Heidi Singer

�Թϱ�� researchers work with Mississauga’s Trillium Health Partners to create ‘learning health system’

Christopher.Sorensen — Wed, 31 May 2023 15:34:26 +0000

�Թϱ�� researchers work with Mississauga’s Trillium Health Partners to create ‘learning health system’

Christopher.Sorensen Wed, 05/31/2023 - 11:34

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From left: Researchers Kerry Kuluski, Walter Wodchis, Robert Reid, Laura Rosella are working closely with Trillium Health Partners and the communities it serves to improve health care and planning immediately and tangibly (supplied image)

Heidi Singer

Topic

Our Community

Dalla Lana School of Public Health

Subheadline

‘It’s quality improvement on steroids’

University of Toronto researchers are addressing hospital overcrowding by looking far beyond packed waiting rooms and overburdened corridors.

Working closely with Mississauga’s Trillium Health Partners, researchers at the Dalla Lana School of Public Health – including epidemiologist Laura Rosella, and health systems experts Kerry Kuluski and Walter Wodchis, as well as Robert Reid, chief scientist at Trillium’s Institute for Better Health – have spent the past two years talking to people with complex medical needs, such as diabetes and mental health challenges and spending time with patients and their families to understand what good care means to them.

Next, they use the data collected from the community and three local hospitals to create indicators and dashboards that can be used to improve care and planning immediately and tangibly – not theoretically, and in some distant future.

In short, they are helping to turn a community hospital system into what they’re calling Canada’s first learning health system.

“We’re redefining the role of the hospital in the Canadian context,” says Karli Farrow, THP’s president and CEO. “This is no longer only about high quality acute-care services delivered to those who make their way to us. Our goal is better health for the community, which means we need to be a part of a complete and inclusive system of care.

“Our research mission is completely embedded into this effort.”

Reid, a professor at the Dalla Lana School of Public Health, says research is not only about discovery for its own sake – but having impact.

“Health systems across the world are broken, with too many people left behind, and I believe research can have a strong role to play in changing how they bring value to the populations they serve,” he says. “We’re combining high-powered research methods with expertise in rapid implementation – it’s quality improvement on steroids.”

Read the full story at the Dalla Lana School for Public Health

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Trillium Health Partners

Discovery of new gene mutation could play a role in breast cancer prevention: Study

Christopher.Sorensen — Mon, 03 Apr 2023 16:22:03 +0000

Discovery of new gene mutation could play a role in breast cancer prevention: Study

Christopher.Sorensen Mon, 04/03/2023 - 12:22

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(photo by Michael Hanschke/picture alliance via Getty Images)

Heidi Singer

Topic

Breaking Research

Temerty Faculty of Medicine

Cancer

Dalla Lana School of Public Health

Research & Innovation

Women's College Hospital

An international team of researchers have discovered a new genetic mutation that could help predict the likelihood of hereditary breast cancer.

The discovery, published in the American Journal of Human Genetics, sprang not from the latest technology, but from decades-long research relationships that spanned continents.

Mohammad Reza Akbari

Mohammad Reza Akbari, a cancer researcher at Women’s College Hospital and professor of genetic epidemiology at the University of Toronto’s Dalla Lana School of Public Health, says he and his colleagues in Poland identified the mutation in a gene called ATRIP by working with a highly homogenous population of Polish breast cancer patients.

That, in turn, helped them to spot what might have been impossible to see otherwise.

“People say discovering a cancer-causing mutation is like finding a needle in a haystack,” says Akbari. “But I think it’s more like finding a specific piece of hay. The low-hanging fruit has already been picked, but we still don’t know what causes breast cancer in at least one-third of families with generations of cases.”

In 1994, an international group of scientists, including Akbari’s colleague Steven Narod, a senior scientist at Women’s College Hospital and a professor at Dalla Lana School of Public Health and in the Temerty Faculty of Medicine, discovered the BRCA1 and BRCA2 gene mutations that cause breast cancer in the vast majority of women who carry them. It was a momentous finding. But BRCA1/2, together with a small cluster of subsequently uncovered gene mutations only account for two-thirds of breast cancers that run in families.

For the other third, there has been no test to help members make decisions about how to protect themselves with procedures like preventative mastectomies.

It has been years since a new gene has been identified in the breast cancer world. The remaining mutations might lurk in the lesser-known quarters of our genomes or would be more rare than BRCA mutations or less obviously tied to breast cancer. But Akbari and his colleagues in Poland had something very valuable: access to a “founder” population of patients – a large group of people whose genetic mutations are magnified because they are descended from a small group. Founder populations exist in many parts of the world such as Quebec, Iceland and Poland.

Starting in 1998, the familial breast cancer research team, led by Narod, had established ties with Polish scientists, allowing the Women’s College Hospital group access to a founder population of breast cancer patients. After joining Women’s College Hospital a decade ago, Akbari cultivated these ties, working collaboratively with Cezary Cybulski at Pomeranian Medical University to establish a large breast cancer recruitment program – and making sure to visit frequently.

The two research groups clicked.

“They’ve been great collaborators,” says Akbari, of the Polish group, along with fellow researchers Jean-Yves Masson and Amir Abbas Samani, from Laval University and �Թϱ�� respectively. “There was no ego involved, just a willingness to work together. I’ve never seen such a thing anywhere else. We made a great team.”

Akbari and his colleagues sequenced the genomes of about 500 Polish breast cancer patients, plus a control group, and validated the preliminary findings with more than 25,000 breast cancer patients and controls from Poland. He found his smoking gun: a genetic mutation associated with more than a 100 per cent increased risk of breast cancer in the women studied. But the risk estimation was based on a single founder mutation in a gene known as ATRIP. Next, they searched for the mutations in the UK Biobank, which contains half a million genomes from a more diverse group of people. In that population, the relationship between the mutation and the likelihood of developing breast cancer was even stronger – more than 200 per cent.

