Steps to finding the right prescription to tackle food insecuriity

Dr. Meta Van Den Heuvel, a pediatrician at The Hospital for Sick Children (SickKids), learned about financial empowerment, including tax filing and access to benefits services, when previously working on a study about food insecurity. Dr. Van Den Heuvel, and her colleague, Dr. Catherine Birken, received funding from SickKids Foundation to look at food insecurity amongst families with children requiring inpatient hospital care. The two physicians originally thought the best way to address the high levels of food insecurity they were seeing was to create a food bank or other food program for patients and families. After consulting with Valerie Tarasuk, a leading expert in food insecurity, they realized that much like health outcomes, insufficient income was actually a major structural barrier to accessing food. The link between increased income and access to tax filing services and benefits access became abundantly clear. Seeing that food insecurity was high amongst these families meant that increasing income opportunities was at least one way to help address that issue. “As a doctor, I can’t prescribe income, but I can advocate to help ensure people have assistance to access all their income benefits.”

Dr. Van Den Heuvel sees tax filing and access to benefits services as supporting the health outcomes of her patients, “I think anything we can do to decrease barriers for families to file their taxes and improve access to all benefits they are entitled to would make a huge difference [to food insecurity]. In our work we found, not surprisingly, that families who experienced household food insecurity also had higher parental stress. We know that children who live in poverty and who experience stress have negative child health and developmental outcomes. Improving income security would have a great benefit on child health and developmental outcomes.”  

Dr. Van Den Heuvel and collaborators partnered with *Community Volunteer Income Tax Program (CVITP) volunteers to provide tax filing services to patients’ families – knowing that tax filing is an important step in accessing the Canada Child Benefit. Parents of children with complex health needs have many competing priorities for their time and energy, including multiple health appointments, and completing their taxes can be pushed down the priority list. Dr. Van Den Heuvel hoped that providing the service onsite would alleviate the time and cost barriers for patients’ families to file. The physician learned, however, that although there was great interest amongst families in using the CVITP service, most of the families were not eligible due to the income and self-employment restrictions of the free program. 

Dr. Van Den Heuvel is now starting to examine the concept of a Medical-Financial Partnership (MFP), a program in which all aspects of one’s financial life can be supported. “I love the idea of a medical-financial partnership in a hospital setting. This is defined as a novel cross-sector collaboration in which health care systems and financial service organizations work collaboratively to improve health by reducing financial stress. Currently, when I refer families to community organizations, they often do not reach these organizations (it’s another step they have to take…). If hospitals and community organizations could combine our expertise and have an onsite MFP in a hospital setting, families could potentially combine medical and financial appointments, including financial education and empowerment in addition to assistance filling out forms.”

In addition to shared expertise, Dr. Van Den Heuvel also sees an opportunity for community organizations and physicians to advocate together on CVITP eligibility and the complexity of benefit application forms. “We are facing some of the same challenges. The new Disability Tax Credit form is 16 pages long and very complicated. Families need specialized support with these forms, which ideally would require a multidisciplinary team to both identify the families who require assistance and provide this support in a timely manner.” What is clearer than ever before is that families need support in hospital settings beyond what one would normally consider. Managing on low income simply adds further burden on top of an already challenging situation. More knowledge is needed on just how to best support families to increase financial resilience and access much needed income benefits. 

* CVITP is an initiative supported the Canadian government where community organizations offer free tax filing services to eligible individuals living on low incomes.