DLSPH 2016-17 Annual Report: Local Responsiveness Global Impact by Dalla Lana School of Public Health

Local Responsiveness Global Impact Annual Report 2016-2017

We aspire to be one of the worldâ&#x20AC;&#x2122;s leading schools of public health known for innovations that are driven by evidence-based and holistic ideas of what a healthy, equitable and sustainable society will look like in the future.

Dean’s Message The time is right to leverage the School’s longstanding and new collaborative partnerships to influence fundamental changes in health, both locally and globally.

Glocal is a term that was part of my vocabulary,

Another strategic priority is to establish highimpact capacity development initiatives to help mobilize communities and create resilient health systems. Professor Greg Marchildon launched the North American Observatory on Health Systems, an academic hub enabling comparisons and assembling information for governments to make evidence-informed policy decisions. Under the research impact and excellence direction, one priority is to support centres of interdisciplinary scholarship and build communitybased collaboratories that support health and health system improvement. The Healthy Barrie project, led by Professors Adalsteinn Brown, Ross Upshur and Public Health and Preventative Medicine resident Aamir Bharmal, is a positive example of how collaboration across the heath system, municipal government, the private sector, and the university can help build a sustainable healthcare system. In the process, the project will help make Barrie one of the healthiest cities in the world while providing a platform for collaborating with similar initiatives around the world that will enable sharing best practices and innovations going forward. Finally, enhancing partnerships and management is the third strategic direction, and a crucial piece of this is to establish a physical and professional environment that supports health for learners, staff and faculty. The early work of DLSPH’s Diversity Committee, co-chaired by Professors Rhonda Cockerill and Arjumand Siddiqi, demonstrates the School’s commitment to supporting diversity and equity. These are just a few examples that highlight how we are progressing towards meeting the goals set forth in the strategic plan, and how we continue to leverage our newly combined strengths to enhance DLSPH’s world-class education and learning, research and service on a local and global scale. As this is my last annual report, I reflect on the past five years that have been a period of significant growth and change for the School. We have brought together a group of historically strong divisions, academic units and centres into a newly forged entity, and I am proud that the DLSPH is one of the most diverse and comprehensive schools of public health in the world. I have the utmost confidence in Professor

but not a reality that I saw truly achieved in my previous academic roles in Boston and Ann Arbor…until I arrived in Toronto. Referring to “glocalization,” which combines and balances global with local initiatives and considerations, it is a term that succinctly summarizes the Dalla Lana School of Public Health’s (DLSPH) vision. Indeed, the importance of harmonizing global and local agendas — which requires deep engagement with local communities here and abroad, as well as working with collaborators at the highest levels — and the potential for DLSPH to attain this vision, is one of the key reasons why I chose to come to Toronto in 2012. To be the leading model for public health and health systems learning, research and service, with impact at local and global levels. This vision is now articulated in Towards 2021 and Beyond, the School’s first strategic plan as a stand-alone Faculty that provides a comprehensive view of the School, including its divisions, academic units and centres. The plan is a roadmap for how the DLSPH can continue to enhance its leadership in public health and health systems on a local and global scale, and I am proud of this visionary centrepiece, and of each individual, committee and consultation that contributed to it. This annual report marks the completion of year one on the journey towards 2021, and in the pages that follow, you will see specific examples of how the DLSPH is having a broad and deep impact in public health and health systems. Organized around the plan’s three strategic directions, this report fully integrates achievements in the learner experience, research excellence, and partnerships and management across our Faculty. One of our strategic priorities is to leverage our close connection to the local health system to build coherent public health and health systems capacity plans. Professors Barry Pakes and Eileen de Villa served as Medical Officers of Health in Nunavut and Toronto and are building local and national health systems while providing our students with invaluable front-line lessons via practica and rotations in the field.

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Adalsteinn Brown as steps he into DLSPH scholars will continue to work in partDLSPH’s Interim Dean role on July nership with decision-makers, practitioners, 1, 2017. I know he will provide global and local philanthropists, and commusuperb leadership for the Faculty as nities to address today’s critical health issues. it operationalizes the strategic plan and navigate the School through the challenges and opportunities that lie ahead. community to draw inspiration from the strategic I believe that the time is right to leverage the plan, talk with your peers and leaders about how School’s longstanding and new collaborative partneryou can get involved, and continue to set a wonderships to influence fundamental changes in health, ful example to Toronto and the world about what a healthy, equitable and sustainable society looks both locally and globally, and that DLSPH scholars like, today and in the future. will continue to work in partnership with decisionmakers, practitioners and communities to address today’s critical health issues. Howard Hu I encourage every member of our Faculty Dean, Dalla Lana School of Public Health 5

Annual Report 2016-17

Dalla Lana School of Public Health

Dalla Lana School of Public Health at a Glance

Graduate Degree Programs Public Health Sciences

Core faculty

778

Master of Science (MSc) • Biostatistics

720

272

Master of Science in Community Health (MScCH) • Addictions and Mental Health • Family and Community Medicine • Health Practitioner Teacher Education • Occupational Health Care • Wound Prevention and Care

$34,379,079

PhD • Biostatistics • Epidemiology • Occupational and Environmental Health • Social and Behavioural Health Sciences Master of Public Health (MPH) • Epidemiology • Family and Community Medicine • Health Promotion • Nutrition and Dietetics • Occupational and Environmental Health

Community- and partner-based faculty

Master's program students

Cross-appointed faculty

Post-doctoral fellows

PhD program students

Annual research funding

Master of Health Science (MHSc) • Bioethics

Institute of Health Policy, Management and Evaluation

PhD • Clinical Epidemiology and Health Care

Research • Health Services Research

Master of Science (MSc) • Clinical Epidemiology and Health Care

Research • Health Services Research • Quality Improvement and Patient Safety • System Leadership and Innovation

Master of Health Science (MHSc) • Health Administration • Combined Health Administration and

Social Work Master of Health Informatics (MHI) • Health Informatics

Annual Report 2016-17

Facts and Figures

September 2016 Intake Domestic International

MPH: Master of Public Health MSc: Master of Science MHSc: Master of Health Science MScCH: Master of Science in Community Health MHI: Master of Health Informatics

Applications Offers Registration

Public Health Sciences

Institute of Health Policy, Management and Evaluation

855 173 85

118 136

46 116

56 44

32 27

37 229

20 26

132 3 1

PhD

15 5

2 MPH

MSc

3 2

MScCH

MHSc

November 2016 Head Count

MScCH 64

4 1

MSc

12 36

2 2

0 0 PhD

0 0

0 0 MHSc

MHI

November 2016 Head Count

MHSc 15

MHI 87*

PhD 129

PhD 143

MSc 32

MHSc 78 MPH 266

MSc 178 * Includes 72 regular MHI plus 15 Executive stream which started in fall 2016

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Faculty

Staff Cross-appointed faculty 63

Administrative 45

Core faculty 92 Adjunct 211

Community- and Partner-based Faculty 778

Status-only 567

Research (casual) 109

Research (appointed) 27

Promoted to Associate Professor 3

Canada Research Chairs 8

Post-doctoral fellows 22

Promoted to Professor 6

Research Total Funding for the 2015-16 Grant Year Total research funding awarded to DLSPH investigators was $34,379,079, including funds administered through affiliated institutions in the 2015-16 grant year, of which $11,548,942 was administered at DLSPH.

