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Join Us on the Forefront of Change in Health Annual Report 2017-18


Join Us on the Forefront of Change in Health | Annual Report 2017-18

The Dalla Lana School of Public Health’s 2017-18 annual report welcomes you to join us on the forefront of change in health.

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Interim Dean’s Message

Dalla Lana School of Public Health

The Dalla Lana School of Public Health’s 2017-18 annual report welcomes you to join us on the forefront of change in health.

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THIS INVITATION IS particularly relevant as we reflect on our Faculty’s recent achievements — from progressing in the global university rankings to renewed investment from our lead donors — there is clear progress in the life of the DLSPH, and we’re articulating this impact in new and exciting ways. The year 2017 marked an important milestone to celebrate our shared history and recognize our community’s impact on public health and health systems. The DLSPH celebrated its 90th anniversary last year (the School of Hygiene opened June 9, 1927) and the Institute of Health Policy, Management and Evaluation (formerly the Department of Health Administration) recognized its 70th anniversary in October 2017.


Today we stand on the shoulders of leaders who came before us. As we remember the past while planning for the future, one thing remains clear: the DLSPH is on the forefront of change in health. We were on the forefront of change in health when our researchers examined sexual risk factors for HIV infection in the 1980s. We were on the forefront when we recommended hospitals adopt balanced scorecards to improve quality in the early 2000s. And, two years ago, we were on the forefront when we developed recommendations for healthcare professionals to deliver medical assistance in death. This year’s achievements further demonstrate how the DLSPH is on the forefront of change in health. We’re introducing our first MPH concentration in Indigenous health with a unique community-focused, land-based approach to learning. We also co-designed a new national PhD training model to better prepare academics for applied careers in the health system. And we are launching an ethics and artificial intelligence collaboratory to implement data-driven innovations in the health system in a thoughtful way. In addition to these important achievements, we’ve done a lot of thinking about who we are as a Faculty, why we do the work we do, and our unique edge in improving health and health systems in Canada and globally. As we talked to our internationally recognized community of leaders, we consistently heard how we are creating new knowledge, educating change-makers, advancing practice and guiding the way

to better, more equitable outcomes in population health and health systems — locally, nationally and globally. The expression Join us on the forefront of change in health sums up our story in a way that builds on our proud history while optimistically anticipating future impact. It’s an open invitation to our students, faculty, staff, alumni and partners to engage with us as we chart new territory, grapple with change, and improve health and health systems in a place of broad influence. I invite you to explore this year’s report that highlights how our School’s contributions are supporting change in the broader public health and health system ecosystems. We’re all here to change outcomes. With a shared vision of improving health at a population level and health services at a system level, we will continue to push the boundaries and co-create change in health. With gratitude to the DLSPH community for 2018 and beyond,

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“With a shared vision of improving health at a population level and health services at a system level, we will continue to push the boundaries and co-create change in health.”

Adalsteinn Brown Interim Dean, Dalla Lana School of Public Health Dalla Lana Chair in Public Health Policy

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Dalla Lana School of Public Health At a Glance

Graduate Degree Programs

Dalla Lana School of Public Health

Public Health Sciences

PhD

Master of Science (MSc)

• • • •

• Biostatistics

Biostatistics Epidemiology Occupational and Environmental Health Social and Behavioural Health Sciences

Master of Public Health (MPH) • • • • • •

Epidemiology Family and Community Medicine Health Promotion Indigenous Health Nutrition and Dietetics Occupation and Environmental Health

Master of Science in Community Health (MScCH) • • • •

Addictions and Mental Health Family and Community Medicine Health Practitioner Teacher Education Wound Prevention and Care

Master of Health Science (MHSc) • Bioethics

Institute of Health Policy, Management and Evaluation

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PhD

Master of Health Science (MHSc)

• Clinical Epidemiology and Health Care Research • Health Services Research

• Health Administration • Combined Health Administration and Social Work

Master of Science (MSc)

Master of Health Informatics (MHI)

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

• Health Informatics


98

41

789

22

741

304

Core faculty

Post-doctoral fellows

Cross-appointed faculty

Master’s program students

Community and partner-based faculty

PhD program students

Join Us on the Forefront of Change in Health | Annual Report 2017-18

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

$35,996,401 Annual research funding

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Facts and Figures September 2017 Intake Public Health Sciences (PHS)

200

Domestic students International students 150

100

Dalla Lana School of Public Health

50

PhD 83 32 25

Applications Offers Registration

Institute of Health Policy, Management and Evaluation (IHPME)

MPH 53 3 2

919 202 126

MSc 131 8 4

81 17 13

66 14 11

MScCH

MHSc

53 33 27

21 16 13

9 2 1

200

Domestic students International students

150

100

50

PhD

6

Applications Offers Registration

48 33 20

MSC 20 1 1

167 81 59

MHI 12 2 1

147 44 36

MScCH 36 0 0

120 52 37

25 0 0

3 2 0


2017 Faculty & Staff Faculty November 2017 Headcount

MScCH

22

MSc

PhD

MPH

274

789 582 209

Community-and partner-based faculty

Status-only

Adjunct

9

3

5

Canada Research Chairs

PhD: Doctor of Philosophy MPH: Master of Public Health MSc: Master of Science MScCH: Master of Science in Community Health MHSc: Master of Health Science

Staff

106*

161

Promoted to Professor

Promoted to Associate Professor

41

32

Administrative

94

Research (casual)

IHPME

Cross-appointed faculty

Research (appointed and associate)

22

Post-doctoral fellows

Research

Join Us on the Forefront of Change in Health | Annual Report 2017-18

143

MHSc

35

41

Core faculty

39

PHS

98

MHI PhD

75

Total research funding awarded to DLSPH investigators was $35,996,401 (an increase of 8% from last year), including funds administered through affiliated institutions in the 2016–17 grant year, of which $12,636,869 (an increase of 9% from last year) was administered at DLSPH.

