In this excerpt of Upstream Medicine: Doctors for a Healthier Canada, Upstream's Executive Director Monika Dutt shares her experience of thinking and working Upstream.
Koray Demir: It’s inspiring that you’ve had the chance to work in such diverse places, like Nunavut and metropolitan Toronto. Across your experiences, is there one particular patient story that sticks out for you as being especially representative of the ideas of social determinants and health inequality?
Monika Dutt: The person who sticks out most in my mind is someone I just saw, someone from clinic last week. She had come in crying, in tears, stressed out from her work. She works in a call centre, which is one of the jobs here that hires quite a few people. It’s a low-education job; she never finished high school. She hates her job, she works full time, is stressed out from her supervisor, and is a single mother taking care of her son.
"Income is a clear determinant of health."
She tried another job that she liked, but she was only able to get part- time hours, so she went back to this call centre job that she can’t deal with emotionally. But because she doesn’t have the education, she can’t find anything else that’s full time, and she can’t take any time off work to access that education. She’s doing all this to give her son a better life than she has had, so it is this cycle that is really impossible for her to get out of right now.
She wants to stay in her home community, and even if she did move, she might not be able to get a job because of lack of education. She is still living in poverty despite working full-time hours and doesn’t have a partner to help support her family. This patient has a number of different factors that make it really difficult to figure out how to get out of this situation.
KD: I’m sure you hear those kinds of stories often in your practice. When I came into medical school, I wasn’t completely aware of the idea of health equity, but once I began working in the hospital, I saw how different socio-economic backgrounds and opportunities, like education, or even just the environment you were born into, could influence health. What do you think is the best approach to using these stories for political advocacy on behalf of our patients? How do you think we can be inspired by what we see in clinic and use it to make a difference?
"Pick something to focus on and move some policies forward in those areas."
MD: One of the challenges of thinking of things in terms of advocacy is figuring out where to focus. For example, income is a clear determinant of health that is linked to many other factors, and advocacy around income is something that I have been involved in. Lately, I have been getting involved a lot in political discussions, and so much talk is about jobs and the economy.
I’ve been trying to reframe that because we know that two of the greatest determinants in whether you can participate in the economy are child care and transportation. We need to address those determinants rather than just seeing jobs and the economy as the ultimate outcome, and we need to have these supports in order to have full participation in the economy.
It’s all about focusing on an issue that you want to get involved in. There is a risk with public health sometimes, feeling as though you can get involved in a million different issues. My advocacy has tended to be in climate change and housing, and even those are massive issues, but you can pick something to focus on and move some policies forward in those areas.
Dr. Monika Dutt has been a Medical Officer of Health in Nova Scotia, northern Saskatchewan and Ontario. She has worked in health policy at the federal level and is the Chair of Canadian Doctors for Medicare.
She lives in Nova Scotia, where she is a family physician in Wagmatcook First Nation. When not at work, her favourite place to be is outdoors in the Cape Breton Highlands with her five year old son.