribing Income: A New Approach to Healthcare
The speaker outlines a new approach to healthcare that involves directly addressing patients' financial situations as a means to improve their health. They suggest four interventions: asking patients about their income, listening to their stories to understand their needs, prescribing social cures like income and housing support, and building a poverty team within healthcare practices to better address these issues. The speaker emphasizes the importance of staying informed about welfare reforms and income security benefits to effectively 'prescribe income' and improve patients' health outcomes.
🏛️ Advocating for Systemic Change in Healthcare and Society
In the final paragraph, the speaker calls for systemic change in healthcare and society to address poverty as a health issue. They recount their experiences with special diet clinics that directly challenged government inaction on poverty, leading to increased awareness and advocacy from healthcare professionals. The speaker outlines four interventions: asking and listening to patients' financial situations, prescribing income and social supports, building a poverty team within healthcare practices, and demanding change from government programs. They express a newfound satisfaction in their role as a doctor, feeling that they are making a tangible difference in their patients' lives by addressing the root causes of their health issues.
Mindmap
Keywords
💡Homelessness
💡Transgender
💡Survivor
💡Community
💡Poverty
💡Income
💡Social Determinants of Health
💡Toxic Stress
💡Prescribe
💡Advocacy
💡Income Security
Highlights
Children observe a homeless transgender woman named Sarah, sparking questions about her life and circumstances.
The speaker, a family doctor, feels a sense of powerlessness in addressing the root causes of homelessness and poverty in their patients.
The doctor shares stories of patients like Wanda, who lives in squalor due to her low income and multiple health issues.
Teresa, a single mother, struggles with poverty due to lack of childcare, preventing her from securing employment.
Despite medical interventions, patients like Wanda and Teresa do not improve, highlighting the inadequacy of treating only the physical symptoms of poverty.
Research evidence shows a strong link between poverty and health issues, with poverty being a more significant risk factor than smoking or high cholesterol.
The doctor decides to treat poverty as a disease, aiming to address it directly within their medical practice.
Participation in clinics that provide additional income through special diet forms for those on social assistance.
Reveals the shockingly low amount of money people on welfare have left for food after covering other expenses.
The emotional impact of providing additional income to patients and the realization of the doctor's ability to make a difference.
The government's response to the special diet clinics and the subsequent halt of the program.
Four proposed interventions by doctors to treat poverty: asking and listening, prescribing social cures, building a poverty team, and demanding change.
The importance of asking patients about their income and listening to their stories to understand their health issues.
Prescription of social cures, such as welfare applications and community resources, to improve patients' financial situations.
Building a team to address poverty within healthcare, including nurses, social workers, and a dedicated poverty specialist.
The role of doctors in advocating for systemic change to address poverty as a health issue.
The personal satisfaction the doctor finds in addressing poverty directly and the improvements seen in patients' health.
The call to action for the medical profession and society to recognize and treat poverty as a core health issue.
Transcripts
[Applause]
thank
you
so many mornings my kids wake up run
into my room and peek through the blinds
at Sarah the homeless transgendered
woman who sleeps in the park across the
street from our
house they get that Sarah's unwell they
watch as she splashes water over her
body as she speaks to unseen
tormentors they also get that she's a
Survivor she's there in any weather rain
snow minus 20 plus
30 there's been a lowlevel war running
through our neighborhood over Sarah's
presence in the past few years but to my
kids she's nothing less than a neighbor
an essential member of our
community my eldest daughter drew this
picture a few weeks ago which shows
different types of homes in our
community apartment
twostory semidetached and
Street my kids ask many questions about
Sarah why does she have a woman's name
and a man's body why does she speak to
people or things that we can't see where
does she eat these are questions I can
usually muster up some semblance of an
answer to but but then there are the
questions I'm at a loss to
explain why doesn't Sarah have a
home where's her family why can't she
just move into our
basement how can we help
her now these questions bring up a
familiar feeling of powerlessness in me
feelings I remember from my first years
in practice I'm a family doctor I work
in inner city Toronto I've seen lots of
people who've experienced homelessness
and poverty in fact I've seen a lot of
people like
Sarah but despite all the usual
interventions the Saras in my practice
just didn't seem to get much better and
it's those questions I couldn't answer
that kept running themselves through my
head maybe there was something I was
missing something else I could be doing
for my
patients and so this is the journey I
want to take you on today from a feeling
of powerlessness opening new windows on
what we can do as doctors to really
improve our patients
Health to frame this for you I want to
give you a little bit more of a sense of
who I see in my office and the stories
they tell
me this is
Wanda I've known her for eight or nine
years and probably seen her every month
or two in that time she's 52 years old
she has multiple sclerosis and heart
disease
she lives alone in a downtown Toronto
housing
project her mind wanders in and out of
