Why in-person learning matters: A dispatch from the front lines

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Opinion piece written by Dr. Sloane Freeman and Dr. Ripudaman Minhas

After coping with the isolation and uncertainty of virtual school, this fall’s return to in-person learning has been a breath of fresh air for many students.

As pediatricians working in school-based clinics in Toronto, we have witnessed the deterioration of students’ well-being with school closures. Since September, we have watched many of our patients once again thrive in in-person learning environments, with clear positive impacts on their mental, physical and academic well-being. As we nervously watch daily COVID counts and await further information about the Omicron variant, we must do everything possible to keep schools safely open.

While teachers quickly created online learning environments in response to pandemic-related school closures in spring 2020, vital pieces of the school experience could not be translated into a virtual space. Across age ranges, students have remarked on the tragic impacts of prolonged social isolation from their peers. They have mourned disrupted social customs and rites like attending birthday parties, camps, graduations, concerts and sports tournaments. We know there have been huge impacts on mental health, with record-high numbers of calls to crisis lines, mental health referrals, and admissions for eating disorders.

L’importance de l’apprentissage en personne : des nouvelles en provenance du terrain


Article d’opinion rédigé par la Dre Sloane Freeman et le Dr Ripudaman Minhas

Après avoir fait face à l’isolement et à l’incertitude inhérents aux classes virtuelles, le retour à l’apprentissage en personne, cet automne, a constitué une véritable bouffée d’air frais pour de nombreux élèves.

En tant que pédiatres travaillant dans des cliniques scolaires à Toronto, nous avons été témoins de l’impact négatif de la fermeture des écoles sur le bien-être des élèves. Depuis septembre, nous avons vu nombre de nos patients s’épanouir à nouveau dans des environnements d’apprentissage en personne, avec des effets positifs évidents sur leur bien-être mental, physique et scolaire. Alors que nous surveillons attentivement le nombre quotidien de cas de COVID-19 et que nous espérons en savoir plus sur le variant Omicron, il est impératif de prendre toutes les mesures nécessaires pour que les écoles restent ouvertes, en toute sécurité.

Au printemps 2020, alors que les enseignantes et les enseignants ont rapidement créé des environnements d’apprentissage en ligne en réponse aux fermetures d’écoles liées à la pandémie, des éléments essentiels de l’expérience scolaire n’ont pas pu être transposés dans un espace virtuel. Quelle que soit leur tranche d’âge, les élèves ont souligné les conséquences douloureuses d’un isolement social prolongé. Ils ont dû faire le deuil de traditions et de rites sociaux, comme la participation à des fêtes d’anniversaire, à des camps de vacances, à des remises de diplômes, à des concerts et à des tournois sportifs. Nous savons qu’il y a eu d’énormes répercussions sur la santé mentale, avec un nombre record d’appels aux lignes de crise, d’aiguillages vers des services de santé mentale et d’admissions hospitalières en raison de troubles alimentaires.

Deaths from the opioid crisis often make headlines. What’s overlooked is the toll on survivors

From The Globe and Mail article

Fatal overdoses are the headline news in the opioid crisis. The numbers are staggering and they are getting worse: British Columbia just reported more than 200 deaths in a single month. What is often overlooked is the toll on the survivors – the walking wounded of the crisis. Some get through overdoses and suffer brain damage or other disabling consequences; others struggle with rashes, abscesses, collapsed veins or hepatitis C.

“It’s easy to project the spotlight on overdose deaths, but there are far, far more people who have experienced an overdose, lived and had long-term effects from that,” said Seonaid Nolan, a doctor at Vancouver’s St. Paul’s Hospital. Though they cheated death, “their trajectory in life has just markedly shifted.”

“My concern is that we make this broad-sweeping assumption that if people survive the overdose they’re okay,” said Tara Gomes, a scientist at St. Michael’s who was one of the authors of the Ontario study on infections. “It’s not enough just to think the overdose is reversed and they’re just back to where they were before.”

Because of the stigma that still comes with drug use, she said, many patients aren’t taken seriously, given the proper tests or treated in a timely way.

Honouring our incredible staff: Congratulations to this year’s MAP Award Winners

On Dec. 14, MAP Centre for Urban Health Solutions announced the 2021 winners of the first annual MAP Awards: Jemal Demeke, Genevieve Blais, and Pearl Buhariwala. The MAP Awards recognize three outstanding MAP staff, students or volunteers who have excelled in their roles and demonstrate a passion and commitment to applying MAP’s values in their work.