Three councils 10,511,115

Not-for-profit 11,639,511

$34,379,079

Total research funding 34,379,079

Total research funding awarded to DLSPH

Institutional initiatives 962,409 Corporate 3,793,161 Government, other 7,472,883

$11,548,942 Administered at DLSPH

Annual Report 2016-17

1 Learner Experience

Zhong, whose fellow conference co-chairs were: Antu Hossain, Jaya Raghubir, Joy Dawkins and Rachel McGihon. In October 2016, the conference brought together 40 interdisciplinary speakers and more than 200 diverse participants through keynote addresses, breakout sessions, a panel discussion, a community partners and networking fair, and a research and practice showcase. Following the conference, organizers wanted to continue the discussion through a student blog post that asked: How can we as change-makers continue to advocate and work towards equitable and action-oriented solutions to income insecurity? How can the lived experiences of those who have

Student-Led Conference Explores Public Health’s Role in Mitigating Income Insecurity

The ninth annual DLSPH Student-Led Conference, “Secure Income, Secure Health: Working towards equitable solutions,” created a platform for critical thinking about income insecurity and its relationship with health. “Income is arguably the determinant of all determinants of health,” said Adrina Zhong, a conference co-chair who received her MPH degree in Health Promotion in June 2017. “It has far-reaching impacts on the quality of life and is pervasive over the life-course,” said

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Photo: alamy

The Dalla Lana School of Public Health is a dynamic learning community where tomorrow’s public health and health policy leaders are exposed to new areas of scholarship that challenge paradigms about what it means to be healthy and cultivate a solutions-oriented approach to address complex health issues.

Section 1: Learner Experience

Against Tuberculosis and Lung Disease and has consulted for the United Nations and World Health Organization on this topic. Although TB isn’t Toronto’s top public health challenge as it was 60 years ago, it is still a problem in Canada and globally. The Inuit are 100 times more vulnerable to TB than the rest of the population, and it is widespread in many African, Asian and Latin American countries. The course explores TB control through medicine, public health, ethics, history, health systems and global health lenses, and features many national and internationally acclaimed experts as instructors. “I’d like to get a generation to work in the area and create a TB centre at U of T that helps to reshape the global health landscape,” said Wei. faced income insecurity, precarious work and discrimination be central to this work? Their blog post addressed some of these questions and encouraged public health professionals to actively participate in discussions surrounding income security and help break down barriers so vulnerable groups can have their voices heard. “As health professionals we need to be reflexive and acknowledging our power and privilege. We need to critically analyze and evaluate policies and programs. We need to collaborate, translate knowledge and engage in upstream work that addresses health equity,” said Zhong.

Canadian Inuit are 100 times more vulnerable to TB than the rest of the population

New Recipe for Nutrition Curriculum

For confirmation that the MPH program in Nutrition and Dietetics has found a comfortable home with DLSPH’s Division of Clinical Public Health, look no further than a community food project at Sistering, a women’s drop-in centre in Toronto. MPH students sought to make a difference in the nutrition of women who live without kitchens, many of them living with chronic health issues while surviving on the streets. Shelters rely on fresh food donations from restaurants and supermarkets to round out their non-perishable goods, but the cooks can’t predict what will be donated on any given day. The students created a low-tech solution, easily stored in the kitchen: a binder filled with recipes for healthy meals that can be assembled with various combinations of

New Course Shines Spotlight on Tuberculosis

Tuberculosis (TB) is a leading killer among infectious diseases and an important global public health challenge, but until recently, DLSPH did not have any courses on the disease. In winter 2017, Xiaolin Wei, Associate Professor of Health Systems and Clinical Public Health in Asia, and an IHPME alumnus, introduced a TB course to DLSPH’s curriculum — the first at U of T — with the support of and co-directed by Professor Ross Upshur, Clinical Public Health Division Head. “It’s a very important global health topic and I wanted to nurture capacity in Canada so we can take leadership in this area,” said Wei, who is also Secretary-General of the International Union

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100x

250

Sistering drop-in centre serves 250 meals each week to women who are homeless, under-housed, low income or marginalized

Top left: Student-led conference leaders (left to right): Jaitra Sathy, Antu Hossain, Liza Oulman and Tayla Smith Bottom right: Nutrition and Dietetics students (left to right): Courtney McAskile, Sarah Kassel, Etienne Nemanishen and Hazel Fernandez

Professor Eileen de Villa became Toronto’s Medical Officer of Health on March 27, 2017

donated fresh food and pantry items. Lecturer Charna Gord noted that the recipe binder has been so popular in the kitchen that the coordinator has shared it with other drop-in centres across the Greater Toronto Area. “These projects give students an opportunity to apply the knowledge they’ve learned and to develop competencies that will serve them well across a spectrum of workplaces,” said Pierrette Buklis, director of the MPH Nutrition and Dietetics program, which is in its second full year of the new curriculum. “Our program is the only one in Canada with a clinical public health focus, which provides an

excellent foundation for work using an interdisciplinary, interprofessional approach.”

Building Local and National Health Systems

Students at DLSPH are learning from public health professionals on front lines: people such as Dr. Barry Pakes, who served as Deputy Chief Medical Officer of Health for Nunavut for the past year, and Dr. Eileen de Villa, Toronto’s new Medical Officer of Health. Pakes balanced his duties in Nunavut with his academic responsibilities at 13

Annual Report 2016-17

Section 1: Learner Experience

DLSPH, while de Villa, an Adjunct Professor, and her team oversee DLSPH students during their practica and Public Health and Preventive Medicine residents during their field rotations. “The frameworks we teach to public health and preventative medicine residents in Toronto are exactly those necessary to address the complex issues in Nunavut,” said Pakes. “It’s great to share lessons learned in Nunavut with my colleagues in Toronto and in training the next generation of Canadian public health leaders.” In Toronto, de Villa is just a few months into her new position and knows there are many challenges ahead, but she is eager, rather than daunted. “Public health is the best work in the entire world,” she said. “It’s where you can actually work with key partners on issues that make a contribution to the health of the population. Just look at the front page of the newspaper and you’ll see examples, including the opioid crisis and the upcoming cannabis legislation.” She hopes to draw on DLSPH scholars as she moves forward. “We often encounter issues around the most efficient way to address a problem, and it’s a golden opportunity to have academics help find answers,” de Villa said. “For academics, there is nothing better than seeing your research being used to make a difference in the world.”

Care in Canada: What Works? What Needs to Be Done? The book covers a wide range of topics, such as how the system operates, healthcare financing and how Canada stacks up against other countries in delivering care. It is part of the U of T Insights series, which attempts to clarify key issues for a general audience. She hopes that her practical approach to teaching translates perfectly to the page. “I build on what’s happening in the field,” Deber said. “I’m interested in theory if it helps you understand issues. I also learn from my students and colleagues, which is essential in such a diverse field as health policy.”

New Global Health Learning Opportunities for Students

April Siwon Lee, a MPH Health Promotion student, will begin her placement with the Shanghai Municipal Center for Disease Control and Prevention (SCDC) this summer where she will be working on policy evaluation of the new Shanghai indoor smoking ban. “Since almost one-third of the world’s smokers are in China and it has weak tobacco control measures, this seemed like a great learning opportunity for me,” said Lee. “I’m hoping to build competency in policy evaluation through this practicum and work in this field after graduation.” As director for DLSPH’s Office of Global Public Health, Education and Training (OGPHET) and the Collaborative Specialization in Global Health, Erica Di Ruggiero takes seriously her mandate to increase the diversity of opportunities for DLSPH students undertaking global health practica. “Global health placements help students get a better understanding and appreciation for the interconnection between different cultures, countries and agencies in public health,” said Di Ruggiero, an Assistant Professor of Social and Behavioural Health Sciences. Since many interesting placements are unpaid, the OGPHET has established a biannual competition for travel awards that make it easier for students to afford a supervised global health learning experience as part of their formal graduate training. “We’ve just signed an agreement with the

Health Policy for the Public

Following publication of the second edition of Professor Raisa Deber’s case studies textbook in 2014, her publisher, University of Toronto Press, asked her to tackle the task of explaining health policy issues and concepts to the general public. Deber, an IHPME Professor, created her popular textbook, Case Studies in Canadian Health Policy and Management, using real-life cases co-authored by and developed by close to 130 students who took her course, many of whom are mid-career professionals with significant on-the-job experience. Deber believes it’s popular because her approach to public health is “empirical and practical.” Her new book, Treating Health Care, is slated for publication in December 2017. As its subtitle indicates, it tackles a very broad subject — Health

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“ In response to student needs, we’re also teaching them about issues of power and privilege, how to navigate complex issues and about the importance of self-care.” — Professor Erica Di Ruggiero

Photo: Ethan Horst Mitchell

Professor Erica Di Ruggiero named Director of the Office of Global Public Health, Education and Training and of the Collaborative Specialization in Global Health on December 1, 2016.

