Healthy Lives for All: A Campaign for the Dalla Lana School of Public Health

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HEALTHY LIVES FOR ALL................................................................... p. 3 1 A LEADER FROM THE BEGINNING..................................................p. 5 2 INSTITUTE OF HEALTH POLICY, MANAGEMENT AND EVALUATION..................................................p. 11 3 THE UNIVERSITY OF TORONTO JOINT CENTRE FOR BIOETHICS..................................................... p. 15 4 AREAS OF STRENGTH AND STRATEGIC FOCUS...........................p. 19

i. USING BIG DATA FOR POPULATION HEALTH........................................................p. 20

ii. THE HEALTH OF INDIGENOUS COMMUNITIES.....................................................p. 22

iii. INTEGRATING PUBLIC HEALTH AND PRIMARY CARE ......................................... p. 24

iv. HEALTHIER CITIES AND COMMUNITIES............................................................... p. 27

v. A HEALTHY WORLD FOR EVERYONE, EVERYWHERE............................................p. 28

5 PARTNERSHIP OPPORTUNITIES.................................................. p. 33

i. STUDENT SUPPORT...............................................................................................p. 35

ii. FACULTY SUPPORT................................................................................................p. 35

iii. RESEARCH SUPPORT...........................................................................................p. 35

iv. PROGRAM SUPPORT............................................................................................p. 35

REDEFINING HEALTH...................................................................... p. 36

“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.” Dean Howard Hu

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HEALTHY LIVES FOR ALL The Dalla Lana School of Public Health is addressing the major health questions that shape our world.

How do we age successfully and happily — and then die a good death? How do we protect the most vulnerable communities from infectious diseases such as Ebola and Zika? How do we continue to improve the quality of our healthcare systems in a financially sustainable way? What are the upstream factors that determine the risk of developing obesity, diabetes and addiction, and how do we prevent them? And how does our food supply remain secure and nourishing in the face of threats from environmental pollution, diminishing air quality and rising sea levels? These are just some of the major questions that public health leaders are attempting to address. Public health focuses on preventing health issues rather than treating them after they occur, and serving entire populations rather than only those individuals seeking help for a particular health concern. It looks at the systems that deliver our health care, and the policies that shape them. It can seem like an elusive concept when we’re accustomed to clean water in our taps, safe roads in our communities, and contamination-free meat and vegetables in our supermarkets. Yet when systems break down — such as the E. coli outbreak in Walkerton, Ontario in 2000 or Canada’s tainted blood tragedy in the 1980s — and when fresh challenges arise — such as the epidemic of obesity and diabetes that now plagues Canada and much of the world — the need for public health knowledge, training and practice becomes startlingly evident. The University of Toronto recognizes this, which is why it re-established a school of public health in 2008. The School then became the University’s newest stand-alone faculty in 2013 — all made possible through the visionary leadership support of Paul and Alessandra Dalla Lana. The Dalla Lana School of Public Health is already a world leader in public health research, education and service. Its HIV Studies Unit was one of the first in the world to examine social and behavioural aspects of HIV transmission, disease impact and treatment; some of its faculty members played a vital role in overcoming the 2003 SARS crisis; and others are leading some of the largest population studies ever undertaken to examine risk factors and chronic diseases. Novel approaches like these are especially critical at this point in time. Health care is Canada’s single largest expenditure: upwards of $214 billion in 2014, according to the Canadian Institute for Health Information. Particularly as our population ages, it is essential that we develop a sustainable health system for the future. There is an urgent need to invest in disease prevention and the factors that determine health and well-being, to improve the services that currently exist and the policies that impact health, and to work towards a world where all citizens have equal access to health care. For this reason, the Dalla Lana School of Public Health is aiming to raise $50 million through a fundraising campaign that is anchored in U of T’s Boundless campaign. This is a first for a Canadian public health school. With the support of our philanthropic collaborators, we will educate Canada’s future public health leaders, significantly influence health policies and practices, and uncover new knowledge that will help entire populations flourish. This investment in public health will move us towards a vision of ensuring healthy lives for everyone, both in Canada and around the world.

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1 Left: An increasingly urbanized Toronto encouraged growth in public health education. Above: Connaught Laboratories played an essential role in the early development of insulin, discovered by Dr. Frederick Banting and Charles Best.

A LEADER FROM THE BEGINNING Today’s Dalla Lana School of Public Health can trace its origins to the last years of the 19th century. At that time, health threats such as smallpox, typhoid and tuberculosis in an increasingly urbanized Toronto highlighted the need for public health training and research. By the 1900s, the University of Toronto was offering courses in sanitary science and preventive medicine, and by the advent of the First World War, it had opened Connaught Laboratories, which played a foundational role in the early development of insulin. This life-changing discovery in 1921 by Frederick Banting and Charles Best catalyzed considerable growth in public health education, and resulted in the creation of the School of Hygiene. The Rockefeller Foundation was so impressed with U of T’s accomplishments in public health, and its collaborative relationships with government and agencies, that it furnished the funds needed to endow the School’s new departments and construct its building, making it, along with counterparts at Harvard and Johns Hopkins Universities, one of just three such schools in North America.

