Pinto isn’t the average family doctor. He’s a scientist in The Upstream Lab, part of the Centre for Urban Health Solutions in Toronto’s St. Michael’s Hospital. A lot of his patients are poor, so Pinto sends them down the hall to talk to a full-time “income security health promoter” who works in his clinic.
More than three-quarters of these patients come away from their doctor’s appointment with more money — 27 per cent got help applying for welfare, 27 per cent were helped applying for the Ontario Disability Support Program and 28 per cent were guided through filing tax returns so they could collect refunds.
More money improves patient health, Pinto said.
“We’ve always known about these social determinants of health. There are countless studies that emphasize that the root cause, often it’s social,” he said. “What we’re trying to do in our research group is really rigorously study these new interventions that tackle root causes of illness.”
The fact that a little financial counselling can help most poor patients increase their income is only a preliminary result in Pinto’s four-year study. He published these first results in a 10-page paper in BMJ Open, one of the publications of the British Medical Journal. By 2019 he will have run a randomized, blind test and measured the health outcomes of patients who received free financial guidance.
While the Ontario College of Family Physicians has tried to make its members aware of poverty and the social determinants of health, Pinto’s program is really the first of its kind.
Aware that not every family doctor is going to have the resources of a major research and teaching hospital like St. Mike’s at their disposal, Pinto’s team is also working with the charity Prosper Canada to develop an online tool that will help doctors’ offices tackle the financial literacy and planning problems of poor patients.
“We know that poverty is a major driver of ill-health. We also know that poor people trust doctors. It’s a free service. Many other services they won’t access because they worry about the cost,” said Prosper Canada CEO Liz Mulholland.
Getting poor people past their fear of filing their taxes can do a lot to improve their lives and financial health, Mulholland said.
“We estimate that as much as $1 billion a year in federal money alone sits on the shelf,” she said. “That could be going into the pockets of the lowest income people in the country.”
Poor people naturally want to keep their heads down and escape notice, but that often means they fail to access programs that are designed to help them.
“Job one, let’s make sure everybody who is eligible for the benefits that are already there gets them. Then we can talk about expanding them or adding new ones or doing more,” Mulholland said. “But let’s just make sure that the ones we have are getting into the hands of the people who are eligible.”
As Employment and Social Development Canada was wrapping up public consultations on a national poverty reduction plan on Aug. 31, Mulholland was hoping financial literacy and greater access to banking and other services will be part of the policy expected early next year.
“There’s still work to be done on that whole financial inclusion piece,” she said.
Prosper Canada runs clinics and workshops in homeless shelters and has found a little financial education can help shelter dwellers avoid lapsing back into homelessness after they finally do land an apartment. Getting their services into doctors’ offices would expand Prosper Canada’s outreach.
“We don’t want to try and hunt people down, or try to drive them into our arms when they have busy lives and have a lot of other pressures,” she said. “We want to meet people where they’re already going.”
Working with Pinto and Mulholland on the online financial counselling tool, researcher Anne Rucchetto is excited to be finally making the connection between what science already knows about poverty and health and what happens in the clinic.
“At this point in time, it is a very novel approach,” she said. “There aren’t very many interventions like this happening. So it is very exciting to be involved in something like this.”
Pinto is happy that his research fits so well with the history of St. Michael’s Hospital, founded by the Sisters of St. Joseph in 1892 in an old Baptist church to serve to poor and forgotten of a fast-growing city.
“St. Mike’s has a strong history from its start of serving the poor. That’s part of why I’m based at St. Mike’s,” he said.