Population Council, which has offices in fourteen countries, and we continue to collaborate with international health organizations, including the World Health Organization, on student placements,” said Di Ruggiero. These opportunities are also the result of maintaining strong relationships with DLSPH alumni. “In response to student needs, we’re also teaching them about issues of power and privilege, how to navigate complex issues and about the importance of self-care.”

Fire at Sea Explores Migration and Health

In the spring of 2017, DLSPH and the Toronto International Film Festival (TIFF) hosted a screening of Fire at Sea, an award-winning documentary that illustrates the complex and compounding health issues facing migrants during their migration and resettlement. Approximately 150 students, faculty, community groups and moviegoers with an interest in 15

Annual Report 2016-17

Section 1: Learner Experience

global health gathered at the TIFF Bell Lightbox to watch a free screening of the film and participate in a panel discussion on migration from a global health perspective. “Film is a powerful tool to engage people on global health issues,” said Uttam Bajwa, who led the partnership with TIFF and is a post-doctoral fellow in the Office of Global Public Health Education and Training. She worked with TIFF programmers and Collaborative Specialization in Global Health students — Ifrah Abdillahi, Gurveer Bains, Virginia Gunn, Jesse Jenkinson, Sarah MacLeod, James White and Jannah Wigle — to select the film. The post-film discussion was chaired by Professor Lisa Forman, Canada Research Chair in Human Rights and Global Health Equity, and featured three scholars with expertise in global migration, refugee health and family medicine. The film follows a boy who lives on the Italian island of Lampedusa and contrasts his experience with those of the refugees. In one scene, the child is diagnosed with a lazy eye. To close the event, Forman

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used that diagnosis as a metaphor for how countries are ignoring the global refugee crisis. “What do we need to do to enable the world to see?” Forman asked.

Climate Change is Here: Kuwa Tayari

A two-day symposium about climate change, nutrition and food security in East Africa has laid the groundwork for ongoing collaboration between DLSPH and Moi University in Eldoret, Kenya, resulting in a memorandum of understanding between the two institutions. “East Africa is one region of the world that is being hit the hardest by climate change,” said Paula Braitstein, Associate Professor at DLSPH and Moi University Visiting Professor, who co-chaired the Kuwa Tayari (Swahili for Be Prepared) symposium last May, along with Susan Keino, a faculty member at Moi’s School of Public Health. “It is really vulnerable and woefully unprepared

150

More than 150 students, faculty, community groups and moviegoers gathered at the TIFF Bell Lightbox on March 3, 2017, to watch a free screening of Fire at Sea

DLSPH and TIFF co-hosted a screening of Fire at Sea, an award-winning documentary illustrating the complex health issues facing migrants

“ The NAO will enable comparisons and assemble information in a useful format for governments to make evidence-informed policy decisions.” — Professor Greg Marchildon

in the midst of a really serious drought.” Kuwa Tayari brought together 121 participants from 26 institutions in Kenya, Uganda, Canada, the United States and elsewhere. DLSPH presenters included Professors Daniel Sellen, Lisa Forman and Andrea Cortinois. The conference’s top recommendation was to implement a rights-based approach to food security, health and achieving the sustainable development goals. It was also recognized that public health curricula need revision to incorporate climate change. In response, Braitstein piloted a planetary health course at DLSPH, and has put together related collaborative research proposals, including one proposal to use climate-smart agriculture to improve women’s and children’s nutrition. Meanwhile, Moi University is working toward the establishment of a certificate program in climate change and public health. “We have a number of grant applications and papers in the works,” Braitstein said. “This climate change issue has legs; the younger generation gets it and they care.”

Inspired by the structure and mission of the European Observatory on Health Systems and Policies, a special operating agency of the World Health Organization’s Regional Office for Europe, the NAO will focus on state and provincial health systems in North America to create a foundation for more systematic health system and policy comparisons among subnational states. “The NAO will enable comparisons and assemble information in a useful format for governments to make evidence-informed policy decisions,” said Marchildon, who holds an Ontario Research Chair in Health Policy and System Design at IHPME. This is the first such entity for North America, and Marchildon plans to expand the NAO by creating academic hubs in the United States and Mexico, and eventually Central America and the Caribbean.

U of T Home to First North American Academic Hub for Health System Comparison

Professor Paula Braitstein with Professor Miriam Were, Chancellor of Moi University

The North American Observatory on Health Systems and Policies (NAO) launched the first academic hub at IHPME in February 2017. “U of T is the natural home for the NAO because we have the largest and most productive group of scholars who are trained to create and use evidence to design, implement and evaluate health policy,” said Professor Adalsteinn Brown, Director of IHPME. NAO’s founding director, Professor Greg Marchildon, explained that Canada has one of the more decentralized health system models in the world — though the United States and Mexico have recently become more decentralized — with provincial and territorial governments administering and financing health services.

JCB Plays National Leadership Role in Medical Assistance in Dying Legislation

The Joint Centre for Bioethics (JCB) is contributing to the evolution of medical assistance in dying (MAID) policy and practice in Canada. Created in the wake of the landmark Carter decision, the JCB is home to a province-wide 17

Annual Report 2016-17

Section 1: Learner Experience

IHPME Launches New System Leadership and Innovation Concentration

IHPME launched its newest MSc concentration, System Leadership and Innovation (SLI), in September 2016, enrolling nine medical students and five residents. The program is designed to allow students to complete their SLI degree at the same time as they complete their medical training. “We knew that there was the need for this type of program and that we had the resources within IHPME to provide a world-class educational experience for students,” said Professor Geoff Anderson, Director of the SLI concentration. The SLI concentration evolved out of the Leadership and Education Development (LEAD) Scholarship program within U of T Medicine, which was designed to address a gap in physician leadership development and provide leadership training to medical students. SLI formalizes this training into a degree offering, and it’s expanding the student base to include residents as well as medical students. SLI includes both academic courses and practicums in a range of clinical and health system settings that have provided students like Ali Damji with valuable leadership experience. “The program helped me to engage at the population and health systems level,” said Damji. “As the role of the physician evolves, we will be relied upon to provide leadership and understand the policies that contribute to an effective healthcare system.” Damji and his classmates are set to complete their degrees in June 2018. In the 2017–18 academic year, the SLI concentration will enroll a cohort of 12 medical students and 11 residents.

community of practice, chaired by JCB faculty member Sally Bean, among practicing healthcare ethicists in health institutions across Ontario. “We wanted to provide a community of practice for the ethicists who are working at the front-lines supporting patients, families, and health professionals,” said Jennifer Gibson, Director of the Joint Centre for Bioethics and Sun Life Financial Chair in Bioethics. “As a result, we are contributing toward advancing quality of end-of-life care, standardization of practice across care settings, and anticipating ethical issues proactively.” Gibson and other JCB faculty members have also been lending their expertise at a national level, including to the parliamentary committee deliberations related to Bill C-14. Recently, Professors Gibson, Ross Upshur and Trudo Lemmens were appointed to the Expert Panel on Medical Assistance in Dying created by the Council of Canadian Academies at the request of the federal government to conduct three statutory studies of MAID in relation to mature minors, advance requests and requests where mental illness is the sole underlying condition. Gibson is also working closely with the Canadian Institute for Health Information on developing a pan-Canadian framework for data collection related to MAID. She is also principal investigator on Medical Assistance in Dying in Canada, a panCanadian analysis of data in the first year.