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Over the next 50 years, U of T’s School of Hygiene consolidated its position as a global leader in public health — from continued vaccine development to nutrition studies and recommendations on disease control measures employed during the Second World War to pioneering air pollution studies in the 1950s. In 1947 the School of Hygiene created the Department of Hospital Administration — the precursor of the School’s Institute of Health Policy, Management and Evaluation of today — when it recognized that the study, management and planning of hospitals had a key role to play in preventive medicine and public health. The W.K. Kellogg Foundation played a vital part in establishing the department by funding the first three-year postgraduate program in hospital administration, and it continued to be a staunch supporter in subsequent decades. In 1975, when infectious diseases no longer appeared to be threatening Canadians at home, the School of Hygiene was absorbed into the Faculty of Medicine as the Division of Community Health. This shift served as a launching pad for the development of specialized graduate programs to train public health professionals and researchers for practice across Canada and beyond. It also helped all medical students receive public health education and contributed to social reform and health advocacy.

Top Left: The discovery that diphtheria antitoxin could be prepared from horse blood led Dr. John Fitzgerald to build a stable and lab in Toronto, placing the product within reach of Canadians. Bottom Left: Dr. John Fitzgerald brought the latest in public health strategies back to Toronto after visiting Europe and the U.S. between 1910 and 1913.

After a new infectious disease — SARS — traumatized Toronto in 2003, public health in Canada was critically examined. A commission led by David Naylor, then Dean of U of T’s Faculty of Medicine, pointed to a serious shortfall in public health personnel, such as community medicine specialists, public health nurses and health promoters. It recommended re-establishing schools of public health to train these specialists and to foster the research needed to combat public health issues such as SARS, outbreaks of E. coli and skyrocketing obesity. In 2008, a landmark gift from the Dalla Lana family — the largest ever to public health in Canada — transformed public health at U of T, making it possible for the Dalla Lana School of Public Health to become the most influential school of its kind in Canada, as its predecessor was throughout much of the 20th century. Today the School’s impact has been recognized by the University of Toronto’s ranking among the top 14 global universities for social science and public health. In 2013, it became U of T’s first new stand-alone faculty in 15 years, underscoring

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the indispensable importance of public health to the University and the community. Since 2012, the Dalla Lana School has been led by Howard Hu, a physicianscientist who held leadership roles at Harvard University and the University of Michigan and has conducted pioneering studies in exposure to toxicants and the resulting impacts on child development and the risk for chronic disease. Under Dean Hu’s leadership, the Dalla Lana School has launched several strategic research and education initiatives that capitalize upon its unique strengths and the immense talent of its scholars. These include an undergraduate curriculum, which will help to increase understanding of public health and its critical role in society among students from every background and faculty, as well as satisfy the acute interest shown by undergraduates in public health issues. The Department of Health Administration was renamed the Department of Health Policy, Management and Evaluation in 2001, and in 2012 became an institute. In 2014, this global leader in scholarship in health policy, health services and clinical epidemiology joined the Dalla Lana School, reuniting two groups that were once closely aligned, and resulting in one of the world’s largest public health schools with a vision of improving health and health systems. The School was further strengthened in 2015 when it became the home faculty for the University’s globally respected Joint Centre for Bioethics. The Dalla Lana School’s presence at Canada’s top university provides it with access to a vast array of experts in fields as diverse as philosophy, economics, law, architecture, psychiatry and engineering, which is fundamental to the interdisciplinary nature of its work. Fifteen research centres and institutes led by Dalla Lana School faculty underscore the importance of its collaborative, multi-faceted work, and serve to attract talent to an already productive core. In addition, its location in Toronto — one of the world’s health powerhouses  — makes it part of a vast network of hospitals, government agencies and academic resources, and gives it the opportunity to interact with one of the world’s most diverse populations — a living laboratory for public health studies. Its solid track record of partnering with the community and its strong international relationships have established a culture of knowledge exchange and knowledge translation that few similar schools can match. And being in a country with a universal health-care system means that novel approaches in policy or programs have the potential to benefit an entire population.

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Public Health in Action

A recent study co-authored by Institute of Health Policy, Management and Evaluation expert Walter Wodchis discovered that a very large proportion of people in Ontario spend their final days in hospitals. Analysis of the data revealed that the average person generates $14,000 in health-care costs during their last 30 days of life and nearly $54,000 in the last year. More importantly, these costs reflect expenses from acute care hospitals that may only make a person’s passing more challenging. This landmark research highlights the need to shift treatment of the dying out of hospitals by drawing attention to the huge — and unsustainable — portion of the health-care budget spent on end-of-life care. Wodchis heads up a network of scholars who focus on identifying groups of patients with complex issues and how the health system might best care for them. Their end-of-life study makes it clear that people go into hospital because they often have no other option, even though they would rather spend their final days of life surrounded by loved ones and in their own home. Although at present there are highly inconsistent palliative care options or support services for home care in Ontario, the Institute team’s work is prompting the provincial government to look closely at this issue.

