Where some doctors see only heart disease or depression, Canadian GP Gary Bloch also sees poverty and homelessness. He realised that his patients’ health was unlikely to improve until one particular issue that plagued them was addressed – money

Gary Bloch, a family doctor working in Canada, has an unusual way of treating his patients. He looks beyond health and wellbeing to prescribe something he believes can be more powerful than medication: money. Individual factors – such as encouraging a smoker to give up – are important on one level, he came to realise, but what about the fundamental, systematic causes of poor health, such as poverty, inequality, marginalisation or racism? Though it’s nice to imagine Bloch dishing out banknotes left, right and centre, this isn’t exactly about putting hard cash into his patients’ hands. Instead he helps to boost their income, by encouraging them to apply for welfare support. “As frontline providers, we can do things to improve people’s income, for example encouraging them to file their taxes,” explains Bloch. “Many low-income people don’t, maybe because their life is full of stress, but it can be a gateway to a range of income benefit programmes. Some patients dramatically increase their income as a result.”

Good journalism about good things Rebalance your media diet with Positive News, the inspiring current affairs magazine. A carbon neutral publication, featuring stories of social and environmental progress alongside impactful photography and stunning visual design. Subscribe to Positive News magazine

He shares the story of Jason (not his real name), a patient in his late 50s who had been sleeping rough for more than 20 years and suffered from multiple health issues. “He was run down physically and mentally and suspicious of the healthcare system. He’d reached rock bottom and wasn’t accessing any social benefits when he saw me. “We helped him access income support and disability support, which gave him a steady income, and then we looked for housing for him and found him an apartment. He had been completely alienated from family and we managed to reunite him with his sister and father and develop a sense of network and community.” Five years later and Jason is a changed man, Bloch reports. “There’s a dramatic improvement in his physical health. He works part-time and he’s gone from being angry and anxious to coming in to see me laughing. He’s one of the happiest people that I know.” Such transformations made Bloch wonder: what if more doctors made this part of their practice? “It’s about taking the time to understand the types of social situations people are living in,” he clarifies. “It means that when patients lay out their health issues, I know I’m also looking at low income, inadequate housing or a lack of community connections. I then know what we need to explicitly address together moving forward.”

It means that when patients lay out their health issues, I know I’m also looking at low income, inadequate housing, lack of community connections

He began developing the concept of prescribing money in 2005 and says this kind of intervention is now woven into his work at St Michael’s Hospital in Toronto, where lawyers and income support specialists are embedded in the team to help. Having explored the approach for 14 years, Bloch is now convinced that ensuring patients have enough money to pay for things like rent and food is more effective in some cases than prescribing drugs or advanced medical procedures. So what research is there to back him up? Studies show that people living in poverty have a much lower life expectancy than those who do not. In England, for example, the gap in life expectancy for those in the least and most deprived areas of the country was 9.4 years for men and 7.4 years for women in 2015 to 2017, according to the Office for National Statistics. Research by the Child Poverty Action Group found that babies born in the poorest areas in the UK weigh on average 200 grams fewer than those born in the richest areas. To try to urge other practitioners to follow suit, Bloch developed a clinical tool: a brochure with a three-phase approach to dealing with poverty. It involves: first screening patients to find out about their income and situation, secondly, understanding the health risks posed to them by low income; and, third, connecting patients to income benefit programmes.

‘It’s about taking the time to understand the types of social situations people are living in,’ says Bloch about his approach to treating patients