Poverty

A powerful body of evidence shows that poverty puts patients at higher risk for cardiovascular diseases, diabetes and depression. Children in low income families are at higher risk of low birth weights, mental health problems, asthma, malnutrition, injuries and hospitalization. Providers should routinely screen patients and intervene for poor diet, lack of exercise, substance abuse and high-risk sexual behaviour. It is clear that poverty is another very important risk factor that requires screening and intervention. However, poverty is not always apparent. In Ontario 20 per cent of families or 1.57 million people live in poverty. Poverty is a high risk factor for new immigrants, women, Indigenous peoples, LGBTQ+ and children.

The first and most important step is to identify those who live in poverty.

Poverty: A Clinical Tool for Primary Care Providers is designed to be used over a series of visits to:

• Screen all patients using a key question identified as a good predictor of poverty.
• Consider that new immigrants, women, Indigenous peoples and LGBTQ+ people are among the highest groups at risk.
• Understand that otherwise low risk patients who live in poverty are at higher risk for certain health conditions.
• Intervene, educate and support patients to access tax and other government benefits, and connect them with resources and services.

Poverty puts patients at higher risk for most chronic diseases, mental illnesses, and even accidents and trauma. A Statistics Canada study shows that income inequality is associated with the premature deaths of 40,000 Canadians per year. People living in poverty:

• Are more likely to report having diabetes than higher-earning individuals.Experience higher rates of lung, oral, and cervical cancer.
• Experience cardiovascular disease at a rate 17% higher than the average Canadian.
• Have 58% higher rates of depression than the Canadian average.
• Experience elevated risk of hypertension, arthritis, COPD, asthma, and multiple chronic conditions.

Children in low-income families are at higher risk of:

• Low birth weight
• Mental health problems
• Micronutrient deficiencies
• Asthma
• Injuries
• Hospitalization

There is no internationally-accepted definition of poverty and no clear consensus on how it should be measured. In Canada many people use Statistics Canada’s low income cut-off lines as a way of understanding who is living in poverty. By this measure, approximately 15% of Canadians, including 1 in 7 children, live in poverty. New immigrants, women, Indigenous peoples and LGBTQ+ people are among the highest risk groups.

The Centre for Effective Practice (CEP) and the College of Family Physicians of Canada (CFPC) have collaborated on an initiative to expand and disseminate the Ontario poverty tool for primary care providers across the country. The Ontario version of this tool has been modified for participating provinces/territories.

Social accountability and equity of care are important components of the College of Family Physicians of Canada’s strategic plan. Poverty screening plays a significant part in addressing these goals. See below to access these tools by province or territory.