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INSTITUTE OF HEALTH POLICY, MANAGEMENT AND EVALUATION Canadians generally believe our health-care system functions well. But if we suffer a serious health condition that requires a referral to a specialist or multiple diagnostic tests, or we need our records transferred from one hospital to another, we may discover that the system contains gaps. Precious time could be lost as we wait for appointments to be scheduled, and there could be a lengthy waiting list for the oncologist or cardiologist we need to see. Studies have shown that one in five patients is not equipped to care for themself after leaving hospital. Many diabetics are not monitored regularly, so that their health often worsens. And Canada has one of the highest rates of perinatal death in the developed world. Simply put, the various pieces of the health-care system do not currently fit together in a way that ensures patients receive the best care possible. So how do we ensure that patients are treated effectively and efficiently? That health-care spending remains affordable for taxpayers? That hospital infections, staff shortages and poor record-keeping do not threaten the well-being of our loved ones? This can be accomplished by rigorous attention to the policies, management and evaluation of the health-care system.

Left: Dr. Adalsteinn Brown leads the Institute of Health Policy, Management and Evaluation (IHPME). Above: The IHPME plays an instrumental role in training future health policy-makers and scholars.

The Institute of Health Policy, Management and Evaluation (IHPME) is tackling this important task, drawing on its rich history as the former University of Toronto Department of Health Administration to make our health system safer, more functional, more efficient and more accessible. Considered the top group of its kind in Canada and recently ranked number nine in the world, the IHPME bridges the gaps between clinical sites, administration and policy-makers. Its experts produce innovative ideas that will improve the system and then shepherd these ideas into practice, allowing sound research to become reality within a very short time. For example, IHPME researchers and students recently created a protocol that has reduced unnecessary antibiotic use in hospitalized patients.

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IHPME RESEARCHERS AND PROGRAMS: • produce innovative ideas to make our health system safer, more functional, more efficient and more accessible • train health policy-makers, scholars in health policy and health management, and experts in health systems • bridge the gaps between clinical sites, administration and policy-makers • convene stakeholders around policies, management and evaluation of the health-care system • aim to keep health-care spending affordable for taxpayers

In the past, many patients automatically had their urine tested for possible infection while they were in hospital, and were given antibiotics as a precaution. Now doctors request the tests only from patients they suspect may have an infection, which limits the indiscriminate use of medications that aren’t needed and could even be harmful. In a long-standing performance improvement project, the IHPME developed scorecards for use in hospitals across Ontario — a standardized evaluation metric that enables health professionals to make better-informed decisions about care. These scorecards have been adopted in countries as far away as Japan. The knowledge transfer illustrated by these two examples happens not only quickly but frequently, and is due in large part to the IHPME’s extremely successful partnerships with health system agencies, providers and the Ontario government. The IHPME also plays an instrumental role in training those who will go on to become health policy-makers, scholars in health policy and health management, and experts in health systems and the use of data to produce insights based on quantitative data and rich qualitative research. At any given time, the Institute hosts approximately 450 students. It also regularly convenes gatherings with decision-makers and other health system professionals, ensuring that its findings are having an impact that goes far beyond one patient, and often far beyond Canada. Many health-care systems, programs and policies need to be re-examined and reorganized. This will require significant changes in behaviour and processes, large groups of people working together under often demanding conditions, and the redesign of complex technologies that are employed when people are at their most vulnerable. Recognizing this, the IHPME aims to increase the number of scholars who can lead research in these areas, expand its training of physicianleaders, offer more opportunities for engaging stakeholders and augment support for the very talented students who demonstrate interest in improving health care. The Institute also seeks to harness health research conducted in Canada for Canadians — in areas such as mobile health, medical devices, robotics and software. With donor investment, these goals will be possible: the IHPME is in a stronger position than any comparable organization in the world to convert financial support into noticeable results — in policy and education, in improved patient safety and patient experience, and in economic benefits.

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THE UNIVERSITY OF TORONTO JOINT CENTRE FOR BIOETHICS Matters of health and health care inevitably bring up ethical questions. If there is a drug shortage, should it be first come, first served, or should more critically ill patients receive access first? During flu season, should it be mandatory that health workers get vaccinated? More health data now allows us to identify who will become sick and what impact this will have on our health system, but is this personalized medicine or an invasion of privacy? What ethics training do health professionals need to tackle complex chronic disease, end-of-life care and matters relating to the digital age?

Left: Dr. Jennifer Gibson, Director of the U of T Joint Centre for Bioethics. Above: The World Health Organization drew on expertise from the U of T Joint Centre for Bioethics during the 2015 Ebola outbreak in West Africa.

These are just some of the issues that the Joint Centre for Bioethics (JCB) is tackling. Founded 20 years ago, the JCB has become one of the world’s leading bioethics centres. With a network of over 180 bioethics scholars and professionals, it has the largest critical mass of bioethicists anywhere in the world. This unique centre became the first World Health Organization (WHO) Collaborating Centre for Bioethics in 2002, and is led by Dr. Jennifer Gibson, whose expertise in health system and policy ethics has informed health policy development locally, nationally and internationally. She chaired the Ontario Ministry of Health and Long -Term Care’s Ebola Bioethics Table, providing advice related to the impact of Ebola on standards of care, and served on the WHO’s Ebola Ethics Working Group. She also serves as co-chair of the Provincial -Territorial Expert Advisory Group on PhysicianAssisted Dying. In 2015, the JCB moved from the Faculty of Medicine to the Dalla Lana School, reflecting the expansion of bioethics to address both social determinants of health and patient care, health policies and population health.