Lucidity as her body lets her know day
by day what it's going to allow her to
do she relies on a handwritten sign on
her door to keep the crack dealers
away she's watched her closest friends
Die
Young her husband left her a few years
ago because he was just too exhausted
from trying to care for her
without any other
supports she manages to survive but
lives in squalor on a thousand odd
dollars a month she's told me she would
love to have a nicer apartment in a
safer neighborhood she'd love to go to a
movie once in a while have some help
with cooking and cleaning at home maybe
even take a
vacation she had this once but she can
hardly imagine it
now and this is
Teresa she's a young single mother of
two small children who left Toronto a
couple of years ago for a smaller town
outside the city to get her kids away
from the bustle of city life she's
struggled through and finished a
part-time nursing program but she's been
stuck on welfare for a lack of child
care the last job she was offered she
had to turn down cuz it started at 6:30
and her daycare only opened at 6:30 now
she can't even get out to job interviews
because she can only get a daycare
subsidy once she has a full-time job and
she has no one to care for her kids
during the day she came to me asking for
help with stress and
depression now I did everything I was
supposed to do for the wanders and
teresas that I saw I prescribed them the
right drugs I ordered the right tests I
referred them to the right
Specialists I told them to eat better to
exercise more to seek counseling for
their mental health but despite all this
they just weren't getting better in fact
they were as debilitated as stressed as
unhealthy pretty much as the day I met
them and so it left me thinking was
there something I was missing in what I
was
doing and it was pretty obvious to me
what the problem was I was treating
their bodies but not their social
situations and especially not their
income which seemed to be the biggest
barrier to their health improving
the research evidence was pretty clear
on this income poverty is intimately
connected to my patient's Health in fact
poverty is more important to my
low-income patients than smoking high
cholesterol high blood pressure obesity
salt or soda pop poverty reeks havoc on
my patients
bodies a 177% increased risk of heart
disease more than 100% increased risk of
diabetes 60% higher rates of depression
higher rates of lung oral cervical
cancer higher rates of lung disease like
asthma and
empyema in Toronto's poorest
neighborhoods a 60% higher rate of
infant
mortality and then there's what's been
called the toxic stress of living in
poverty and this we can actually measure
in my patients bodies in higher levels
of stress hormones and other biomarkers
even down to alterations in their genes
so through all this it became pretty
clear to me that I was treating all of
Wanda's and Teresa's health issues
except for the most important one their
poverty and so I realized that we needed
to bring poverty out of the periphery
and right to the center of what we do as
doctors and so I decided to start to
treat poverty not as a social or a moral
issue but as a disease to be diagnosed
and treated like any any
other that's easy enough to say but
there really is nothing in the
traditional medical tool kit geared
towards treating income as a disease and
this is what doctors told me over and
over again they said why should we spend
so much time on something like poverty
when there's nothing we can do about
it luckily a couple of years ago I was
shown away through this
quander I was asked by an anti-poverty
organization ation called the Ontario
Coalition against poverty to participate
in clinics focused on one purpose to
fill out forms called special diet forms
that provide people living on social
assistance with up to
$250 a month in extra income for dietary
needs I was brought out to community
centers drop-ins libraries I was sat
down behind foldout tables often behind
rough cardboard barriers and I was is
asked to prescribe income to people at
the lowest end of our income
scale now to give you a sense of the
challenges these people were facing I'm
going to take a
poll I'm wondering if you can tell me
what you think a single person living on
basic welfare in Ontario receives every
month this amount meant to cover
everything from rent to food to
transport to clothing I'm going to give
you four choices
$600 900 $1,100 or $1,400 a month hands
for
six
9
11
14 the
answer $600 a month don't worry most
people I ask this question to have no
idea of the right answer unless they've
actually lived on
welfare and to call this subsistence
living is insensitive in fact it's
completely out of touch with reality
almost no one can survive on $600 a
month in Toronto we actually asked
people coming into our clinics a simple
question we said to them after you've
covered all your other expenses how much
do you have left for food every month
the answers for someone on basic welfare
an average of less than a dollar per day
for someone on disability supports just
under4 a day that's less than many of us
spend in our daily cups of
coffee so to be able to prescribe an
extra
$250 a month to these people was
astounding Our climactic Moment came
when we set up a clinic on The Lawns of
the legislature at Queens Park and 40
Health Care Providers prescribed a
thousand people living on welfare this
supplement I've I've never seen my
patients so consistently thankful so
joyful about something I've
done unfortunately the government not
having budgeted for the true needs of
people living on social assistance
changed the program changed the forms
and stopped us from being able to carry
out these clinics but I was left with
the emotional Rush with the feeling that
IID finally found a way to plug up that
hole in my skills I prescribed income
here was a way to maybe bridge that gap
between my mandate to improve health and
my professional inability to do so so I
turn my mind to this one question what
can we as doctors do to actually treat
our patients income actually deal with