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“ We wanted to provide a community of support for those who support everyone else.” — Professor Jennifer Gibson

Top left: Professors Jennifer Gibson, Ross Upshur (pictured above) and Trudo Lemmens were appointed to the Council of Canadian Academies' Expert Panel on Medical Assistance in Dying Bottom left: Professor Geoff Anderson launched IHPME’s newest MSc concentration, System Leadership and Innovation, in September 2016 Bottom right: SLI student Ali Damji is part of the concentration’s first cohort

IHPME PhD Modernization

A growing number of PhD graduates are finding themselves on diverse career paths that include both academic and non-academic responsibilities. CIHR’s Institute of Health Services and Policy Research recognized this growing trend and appointed IHPME Director Adalsteinn Brown and and Dr. Stephen Bornstein, Director for the Centre of Applied Health Research, to assemble a diverse working group to identify strategies to improve health services research doctoral training in Canada, and align training with the realities of today’s career trajectories. “The training modernization initiative ensures that PhD graduates emerge with strong academic skills and the professional competencies that are required to lead meaningful careers in health system settings,” said Meg McMahon, an IHPME PhD student in health economics who is working with Brown and Bornstein to lead the development and implementation of the PhD training modernization strategy. While completing her PhD, McMahon is working at CIHR as a Project Director to implement PhD training modernization through the new program. More than 40 fellows will commence their fellowships in September 2017 when they will receive experiential learning and enhanced competency development in areas like change management, leadership, and dialogue and negotiation, to equip themselves with the skills necessary to lead impactful careers. More than 40 leading health institutions have expressed an interest in working with these fellows, including Canada Health Infoway, Canadian Blood Services and Choosing Wisely Canada, all of which are eager to support on-the-job training for PhD graduates, accelerating their career preparedness.

Quality Ontario, the Institute for Clinical Evaluative Sciences, and six faculties of medicine across the province. It offers innovative, evidence-based training programs to build much-needed quality-improvement capacity in Ontario’s healthcare system. New this year is IDEAS Campus, a customized learning management system that launched in March 2017 as an accessible online platform for student learning materials. “IDEAS Campus allows us to package the program in a way that better facilitates learning and improvement. By moving more content online and using a blended learning model, the program becomes more accessible to busy health professionals across the province,” said Gillian Ritcey, Director of IDEAS. An additional development this year was the introduction of the IDEAS focused cohort strategy for the Advanced Learning Program. These cohorts seek to accelerate quality improvement learning by bringing together individuals who are working on similar topics or patient populations. There are plans under way for four more focused cohorts, including: Major Depression Quality Standards, Effective Transitions in Care, Palliative Care Quality Standards, and Primary Care Access and Efficiency. IDEAS graduates leave the program with a common language and approach to patient care, which in turn provides them with confidence and a capacity to act as leaders in improving health outcomes.

An Evolution of IDEAS

Gillian Ritcey, Director of IDEAS

The Improving and Driving Excellence Across Sectors program (IDEAS) — Ontario’s quality training program for healthcare professionals — was renewed by the Ministry of Health for a second term, from 2016 to 2019. The program is one of the first partnerships of its kind between IHPME, Health 19

Annual Report 2016-17

2 Research Impact & Excellence

Barrie Primary Care Campus in November 2016, physicians at the BCFHT started prescribing park time to their patients. “There is evidence suggesting that people with depression, anxiety or general stress who spend time in outdoor green space see significant improvements in their health and well-being,” said Dr. Aamir Bharmal, a final-year Public Health and Preventive Medicine resident who is a co-investigator in the “Park Rx” pilot project. “Health isn’t just about going to a doctor’s appointment or what happens inside a hospital. We want people to make the connection between everyday activities, such as walking through a park, and health,” said Bharmal.

Community Collaboratory Integrates Primary Care and Public Health in Barrie

A partnership between DLSPH and the city of Barrie is improving community health by enhancing integration among partners and maximizing the region’s green space. The collaboration is called the Healthy Barrie project and includes DLSPH, U of T Medicine, the City of Barrie, the Barrie Community Family Health Team and Family Health Organization (BCFHT), Royal Victoria Hospital Family Medicine Teaching Unit, and the Simcoe Muskoka District Health Unit. Shortly after the project team moved into the

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Photo: Courtesy of Na-Me-res

From our beginnings in sanitation science, nutrition and vaccine development to today’s advances in infectious and chronic disease prevention, we are deeply engaged in a broad array of multidisciplinary research that benefits people in local communities and across the globe.

Section 2: Research Impact & Excellence

The next phase of the grant opens in spring 2017 when the new office and wired conference space will open in the Health Sciences Building. “It will be a student hub,” Forman said. “It will allow me to grow the number of students doing human rights work, both PhDs and master’s students. “Shared space is enriching for scholarship. Having people doing similar types of research in close proximity is very valuable. They develop a community and interact with each other’s work.” Forman also envisions using the conference room for her seminar class, the Right to Health in International Law, and for remote guest lectures. “The audiovisual capability will be far better than using Skype,” she said.

Research Day and Workshop Showcase Biostatistics Scholarship

For Professor Wendy Lou and many biostatistics students, Biostatistics Research Day and SORA-TABA Workshop is “the highlight of the term.” The event is a hub for students, faculty, alumni and statisticians working in the community for highly anticipated professional development lectures, a research poster session and a networking event. The day also serves as the division’s spring reunion. Each year, it has a different theme and features lectures given by experts. The 2016 theme was causal inference, while in 2017, the theme was data visualization. “We looked at the very broad scope of possibilities for using graphic tools to communicate with the public,” Lou said. “With increasing volumes of raw data being collected in, for example, healthcare and business analytics contexts, new graphical approaches are needed to generate hypotheses and extract actionable information.” The speakers were from the public and private sectors: professors from Ryerson and York universities and professionals from IBM and TD Bank. The SickKids Research Institute co-hosted the day. Another part of the event was career-focused where students had a chance to present their research at a poster session and to learn about career possibilities from a panel that offered career-building advice.

Not only is the project helping the community view health more holistically, it is also putting the community at the forefront of health research and education. “The Healthy Barrie project is a positive example of how collaboration across the heath system, municipal government and the university can help build a sustainable healthcare system,” said Professor Adalsteinn Brown, Director of IHPME.

The Right to Space

When Lisa Forman, an Assistant Professor in the Social and Behavioural Health Sciences Division, was named the Canada Research Chair in Human Rights and Global Health Equity in 2014, she was delighted. “It’s a real enabler,” Forman said. “The generous funding allows me to support students and PhD fellows and bring in colleagues from around the world. It also frees up time for my own research. It has just been a dream.”