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The impacts of JCB research are many and far-reaching. For example, JCB scholars developed the Living Will, which allows people to express their wishes around end-of-life care. This tool has been influential as a precursor to advance care planning and has helped families across Canada to talk about their wishes for the end of their lives. The JCB also developed a framework for priority-setting in health care, which has become an essential tool in health organizations across the country and has served as a model internationally. After the SARS crisis hit Canada, the JCB developed an ethical framework to help us prepare for pandemics. This was adopted locally, nationally and internationally by health ministries, including the WHO. This framework has also proved critical as new threats have arisen, such as the recent Ebola outbreak, where the JCB participated in the WHO’s response. In addition to these successes, the JCB has trained more than 300 bioethics scholars and professionals, many of whom are now leading ethics programs in academic institutions and health organizations across Ontario, Canada and the world. Achievements like these demonstrate the importance of ethics and values, employed as a guide alongside evidence to make decisions in clinical settings, at organizational levels and at a policy level in health systems, all of which encompass public health, both in Canada and abroad. As we look to the future, the JCB hopes to use its leadership and established track record to help build ethics capacity in community-based health, including primary care, home care and public health. JCB scholars also plan to advance research and practice on complex ethical challenges at the intersection of health care and public health, including end-of-life care, epidemics, global health and big data in health system planning. The JCB will also focus on evaluating the impact of current ethics practice, and how this should be structured as systems evolve towards patient-centred care and population-focused policy. This involves examining how health systems and providers have interacted with patients and populations in the past, asking what could be done differently, and applying new approaches. Donor investment would allow the JCB to create research chairs and research programs in these, and other, topical areas for a lasting impact on health. With hubs dedicated to advancing bioethics research and knowledge translation, to training the next generation of bioethics leaders, and the ability to draw steadily on the expertise of dedicated scholars, the JCB would be better equipped to advance its significant research, education and practice work into the ethical, health-related matters that touch us all.

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Public Health in Action

A sexual health education program led by Dalla Lana School of Public Health PhD students is empowering young women living in northern Canada to develop leadership and confidence. FOXY—Fostering Open eXpression among Youth—is the brainchild of Candice Lys, who remembered the inadequate sexual education she received as a teen growing up in Fort Smith, Northwest Territories. Using theatre, storytelling and other arts, the program introduces a new way of talking with young women about sexual health, sexuality and relationships. The ultimate goal is to help them to make healthy life choices in a region where the sexual health of youth is a serious public health concern, with extremely high rates of sexually-transmitted infections, adolescent pregnancy and sexual violence. FOXY began as Lys’ PhD research project in collaboration with then fellow Dalla Lana School student Gwen Healey, and is now a non-profit organization that has reached more than 500 youth through workshops in 20 communities.

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AREAS OF STRENGTH AND STRATEGIC FOCUS The Dalla Lana School of Public Health has built a solid foundation in areas of public health scholarship that are having a direct, and often immediate, impact on people in our communities. These are areas where the School’s highly qualified faculty and students are leading the way —  on a global stage — and offering unique perspectives. Over the next several years, with the support of our donors, we intend to further develop these areas of strength, with a particular strategic focus on the following: i. ii. iii. iv. v.

Left: The Dalla Lana School of Public Health is helping to create policies and processes that improve life for city-dwellers. Above: Community health workers in Bangladesh use smartphones in a breast cancer awareness project.


These areas of strength are dynamic and cross-disciplinary, and findings from one can help to inform another. For example, the use of big data (the rapid integration and analysis of large-scale information) may help to promote healthier cities and communities, including Indigenous communities, while the integration of public health and primary care could have huge potential for global health. Meanwhile, the Institute of Health Policy, Management and Evaluation’s work in improving health systems can be assisted by big data, and can contribute to healthier communities, as well as better integration of public health and primary care, leading to affordable and equitable health policies. The Joint Centre for Bioethics can help to inform protocols and priorities in all these areas, ensuring that ethics are integrated into decision-making and policy.

