Developing a Diagnostic Approach to Multi-Dimensional Poverty

Resource accumulation benefiting some people over others has been naturalized throughout human social evolution, even when its acquisition caused widespread suffering, disease, and premature death. The first religious orders, humanitarians, and indeed nurses, all emerged in response to this widespread exploitation and misery. In our globalized and technologically advanced world, there is widening inequality, deepening impoverishment, complex threats to health and security, and increasing uncertainty. As clinicians, we seek to assist people living in multi-dimensional states of suffering, yet our tools and methods are insufficient. Poverty measures often focus on monetary impoverishment alone; most are not meant to be broad or diagnostic in nature; political barriers and other perverse incentives limit the scope of poverty case finding; practice barriers (not least, time) limit case finding in the clinic; and often we focus on symptoms and surface manifestations of poverty – not the root causes. Grounded on an ontological foundation of critical realism and guided by an epistemology of critical theory, this study seeks to address this practice gap by synthesizing existing poverty measures and approaches via a literature scoping review; collecting primary data from health providers and clients through a generic qualitative research study; and constructing a novel diagnostic approach to multi-dimensional poverty with an emphasis on clinical utility. During eight months of data collection in urban Toronto, semi-structured interviews were carried out with 11 healthcare professionals and 6 clients, as well as a multidisciplinary focus group of 5 clinicians. Findings revealed that respondents held diverse perspectives on the definition of “poverty”, what to do about it, and what provider and client roles ought to be. Respondents also helped prioritize life domains, proposed ways to measure complex aspects of life, and suggested settings where a diagnostic approach to poverty would be useful. Based on these findings, I propose the Survival – Orientation – Self-Actualization (S.O.S.) Diagnostic Approach, a novel multi-dimensional measure infusing elements of the nursing process, person-centered care, and ethical triage to better guide poverty case finding and praxis in the clinical setting. The study concludes by offering suggestions on application to practice, informing policy, and suggestions for future research.

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