The mutation is rare – affecting only 0.25 percent of breast cancer patients in the study. But the team made a parallel discovery that could help tailor treatments to the next generation of breast cancer patients. They found that the breast tumours of the patients with a germline ATRIP mutation had a hallmark trait indicating they would respond to an existing class of targeted therapies called PARP Inhibitors. And this could apply to an even wider group.

If a breast cancer patient doesn’t have the ATRIP mutation in their germline DNA, the mutation might still appear in their tumors, meaning they could potentially respond to PARP inhibitors.

“These are preliminary data and more research needs to be done before being able to use it in clinic,” Akbari cautions. “But it shows that the finding can have implications for a greater number of people.”

Akbari is hopeful about the public health ramifications since breast cancer is the leading cause of cancer death in women around the world.

“When we understand why breast cancer occurs in families, we can easily screen all the members and determine who is at high risk and who’s not,” says Akbari. “If the risk is big enough, women can choose preventive surgeries or more aggressive screenings to detect it earlier. And every gene we identify will improve our general knowledge of breast cancer biology – which will pave the road for developing more effective targeted treatment of breast cancer in all patients.”

�Թϱ�� researchers to advise health providers on improving Ontario's primary care system

Christopher.Sorensen — Mon, 09 Jan 2023 18:28:29 +0000

�Թϱ�� researchers to advise health providers on improving Ontario's primary care system

Christopher.Sorensen Mon, 01/09/2023 - 13:28

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(Photo by XiXinXing/iStock/Getty Images)

Heidi Singer

Topic

Our Community

Dalla Lana School of Public Health

Health

Research & Innovation

With Canadian health-care systems in crisis, Monica Aggarwal and her colleagues at the University of Toronto’s Dalla Lana School of Public Health are working to advise health providers on building better integrated primary care systems – work she hopes will help realize real change in the sector.

Aggarwal is leading a research collaboration between �Թϱ��’s Dalla Lana School of Public Health, the Association of Family Health Teams of Ontario (AFHTO), the Ontario College of Family Physicians (OCFP) and the section on general and family practice of the Ontario Medical Association (OMA). As a leading expert in primary care systems across Canada – anchored by family doctors – Aggarwal has consulted at the federal and provincial levels on multiple occasions.

Monica Aggarwal

She recently completed a cross-comparative study of primary care transformation in Canada, which identified more than 100 sector innovations in the country.

“I feel honoured and privileged to have the opportunity to work with inspiring and passionate primary care leaders who truly want to make a difference for the primary care sector in Ontario,” says Aggarwal, an assistant professor in the Dalla Lana School of Public Health’s division of clinical and public health. “The leaders of these organizations have a deep understanding of the issues in health care and recognize the critical role that evidence-based research can have to advance improvements in the primary care sector.”

The researcher decided to first focus on showing how Ontario could implement compensation models that encourage and reward team-based care.

“There’s a real desire to build and spread interprofessional teams,” says Aggarwal, who is supported by a three-year grant from the partner organizations. “However, we are not seeing the results expected from mainstream models in Canada. I think this is not because teams don’t work, but because they are not being implemented in a manner that would allow them to be successful. Provider compensation is a key piece of the puzzle.”

Ross Upshur

She is working with Professor Ross Upshur, head of the Dalla Lana School of Public Health’s clinical public health division, to develop collaborations with researchers and primary care leaders in Canada and internationally to meet the research needs of knowledge users.

“This is a timely and important collaboration in light of the current crisis in primary care,” Upshur says. “Rigorous research is needed to inform solutions to the current situation.”

Aggarwal’s research will inform policy recommendations to help strengthen primary care in Ontario.

“Across the world, cost-effective and high-performing health systems share a common characteristic – they are based on a foundation of comprehensive primary care, which is supported through a team,” says AFHTO CEO Kavita Mehta. “Jurisdictions that invest robustly in primary care are farther ahead in achieving health system goals, ensuring a lens on equitable and accessible care close to home.

“The research is clear,” she adds. “Now we need to develop an evidence-based roadmap on the best way to invest in interprofessional primary care teams in Ontario to create a strong and sustainable health system.”

Building a strong primary care foundation would also help to address the current staffing crisis, says family physician David Barber, vice-chair of the OMA’s general and family practice executive.

“We are seeing an ongoing decline in medical students wanting to practice family medicine because of the expanding demands in the current practice model, and we will continue to see doctors leaving comprehensive family medicine” Barber says. “We need to change how primary care systems work in Ontario so that family medicine becomes a more viable and attractive practice.”

The �Թϱ�� research partnership underscores how primary care is the bedrock of the health system, notes OCFP CEO Kimberly Moran.

“Primary care is where most care happens in our health system and evidence from around the world shows that high-performing health systems have strong primary care foundations, anchored by family doctors,” Moran says. “This important research effort will inform much-needed policy action and spark meaningful change for Ontario’s patients and families.”

Study finds lethality of air pollution in India may be overestimated

Christopher.Sorensen — Tue, 18 Oct 2022 14:12:10 +0000

Study finds lethality of air pollution in India may be overestimated

Christopher.Sorensen Tue, 10/18/2022 - 10:12

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India has among the highest levels of air pollution in the world, but researchers have found that its impact on mortality rates in the country has been overstated (photo by Peter Adams/Getty Images)

Heidi Singer

Topic

Breaking Research

Unity Health

Dalla Lana School of Public Health

Global

India

Research & Innovation

St. Michael's Hospital

High levels of exposure to air pollution in India have a smaller effect on mortality than previously estimated, according to a study that covered the entire country.

Prabhat Jha

The nationwide study – published in Environmental Health Perspectives by Prabhat Jha, a scientist at Unity Health Toronto and a University Professor at the University of Toronto’s Dalla Lana School of Public Health, as well as his colleagues – linked concentrations of PM2.5 derived from satellite-based measurements of deaths in over 7,400 small areas among seven million people.

