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Dalla Lana School of Public Health ANNUAL REPORT 2015–2016

Diversity and Partnerships in an Evolving Health Landscape


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DEAN’S MESSAGE

EDUCATION

RESEARCH

PARTNERSHIPS & LINKS

We are leveraging diversity and strengthening partnerships within our Faculty, the University, the city of Toronto and internationally.

A dynamic learning community where tomorrow’s public health and health systems leaders develop a solutions-oriented approach to complex health issues.

From sanitation science, nutrition and vaccine development to infectious and chronic disease prevention, researchers strive for globally recognized excellence and impact in public health and health systems.

Strong connections to decision-makers across government, the health sector and social policy system support a meaningful and continued impact on health policy and practice.

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AWARDS & HONOURS

OUR FOOTPRINT

INSTITUTES, CENTRES & DIVISIONS

A stellar complement of faculty members, supervisors and staff are recognized for their contributions to this dynamic academic community.

With a new strategic plan to guide the growing Faculty and exciting events to enhance its profile, the School is forging new partnerships and opportunities to enhance public health and health systems.

The scope and breadth of the School’s programming provides unparalleled opportunities to learn and work on a range of critical issues in public health and health systems.

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“There are signs of a culture shift in Canada from hardly ever collecting [race] information to now being more open to it.” Arjumand Siddiqi, page 9

FACTS & FIGURES A snapshot of student, faculty and research activities.

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The Dalla Lana School of Public Health is driving societal change through strong partnerships with diverse communities, locally and globally. The School’s innovations in public health education, research and service are visible at a macro level — influencing government policy and building healthier cities — and a micro level — providing culturally specific interventions and mobile technology to manage chronic disease.


Dean’s Message

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A BBC Radio study released in May 2016 found that 51 per cent of Toronto’s population is foreign born and 230 different nationalities live in the city.

THE CHALLENGES ABOUND. With

diversity come differences in language, culture, historical relationships, appearances and preferences — making communicating, interacting and simply coexisting — difficult endeavours at times. On the other hand, the need for both health care and maintaining health is universal. What all humanity shares in terms of human biology, our responses to our physical and social environments and what is in our food and water, and an intuitive grasp of how “an ounce of prevention is worth a pound of cure” dwarfs the differences between us. Our Faculty’s vision is to be the leading public health school in the world that has an impact on local and global communities and populations. To achieve this vision, we are leveraging diversity and strengthening partnerships within our Faculty, the University, the city of Toronto and internationally. The theme of the 2015–16 Annual Report, Diversity and Partnerships in an Evolving Health Landscape, was selected because it captures the spirit of a number of activities led by faculty, students and alumni who are improving health and health systems with support of community partners near and far.The cover and visuals throughout the report illustrate diverse landscapes, macro and micro, and the effect humans have on their surroundings that dramatically impact health. As an environmental epidemiologist, these visuals remind me of the complex interplay between the external environment and health. Public health professionals work hard to ensure that cities, towns, workplaces and homes have pollution-free air, safe drinking water and food, and effective sanitation systems. It is when these macro systems break down that we see negative health consequences. The Flint, Michigan, water crisis exemplifies one recent breakdown of

PHOTO BY JIM RYCE

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Toronto is the most diverse city in the world. A BBC Radio study released in May 2016 found that 51 per cent of Toronto’s population is foreign born and 230 different nationalities live in the city. As the only public health school in Toronto, the Dalla Lana School of Public Health is arguably faced with both unique challenges and opportunities.


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crucial public health systems and the tragic consequences. After the city switched Flint’s water supply from Lake Huron to the Flint River — a notoriously filthy tributary that runs through the city — to save money in 2014, physicians reported that levels of lead in children in certain parts of Flint doubled or tripled. The children and families hardest hit lived in poorer areas of Flint and many were ethnic minorities, illustrating two determinants of health that public health professionals — and all levels of government — must consider when making decisions that minimize harm and maximize health. What is the relationship between marginalized populations and diversity? In this report, you’ll find a number of stories that showcase members of our community addressing the social determinants of health in a way that recognizes diversity while tailoring interventions and programs to celebrate differences and enhance health. Professor Arjumand Siddiqi’s research is among the first to show how large the racial health inequities are in Canada. Research by Professors Laura Rosella and Walter Wodchis demonstrates that frequent health-care consumers often struggle in other parts of their life in areas such as income, housing and food security. PhD candidate Kinnon MacKinnon is breaking down the barriers LGBTQ people face when participating in sport and physical activity. These are just a few examples of the tremendous impact our thriving community of diverse scholars are having on Torontonians and people across the globe. To make inroads with marginalized groups, it is crucial to have collaborative partnerships with all levels of government, community organizations, within the University and with external academic partners. The School’s broad and deep connection to decision-makers across the

local, provincial and federal governments and sectors of the health and social policy system support a meaningful and continued impact on health policy and practice.The School was also an early adopter of community-based research that includes community members in studies as co-investigators or advisors and as such has cultivated authentic partnerships with a host of community-based organizations. Researchers at the School, Cancer Care Ontario and Public Health Ontario are working together to examine cancer incidence rates in the First Nation population near Kenora, Ontario, in full partnership with the Indigenous community to determine if cancers are elevated and environmentally linked. The Joint Centre for Bioethics is partnering with U of T’s Department of Family and Community Medicine, the Toronto Central Community Care Access Centre and Local Health Integration Network to help primary care doctors manage ethical challenges present when treating people with complex chronic illness. The University of Toronto Joint Centre for Bioethics transitioned from the Faculty of Medicine into the Dalla Lana School of Public Health in July 2015. Together with divisions in the Public Health Sciences and the Institute of Health Policy, Management and Evaluation, our Faculty is addressing upstream social determinants of health and downstream implications on patient care, policies and population health in a truly unique way. To forge a sense of unity in the School, we launched a consultative strategic plan exercise, Towards 2021 and Beyond. This is the first strategic plan for the new Faculty that provides a path forward to leverage our newly combined strengths and enhance our world-class teaching, research and service on a local and global scale over the next five years and beyond.

“We aspire to be one of the world’s leading Schools of Public Health known for innovative initiatives that are driven by evidence-based and holistic ideas of what a healthy and sustainable society will look like in the future.”

The plan’s strategic directions aim to improve the learner experience, ensure globally recognized excellence and impact in research, and enhance partnerships and management of the Faculty. I invite you to read more about the strategic plan in Section 4: Our Footprint and consider how we can use it to ignite passion among all our audiences — from students, faculty, staff, alumni, partners and beyond — to improve public health and health systems. By bringing together this group of three historically strong academic units into one Faculty that continues to grow and strive for excellence, the School has earned its place as one of the most diverse and comprehensive schools of public health in the world. Our strength is not only in our sheer size as the largest in Canada. We also have an unmatched breadth and depth of expertise that is reflective of the evolving health and health system landscape. I bestow my utmost gratitude for making this possible to all our faculty members, staff, alumni, supporters and, in particular, our students. Their 2015 student-led symposium on racial health equity helped accelerate our push to highlight racial diversity as a public health issue. Together, we will continue to push the boundaries in scholarship and service in public health and health systems. In Toronto, the world’s most diverse city, I encourage our entire Faculty community to engage citizens in conversations that matter and create a cultural shift in Canada about what it means to be healthy. Let us draw inspiration from our diverse city to show the rest of Toronto and the world what a healthy and sustainable society looks like, today and in the future. Howard Hu Dean, Dalla Lana School of Public Health

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To forge a sense of unity in the School, we launched a consultative strategic plan exercise, Towards 2021 and Beyond.