MHSc

$11,497,896

MSc

$14,314,615 190 PhD: Doctor of Philosophy MSc: Master of Science MHSc: Master of Health Science MHI: Master of Health Informatics* * includes 73 regular MHI plus 33 executive stream

$35,996,401 Total

Three councils Institutional initiatives Government, other Corporate Not-for-profit

$2,685,062

$495,898 $7,002,930

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Dalla Lana School of Public Health

Section 1


Join Us on the Forefront of Change in Health | Annual Report 2017-18

Learner

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10 Dalla Lana School of Public Health

Experience


Section 1 Learner Experience

“Our investment in the program rep­resents one of our Government’s efforts to both train and keep our best and brightest researchers right here at home. It will also help rethink the traditional model of workplace integration for PhD students across the country,” – Ginette Petitpas Taylor, Federal Health Minister

Right: (left to right) Frances Morton-Chang, Hon. Ginette Petitpas Taylor, Dan Buchanan, Steini Brown, Interim Dean, DLSPH, Robyn Tamblyn, Scientific Director, CIHR, Peter Rekai, Rekai Centres, Susan Graham-Nutter, CEO Rekai Centres

Join Us on the Forefront of Change in Health | Annual Report 2017-18

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 and cultivate a solutionsoriented approach to address complex health issues.

Health System Impact Fellowships and Training Modernization IN OCTOBER, FEDERAL HEALTH MINISTER Ginette Petitpas Taylor announced an additional investment of $5.8 million towards the Health System Impact Fellowship and Training Modernization Start-Up Grants (HSIF). These grants provide doctoral graduates and postdoctoral fellows who have a background in health services research with experiential learning opportunities at health system organizations across the country. “Our investment in the program represents one of our Government’s efforts to both train and keep our best and brightest researchers right here at home. It will also help rethink the traditional model of workplace integration for PhD students across the country,” said Taylor. The HSIF training model was developed by Adalsteinn Brown, DLSPH Interim Dean, and Stephen Bornstein, Professor at Memorial University, in collaboration with the Canadian Institutes of Health Research Institute for Health Services and Policy Research, and the Canadian Health Services and Policy Research Alliance. It offers 46 fellowships to help prepare academics for careers in the health system.

Fellowship recipient and IHPME alumna Dr. Frances Morton-Chang had the opportunity to apply her knowledge and expertise in finding solutions for integrated care for seniors, while working at host organization AdvantAge Ontario, a not-for-profit organization advancing long-term care, housing and services for seniors. “My goal is to see a health system that offers people a degree of choice and support in how and where they live as they age — particularly options that allow for remaining in their own communities,” said Morton-Chang. “The fellowship has provided me with multiple opportunities for interdisciplinary learning and participation with senior leadership and association members, and a seminal research opportunity on seniors’ campuses. The two combined provided a real opportunity to make an impact on the health system.”

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Section 1 Learner Experience

16 Dalla Lana School of Public Health

Students worked in teams in World Health Assembly simulation

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Below: Front row left to right: Panashe Tombindo, Zahra Mamdani, Sarah Sutherland, Emmanuelle Arpin, Min Su. Back row left to right: Narhari Timilsina, Khaled Almilaji, Zahraa Saab, Vidhi Thakkar, Nick Moroz, Salima Mithani, Prof Erica Di Ruggiero, Nelly Desrosiers, Luke Jones

Students Conduct Win-Win Negotiations NEGOTIATING A HEALTHCARE RESOLUTION

for the World Health Assembly (WHA) of the United Nations requires both skill and empathy, as public health and health policy students discovered during a February simulation exercise. The simulation, organized by Assistant Professor Erica Di Ruggiero in partnership with Canada’s Office of International Affairs, was launched this year as a co-curricular activity designed to build students’ skills in debating, negotiating, policy analysis, presentation and collaboration to provide an opportunity to consider careers outside academia. It was moderated by two policy staff from the Office of International Affairs who actually prepare Canada’s materials for WHA negotiations.

“In our globalized world, multilateralism plays an increasingly important role in advancing global health. That’s why we supported this initiative by sharing our experiences and expertise to help Canada’s future global health leaders get a realistic perspective on what truly happens during multilateral negotiations at fora like the World Health Assembly,” said Luke Jones, Senior Advisor at the Office of International Affairs for the Health Portfolio. Jones worked closely with Nelly Desrosiers, a Policy Analyst at the Public Health Agency of Canada, on the initiative. The simulation was the culmination of five months of preparation by 16 students who worked in teams to represent the major regions of the world. They chose to negotiate a resolution about ending inappropriate promotion of food for infants and young children. In the months leading up to the exercise, they researched their regions and the countries who were the key players and prepared to represent diverse interests. Based on informal feedback to date, the simulation itself was considered a success, and a formal evaluation is under way. “It was a unique experience to embody our respective regions and to learn how the negotiation process works and how decisions are made at the WHA,” said Emmanuelle Arpin, a PhD student in health economics at IHPME, who helped represent the Americas. Zahra Mamdani, an MPH student who represented the Africa region in the negotiations, said she found it “valuable to step out of our comfort zones and challenge ourselves to see things from different perspectives, as we represented our respective regions.”


– Allie Margaret May, MHI student

Above: Danielle Martin, Husayn Marani, Greg Marchildon, Bernie Sanders, Meric Gertler, Michael Sherar Right: Allie Margaret May

MHI STUDENT ALLIE MARGARET MAY embarked on a practicum with the Northwest Territories Government in the city of Yellowknife this past summer to learn more about how eConsultation can help improve health systems. Working with the NWT Chief Medical Information Officer, Dr. Ewan Affleck, May was responsible for analyzing effective communication models to promote better health outcomes and equitable access to care for residents in this widespread and rural northern community. “When I first arrived in Yellowknife, I expected to face a completely new set of healthcare challenges, but I realized that many of the challenges my patients faced in Ontario were similar to those of the Northwest Territories. Access to the right medical care at the right time is a universal issue,” said May. eConsultation can help clinicians remotely assess patients in rural areas, reducing the need for them to be medically evacuated

Spotlight on the Canadian Healthcare System and Global Health Role AS COUNTRIES GRAPPLE WITH political uncertainties, Canada and its single-payer healthcare system — a symbol of stability — have gained powerful recognition in the United States and abroad, and a number of DLSPH faculty have figured prominently in the increased exposure. IHPME Professors Danielle Martin and Gregory Marchildon invited Senator Bernie Sanders, the former presidential candidate with a progressive agenda, to Toronto in October for an up-close look at Canada’s healthcare system in action. Sanders gave a public lecture sponsored by U of T and the North American Observatory on Health Systems and Policies at a packed Convocation Hall. He also visited Women’s College Hospital and various teaching hospitals to speak with clinicians and health policy experts.

