Public Health

COVID-19

Equity

Faculty of Law

Emerging and Pandemic Infections Consortium

Disability rights, disability justice and disability advocacy have been an increasing focus of Trudo Lemmens’s research – particularly in the wake of COVID-19.

“The recent COVID-19 pandemic revealed again how various measures and policies often uniquely impact on persons with disabilities,” says Lemmens, a University of Toronto Faculty of Law professor who holds the Scholl Chair in Health Law and Policy with cross-appointments to U of T’s Temerty Faculty of Medicine, Dalla Lana School of Public Health and Joint Centre for Bioethics.

“The voices of disabled persons were largely ignored, and the disability community was not meaningfully involved in the decision-making process.”

Lemmens and co-principal investigator Alison Thompson, an associate professor and a bioethicist at U of T’s Leslie Dan Faculty of Pharmacy and Dalla Lana School of Public Health, as well as former members of the COVID-19 Science Advisory Table, are leading a global interdisciplinary study on “Rebuilding public trust after COVID-19: Examining public health measures and their impacts on disadvantaged communities.”

Their research, supported by the Social Sciences and Humanities Research Council’s (SSHRC) New Frontiers in Research Fund for post-pandemic recovery, aims to shed light on the challenges faced by disadvantaged communities during the pandemic and provide insights to rebuild public trust and address health disparities.

“Viruses don’t discriminate, societies do,” says Thompson, who has worked on ethics and policymaking issues both nationally and internationally and was a member of the Ontario COVID-19 Bioethics Advisory Table.

“We need to listen to persons living with disabilities, for example, about how their concerns can be better addressed, and how policy processes can be made more inclusive and responsive to the needs of people who are disproportionately harmed because of pre-existing, unjust social conditions.”

Alison Thompson (supplied image)

Their post-pandemic recovery research is born in part out of earlier work by the project's team members, including Deborah Stienstra, a professor of political science and director of the Life Work Well Research Centre at the University of Guelph, and Kevin Bardosh, an applied medical anthropologist at the University of Washington. The work was also informed by policy discussions on clinical triage policies with the Ontario Human Rights Commission, ARCH Disability Rights Centre, and the AODA Alliance (Accessibility for Ontarians with Disability Alliance).

Stienstra’s report, “Consistently excluded: A disability inclusion analysis of Canada’s COVID-19 policies,” was featured during the Faculty of Law’s ongoing Health Law, Policy & Ethics Seminar Series, which was organized by Lemmens.

Another seminar featured the collaborative research paper – “The Unintended Consequences of COVID-19 Vaccine Policy: Why Mandates, Passports, and Segregated Lockdowns May Cause more Harm than Good” – written by Bardosh, Lemmens, and others involved in the new project. A recording of the discussion for "Unintended Consequences" has since received more than 77,000 YouTube views.

“Experts have been recommending development of pandemic policies for a long time – since SARS-CoV [severe acute respiratory syndrome] in Ontario – and still it appears we were unprepared and failed to have equitable policies in place,” Lemmens says.

He adds that other countries introduced different measures and policies during COVID-19 and that we can learn from various approaches. Fernando Aith, a visiting professor of health law at University of São Paulo, is part of the research team that will be exploring Brazil’s approaches.

“Brazil had one of the highest COVID-19 fatality rates in the world. Denialism, mistaken political and administrative decisions, lack of co-ordination between the different Brazilian federative entities, stand out among the problems faced throughout the pandemic, which killed more than 700,000 people in the country,” says Aith.

“A comparative study between Brazil-Canada will allow us to understand the similarities and differences of these countries in confronting the pandemic, and thus consolidate strategic knowledge to prevent future public health emergencies."

Lemmens says public health policy has traditionally emphasized the importance of building, strengthening, and maintaining public trust. To that end, researchers will explore how the implementation or absence of different measures, such as testing strategies, vaccine and mask mandates, clinical triage policies and public health communication have influenced public trust – particularly between already disadvantaged communities, health authorities and other institutions such as universities.

“Our research is built on this premise that trust is key to promote public health in the long-term and to ensure compliance with public health measures,” Lemmens says. “But during the pandemic, measures and policies – often of a rights-restrictive nature – were implemented or withdrawn without discussion with those particularly affected.”

He says it can be argued that the seriousness and urgency of the public health threat may have hindered elaborate consultation, but stresses that the need for inclusion in decision-making is a must.

“In our research, we want to explore what the impact is on how governments, health-care institutions and universities acted during the pandemic, and whether things could have been done differently, particularly from a disability justice perspective. We want to come up with more inclusive public health governance approaches,” he says.

“Could we design an advisory committee structure that involves more stakeholders from the disability community, racialized minorities, Indigenous Peoples and those living in poverty? How would such a different governance structure function during a pandemic?”

By examining the intersection of public health policies and societal factors, the project can help inform future policymaking and public health interventions.

“We shouldn’t too quickly turn the page and move on as if everything went well,” says Lemmens. “We need to learn from our experiences.”

Research shows how boosting immune memory could help develop improved flu vaccine

siddiq22 — Thu, 11 May 2023 20:33:55 +0000

Research shows how boosting immune memory could help develop improved flu vaccine

siddiq22 Thu, 05/11/2023 - 16:33

Cutline

PhD student Karen Yeung is one of the recipients of the inaugural EPIC Doctoral Awards for her work on boosting immune memory to enhance protection against influenza (supplied photo)

Betty Zou

Topic

Breaking Research

EPIC

Temerty Faculty of Medicine

Karen Yeung is no stranger to outbreaks of respiratory infections. As a child growing up in Hong Kong, she lived through the first SARS outbreak in 2003 and witnessed the city dealing with repeated threats of bird flu in the years that followed.