Dalla Lana School of Public Health At a Glance

GRADUATE DEGREE PROGRAMS

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 Master of Science (MSc) • Biostatistics Master of Health Science (MHSc) • Bioethics 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

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

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44

663

38

645

235

Core Faculty (including five budgetary cross)

Residents and Post-Doctoral Fellows

Non-budgetary cross appointed faculty

Master’s Program Students

Community and Partner-Based Faculty

PhD Program Students

$33,502,437 7 Annual Research Funding

Canada Research Chairs

Master of Health Informatics (MHI) • Health Informatics

DLSPH is the largest and most comprehensive public health school in Canada and is ranked as one of the top 15 schools of public health globally.

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Public Health Sciences


Section 1: Education

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Education

New Course Focuses on Cultural Diversity The School is a diverse community with a history of focusing on cultural diversity and inequity. Following in this tradition, a new course was introduced in January 2016, led by Assistant Professor Ananya Tina Banerjee, which reflects the healthcare needs and sensitivities of Toronto’s diverse cultural groups. Banerjee’s own research focuses on developing physical activity interventions for diabetes prevention and management in the South Asian community. “My work is mindful of barriers, respectful of culture and language appropriate,” said Banerjee. A group of master’s degree students keen to take such a course wrote to Dean Howard Hu explaining that, “the course

would be an opportunity for students and faculty alike to become more cognizant of how their own identity and the ethnocultural identities of the communities with whom they work impact our role as public health professionals.” Less than six months later, Banerjee was in the classroom, teaching a pilot version of the ethnicity, culture and health course. “We focused on developing cultural competency and trying to understand cross-cultural transactions in healthcare settings,” Banerjee said. “We also looked at social determinants of health and how they intersected with culture and opportunities.” Banerjee said the feedback from her inaugural six students has been positive and rewarding. Her interdisciplinary approach, a variety of guest speakers

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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.


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Education

The first joint MD/MPH degree will be offered in Canada next year.

“There is a transformation in the way we are practicing medicine and organizing health-care systems with Joint MD/MPH Degree Nears an emphasis Implementation on population health and Once all approvals are in place, the social deterUniversity of Toronto will be able to minants of boast of having the first joint MD/MPH health.” who work with diverse populations and relevant assignments prompted some students to call it one of the best courses they have taken. Given such a good response, in 2017 the course will be open to many more students.

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(Master of Public Health) degree in Canada in September 2017. “There’s a huge need for this degree,” said Professor Ross Upshur, a prominent public health researcher and one of the DLSPH faculty leading the charge for the program. “If you look at the literature and the policy, there is a transformation in the way we are practicing medicine and organizing health-care systems.There is an incredible emphasis on population health and social determinants of health.” Upshur praised the foresight shown by the Faculty of Medicine and the

Left: Professor Ross Upshur is the Clinical Public Health Division Head and is spearheading a new MD/MPH degree program. Above: (left to right) Racial Justice Matters co-chairs Navita Singh, Meena Bhardwaj and Anjum Sultana (not pictured: Eden Hagos).

Dalla Lana School of Public Health in establishing the joint five-year degree program, which will encourage physicians “to take a broader population view on delivering health care.” The degree already exists at a number of universities in the United States. He anticipates that the first class to earn the joint degree would probably comprise five medical students, with additional places added as interest demands. The course cycle hasn’t been finalized yet, but Upshur said the program will utilize the depth and strength of DLSPH faculty to tailor the degree to student interests. “This program creates a vehicle for students who are motivated to be

clinicians for the twenty-first century,” Upshur said. “They will have an enhanced set of skills to diversify their practices and scholarship.” New System Leadership Concentration at IHPME There’s a new Master of Science (MSc) degree concentration offered by the Institute of Health Policy, Management and Evaluation (IHPME) in System Leadership and Innovation (SLI). The program builds on IHPME’s rich history in leadership training and the Leadership Education and Development initiative developed


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Racial Justice Matters hosted more than 200 participants, 30 speakers and 22 breakout sessions in October 2015.

Racial Justice Matters Four graduate students co-chaired the 2015 Racial Justice Matters: Advocating for Racial Health Equity conference at DLSPH. The student-led conference was recognized at U of T’s inaugural International Day for the Elimination of Racial Discrimination campaign on March 21, 2016. “We chose this theme for our conference because of the staggering inequities faced by racialized individuals in Canada that not only affect their social outcomes, but health outcomes as well,” wrote the co-chairs, Meena Bhardwaj, Eden Hagos, Navita Singh and Anjum Sultana. “Racial health inequities are a public health concern and we must address the consequences of racism and its root causes.”

Above: Professor Arjumand Siddiqi argues race-based data are required to help address health inequity.

In the run-up to the conference, DLSPH students created a Digging Deeper blog to educate the public about the ways racism infiltrates their lives. Topics included How Media Representations of Race Affect Us and Environmental Racism:Yes, It Happens in Canada. Associate Professor Arjumand Siddiqi contributed the blog entry Should We Routinely Collect Data on Race? Canada at a Crossroads, in which she argued for the necessity of having data to help illuminate (and address) inequities in care. “Put crudely, we need to get over it, and start thoughtfully collecting information about race in every facet of life

that influences our access, opportunities and our health,” she wrote. “Until then, Canadians will continue to have trouble telling our story, learning the true nature of the problems our fellow Canadians face and the solutions in which we all must participate.” Siddiqi said there are signs of a culture shift in Canada from hardly ever collecting this information to now being more open to it.This conference offered a step forward in educating the public health community about existing racial inequities and providing an opportunity to work towards solutions.

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PHOTO BY JIM RYCE

in partnership with the Faculty of Medicine’s Undergraduate Medical Education program. The SLI concentration will provide medical students and postgraduate medical trainees with leadership education through coursework and practicums. The first cohort of students was accepted in spring 2016. The coursework in this non-thesis MSc program focuses on the key aspects of physician leadership for system innovation, including leadership and motivation; strategic thinking and planning; research methods for evaluating health system innovation; and policy analysis and techniques for system change. The practica allow students to apply that knowledge and work with mentors in a range of health and healthcare settings.


PHOTO BY JIM RYCE

Section 2: Research

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Research

High-Cost Health-Care Users Walter Wodchis was the first researcher in Canada to evaluate an entire province’s health-care costs by examining anonymized patient records for nearly 15 million Ontarians over three years. He found that five per cent of Ontarians account for 65 per cent of provincial health-care costs attributable to individual care with the top one per cent accounting for onethird of these costs overall. “People who have high health-care needs over multiple years are frequently hospitalized, which is the most expensive type of care,” explained Wodchis, Associate Professor in IHPME. The study — the largest completed to date in Canada and published in the Canadian Medical Association Journal

in January 2016 — suggests that it is likely that at least some of these patients are not receiving adequate community-based care that could prevent such repeat hospitalizations. “By finding ways to better support the care needs of this small but needs-intensive segment of the population in the community when appropriate, we could substantially lower costs for the healthcare system overall.” This research builds on earlier work with Assistant Professor Laura Rosella that linked Canadian Community Health Survey data to medical claim data where they found that many high-cost health-care users were also struggling in other parts of their life in areas such as income, housing and food security. “Those of lower socioeconomic status are much more likely to become future

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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, problem-oriented research that benefits people here in local communities and across the globe.