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“When I first arrived in Yellowknife, I expected to face a completely new set of healthcare challenges, but I realized that many of the challenges my patients faced in Ontario were similar to those of the Northwest Territories. Access to the right medical care at the right time is a universal issue.”

Yellowknife Practicum Experience

into a city in order to receive care. As part of her practicum, May was responsible for leading the development of a health information exchange strategy, which would help make this process a reality. “It was empowering for me as an emerging professional to be given this chance at leadership” said May. “Through practicum work, our students create lasting relationships within healthcare communities across the province and country,” said MHI Program Director Julia Zarb. Though it was challenging to move outside of her comfort zone, May called the experience “eye-opening,” and a lesson in adaptation, a key skill for a successful health informatician.

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Section 1 Learner Experience

“[This is] a push for vocal leadership and action on a vision of global health that prioritizes equity.”

Dalla Lana School of Public Health

– Professor Stephanie Nixon

Above: Professor Suzanne Stewart

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Below: Professor Danielle Martin with Senator Bernie Sanders on October 29, 2017

“It’s very Canadian to downplay your accomplishments and focus solely on the distance yet to be travelled,” Martin told U of T News prior to the visit. “So we won’t solely be highlighting the challenges, we will also be celebrating our successes.” Following Senator Sanders’ visit, Marchildon said that, “He made it very clear that Canada was an inspiration for him.” Meanwhile, the Lancet took an in-depth look at Canada’s healthcare system and global health role in a special Canada country series, launched in February 2018. Martin and Marchildon, along with Professors Stephanie Nixon and Zulfiqar Bhutta, were among the researchers invited to write the Series’ two anchor articles, one focusing on how the healthcare system can achieve its potential, and the other on Canada’s role in supporting equity and global citizenship. Marchildon, an author of the former analysis, said that “the principles remain solid,” but that moving forward “probably will take a crisis. We’ve certainly been reconsidering the system for the last few months with respect to Indigenous healthcare and national pharmacare.” Nixon, who co-led the latter paper, said the issue was “a push for vocal leadership and action on a vision of global health that prioritizes equity.” The article is now required reading for a series of consultations by the Canada Institutes of Health Research and the

International Development Research Centre about Future Priorities for Global Health Research in Canada, in which Nixon and some of her co-authors will be participating.

Indigenous Health Institute Launches New MPH Field and Leads International Journal WITH A NEW CONCENTRATION in the master’s of public health (MPH) program focusing on Indigenous health beginning in fall 2018 and editorial responsibility for the International Journal of Indigenous Health, the WaakebinessBryce Institute for Indigenous Health is growing its scholarly impact. A new student lounge, designed to reflect Indigenous culture, can be considered a visible symbol of the Institute’s growing strength. “We’re creating a safe space so Indigenous students want to come to school here,” said Suzanne Stewart, Director of the Institute and an Associate Professor of Social and Behavioural Health Sciences. “It’s important to have the Indigenous culture valued and part of the environment.” The Indigenous health concentration is the MPH program’s sixth field and will “teach students what they need to know when working in Indigenous communities and give them the experience to do so, allowing them to be successful in their jobs,” Stewart said.


one of four children to a Ghanaian-born widower, as her mother died when she was seven years old. “Our food options weren’t necessarily the healthiest and we didn’t always have enough food,” Mensah said. “It was a challenge.” It was a challenge that Mensah met head-on: she conducted online research into nutrition, changed her eating habits and exercised more frequently. After completing her undergraduate degree, she joined the Black Creek Food Justice Network (BCFJN), a grassroots food justice advocacy group in her community, where she co-led a communitybased research project highlighting the social and health inequities that affect her neighbourhood. “Being part of the BCFJN has showed me the importance of advocacy,” Mensah said, “and, as a healthcare professional, I’ve learned the importance of addressing the root causes of health issues and inequities within the healthcare system.” After graduation, Mensah has her sights on certification as a Registered Dietitian and on finding a career opportunity that allows her

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The Waakebi­ness-Bryce Institute for Indigenous Health will enrol 20-30 students in the new Indigenous Health MPH concentration

Join Us on the Forefront of Change in Health | Annual Report 2017-18

The new concentration will enrol 20 to 30 students annually. Although it wasn’t approved until March 2017 and had little opportunity to recruit students, enrolment for the fall is nearly full. Management of the International Journal of Indigenous Health, an opportunity Stewart relishes, began in May. She will serve as editor-in-chief, with Angela Mashford-Pringle the co-editor. “It’s a good fit and an opportunity for us to be part of sharing knowledge and creating a clearinghouse for Indigenous scholarship,” said Mashford-Pringle, Associate Director of the Institute. “I’m excited because it will allow all of our researchers to interact with interdisciplinary researchers around the world. We can build relationships that may lead to future research partnerships, career opportunities, and program evaluation and development.” The journal will publish two regular issues annually, as well as a special issue. The Summer 2018 edition will focus on global Indigenous health, while the theme of the special issue this fall will be death and dying, reflecting the program at the Institute’s summer conference.

Below: Nutrition and Dietetics MPH student Rosie Mensah. Photo by The Toronto Star

Food Justice Advocate Merges Life Experience and Education ROSIE MENSAH IS PASSIONATE about food, health and equity, and earning her Master’s of Public Health in Nutrition and Dietetics at DLSPH is another step along her path to making a difference in people’s lives. Mensah, who graduates in June 2018, isn’t the typical MPH student. She grew up in poverty in the Jane-Finch area of Toronto,

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Section 1 Learner Experience

Dalla Lana School of Public Health

“This program allowed us to partner with international colleagues to build capacity well beyond Toronto and to do so in a way that shares the intellectual capital built at the School.” – Professor Adalsteinn Brown

to incorporate “a more social determinants of health and equity lens into my practice.” “Rosie understands the challenges others are facing and sees how social justice issues or poverty issues affect people’s ability to take health advice or next steps,” said Assistant Professor Pierrette Buklis, Director of the Nutrition and Dietetics Program. “People spend their entire careers trying to build the understanding that she has. She is poised to make amazing contributions as a dietitian.”