Jemal Demeke

Jemal Demeke, Clinical Research Coordinator on Dr. Darrell Tan’s team, is the winner of the MAP Values in Practice (MVP) Award, an award to recognize an individual who exemplifies and advocates for MAP values in their work and interactions. Members of Jemal’s team note that, “Jemal is fiercely dedicated to making meaningful and much needed change within their program and the organization to ensure systemic barriers are dismantled. They continuously demonstrates the upmost courage in vocalizing inequities in many practices… While many are willing to raise concerns, Jemal often stands out as often being first to raise their hand and asks “what can I do to help make this happen?” and to follow through.”

Genevieve Blais, who is First Nations from Oneida Nation of the Thames, and a Research Coordinator at the Well Living House, is the winner of the Community Partnership Award, awarded to an individual who consistently models exemplary community partnership practices and integration of the perspectives of community and people with lived expertise into their research. Her colleagues note that “Gen is incredibly kind, thoughtful, and committed—every project she supports benefitting from her involvement. Her ability to establish trusting relationships quickly and effectively with organizations, Indigenous knowledge keepers and community research partners is consistently demonstrated. Gen brings an understanding of community data governance systems which informs her way of working and interacting that uphold the role of Indigenous community partners.”

Pearl Buhariwala

Pearl Buhariwala, Research Coordinator on Dr. Pat O’Campo’s team, is the winner of the Peer Mentor Award, an award to honour an individual who works hard to help colleagues learn, feel valued, and do well at work. Pearl’s colleagues shared several anecdotes about how she practices these values in her work. “Pearl has thrived at MAP in part because her own values align so well with those of MAP—equity, social justice, anti-racism, and equitable engagement with community. Pearl works with many different stakeholders, bringing them up to speed on a variety of projects and research methods and always does so with grace and respect, ensuring to build on each person’s unique strengths.”

Congratulations to the winners, and to all of the 2021 MAP Award nominees!

13 ways to make Canada’s COVID-19 recovery more equitable

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From the Toronto Star article

They’re making a list and checking it twice. A team of health researchers have put together a short list that would put Canada on the path to a more equitable pandemic recovery.

Written by 11 researchers from St. Michael’s Hospital’s MAP Centre for Urban Health Solutions, the guidelines pull blueprints from trials, policies and other examples from Canada, the U.S. and around the world to show what is possible and effective to help people struggling to meet their basic needs.

The result is 13 clear recommendations that would help solve problems related to income, housing, intimate partner violence, children’s well-being, racism and access to health care. The recommendations were published Monday by the Canadian Medical Association Journal. Some could be put into place in a matter of weeks or months — paid sick leave, pharmacare and eviction interventions are things that already have infrastructure around them — what governments need is the will, researchers said.

“I hope that part of what this document shows is that the inequities we’re seeing today and suffering from today, are a result of choices that we’ve made,” Dr. Nav Persaud, co-author and scientist at St. Michael’s Hospital told the Star in an interview. “If we choose different policies, if we make different decisions, we could have a more equitable society, and we could have more equitable health outcomes.”

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Treize façons de rendre plus équitable la reprise en réponse à la crise de la COVID-19 au Canada

Extrait de l’article du Toronto Star :

Comme le dit la chanson, « They’re making a list and checking it twice ». Une équipe de chercheurs du domaine de la santé a dressé une liste restreinte de solutions qui mettraient le Canada sur la voie d’une reprise plus équitable en situation de pandémie.

Rédigées par 11 chercheurs du Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael, les lignes directrices s’inspirent d’essais, de politiques et d’autres exemples provenant du Canada, des États-Unis et du monde entier qui présentent des solutions possibles et efficaces dans le but d’aider les personnes qui ont du mal à satisfaire leurs besoins fondamentaux.

Il en résulte 13 recommandations claires qui permettraient de remédier aux problèmes liés aux revenus, au logement, à la violence entre conjoints, au bien-être des enfants, au racisme et à l’accès aux soins de santé. Les recommandations ont été publiées lundi par le Journal de l’Association médicale canadienne. Certaines de ces mesures pourraient être mises en place en quelques semaines ou quelques mois; les congés de maladie payés, l’assurance médicaments et les interventions en cas d’expulsion sont des mesures qui disposent déjà d’une infrastructure. Selon les chercheurs, il ne manque aux gouvernements que la volonté nécessaire pour y arriver. « Je souhaite que ce document puisse démontrer que les inégalités que nous constatons et dont nous souffrons aujourd’hui sont le résultat de choix que nous avons faits, a déclaré dans une entrevue au Star le Dr Nav Persaud, co-auteur et scientifique à l’hôpital St. Michael. Si nous choisissions des politiques et des décisions différentes, nous pourrions avoir une société plus équitable, ainsi que des résultats plus uniformes en matière de santé. »

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Canada’s Recovery from COVID-19: Policy Recommendations for a More Equitable Future

View a graphic summary of the recommendations.