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i. USING BIG DATA FOR POPULATION HEALTH In this era of technology, most of our actions leave a footprint. When we post on Twitter, purchase apples at the supermarket, visit a family doctor or wear a personal monitoring device, we generate vast quantities of data which can then be gathered, linked to each other and analyzed. This “big data” presents opportunities for marketers, who send ads to our webmail or Facebook accounts that uncannily reflect our interests. Yet it can also be used by public health experts. For example, by linking emergency room visits to cell phone records researchers in Ontario discovered a clear correlation between car accidents and cell phone usage, leading to an international movement to ban the use of phones while driving. The Dalla Lana School of Public Health is home to world-leading experts in this field. By collaborating with the Toronto-based Institute for Clinical Evaluative Sciences (ICES), scientists at Dalla Lana have access to some of the most comprehensive community health data sets in the world. Scholars like David Henry are using data generated by everyday activities to formulate answers to public health questions. For example, with fellow Dalla Lana scientist Dr. Laura Rosella, Dr. Henry is examining 1.9 million death records linked to medical treatment details to better understand which factors have contributed to the rapid drop in mortality we have witnessed over the past 40 years. This is the largest study of its kind. Another area where the Dalla Lana School stands poised to lead the way with big data is in examining links between environmental exposures, genomics and health outcome data, which will increase understanding of these hazards to health. By studying the links between socio-economic status and health-care access, researchers will address the inequities that exist in the system. The use of big data is a very cost-effective way to conduct public health research  — maximizing the value of information already being collected rather than devising separate studies. This research is not intrusive, and all the personal data remains anonymous. Our scientists have access to vast collections of billing information from medical visits and population-based surveys. Specialized collections enable collaborative studies of data specific to Indigenous and immigrant peoples. Large volumes of data from new partners such as government ministries continue to be linked through ICES, meaning that records are not confined to physician and hospital files, but include data that is not traditionally associated with health, such as details of high school results and information from social services and correctional facilities. Dalla Lana scholars will be able to connect millions of records and use them to unleash advances in health and human development. Significant investment from donors will help our scientists to capitalize on the myriad research opportunities that are emerging in this exciting area, as well as develop the programs needed to train future leaders in the effective use of big data for health. Harnessing big data for health will inform policies and practices, promote innovation and improve care, ultimately helping people live healthier lives.

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Dalla Lana School faculty member Dr. Laura Rosella uses big data to ultimately help people live healthier lives.

Dr. David Henry co-leads the Big Data for Health initiative at the Dalla Lana School of Public Health.

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ii. THE HEALTH OF INDIGENOUS COMMUNITIES While Canada’s Indigenous peoples confront some of the same health issues as the wider population, a plethora of major inquiries, including Statistics Canada reports, show a growing gap in health and well-being. Despite this, health services are less accessible in Indigenous communities. Moreover, factors that determine health — such as clean water, employment, income, housing and opportunities for education — are typically at a standard far below what is acceptable in a developed country. In 2014, Michael and Amira Dan donated $10 million to establish the Institute for Indigenous Health at the Dalla Lana School of Public Health. Anchoring this Institute in the School gives it the strongest position possible, thanks to an existing cadre of Aboriginal health researchers (including a number of talented graduate students and new investigators), solid partnerships with other Toronto and Canadian institutions, and access to Dalla Lana experts in areas such as clinical and population health, health systems, health economics, anthropology and political science. The Institute aims to narrow the health gap between Indigenous and non-Indigenous peoples by consolidating work currently being conducted by scholars across the University, and to create health in Indigenous communities by providing opportunities for new and innovative work in this area.

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“Canada is a prosperous country, with our citizens generally experiencing good health, and so many Canadians don’t recognize the existence of a public health safety net until something breaks down, such as when SARS severely impacted day-to-day life in 2003. The situation is very different for Canada’s Indigenous peoples. Health and health care in some of their communities are astonishingly poor for a developed nation. U of T is putting its considerable resources and network to work for this issue, as befits the greatest university in the country and one of the top 20 universities in the world, which is why Amira and I were proud to support the creation of the Waakebiness-Bryce Institute for Indigenous Health in the Dalla Lana School of Public Health. Since the Truth and Reconciliation Commission, a new chapter in Indigenous and settler relations is in the process of being written. By choosing to donate to the Waakebiness-Bryce Institute, I believe that Canadians can help to put the wheels of reconciliation in motion because, with its focus on the health and well-being of Indigenous peoples, the Institute is all about reconciliation.” Dr. Michael Dan (MD 1984), founding donor, Waakebiness-Bryce Institute for Indigenous Health Vice-Chair, Dalla Lana School Boundless Campaign Cabinet

In the past, research carried out in Indigenous communities usually didn’t involve community members in decision-making. Although immense diversity exists between Indigenous communities, one factor they share is a belief in community-level consent for research to proceed. Therefore, a focus on ethics is critical to working respectfully with Canada’s Indigenous peoples; all research will be aligned with community priorities and evidence from research findings will be used to inform innovative programs to improve health. For example, determining the best ways to provide children with good nutrition, a comprehensive education and access to extended family networks will promote a healthy start in life. In this way, Indigenous communities can imagine a better future. Now named the Waakebiness-Bryce Institute for Indigenous Health, the Institute builds on the foundation laid by the Dan family’s generosity, and its first step is to convene advisers such as elders and Indigenous scholars from across Canada, and public health experts. Moving forward, it needs to develop collaborative education programs to train the next generation of researchers, and attract additional scholars to the existing team to combine the pursuit of scientific excellence (according to international standards) with community relevance. Investment from donors will help to make this possible. The Institute’s ultimate goal is to disseminate evidence-based research that will save lives, influence health and social policy, and produce efficiencies in the health-care system, which will benefit Indigenous communities, but will also produce learnings that could be applied to non-Indigenous communities.