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Research

The Healthier Cities and Communities Hub supports nine projects in partnership with researchers, community organizations and local government.

Left: The Healthier Cities and Communities Hub is improving health through partnerships between researchers, community groups and government. Below: Professor Prabhat Jha is saving lives by outlining a global plan for cancer control.

The guide explains to parents how to work with local transportation officials to implement some of the many identified strategies for overcoming these obstacles — a raised pedestrian crossing, for example, or reduced speed limits on residential streets. “The focus of these strategies is to increase active transportation as a way to prevent youth problems with obesity and chronic disease,” said Campbell. The guide will be available online in the summer of 2016, with an interactive website to follow. Investment in Cancer Control in Low- and MiddleIncome Countries

high health-care users, which emphasizes the far-reaching health effects of poverty and economic disadvantage,” said Rosella.

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Safer Streets Pave Way for Healthier Cities Toronto residents who would like to see their children walking to and from school will soon have clear guidance about how to advocate for roadway changes that make their neighbourhoods safer with the help of a Guide to Safer Streets Near Schools. The guide is one of nine projects supported with seed grant funding from DLSPH’s Healthier Cities and Communities Hub as part of a shared

vision to improve community health through partnerships between researchers, community organizations and local government. Preparation of the guide was led by Green Communities Canada’s Katie Wittmann, in collaboration with Monica Campbell, Director of Healthy Public Policy at Toronto Public Health, and Assistant Professor with DLSPH. “About sixty per cent of the parents of today’s students walked to school, but now, only about thirty per cent of students do so,” said Campbell. “Many parents want to improve traffic safety around their schools, but they don’t know where to begin,” explained Wittmann. Among the identified obstacles to walking are safe crossings and traffic.

More than one-third of the world’s eight million cancer deaths occur in low- and middle-income countries (LMICs), but many of these cancer patients received no effective treatment and no opioid drugs to control severe pain, or their families became impoverished paying for treatment.

“Those of lower socioeconomic status are more likely to be high healthcare users, emphasizing the far-reaching health effects of poverty.”


More than one-third of the world’s eight million cancer deaths occur in low- and middle-income countries.

That’s why a team of researchers led by Professor Prabhat Jha have outlined a global plan for cancer control, including prevention, detection, diagnosis, treatment and palliative care. “Most middle-income countries could achieve high coverage of life-saving cancer control within a few years,” said Jha, also Director of the Centre for Global Health Research at St. Michael’s Hospital. The study, published in The Lancet in November 2015, outlined a series of practical, cost-effective strategies to address most preventable or treatable cancer burdens in LMICs that would cost an additional $20 billion per year for all LMICs, mostly funded by governments themselves. Global partners and universities can support innovations that make cancer control investments more attractive. Some of the recommended interventions included increasing tobacco taxes, supporting vaccination programs, encouraging early diagnosis and treatment of breast cancer, cervical cancer and selected childhood cancers, and widespread availability and use of palliative care and pain management. U of T Public Health Researchers Urge that Movies with Smoking Be 18A Rated An Ontario 18A rating for all movies with smoking would avert more than 30,000 tobacco-related deaths and save more than half a billion dollars in health-care costs, according to Associate Professor Robert Schwartz and his research team at the Ontario Tobacco Research Unit (OTRU).

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At least 185,000 children and teens in Ontario will start smoking cigarettes due to exposure to on-screen smoking.

Above: Robert Schwartz is reaching youth via social media to warn them about the dangers of smoking and the link between tobacco and film.

“There is a solid body of research that demonstrates youth who are exposed to smoking in movies are more likely to start smoking than youth who are not exposed, regardless of personality characteristics or their friends’, siblings’ and parents’ smoking and alcohol use,” said Schwartz, OTRU’s Executive Director. OTRU has long advised that it’s time to butt out smoking in movies that are youth rated, but this report, Youth Exposure to Tobacco in Movies, provides new data about the costs — both economically and in lives lost — of youth smoking due to movie exposure. The report projects that at least 185,000 children and teens in Ontario will start smoking cigarettes due to exposure to on-screen smoking. These future Ontario smokers would

be responsible for at least $1.1 billion in health-care costs attributable to their exposure to on-screen smoking. At least 59,000 of these smokers recruited to smoking by exposure to movies depicting tobacco imagery are projected to eventually die prematurely from smoking-related disease. To communicate this research to the public, Schwartz and Thunder Bay District Health Unit created a five-minute live-illustration video that has had close to 35,000 views on YouTube and more than 37,000 views on Facebook.

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Section 3: Partnerships & Links

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Partnerships & Links

Student-Led Start-Up Helps Women Seize Their Birth Control Fifteen million women in Canada and the United States use oral contraceptives for birth control, yet up to one in 10 of these women become pregnant during their first year on the pill. Most often, this is because they forget to take it, or take it irregularly. That’s why a team of U of T students designed the Diem Pouch (formerly Pillsy), a smart pill pouch that automatically tracks when pills are taken, and syncs to a smartphone via Bluetooth to give reminders or advice if a pill is missed. “Diem Pouch is an intuitive device that will give women the confidence that they’re effectively managing their birth control, thereby reducing anxiety and preventing unplanned pregnancies,” said

Courtney Smith, a recent MPH Epidemiology graduate who worked with graduate students in U of T’s Institute of Biomaterials and Biomedical Engineering and Institute for Aerospace Studies on the device. Smith joined the mostly male engineer team to develop a research trial protocol to prove Diem Pouch’s effectiveness, but her role evolved as her public health perspective persuaded the team to consider far-reaching consequences of unintended pregnancies, such as poor educational and behavioural outcomes for the child and increased risk of depression in the mother. “Learning about the role of the private sector in public health, and gaining experience in a cross-disciplinary team, have been valuable additions to my core public health education,” said Smith.

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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, Nursing, 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.


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Partnerships & Links

Three-day workshop in December 2015 included close to 50 delegates from Toronto, Australia and China.

Left: MPH Epidemiology student Courtney Smith and Diem Pouch collaborator Tony Zhang, U of T Aerospace Engineering student, opened the Toronto Stock Exchange on May 9, 2016.

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Tri-National Public Health Collaboration Creates New Opportunities in Global Health

“Multinational collaborations, such as this one, enable student and faculty exchanges and global partnerships that can improve health for all.”

The first five-institutional collaboration between DLSPH and leading public health institutions in Australia and China kicked off in a December 2015 workshop in Shanghai, China, that asked:What can we do collectively that each institution cannot do independently? Led by Professors Arun Chockalingam and Dan Sellen, the three-day workshop included close to 50 delegates from DLSPH, the University of Melbourne School of Public Health, Shanghai Jiao Tong University School of Public Health, Shanghai Center for Disease Control and Prevention, and the Shanghai Mental Health Center.

