If You Want to Help Me, Prescribe Me Money: Gary Bloch at TEDxStouffville

Summary

In 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

00:00

🌱 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.

05:01

📊 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.

10:01

💼 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.

15:04

🏛️ 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.

Keywords

💡Homelessness

Homelessness refers to the condition of people without a permanent dwelling, often living on the streets or in temporary shelters. In the video, Sarah represents a homeless individual, and her presence is a focal point for the community, including the speaker's children. The script discusses the impact of homelessness on health and the broader social implications.

💡Transgender

Transgender is an umbrella term for people whose gender identity differs from the sex they were assigned at birth. Sarah, a character in the script, is described as a homeless transgender woman, emphasizing the intersection of gender identity, societal challenges, and the lack of resources for transgender individuals.

💡Survivor

A survivor is someone who continues to live and function despite difficult circumstances. The script uses the term to describe Sarah's resilience despite her homelessness and the adversities she faces, highlighting her strength and the human capacity to endure.

💡Community

Community refers to a group of people living in the same place or having a particular characteristic in common. The video script emphasizes the importance of viewing individuals like Sarah as integral parts of the community, challenging the stigma and isolation often associated with homelessness.

💡Poverty

Poverty is the state of being extremely poor. The script discusses poverty as a central issue affecting the health of the speaker's patients, like Wanda and Teresa, and how it's intimately connected to various health problems, including heart disease and depression.

💡Income

Income refers to the money received on a regular basis for work or through investments. The video script makes a powerful case for treating income as a health issue, showing how low income can lead to inadequate nutrition, poor housing, and increased stress, all of which negatively impact health.

💡Social Determinants of Health

Social determinants of health are the conditions in which people are born, grow, work, live, and age. The script discusses how factors such as income, housing, and social support are social determinants that significantly influence health outcomes, beyond just medical care.

💡Toxic Stress

Toxic stress refers to prolonged and frequent exposure to stress without adequate support. The script mentions toxic stress as a consequence of living in poverty, which can be measured through higher levels of stress hormones and even genetic alterations, affecting health negatively.

💡Prescribe

To prescribe, in a medical context, is to recommend a treatment or medication. In the video, the speaker uses the term to describe actions beyond medical prescriptions, such as referring patients to social services or advocating for policy changes, to address the root causes of health issues.

💡Advocacy

Advocacy is the act of supporting a cause or policy. The script describes how doctors can advocate for their patients by demanding systemic changes to address poverty, joining protests, and engaging with media and government officials to influence policy and improve health outcomes.

💡Income Security

Income security refers to the availability of stable and sufficient income to meet basic needs. The video script discusses how doctors can help patients by increasing their income security through welfare applications and tax benefits, which can have a direct impact on health.

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