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Being Poor is Expensive – Nursing Needs to Raise its Game, by Zak Matieschyn BSN, MN, RN, NP(Family)

I live in a great neighbourhood in an amazing little town in the Kootenays. I have a chubby cat. My wife and I have professional, high profile jobs that pay us well. I eat three (and ok, sometimes more) meals every single day and if I’m hungry, I jump in my car and head to the grocery store. I have decent clothes, a warm bed and good health. And I know that tomorrow and next week and next year, all or most of these things are still going to be true.

But here’s the reality of life in B.C. for one out of every five kids… they live in poverty. They don’t wonder where their next meal is coming from because a full meal is something they have rarely experienced. They don’t worry about playdates after school because they know they need to be home to look after the younger kids and make sure dinner is ready for mom before she goes to her second job. They don’t do tradsies with the other kids at lunch because they only brought one slice of bread and butter that dad made that morning.

Since my first semester of my nursing education, I’ve been interested in the social determinants of health – things like income and social status, social support networks, education, employment, working conditions, environment, gender and culture. I have a passionate drive for social justice – the fair and just relation between the individual and society. I’m sure this grew in part from being one of those kids who lived in poverty for part of my childhood.

Throughout my nursing career, I’ve struggled with the worry that I’m not doing enough. I’m not making a difference. I’m not changing lives in a big way. I’ve always worked in direct care with patients and families and I can tangibly see the impact of my work on those I care for. Some people get better, some get healthier, others don’t – but through it all, I am connected by a therapeutic relationship to every single one of them, no matter what stage of health they may find themselves in. I am grateful for every success my patients experience, but I cannot and I should not be satisfied with that.

Nursing is more than that. Health is more than the absence of disease. Good health starts with prevention. Nurses know that determinants like income, education, physical environment, housing and gender have far more impact on a person’s health than any single interaction we might have with a patient in the course of a day.

We see it. Every single day we see it. We know there are people in our communities, who come into our clinics and our hospitals, and they are struggling. They don’t have the money to buy good, nutritious food for their families. They can’t find a decent place to live because every landlord has rejected them from bias of race or sexual orientation. They are exhausted because the bedbugs in their run-down apartment make it impossible to sleep.

The single greatest determinant of health is income. We nurses totally get this - poverty is bad for your physical and mental health. With poverty comes the difficult decisions of what to prioritize first – housing, food, clothing, etc. These are difficult decisions for a relatively healthy person, but for those whose monthly income relies on disability or social assistance, these decisions are impossible because the monthly amount they receive is much too low in B.C. As a result, they often end up purchasing the cheaper, and less nutritious options, rather than items that promote good health

Nursing knows better than almost any other profession that poverty is like slow-acting poison to health. It saps health insidiously over time. In the struggle just to survive, the opportunity to thrive is lost. Nurses come into contact with those who live in poverty at every step of their involvement with the healthcare system. We are the ones who advocate for them as they negotiate this system from sickness to health. We are experts at this. And yet, all too often, once they have achieved a measure of health, we move patients out the door without giving any thought to what is waiting for them on the other side. Or rather, we do know what’s waiting, but are powerless to change it.

Am I doing enough? Probably not. Are we as a profession doing enough? I know we are not.

We already flex our minds and our hearts every day with our patients and their families. What if the entire nursing profession flexed our collective strength to address these root causes of poverty? What if we ALL became activists? What if all 40,000 RNs and NPs in the province came forward and said “ENOUGH!”? What if we tapped into our tremendous knowledge and compassion to challenge the way things are? What if we joined with those who are in poverty and together asked “how can we come together to break this cycle”? What if we pursued evidence-informed social policy for our society with the same zeal and vigor that we strive to introduce evidence-informed practice into our healthcare system?

We owe it to our patients and their families. For our communities. For the kids.

Because when you are hungry and anxious about whether mom and dad have enough money to buy bread, you just can’t make yourself care about the war of 1812, or how to carry the 4. Because one out of every five kids living in poverty is NOT acceptable - and because we should NOT be comfortable with that statistic.

Our prime minister said it well... “Because it is 2016.”


Zak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.

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Kathleen Harris

Thank you Zak, for using the power of your voice at ARNBC to speak on this serious issue in BC. My Masters degree is a combination of a Master of Public Health program at SFU, with a specific concentration in social inequities, and nursing leadership. I am currently involved with the BC Poverty Reduction Coalition and local Nanaimo area Aboriginal groups that are concerned with poverty and general SDH that grossly disproportionately affect Aboriginal people.

I could not agree more that BC nurses have a crucial role to play in making improvements on the issue of poverty and social inequities in health. I believe we have an ethical responsibility to stand up to what we know are societally driven health harms. As you point out, poverty is likely the most significant sole contributor to ill health in BC. I would like to join a call for nurses to take a public stand at the BC legislature. I have some ideas around this and am hoping you might be interested in helping to make a very visible gathering of BC Nurses heard in Victoria.

Please contact me if you know of others that it would be helpful for me to connect with to create nursing action in poverty awareness and poverty reduction.

Zak Matieschyn

Hi Kathleen,

I'm interested in hearing more about your ideas of how to raise the profile of this important issue amongst nursing. We have a lot of power and influence waiting to be unleashed.
Feel free to email me at president@www.nnpbc.com to discuss this further.



Thank you for bringing voice to this vitally important issue. I am in complete agreement that the nursing profession has a role and responsibility to advocate for those whose lives are greatly impacted in a negative way by the limits poverty places on their lives, health and well being. It is known that we have the highest rates of child poverty in the country, too many children are poor and living with food and housing insecurity, this is not acceptable. We need to show the children in this province, in this country that they matter.
As Cindy Blackstock noted in her Globe and Mail article, Stacking the odds against First Nations families, "We only get one childhood. Raising a generation of children who are honoured, loved and supported creates a better future. The World Health Organization reports that investing $1 in a child saves taxpayers $6 to $7 dollars downstream and creates a better society." We must address the issue of poverty for children, their families and their communities.
There are many who working to bring awareness to the issue of poverty it would be a huge boost and perhaps create a tipping point if we could all come together to add our collective voice to this issue to create the change that is needed. I continue to advocate for awareness and change for Aboriginal people and will look for opportunities to participate and influence social policy that addresses poverty in a tangible and meaningful way.

Zak Matieschyn

Well said, Penny. It sounds like you are doing excellent advocacy work for the people and communities you work with. A true nurse! I look forward to a day when nursing will have a greater stake in the development of social policy in British Columbia.


Karen Irving

Thanks for your blog on poverty and the need for nurses and NPs to raise the bar on poverty, particularly for children. I strongly believe that as NPs and nurses we need to work from the bottom up rather than the top down to help move the determinants of health forward. This would be beneficial in many ways as it would improve the health of individuals and families and also decrease the overall cost of healthcare as a whole.

I also work with marginalized and people that live on the street. Many do not have a roof over their head or a bed to sleep in. Many depend on the food bank or the meals that are dispensed through various agencies for their token one meal per day. Many of us do provide extras to assist our clients to help them make ends meet but are we doing enough?

That is the question--are we speaking out so that our voices are heard by those that make a difference? Do we take every opportunity to voice our concerns? What are we doing as individuals and groups to raise the bar to help ensure that the social determinants of health are being more frequently met for our clients and particularly the children? If each one of us can make a difference for one child we will impact approximately 30,000 children. How will you make a difference? I challenge you ...



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