Tax season is upon us and my practice is humming. I am not an accountant, I am a family doctor. My patients are not bank executives, they are largely people who live in poverty, many who are homeless and on social assistance. Yet I have set out to remind my patients – each and every one of them – to fill out their tax returns.
Is this a case of confused professional identity? Have I confused RRSPs with ECGs? I don't think so. This is a powerful health intervention.
Rena, a patient of mine who suffers from high blood pressure, chronic back pain and depression, and with whom I have spent countless hours, once said to me, "Doc, if you really want to make me better, get me more money."
Rena works full time at a minimum wage job, earning just under $20,000 a year. With this, she does her best to support herself and her young daughter. However, she has not always been diligent in filing her tax returns. If she had, she could have received over $8,000 more a year in tax credits from the provincial and federal governments. That might have gone a long way to make things just a little bit better for her, including her health.
Suggesting Rena fill out her tax return is prescribing income. And prescribing income can be just as powerful as prescribing medications for her blood pressure or her mood.
This approach is grounded in evidence.
The link between health and income is solid and consistent – almost every major health condition, including heart disease, cancer, diabetes, and mental illness, occurs more often and has worse outcomes among people who live at lower income. As people improve their income, their health improves. It follows that improving my patients' income should improve their health.
There is evidence that this approach to delivering health care works. Family practices in the U.K. have worked with "welfare rights advisors" for two decades. These advisors focus on helping low income patients access the income benefits they are due. These programs have been shown to improve patients' income and sense of wellbeing in the short-term studies that have been conducted so far.
Closer to home, a study conducted in Dauphin, Man., in the 1970s, recently analyzed by health economist Evelyn Forget, showed that an income supplement offered to an entire town reduced hospital visits, birth rates, and hospitalizations for mental illness, accidents and injuries.
It is true that the most meaningful answer to addressing poverty lies in much larger scale interventions than my attempts to have my patients fill out their tax returns. In fact, the same can be said for many conditions we treat. We can combat heart disease with cholesterol and blood pressure medication, but what about reducing saturated fats in processed foods? Diabetes can be improved with metformin and insulin, but what about decreasing access to sugary drinks?
We do our best to treat each patient and their illness in our own practices while advocating for broader policy change. The same approach is necessary for fighting poverty. As doctors we need to, and we can, prescribe income while advocating for real, effective policies to combat poverty.
I will continue to advise my patients to exercise more and eat healthier food, but this tax season I will also spend time prescribing tax returns. Income is a powerful determinant of health – more so than many medications I prescribe. I will do my part to make it a positive force in the health of my patients.
Gary Bloch is a family physician with St. Michael's Hospital in Toronto, and the chair of the Ontario College of Family Physicians' Committee on Poverty and Health. He is an expert advisor with EvidenceNetwork.ca.