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“ With increasing volumes of raw data being collected, new graphical approaches are needed to generate hypotheses and extract actionable information.” — Professor Wendy Lou

Dr. Aamir Bharmal, Public Health and Preventive Medicine resident

Photo: ethan horst mitchell

sustainable and healthy way. That’s why the Canadian Urban Environmental Health Research Consortium (CANUE) was created in spring 2016, a pan-Canadian research partnership connecting detailed environmental data with public health data. “This consortium will provide critical environmental health research so policy-makers and urban and regional planners can make evidence-based decisions when addressing the challenges of urbanization and growing suburbs,” said Jeffrey Brook, Assistant Professor of Occupational and Environmental Health and CANUE’s Scientific Director.

“This event gets bigger and bigger every year,” Lou said. “It brings our statistical community together.”

National Research Hub Connects Environmental and Health Data

Professor Lisa Forman in her Canada Research Chairsupported space

With the rise of global megacities, there is an urgent need to design and modify cities to improve, not degrade, population health. Canada’s urban populations also continue to grow and there are tremendous opportunities to help them evolve in a 23

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Section 2: Research Impact & Excellence

Photo: Marit mitchell

in recognition of her research potential, academic excellence and demonstrated leadership abilities. After working with patients throughout medical school, Chrystoja became interested in how new technologies and procedures are introduced into medical use. Her Vanier-supported doctoral work focuses on developing a calculator to assess the accuracy and predict the benefits and risks of healthcare interventions. “Unlike new drugs, there is often no rigorous methodological evaluation of treatment effectiveness for many medical devices and surgical procedures. There are many examples of highprofile medical device recalls and surgical techniques found to not significantly improve health or even cause harm,” said Chrystoja. She hopes to develop an interactive calculator that more accurately interprets study data and biases to aid in clinical decision making. “When benefits of new technologies are overestimated, it can mean the misallocation of scarce healthcare dollars, not to mention the human cost in suffering. When risks are underestimated, the consequences can range from mild complications to the catastrophic, and even death,” said Chrystoja. “It’s exciting to be doing work that could impact health policies and benefit patients around the world.”

Following CANUE’s first workshop in December 2016, a strategic plan is in place and projects collecting data related to air quality, green spaces, walkability, noise, weather and climate have launched. “What’s really exciting about CANUE is the strong community of people currently working on both environment and health, with backgrounds in geography, transportation, engineering, chemistry, epidemiology, biology, medicine and public health,” said Brook, who is working closely with Occupational and Environmental Health Professor Greg Evans on air quality studies and measurement. Howard Hu, DLSPH Dean, explains that CANUE is one of the first interdisciplinary collaboratories to study the exposome — the cumulative effect of the environment on health over an individual’s lifetime. “This partnership will examine how environmental factors affect our health — from birth to old age — at an unprecedented, national scale,” said Hu.

More than 80% of Canadians live in cities

“ It’s exciting to be doing work that could impact health policies and benefit patients around the world.” — Caitlin C. Chrystoja, IHPME MD/PhD student

Vanier Scholar Develops Calculator to Predict Benefits and Risks of Healthcare Interventions

Top left: Professors Jeffrey Brook (left) and Greg Evans lead a pan-Canadian research consortium that is connecting environmental and public health data to study Canadians’ exposomes

Caitlin C. Chrystoja, an IHPME MD/PhD doctoral student studying clinical epidemiology, was awarded Canada’s most prestigious doctoral award, the Vanier Canada Graduate Scholarship,

Dalla Lana School of Public Health

80%

Bottom right: Caitlin C. Chrystoja, IHPME MD/PhD student

Photo: Living-Learning programs via Flickr / CC BY-NC-ND 2.0

benefit these communities. “This is an excellent example of fitting the service to the real, unmet needs of people who use drugs,” said Ahmed Bayoumi, IHPME professor and clinician-scientist at St. Michael’s Hospital.

Andrea Tricco Awarded Canada Research Chair in Knowledge Synthesis

Andrea Tricco received a Canada Research Chair in Knowledge Synthesis in December 2016 to continue her work in knowledge synthesis — combining information from large numbers of research studies in a way that helps governments, policymakers, physicians, patients and others make evidence-based decisions around healthcare. “I am thrilled to receive a Tier 2 Canada Research Chair,” said Tricco, an Assistant Professor of Epidemiology. “My dream is to improve the health of all Canadians by providing decisionmakers with the specific information that they need just in time for them to make a decision.” Tricco and her team are frequently commissioned by federal and provincial governments in Canada to provide evidence to support decision making, as well as foreign governments and international agencies such as the World Health Organization (WHO). For example, in the summer of 2016, Tricco helped the Canadian Institutes of Health Research

Supervised Injection Services Coming to Toronto

80%

More than 80% of Torontonians who participated in recent surveys agreed that supervised injection services would benefit communities

Bottom right: Professor Andrea Tricco received a Canada Research Chair in Knowledge Synthesis in December 2016

Across Canada and the United States, rates of overdose from opioid drugs, including Fentanyl, have skyrocketed in recent years. Ontario has seen an almost fourfold jump in the rate of opioid-related deaths over the past 25 years. To save lives and keep communities safe, recommendations by Professors Carol Strike and Ahmed Bayoumi are being implemented and supervised injection services are coming to Toronto. “If we do not provide a safe space, we are ignoring a problem that is only getting worse — more people will overdose and we will fail to prevent infections such as hepatitis C and HIV,” said Strike, Professor of Social and Behavioural Health Sciences. Supervised injection services are legally sanctioned spaces where people can inject illegal drugs, typically opiates or cocaine, under the supervision of trained health staff and without fear of arrest. These services allow for safer injection and scientific evidence shows that they lead to a reduced number of overdoses, increase referrals to drug treatment, and benefit public order. City officials carefully selected three locations for these services within communities where rates of injected drug use are high. More than 80 per cent of Torontonians who participated in recent surveys agreed that supervised injection services would 25

Annual Report 2016-17

Photo: DFID – UK Department for International Development via flickr / CC BY 2.0

create modules to make peer reviewers aware of gender bias and to promote gender equity when reviewing grant applications. Her team also helped the WHO and the South African government implement policies to prevent bankrupting the country’s healthcare system.

“ These scholars will be Canada will learn to apply novel multidisciplinary trained to develop rouresearch methods to improve MCH surveillance tine, reliable, low-cost, systems and link data to national MCH programs long-term surveillance and policies. of health conditions that impact their respective “These scholars will be trained to develop populations, evaluate routine, reliable, low-cost, long-term surveillance the success of interof health conditions that impact their respective ventions and improve populations, evaluate the success of interventions accountability for health expenditures.” and improve accountability for health expenditures,” said Jha, Dalla Lana Chair in Global Health — Professor Prabhat Jha and Epidemiology. The SAVE program — a partnership between DLSPH and the Centre for Global Health Research based at St. Michael’s Hospital — is one of 23 national research projects funded by the Canadian Queen Elizabeth II Diamond Jubilee Advanced Scholars Program that supports global research projects.