Twenty years later, in the midst of a global pandemic caused by SARS-CoV-2, the fourth-year PhD student in the department of immunology at the University of Toronto's Temerty Faculty of Medicine is leading critical research to understand how our immune systems respond to influenza infection – and how we might be able to leverage that knowledge to create a long-lasting, universal flu vaccine.

Yeung is one of 31 recipients of the inaugural Emerging and Pandemic Infections Consortium (EPIC) Doctoral Awards, which supports outstanding students pursuing infectious disease research.

“Current flu vaccines work by inducing an antibody response against a specific component of the influenza virus, but this viral component mutates very quickly every year. This means that the antibodies that you make against this year’s flu vaccine likely won’t match the strain of flu that we’ll see next season,” says Yeung, who is supervised by Tania Watts, a professor of immunology at U of T who holds the Canada Research Chair in anti-viral immunity.

Immune cells called memory CD8+ T cells might hold the key to unlocking broad protection against multiple flu strains. These immune cells retain a memory of a pathogen long after the initial infection, which allows the body to quickly mount a powerful immune response the next time it encounters that pathogen. And unlike the antibodies generated from a flu vaccine, memory T cells recognize parts of the influenza virus that are more likely to remain unchanged between strains and from one year to another.

Previous work from Watts’ lab was the first to show that a protein receptor on CD8+ T cells called 4-1BB is an important player in the formation of memory T cells after a flu infection. 4-1BB is part of a communications cascade that relays cues to regulate the immune system. Yeung’s doctoral research aims to uncover how this pathway is turned on to produce memory CD8+ T cells.

“We’re really interested in how cells can communicate to each other through the language of receptors like 4-1BB and signaling,” Yeung says.

“When you have a lung infection due to flu, what kinds of signals are the CD8+ T cells receiving in the lungs that are helping them transition to memory T cells? How can we manipulate these mechanisms to form more of these memory cells?”

So far Yeung’s work points to monocytes – a type of immune cell that is recruited to the lungs early on during an infection – as providing the activating signal to allow more CD8+ T cells to become memory cells. Next, she’ll be looking at what happens during a secondary flu infection if 4-1BB signaling is disrupted and there are fewer protective memory T cells.

By deepening the understanding of how immune memory develops, Yeung’s research – which is funded by the Canadian Institutes for Health Research – is laying the groundwork for new approaches that could complement existing flu vaccine strategies to elicit a broader and longer-lasting immune response.

“It takes us closer towards a universal flu vaccine strategy, where one shot will be enough to protect against seasonal influenza and future influenza pandemics as well.”

Lessons learned during Ebola crisis can help manage Marburg outbreak: U of T expert

Christopher.Sorensen — Thu, 23 Mar 2023 15:08:31 +0000

Lessons learned during Ebola crisis can help manage Marburg outbreak: U of T expert

Christopher.Sorensen Thu, 03/23/2023 - 11:08

Cutline

A colourized transmission electron micrograph of two Marburg Virus particles (image courtesy of NIAID)

Betty Zou

Topic

Emerging and Pandemic Infections Consortium

EPIC

Temerty Faculty of Medicine

World Health Organization

Earlier this year, Equatorial Guinea declared its first outbreak of Marburg virus disease, with 11 confirmed deaths so far.

The Marburg virus – a rare but severe hemorrhagic fever which affects both people and non-human primates – belongs to the same family of viruses as Ebola. The disease presents with similar symptoms, including high fever, diarrhea, abdominal pain and cramping, and occasionally severe bleeding.

Rob Fowler, a critical care physician at Sunnybrook Health Sciences Centre and a professor in the department of medicine at the Temerty Faculty of Medicine at the University of Toronto, volunteered with the World Health Organization (WHO) on the frontlines of the Ebola outbreak in West Africa in 2014 and in Congo in 2018. In 2021, he co-chaired the WHO guideline development group that published the first guidelines for Ebola virus disease therapeutics.

He recently spoke with writer Betty Zou at the U of T-based Emerging and Pandemic Infections Consortium (EPIC) about the recent Marburg outbreak and what lessons health professionals can learn from the prior Ebola crisis to help manage this infectious disease.

What do we know about Marburg virus and how it’s transmitted?

Marburg is typically spread from an animal reservoir to other animals or to humans. When it gets into humans, there can be human-to-human spread through direct contact. The direct contact is often through bodily secretions, such as someone vomiting, having diarrhea or bleeding.

Once the virus gets onto a person’s hands, it can enter the body through mucus membranes like your eyes or the inside of your nose and mouth. In rare instances, we’ve seen health-care workers get infected through a needle-stick or sharps injury in the skin that allows the virus to directly enter the blood. And very, very rarely, people have found residual virus in certain bodily fluids that evade the immune response after the acute infectious phase has passed.

How did you react when you first found out that the cluster of people who died of suspected hemorrhagic fever had tested positive for Marburg virus?

Any time there’s a Marburg outbreak, it’s worrisome. Historically, it’s a virus that spreads efficiently from person to person and the mortality has typically been very high.

Like Ebola, this virus often shows up in areas that have underdeveloped health-care systems and a lot of characteristics within society at large that enable person-to-person spread. Tight living quarters is one example. These areas oftentimes don’t have the ability to limit virus spread because of a lack of access to consistent running water. So Marburg or Ebola outbreaks are, of course, very tough for patients and health-care teams, but also very difficult for the health-care system and the population at large to manage.

I feel for the folks that are in the thick of it right now because it’s very, very hard.

What lessons can we take away from the Ebola outbreaks over the past decade to respond to the Marburg virus disease outbreak?

When you have a disease that has a high mortality rate – mortality for Marburg virus disease can range from 25 per cent to 90 per cent – and is very transmissible, we really need to focus on prevention and trying to stop the outbreak from getting larger.

