Healthcare Quarterly

Healthcare Quarterly 11(4) September 2008 : 8-9.doi:10.12927/hcq.2008.20083

Opinions: When Poverty Gets in the Way... of Health

Michel Bilodeau


When you look up poverty in the dictionary, you find it defined as an "economic condition that triggers deprivation of those things that determine the quality of life, including food, clothing, shelter and safe drinking water." What the definition fails to highlight, but has long been recognized by those dedicated to the health and well-being of children, is that poverty also deprives children of good health.
Poverty does make children sick. While poverty is not a contagious disease, it does top the list of conditions that commonly affect children and youth. And while doctors ask patients about their health history and exposure to contagious diseases, no question is asked about the one factor that single-handedly affects health - poverty. Perhaps the triage nurse in the emergency department should also ask children and their families if they've been in contact with poverty in the past 12 months. Given the relevance of poverty on a child's health, it would only make sense to ask this question and then have the appropriate resources to help.

Pediatricians are trained to find the root cause of a child's health condition, thus allowing them to initiate treatment. But what if the root cause is poverty? If such is the case, what treatment can we possibly prescribe to restore good health? Prescribing options to ensure the best health outcome for children and youth are what motivated the Children's Hospital of Eastern Ontario's (CHEO's) submission to the Ontario Provincial Cabinet Committee on Poverty Reduction.

Some may ask why a pediatric hospital is preoccupied with poverty. The list of medical conditions associated with poverty is significant - from low birth weight to asthma to impaired neural development. Given the serious implications, our prescription is focused on four main areas: child care, housing, education and prescription drugs.

The National Children's Alliance reports that 60% of children under the age of 12 years are left at home after school without supervision. Child care programs for school-age and preschool children are necessary for children's well-being, and for parents who rely on child care in order to work. The absence of reliable and affordable child care prevents parents from entering the workforce, thus contributing to poor economic conditions. Systemic changes that support affordable and subsidized child care will go a long way in reducing poverty.

Affordable housing is next on our list of priorities to reduce poverty in Ontario. Who would believe that in Canada's capital city, more than 4,000 families are in the queue waiting for social housing - housing that is provided by municipal and provincial authorities. The dream of living in the house with the white picket fence eludes thousands of families whose income simply cannot support adequate housing. As a result, families are housed in crowded apartments or dwellings that are unsafe and inadequate. The consequences of inadequate housing on a child's health are wide ranging, from an increased risk of asthma and respiratory disorders to lead exposure, ear infections and vomiting and diarrhea in infants.

A 2005 study conducted in CHEO's emergency department confirmed what we knew intuitively. Through a month-long study, over 1,360 patients and families presenting at CHEO's emergency department were asked to complete a questionnaire about their housing needs. The survey results pointed out that 33% of respondents spent more than 50% of their income on shelter costs, 17% felt there was something unsafe in their home or neighbourhood, 8% had someone sleeping in a common area and 2% had used an emergency shelter; 7% of children and youth had stayed with relatives or friends. This small snapshot in time reveals the hardship associated with poor housing conditions.

And what about education? While our educational system is publicly funded and accessible to all, inequities remain. Participation in sports teams, field trips, school supplies and resource materials are things that most kids take for granted; but for children living on low incomes, the same opportunities are simply out of reach. More must be done to ensure that all children, irrespective of their economic standing, participate equally in their school environment.

While mentioned last, a prescription drug plan for children and youth living on low incomes is a definite necessity of any poverty reduction strategy. With more and more children treated on an outpatient basis and quicker discharges from hospital after treatment, many families are faced with the significant financial hardship associated with the cost of prescription drugs. With programs such as the Ontario Drug Benefit and Trillium Drug Program, families may have options; but the burden of approval and the copayment formula doesn't suit the need of every family. For children living on low incomes, even a small deductible or copayment is challenging. Several studies confirm that patients may reduce or suddenly stop using prescription drugs when deductibles or copayments are required.

It is an indisputable fact that poverty affects the health of children and youth. It is a fact that thousands of Ontario children and youth are afflicted with poverty. Reducing or eliminating poverty will improve the health of children and youth - call that science, math or simply common sense. While the issue of poverty remains, solutions are within reach. The creation of the Ontario Provincial Cabinet Committee on Poverty Reduction is timely, necessary and most definitely welcomed.

A prescription for improving the health of children and youth is being put forward by CHEO and many others concerned with the well-being of Ontario's children. An effective poverty reduction strategy is what is needed. Affordable child care, adequate housing, equity in education and affordability of prescription drugs are all part of the remedy to ensure healthy outcomes for all children and youth of Ontario. One can trust that hospitals and their doctors know a thing or two about the health of children and youth. Following doctors' advice has never been more important!

About the Author(s)

Michel Bilodeau is president and chief executive officer of Children's Hospital of Eastern Ontario, Ottawa, Ontario.


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