their
finances in fact I became obsessed with
this question I went to bed reading
fiscal policy I dreamt of rsps and tax
breaks and tax-free savings accounts and
through this all it became clear that
the answer actually lay pretty close to
home that there were things that we
could do as doctors in our day-to-day
practices to actually treat
income now these are ideas in evolution
but to give you a sense of how simple
this is I'm going to suggest four ways
that we as doctors can actually
intervene in our offices with the
individuals sitting right across from us
in their poverty and my hope is that
after hearing these no doctor will again
turn to me and say that poverty is not a
disease they can
treat so let me start simple ask and
listen a couple of months ago a young
guy came into my office complaining of a
sore back he was dressed pretty funky he
had clean slim jeans a nice t-shirt
neatly quaffed hair do a nicely trimmed
beard he could have been been some
hipster
Barista but then I asked him about his
social situation it turned out he had no
income and he was living in his car he'd
actually come to Toronto 6 months before
from a smaller town hadn't been able to
find a job had no family or supports in
town and he was near complete collapse
he was too embarrassed to go home I
never would have found out any of this
if I hadn't asked specifically about his
finances
now I started asking all of my patients
about their income a couple of years ago
and I've been consistently surprised
there is often very little correlation
between what someone looks like and how
well off they are and through this
simple question I immediately identify
my low-income patients major health
issue and then I listen to their
stories sometimes these take longer than
I have booked for an appointment
sometimes they're disjointed and hard to
follow but this is essential to my
practice I haven't lived the Lives Many
of my patients have lived with their
stories they tell me what they want and
need how else would I have known about
the sign on Wanda's door Teresa's Child
Care dilemma it is through those stories
that my patients guide me to what I can
do to really improve their health so
that's my first intervention ask and
listen
once I have a sense of what's going on I
prescribe not drugs but social cures
income housing social supports for my
patient living in the car I prescribed
an application for welfare I hooked him
up with a community agency that had a
housing work and an Employment Program I
prescribed him websites and phone
numbers to access to look into what
other supports he might be able to
access I develop my skills in
prescribing income the same way I
develop my skills in treating chronic
disease I stay on top of the latest in
welfare reform changes in income
Security benefits programs the ins and
outs of disability support applications
and I've seen the impact of these
interventions over and over again a
doubling of someone's income just by
applying for disability
supports access to Myriad benefits
simply by filling out an income tax
application the health impact of these
interventions is
remarkable but I can't do this alone so
third I build a poverty
team now this is something we've been
doing for Di with diabetes for years we
have diabetes teams that have tentacles
that run through our clinics into our
hospitals and out into our communities
and we're now starting to do the same
thing with poverty I work with nurses
social workers dieticians and others and
all of us have developed our skills in
treating income and we know who in our
community we can refer our patients to
for help with their income Security in
the last couple of months we've even
developed a position in our team for a
dedicated poverty specialist this is
someone whose specific job it is to help
our lowincome patients improve their
income and their savings and to help us
increase our skills in doing this this
will be a huge step forward an actual
health doll funded position geared
towards treating poverty as a
disease but the answers to my patients
poverty will not just be found in our
offices we really need to look to
government programs and big social
change and as doctors we need to demand
this change and so this is my fourth
intervention while I and my colleagues
join the special diet clinics saw the
immediate impact of our interventions on
our patients we never imagined that that
program was the answer to those patients
poverty we use those clinics to pose a
direct challenge to the government that
we will not stand idly by and watch our
patients die of poverty we spoke with
media we met with elected officials and
bureaucrats we wrote oped pieces in
newspapers and we participated in in
direct actions in Street demonstrations
like this one where we banged our heads
against a figurative poverty
wall and when the government stopped us
from being able to carry out those
clinics we continue to demand big level
change we brought the urgency the
legitimacy and the expertise of health
professionals to the Forefront of
conversations about addressing poverty
and we made it clear that poverty is not
just a moral issue it's a health issue
and until we see our patients poverty
improve we will not see their health
improve so that's what I can offer as an
approach to doctors intervening in
poverty ask and listen prescribe income
build a poverty team and demand change
and it's in this work that I finally
found real satisfaction as a doctor I
don't think we're going to systemically
eliminate poverty through these kind of
interventions but I finally found a way
in my day-to-day practice to feel like
I'm actually dealing with what my
patients want and need and actually
starting to see improvements in their
health this is what I'm hoping my
profession will accept at the core of
our duties to our most vulnerable
patients it's what I'm hoping that all
of us all of you will take as a
challenge into your own
worlds and this is what I tell my kids
when they ask me what I think will help
Sarah the most
thank you
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