If you’re not living in an area where clinicians are able to send samples for rapid testing, then you can get behind very quickly in an outbreak. Having reference testing laboratories that are geographically nearby is critical. It’s also really important to have a culture of infection prevention and control embedded in health-care settings. The same precautions we use to prevent norovirus transmission in Canada would work well to protect people from more serious viruses like Marburg and Ebola.

If we can provide health-care teams with basic precautionary tools – gloves, gowns, eye protection, medical masks, access to running water and soap – combined with well-practiced infection prevention and control hospital processes, then that will help to prevent spread within health-care facilities.

Another key element is clear and effective messaging to the public about how we can prevent spread in the community. In addition to excellent infection prevention and control practices in hospital, you also need equal engagement in the community where the virus can otherwise spread.

Rob Fowler, second from right, with WHO colleagues, clockwise from bottom left: Sharmistha Mishra, Benon Tumwebaze, Senyonga Muzafalu, Adrienne Chan, Peter Kiiza and Mekonnen Tadesse at the Ebola Clinical Training Centre in Freetown, Sierra Leone (photo courtesy of Rob Fowler)

Where are we with vaccines and treatments for Marburg virus disease?

There currently isn’t an approved vaccine for Marburg virus. However, there are a number of promising early-phase evaluations underway. Having an effective and accessible vaccine is key in terms of prevention of infection.

For treatments, there are nonspecific antiviral medications that may be effective – including repurposed medications such as remdesivir, which has been used to treat people with COVID-19 and tested previously in Ebola virus outbreaks.

Important products in development include monoclonal and polyclonal antibodies that are specific to the Marburg virus. In our experience with Ebola, those antibody treatments were incredibly effective in reducing mortality. For Marburg, that probably represents one of the brightest hopes. To develop these antibodies, there has to be a will – not just medical or societal will, but an economic will – to do it. For Ebola, that economic will existed during and after the 2014 outbreak in West Africa. For Marburg, there has been less of an economic imperative for companies to dive into this, but hopefully that changes.

One of the things that the WHO can do is bring people together from academia, industry and other sectors and set priorities that help to send a signal and direct funds. That has happened recently for Marburg and now there are more candidate drugs being tested. I think there’s lots of hope that, as with Ebola, Marburg will have effective therapies.

What’s your outlook on this current outbreak?

It’s hard to share predictions being so far away from what’s happening on the ground, but I think it’s fair to say that we’re never out of a danger zone when an outbreak is ongoing. Sometimes you have an initial surge of cases being diagnosed, followed by concern among the public and people not seeking care or not getting tested out of fear. That can create a lull between the first set cases and the next bump in cases. The incubation period is usually about a week, but can be up to about three weeks.

Theoretically, if you go three weeks without a new case, you might think that the outbreak is clearing. However, that assumes you know about all the new cases – which is almost never true. There’s a relatively large risk that there will be unknown cases. That’s why we generally go through at least two 21-day periods without a new case before we think an outbreak is over.

How can the EPIC community help respond to outbreaks like this one – now and in the future?

There’s so much expertise in the EPIC community – and in the Toronto and Canadian communities more broadly. I think we really have had an outsized influence on vaccine and therapeutic development, diagnostic testing and clinical care.

Canada has been a leader in developing vaccines and monoclonal antibody treatments that were very helpful during the 2014 Ebola outbreak in West Africa. Supporting lab-based diagnostic capacity in Africa was also incredibly helpful. The National Microbiology Lab in Winnipeg has been very good at supporting other countries and helping them build up their diagnostic capacity.

Canadians have helped to build the foundations of excellent acute and critical care for patients with Ebola – this goes such a long way to reduce mortality even when there isn’t a specific therapy available. Yet, all of this requires people to say that it’s not just someone else’s issue – it’s our collective issue that we can bring our expertise and resources to help with. It’s about individual people asking themselves the question, “Do I have something to offer?” The answer is almost always, “Yes.”

Through quilting, PhD student accepts her sleeplessness and challenges the 'sleep industrial complex'

geoff.vendeville — Thu, 25 Nov 2021 17:31:55 +0000

Through quilting, PhD student accepts her sleeplessness and challenges the 'sleep industrial complex'

geoff.vendeville Thu, 11/25/2021 - 12:31

Cutline

Kristie Serota, a PhD student in public health, made a quilt to describe her relationship with sleeplessness and challenge the conception of insomnia as a medical disorder (photos courtesy of Kristie Serota)

Françoise Makanda

Topic

Breaking Research

COVID-19

Sleep

About one-in-four adults in Canada reports being dissatisfied with their sleep. But instead of fighting sleeplessness, Kristie Serota chose to embrace it.

The PhD candidate at the Dalla Lana School of Public Health took up quilting in the wee hours to document her relationship with sleeplessness – and to critique what some researchers call the “sleep industrial complex.”

In the latest issue of Art/Research International: A Transdisciplinary Journal, she says nocturnal quilting helped her accept sleeplessness as a part of her life rather than a medical disorder in need of fixing – an insight that speaks to a larger public health issue related to precarious employment, inflexible work schedules and other stressors that often disproportionately affect marginalized groups.

Kristie Serota

“You know sporadically, periodically or continuously having trouble falling asleep and staying asleep is just a normal part of our human experience, and yet we have special mattresses, oil diffusers, teas and meditation,” Serota says. “Who is benefitting from this?”

Serota came up with the idea of quilting to critique the “biomedical construction of sleeplessness as insomnia” during a narrative research course taught by Michael Atkinson, a professor at Dalla Lana who specializes in the study of suffering and pain across cultures and health-care contexts.

The course challenges students to recount a personal health experience using a medium of their choice.

Although sleep aids represent a multi-billion-dollar market, Atkinson notes these products do not address the core causes of insomnia. “It doesn’t fix the conditions of your existence,” he says. “You still have to get up early. You still have to go to work. You still live within those structures. You still have anxieties.”