India has among the highest levels of air pollution in the world and nearly every person in the country lives in areas with fine particulate matter levels well above PM2.5 – the level considered safe by the World Health Organization (WHO).

The authors quantified the relationship between PM2.5 exposures over several years to the subsequent mortality risk, focusing on the leading killers of Indian adults: respiratory disease, heart disease, stroke and overall mortality. Their analyses adjusted for risk factors that make these diseases more common such as smoking, urban or rural residency, and education. Because these diseases and PM2.5 tend to cluster in some areas but not others, they also adjusted for spatial clustering.

“Measuring the health effects of air pollution is complicated,” says lead author Patrick Brown, an associate professor in �Թϱ��’s department of statistical sciences in the Faculty of Arts & Science. “There are so many things to tease out to establish if a relationship with deaths is true, or just noise in the data. Even the modest excess risks we found for stroke might reflect the uncertainty that is inherent in these types of epidemiological studies.”

Analyzing over 200,000 deaths of people aged 15 to 69 years, the authors found a nine per cent excess risk in stroke deaths for every 10 units of increase in PM2.5 exposure (measured as micrograms per cubic meter). However, there were no excess risks for respiratory or heart disease and for total mortality (after excluding stroke). Study results were broadly similar in different age groups and in areas with higher or lower use of household solid fuel, which itself is the major contributor to PM2.5 exposure as measured by satellites.

Results showing little or no effect on heart disease and only modest effects on stroke are similar to an earlier, smaller study led by McMaster University that examined air pollution and deaths in 750 communities in 21 countries. In contrast to these direct observations, earlier estimates of air pollution deaths in India use complex models that assume much higher mortality risks from PM2.5 exposure.

The results are one of many insights being generated by the Million Death Study – one of the largest studies of premature mortality in the world. The study, covering deaths from 2001 to 2014, is a long-running effort to better understand the causes of mortality in countries such as India, where the vast majority of people die at home without a death certificate. Launched by Jha, it has helped governments and health providers to better allocate scarce public health funding.

“Direct studies like the MDS are far preferable to extrapolating from models, many of which take reports from non-Indian settings and apply them – unseeingly – to India,” Brown said. “Earlier models have probably overstated the extent to which air pollution kills adults in India.”

“Most existing studies on air quality and health are done in high-income countries, where PM2.5 exposures are far lower and disease patterns are substantially different than in low and middle-income countries such as India,” adds co-author George D’Souza, dean of St. John’s Medical College in Bengaluru, India. “That needs to change.”

There remain many reasons to act on air pollution in India.

“PM2.5 may not be the big killer in India as has been touted, but action to reduce PM2.5 exposure is still necessary,” says Jha, who is also a physician at St. Michael‘s Hospital, a site of Unity Health Toronto. “Air pollution worsens child lung health and lowers quality of life, and that is sufficient justification to act.”

The research received support from the Indian Council of Medical Research, Canadian Institutes of Health Research and the U.S. National Institutes of Health.

Public health researchers use telemedicine to manage diabetes and hypertension in rural Pakistan

geoff.vendeville — Wed, 02 Mar 2022 15:56:15 +0000

Public health researchers use telemedicine to manage diabetes and hypertension in rural Pakistan

geoff.vendeville Wed, 03/02/2022 - 10:56

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A Rural Health Center clinic in Khalaspur. �Թϱ�� researchers in public health are using telemedicine to manage chronic conditions like diabetes and hypertension (photo courtesy of RHC)

Heidi Singer

Topic

Breaking Research

Dalla Lana School of Public Health

Diabetes

Researchers at the University of Toronto's Dalla Lana School of Public Health (DLSPH) are working to implement telemedicine for managing diabetes and hypertension in rural Pakistan – care that is urgently needed to replace traditional services disrupted by the COVID-19 pandemic.

Amid the chaos and calamity of COVID-19, the potential for telemedicine is finally being realized in health care and health systems around the world. The DLSPH team is hoping to learn whether specialists in Pakistani cities can use it to support health providers on the ground, not just to re-establish care but to provide even better treatments than they offered pre-COVID-19.

Xiaolin Wei

“Pandemics will teach us how to adopt new technologies to remote care,” says Xiaolin Wei, an associate professor at DLSPH, epidemiologist and global health policy scientist leading the study. “Remote management will be the future of health care – especially for primary care which has a low capacity in low- and middle-income countries (LMICs). There is a great potential for chronic, serious diseases like diabetes and hypertension as they are the rising burden of disease in LMICs.”

In many parts of Pakistan, care for chronic diseases has fallen apart, Wei says. The country suffers high rates of diabetes and hypertension, and once patients begin to improve, they sometimes discontinue treatment because it's too expensive.

As a result, Wei hopes to improve not just care but patient education. The team is using new technologies such as ECHO training platform to allow senior physicians based in Karachi to train and mentor nurses and other health providers in rural parts of the Punjab, and to see patients directly via video. Patients will also have access to a mobile app to monitor their blood pressure, blood sugar and medications.

The project is co-led by Dr. Amir Khan, the head of Pakistan’s Association of Social Development and an award winner in leading health policy changes.

“The development of telemedicine in LMICs and the progress we have made has been exponential,” says Hammad Durrani, the project manager and a PhD student at the Institute of Health Policy, Management and Evaluation (IHPME). “What we have achieved in the past two years of COVID-19 in terms of digital health diffusion and adoption is equivalent to the development of the past 20 years globally. Patients and providers are more willing and governments have fast-tracked the regulatory paperwork.”

Hammad Durrani

The disruption offers a chance to “reinvent virtual and hybrid virtual/in-person care models, with a goal of improved health-care access, outcomes, and affordability,” he says.

For the current project, the �Թϱ�� research team will focus on the most vulnerable patients first, and will also offer remote COVID-19 education and treatment. They believe their learnings will help to combat the same diseases among South Asian and other populations in Ontario, in regions such as Peel.