“Our world is more interconnected now than ever before. All countries — low, middle and high income — are experiencing the massive societal impact of both infectious and chronic disease,” said Chockalingam, Director of the Office of Global Public Health Education and Training. “Multinational collaborations, such as this one, enable student and faculty exchanges and global partnerships that can improve health for all.” Workshop presentations were focused on big data, health systems, mental health and non-communicable diseases. The mental health presentation was led by Professors Kwame McKenzie, Chief Executive Officer of the Wellesley Institute, and Arun Ravindran of U of T’s Department of Psychiatry, both partners of DLSPH’s Institute for Global Health Equity and Innovation. It explored migrant mental health as an emerging and urgent area of scholarship with implications for the incoming wave of Syrian refugees worldwide. The collaboration goal is to develop a five-way memorandum of understanding that will allow for student and faculty exchanges and development of a large research partnership between all five institutions. The next workshop will likely be held this fall.


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Shafi Bhuiyan and colleagues introduced the Maternal and Child Health Handbook to 30 countries.

Inexpensive to produce at just 50 cents per copy, the handbook can be adapted for each target population, using drawings to supplement the language when literacy is low.

In rural areas and in underdeveloped countries, the handbook can be a lifeline, Bhuiyan said. Inexpensive to produce at just 50 cents per copy, it can be adapted for each target population, using drawings to supplement the language when literacy is low. “It’s the cornerstone of the United Nations’ Millennium Development Goals [to reduce mortality rates for infants and for women during childbirth],” Bhuiyan said. “It’s a handbook that connects all the programs focusing on a mother and her child from pregnancy until a child turns six. It’s a bold and solid idea.”

Right: Dr. Babatunde Osotimehin (Executive Director of the United Nations Population Fund) and Professor Shafi Bhuiyan at the Maternal and Child Health Handbook meeting in May 2014 in Toronto.

50 Cents Can Save Two Lives Assistant Professor Shafi Bhuiyan is on a mission to improve maternal and child health worldwide using a cost-effective, low-tech tool: the Maternal and Child Health Handbook. The handbook was first developed by the American army for distribution in Japan during the post–Second World War reconstruction to support healthy pregnancies, reduce birth risks and improve the quality of child care by providing important information about pre- and postnatal care. During the past 18 years, Bhuiyan, Professor Yasuhide Nakamura of Osaka University in Japan and colleagues worldwide have collaborated to bring the handbook to 30 countries,

including Bangladesh, Cameroon, the United States and the Netherlands in multiple languages. In countries where the health infrastructure isn’t well developed and technology may not be embedded into daily life, the handbook serves multiple purposes: • A record of a mother’s ongoing health history during pregnancy and a baby’s afterward; • An education and referral document for information about pre- and postnatal care; • A repository of family vital statistics in countries without a collection system; • A way to promote two-way communication with health-care personnel.

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Above: Delegates from Toronto, Australia and China at a workshop in Shanghai, China, from December 3 to 5.


Section 4: Our Footprint

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Our Footprint Stimulating the activities of faculty, students, staff and alumni is a top priority for the School. Since achieving faculty status in July 2013, our path of accelerated growth has continued and, together, we will chart the course towards better public health and health systems to support a healthier world.

In 2015, DLSPH began a strategic planning process to leverage its newly combined and unique strengths. The strategic planning exercise was co-led by Professors Adalsteinn Brown and Daniel Sellen and included: • Participation of more than 60 students, alumni, staff and faculty members giving direct inputs through six consultative subcommittees which identified 24 potential strategic directions; • Review of the emerging plans by School community online and School committee meetings; • Discussion of priorities by more than 150 participants at a Strategic

Planning Retreat on November 23, 2015; • An external landscape assessment to articulate the School’s local, national and global position. “Going through this process thoughtfully will help us create a sense of purpose across the School, and I think we have an excellent roadmap for growth as a dynamic organization that strives for impact in public health and health systems,” said Professor Adalsteinn Brown. The new Strategic Plan, to be published summer 2016, outlines several emerging areas of focus and commits to building on strengths in three new strategic directions: 1. Improve the learner experience in existing and newly created

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New Faculty, Renewed Strategy: Towards 2021 and Beyond


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Our Footprint

Students, alumni, staff and faculty participated in subcommittees that informed strategic plan directions.

Left: Dean’s Leadership Series Panellists discussed what inno­ vation is needed to create a sustainable health system.

impact through shared strategic directions focused on engagement, excellence and impact,” said Sellen.

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Celebrating and Strengthening the DLSPH Community

“The University can advance scholarship and ideas while equipping the next generation to effect the change desperately needed in our health-care system.”

programs of education and public health and health systems capacity development; 2. Ensure globally recognized excellence and impact in public health and health systems research; 3. Enhance partnerships and management of the DLSPH. The plan will be reviewed annually by the Dean, DLSPH’s Executive Committee and the Dean’s Advisory Board, and a strong performance management and benchmarking framework will be developed. “The plan emerging from broad and deep engagement of so many will guide diverse efforts to enhance our collective

As the newest Faculty at the University of Toronto, building the profile of the Dalla Lana School of Public Health is fundamental to engaging students, faculty and partners and creating new opportunities for learning, research and service. Three high-profile events brought close to 800 members of the DLSPH community together around a renewed sense of unity, celebration and academic discussion. The Building the Future Together event was a shared celebration of DLSPH becoming the University’s first stand-alone faculty in 15 years and the transition of the Institute of Health Policy, Management and Evaluation and the Joint Centre for Bioethics into the School. “Graduates of this school, if they are to correct health inequity and eliminate preventable deaths, must have a broad world view. That’s the promise of the School’s new composition,” said Paul Dalla Lana, who attended the event on September 21, 2015. Following the fall celebration, DLSPH hosted the inaugural Dean’s Leadership Series (DLS) on February 3, 2016, which featured University of Toronto President Emeritus David Naylor and an expert panel addressing the question: Can we innovate our way to a sustainable health system? The DLS is designed to strengthen connections between the Faculty and


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the University community and beyond through lively discussion on significant issues facing the health of Canadians and stimulating ideas on how society can respond to these challenges. The impressive panel included government, hospital and not-for-profit CEOs alongside nationally acclaimed Globe and Mail columnist André Picard and Dr. Ross Upshur, a veteran family physician. “The University can advance scholarship and ideas while equipping the next generation to effect the change desperately needed in our health-care system,” said Upshur, DLSPH’s Clinical Public Health Division Head. At the close of the academic year, DLSPH hosted the inaugural Health for Tomorrow:Year-End Celebration on May 31, 2016, at the Gardiner Museum. The event celebrated graduating students and award recipients, many of whom received a scholarship made possible by one of the School’s donors who also attended the event. Professor Natasha Crowcroft delivered the keynote address and MPH Epidemiology graduate Courtney Smith spoke on behalf of her fellow students.

Above: Building the Future, Together event, held at the MaRS Discovery District on September 21, 2015.

Advancing Our Mission and Vision With the support of philanthropic partners and donors, DLSPH is educating Canada’s future public health and health system leaders, significantly influencing health policies and practices and uncovering knowledge that will help entire populations flourish. Through the School’s Boundless campaign, the last year saw an expansion

DLSPH became U of T’s first new faculty in 15 years, which now includes the Institute of Health Policy, Management and Evaluation, and the Joint Centre for Bioethics.

of student scholarships, faculty-honoured awards and innovation funds expanded thanks to donors who support excellence in education, research and programs. Over the next year, DLSPH will further develop its strengths by focusing on dynamic, multidisciplinary and cross-cutting platforms of Integrating Public Health and Primary Care, Using Big Data for Health, Healthy Cities and Communities, Indigenous Health and Global Health. Thank you to all supporters whose financial contributions help move the Faculty towards a vision of ensuring healthy lives for everyone, both in Canada and around the world.

