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Going upstream to improve health

Toronto, April 10, 2015

By Geoff Koehler

Dr. Gary Bloch holds up a prescription based on the social determinants of health
Dr. Gary Bloch doesn’t always believe the first stop a patient makes after receiving a prescription has to be at the pharmacy. (Photo by Katie Cooper)

St. Michael’s has established a committee dedicated to addressing the social determinants of health, the first family health team in Canada to do so.

Social factors such as income, education and employment status, play pivotal roles in a person’s health and well-being. These factors, known collectively as the social determinants of health, have been shown to particularly affect the health of inner city populations.

“Every day in clinic we saw the effect social determinants of health had on our most vulnerable patients and knew we had to do something to change the status quo,” said Dr. Gary Bloch, a family physician and chair of the Social Determinants of Health Committee in the Department of Family and Community Medicine.

The committee oversees several projects targeting root causes of health inequity.

The Family Health Team has a dedicated health promoter, Karen Tomlinson, focused on improving income security for patients living in poverty. The IGNITE (addressInG iNcome securITy in primary carE), randomized controlled trial will evaluate this position.

Legal Aid Ontario funded a lawyer, employed by the ARCH Disability Law Centre, to work at St. Michael’s 80 Bond St. clinic. The lawyer, Johanna Macdonald, works closely with community partners to address legal needs affecting patient health outcomes, such as employment or housing disputes.

To improve literacy, Family Health Team clinicians encourage parents to read aloud to their kids. A joint initiative with the Toronto Public Library called Reach out and Read makes age-appropriate books available for free to kids during checkups.

  “Patients are surprised to be handed a children’s book or referred to someone in the clinic who can help them with their taxes, but they’re pleasantly surprised.”
- Dr. Bloch

The result of such diverse projects is a multidisciplinary practice unlike any other doctor’s office.

“Patients are surprised to be handed a children’s book or referred to someone in the clinic who can help them with their taxes, but they’re pleasantly surprised,” said Dr. Bloch.

These interventions are only the first part of the committee’s plan to improve health outcomes for St. Michael’s inner city patients.

“These interventions likely make a difference for our patients but we need to quantify that,” said Dr. Andrew Pinto, a family physician and scientist at the Li Ka Shing Knowledge Institute. “As an academic centre, we study each project to find out what works and what can be improved.”

As the committee’s lead researcher for these projects, Dr. Pinto said he hopes that such evidence will encourage other institutions with similarly vulnerable patients to develop their own social determinants of health committees, try novel interventions and challenge the status quo.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.