May 18, 2016

"Doctors should be foot soldiers to advocate for a fairer society" was the message delivered by Sir Michael Marmot, a leading international expert on the link between health and social inequality.

Speaking to a packed auditorium at St. Michael’s Hospital in early April in an event jointly hosted with the OCFP, Sir Michael shared some of the very compelling stories and data from his new book The Health Gap – The Challenge of an Unequal World, and urged us all to take action in alleviating poverty and addressing the other social determinants that lead to inequitable health outcomes.

OCFP President Dr. Sarah Newbery with Sir Michael Marmot and OCFP Poverty and Health Committee Co-Chair Dr. Gary Bloch. 

What does that mean for us as family doctors?

Being on the frontline of health care means we often work directly with people who live with challenges that lead to health inequity – whether they be refugees, people with disabilities or developmental delays, or people living in poverty. Sometimes, the challenges that people face are obvious to us as health-care providers, but sometimes they are not. Unless we ask directly, we don’t always know, whether our patients can pay the bills, put food on the table or have safe housing. Asking good screening questions, like that recommended in the poverty tool - “Do you ever have trouble making ends meet?” - can help us to identify those patients in whose lives we can make a difference, not through “traditional” therapies, but rather through addressing the social determinants and prescribing income.

Sir Michael’s description of family doctors as “foot soldiers” - like Virchow’s statement that physicians are the “natural attorneys of the poor” - really struck me. As a family physician, my goal ultimately is to improve the chances of my patients living to their fullest health potential. While often this entails screening for disease, or making a diagnosis and prescribing medications, it also must sometimes mean better understanding the context of my patients’ lives and helping them to access things like income, better housing, better food, etc.

Who is Sir Michael Marmot? Sir Michael is the President of the World Medical Association and has recently been commissioned to lead a report on health inequalities for the Pan American Health Organization. Watch his presentation: An Evening with Sir Michael Marmot

The role of the family doctor does not end with the individual patient encounter. We can also affect change at the policy level. We have seen excellent examples of family physician advocacy in just the past few months. Family physicians have been advocating for indigenous people living in impoverished conditions in our remote First Nations communities; many have been advocating for a national pharma-care strategy to support access for all Canadians to the medications they need, and recently, we have seen the success of  health-care providers and others advocating for a guaranteed income. 

Equity in health is a matter of social justice, and a matter in which we all can make a difference. Working to shape the health of individuals, we support healthier families, and help build more vibrant communities that, in turn, support our future health. I believe that family physicians can and do play a crucial role in decreasing health inequity. With the courage and determination to act, and enough imagination to envision a more equitable society, we can make a huge difference.

On May 19, family doctors around the world observe WONCA’s World Family Doctor Day and celebrate the contributions each of us make to the lives of our patients, health-care systems and broader society. As I reflect on my work, and our work together, I wonder what role you see family doctors having in shaping a society where patients can live their best possible life?

Links and Resources:

While there are many great resources focused on the social determinants and the role of family doctors, here are some recent ones to explore:

OCFP - Poverty and Health Resources

CFPC - Best Advice Guide: Social Determinants of Health

Health Quality Ontario - Income and Health: Opportunities to achieve health equity in Ontario

Health-Care Providers Against Poverty

Upstream

Video - Presentation Dr. Michael Kirlew from the Sioux Lookout First Nations Health Authority to the House of Commons Aboriginal Affairs Committee

Canadian Family Physician articles

Social accountability at the micro level: One patient at a time - April 2016

Indigenous relationships, logging roads, and first-class medicine - January 2016

Practising social accountability: From theory to action - January 2016

Dutch Masters and social determinants - January 2016