Philanthropy is integral to advancing DLSPH’s mission, vision and programs. Contributions may be directed towards support of annual funds of greatest need, estate planning, or to create a new, named award. For more information, please contact the Office of Advancement at dlsph. advancement@utoronto.ca or visit www.dlsph.utoronto.ca to donate today. 21 ANNUAL REPORT 2015–16

Three high-profile events brought close to 800 members of the DLSPH community together around a renewed sense of unity, celebration and academic discussion.


Section 5: Institutes, Centres & Divisions

5


Institutes, Centres & Divisions

Institutes and Centres Institute of Health Policy, Management and Evaluation Improving Infectious Outbreak Reporting Health-care organizations worldwide regularly turn to respected researchers at DLSPH. Robert Fowler, a critical care physician and Director of IHPME’s Clinical Epidemiology and Health Care Research program, is collaborating with organizations worldwide to improve the

communication and reporting done during outbreaks of novel infections. With a large team of clinical researchers at the World Health Organization and Oxford University, he has helped to develop a new, flexible, tiered case reporting form that aims to make data collected worldwide more accountable by employing standard definitions and allowing health-care workers to collect as much data as they can, depending on the resources available. His clinical focus and research has become the basis for a surveillance program for the severe acute respiratory infections in Canada and Mexico, revealing that outbreaks leading to high mortality in one health-care setting may not be cause for panic in another, given the variation in health systems and resources among countries.

23 ANNUAL REPORT 2015–16

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.


Institutes, Centres & Divisions

CCHE

As lead of the Canadian Centre for Health Economics, Professor Audrey Laporte says Canadians need a better understanding of new drug and technology financing.

“My own education in global outbreaks grew out of our difficult experience with SARS,” said Fowler, whose subsequent research and clinical work has spanned H1N1, Ebola and MERS-CoV. He is now helping Latin American colleagues describe complications of Zika virus.

24 DALLA LANA SCHOOL OF PUBLIC HEALTH

Using Data to Drive Health Policy Professor Audrey Laporte, the new director of IHPME’s Health Services Research program, is working hard to ensure that the program’s graduates “are always adding value and have enhanced skill sets that are at the cutting edge.” Laporte, who also directs the Canadian Centre for Health Economics (CCHE), is determined that the institute’s programs and her own research contribute to that vision and enhance public knowledge. IHPME’s weekly public seminars, semi-annual symposia and white papers illuminate important areas of policy; Laporte’s most recent white paper on

drug pricing, written in collaboration with Brian Ferguson from the University of Guelph, maintains that Canadians need a better understanding of the forces driving the introduction and financing of new drugs and technologies. Working with Whitney Berta, she is also in the midst of a CIHR grant that is examining the role of personal support workers in the health-care system in order to build a forecasting model for deploying health-care workers in various community and health-care settings. “We want to be able to meet the needs of the changing landscape of care as complexity of care increases,” Laporte said. Mobile Telemonitoring Platform Improving Heart Health A mobile telemonitoring platform, or app, that Assistant Professor Emily Seto and her colleagues have been developing, testing and refining for a decade will soon become a permanent fixture at the heart function clinic at the University Health Network.

Left: Professor Robert Fowler is working with the WHO to identify and report infectious disease outbreaks. Below: Professor Emily Seto is using mobile technology to change patient behaviour.

“We’ve had so many pilots that the opportunity for a sustained program is wonderful,” said Seto. The app allows patients to enter their symptoms and collects measurements, such as weight and blood pressure, and then uploads the data to servers. If any readings are abnormal, self-care instructions are sent and the patient’s clinician receives an alert. In a randomized controlled trial at UHN, patients were not only compliant, many changed their behaviour. Seto has also been involved in testing the platform for patients with other chronic conditions, including those with multiple chronic conditions. A sustained telemonitoring program is going to be launched for chronic kidney disease patients at UHN as well. The platform’s aim is to keep chronically ill people out of hospital. Seto would ultimately like to see it used nationwide.

Waakebiness-Bryce Institute for Indigenous Health New Leadership and Governance The Waakebiness-Bryce Institute for Indigenous Health (WBIIH) inaugural Interim Director, Jeff Reading, concluded a remarkable year at the close of 2015, which included the memorable naming ceremony in March 2015 and the creation of a community advisory council. “I am extraordinarily grateful to Michael and Amira Dan who made the Institute possible, and the support


20

In fall 2015, WBIIH established a 20-person Community Advisory Council comprised of Indigenous scholars and community members from across Canada.

Left: Professor Anita Benoit (left) and Chief Darlene Comegan of Northwest Angle 33 First Nation at the U of T Faculty Club on February 11, 2016.

“We draw our students heavily from public health and education, but we’re also affiliated with anthropology, geography and nutritional sciences and it would be great to get more students from those departments,” Sheppard said.

of staff and faculty who made it a successful inaugural year,” said Reading, who remains connected to DLSPH as an advisor to the Dean. Assistant Professor Earl Nowgesic, the Institute’s Associate Director, took on the Acting Director role while Assistant Professor Anita Benoit became the Interim Associate Director in December 2015. In fall 2015 and spring 2016, WBIIH hosted the first two Community Advisory Council meetings. This 20-person council is comprised of Indigenous scholars and community members from across Canada who guide WBIIH’s strategic direction and promote community-driven and relevant scholarship, education and partnership.

Collaborative Program in Aboriginal Health The Collaborative Program in Aboriginal Health (CPAH) is settling into its new home as part of the Waakebiness-Bryce Institute for Indigenous Health. “It’s a great move,” said the program’s director, Assistant Professor Amanda Sheppard, herself a CPAH graduate. “I think it will help the program grow. The Institute has an agenda and the objectives are in line with ours, and we’ll be able to work together and build momentum.” The recent move from the Faculty of Medicine will also provide CPAH with physical space on campus and administrative support needed to unite the diverse faculty together and promote the program both inside and outside the University.

“We must consider such issues as cultural sensitivities, community participation, ownership of the data, the First Nation’s relation to the environment and its acknowledged historical grievances.”

Dean Howard Hu, an environmental epidemiologist, and a team of colleagues have been chosen by Health Canada to conduct a study in partnership with the Northwest Angle 33 First Nation near Kenora, Ontario, to determine if cancer incidence rates in the First Nation population are elevated and environmentally linked. “The geographical area has a cancer cluster and there are a lot of worries about environmental exposure, but these are anecdotal reports,” said Hu. “The first step is to rigorously do a count to determine the true rates and see if they are elevated.” The researchers, along with Cancer Care Ontario and Public Health Ontario, are currently identifying the communities of interest and examining existing data from the Ontario Cancer Registry as part of the epidemiological study. They will also review previous studies about environmental exposure that relate to the area. “The ultimate goal of their work is to respond to the concerns of the community and determine what action needs to be taken,” Hu said. Once the first phase of the project is completed, Hu hopes to have some idea about whether the cancers have an

25 ANNUAL REPORT 2015–16

Examining Cancer Rates in Northern Ontario First Nation Community


60

Institutes, Centres & Divisions

Exploring Social Innovation @ U of T brought together 60 students, faculty members, staff and external partners to explore the potential of social innovation.

environmental cause. He has proposed a second phase of research — yet to be funded — that includes an in-depth biomedical study of the residents. “We are conducting the research in full partnership with the community,” Hu said. “We must consider such issues as cultural sensitivities, community participation, ownership of the data, the First Nation’s relation to the environment and its acknowledged historical grievances.”

