My clinical, community, and research work revolves around the relationship between poverty and health. I am privileged to hear the stories of patients who are struggling. I get it, I think to myself, and I'm committed to making a change. Do I need to do the Welfare Food Challenge to help me do this? Probably not. But perhaps I can learn something.
On Day 1 of the food challenge, I had a commitment to speak at the BC Renal Agency annual conference on the topic of poverty and health; the coincidence was too tempting. So I decided to jump in, and invited the conference attendees to join me. No one did. The audience laughed a little, although the food challenge monopolized the Q&A session, and I received several comments and emails afterwards that this was an inspiring commitment to advocacy. This boosted my spirits.
1. Welfare Food Challenge update
But this weekend, a meagre 2 days from the start of the challenge, I cheated. I needed more calories to fuel a weekend in class at UBC. My concentration was impaired. I had no energy to go to the pool or do any exercise to counteract the sitting. Paying attention in class was like meditation (tough): constantly bringing my mind back from wandering to thoughts of food. The oatmeal, rice and lentils weren't lasting long enough. What is the point of this? I asked myself. I was actively processing point No. 2 below. I was ready to throw in the towel.
After my cheater meal, I guiltily returned to my oats and lentils diet, but the food boost helped me to take double the notes in class on Sunday compared to Saturday. Monday, I struggled through a long day of seeing patients whose crises were far greater than my own. Doctors are busy and skip meals all the time (an open heart and mind effectively distracts from the stomach), so this felt oddly familiar. But it caught up quickly. This evening I returned to the tired and hungry life of a hermit on the food challenge, minimizing both energy expenditure and social contact. This isn't healthy. I'm a doctor and I know that, but now I feel it too. And as struggle on top of struggle does, it's surfacing all kinds of frustration.
2. Poverty is invisible
On Day 2 of the Welfare Food Challenge, I was invited to meet with Vancity and the Health Connection clinic in North Vancouver. As Chair and co-founder of Basics for Health Society (a project modelled upon Health Leads USA and previously piloted in Vancouver by ImpactBC), we were figuring out how to sustain this grassroots health clinic for homeless and marginalized patients on the North Shore. We see poverty in the Downtown Eastside, but not as much in other neighbourhoods in the lower mainland, and so few health services exist on the North Shore (and elsewhere) for such patients.
Their stats dropped my jaw to the floor: In the nine months since the clinic had been open, the patients of the Health Connection clinic were visiting the ER 60 per cent less. Their average inpatient stay when they did have to go into hospital (because poverty is linked with poorer health, so living in poverty means you will likely be more sick) -- dropped from 12 days to 4 days. The number of ALC days in hospital (days that patients were sleeping in a hospital bed simply because they didn't have anywhere else to go), dropped to zero. Patients said they felt safe, respected and validated at the clinic. This is the stuff of gold standard primary care.
Vancity staff rightly pointed out that they don't fund health services, but why doesn't MSP fund this project with evident need and proven cost-savings? The only answer I had to offer was that poverty is invisible. It's one thing not to have the budget to fund core health services for patients in need. But it's quite another to have the model set up, ready to go, and proven to save the system money, and not jump at the chance to fund it. To me, it was emblematic of how we often treat the poor: not worthy of our attention or investment. It broke my heart. Why was I enduring this draining and unhealthy diet for a week if research showing effectiveness and cost savings isn't enough to get the health system to invest in the poor? Perhaps I cheated on the challenge because I was coping with this shameful reality.
Suddenly I felt invisible in this food challenge. Where are the other powerful people who know about the impacts of this absurd dietary allowance on health? Where are the politicians in the challenge this year? I know that poverty isn't truly invisible. Even the wealthiest among us know someone living in poverty, or who has lived in poverty. Perhaps we employ them. Or perhaps we see a homeless person on the street, or we give to a charity or food bank. But until our compassion is awakened, until one knows the suffering of this experience, the simple truth is that we can look away if we so choose. We live in a society where we tend to look away from suffering; we equate courage with stoicism and glorified survivorship rather than vulnerability. And so our compassion doesn't extend to the poor. We might see poverty, but it isn't truly visible to us. We don't see ourselves as interrelated; or perhaps we don't acknowledge that our wealth is partly dependent on their poverty -- an idea that I may not have the courage to name if I wasn't hungry enough.
3. Pull your socks up!
On Day 5 of the Welfare Food Challenge, my parents decided to join, after four days of planning. They are both proud of what I'm doing and excited by the challenge. My mom boasts of the "Croatian peasant cooking" that she survived on through her youth as she and my grandparents climbed out of desperate poverty.
The Welfare Food Challenge, however difficult to complete, is a temporary discomfort amongst motivated, generally well-resourced, self-selecting volunteers who are able to return to their usual comforts. I find myself revolted by even a hint of judgment -- that if the poor were resourceful enough, they could live on this budget, or climb out of poverty. Or, that only those who truly work hard enough are worthy of our compassion.
This is so far from the truth that in my hungry state, I feel I must outline why it is such an offending tenet:
- We do not live in the same economic times as the baby boomers did. To expect people living in poverty to climb their way out of it through hard work in current economic times is absolving ourselves of the responsibility for caring for those less fortunate.
- Social mobility is worse in countries with greater inequalities between the richest and poorest. As Richard Wilkinson of the Spirit Level said when he spoke in Vancouver a few years ago, "If you want to live the American dream, move to Denmark."
- As it so happens, B.C. has the greatest levels of inequality between richest and poorest in Canada. And the highest poverty rates. The minimum wage is half of the living wage in Vancouver. It is unreasonable to expect welfare recipients in B.C. to climb their way out of this situation. We are entrapping them in poverty.
- Research shows that people living in poverty have worse health outcomes from every illness, compared to higher-income people. This isn't just true above the poverty line, but at every step along the income ladder. When people are facing illness and poverty, which is an undisputable truth, pulling their socks up is more than double as difficult.
- The cascading impact of poverty on poor health is further evident in places with inadequate services for the poor. Daily discrimination has been shown in over 200 international research studies to be linked to poor health. Our policies of austerity, rather than compassion and mutuality, make the problem all that much worse.
How can you pull your socks up if you can't afford socks in the first place?
4. Are we quitters?
If this challenge is emblematic of our struggle to create a more compassionate, equitable society that cares for the health and wellbeing of the disadvantaged, then I must continue as long as I can. Not because there aren't other means of creating this change, or because a more equitable society and health system has been proven to translate to better health outcomes even for the wealthiest among us. But because once you pay attention to suffering, you can't look away. This is how compassion grows, and what else is worth living for than expressing compassion for one another? It's in all of our best interests to stick with it.
Though my work binds me to a movement that is standing up for compassionate, equitable and healthy public policy, the Welfare Food Challenge has taught me something more. In advocating for what we feel is right, we mustn't be discouraged by the outcome that feels out of reach. It is this process of learning and the struggle that we carry collectively that matters most.
Photo: Christopher Porter/flickr
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