“Globally, we have seen that due to COVID-19, care for other diseases such as heart diseases, diabetes and cancers has been delayed,” says Durrani. “This stands true for Canada also, where we see patients [who] are struggling to get access to care for conditions like mental health and heart disease. At the moment, telemedicine is not part of our usual treatment delivery options, especially for specialist care. Our model is definitely something to think about even for a developed country like Canada to improve access to quality health care.”

Patients today appear more open to telehealth, and more interested in health overall, says Wei. He argues that the disruption of the pandemic has opened new opportunities to deliver medicine differently.

“I can see health literacy has been raised up, even in remote areas of developing countries,” Wei says. “The pandemic has raised people’s interest in their own health. That could open opportunities for us to measure disease and improve outcomes even in places where it has been difficult.”

The research is supported by a grant from the Canadian Institutes of Health Research.

In the Philippines, �Թϱ�� researchers combat vaccine hesitancy fuelled by history, geopolitics

Christopher.Sorensen — Wed, 23 Feb 2022 16:21:16 +0000

In the Philippines, �Թϱ�� researchers combat vaccine hesitancy fuelled by history, geopolitics

Christopher.Sorensen Wed, 02/23/2022 - 11:21

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When COVID-19 hit, the Philippines was still reeling from the aftermath of a bungled vaccine rollout for dengue fever, which shook many people’s faith in the safety of immunization (photo by George Calvelo/NurPhoto via Getty Images)

Heidi Singer

Topic

Global Lens

COVID-19

Dalla Lana School of Public Health

Global

Vaccines

Researchers at the University of Toronto’s Dalla Lana School of Public Health are working with NGOs, religious and other community leaders in the Philippines to build trust in COVID-19 vaccines – helping to address unique historical and geopolitical factors that have contributed to a low national vaccination rate.

Xiaolin Wei

“COVID has been a big tragedy in the Philippines because they couldn’t afford to get people vaccinated and because the health-care system is a chaotic mix of public and private,” says Associate Professor Xiaolin Wei, a physician, epidemiologist and Dalla Lana Chair in Global Health Policy who is leading the effort. “But vaccine confidence was seriously undermined already. The pandemic was the perfect storm.”

When COVID-19 hit, the Philippines was still reeling from the aftermath of a bungled vaccine rollout for dengue fever, which shook many people’s faith in the safety of immunization. As a result, many have balked at getting routine immunizations for diseases such as measles in recent years.

“We were hopeful that people would see COVID vaccines differently, but this is part of the history that lingers,” says co-principal investigator Lincoln Lau, an assistant professor of clinical public health and the research director of International Care Ministries (ICM). “We saw very high uptake in the capital region, but we’re struggling in the provinces. In a November 2021 survey, more than half said they would never get the COVID vaccine. We estimate that in the end, three quarters won’t get it.”

Lincoln Lau

To help build confidence in the vaccine, the research team is using an implementation science framework to find the populations at highest risk, identify the specific barriers they face and learn how best to engage them.

The team plans to work with religious leaders, health-care providers, and non-profits to develop a toolkit to enhance vaccine confidence, and to reach people through social media platforms and apps like WhatsApp. They are being supported by a grant from the Canadian Institutes for Health Research.

A world authority on the spread of tuberculosis, Wei has worked in the Philippines for many years. When the pandemic hit, he immediately pivoted to COVID-19, helping Filipino policymakers develop guidelines, diagnosis and treatment plans, as well as contact tracing and community support for care providers.

“From my work in tuberculosis, I’ve learned the critical importance of working together with community leaders in the Philippines – especially government and religious figures,” Wei says. “It’s a strongly Catholic community and priests are the de-facto community leaders. We’ve worked with them for decades and learned to see religious gatherings as a place for building vaccine confidence. You have to earn the trust of religious leaders, and let them use their knowledge to guide the language and tactics.”

The team has already begun to educate people about vaccines, using pre-existing partnerships. Lau had been working in the Philippines with ICM, a major non-profit, to teach financial literacy and maternal health when COVID-19 broke out. For the past year, he has helped the organization add vaccine education to the program, which is delivered to a quarter million people per year.

“We invite religious leaders to be part of our lessons,” says Lau. “We ask them to lead a prayer and stay at the front of the room while a nurse teaches. Some religious leaders are teaching anti-vaccine messages, so we want to show people that the medical field isn’t fighting the priests. There are faith leaders who agree with us and we want them to be present in the community so people see that if you do receive the vaccine, you won’t be condemned by your religion.”

Another challenge: the country’s population is spread across some 2,000 islands (there are about 7,640 islands in all). Many villages can only be reached by motorcycle – an exhausting hours-long ride up steep, unpaved roads. Others take an hour to reach on a bamboo boat.

And like other countries in the South Pacific, the Philippines has been caught in a trade war between the United States and China. Despite vaccine shortages, and the difficulty of delivering doses to remote areas, the two industrial superpowers have sought to convince Filipinos that their vaccines and masks are the better ones, says Wei.

“The Philippines is a battlefield of global health policy between China and the U.S.,” he says. “Geographically, it’s close to China, but it’s a former U.S. colony, and the country’s leadership goes back and forth in its allegiances. Both countries give them free vaccines, but try all the means to promote theirs. With vaccine hesitancy already so high, this has complicated consequences.”

Political leaders have also contributed to the problem by responding to genuine fear with threats of punishment, says Lau. Recently, Philippines President Rodrigo Duterte threatened to jail those who refused to get vaccinated – a tactic Lau fears will only backfire.

“When 70 percent of people in a remote community don’t want the vaccine, and then the president says we’re going to lock up those who don’t [get it] – it’s such a big disconnect,” he says. “It bothers me. People have concerns and instead of addressing them, all they get is fear.”