Institute for Global Health Equity and Innovation Renewed Leadership and Vision Professor Alejandro (Alex) Jadad became the permanent Director of the Institute for Global Health Equity and Innovation (IGHEI) on January 1, 2016, after nine months serving IGHEI as Interim Director. A global leader in transforming the way health is defined and measured,

Innovation @ U of T, an invitation-only, student-led event that brought together 60 students, faculty members, staff and external partners to explore what social innovation is and what it should aspire to be at our institution. It also served as a platform to announce IGHEI’s social innovation seed fund, which seeks to accelerate the transformation of innovative ideas into social enterprises that could promote greater equity in health, and to harness the diversity of Toronto to facilitate their scalability and sustainability worldwide.

Below: Professor Alex Jadad hopes that IGHEI can create a pandemic of health through social innovation and entrepreneurship. Right: Students at IGHEIsponsored Hacking Food event on February 28, 2016, tackling food insecurity with social entrepreneurship.

Jadad engaged a team of students, faculty members, staff and community partners to co-create the vision, mission, core values and strategic objectives of IGHEI to position it at the epicentre of a pandemic of health through social innovation and entrepreneurship. “The time has come for us as a species to join forces and ensure that every person and community could have the same opportunities to live a long and healthy life, as part of a sustainable planet,” said Jadad.

26 DALLA LANA SCHOOL OF PUBLIC HEALTH

The Agency: Co-creating (Ad)ventures for Social Change The Agency is a hub that facilitates introductions and way-finding for students, faculty, teaching staff, alumni and partners focused on social innovation at U of T. This university-wide initiative of IGHEI is co-chaired by Ms. Cindy Ross Pedersen, President of U of T’s Alumni Association, and Professor Alex Jadad. On June 27, 2016, IGHEI co-sponsored and convened Exploring Social

Joint Centre for Bioethics University of Toronto Joint Centre for Bioethics Joins the Dalla Lana School of Public Health On July 1, 2015, the University of Toronto Joint Centre for Bioethics (JCB) transitioned from the Faculty of Medicine to DLSPH, a reflection of the evolution of bioethics as a field that is expanding its scope to address both upstream social determinants of health and downstream implications on patient care, health policies and population health. Health system integration, big data, chronic disease, epidemics, end of life policy and practice, and the globalization of health are a few areas of focus. “Health systems face complex challenges locally and globally. These challenges demand new ways of thinking and new approaches to tackling them. We have a moral imperative to


11

Professor Jennifer Gibson co-chaired a Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, which included 11 Canadian provincial and territorial governments.

“We are building ethics capacity across the care continuum to help achieve the highest possible integration and quality care for people in the community.”

The JCB Task Force included provincial ethics and legal experts, health professionals and community members working in collaboration with professional associations and health organizations to provide rigorous ethical analysis and to develop educational and policy materials and resources for patients and families, health professionals and policy-makers.

work through these challenges together towards the greater goal of improving health,” said Associate Professor Jennifer Gibson, JCB Director. A world-leading network of more than 180 interdisciplinary scholars and professionals, the JCB is home to the WHO Collaborating Centre for Bioethics and celebrated its 20th anniversary in December 2015. Providing Ethical Advice on Medical Assistance in Dying The JCB published a number of reports to help policy-makers, health professionals and families navigate the legal, medical, social, ethical and personal

challenges of medical assistance in dying (MAID). “We want to avoid a patchwork of approaches and develop aligned policies where Canadians know what to expect if they choose to request a physician-assisted death, regardless of where they live,” said Gibson. Gibson co-chaired the ProvincialTerritorial Expert Advisory Group on Physician-Assisted Dying, which was created by 11 Canadian provincial and territorial governments in August 2015 to provide advice on the implementation of assisted dying in Canada. She also commissioned a JCB Task Force on medical assistance in dying to inform thinking on key ethical dimensions and implications of MAID.

The JCB, Toronto Central CCAC, Toronto Central LHIN, and the Department of Family and Community Medicine are partnering on the Primary Care Ethics Integration Initiative, which will ensure that primary health-care providers can deal with the ethical challenges in their daily practice and in an environment of complex chronic illness. “To date, the primary focus of ethics scholarship and practice was on acute hospital-based care,” said Gibson. “Now we are building ethics capacity across the care continuum to help achieve the highest possible integration and quality care for people in the community.” The initiative includes educational, research, and service components for medical students and inter-professional teams in community-based primary practice with a vision of scaling up across Ontario. It also provides a forum for building bioethics leadership in primary care through the active involvement of their Master of Health Science in Bioethics graduates who are practicing family physicians.

27 ANNUAL REPORT 2015–16

Building Ethics Capacity in Primary Care


Institutes, Centres & Divisions

40–65 Researchers are working with Durham Public Health to improve prevention and screening among adults ages 40 to 65 living in lowincome neighbourhoods.

Probabilistic graphical models, Bayesian inference and meta-analysis were among the techniques employed to create the nodes of the model and string them all together. “The model will now need to be tested,” said Escobar. “We are learning how to use these techniques in ways that can be useful.”

Below: Dr. Onye Nnorom created Toronto’s first community-academic partnership to address breast and cervical cancer education with an Afrocentric lens.

Peer Cancer Education Program for Black Women Improves Awareness and Screening Dr. Onye Nnorom and her team of researchers created a novel peer education project to improve breast and cervical cancer awareness and screening for black women in Toronto’s Malvern community. “There is a lot of silence in the black community. People think that cancer is not a black issue and many survivors are shy to speak out,” said Nnorom, Associate Director of DLSPH’s Public Health and Preventive Medicine Residency Program. The project is known as Ko-Pamoja, which means “learning together” and is Toronto’s first community-academic partnership to address breast and cervical cancer education with an Afrocentric lens.

Clinical Public Health Divisions Biostatistics

28 DALLA LANA SCHOOL OF PUBLIC HEALTH

Combining Bayesian Networks and Food Security Some of the world’s top biostatistics and food security researchers, led by Professor Michael Escobar, joined forces at U of T in May for a workshop focused on creating a new decision support system — a sophisticated mathematical model that will show the consequences of various decisions for food security in Canada. The goal of the exercise was to aid crisis management, policy design and decision-making in food security at the local, regional, national and — eventually — global levels, Escobar said. “Rather than a traditional conference, we decided to do something where we get people with ingredients to bring to the salad, mix them and see what they can do,” Escobar said. “We’ll bring everyone together in a room and figure it out.”