Atkinson says the influence of one's social climate on sleep cannot be underestimated. Studies suggest that socially marginalized people, including disadvantaged women, are most vulnerable to insomnia.

“The most vulnerable members of any social structure usually report higher in categories related to population health conditions and this is certainly true of insomnia,” Atkinson says.

While there is a substantial body of research on sleep and a massive sleep product industry, there is relatively little public-health research on the subject, Atkinson says – except for a small area of scholarship on the sleep industrial complex.

He says it may be time to pay greater attention to the social causes of insomnia, which Atkinson categorizes as an invisible disability.

With the shift in work schedules during the pandemic, many have experienced disruptions to their sleep for better or worse. While added anxiety has kept some up at night, others have said remote work has given them greater flexibility catch some shut-eye according to their own schedule.

In Serota's case, she says working remotely allowed her to follow a sleep cycle that matches her internal clock.

“I have just embraced sleeplessness and instead of fighting against myself and getting really frustrated and worked up that I can’t fall asleep. I just get out of bed and go do something else, and then wait until I feel tired and then say ‘Okay, I guess, now is when I’m going to go to sleep,'” she says.

However, Serota acknowledges that embracing sleeplessness requires a flexible work schedule that isn't available to everyone.

Atkinson, too, says a nine-to-five work schedule, plus after-hours work demands, can cause stress that makes it difficult to sleep.

“We’ve got these nine-to-five schedules or whatever schedules that structure our existence,” he says. “But we take so much of that home and it’s never over, and so we’re either working late into the night, or we have 100 million things in our head at night. And this is such a common thing.

“You’re not able to sleep within the confines of that structure,“ he adds. “You never get to sleep, and then it creates more anxiety when you try to sleep because you’re constantly worried.”

Atkinson recommends looking into health interventions that could promote work-life balance: changing the length of work shifts, giving employees the ability to work from home and reducing job insecurity.

On a cultural level, he says it is worth re-examining the idea that living with stress that keeps us up at night is natural. “The worst thing that happens is that we assume culturally that the lack of sleep is normal,” he says.

Stories from the Field: Podcast on public health nursing launched with U of T support

Christopher.Sorensen — Thu, 30 Sep 2021 17:54:37 +0000

Stories from the Field: Podcast on public health nursing launched with U of T support

Christopher.Sorensen Thu, 09/30/2021 - 13:54

Cutline

Susan Blue and Maureen Cava, both retired public health nurses, created the Stories from the Field podcast to shine a light on the important role public health nursing plays in the health-care system.

Rebecca Biason

Topic

Lawrence S. Bloomberg Faculty of Nursing

Coronavirus

Temerty Faculty of Medicine

The COVID-19 pandemic has pushed the field of public health into the spotlight. Yet nurses, who often work most closely with the community, have somehow remained largely in the background.

It’s an oversight Susan Blue, an alumna of the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, and Maureen Cava, who was cross-appointed to the faculty and taught community health nursing, are hoping to rectify.

Both retired public health nurses, the pair decided to create a podcast called Stories from the Field to amplify nursing voices and help students and the wider public learn more about what public health nurses do – perhaps even consider it as a career.

Stories from the Field’s six episodes take listeners on a journey across Ontario as co-hosts Blue and Cava speak with public health nurses about everything from harm reduction and the opioid crisis to nursing leadership and the COVID-19 pandemic.

“I’ve worked in public health for almost 40 years, and I still get asked what hospital I work in,” says Cava, who is also the former president of the Ontario Association of Public Health Nursing Leaders.

“We are passionate about public health and committed to ensuring the public, as well as other nurses, know what public health nursing means.”

“As a public health nurse, you are taking a preventative approach to the health and wellbeing of the community at large, as well as individuals,” adds Blue, “It’s why we hope to see more nurses in the field.”

The podcast is proudly sponsored by the Lawrence S. Bloomberg Faculty of Nursing’s Verna Huffman Splane Fund, an endowed award named after Verna Splane, a public health nurse who graduated from U of T in 1939 and enjoyed an illustrious career in nursing and health care.

“Maureen and Susan have captured the essence of what makes public health nursing essential and have shone a much-needed light on the work of our public health nurses,” says Linda Johnston, dean of the Lawrence S. Bloomberg Faculty of Nursing. “This podcast will be an important tool for future nurses to see the breadth of expertise that this particular field of nursing has to offer.”

Writer Rebecca Biason recently spoke with Blue and Cava about the importance of giving nurses a voice and what they are hoping the podcast’s listeners will learn.

What is the role of the public health nurse?

Blue: To me, public health nursing means putting energy and resources into disease prevention instead of waiting until people get sick to spring into action. As a public health nurse, that means reaching the entire population to maintain and improve people’s health and quality of life.

The community is our client and that’s something I’m very passionate about. Keeping people out of hospitals can make a real difference in their health.

Cava: Public health nurses play a significant role in policy development – things like food security, basic income, housing and other social determinants of health. That kind of preventative upstream approach is what we focus on to ensure people are healthy, physically fit, have harm reduction strategies and have the resources they need so they don’t end up in emergency rooms or hospitalized for things that are preventable.

It makes sense to put money into prevention, but there has been a chronic lack of funding since we’ve been in the field. Public health gets a small piece of the pie to do an inordinate amount of work in preventing people from getting sick. It is why we are so committed to our work, as we see the value in public health nursing as an investment in the future of society.

What led to the creation of Stories from the Field?

Cava: Public health nursing is not well understood – by nurses, by politicians, by the public. When I was the president of the Ontario public health nursing leaders association, it was one of my goals to ensure people knew about what public health nurses do and the impact they have.