IHPME Helps Launch Health Informatics Degree Program in Israel FACULTY AT IHPME HAVE HELPED LAUNCH A

Certificate in Health Informatics program at Jerusalem College of Technology (JCT) in Israel, the first of its kind in the country. The program is aimed at nurses studying on the women’s campus, and will provide them with advanced knowledge in the field of health informatics, as well as further leadership career opportunities. “We have contributed to a remarkable milestone in our health informatics field,”

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Right: Nurses from the JCT Health Informatics certificate program

said Julia Zarb, Program Director of the MHI program at IHPME. “By building a bridge with faculty at the Jerusalem College of Technology, we have been able to help transfer knowledge and support the development of this discipline.” Following campus visits between IHPME and JCT, and the exchange of syllabi and curriculum ideas, the program was first launched as a joint certificate program with U of T in late 2017. “This sort of program allowed us to partner with international colleagues to build capacity well beyond Toronto and to do so in a way that shares the intellectual capital built at the School,” said Interim Dean Adalsteinn Brown. Upon the first cohort’s completion of the certificate in April 2018, Israel’s council of higher education approved the creation of the Master of Health Informatics degree which will evolve from the certificate program. “We have come to the realization that nurses carry the main burden of patient care,” said the nursing students in a thank-you letter to the IHPME collaborators. “We understand we should be leading and participating in the processes of digitization in our health system. Our voices need to be heard!”•


– Rosie Mensah, Nutrition and Dietetics student

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“As a healthcare professional, I’ve learned the importance of addressing the root causes of health issues and inequities within the healthcare system.”

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18 Dalla Lana School of Public Health

Section 2


Join Us on the Forefront of Change in Health | Annual Report 2017-18

Research Impact

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20 Dalla Lana School of Public Health

& Excellence


Section 2 Research Impact & Excellence

Practitioners that Bridge the Clinic and the Community

Right: Clinicians push for a community of practice in clinical population medicine Source: iStock by Getty Images

IN RECENT TIMES, the worlds of clinical care and public health have been estranged, but given the complex and challenging health problems in today’s world, it’s a gap that two DLSPH faculty members would like to bridge. One solution, say Professor Ross Upshur and Dr. Aaron Orkin, is a community of practice in clinical population medicine, and they made their case as guest editors of an online version of the journal Annals of Family Medicine in September 2017.

In editing this virtual journal edition, Orkin, Upshur and their co-editors selected previously published papers that demonstrate how clinical population medicine can help address health inequities so that underserved populations have greater access to care; make care delivery more efficient; and improve both patient outcomes and community health. “Rather than continuing the debate about whether public health or clinical medicine is worthiest, we decided to see if there were people doing work at the interface of these fields,” said Orkin, a public health physician at DLSPH and emergency physician at Mount Sinai Hospital. “There is a lot of overlap between the missions of family medicine and public health,” said Upshur, pointing to the work being done at St. Michael’s Hospital by Dr. Andrew Pinto, one of the guest co-editors of the journal. His Upstream Lab conducts research into how the use of clinical services can affect the social determinants of health. For example, the lab has developed an income security intervention that is being used by the hospital’s family health team, and Pinto will evaluate the impact of this service on patient health. Physicians who complete a public health and preventive medicine residency are at the vanguard of clinical population medicine, Upshur said. They spend two years in a family medicine residency, a year studying

Join Us on the Forefront of Change in Health | Annual Report 2017-18

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.

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Section 2 Research Impact & Excellence

Dalla Lana School of Public Health

towards a graduate degree in public health and two years in public health rotations, making them “highly credentialized.” “They are the gold of future health system transformation,” Upshur said. “We need to create a context where their skill set can ply its trade to optimize health systems.”

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Providing Understandable, Practical Data PROFESSOR LAURA ROSELLA, the Canada

Research Chair in Population Health Analytics, is making a name for her Population Health Analytics Laboratory by analyzing large, population-based health data and providing direct feedback about the health system to government officials and researchers alike. The recently published Ontario Atlas of Adult Mortality, 1992 – 2015: Trends in Local Health Integration Network is one example. Like many of the lab’s undertakings, the atlas grew out of questions posed by provincial decision-makers. Using a variety of analytic approaches, Rosella and her team explored premature mortality during that time period: deaths occurring before age 75, which are generally preventable. They overlaid their findings on provincial maps to demonstrate regional variation; for example, there was great improvement in the Toronto area, but much less so in Northern Ontario. “From an equity perspective, we have reduced premature mortality by twenty-five per cent and overall mortality by forty per cent, but the gap between those benefiting and those who aren’t is widening over time,” Rosella said.

“I realized that underlying it all were the social determinants of health.” Rosella, who is the U of T site director for the Institute for Clinical Evaluative Sciences (ICES), and her team also joined ICES for a study that demonstrated that Ontarians are increasingly suffering from multiple chronic conditions over their lives. They found that 95.3 per cent of the population died with two or more chronic conditions in 2013, compared to 79.6 per cent in 1994. “There is a need to focus more on prevention,” Rosella said, noting that the majority of healthcare resources are spent on acute care.