Left: Drs. Michael and Amira Dan at the naming ceremony for the Institute. Above: Dr. Earl Nowgesic became acting director of the WaakebinessBryce Institute in 2016.

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iii. INTEGRATING PUBLIC HEALTH AND PRIMARY CARE Health professionals are accustomed to treating patients for ailments — perhaps high blood pressure, arthritic knees or abscessed teeth — instead of focusing on how to prevent these ailments in the first place. Also, they’re trained to help that one patient, rather than to look at which other patients are experiencing the same issue, and what commonalities exist in lifestyle, living conditions or environment. How do we equip physicians, nurses, dentists and allied health professionals with these skills and create systems that allow them to advance prevention programs and policies? Although pressing arguments have been made for the better integration of public health and primary care, post-secondary institutions have not yet structured themselves to train professionals who truly understand both. The Dalla Lana School of Public Health has established the Division for Clinical Public Health — among the first of its kind in the world. Overseen by Dr. Ross Upshur — who is both a family physician and a public health physician — the Division is transforming the way health professionals are trained, and generating advanced knowledge on how to best integrate the two areas of health most pertinent to improving the health of Canadians. For example, faculty in the Division will be looking at ways to ensure that immunizations bring optimal health benefits to individuals and communities, which is especially important at a time when people are questioning the value of vaccines. This proposed integration of public health and primary care will take some time to make a significant difference to the existing health system, but it is absolutely critical for the future health of our society. For example, health services could be planned according to the needs and characteristics of a particular population. With the support of donors, the Dalla Lana School envisions a research centre for clinical prevention and public health practice, a space where the health professional of the 21st century would be trained in both disciplines, and where the scholars dedicated to making the integration happen would carry out their studies. These would include public health and community medicine experts, but also social scientists, whose expertise in historical, psychological, economic and philosophical aspects of health will be invaluable. The ultimate goal is to reach a point where public health and primary care are no longer considered separate professions, but work seamlessly to promote the health of all citizens.

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Dr. Ross Upshur leads the Division for Clinical Public Health.

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iv. HEALTHIER CITIES AND COMMUNITIES According to United Nations statistics, 3.5 billion people around the globe live in cities, a number that is projected to increase to six billion by 2050. This growth is accompanied by quality-of-life challenges, including social and health inequities. For example, because of the shortage of affordable housing, many Canadians don’t have a roof over their heads, which can have a severe effect on their mental and physical health. While meeting their immediate needs for food and shelter is important, addressing the underlying causes of homelessness so that they might have a place to call home would lead to improved health and well-being for many. Reshaping cities into healthy places for everyone becomes increasingly important as the percentage of people living in urban areas rises. As more people migrate to cities to seek employment, public health professionals must be thinking about ways to ensure that those cities promote health equity for all citizens. The Dalla Lana School of Public Health is conducting research that focuses on seeking effective solutions to this issue— in the form of new or adjusted programs, services, and policies. With the support of Toronto Public Health and the Wellesley Institute, the School established the Healthier Cities and Communities Hub, the only research group of its kind. The Hub emphasizes solutions-based research, and has close partnerships with organizations and policy-makers such as the Toronto Central Local Health Integration Network, the Ontario Ministry of Health and Long-Term Care, and the World Health Organization who, because of their “on-the-ground” work, are in a position to identify the most critical needs. Being located in the diversity-rich city of Toronto enables their research, because what works for a particular population in this region can almost certainly be applied elsewhere. Already the Dalla Lana team has seen their proposed solutions make a consistent difference in a way that few research groups can match. For example, in 2013 the governments of Canada and Ontario committed funding to the Housing First program after Dalla Lana School findings demonstrated that this was a costeffective way to provide well-being and stability for homeless people. In 2015, the Hub awarded nine seed grants to local projects related to creating resilient cities, the built environment, and health- and place-based interventions. For example, one project aims to help homeless people deal with extreme temperatures while living on the city streets. Other projects will foster a new sense of community for people living in apartment towers and make it safer for kids to bike and walk to school during rush hour. The Dalla Lana School has received numerous requests to share their strategies globally, which could be made possible through international exchanges. As we continue to work towards processes and policies that can support all city-dwellers, we will require investment from our donors. There is a pressing need for more researchers dedicated to this focus, as well as training for new graduates and existing practitioners so that they are focusing on solutions, and learning to evaluate programs as they progress. We also envision spaces that will promote collaboration between academics and community, politicians and business people, recognizing that we all have a role to play in promoting healthy cities.