Preventing Cancer in Low-Income Neighbourhoods Researchers are working with Durham Public Health on a four-year study designed to improve participation in prevention and screening actions among adults ages 40 to 65 living in lowincome neighbourhoods who don’t have family physicians. The study is funded by the Canadian Institutes of Health Research and Canadian Cancer Society Research Institute. The study will provide interventions to half the study population and the control group will be told they are on a waiting list. Local public health nurses will meet with participants one-on-one to review their current health status, see what they want to improve and encourage them to undertake preventive actions by getting screened, quitting smoking, etc. Six months later, nurses will check what actions participants have taken, chart measurable improvements and see whether this is a viable strategy for improving prevention.

“Our long-term vision is to decrease cancer rates in this population,” said Assistant Professor Aisha Lofters, a family physician.

“There is a lot of silence in the black community. People think that cancer is not a black issue and many survivors are shy to speak out.”


provide a signal when the dynamics of an epidemic are fundamentally changing, when a first wave of the epidemic is ending and the second is beginning, for example. “This ability to identify changing dynamics may ultimately be the greatest value added with this model.”

Occupational and Environmental Health

Program evaluation found increased awareness of breast cancer and cervical cancer risk factors and benefits of screening and early detection. Most participants reported they planned to get screened. “We need more culturally specific cancer prevention programs and research to address the needs of the diverse communities in Ontario.”

Epidemiology Predicting Seasonal Influenza Patterns The government virology labs in Alberta, Nova Scotia, Ontario and Ottawa will be

forecasting seasonal influenza this fall with the help of a bright IDEA. Professor David Fisman and alumnae Tahmina Nasserie and Ashleigh Tuite have developed a simple, single-equation mathematical model — IDEA (Incidence Decay with Exponential Adjustment) — which has proven useful in characterizing and projecting re-emerging infectious diseases, including cholera, MERS coronavirus and Ebola. They tested the model this past year with their Alberta, Nova Scotia, Ontario and Ottawa partners and found that it performed as well as more complicated models in characterizing the epidemiology of the seasonal influenza outbreaks. “It could have a role in guiding public health responses to influenza in real time,” Fisman said. “It also seems to

Above: Avid cyclist David Fisman developed a model to predict flu outbreaks with Epidemiology alumni.

Professor Andrea Sass-Kortsak was recognized by the American Industrial Hygiene Association as a distinguished fellow last June. Sass-Kortsak is one of only 10 or so Canadians to have received this career-recognition honour from the 10,000-member association. “I was thrilled,” said Sass-Kortsak, former Associate Dean of Academic Affairs. “I’ve trained a whole generation of occupational hygienists, across Canada, many of whom are now in senior leadership positions.” When Sass-Kortsak entered the field of occupational hygiene almost 40 years ago, she stood out because she wasn’t one of the fellows. Her bosses didn’t want her to go underground into the mines, because women didn’t do such things. Today, this experienced professor, mentor, researcher and administrator has no qualms about taking students — many of whom are women — to a wide variety of workplaces. “I wasn’t originally thinking of an academic career,” Sass-Kortsak said, “but

29 ANNUAL REPORT 2015–16

PHOTO BY JIM RYCE

Andrea Sass-Kortsak Honoured as AIHA Fellow


12,000

Institutes, Centres & Divisions

The UAMH Centre for Global Microfungal Biodiversity research biobank comprises nearly 12,000 living biospecimens and is now based at DLSPH.

Left: Baudoinia compniacensis, known as the angels’ share fungus, that is part of the UAMH Centre for Global Microfungal Biodiversity species catalogue. Below: In the developing world, there is often no separation between home and the workplace so families often face exposure to workplace health hazards.

after my master’s degree, I decided that teaching this would be very rewarding.” Hundreds of students — and workplaces — have benefited as a result.

30 DALLA LANA SCHOOL OF PUBLIC HEALTH

Welcome, Microbes! DLSPH is the new home for the world-renowned UAMH Centre for Global Microfungal Biodiversity, a premier repository of biomedically and environmentally important fungi and bacteria. This research biobank comprises nearly 12,000 living biospecimens representing more than 3,200 species. The majority of the strains are not replicated elsewhere. “This is the largest repository in the western hemisphere,” said Associate Professor James Scott, head of the Occupational and Environmental Health Division. “It began in the 1930s with the Alberta Public Health Service. Any time a novel or important species was found, ranging from ringworm to systemic disease, they saved it as reference material and for later comparative study. Over the years, the biobank grew,

expanding to include an unparalleled diversity of living, disease-causing microbes from around the world.” When the University of Alberta was no longer able to host the biobank, DLSPH took on the responsibility. “It serves the interests of DLSPH and researchers worldwide because diseases caused by these micro-organisms have recently prompted some of the most catastrophic extinctions ever seen in crop plants and wild animal species.” Levitsky Honoured for Global Contributions to Occupational Hygiene In recognition of her career contributions to occupational hygiene, including her work as the founding president of

Workplace Health Without Borders, Adjunct Lecturer Marianne Levitsky received the 2015 Hugh Nelson Award from the Occupational Hyg iene Association of Ontario. Levitsky is a senior associate with ECOH Management, but devotes about 50 per cent of her time to Workplace Health Without Border s, which addresses issues in the developing world. In these countries, there is often no separation between home and the workplace and entire families often face exposure to workplace health hazards, leading to a need for novel solutions. “The hazards are familiar, but the barriers are new and we have to be inventive,” said Levitsky, who has personally participated in a Grand Challenges Canada grant project in Gujarat, India, to reduce exposure to silica.


10

Four 10-week programs were created: textile arts; mindful movement for pregnant women; songwriting; and Chrysalis, a multidisciplinary space for transfeminine youth exclusively.

“This experience has left me more confident, hopeful and excited about my future career in the field of qualitative research.”

Students Gain Insight into Publishing and the Peer-Review Process

Social and Behavioural Health Sciences Changing the Game for LGBTQ Athletes PhD student Kinnon MacKinnon received one of three special 2015 INSPIRE Sports Hero Awards from the LGBTQ community as the first transgender man to win a gold medal in powerlifting at the Gay Games. “These awards were created especially to mark the 2015 Pan Am/Parapan Am Games and recognized the significant barriers that LGBTQ people face in participating in sport and physical activity,” MacKinnon said. As a teenager, MacKinnon competed at a national level in freestyle skiing and snowboarding, but like many LGBTQ youth, quit sports after coming out. Later, he discovered powerlifting. His efforts in drawing attention to the importance of inclusive policies led the Canadian Powerlifting Union to develop and release trans-inclusion guidelines in late 2014.

University of Toronto Professors Denise Gastaldo, Director of the Centre for Critical Qualitative Health Research (CQ), Joan Eakin, retired founding director of CQ, and Ping-Chun Hsiung, Department of Sociology and Guest Editor of a special issue of the prestigious journal Qualitative Inquiry, engaged graduate students in the peer-review submissions process of this internationally authored issue. This innovative exercise was highly productive, offering much to the graduate students (research and professional knowledge), the Editor (careful and thoughtful assessments) and CQ

(extension of its educational program). Student involvement in the peer-review process reflected the theme of the journal issue: teaching as an essential means for the production and reproduction of critical qualitative research. Martyna Janjua, a doctoral student reviewer, said the experience was transformative. “Altogether, this experience has left me more confident, hopeful and excited about my future career in the field of qualitative research.” Investing in Social Inclusion through the Arts

Above: PhD student Kinnon MacKinnon’s research recognizes the significant barriers that LGBTQ people face when participating in sport. Left: SKETCH is a community arts space for street-involved youth that offers programming in textile arts and more.