High levels of hazardous chemicals found in Canadian nail salons: �Թϱ�� study

Christopher.Sorensen — Mon, 14 Feb 2022 21:20:26 +0000

High levels of hazardous chemicals found in Canadian nail salons: �Թϱ�� study

Christopher.Sorensen Mon, 02/14/2022 - 16:20

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Jackie Liang, a nail technician and community health worker at Parkdale Queen West Community Health Centre, paints nails in a Toronto salon (photo by Giovana Ramos and Praven Yoganathan)

Heidi Singer

Topic

Breaking Research

Resarch & Innovation

Dalla Lana School of Public Health

Faculty of Arts & Science

Researchers at the University of Toronto’s Dalla Lana School of Public Health, in collaboration with Parkdale Queen West Community Heath Centre and the Healthy Nail Salons Network, have found that nail technicians in discount salons are exposed to several chemicals widely used as plasticizers and flame retardants.

The study, published this week in the journal Environmental Science and Technology, found that exposure to some hazardous chemicals was higher among nail technicians than among electronic waste workers.

Miriam Diamond (photo by Camilla Pucholt)

“We were very surprised to find exposures for some chemicals up to 30 times higher among nail salon workers relative to exposures in homes, and up to 10 times higher than in e-waste handling facilities,” says Miriam Diamond, co-author and professor at the Dalla Lana School of Public Health and the department of Earth Sciences in the Faculty of Arts & Science.

The study reported higher exposures of several phthalate plasticizers, which was expected given the use of these chemicals in personal care products. One phthalate plasticizer, DEHP, which is not allowed for use in cosmetics under the Canadian Environmental Protection Act, was found at low levels.

“The finding of low exposure to the plasticizer DEHP is important – it shows the current regulations for this compound are working,” Diamond says.

However, the researchers did not expect to find high levels of flame retardants that are not known to be used in personal care products.

Several of the chemicals studied have some restrictions on their use (or restrictions are proposed) under the Canadian Environmental Protection Act. Yet, most of these chemicals are not explicitly regulated in Ontario workplaces. The specific source of these chemicals in nail salons was not determined in the study.

The chemicals in question have been associated with adverse health effects, including neurological and reproductive effects, with some evidence that in utero exposure may be important.

Victoria Arrandale

“Nail technicians have been raising concerns about the impact of their work on their bodies, including worries about reproductive, respiratory, skin and musculoskeletal health for many years now,” says Victoria Arrandale, co-author and assistant professor at the Dalla Lana School of Public Health.

Despite these concerns, nail technicians enjoy the artistry and personal care that their work entails.

“This research shows us that our federal government needs to pay attention to making the products that are used in nail salons safer for both customers and nail technicians,” says Van Tran, nail technician and nail salon outreach Worker at Parkdale Queen West Community Health Centre.

This study points to the need to consider the wide range of workplace settings when regulating chemical use in Canada. Study authors urge government and product manufacturers to make safer personal care products and safer spaces for workers and customers in the personal services sector.

“We are proud of the work we do and we would like our workplaces to be safer,” says Jackie Liang, a nail technician and community health worker at Parkdale Queen West Community Health Centre.

The study was a joint effort of researchers at �Թϱ��, Occupational Cancer Research Centre, Centre for Research Expertise in Occupational Disease and the Parkdale Queen West Community Health Centre. It was funded by the Ontario Ministry of Labour, Training and Skills Development Research Opportunity Program.

�Թϱ�� researchers help design blueprint for Black food sovereignty in Toronto

Christopher.Sorensen — Wed, 05 Jan 2022 18:18:35 +0000

�Թϱ�� researchers help design blueprint for Black food sovereignty in Toronto

Christopher.Sorensen Wed, 01/05/2022 - 13:18

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The Afri-Can FoodBasket, a community non-profit, has partnered with the City of Toronto to address food insecurity among Black Torontonians (photo courtesy of Afri-Can FoodBasket)

Heidi Singer

Topic

Our Community

COVID-19

Dalla Lana School of Public Health

Food Security

Researchers at the University of Toronto's Dalla Lana School of Public Health helped launch North America’s first Black food sovereignty program – an effort to address food insecurity by creating a Black-run food pipeline from field to table.

The Toronto Black Food Sovereignty Plan is the result of a partnership between the City of Toronto’s Confronting Anti-Black Racism Unit (CABR) and the Afri-Can FoodBasket, a community-based non-profit that advocates for food justice and food sovereignty. Toronto City Council unanimously approved the plan last fall.

“It’s well established that there’s a chronic issue with food insecurity among Black communities in Toronto, and we think the standard approach in dealing with it won’t take us far,” says Winston Husbands, an associate professor at Dalla Lana who was part of the working group behind the plan. “We want to step outside the normal way we think about food insecurity and talk about food sovereignty, which means Black communities have some degree of control that ensures much more access to food.”

Winston Husbands

More than a quarter of Black households in Toronto are food insecure, including about 300,000 children. Research shows that Black families are three-and-a-half times more likely than white households to be food insecure – a statistics that calls for community-led solutions, Husbands says.

The plan calls for access to growing space and infrastructure, Black-led food hubs, and culturally rooted community health and nutrition programs. City agencies will provide resources such as land and water for urban gardens and education in creating sustainable food systems and minimizing waste.

The origins of the plan date to the mid-90s, when the Afri-Can FoodBasket began building capacity among individuals and neighbourhoods across the city to grow their own food. The group’s efforts led to more than 100 new gardens; a composting program; food animation workshops; seed saving; the Ujamaa Urban Farm, with sites in Toronto and Brampton; the Black farmers incubator training program; and Cultivating Youth Leadership, a youth community food security program.

At the onset of the COVID-19 pandemic, food insecurity worsened in the city’s Black communities. The FoodBasket responded with Black Food Toronto, a traditional food bank that helped to meet immediate needs for access to culturally appropriate food. But Husbands and others, including Imara Rolston, an assistant professor at Dalla Lana, were already thinking about longer-term solutions.

“There’s the idea of recognizing that access to food is a human right,” says Husbands, a former research director of the Daily Bread Food Bank. “But then we need programs and policies to make it really effective.”