Global Health Researchers Receive Prestigious Grant to Build Global Health Capacity

Global health researchers Erica Di Ruggiero and Prabhat Jha received funding from the Canadian Queen Elizabeth II Diamond Jubilee Advanced Scholars Program to enable global talent exchange and develop the research capacity of scholars who will improve maternal and child health (MCH) in Canada and four low- and middle-income countries. “This program will help build research capacity among scholars to use mortality evidence to improve maternal and child health outcomes and become engaged leaders in their countries,” said Di Ruggiero, who was appointed Director of DLSPH’s Office of Global Public Health Education and Training in December 2016. The funding leverages the Statistical Alliance for Vital Events (SAVE) program through which 20 scholars — 50 per cent of whom are women — from Ethiopia, India, Mexico, Mozambique and

Dalla Lana School of Public Health

Gillian Einstein Named Inaugural Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging

Professor Gillian Einstein received the inaugural Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging to examine a number of key mysteries surrounding women’s brain health. “There are a lot of expectations about the way that women are supposed to be, and sometimes 26

developing dementia than those who live further away. Led by Professors Hong Chen and Ray Copes, researchers examined records of more than 6.5 million Ontarians to explore the correlation between living close to major roads and dementia, Parkinson’s disease and multiple sclerosis. They found that people who lived within 50 metres of high-traffic roads — like Ontario’s Highway 401 — had a seven per cent higher likelihood of developing dementia compared to those who lived more than 300 metres away from busy roads. “With our widespread exposure to traffic and the greater tendency for people to live in cities these days, this has serious public health implications,” said Chen, Assistant Professor of Occupational and Environmental Health and lead author on the paper, Living Near Major Roads and the Incidence of Dementia, Parkinson’s Disease, and Multiple Sclerosis: A Population-based Cohort Study. He is also a scientist at Public Health Ontario and the Institute for Clinical Evaluative Sciences. “Our study is the first in Canada to suggest that pollutants from heavy, day-to-day traffic are linked to dementia,” said Copes, Associate Professor of Occupational and Environmental Health and Chief of Environmental and Occupational Health at Public Health Ontario. As urban centres become more densely populated and more congested with vehicles on major roads, researchers suggest these findings could be used to help inform municipal land use decisions as well as building design to take into account air pollution factors and the impact on residents.

“ Women bear children so we focus enormous energy and time on reproductive health. This chair allows us to study some surprising things that might not be expected.” — Professor Gillian Einstein

Professors Hong Chen and Ray Copes examined records of more than 6.5 million Ontarians to explore the correlation between living close to major roads and dementia

Top: Professor Gillian Einstein received the inaugural Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging in December 2016

Living Near Major Traffic Linked to Higher Risk of Dementia

Photo: istockphoto

6.5m

we only research those things. Women bear children so we focus enormous energy and time on reproductive health. This chair allows us to study some surprising things that might not be expected,” said Einstein, Associate Professor of Social and Behavioural Health Sciences. Einstein’s work is breaking new ground in how biological and social factors relate to health. “Humans are living in stressful circumstances and different gendered environments. These environments affect human biology,” she said. “Combining the study of culture, social milieu and women’s personal experiences along with physical health creates a holistic view of women’s cognitive health that will fill a gap in existing research.” In addition to pursuing her own research, Einstein is passionate about encouraging students who are interested in studying sex, gender and brain health. “One of the goals of the chair is to provide graduate students in psychology and neuroscience who are studying the brain and cognition extra financial support if they’re interested in adding sex differences to their studies or adding females to their research,” she said.

Researchers have found that people who live close to high-traffic roadways face a higher risk of 27

Annual Report 2016-17

3 Partnerships & Management

proposal — we are providing young innovators with the skills and knowledge to get their ideas off the ground,” said Ashley Clerici. The Clerici family shares IGHEI’s vision of creating a pandemic of health through social innovation. “This fund will enable students to learn about the power of public health innovation to transform their knowledge, ideas, creativity, passion and networks into positive change in society,” said Professor Alex Jadad, IGHEI Director. Another gift, this one to the Waakebiness-Bryce Institute for Indigenous Health, will also support health innovation. Merck for Mothers has committed $2.6 million to fund an Indigenous midwife-led

Clerici Family and Merck for Mothers Support Health Innovation and Capacity Building

Two gifts supporting innovative research at DLSPH are helping to create a healthier population. In October 2016, siblings Adam and Ashley Clerici and Ashley’s husband Yianni Soumalias established the Healthy Generation Fund at IHPME. This new fund, co-led by the Institute for Global Health Equity and Innovation (IGHEI), supports an annual competition calling for innovative ideas in healthcare. “The Healthy Generation Fund is unique in that we aren’t simply investing financially in a

Dalla Lana School of Public Health

Photo: Stefanie Neves

The Dalla Lana School of Public Health works collaboratively to achieve our collective vision of a healthier Canada and a healthier world. We do this by partnering with the University of Toronto’s Faculties of Medicine, Information, Engineering, Management, Law, Arts and Science, and many others. We also have strong alliances with Toronto’s powerful community of research-intensive hospitals, government agencies and institutes, and local and global philanthropists.

interdisciplinary wrap-around care project called Kind Faces, Sharing Places. It launched in May 2017. Professors Janet Smylie and Pat O’Campo are leading the project with Indigenous midwife, Sara Wolfe, from Seventh Generation Midwives Toronto, and Frances Sanderson from Nishnawbe Homes. Their aim is to enhance Indigenous maternal and child health by addressing some of the underlying causes of health inequity, including the multi-generational disruption of Indigenous identities, families and communities. “Through this partnership we will address specific health needs of Indigenous families using Indigenous values and knowledge to improve family and community well-being,” said Smylie.

plan. A related effort is under way with U of T’s Truth and Reconciliation Steering Committee as Indigenous knowledge and well-being are central to the DLSPH’s commitment to diversity and equity. Professors Siddiqi and Stephanie Nixon cochaired the subcommittee developing a statement that will affirm the Faculty’s commitment to advancing diversity and equity. In an extension of the Faculty’s commitment to diversity, DLSPH hosted Making Trans Health Count, a lecture and dialogue on November 21, 2016, to align with the Trans Day of Remembrance. Professor Lori Ross explained that the event was “initiated as a way for the DLSPH to do our part in creating safe and supportive spaces at the university for our trans students and community members.” “Often in research, we don’t ask about gender in a way that makes sense, which makes trans people invisible,” said Ross, Associate Professor of Social and Behavioural Health Sciences, who chaired the organizing committee for the event. “The ideas presented will help increase our Faculty’s capacity to use public health research to ensure trans health is counted in meaningful and community-relevant ways.”

DLSPH as Role Model for Diversity, Inclusion

Co-chaired by Professors Arjumand Siddiqi and Rhonda Cockerill, as well as post-doctoral fellow Uttam Bajwa, the DLSPH Diversity and Equity Committee was established in the fall of 2016 as part of the School’s commitment to creating “a model physical and professional environment that supports health for learners, staff and faculty.” The co-chairs opened the committee to all students, faculty, and staff and “we had an overwhelming response,” Siddiqi said. Sixty-four people volunteered and the group was divided into subcommittees to pursue five major tasks: creating a DLSPH diversity and equity statement; reviewing initiatives at other institutions; assessing diversity and equity at the DLSPH; identifying targets and benchmarks; and developing an implementation

Dalla Lana School of Public Health

Sixty-four people volunteered to participate in DLSPH's Diversity and Equity Committee in fall 2016

Truth and Reconciliation Committee

In response to the 2015 report of the Truth and Reconciliation Commission of Canada (TRC), U of T established the Steering Committee for the U of T Response to the TRC. Over the course of 2016, the committee, with support from its five working groups, produced a report, Wecheehetowin (Working Together), and presented it to President Meric 30

Kind Faces, Sharing Places partners (left to right): Chirfi Guindo, Jennifer Chan, Sara Wolfe, Suzanne Stewart, Theresa Burning, Janet Smylie, Howard Hu, Summer Faith Garcia, Mary-Ann Etiebet

Engaging Our Empathy

Photo: stefanie neves

After the election of Donald Trump, Blake Poland, an Associate Professor of Social and Behavioural Sciences, noticed that “students were feeling anxious about the state of the world and didn’t have much of an opportunity to address those feelings in a deeper way other than through hallway conversations.” Poland, who is studying non-violent communication with a certified trainer in Quebec, offered support in the form of an empathy circle, “intentional spaces of presence and non-judgement that groups create together in order to hear and be heard differently.” The circle was held in February 2017. “In an empathy circle, participants connect deeply to what is alive in them and share from the heart into the circle. The rest of the circle holds this in silence until the next person is moved to speak what is there for them,” Poland explained. “Slowing down and connecting with ourselves and each other in this way allows us each, and collectively, to access thoughts and feelings from a deeper place than our recycled thoughts of what we already know about something.” Empathy circles typically last about an hour, can have anywhere from three to 30 people and are ideally facilitated by someone trained in non-violent communication. Participants self-select, so they are open to the experience. Poland said he can envision holding additional empathy circles in the coming academic year, addressing topics such as dealing with interpersonal conflict, work-life balance, precarious work, and what comes after graduation in an employmentconstrained economy.

