doctors and poverty

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A CBC article talks about a Toronto physician, Dr. Gary Bloch helping his patients get income support because “Treating people at low income with a higher income will have at least as big an impact on their health as any other drugs that I could prescribe them.” I wonder whether he will now be investigated, as rumors have it doctors are being investigated if they frequently perscribe the Special Dietary Allowance for those on social assistance.

A different Toronto physician, Dr. Roland Wong, was found guilty last year of professional misconduct. My understanding from the National Post article is that he may well have been lying on medical forms to allow patients on social assistance to access the maximum amount of money available for those requiring a special diet. Basically, he was prescribing an increased income for them so they could buy healthy food (or pay their living expenses, since many people on social assistance can barely manage that on the tiny amounts given). He was working within the framework of what was available, trying to help his patients. Could it be seen as the equivalent of off-label prescriptions? The Special Dietary Allowance could be offered for specific illnesses but not all, but it benefits others too so he prescribed it for them too.

I don’t like trying to defend lying. I really don’t. Yet at the same time, I don’t want to make an idolize telling the truth to the point that I would say yes, people should tell the truth even if it means that other people end up suffering because of it. Dr. Wong may have sacrificed his honesty in order to feed people, accepting their self-diagnosis of four food allergies or adding that to the form on his own initiative. He was treating his patients by perscribing them an income increase.  Is it a form of justifiable civil disobedience, to force the government to extend funding to people in need? The Ontario government retaliated by restricting even further what conditions the Special Dietary Allowance would cover and reducing the amounts.

I like it when health care providers take a broad look at health determinants. I remember hearing a lady speak once about how a highway cutting across two residential areas affected the health of the young people in the neighbourhoods because it made it less possible for them to visit their friends houses. City design can influence if people can walk or not, where they can go and whether they can obtain supports they need. Immigration and refugee laws influence access to healthcare as well as family support and stress levels.

Doctors have such limited power. We need cannot expect them to take on the burdens of the world – particularily at the risk of losing their medical licenses, for which they may well still be in debt for! The doctors can say raising income levels helps keep people healthy, and they can help patients access what funds our governments make available, but we need to be out there building the political pressure to make more funds available.

Knowledge that poverty is a health determinant is not new, yet the Ontario government has continued to allow the real income of those on social assistance to decline. The evidence and knowledge alone won’t change things. We  build the political pressure to ensure the laws and programs we need, and to ensure the funding for such programs are adequate.

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