“From an equity perspective, we have reduced premature mortality by twenty-five per cent and overall mortality by forty per cent, but the gap between those benefiting and those who aren’t is widening over time.” – Professor Laura Rosella

Exploring the Ethics of Artificial Intelligence AS THE PUBLIC’S HEALTH becomes increasingly intertwined with digital technology through the use of big data and machine learning, the Joint Centre for Bioethics (JCB) is leading the way in bringing the related ethical issues to the forefront. “How can we ensure that ethics informs the evolution of this digital age?” asked Associate Professor Jennifer Gibson, JCB Director and Sun Life Financial Chair in Bioethics, who conducted an environmental scan that found very little ethical guidance at the foundation of this complex area. “While technology may help us meet health system and global health goals, there may be associated harms. For example, existing patterns of global health inequities

Above: Population Health Analytics Laboratory team (left to right): Emmalin Buajitti, Kathy Kornas, Nicholas Fazio, Aleksandra Zuk, Tristan Watson, Laura Rosella, Eric De Prophetis, Catherine Bornbaum, Jennifer Shuldiner, Rachel Savage


might also be exacerbated if the benefits of artificial intelligence (AI) are only realized by patients and populations in high-income countries. We need to minimize inequities while maximizing benefits.” Last fall, the JCB launched the Ethics and Artificial Intelligence for Health project, started planning an Ethics and AI for Health symposium and are agenda setting with local and international researchers. In the middle of this, the JCB is expanding its scope and becoming an Ethics Observatory to drive innovation in bioethics by developing research capabilities to advance knowledge in priority areas. “We’re proactively thinking about emerging ethics issues, building capacity and responding to bioethics challenges,” Gibson said. “As an Ethics Observatory, the JCB will serve as home for AI ethics research in health systems and population health at DLSPH and will monitor related research globally.”

SEEING YOUR RESEARCH HAVE an immediate impact on public policy doesn’t happen often, but Lee Vernich, DLSPH’s research manager, had that opportunity when Toronto City Council used results collected for the Toronto Centre for Active Transportation (TCAT) economic impact study to inform their decision to make experimental bike lanes on Bloor Street permanent. “It often takes years of research to get a policy approved, so to have a short-term project and see its results accepted was gratifying,” said Vernich, who attended the November council session where the vote was taken. The DLSPH Office of Research worked in partnership with TCAT, U of T’s School of the Environment and Department of Human Geography to conduct the research and prepare the report, looking at the economic impact of this pilot project, which covered a stretch of Bloor Street near the St. George campus. Vernich contributed to the interpretation of the results in the final report. The Office of Research also helped train a cadre of students to do primary data

AI The Joint Centre for Bioethics is leading the way in bringing ethical issues related to artificial intelligence to the forefront.

Join Us on the Forefront of Change in Health | Annual Report 2017-18

Using Public Health Data to Make a Case for Bloor Street Bike Lanes

Above: Professor Jennifer Gibson Below: Research Manager Lee Vernich uses public health data to make a case for Bloor Street bike lanes

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Section 2 Research Impact & Excellence

Dalla Lana School of Public Health

“Usually, any research I take part in takes place in the lab. I like public health because you get a macro perspective. This made me feel like I’m on the right track.” – Gabrielle Di Sapia Natarelli, second-year immunology student

collection, both on Bloor Street and on the Danforth, which served as the control area. The students carried tablets loaded with survey questions about mode of transport and spending at local businesses and were taught to intercept every third person on the street in order to randomize the sample. They also interviewed the local merchants, both before and after the bike lanes were installed. Gabrielle Di Sapia Natarelli, a second-year student majoring in immunology, health and disease, enjoyed collecting the data and said the experience confirmed her interest in pursuing a master’s degree in public health after graduation, concentrating in epidemiology. “Usually, any research I take part in takes place in the lab and provides a microscopic perspective,” she said. “I like public health because you get a macro perspective. This made me feel like I’m on the right track.”

Widespread Antibiotic Misuse Reduced in Rural China

Above left: Professor Xiaolin Wei Above right: Professor Emily Seto

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Below: Naloxone kit image by Jeff Anderson via Flickr

AN INTERNATIONAL TEAM led by Professor Xiaolin Wei has significantly reduced the widespread practice of prescribing antibiotics to children with common colds in rural China. The study, “Effect of a training and educational intervention for physicians and caregivers on antibiotic prescribing for upper respiratory tract infections in children at primary care facilities in rural China: a cluster-randomised controlled trial,” was published in the October 2017 edition of The Lancet Global Health. Researchers examined the effectiveness of implementing an antimicrobial resistance stewardship program in primary care facilities in a low-and-middle-income country

(LMIC), involving 1.4 million residents. The intervention is now under consideration by China’s National Committee on Antibiotic Use and Antimicrobial Resistance for a national policy update. “Antibiotic misuse is high because parents demand care for their children, and for many, care equals medicine,” said Wei, Associate Professor of Health Systems and Clinical Public Health in Asia. “Evidence is urgently needed in LMIC’s primary care settings where both doctors and patients have poor knowledge and antimicrobial stewardship is weak.” Inappropriate antibiotic prescribing contributes to antimicrobial resistance, which makes infections and illnesses more difficult to treat and puts strain on the healthcare system. Most research on reducing antibiotic use is conducted in Europe, the United States and Canada, which limits their application to LMICs. The intervention included clinician guidelines and training on appropriate prescribing, doctor-patient communication, monthly peer-review meetings to measure guideline adherence, and caregiver education


Medly “The goal is to support patients in self-care and assist their healthcare team in providing the best clinical care,” said Seto.

Health Innovation Apps Naloxone: Valuable, but Potentially is leading the way in telemonitoring innovation through Stigmatizing ASSISTANT PROFESSOR EMILY SETO

her research and development of mobile apps that improve patient care and self-care. “Telemonitoring enables patients to track their health from home, including parameters such as weight, blood pressure and symptoms. The information is then sent automatically to their healthcare provider through a digital device like a smartphone,” said Seto, who is faculty lead of Health Informatics at IHPME. Through partnerships with University Health Network and William Osler Health System, Seto and her team are building a model of care for complex patients, including those with multiple chronic conditions. Apps like Medly target complex patients who run the risk of being readmitted to hospital for many reasons related to their conditions. Using the app, patients monitor their own symptoms and receive feedback on how to manage their health, such as to take more medication or reduce their salt intake. “We are in the process of scaling up the use of these apps such as by making them accessible on different types of smartphones,” said Seto. The more patients who have access to these types of mobile applications, the greater the reduction in their readmission rates to hospital, and the greater the savings for the healthcare system.

