Income Security Health Promotion: Addressing Patients’ Unmet Income Needs in a Toronto Family Practice, a Qualitative Study

Poverty is acknowledged as an important social determinant of health, and health care professionals are responding to it in some settings, most notably in the primary care setting. The Income Security Health Promotion service offered by the St. Michael's Hospital Academic Family Health Team in Toronto, Ontario, Canada, is an example of a primary-care intervention to address patients' unmet income needs. Understanding the history and social conditions of existence of this service will be helpful to other primary care practitioners considering income interventions in their own setting. A qualitative case study was conducted to describe the origins, context and functioning of this intervention. Purposive sampling was used to recruit 12 key informants from the Family Health Team, including income security health promoters, clinicians and management. Interviews revealed the origins of the service as part of a new and well-resourced family practice, with a team of clinicians well-versed in the social determinants of health and with a strong social justice orientation. They described the required skill set of a promoter, and the importance of assimilating the role into the circle of care. Their experience offers important insights into how to create and sustain such a program in other primary care settings.