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v. A HEALTHY WORLD FOR EVERYONE, EVERYWHERE What if we could initiate contagious ideas and innovative projects that promote a healthier and fairer future for every person and community on the planet? What if we could forge alliances across traditional boundaries, harnessing our collective talent and creativity, to create and spread health? What if we mobilized what we have in abundance to promote greater equity? What would it take for everyone in the world to be healthy? These are just some of the questions that are guiding the Dalla Lana School of Public Health’s approach to the field traditionally referred to as global health. Dalla Lana researchers have enormous strengths in tackling health issues, and generating novel solutions that transcend borders. For example, our faculty provided advice to the World Health Organization during the Ebola outbreak in West Africa. And in November 2014, we hosted the highly successful Creating a Pandemic of Health Summit. Inspired by the appreciation that health is a concept far broader than simply being free of disease, this event brought together more than 750 attendees and hundreds of remote participants from around the globe. Many new ideas emerged from the summit, and are being championed by the Institute for Global Health Equity and Innovation, which is based at the Dalla Lana School. Guided by its vision of a world in which every person and community can have the same opportunities to live a long and healthy life, as part of a sustainable planet, the Institute is now pursuing groundbreaking initiatives, which include: • The Health of Humanity: A worldwide effort to answer questions such as: What is the meaning of health? What causes health? • The Good Death: What do we mean by a good death? Are there minimum standards that every human being, anywhere in the world, could expect to have at the very end of life? • One Toronto for the World: How can Toronto become the location of choice to design, test, refine and evaluate scalable and sustainable social innovations for a healthier world? • The Agency: How can we foster scalable and sustainable social enterprises that could contribute meaningfully to solving some of the greatest problems of our time? • Conversations that Matter: How can we create a safe space in which to feel comfortable asking the unasked questions, to generate constructive ways to make the world a healthier and fairer place?

Recognizing that we have much to learn from each other, the School plans to invest in partnerships that connect the local with the global, which will lead to a coalition of willing scholars, students, governments, corporations, non-profit organizations and communities from six continents pursuing collaborative projects designed to improve the health of humans and the world. We also intend to significantly increase the number of international learners participating in our programs, and to support them as they take part in innovative activities in key locations around the globe. Our ambitious new undergraduate course — Grand Opportunities in Global Health — has seen unprecedented demand, and is only the first of what we hope will be increased opportunities for U of T students to learn about how we might create a healthier, fairer and more sustainable world, together.

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Public Health in Action

Dalla Lana School faculty members Paul Bozek and Dr. Donald Cole are working with Canadian and Indian NGOs to help reduce exposure to silica among workers who grind agate used in jewellery and trinkets in Gujarat, India. Silica dust can cause cancer, tuberculosis and lung disease, and tens of millions of Indians are regularly exposed to it. This number includes children who either work in the industry, go to work with their parents, or live in a home that doubles as a workplace. Recognizing that the Gujarat communities may not have the financial, energy or social resources to adopt solutions commonly applied in the developed world, the School and its partners are creating special fans — that use affordable energy options — to control dust and particles in the agate workshops. At the same time, local educators are raising awareness of risk prevention in a culturally appropriate manner, and business models are being developed to provide incentives for safer production methods. This three-pronged approach is taking place in consultation with the workers and their families, to ensure community acceptance and ultimately improve workplace safety.

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“What drew my wife and me initially to what is now known as the Dalla Lana School of Public Health was a few things — firstly, that U of T had deep public health expertise with a solid history and a lot of unique capabilities. It just needed a catalyst, and the opportunity to help an organization with such unique strengths realize its potential was very appealing to us. Second, was an increasing understanding that many of the most challenging global health issues were a lot closer to home than we realized. Living in Toronto, one of the most interconnected cities in the world, we learned with SARS just how efficient those connections really were, and not necessarily in a positive way! Finally, we also saw big and difficult public health problems here in Canada, in areas we felt were not seriously on the agenda for improvement, such as Aboriginal health and Canadian health policy. What’s happened at the School since then has really reinforced our initial interest. Over the past five years it has transformed into a fully developed faculty with all of the credibility and capability that global leaders have. It’s taken some incredible steps and integrated all of its component parts in a way that allows it to truly be impactful and successful in some of the most important issues of public health. It has the ability to break down and figure out some of society’s biggest challenges. And I find that very inspiring.” Paul Dalla Lana, founding donor, Dalla Lana School of Public Health Chair, Dalla Lana School Boundless Campaign Cabinet

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Left: Dr. Adalsteinn Brown, Director of IHPME; Dr. Howard Hu, Dean, Dalla Lana School of Public Health; Dr. Jennifer Gibson, Director of JCB; Paul Dalla Lana, founding donor, at “Building the Future, Together” celebration. Above: Paul Dalla Lana, the Dalla Lana School’s founding donor.

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PARTNERSHIP OPPORTUNITIES The Dalla Lana School of Public Health’s fundraising campaign is part of Boundless: the Campaign for the University of Toronto. Boundless addresses the University’s commitment to enhancing the social and economic well-being of our communities, and to helping our citizens live healthy and productive lives. For the Dalla Lana School, it means accelerating our ability to lead the way in public health research, training and service by building on our existing strengths to achieve even greater impact. With the support of our benefactors, we can do just that.

Left: Scholarships and fellowships ensure that the Dalla Lana School can attract talented students. Above: Dr. Arjumand Siddiqi’s research examines racial inequities in health in Canada.

Philanthropic investment will make a pivotal difference for the School, increasing capacity in our areas of strategic focus, consolidating our exceptional scholarship, strengthening our community of students, researchers, teaching faculty, field instructors and alumni, and offering the freedom to embrace new directions. We are seeking forward-thinking donors to collaborate on opportunities to support students, faculty, research and programs at the Dalla Lana School.