The plan also differs from traditional food security efforts because it addresses racism as a major cause of food insecurity in Black communities. Without this understanding, traditional efforts privilege certain groups and undermine the health and wellbeing of others, Husbands says. He draws an analogy from his work in HIV research: “You might say everyone should get tested for HIV without understanding why different segments of the population are not getting tested. Then some will lag behind, and you end up thinking that people work against their own interest.”

Considering anti-Black racism as part of a food sovereignty plan means asking questions like why there are so few Black farmers in Ontario, or why many food stores in Black neighborhoods are not owned by community members, Husbands says – and investing resources to address these gaps.

The food sovereignty plan came together under the leadership of a long-time Black food activist Anan Lololi, executive director of the FoodBasket, who spearheaded the plan with CABR’s Melana Roberts.

Anan Lololi

“We want to work with nature, value urban farmers and nutritionists. We want to make sure we realize the sacredness of food,” Lololi says. “Food is a business but really it’s a human right. We want to look at it appropriately.”

Lololi says he was surprised at how quickly the plan was adopted by council – a nod, perhaps, to the increased need to create community resiliency in the face of disruptions like COVID-19. During the pandemic, Black Food Toronto says it has distributed one million pounds of food with support from CABR, Community Food Centres Canada, Network for the Advancement of Black Communities and the public. Vegetables have also come from Ujamaa Farm and the Backyard Urban Farm Company, but without the kind of infrastructure that such a complex operation requires.

“We’re doing this with blood, sweat and tears because we don’t have the resources to do it, not even a warehouse,” Lololi says. “The next steps from the Working Group are to mobilize our knowledge base. Bring food policy folks, those who know about farming and gardening, the activists, academics, nutritionists and food businesses to collectively determine the future of food sovereignty in Canada.”

'An essential resource': �Թϱ�� course focuses on Black mental health

Christopher.Sorensen — Mon, 27 Sep 2021 19:22:25 +0000

'An essential resource': �Թϱ�� course focuses on Black mental health

Christopher.Sorensen Mon, 09/27/2021 - 15:22

Cutline

Akwatu Khenti, an assistant professor at the Dalla Lana School of Public, developed a course that focuses on the increased mental health pressures for Black people and the most effective treatments and interventions (photo by Adam Coish)

Heidi Singer

Topic

Our Community

Temerty Faculty of Medicine

Academics

Black

Centre for Addiction and Mental Health

Dalla Lana School of Public Health

Mental Health

A new University of Toronto course explores Black mental health from a public health perspective amid mounting evidence that the COVID-19 pandemic has had inequitable effects on the wellbeing of racialized Canadians.

Offered by the Dalla Lana School of Public Health this fall, Fundamentals of Black Mental Health examines specific racialized challenges facing Black people and the most effective treatments and interventions related to addiction, mood and anxiety disorders, dementia and psychosis.

“All of the post-slavery societies have constructed a racialized experience in which Black people have increased mental health pressures,” says Akwatu Khenti, an assistant professor at the Dalla Lana School of Public and a scientist at the Centre for Addiction and Mental Health (CAMH) who developed the course and will teach it.

“There’s added stress from the slavery-based stereotypes and stigmas that exist around Black phenotypes, beauty, intelligence and morality.”

Perceived dangerousness is also an ever-present source of stress and/or distress for men of African descent. Khenti points out that Black populations in the West suffer higher rates of schizophrenia – suggesting that racism can even influence diseases considered genetic in nature. In Ontario, Kwame McKenzie, a professor of psychiatry in the Temerty Faculty of Medicine and director of health equity at CAMH, has found that Black populations face a 200 to 300 percent increased risk for serious mental health conditions.

Khenti and McKenzie have adapted cognitive behaviour treatment interventions (CBT) for Anglophone, Francophone and Spanish-speaking Black communities that have expanded the repertoire of depression counselling. The culturally adapted approaches add cultural and socio-economic context to better address what sociologists call “virtual social identities” – the stereotypes and stigmas that influence how racialized “others” are perceived by the mainstream.

They argue that cultural adaptation should be a necessity given the pervasiveness of systemic racism experiences across Black people’s lifetime.

“Black children have to deal with low academic expectations, underappreciation of their beauty and giftedness that starts as early as kindergarten,” says Khenti. “It grows worse. By the time you get to high school you’re dealing with expectations of criminalization. You don’t get to do the same things white male adolescents do and get a pass.”

Khenti is concerned about the pandemic’s effect on mental health rates, particularly among Canadians who face other pressures such as inability to work from home, loss of social supports, job insecurity, home schooling and other social determinants of health. The course offers tools to support effective treatment and early interventions as well as health promotion, prevention, and harm reduction for Black communities.

Khenti and his guest lecturers, including McKenzie, will teach approaches for engaging with Black communities in public health efforts to reduce mental health stigma and culturally adapted treatment approaches.

“Given huge mental health consequences of COVID-19 for Black Canadians, this course will be an essential resource for post-pandemic planning and the development of meaningful interventions,” McKenzie says.

The course, open to all �Թϱ�� students, is aimed at physicians, nurses, social workers, public health practitioners and policy analysts.

“The literature showing the effectiveness of culturally adapted interventions is growing,” says Khenti. “Health sciences and social work students should be learning this in school, and it should be normalized expectation for both clinical and non-clinical practice.”

�Թϱ�� public health experts on what 9/11 and its aftermath revealed about air contaminants

Christopher.Sorensen — Fri, 10 Sep 2021 15:00:31 +0000

�Թϱ�� public health experts on what 9/11 and its aftermath revealed about air contaminants

Christopher.Sorensen Fri, 09/10/2021 - 11:00

Cutline

Fire and rescue workers search through the rubble of the World Trade Center in the days after the 9/11 attacks as a plume of dust swirls in the air (Beth A. Keiser/AFP via Getty Images)

Heidi Singer

Topic

Global Lens

Dalla Lana School of Public Health

Global

Sept. 11

On the 20th anniversary of 9/11, Heidi Singer, director of communications at the University of Toronto’s Dalla Lana School of Public Health, recounts her personal experience with the tragedy and its aftermath before sitting down with three environmental health experts – Miriam Diamond, Paul Bozek and Christine Oliver – to talk about lingering health impacts and lessons learned.

