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Tracy Warne, a community health worker with UHN, outside Toronto General Hospital, June 23.Eduardo Lima/The Globe and Mail

When it became clear, early in the pandemic, that the most devastating effects of COVID-19 were being felt by racialized individuals, people living in poverty and other marginalized groups, community health leaders in Toronto rallied by bringing pop-up vaccine clinics to some of the hardest-hit areas of the city.

The clinics proved to be such a success, with lineups forming in the early morning hours, that it led Andrew Boozary, one of the physicians involved, to come up with new ways for hospitals to reach vulnerable individuals beyond the pandemic – people in circumstances that make it difficult or even impossible to schedule appointments, fill prescriptions or meet other vital health needs.

“We need to be prioritizing improved health outcomes for the most marginalized patients, period,” said Dr. Boozary, the founding executive director of the Gattuso Centre for Social Medicine at the University Health Network.

The result is a new initiative at UHN in which a community health worker is embedded full-time at the hospital’s Francis Family Liver Clinic to help vulnerable individuals navigate the system, whether that means accompanying them to a medical appointment, answering questions about their medication or helping them fill out forms to access government benefits.

Tracy Warne, a community health worker with years of experience in hospital and community settings, started the role a few months ago and says many of the people she sees would otherwise get lost in the system, often ending up in the emergency room as a result of a health-related crisis. Her role, which allows her to meet with patients in their homes or the shelters where they are staying, gives people struggling with poverty, mental-health challenges, substance use or other concerns the chance at better health.

“Being that point person, we can find things that are happening and find things that are alternative ways of resolving things before people end up in an emergency situation,” Ms. Warne said in a recent interview.

In many instances, the people she sees have faced discrimination and have lost trust in the healthcare system. Many health professionals treat those individuals differently because of the way they look or act, Ms. Warne said, but having a community health worker at their side conveys the idea that the individual does not pose a risk and deserves attention.

“It role models for the people around them,” Ms. Warne said.

Doctors and nurses at the clinic use a social determinants of health screening tool to refer at-risk patients to Ms. Warne. In most cases, individuals are happy to get the help. But she recalled one instance in which an individual initially turned down her services. Then, one day, he showed up unannounced at the clinic without shoes, a coat or a wallet. It turns out he had been assaulted and robbed and had nowhere else to go.

“At that point, he said my doctor had recommended you and I should have gotten your help at the time,” Ms. Warne said.

She helped him get back on his feet and replace his ID and now has a good rapport with him, even accompanying him to medical appointments at his request.

For Dr. Boozary, this new initiative is a way to build on lessons learned during the pandemic and find innovative ways to help put some of the most vulnerable people on a more even playing field when it comes to health care. He has seen how the system can treat such people, offering no second chances for those who miss appointments and too few supports for people struggling to find or keep housing.

“The current system is very cruel,” he said. “It’s impossible enough for people who have everything to manage their health and their health care visits. Imagine that every other obstruction from poverty is weighing down on you.”

There’s also a growing body of evidence that initiatives linking community health workers to vulnerable individuals leads to a decrease in hospital readmissions and other improvements in health outcomes, in addition to savings for the health-care system.

Dr. Boozary said he hopes the new initiative, which is funded by the Gattuso Centre for Social Medicine and includes partners such as the Parkdale Queen West Community Health Centre, Black Creek Community Health Centre, Sound Times and the Neighbourhood Organization, will help launch similar programs and put a new focus on ensuring equitable health care access for all.

“To me, it’s about placing human dignity at the centre of the way health care is delivered.”

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