MAKING NALOXONE KITS readily available has saved numerous lives during the current opioid drug crisis, but the kits come with risks of their own: They potentially stigmatize users and make them feel they are unwelcome in the emergency rooms of the nation. In a 2018 paper published in Public Health Ethics, Assistant Professor Daniel Buchman, a bioethicist with the Joint Centre for Bioethics, Dr. Aaron Orkin, an emergency room physician who teaches at DLSPH, and their co-authors maintain that although the take-home kits were developed to avoid the stigma of use and overdose, they don’t magically erase either stigma or marginalization. The opioid antidote first became available without a prescription in Canada in 2016 and use of kits has grown rapidly. Many Ontario pharmacies provide it free of charge. “People were not calling 911 when they overdosed because the police came along, too, so they panicked or tried to help themselves, but time ran out,” said Orkin. “It was happening by the thousands. Takehome naloxone kits are lifesaving and community-altering. “I’m strongly in favour of their distribution, but they are a sign of our failure in designing

Mobile app to improve patient care and self-care

Join Us on the Forefront of Change in Health | Annual Report 2017-18

on rational use of antibiotics. Videos and pamphlets were also provided to patients and families. “Educating primary care doctors on how to use antibiotics and incorporating key public health messages during consultations are critical, and they also give doctors the confidence not to prescribe when unnecessary.”

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Section 2 Research Impact & Excellence

Dalla Lana School of Public Health

care. It’s pretty tragic that people don’t feel they’re able to call 911. Using them is empowering but it shows we haven’t fixed the core problem. People shouldn’t feel afraid to call 911 or to access emergency care.” Orkin says the paper is an opportunity to open the discussion about naloxone distribution and how to avoid the marginalization of addicts from becoming entrenched in the healthcare system.

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Canadian Partnership for Tomorrow Project Accelerates Cancer and Chronic Disease Research

Above: (left to right): Dr. John McLaughlin, Executive Director of CPTP; Cindy Morton, Chief Executive Officer of the Canadian Partnership Against Cancer; and Dr. Philip Awadalla, National Scientific Director of CPTP.

THIS SPRING, U OF T WAS SELECTED to serve as the national scientific host agency for the Canadian Partnership for Tomorrow Project (CPTP), Canada’s largest population research platform investigating why some people develop cancer and chronic diseases while others do not. Through a competition held by the Canadian Partnership Against Cancer in partnership with the Ontario Institute for Cancer Research, Professors Philip Awadalla of the Faculty of Medicine and John McLaughlin of DLSPH were chosen to lead CPTP into its next phase. “While benefiting from the University’s massive research capacity and range of expertise, we will work collaboratively with our many partners to heighten scientific outputs and impacts, enrich the platform with new data linkages, and work with researchers across campus and across Canada who share our vision of how health and health systems can be improved

nationally,” said McLaughlin, who will serve as Executive Director of CPTP. He is also a Professor of Epidemiology and Chief Science Officer at Public Health Ontario. More than 300,000 adults are now participating in CPTP and have provided information about their health, environmental exposures and biological factors. With long-term follow-up enabled by linkage to healthcare system information, researchers can study the causes and consequences of illness, and CPTP’s scale allows for studies of the full range of genetic, environmental, behavioural and societal factors. “We’re looking forward to enabling Canadian researchers to access the CPTP platform to further their own research and international collaborations, as well as leveraging the data generated to transform population health in Canada and globally,” said France Gagnon, Associate Dean of Research.•


– France Gagnon, Associate Dean of Research

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“We’re looking forward to enabling Canadian researchers to access the CPTP platform to further their own research and international collaborations, and leveraging the data generated to transform population health in Canada and globally.”

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Section 3


Join Us on the Forefront of Change in Health | Annual Report 2017-18

Partnerships

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and Management


Section 3 Partnerships and Management

“By taking a tactical approach using project manage­ment techniques, we’re continuing the School’s forward momentum and delivering on our strategy.”

Launching the Faculty’s First Administrative Review and Operational Plan

– Professor Adalsteinn Brown

ADMINISTRATIVE EFFICIENCY and transparency are two important priorities for the DLSPH in the last year, two important milestones were reached: the Faculty’s first Administrative Review took place and Operational Plan was implemented. All faculties undergo an Administrative Review every five years to ensure administrative services best support the Faculty’s goals and priorities. DLSPH’s first review since becoming a Faculty made two key recommendations: to ensure information technology infrastructure supports future educational aspirations and optimizes core activities; and create a new Public Health Sciences Business Manager position to manage day-to-day operations while enhancing communication and transparency of financial policies and procedures. In addition to the Administrative Review, the DLSPH also rolled out its first Operational Plan (2017–20), which was one of the recommendations following the 2016–17 University of Toronto Quality Assurance Process.

“The School cannot formalize our strategic plan under interim leadership so the operational plan focuses on implementation of our existing efforts,” said Adalsteinn Brown, Interim Dean and Dalla Lana Chair of Public Health Policy. “By taking a tactical approach using project management techniques, we’re continuing the School’s forward momentum and delivering on our strategy.” The Operational Plan includes four priority areas, including: World-Class Governance and Administration; Investments in People and Relationships; Program and Process Excellence; and Strategic Research Initiatives. Clear deliverables, schedules and any associated risks are built in to each priority, which are overseen by the Dean’s Office to ensure the Faculty delivers on its shared vision of impact on public health and health systems.

Join Us on the Forefront of Change in Health | Annual Report 2017-18

We’re working collaboratively with University partners, hospitals, communities, government agencies and philanthropists to achieve our shared vision of improving health at a population level and health services at a system level.

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Section 3 Partnerships and Management

500 Dalla Lana School of Public Health

More than 500 alumni attended DLSPH’s signature alumni networking events, Moonshot and In the Loop.