White smoke rolled in from lower Manhattan, wrapping the Brooklyn waterfront in a sudden haze. The top third of the second tower had just crumbled to the ground, and I was on my bike, pedalling as fast as possible to the World Trade Center.

It was the morning of Sept. 11, 2001, and I was a reporter for the Staten Island Advance newspaper, living in Brooklyn.

Normally congested streets were almost empty – people were pulled over in clumps, listening to the radio, learning about other attacks in other places. In those first few hours, we were terrified, wondering if the world was going to end.

Nobody thought too hard about the white smoke. Or the dust that covered the blank-faced people marching home across the Brooklyn Bridge and powdered the silent, empty streets like fresh snow.

A single police officer stood guard at the entrance to lower Manhattan. I showed him my press credentials allowing me to cross police lines. He tried to stop me, but I argued until he gave in. As I headed toward Ground Zero, he handed me a mask, saying, “Here, if you’re going in, at least take this.” I have no memory of using it.

I breathed that dust all day and again two days later, working directly on the pile of debris, shovelling out the dead one bucket at a time. I’ll never forget the acrid taste of it. I smelled it for two months afterward from my desk in the press room of city hall as the fires continued to burn nearby. I developed “the cough” – an irritating constant hacking that first responders and residents of lower Manhattan got in those first weeks. A decade later, I was diagnosed with one of the cancers believed to be linked to 9/11 exposure.

Today, I’m haunted by the attack – the catastrophe, the lives lost, but also by the terrible health consequences that crept up on so many of us. The firefighters I interviewed who could barely walk due to lung damage. The cancers. The undocumented immigrants who did the dirtiest work cleaning up the rubble, then struggled to get help for their ruined health.

The smoke and dust have followed me through the years, a constant reminder of the risks we take, many of them reckless. Mostly I regret being there. But now, facing a very different public health disaster, these memories give me courage to ask people to mask when they’re not following public health guidelines, or to engage the hesitant in dialogue about vaccination.

Twenty years later, I wonder what the experts have learned about the environmental health consequences of that terrible day – and whether much has changed. Would firefighters today be taking deep breaths of asbestos and silica dust as they worked themselves to the bone trying to dig out victims? Would exhausted recovery workers taking the Staten Island ferry home in the middle of the night simply be told to take a hot shower and throw their dusty clothes in the laundry? Would I as a reporter have been allowed into Ground Zero at all?

Left to right: Miriam Diamond, Paul Bozek and Christine Oliver (Photos by Camilla Pucholt, Adam Coish and courtesy of Christine Oliver)

For answers, I turned to three environmental health experts at �Թϱ��’s Dalla Lana School of Public Health: Christine Oliver, an adjunct professor, was based in Boston on 9/11 and subsequently treated some of the first responders and studied their unique illnesses; Professor Miriam Diamond immediately began putting together a team of graduate students from her �Թϱ�� office who drove all night to lower Manhattan to measure contaminants in the air; and Associate Professor Paul Bozek, an asbestos and PPE expert who still uses environmental health lessons from that day in his work helping to protect firefighters and others with high-risk jobs.

Here is an edited transcript of the conversation:

Singer: What environmental health lessons have been learned from 9/11 in the past 20 years?

Oliver: I think for me it was a wake-up call in terms of the types of diseases that have emerged related to these exposures – the chronic rhinosinusitis and the gastroesophageal reflux disease (GERD). The cancers and the asthma and bronchitis were not a big surprise. But a cluster of four sarcoidosis cases was reported following 9/11, and that was surprising. This is a rare, serious inflammatory disease that affects the lungs primarily. At the time, it was considered a disease of unknown cause. In 2001 we were just beginning to recognize environmental factors as possibly causal. I started to look at what could have caused it in responders, and silica has turned out to be an exposure that’s associated with sarcoidosis. Silica was in the dust from the World Trade Center.

Bozek: It was a big experiment that allowed us to make a lot of connections clearer in terms of cause and effect. Normally, with broad-based population studies, it’s very difficult to look at low-level particle exposure and make that cause-and-effect relationship. But because of the acute nature of 9/11, we learned a lot. And they identified how far the contamination spread, which allowed them to track health effects.

A New York City firefighter, covered in dust, walks away from Ground Zero (photo by Anthony Correia/Getty Images)

Diamond: 9/11 was a profound and extreme disaster that accelerated our learning considerably around the chemical intensity of our cities. At the time, I was surprised and dismayed at the frequency of “ordinary” building fires in cities that put residents at risk. The incidence of these fires has gone down but the types of materials used in cities can potentially exacerbate toxicity. For the World Trade Center, we learned of the PCBs in the basement of one of the buildings. A very complex soup of toxic compounds was created by the lower temperature combustion of all the stuff in the towers, all the electronics and upholstered furniture.

Just think of all those wires. All those motherboards that already contained toxic materials. It became even more of a concern with this low temperature combustion. Since then, our cities have become filled with yet more wires and synthetic chemicals as we have replaced our trees with an urban landscape. We don’t just have wood furniture; we have particleboard furniture held together with all these synthetic resins. There’s shockingly little done on the actual chemistry of these mixtures of building materials, especially if they burn in a structural fire. My concern is what did we learn, what haven’t we learned and how are we just continuing on and making things worse?