When I worked at Toronto Public Health, many of the student nurses I encountered had no idea about the scope and breadth of all that is involved as a public health nurse. It was such an eye-opening experience for them, as I hope this podcast will be for other nursing students.

Blue: Maureen and I met in 1990 working for the former North York Public Health Department (now Toronto Public Health). So, having known each for other for 30 years, it wasn’t a huge leap to consider embarking on this project together. We both share a drive to ensure public health nursing is understood and valued as a key part of the health care sector and wanting public health nursing to be brought to the forefront.

What were some of the unforeseen challenges in creating the podcast?

Blue: Well, we are novice podcast hosts. We had listened to a few podcasts, but certainly hadn’t developed one. Maureen came across a podcast camp offered through Ryerson University, and we thought it would be a good way to get some knowledge under our belts.

Cava: Following that camp, we thought, “Oh, for sure we could do this!” But it turns out we were a bit naive about the whole process. We had some initial challenges getting funding for the podcast, but eventually after speaking with Dean Johnston of the Lawrence S. Bloomberg Faculty of Nursing, her support and that of the Verna Huffman Splane fund helped get our project off the ground.

Blue: COVID threw a wrench into everything. We thought we would be recording in a studio together, but soon we were met with a steep learning curve of having to set-up equipment and software on our own. We were grateful to the producers at Vocal Fry Studios for assisting us along the way, but it was very tough in the beginning.

Cava: COVID also meant that many of our nursing colleagues who we planned to have as guests were working full tilt, and that took precedence over everything. We were lucky to be able to eventually meet and interview many experienced public health nurses to share their stories. It just goes to show how involved public health nurses are across the health-care spectrum.

Do you have a favourite episode?

Cava: For me, “Episode Three: Frontline in a Pandemic” stands out. It tells a captivating story about the early stages of the pandemic and the work nurses do behind the scenes to get those shots into arms. It shines a light on the role they had across Ontario in a way that hasn’t really been shown throughout the pandemic. Public health nurses were front and centre since the beginning of the pandemic and are continuing to lead in their roles as things are evolving.

Blue: “Episode Two: Harm Reduction Approaches to Opioid Use” is a favourite. Our guest Rhonda Lovell spoke from a personal perspective about being a young mum and how her interactions with public health nurses during that time in her life motivated her to consider this field of practice and move into public health nursing. She shared such great insights and knowledge.

What are you hoping students and the public will take away from this podcast?

Cava: It goes back to why we started the podcast. We want students to be inspired and think about public health as a career choice. We want them to hear from public health nurses who are passionate and excited about what they do, so that they can see the depth and variety of opportunities there are to work with people and communities. And if they do choose public health, or have chosen it already, I hope this also inspires them to advocate and to give back to the field.

Blue: It’s a career where nurses have considerable variety and can move to other areas of practice. Public health nursing offers lots of flexibility, learning and growth opportunities. For the general public, I think just hearing these human-interest stories will change their viewpoints about public health. Hopefully anyone, whether they are a nurse or not, can relate to this content and be informed.

Cava: These are true stories from the field. We hope students, nursing colleagues and those in other disciplines will listen and consider the impact of public health nursing.

A public health visionary, Vivek Goel leaves a lasting legacy at U of T

Christopher.Sorensen — Tue, 29 Jun 2021 16:29:32 +0000

A public health visionary, Vivek Goel leaves a lasting legacy at U of T

Christopher.Sorensen Tue, 06/29/2021 - 12:29

Cutline

(Photo by Nick Iwanyshyn)

Heidi Singer

Coronavirus

Institute of Health Policy Management and Evaluation

Vivek Goel

As he prepares to take on the role of president at the University of Waterloo this week, Vivek Goel will leave behind a lasting legacy at the University of Toronto and the Dalla Lana School of Public Health in particular.

The former U of T vice-president and provost, vice-president, research and innovation, and strategic innitiatives, and professor emeritus at the Institute of Health Policy, Management and Evaluation (IHPME) enjoyed a more than three-decade relationship with the university during which he helped make Dalla Lana a renowned public health school.

After moving up through the ranks of academia, government and to the top rungs of U of T, Goel – along with fellow public health evangelist and U of T President Emeritus David Naylor – seized the moment to carve out a stand-alone school from what is now known as the Temerty Faculty of Medicine. As a U of T medical resident in the mid-1980s, Goel advocated for the creation of a separate public health faculty. As a young academic, he was part of a group that recognized the power of marrying epidemiology with health systems and policy, forming the roots of IHPME.

“The first few weeks of [my] stepping into the dean’s position, Vivek invited me to lunch for a pep talk and a few specific mandates,” recalls Catharine Whiteside, former dean of the Temerty Faculty of Medicine.

“One request was to establish a school of public health and, with his support, the strategic planning was started that required considerable culture change. When Paul Dalla Lana came along a couple of years later, we were ready for his investment and the school was launched. It took a while, but the DLSPH emerged as a separate, very successful faculty – just as Vivek envisioned.”

Vivek Goel earned a master’s
degree in community health
from U of T in 1988.

Goel first arrived at U of T as an intern in 1984 and started as a graduate student and post-graduate medical resident in 1986 in the medicine faculty’s old division of community health (now Dalla Lana). The program has produced a number of top government health leaders, including David Williams and Sheela Basrur, both former Ontario chief medical officers of health, and Howard Njoo, deputy chief public health officer at the Public Health Agency of Canada.

In addition, some of Goel’s former students, including Doug Manuel, Ross Upshur and Laura Rosella, are among the leading Canadian academics in public health.

Along the way, Goel met his wife, then-epidemiology student Susan Jaglal, who is now chair of the department of physical therapy in the Temerty Faculty of Medicine.

