The World Health Organization defines health as a state of complete physical, mental, and social well-being.1 Therefore, health is not merely the absence of disease or infirmity, but takes into account multiple economic, social, and environmental factors affecting individuals and populations.1 The concept of overall health is largely taught in medical schools and is being gradually introduced into health networks across Canada.2 Increasingly, physicians are understanding the importance of interprofessional collaboration and are adopting an integrated approach that considers the various determinants impacting patient health. However, services provided within health institutions are, admittedly, often limited and do not consider the full range of factors affecting patients’ well-being, particularly with respect to vulnerable and marginalized people.3 As a result, individuals living in financially and psychosocially unstable situations, such as those who are homeless or people with substance use disorder, are often isolated and difficult for health care providers to reach. Fortunately, there are medical clinics specifically aiming to serve these patient populations by offering a wider range of psychosocial and physical health services housed within the same establishment. The SPOT clinic in Québec, Que, is one such clinic.
The SPOT clinic is a non-profit organization founded in 2014 with a mission focused on improving the overall health of marginalized people and people living in precarious situations, such as those who are homeless, people who have been previously incarcerated, or refugees.4 This community clinic uses a collaborative, interorganizational, and interprofessional approach to combat social inequalities in health care. The SPOT clinic also offers free dental care, physiotherapy, psychotherapy, community intervention, massage therapy, nursing care, medical consultation, and other services to almost 900 people per year. In addition, this organization uses a therapy dog to build trust between social service workers and some service users. Clinicians observed the benefits that the dog had on vulnerable patients and noted that a portion of the SPOT clinic patient population also owned pets; the clinic decided to establish veterinary services on site at its Maison Mère-Mallet locations in Québec. By adopting this innovative vision of overall health, the SPOT clinic has positioned itself as a leader in community medicine and in linking animal health to the health of vulnerable populations.
The SPOT clinic’s veterinary service project was born through collaboration between 2 veterinarians who are also family medicine residents at Laval University in Québec, Que. Since March 2021, these veterinarians have volunteered 1 day per month, offering their services to pet owners living in psychosocially and financially precarious situations. People who meet the project’s selection criteria are referred by various community organizations in Québec. The Ordre des médecins vétérinaires du Québec was consulted to ensure that the SPOT veterinary clinic was in compliance with Québec’s veterinary medicine regulations. Veterinary services are free and focused on pets. Veterinarians also use these consultations to address public health issues like zoonosis transmission and prevention. On days when veterinary services are offered, patients are greeted by a social worker who uses the animal as an initial point of contact for building trust with the owner. While the owner waits for their veterinary consultation, the social worker has the opportunity to discuss and identify the owner’s needs and to offer support and relevant services as necessary. It also gives isolated individuals who are disconnected from the mainstream health care system the opportunity to access comprehensive health care services in an environment that is safe and welcoming, both for them and their pet.
Impact of animals and the SPOT veterinary clinic
To improve services and better understand the impact of animals and the SPOT veterinary clinic on the health of vulnerable people, surveys were distributed to pet owners who attended appointments in 2021. This initiative was supervised by the SPOT clinic research and ethics committee. The survey was completed voluntarily and administered by attending social workers. Between March and September 2021, 36 pet owners benefited from the veterinary service for a total of 100 medical consultations. Ninety-four percent of the pet owners agreed to complete the survey during their first visit. While interviewing these owners, we were not surprised to find that they all considered their pets to have had a positive effect on their health. In fact, they mentioned that their pets improved their social well-being by decreasing their social isolation, improved their mental health by providing emotional support, and improved their physical health by leading them to adopt a healthier daily routine. Consistent with other studies,5,6 most respondents (56%) admitted that having a pet currently or at some point had compromised their ability to meet their basic needs (ie, housing, food, clothing) because of the associated costs. A substantial proportion of those interviewed (38%) also mentioned that they had previously ignored or delayed their own health care needs (eg, hospitalization) because of their pet. It is also important to highlight that 56% of owners agreed that they would be more likely to use health care services that also accepted animals.
A second survey was distributed to owners during subsequent visits to the SPOT veterinary clinic. Most respondents (70%) completed it during their pet’s booster shot appointments 1 month after the first consultation. Despite 30% of pet owners not returning for follow-up appointments, the initial results demonstrate the positive impact of veterinary services on the health of service users. Ninety percent of respondents experienced reduced anxiety after their pet received veterinary care. One service user said, “I feel less stressed because I know more about the state of my pet’s health.” We noted that 50% of respondents had never used SPOT’s services for their own health, but 90% said they were more likely to do so after visiting a veterinarian there. Additionally, 70% were interested in more information about the SPOT clinic’s other health care services after having used its veterinary clinic.
Social workers supporting people who live in poverty or psychosocial precarity in Québec also gave us positive feedback on the implementation of SPOT’s veterinary service. In fact, according to the social workers the veterinary service “puts the person more at ease and promotes greater trust in the SPOT team as a whole, rather than in one professional in particular.” They also described the presence of an animal as a “facilitating factor in approaching precarious individuals” and an “external motivator for rehabilitation” for owners.
Conclusion
The objective of linking animal health to the health of vulnerable people is related to the concept of comprehensive health promoted around the world. While other free veterinary services for marginalized people exist—such as the Clinique des animaux des jeunes de la rue in Montréal, Que7—very few medical clinics are integrating veterinary services as part of an interdisciplinary, collaborative approach. However, there are some interesting examples that demonstrate the benefits of such an approach. In fact, in 2013 a collaboration between the departments of medicine and veterinary medicine at the University of California, Davis, and several community organizations led to the opening of the Knights Landing One Health Center.8 This centre employs several professionals who serve a rural municipality with a large immigrant population that did not have access to health care services. The synergy between the physicians and veterinarians has allowed them to better understand population needs and increase zoonosis screening, which has, in turn, improved the health of vulnerable individuals.
Finally, while the SPOT veterinary clinic is still new, we have already found that veterinary services housed within the same location as a community health clinic improve the overall health of vulnerable and marginalized people. Meeting with veterinarians helps establish a relationship of trust with the pet owner, in addition to addressing the owner’s fears of not having access to resources while having a pet that requires care. Furthermore, by providing free veterinary care to people living in poverty, individuals are better enabled to put their money toward meeting their own needs, such as housing, food, and clothing. This innovative approach also promotes relationship building between owners and other health care professionals who can respond to the needs of individuals who are often disenfranchised. In the future, this collaboration with veterinarians is expected to develop in a sustainable way that promotes advances in overall health.
Footnotes
Competing interests
None declared
The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.
Cet article se trouve aussi en français à la page 491.
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