The other big picture learning was that wars also released this terrible toxic mess. When the war in the former Yugoslavia was underway, bombing was done strategically at electrical transformer stations containing toxic PCBs and other hazardous dielectric fluids. The twin towers had major electrical transformer infrastructure because of the large number of people there. And this isn’t talked about much, the aftermath. You’ve got the acute effects of war but there are horrible aftermaths also. Tons of ordinary bombs just hitting houses and workplaces that are now stuffed with toxic materials that have become more toxic when combusted at these lower temperatures.

Bozek: It’s practically assumed now that if a firefighter has cancer it must be work-related. 9/11 certainly raised their awareness, and also in the academic world, of contamination of clothing, and they’re much more acutely aware of the need to use respiratory protection, supplied air these days even for a small fire compared to 20 years ago. The captain is yelling at people to make sure they use their supplied air even if it’s a small fire they can put out in a few minutes.

Emergency personnel on site at the World Trade Center wreckage in 2001 (photo courtesy of Heidi Singer)

Oliver: In early days after 9/11 the group of workers least likely to wear respirators were firefighters. It was very surprising.

Singer: Not to me. I don’t know if anyone looked into why, but I can tell you those firefighters felt guilty because they lived and their friends died. They said the respirators slowed them down. They knew nobody was coming out of that pile alive. They knew it that night, but they were still working themselves into the ground trying to dig them out.

But that said, it sounds like we learned a lot, but big picture, some of the hardest lessons of 9/11 weren’t learned because what can you do about our increasingly wired society? How can we learn these lessons that our cities are becoming more and more vulnerable to toxic environmental events? Would we have to reinvent our lives and our cities to really learn the big lessons?

Bozek: Even ‘little picture’ learnings didn’t happen so fast. It took quite a while before we banned asbestos, and that was one of the biggest concerns from the World Trade Center disaster. When I was a student, fiberglass had an exposure limit that was much higher, but now it’s getting to the same level that asbestos was at on 9/11.

Diamond: It’s not just about what we’ve learned but who has learned what? The academic and medical worlds have learned. But as societies as a whole continue to become more complex, it’s a matter of translating the learning into action like building codes. Our regulatory systems are very complex, and in Canada they’re not always transparent. The academics are sometimes brought in to discuss such issues around the governance table, but special interests can effectively lobby against the science as they have a key to the back door of politicians.

Heidi Singer in New York on Sept 13, 2001 (photo courtesy of Heidi Singer)

Singer: I want to show you a picture of myself on Sept. 13. I was a reporter for the Staten Island Advance newspaper at the time, and the Red Cross brought a few of us into Ground Zero on the ferry. We ended up working on the ‘bucket brigade,’ trying to dig people out. What comes to mind when you look at that photo?

Bozek: First, your mask is looking too clean, so you weren’t wearing it enough compared to the dust on that car behind you. It looks like volcanic ashes. My other reaction is that I wish they’d kept you out. That white-ish dust was primarily from silica and gypsum, which settles deeply in the lung, and contains some known carcinogens. At that point, the major white cloud had dispersed, but the particle content from the very fine stuff would still have been quite high. It’s the stuff you can’t see that gets deepest into your lungs and can cause major concerns.

Hopefully after COVID, we’ve all learned about the value of N95s, as opposed to reporters rushing into a situation without any PPE at all.

Oliver: Maybe that’s a lesson we can bring in after Sept 11. Consciousness is higher with regards to the need to protect oneself from contaminants. Use of respiratory protection, even if it’s in the form of a dust mask or N95, is a good thing.

Singer: I’m stunned looking at that photo. I haven’t looked at it in years. Why wasn’t I wearing my mask? What good was it around my neck?

Oliver: Do you remember why you didn’t?

Singer: I was young, I was healthy. The idea that I could get cancer from that dust was so far from my mind. It was, I think, a few weeks before people started developing the cough. We were in the middle of the biggest thing that had ever happened to us. We were the ones who survived and we weren’t focused on our health.

But there was one moment. I ran into a city health official I knew, and she was talking about how terrible it was that they couldn’t get firefighters to wear respirators. When I mentioned I was on the pile, she looked at me with pity. It was one of the few times I got uneasy. I wondered, what does she know that I don’t?

Diamond: I remember at the time there was quite a delay after the 9/11 attack during which the Environmental Protection Agency (EPA) didn’t bring in air monitors. Conspiracies theories arose in the aftermath around the EPA. People contacted us [at �Թϱ��] as honest brokers. There was this feeling of minimizing the potential health threat to get back to so called normalcy and just to keep going. There was minimal testing in people’s homes nearby. I was very surprised that the EPA didn’t take measurements immediately. I thought it was untoward. But Canada probably would have been even worse given our limited ability to respond to disasters.

Oliver: If there’s an overriding lesson to be learned it’s the importance of education. But what are we going to do about this? How are we going to change the way we live in urban environments and the composition and structure of buildings? The World Trade Center does illustrate the importance and necessity of education and that carries over to COVID.

Diamond: I really agree with what you said, Christine. One of the key things about education we haven’t figured out very well is connecting the dots. Our education is tidbits that we don’t have time to integrate. The sad anniversary of 9/11 provides an opportunity to have this more integrative view of the need for a multipronged approach: the education, and regulatory frameworks to implement lessons.

Oliver: I think to some extent the pandemic has said we can do this, we can change how we live and work. Maybe that will be the only gift from the pandemic.

Diamond: It is a big gift. Because what happened after 9/11, the change in regulation was in terms of population surveillance for the purposes of security; there was a increase of resources devoted to security that we weren’t fully aware of. And there’s only so much money to go around. It comes out of a pot that could be for education.

Singer: What’s the one thing you wish had been done differently during 9/11 from an environmental health perspective?

Bozek: Measure it. We don’t do enough measurements to know what the risk is. If they would have done the measurements and said we have all this stuff in the air, they would have taken more precautions. But they walked in blind because they were dealing with the immediate trauma, then the cleanup and trying to get back to normal without understanding the risk. If you don’t do the measurement, assume it’s a worst-case scenario and go in with the spacesuits.

Heidi Singer

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