Goel earned a master’s degree in health administration and another in biostatistics at Harvard University. Walking the halls of a building entirely dedicated to public health in Boston, he was struck by the energy and ambition of the stand-alone faculty.

An early attempt

As chief resident and a member of student government, Goel was tapped to serve on a committee reviewing the division of community health at U of T. It had been a decade since the old School of Hygiene had folded and its remnants were getting lost in the enormous medical school.

“There was a set of us that felt strongly that community health wasn’t working well in medicine and recommended that a separate school should be created,” recalls Goel. “The majority of the committee said we should focus on further implementing community medicine within FOM. I was one of the people signing the minority report. It was my first real engagement in that kind of academic review process and it shaped my interest in academic leadership.”

Goel joined the Faculty of Medicine, as it was then known, as a professor in 1991 and went on to help found IC/ES. During the 1990s, he watched, as a status-only faculty member, as the future of public health at U of T was reviewed and reviewed again. The very first bit of success, he recalls, was in the mid-1990s when preventive medicine merged with other disciplines including the behavioural sciences to create the department of public health sciences. By that time he had moved on to campus as a full-time faculty member.

At the same time, Goel was eyeing the launch of an exciting new area of public health. “We had population epidemiology and preventive medicine, but this emerging strength of clinical epidemiology was largely ignored on campus and it grew up in the hospitals and clinical departments,” he says. “The dean of medicine at the time, Professor Arnie Aberman, coaxed me into becoming the chair of Health Administration, and being part of the team to bring clinical epidemiology into the department.

“We went from being focussed primarily on hospital management and health policy to merging with all this great clinical epidemiological and health services research at the hospitals.”

The department would continue to expand, eventually morphing into IHPME.

Making his move

The 2003 SARS crisis was a defining moment for public health in Canada. The disease hit an unprepared country with a weaker public health infrastructure than existed in peer nations. The following year, Goel started a four-year stint as U of T’s vice president and provost. A year later, Naylor became the university’s president and Whiteside was appointed dean of medicine.

“We were well lined up,” says Goel. “Cathy (Whiteside) commissioned a review and laid out the plan to create a school of public health within medicine and, over time, build up the foundations to create a freestanding faculty. Then Paul Dalla Lana stepped forward with the founding gift to establish the DLSPH as part of the university’s post-SARS vision.

“DLSPH with IHPME as part of it is so well positioned now because you look at its strengths across chronic and infectious diseases, mental health, biostatistics, occupational and environmental health, epidemiology, social sciences in health and bioethics – and then you connect these with the rest of the university and its affiliated institutions, and there are so many great opportunities,” he says. “At Harvard, I remember comparing and asking why can’t we have something like this? Now, when we were able to walk the halls in the Health Sciences Building, you feel the same sort of vibe I felt at Harvard. And I know it’s only going to continue to get better.”

As president of Public Health Ontario, Vivek Goel monitors the latest developments in the H1N1 flu virus in 2009 (photo by Steve Russell/Toronto Star via Getty Images)

Goel left U of T in 2008 to become the founding president and CEO of Public Health Ontario, an organization created in response to SARS. Despite the high-ranking position, Professor Emeritus Chandrakant Shah – an early influence on Goel’s thinking around equity and diversity – frequently called or dropped by his office, unannounced, to advocate for more equitable representation among public health leaders.

Shah recalls fondly that Goel never turned him away, and always levelled with him.

“He always cared for his colleagues, his students and even his mentors,” says Shah. “He’s a brilliant, strategic thinker with the academic experience, but also he knows how to deal with the public and private sectors. He has been a good friend to the school over the years.”

Goel returned to U of T seven years later as vice-president, research and innovation, and strategic initiatives. When the pandemic hit, he quickly became special adviser to the university’s president and provost on the pandemic – all while serving on numerous national COVID-19 committees and task forces and maintaining a regular podcast on the pandemic.

His list of honours is long and includes membership in the Order of Canada and the Canadian Academy of Health Sciences, along with many teaching awards.

Vivek Goel, then U of T’s vice-president, research and innovation, delivers remarks at a 2015 funding announcement that enabled the creation of Medicine by Design, an interdisciplinary regenerative medicine initiative (photo by University of Toronto)

“He is someone who teaches you to believe in yourself and empowers you to have an impact in ways you could not have imagined,” recalls Laura Rosella, an associate professor at the Dalla Lana School of Public Health and former post-doctoral researcher who worked with Goel. “His commitment and dedication to mentorship in a way that builds people up will be felt for generations to come as many of those he has trained have become top public health and health system leaders and researchers.”

As president of a major Canadian university, Goel now hopes to use his experience and platform to advocate for a stronger public health system in Canada.

“I hope I’ll be able to bring a voice for public health much more broadly across the country and to many other tables,” he says. “In other countries they have figured out ways to insulate the public-health infrastructure from politics. We need people to talk about how to protect and sustain them, and there’s a role for academic institutions in that process.”

He is also eager to maintain ties as a professor emeritus at the Dalla Lana School of Public Health, and to share ideas about how to raise the public health literacy of Canadians on a broad level.

That’s a promise Dean Adalsteinn (Steini) Brown says he will remember.

“Vivek has had a leadership role in shaping the careers of many of our students, alumni and faculty, our school, our public health system and Canada’s response to the pandemic, among so many other accomplishments,” says Brown. “I know that he will bring the same impactful leadership to Waterloo – but I can’t imagine our school without him.”

Over-policing in Black communities to be explored in new U of T public health course

Christopher.Sorensen — Fri, 08 Jan 2021 15:52:00 +0000

Over-policing in Black communities to be explored in new U of T public health course

Christopher.Sorensen Fri, 01/08/2021 - 10:52

Cutline

Akwatu Khenti, an assistant professor at the Dalla Lana School of Public Health, says his new course will analyze the public health implications of race-based criminal justice data (photo by Ilkay Dede/EyeEm via Getty Images)

Heidi Singer

Topic

Anti-Black Racism

Graduate Students

A new course offered at the University of Toronto this spring will allow students to analyze the public health implications of race-based criminal justice data in real-time – just as Canadian governments are releasing the information.