“ Slowing down and connecting with ourselves and each other in this way allows us each, and collectively, to access thoughts and feelings from a deeper place than our recycled thoughts of what we already know about something.” — Professor Blake Poland

Professor Earl Nowgesic, steering committee member of U of T’s Response to Truth and Reconciliation Commission of Canada

Gertler and Provost Cheryl Regehr in January 2017. Three DLSPH faculty members and Indigenous scholars contributed their time and energy to ensuring Indigenous voices were heard: Professor Anita Benoit (Mi’kmaq) served on the Indigenous Curriculum working group; Professor Suzanne Stewart (Dene) co-chaired the Indigenous Faculty and Staff working group; and Dr. Earl Nowgesic (Anishinaabe), Assistant Scientific Director of the Institute of Aboriginal Peoples’ Health at the Canadian Institutes of Health Research and a status-only professor at DLSPH, co-chaired the Indigenous Research Ethics and Community Relationships working group. “I was very impressed with our group. I can’t even tell you how rich our meetings were and how committed to the process and energized our members were,” Nowgesic said. Nowgesic, who served as Interim Director of the Waakebiness-Bryce Institute for Indigenous Health from January 1 to December 31, 2016, presented the working group’s report to the overall steering committee for incorporation into the final report. Now the challenge is realizing the steering committee’s calls to action. A university-wide implementation plan is in the works and Nowgesic is eager to see DLSPH make its own efforts. “We could benefit from more tenured Indigenous faculty through cluster hiring and a new dedicated course about Indigenous research paradigms and Indigenous epistemologies,” he said.

Alumni Give Back

DLSPH has two deeply engaged alumni associations: one that is now part of the Institute of Health Policy, Management and Evaluation and the Public Health Alumni Association (PHAA), representing public health sciences alumni. “We have a very engaged group and a long history,” said Lee Fairclough, Vice-President of Health Quality Ontario and inaugural president of the IHPME Alumni Association under its new 31

Annual Report 2016-17

Section 3: Partnerships & Management

from across Canada to discuss the impact that HIV pre-exposure prophylaxis (PrEP) will have on the sex industry. A group of 50 women, men and trans people met at DLSPH for a three-day consultation on the implications of PrEP — a way for an HIV-negative person who is at risk of HIV infection to reduce their risk of becoming infected by taking antiretroviral drugs. The gathering consisted of those working on the front lines in community outreach, social service programming, healthcare and advocacy, from more than 20 sex worker–directed organizations and peer-run programs. “Some suggest PrEP is the new condom,” said Allman, Assistant Professor of Social and Behavioural Health Sciences. “While PrEP won’t prevent syphilis, gonorrhea or other sexually transmitted infections, the evidence is strong that despite side effects, when taken properly, PrEP can work to help prevent individuals from acquiring HIV.” Sex workers are one marginalized group that has inequitable access to health services. Indigenous people, racialized communities and those in the LGBTQ+ community also face equity issues, notably barriers related to access to prevention, care, treatment and support. Many of these issues were discussed during the consultation. In Dean Howard Hu’s introductory remarks, he talked about his early work trying to enhance HIV care for sex workers: “Today’s discussion is a conversation that matters and it is critical that we provide a safe space for you and for other communities to conduct these kinds of conversations.”

structure. “Our Society of Graduates existed for three decades and none of that commitment has changed.” Fairclough identified three areas in which the IHPME group plans to be active: education and events; mentorship; and awards and advancement. “We’ll have new opportunities to contribute,” she said. “Some of our older alumni want to be mentors and help the new graduates. Our professional program has a long history of preceptorships and placements, so we want to build on that and enable our mentors.” Alison Crepinsek, an MPH graduate now working at Dalhousie University, and Sarah Ko, a DLSPH staff member, are co-chairs of the PHAA’s alumni-student mentorship program, now in its fifth year. It matches first-year master’s students with alumni and features informal contact as well as structured networking events. This year, there are 49 mentoring pairs, the most to date. Alumni from around the globe are participating, Crepinsek noted. “The nature of the field takes people away from Toronto,” she said. “It speaks to all of the public health career possibilities, and that’s exciting for our students to see.”

— Professor Howard Hu

Black Health as a Public Health Issue

In February 2017, Dr. Onye Nnorom, Associate Program Director of the DLSPH’s Public Health and Preventive Medicine Residency Program, presented at Public Health Ontario’s Grand Rounds and hosted Think Afro-Pink, a breast cancer

PrEP Consultation with Sex Worker Community

In October 2016, Professor Dan Allman gathered sex workers and people who work with them

Dalla Lana School of Public Health

“ Today’s discussion is a conversation that matters and it is critical that we provide a safe space for you and for other communities to conduct these kinds of conversations.”

IHPME alumni and supporters (left to right): Lee Fairclough, Leslie Sorensen, Ann Wojtak, Jodeme Goldhar and Annette Marcuzzi

hosted 15 mother-daughter pairs for a breast cancer information session and Zumba class where participants received mammography incentive vouchers for their mothers. “It is my hope that we can address health inequity by empowering communities and families to be health champions and address the needs of diverse communities in Ontario,” said Nnorom.

Community-University-Public Sector Partnership Makes Toronto Communities Healthier

“ Our hope is that these projects can inspire policy and practice change here as well as in other communities.” — Professor Blake Poland

Dr. Onye Nnorom

From local environmental leadership among newcomers to extreme weather response plans for the homeless, a series of healthier city and community pilot projects culminated at a showcase event at DLSPH in February 2017. With more than half of the world’s population living in urban areas, DLSPH, Wellesley Institute and Toronto Public Health launched an innovative research platform to address a range of social determinants of health in Toronto. The partnership supported nine projects that developed solutions related to creating resilient cities, the built environment and health, and place-based interventions. One project examined the factors that influence newcomer and second-generation immigrant youths’ perceptions of healthy relationships, including parental, cultural, peer and social media, in order to promote resilient relationships and prevent teen dating violence. Another project explored employment solutions for youth living in the Jane Street corridor. The event and grants were enabled by the Healthier Cities and Communities Hub. Led by Professors Blake Poland and Patricia O’Campo, the Hub is a network of university and community partners that co-create research that generates evidence useful for intervening to improve health. All projects were research partnerships between academia and a variety of community groups with an aim to catalyze new programming, policy change, further research and raise awareness. “Our hope is that these projects can inspire policy and practice change here as well as in other communities,” said Poland, Associate Professor of Social and Behavioural Health Sciences.

awareness event. The common theme was racism and Black health as a public health issue. She says the issue is particularly pressing in Toronto where Black communities represent eight per cent of the population and are the third-largest visible minority group. Although there is some demographic data available, Nnorom said, “We don’t have a tradition of collecting racialized data here in Canada, and as a result, we don’t know the complete picture.” During her Grand Rounds presentation, Nnorom recommended that in addition to collecting ethno-racial data, racism should be added to the Public Health Agency of Canada’s formal list of key determinants of health. Nnorom is an advocate for more data collection and she is also researching ways to improve cancer screening among Black women. “People think that cancer is not a Black issue,” said Nnorom. That’s why she hosted Think Afro-Pink, a unique health promotion initiative targeting second-generation Canadians to influence the health behaviours of their parents. The event 33

Annual Report 2016-17

“ We want to close the gap in Indigenous Health across Canada by engaging in research that is community driven, as articulated by these communities, and doing so in ways that are culturally appropriate.”