Below: Professors Laura Rosella, Timothy Caulfield, Natasha Crowcroft and Julie Foisy at In the Loop on March 22, 2018

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Engagement and Outreach Enrich DLSPH BUILDING COMMUNITY, recognizing achievements and sharing knowledge with the public are key thrusts of the DLSPH, as demonstrated by the past year’s key events. The IHPME Alumni Association celebrated the Institute’s 70th anniversary in October with its annual Moonshot event for close to 300 alumni, faculty and students over an evening that combined learning and socializing. Held this year in partnership with Health Quality Ontario, the event featured Professor Mary Uhl-Bien from Texas Christina University as the guest speaker, discussing adaptability and leadership within complex networks. The Public Health Alumni Association also held its third annual In the Loop event, an opportunity for alumni, faculty and students to connect around a current issue. This year’s sold-out event had a record turnout and was hosted in partnership with Public Health Ontario, reflecting a new way to engage public health alumni. It featured Timothy Caulfield, Canada Research Chair in Health Law and Policy from the University of Alberta, who debunked health misinformation and

the spinning of real science in popular culture. PHAA recognized two outstanding alumni: Mary-Anne Pietrusiak (MSc ‘98) received the C.P. Shah Alumni Award of Excellence for her contributions to public health in Ontario; and Gillian Kolla (MPH ’09) received the Emerging Public Health Leader for her applied work in harm reduction. DLSPH faculty were also the focus of celebratory efforts. Professors’ Rounds recognized the achievements of faculty members who had recently been named full professors, a rank awarded for a combination of scholarly achievement, an established reputation in his/her field of interest and effective teaching. Each of the professors attending spoke about what inspired them and discussed their career journeys. Professor Michael Escobar, Associate Dean of Faculty Affairs, hopes to hold the event regularly. Celebration was also the motivator behind a panel discussion and reception marking the 100th anniversary of Connaught Laboratories (now Sanofi Pasteur Canada), the 90th  anniversary of the School of Hygiene (now DLSPH) and the 70th anniversary of the Department of Hospital Administration (now IHPME). DLSPH partnered with the Office of the Vice-President of Research and Innovation and the Faculty of Medicine to host the evening, which featured three modern innovators, Professors Leah Cowen, Laura Rosella and Emily Seto, discussing the narrowing gap between research and innovation. During a year with much to celebrate, DLSPH faculty and alumni shone.


– Professor Katie Dainty

Partnerships between Hospitals and Individual Researchers Thrive

Left above: Professor Patricia Trbovich Left below: Professor Katie Dainty Right: Professor Walter Wodchis

THREE IHPME FACULTY MEMBERS are embarking on new career adventures as research chairs at hospitals in the Greater Toronto Area. It marks the first time that area hospitals and the University of Toronto are sharing in the funding of research positions. For Professors Katie Dainty, Patricia Trbovich and Walter Wodchis, becoming a hospital research chair offers a chance to take advantage of a ready-made human laboratory and an opportunity to work on research projects that will have an impact on care at their respective institutions. Each of them has been appointed for an initial five-year term. Dainty, a qualitative social scientist, has been named the Research Chair in PatientCentred Outcomes at North York General Hospital (NYGH). “We’ve gotten far away from including patients’ perspectives in how we design and measure healthcare, and we need to get back,” said Dainty, whose recent work includes exploring the efficacy of home

visits by paramedics. “It’s important to think about how they view things when it’s their life situations that will be affected. We need to address what they feel their needs are.” Trbovich is also at NYGH, serving as the Badeau Family Research Chair in Patient Safety and Quality Improvement. “I’m looking at human factors — how people interact physically and psychologically with products, tools and systems,” Trbovich said. “We consider how we can improve systems and make them safer.” Thanks to the Steinberg Family Surgical Safety Program, NYGH has recently installed a black box in an operating room (OR), similar to those on airplanes, and one of Trbovich’s projects will be to use the audio and video data it collects to understand better what is happening in the OR. “The goal is to use it as a performance improvement tool, not to blame and shame. It will help us understand the factors that lead to error and to resilience.” In Mississauga, Trillium Health Partners has appointed Wodchis the Research Chair in Implementation and Evaluation Science at its Institute for Better Health. Wodchis, whose research specialties include health services research and outcomes and evaluation, is excited about the opportunity to do “effective, embedded research” from a patient-centred perspective and is pleased that he’ll be involved in research planning, so that he can properly guide its implementation and evaluation. “We’re setting the conditions in place for success,” said Wodchis, whose work will include bundled care that creates single hospital and post-acute care pathways, as well as evaluating new community-based primary healthcare teams in two distinct regions.

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“We’ve gotten far away from including patients’ perspectives in how we design and measure healthcare, and we need to get back.”

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Section 3 Partnerships and Management

$25K Dalla Lana School of Public Health

Three faculty members have each given major gifts of $25,000 or more to the DLSPH

Above Left: Professor Suzanne Sicchia Above Right: Professor Peggy Leatt

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Below: Professor Les Boehm

Faculty Give Students a Financial Boost WHEN SHE WAS “so close to finishing my PhD I could taste it,” Suzanne Sicchia, an Assistant Professor in the teaching stream at DLSPH, hit a rocky financial patch that almost derailed her career. “My SSHRC (Social Sciences and Humanities Research Council) funding had run out and my husband was ill and as a result we were struggling financially,” Sicchia said, who’s based at the University of Toronto Scarborough’s Interdisciplinary Centre for Health and Society. “I had the most amazing support from the University; everyone was incredibly kind and flexible. When I said I wasn’t going to finish, they said, ‘Ridiculous, we’ll find the money.’” Sicchia decided when she was financially secure she would give back some of the kindness and support she was shown by her mentors. This year, she created the Suzanne Sicchia Scholarship for Women’s Health Research to go to a PhD student affiliated with DLSPH’s Collaborative Specialization in Women’s Health, a major gift ($25,000 or more) that she plans to pay for over five years. Sicchia is not alone in her generosity. This past year, a number of faculty have made major gifts designated to establish student scholarships. Peggy Leatt, the retired former director of IHPME, and her husband, George Pink, established the Peggy Leatt Knowledge and Impact Award, based on achievements in developing transformative evidence on ways and means to improve healthcare and health systems. “I was glad to do it,” said Leatt, who headed IHPME for 12 years. “Most departments don’t have a lot of money to give students. When you’re chair of a department and see students

who need financial help, it motivates you to get involved.” Also donating major gifts this year: Professor Les Boehm, who established the Comparative Health Systems Award this year; the family of a deceased professor, Robert Remis, who established an epidemiology award in his memory; and a faculty member who prefers to remain anonymous. “Typically, when people work somewhere, they don’t make donations at such a high level,” said Annette Paul, Director of Advancement for DLSPH. “These are academics who have worked hard their whole lives for institutions and are still finding other ways to give back.” Paul said the School is honoured by this desire to give so generously to the School and, for 2018, DLSPH will match all major gifts made by faculty members.