In Anti-Black Racism as a Policing and Public Health Crisis, Akwatu Khenti, an assistant professor at the Dalla Lana School of Public Health, will help students build the analytical skills needed to use publicly available data to answer critical public health questions, with the goal of understanding barriers to an equitable criminal justice system.

The course explores the ways in which Canada’s criminal justice system intersects with race, poverty, gender and mental health to create compounded intersectional risks for Black Canadians – and considers how racism and over-policing have undermined Black trust and confidence in the Canadian justice system. It also applies an anti-racist lens to public health approaches to Black gun violence and homicide victimization in Toronto by querying whether public health has effectively dealt with a long-standing racialized epidemic of homicide mortality in Toronto. Students will have the chance to hear directly from guest speakers who have been involved with the system and/or are advocating for changes to eliminate anti-Black racism in criminal justice.

“The framing that the course brings to the issues is distinct,” says Khenti, a mental health researcher at the Centre for Addiction and Mental Health (CAMH) and former assistant deputy minister at the Ontario Anti-Racism Directorate.

“We will examine the issues through the Black community’s crisis of trust in policing, which is at its lowest ebb in Ontario right now, the crisis in police credibility due to the persistence of racial profiling, and the public health crisis resulting from police violence that manifests – not just in gun deaths, but in mental health consequences.”

In 2020, the Ontario government mandated the collection of race-based data across the criminal justice system, from police and prosecutors to jails and courts. For the first time, the public has the opportunity to learn, for example, whether Black and Indigenous people are being granted bail at the same rate as those of other races, or whether racialized people are being arrested with higher rates of use of force than whites for similar offences.

For Khenti, the mental health impact of over-policing is key, but traditionally very difficult to measure. He points to the now-defunct Toronto Anti-Violence Intervention Strategy (TAVIS) as an example of the problem. For a decade, he says, many of these TAVIS officers, deployed to high-crime areas, created fear in Black communities.

But drawing a direct correlation between TAVIS and mental health changes is difficult. Khenti hopes the collection of race-based criminal justice data will increase understanding in this area by showing the huge health costs of over-policing on Black communities.

“Over-policing is a public health issue because it alters people’s wellbeing and their participation in society,” he says. “Those costs have not been calculated but I always believed they are very high – especially around the TAVIS units. If we could calculate the anxiety and depression in the areas where they worked, I believe they would be exorbitant.”

Khenti says the data offer exciting possibilities to help police forces deal more helpfully with the large percentage of mental health calls they receive.

“It’s not a question of defunding the police. It’s about creating a different model of policing,” he says. “We have to move from a militarized and enforcement model to a public service model. Police budgets are growing. But they’re not growing their training practices and/or mental health units, for instance, by expanding training of all dispatchers to equip them for mental health calls. I think there’s a lot of opportunities to work with the police.”

The course (CHL 7001H S5) is open to all Dalla Lana School of Public Health graduate students and should be of interest to those planning a career in government or academia, Khenti says.

“We’ll be creating a group of graduates that should be comfortable with the issues and able to add value to the data,” he says, pointing to a growing need for analysis of race-based data within government now that use-of-force information is being collected.

Even during the coronavirus pandemic, public health workers' role is unrecognized: U of T's Vivek Goel

Christopher.Sorensen — Wed, 29 Apr 2020 19:54:46 +0000

Even during the coronavirus pandemic, public health workers' role is unrecognized: U of T's Vivek Goel

Christopher.Sorensen Wed, 04/29/2020 - 15:54

Cutline

Anthony Fauci, left, director of the National Institute of Allergy and Infectious Diseases, speaks with Robert Redfield, director of the Centers for Disease Control and Prevention, at a congressional hearing in March (photo by Patrick Semansky/AP Photo)

Vivek Goel

Topic

Coronavirus

The Conversation

Vivek Goel

The recent One World: Together at Home virtual concert brought together musical talent from around the world to thank front-line health workers and raised about US$128 million to support COVID-19 response efforts globally. Celebrities and politicians thanked those on the front lines of the response, including health-care workers and scientists working on COVID-19, those working in the food supply chain, as well as sanitation, delivery and mail workers.

However, nobody acknowledged all the people in public health agencies who have been working tirelessly during this crisis. This includes public health nurses and physicians, health inspectors and educators, laboratory technicians, epidemiologists and statisticians.

These are the people who work in the background to keep us healthy. They process the tests that identify who has the disease. They produce the statistics and models that track how the disease is progressing through our countries.

The lack of acknowledgement doesn’t surprise me. The work of public health is invisible, largely unrecognized by society. Despite increases to general spending on medical services, public health agencies are regularly subjected to budget cuts.

Fixation on front-line workers

I say this not just as a disgruntled public health specialist, upset to see my colleagues overlooked. There is something much more significant about our society’s fixation on front-line health care and medical approaches to disease management.

For the past century we have medicalized disease prevention and management for both infectious and chronic diseases. We focus on early detection and treatment (known as screening) and therapies (chemoprophylaxis) for disease prevention. Such medical models run counter to what is known as population health.

Lady Gaga was the driving force behind the One World: Together at Home virtual concert that paid tribute to front-line health-care workers (YouTube/Global One)

In a population health approach, we consider everyone and examine what keeps people healthy. Social and economic determinants of health are much more strongly related to health outcomes than biologic factors.

A population health approach promotes healthy living, healthy environments and healthy social policies balanced with appropriate medical interventions for those who need them. For example, risk of cardiovascular disease can be reduced through a focus on physical activity, good nutrition and smoking cessation. Population health approaches look at the environment in which people live and ensure they have the means and access to services to lead healthy lives.