Photo: stefanie neves

— Professor Suzanne Stewart

that under her leadership, the Institute will advance its mission of creating thriving Indigenous communities in Canada and around the globe,” said Dr. Dan. One of her many duties is to oversee the proposal program, a competitive initiative that distributed approximately $80,000 in seed money to Indigenous community-based national research projects and has also funded Indigenous health research projects, planning efforts and student travel. These projects include: research into the culturally specific supports required by Indigenous women and girls who access one of Ontario’s 35 sexual assault/domestic violence treatment; studying how measures of wellness relate to prescription drug abuse; and using the Native Wellness Assessment tool to collect community wellness data. “The Institute prioritizes centring our work in Indigenous paradigms and helping institutions create space for Indigenous knowledges in health

WBIIH Moves Forward

The Waakebiness-Bryce Institute for Indigenous Health has a new stellar leader at the helm to guide and shape its efforts. Dr. Suzanne Stewart, psychologist and Canada Research Chair in Indigenous Homelessness and Life Transitions, has become the Institute’s first permanent director. “I’m extremely thrilled by the appointment,” said Stewart, a member of the Yellowknife Dene First Nation, who was appointed in January 2017. “In a few short months we have gained a lot of momentum with the support of national, local and international Indigenous communities.” Dr. Michael Dan, founding benefactor of the Waakebiness-Bryce Institute for Indigenous Health, is also pleased by Stewart’s appointment. “Suzanne’s commitment to transforming Indigenous health is impressive and I am confident

Dalla Lana School of Public Health

Professor Suzanne Stewart named first permanent director of the WaakebinessBryce Institute for Indigenous Health in January 2017

research and programs,” Stewart said. “We want to close the gap in Indigenous health across Canada by engaging in research that is community driven, as articulated by Indigenous peoples, and doing so in ways that are grounded in Indigenous knowledges and practices.”

WHO Guidelines and Ethical Guidance

“ The sustainable health system of the future is one where public health professionals, clinicians, policy-makers and communities work together to make individuals, populations — and the planet — healthier.” — Professor Howard Hu

November 2016 Dean’s Leadership Series speakers (left to right): Jennifer Gibson, Denise Marshall, Alex Jadad, Howard Hu, Naheed Dosani, Kory McGrath and Maureen Taylor

The Joint Centre for Bioethics, under the direction of Professor Jennifer Gibson, is collaborating with international colleagues to develop guidelines and resources to support ethical decision-making in World Health Organization (WHO) member states. The JCB is part of the Global Network of WHO Collaborating Centres for Bioethics, which it co-founded in 2009. Recently, Gibson and JCB faculty members helped develop ethical guidelines for infectious disease outbreaks, such as Ebola, tuberculosis, or Zika, as well as public health surveillance guidelines. Gibson co-chaired the governance sub-group of the Ethics and Public Health Surveillance Guidelines Working Group, the final report of which is expected in summer 2017. Professor Ross Upshur also provided input on the WHO’s internal review of its code of conduct. “The globalization of health calls for collaborations across countries and systems to address challenges. Getting out in front of the ethical issues is critical,” said Gibson. In the upcoming year, the JCB will turn its attention to ethical issues related to big data in global health and to the WHO’s healthy aging strategy.

to stimulate ideas on how to address them. “The sustainable health system of the future is one where public health professionals, clinicians, policy-makers and communities work together to make individuals, populations — and the planet — healthier,” said Howard Hu, noting the events provide a unique opportunity for intersecting fields to share a community forum. For his final DLS in May 2017, Dean Hu wanted to tackle a truly wicked problem: climate change. “It is a topic that touches everyone living in Toronto and urban centres across the globe, but also those living in rural settings too. Yet, it is an issue that may seem intangible or impossible to address in a meaningful way,” he said. Another complex issue that the DLS explored was death as a public health issue. The November 2016 event was hosted in partnership with IGHEI, where Professor Alex Jadad narrated a storyteller forum that encouraged the audience to rethink how public health can promote health in life and in death. “How can we feel more comfortable discussing what we would rather avoid, ensuring that we focus on achieving a good life until our last breath?” said Jadad, who infused visual and performing arts into the program. “DLSPH is well positioned to collaborate with governments, communities and industry to tackle wicked problems of urbanization, climate change, death and dying, and beyond,” said Hu.

Dean’s Leadership Series Events Explore Wicked Problems

DLSPH hosted two Dean’s Leadership Series (DLS) events that engaged the community on significant issues affecting Canadians and beyond, and 35

Annual Report 2016-17

Awards and Honours

Dan Allman

Charna Gord

Allie Peckham

2016 John Hastings Award for Excellence in Service DLSPH

2016 Open Robin Badgley Teaching Excellence Award DLSPH

Best Course Preparation IHPME

Ross Baker

Gillian Einstein

Peggy Leatt Knowledge and Impact Award IHPME

Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging Women’s Brain Health Initiative

Ross Baker

Rob Fowler

Board Award Association of Family Health Teams of Ontario

Teasdale-Corti Humanitarian Award Royal College of Physicians and Surgeons of Canada

Nancy Baxter

Howard Hu

Inductee Canadian Academy of Health Sciences

2016 Anthony Miller Award for Excellence in Research DLSPH

Ahmed Bayoumi

Noah Ivers

Robert Schwartz

Paula Goering Collaborative Research and Knowledge Translation Award Canadian Knowledge Transfer and Exchange Community of Practice

Best Mentor IHPME

Alumni of Influence U of T University College

Alex Jadad

Carol Strike

Honourary Doctoral Degree UOC eHealth Center of Universitat Oberta de Catalunya

Paula Goering Collaborative Research and Knowledge Translation Award Canadian Knowledge Transfer and Exchange Community of Practice

Andrew Pinto

Social Responsibility Award in Postgraduate Medical Education U of T Medicine Laura Rosella

Brian MacMahon Early Career Award Society for Epidemiologic Research Laura Rosella

Zulfiqar Bhutta

Prize in Medical Sciences World Academy of Sciences (TWAS)

Prabhat Jha

International Member National Academy of Medicine (U.S.A.)

Lei Sun

Charlotte Lombardo

Joshua Tepper

DiverseCity Fellow CivicAction

2016 Early Stage Robin Badgley Teaching Excellence Award DLSPH

Best Instructor IHPME

Irfan Dhalla

Greg Marchildon

Dr. Maurice McGregor Award Canadian Coordinating Office for Health Technology Assessment

Best Course Preparation IHPME

Ross Upshur Graduate Thesis Mentorship Award Joint Centre for Bioethics

Fiona Miller

George Tomlinson

Best Thesis Supervisor IHPME

Director’s Award of Excellence IHPME

Melodie Buhagiar

2016 Outstanding Administrative Staff Award DLSPH Maria Chiu

Prize in Statistics Statistical Society of Canada

Alison Thompson

Daniel Grace

Early Researcher Award Ministry of Research and Innovation

Shawn O’Connor

2016 Outstanding Research Staff Award DLSPH 37

Annual Report 2016-17

Editor: Nicole Bodnar / Writer: Elaine Smith Design: Fresh Art & Design Inc. / Printing: Colour Innovations

Dalla Lana School of Public Health Communications Office 155 College Street, Room 642 Toronto, On M5T 3M7 dlsph.utoronto.ca