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“Receiving the Dalla Lana Scholarship motivated me to do my very best academically. I’m grateful for the generous donation from the Dalla Lana family, and feel it is very important that they are supporting the field of public health and the new generation of individuals like me who are pursuing careers in public health. Only public health can prevent problems on a large scale, impacting entire populations.” Oleksandr Udovyk, Master of Public Health candidate

Oleksandr Udovyk is focusing on occupational and environmental health, and hopes to use his Dalla Lana School education to help address the physical, chemical, biological and psychological hazards that people often face in their workplaces.

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i. STUDENT SUPPORT The Dalla Lana School of Public Health offers PhD and master’s programs in a variety of public health disciplines. To ensure that the next generation of public health professionals is equipped to face the challenges of our time, the Dalla Lana School is seeking to establish scholarships and fellowships. These will not only help students to focus their energies on their program and reward outstanding work, but they will also provide the School with the ability to attract the best and brightest students from around the world. In addition, we are seeking to establish travel awards, which would allow students to take part in the international experiences that offer invaluable perspective to future public health experts.

ii. FACULTY SUPPORT The Dalla Lana School’s team of public health scholars is innovative, highly respected and tremendously productive. However, to successfully address the public health challenges that exist, we need to recruit additional talented thinkers. The School is seeking to establish chairs and professorships, which, in a competitive scientific environment, help us to attract and retain the most outstanding investigators from the world’s most influential institutions. These appointments serve to support faculty as they create advanced knowledge and contribute ideas to our cross-disciplinary work. While an endowed chair is the highest form of recognition for a faculty member’s scholarship, we are also aiming to create expendable chairs and professorships.

iii. RESEARCH SUPPORT The exciting research taking place at the Dalla Lana School requires significant resources to succeed. While public health research frequently leads to tangible improvements in the health of communities and the practices of institutions, its very nature is experimental, which means that traditional sources of funding such as federal grants usually remain out of reach. To support research at the School and in our institutes, we are seeking to establish a research fund. As with all our work, we will focus on devising solutions with real impact; these will be disseminated beyond the scientific community to stakeholders such as government and not-for-profit agencies, education leaders, health professionals and the public in an effort to effect change.

iv. PROGRAM SUPPORT Programs at the Dalla Lana School cover every aspect of our work, and include conferences and workshops to convene thought-leaders and experts from across a spectrum of disciplines, student-led initiatives, travel to forge partnerships and exchange knowledge, pilot projects to test new ideas, and cross-disciplinary research projects. To support our programs  — which are integral to the school’s activities — we are seeking to establish a Dean’s innovation fund. This resource would be used particularly to ensure that novel approaches to public health issues do not become sidelined due to lack of funding.

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REDEFINING HEALTH One of the defining characteristics of being Canadian is access to free health care. It is this, perhaps more than anything else, which sets us apart from many other nations. But our current health-care system is not functioning well: escalating costs, an aging population and gaps in care all place it under threat. Health might seem like a right to be enjoyed by an economically developed country, and yet it is actually an important driver of economic development. Healthy people flourish, build prosperous communities and contribute to society. Large future changes in health and health outcomes will come about through investments in public health and health systems. The sustainable health system of the future is one where there is a much deeper focus on disease prevention rather than treatment, where the health of entire communities is taken into account, where processes are functioning smoothly and where the gap between public health and health care simply no longer exists. Achieving these goals drives the Dalla Lana School of Public Health. We aspire to be one of the world’s leading institutions of public health that is particularly known for its holistic view of what a healthy individual and a healthy society will look like in the future. We know that our research, education and engagement activities will get us there, but we do require the support of donors who understand just how fundamental public health is to a thriving, productive society. We invite you to consider supporting the campaign for the Dalla Lana School of Public Health. With your generosity and involvement, we will realize our vision of a healthy future for all.

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PhD • Biostatistics • Epidemiology • Social and Behavioural Health Sciences • Occupational and Environmental Health

PhD • Clinical Epidemiology and Health Care Research • Health Services Research

MASTER OF PUBLIC HEALTH (MPH) • Epidemiology • Family and Community Medicine • Health Promotion • Nutrition and Dietetics • Occupational and Environmental Health

and Health Care Research • Health Services Research • Quality Improvement and Patient Safety • Health Technology • Assessment and Management

MASTER OF SCIENCE (MSc) • Biostatistics


MASTER OF SCIENCE IN COMMUNITY HEALTH (MScCH) • A ddictions and Mental Health • Family and Community Medicine • Health Practitioner Teacher Education • Occupational Health Care • Wound Prevention and Care

MASTER OF SCIENCE (MSc) • Clinical Epidemiology



85 Core Faculty

233 PhD Program Students

725 Faculty in Partner Institutions

39 Residents and Post -Doctoral Fellows

596 Master’s Program Students

$32.6 Million in Annual Research Funding


Office of Advancement Dalla Lana School of Public Health 155 College Street Toronto, ON M5T 3M7 416-978-6150

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