– Paul Dalla Lana

Below: Alessandra and Paul Dalla Lana

Dalla Lana Family Commits Second Gift ALMOST A DECADE AFTER making a $20-million gift to establish the Dalla Lana School of Public Health at the University of Toronto, Paul and Alessandra Dalla Lana doubled down on their investment in 2018 with an additional $20-million donation to the School. “It’s been amazing to watch the school grow and to see the impact its research is already having on critically important, but often overlooked public health and health systems issues across Canada and globally,” said Paul Dalla Lana, founder of NorthWest Healthcare Properties REIT. Since the Dalla Lana family’s original donation — the largest gift ever given to public health in Canada — the School has grown into a global leader in public health, health policy and health systems education, research and service.

In addition to four endowed chairs, scholarships and dean’s fund created with the original gift, the new donation will provide funding for new initiatives in health systems improvement and policy innovation, and funding for projects to create healthier communities and improve quality across the health system. “We are extraordinarily grateful for Paul and Alessandra’s transformative gift, which will strengthen our academic excellence and enhance the School’s tradition of building stronger health systems and healthier communities,” said Adalsteinn Brown, Interim Dean of DLSPH and Dalla Lana Chair in Public Health Policy. “This gift will have an impact on all of our health and on our shared vision of leadership in education, research and service in public health and health systems in Toronto and beyond.”

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“It’s been amazing to watch the school grow and to see the impact its research is already having on critically important, but often overlooked, public health and health systems issues across Canada and globally.”

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Dalla Lana School of Public Health

Section 3 Partnerships and Management

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“There’s a lot we can do to curate a space that encourages genera­tive dialogue, but beyond that we cannot micromanage for outcomes. The capacity to create and hold space is what really counts, and our evaluations show the series is impactful every time.” – Professor Blake Poland

Vernissage Health Supports DLSPH’s Emerging Leaders of Tomorrow VERNISSAGE HEALTH 2018: Dialogues for Health Care and Social Change Leaders is a series of dialogue sessions for emerging public health, health system and social change leaders sponsored by DLSPH and IHPME in partnership with Associated Medical Services. In 2018, there were two dialogue groups — one for emerging leaders in healthcare (Vernissage Health) and the other for leaders of social action (a companion series called Change Dialogues). At each session, experienced health system leaders act as mentors and share their own experiences facilitating change throughout their careers with a goal to encourage students to reflect on their views about leadership and their approach to change. They uniquely incorporate a formal circle dialogue setting, which encourages mindfulness and authenticity and allows participants to speak from the heart. “Blake and I had a shared vision of how we wanted the sessions to feel with an intention to make the space a supportive and

authentic environment where participants could connect deeply within themselves and with one another,” said Wendy Nelson, Senior Fellow at IHPME who is an experienced health and social services leader and an alumnus of IHPME’s MHSc program. “We’ve learned that there’s a lot we can do to curate a space that encourages generative dialogue, but beyond that we cannot micromanage for outcomes. The capacity to create and hold space is what really counts, and our evaluations show the series is impactful every time,” said Blake Poland, Associate Professor of Social and Behavioural Health Sciences, who teaches a course on Dialogical Methods and co-led the sessions with Nelson. For students, this type of personal reflection has left a lasting impact. “I’ve learned we all have an innate desire to improve the healthcare system,” said Alice Lan, an MHI student, “a theme that unites emerging and experienced leaders as we strive for change.”•

Above: Students and mentors engaging in a Dialogues for Health Care and Social Change Leaders session


– Alice Lan, MHI student

Join Us on the Forefront of Change in Health | Annual Report 2017-18

“I’ve learned we all have an innate desire to improve the healthcare system — a theme that unites emerging and experienced leaders as we strive for change.”

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38 Dalla Lana School of Public Health


Awards & Honours

Congratulations to...

Khaled Almilaji Meritorious Service Medal Governor General of Canada Ross Baker Barer-​Flood Prize in Health Service and Policy Research Canadian Institutes of Health Research U of T Salutes! Shafi Bhuiyan South Asian Canadian of Excellence Council of Agencies Serving South Asians Paula Braitstein Trailblazer Award Canadian Institutes of Health Research U of T Salutes! Shaan Chugh Harry and Rose Perlstein Award IHPME Alumni Association Chris Ham Peggy Leatt Award IHPME Prabhat Jha MacArthur Foundation Top 200 U of T Salutes! Kamran Khan Innovation Award Governor General of Canada

Gillian Kolla Emerging Public Health Leader Award Public Health Alumni Association Joanne Kotsopoulos Canada Research Chair in Hereditary Breast and Ovarian Cancer Prevention Government of Canada Andreas Laupacis F.N.G. Starr Award Canadian Medical Association Carolyn Tuohy Impact on Public Policy Award Robin McLeod Presidential Citation American Head and Neck Society Emily Seto Connaught New Researcher Award U of T Research and Innovation

Join Us on the Forefront of Change in Health | Annual Report 2017-18

DLSPH 5th Global Ranking of Academic Subjects 2017 — Public Health Shanghai Rankings

Sara Shearkhani Canada Cares Award Canada Cares Foundation Xiaolin Wei Patient-Oriented Research Early Career Investigator Mentorship Award Diabetes Action Canada Kevin Shield Trailblazer Award Canadian Institutes of Health Research Janet Smylie Trailblazer Award Canadian Institutes of Health Research Susan Tarlo EOPH John Peters Award Canadian Institutes of Health Research

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

Editor: Nicole Bodnar Writers: Elaine Smith, Rebecca Biason and Elaine Banks Design: Hambly & Woolley Inc. Printing: Flash Reproductions

DLSPH Annual Report 2017-18  

The Dalla Lana School of Public Health’s 2017-18 Annual Report, “Join us on the Forefront of Change in Health,” is a reflection of the life...

DLSPH Annual Report 2017-18  

The Dalla Lana School of Public Health’s 2017-18 Annual Report, “Join us on the Forefront of Change in Health,” is a reflection of the life...