Associate Professor Suzanne Jackson and Lecturer Charlotte Lombardo, along with alumna Alanna Fennell, collaborated with SKETCH, a community arts space for street-involved youth, in creating programs to engage and empower marginalized female youth, inclusive of transfeminine identities. Four 10-week programs were created: textile arts; mindful movement for pregnant women; songwriting; and Chrysalis, a multidisciplinary space for transfeminine youth exclusively. Each program also provided supports, such as meals, daycare and subway tokens to remove some known barriers to participation. At the conclusion of the programs, research showed an increased sense of self, a sense of inclusion, marketable skills and an interest in advocating for change. “By bringing together arts, space and programming designed specifically for female-identified youth, we saw significant positive impacts on self-esteem and feelings of capacity to move forward,” said Jackson and Lombardo.

31 ANNUAL REPORT 2015–16

Leading up to the 2015 Pan Am/ Parapan Am games, MacKinnon spoke publicly about the importance of making sport more inclusive for LGBTQ people. He has also been named a top 25 finalist in the Social Sciences and Humanities Research Council 2016 Storytellers challenge.


Awards & Honours

Zulfiqar A. Bhutta Geneva Forum for Health Award World Health Assembly Shelley Bull Award for Impact of Applied and CollaborativeWork Statistical Society of Canada Donald Cole Vic Neufeld Mentorship Award in Global Health Research Canadian Coalition for Global Health Research Greg Evans Teaching Award Ontario Confederation of University Faculty Associations Rick Glazier Top 20 Pioneers of Family Medicine College of Family Physicians of Canada Howard Hu John Goldsmith Award Conference of the International Society for Environmental Epidemiology Susan Jaglal Fellow Canadian Academy of Health Sciences Prabhat Jha Trailblazer Award in Population Health Canadian Institutes of Health Research

Earl Nowgesic Outstanding Native Student of theYear University of Toronto President Awards James Orbinski Teasdale-Corti Humanitarian Award Royal College of Physicians and Surgeons Jeff Reading C.P. Shah Alumni Award of Excellence Public Health Alumni Association Jürgen Rehm Highly Cited Researcher (2015) Thomson Reuters Laura Rosella Canada Research Chair in Population Health Analytics Social Sciences and Humanities Research Council Arjumand Siddiqi Canada Research Chair in Population Health Equity Social Sciences and Humanities Research Council Janet Smylie Top 20 Pioneers of Family Medicine College of Family Physicians of Canada Ross Upshur Family Medicine Researcher of theYear Award and Top 20 Pioneers of Family Medicine College of Family Physicians of Canada

Joanne Kotsopoulos Distinguished Alumni University of Toronto Victoria University

PHOTO BY JIM RYCE

John McLaughlin Fellow Canadian Academy of Health Sciences

Institute of Health Policy, Management and Evaluation

Gail McVey TentandaVia Award York University

Onil Bhattacharyya Harkness Fellowship in Health Care Policy and Practice (2015–16) The Commonwealth Fund

Stephanie Nixon Rising Star Alumni Award University of Toronto Faculty of Medicine

Eyal Cohen Harkness Fellowship in Health Care Policy and Practice (2015–16) The Commonwealth Fund

Robert Fowler Order of Ontario Ministry of Citizenship and Immigration David Naylor Inductee Canadian Medical Hall of Fame Kelly O’Brien Elisse Zack Award of Excellence in HIV and Rehabilitation Canadian Working Group on HIV and Rehabilitation Michelle Pannor Silver Connaught New Researcher Award (2015) University of Toronto

Joint Centre for Bioethics Barbara Gibson Ross Upshur Graduate Thesis Mentorship Award University of Toronto Joint Centre for Bioethics Martin McKneally Distinguished Service to the JCB Award University of Toronto Joint Centre for Bioethics Heather Sampson Anderson Award for Program Innovation and Development Wightman-Berris Academy, University of Toronto Randi Zlotnik Shaul Christine Harrison Bioethics Education Award for Integration of Theory and Practice University of Toronto Joint Centre for Bioethics

33 ANNUAL REPORT 2015–16

Public Health Sciences


Facts & Figures

SEPTEMBER 2015 INTAKE

Domestic Students International Students

‘‘Look at every global problem with hope. Partnership and ally-ship can propel change to bring about health and peace both locally and globally.’’

DLSPH

200

150

100

Bethel Aklilu Second-year MPH Health Promotion student

50

PhD 73 30 19

Applications Offers Registration

MPH 44 5 3

792 221 105

MSc 102 7 4

60 18 10

47 27 16

MScCH

MHSc

52 30 20

15 14 12

8 1 1

IHPME

200

150

34 DALLA LANA SCHOOL OF PUBLIC HEALTH

100

50

PhD Applications Offers Registration

20 12 6

MSc 11 1 1

129 84 63

MHSc 10 1 1

131 48 37

MHI 11 0 0

86 47 38

19 0 0

1 0 0


HEAD COUNT NOVEMBER 2015

FACULTY & STAFF

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)

DLSPH

87

44

663

460

203

7

6

3

40

33

56

15

FACULTY

Core Faculty (including five budgetary cross)

235 / MPH

Non-budgetary cross-appointed faculty

12 / MHSc 29 / MSc

Community & PartnerBased Faculty

Status-Only

Adjunct

63 / MScCH

Canada Research Chairs

117 / PhD

Promoted to Associate Professor

Promoted to Professor

IHPME

69 / MHI

STAFF

Administrative

83 / MHSc

Research (casual)

118 / PhD

Research (appointed)

Post-Doctoral Fellows

35 ANNUAL REPORT 2015–16

154 / MSc


RESEARCH

$33,502,437

Total research funding awarded to DLSPH investigators was $33,502,437, including IHPME and JCB funds administered through affiliated institutions in the federal fiscal year of 2014–15, of which $12,005,812 was administered on campus.

Total Research Funding (2014–2015 grant year)

6.5

Average published, peerreviewed papers by each core faculty member with research role (2015-2016)

3.9

Average peer-reviewed presentations by each core faculty member with research role (2015-2016)

‘‘We’re hoping to build new relationships and strengthen existing community partners by showing that building Indigenous ways of knowing and doing into applied health research has tangible benefits.’’ Janet Smylie Associate Professor of Epidemiology and Director of Well Living House

Government, Other $8,014,909

Institutional Initiatives $1,155,405

36 DALLA LANA SCHOOL OF PUBLIC HEALTH

Corporate $950,804

Three Councils $10,592,733

Not-For-Profit $12,788,586


Let’s draw inspiration from our diverse city to show the rest of Toronto and the world what a healthy and sustainable society looks like, today and in the future.

Editor: Nicole Bodnar / Writer: Elaine Smith Design: Underline Studio / Printing: Andora Graphics


Dalla Lana School of Public Health Communications Office

COVER IMAGE BY NASA’S EARTH OBSERVATORY

155 College Street, Room 674, Toronto, ON M5T 3M7 dlsph.utoronto.ca

2015-16 Annual Report: Diversity and Partnerships in an Evolving Health Landscape  

In the report you will see how DLSPH faculty, staff, students and alumni are having an impact on health at a high level — for example, by in...

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