In contrast, the medical model might focus on finding the people at highest risk for cardiovascular disease through screening tests and then prescribing them drugs. Research has consistently shown that a population health approach has greater impact on health status and is more equitable across society.

Losing sight of larger perspective

What does this mean for our responses to COVID-19? The narrative to date has been dominated by the medical model – testing and the search for treatments, ICU beds and ventilators.

Many people, like these residents of Toronto, pay tribute every night to front-line health-care workers. Those who work in public health away from the front lines should also be recognized. (photo by Frank Gunn/Canadian Press)

We absolutely do need to focus on these factors to ensure we can treat those who develop severe disease. But this fixation has come at the expense of the population health perspective.

And I mean this literally. Newscasts are dominated by clinicians on the front lines and those with a biomedical perspective. How often have we seen Anthony Fauci, the head of the U.S. National Institute of Allergy and Infectious Diseases, versus Robert Redfield, the head of the U.S. Centers for Disease Control and Prevention? Fauci has done an incredible job, but the perspective of Redfield is also important.

The medical model has focused on the immediate needs. To get us out of this, the medical model points to a vaccine – which could take years to roll out – as the solution.

A population health perspective to COVID-19 considers the impact on the entire population, not just those with disease. It applies an equity lens to ensure no one gets left behind. A population health perspective will consider whether the consequences of continuing our current restrictive measures will cause more harm than good in the long run.

Socio-economic status is the strongest determinant of health. Long-term economic harm may have greater health consequences than COVID-19. But the deaths from COVID-19 are visible and in the news. The deaths that might result from the economic consequences will only be seen in statistics – we won’t know who was directly affected. They will be invisible, just like public health.

We need to thank our public health workers. We also need to listen to them.

Vivek Goel is a professor at the Dalla Lana School of Public Health and vice-president of research and innovation, and strategic initiatives at the University of Toronto.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

U of T researchers uncover the communities with the highest premature deaths in Ontario

noreen.rasbach — Thu, 08 Aug 2019 17:48:04 +0000

U of T researchers uncover the communities with the highest premature deaths in Ontario

noreen.rasbach Thu, 08/08/2019 - 13:48

Cutline

Emmalin Buajitti, the study's co-author, is a recent graduate of the Master of Public Health program at the Dalla Lana School of Public Health (photo by Lauren Jewett)

Topic

Graduate Students

Research & Innovation

University of Toronto researchers have conducted the first spatial analysis of death in Ontario, discovering that social and demographic factors are by far the biggest factors in predicting who dies before their time.

Public health researchers used traditional statistical and geography tools to break down premature death rates by community in Ontario, allowing them to pinpoint clusters with the highest numbers of people dying before age 75. They found sizable disparities in premature mortality, with the majority of premature deaths occurring in low-income neighbourhoods and the fewest in immigrant communities.

“The fact that immigrant and socio-economic status alone accounted for 80 per cent of the variation – that’s a staggering amount,” says the study’s co-author, Emmalin Buajitti, a recent graduate of the Master of Public Health program at the Dalla Lana School of Public Health.

“This emphasizes the enormous importance of ‘social determinants’ of health.”

Only 10 per cent of the variation was further explained by classic risks like heavy drinking, obesity, smoking and sedentary lifestyles, and another 10 per cent was unexplained, but possibly due to other factors such as lack of access to medical care, Buajitti says. While there would be crossover between risk factors and poverty, she says, income was still a far more powerful predictor of premature death than lifestyle alone. And lower premature mortality among immigrants is not surprising given that Canada chooses people in good health to migrate here.

The most common cause of premature deaths, not surprisingly, was heart disease – the same as for non-premature deaths in Ontario. Men died early at higher rates than women, as did people in more northern, rural and underserved parts of the province. The Toronto and Ottawa metropolitan areas had the lowest rates of premature mortality.

To identify death patterns on a granular level, Buajitti and her co-authors, including Laura C. Rosella, an associate professor at Dalla Lana and Big Data expert, divided the province’s local health regions into 76 sub-regions. They used Bayesian models to map early deaths to known risk factors such as smoking and poverty.

“The techniques we used aren’t that new – they’ve been established, especially among geographers, for some time,” says Buajitti. “The opportunities come from bridging disciplinary gaps – using geography to answer better public health questions and identify patterns more precisely. In Canada, these techniques haven’t been applied on this scale.”

The geography of health is an important area to study, she says, because there’s a connection between a person’s health and the overall health of the population in their community.

“You can be doing quite well personally, not smoking or drinking heavily, but your neighbourhood might not have enough doctors or parks and sidewalks, or it might be a food desert,” she says. “We’re trying to answer the impact your neighbourhood experience has on health and premature mortality so that public health interventions can be targeted where they’re needed most.”

Buajitti and her co-authors published the results of their research on Aug. 1 in the journal Population Health Metrics.

The study was funded by the Canadian Institutes for Health Research and the Institute for Clinical Evaluative Sciences. by Immigration, Refugees, and Citizenship Canada. However, the analyses,conclusions, opinions, and statements expressed herein are

'The scale of grief and loss is terrible': Meet the U of T student fighting to prevent opioid overdose deaths

noreen.rasbach — Thu, 18 Jul 2019 14:45:17 +0000

'The scale of grief and loss is terrible': Meet the U of T student fighting to prevent opioid overdose deaths

noreen.rasbach Thu, 07/18/2019 - 10:45

Cutline

Gillian Kolla, a PhD candidate at the Dalla Lana School of Public Health, has helped save scores of lives with oxygen tanks and naloxone kits at Moss Park (photo by Nick Iwanyshyn)

Topic

Graduate Students