TORONTO, December 13, 2021 – A task force of scientists at MAP Centre for Urban Health Solutions has published the Equity Roadmap: Recommendations for equitable COVID-19 pandemic recovery in Canada. Published in CMAJ (Canadian Medical Association Journal) Dec. 13, these recommendations look to address long-standing health inequities that were exposed and exacerbated by COVID-19, which will continue to threaten health outcomes in Canada after the pandemic.

Based on research conducted throughout the pandemic, MAP recommends governments at all levels across Canada consider the policy changes covered in this report. Implementing these proven interventions and recommendations in the areas of income, housing, intimate partner violence, childhood, access to health care, and systemic racism would help to ensure a healthier future for everyone in Canada, while putting Canada in a better spot to respond to the next pandemic. The task force is led by MAP scientist and Canada Research Chair in Health Justice Dr. Nav Persaud, and includes MAP’s leading experts on interventions to address homelessness, income-related health inequities, gender-based violence, childhood health inequities; barriers to health care; and systemic racism.

“Coordinated pandemic responses include efforts to return life to “normal” after the immediate threat, but the COVID-19 pandemic has underscored the need to address inequities rather than resume the unfair status quo,” write the authors.

As Canada begins to consider a post-COVID-19 future, there is a tremendous opportunity to address long-standing health inequities and ensure that no one in our society is left behind. The recommendations in this report look to guide those efforts, making them as efficient and effective as possible.

The authors define the pandemic recovery period as the stage when the direct harms of COVID-19 abate but their recommendations might be needed for months, years or as permanent solutions.

Read the report


This guideline is endorsed by Black Physicians of Canada, Canadian Doctors for Medicare and the Canadian Medical Association. The College of Family Physicians of Canada supports these recommendations.

About MAP

MAP Centre for Urban Health Solutions is a world-leading research centre dedicated to creating a healthier future for all.

Through big-picture research and street-level solutions, our scientists tackle complex community health issues – many at the intersection of health and equity. MAP is changing the way the world understands the health consequences of social inequality in Canada.

Together with our community and policy partners, we are charting the way to the world’s healthiest cities: places where people, communities, and the political, economic, social, environmental, and health infrastructures come together so that everyone can thrive.

MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and is fully affiliated with the University of Toronto. St. Michael’s is a site of Unity Health Toronto, which also includes Providence Healthcare and St. Joseph’s Health Centre.

Learn more at www.maphealth.ca

The pandemic encouraged virtual family doctor visits. Are they here to stay?

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From the Toronto Star article:

Family doctor and MAP scientist Dr. Tara Kiran looked at how thousands of patients in Toronto feel about virtual care. In a survey of more than 7,000 patients in the city, more than 90 per cent said they were comfortable receiving care by phone, email or video. But those who weren’t were primarily low-income, with poorer health, and came to Canada in the last 10 years.

In the findings, Kiran said health-care providers need to consider how to best incorporate virtual care in their practice to ensure equity of access.

“I don’t think that standalone virtual care can meet the standard of care,” Kiran said.

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La pandémie a favorisé les visites virtuelles chez les médecins de famille. Sont-elles là pour de bon?

Extrait de l’article du Toronto Star :

La Dre Tara Kiran, médecin de famille et scientifique spécialiste du MAP, s’est penchée sur la perception qu’ont des milliers de patients de Toronto des soins virtuels. Un sondage réalisé auprès de plus de 7 000 patients de la ville a révélé que plus de 90 % d’entre eux étaient à l’aise avec le fait de recevoir des soins par téléphone, par courriel ou par vidéo. Mais ceux qui ne l’étaient pas étaient principalement des personnes ayant de faibles revenus, en moins bonne santé et arrivées au Canada au cours des dix dernières années.

Dans ses conclusions, la Dre Kiran a déclaré que les prestataires de soins de santé doivent réfléchir à la meilleure façon d’intégrer les soins virtuels dans leur pratique afin de garantir l’équité d’accès.

« Je ne pense pas que des soins virtuels à eux seuls puissent répondre à la norme de soins », a déclaré la Dre Kiran.

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Opinion: Pharmaceutical costs are soaring due to innovative but pricey new drugs


By Mina Tadrous, Tara Gomes, and Michael Law.

In this opinion piece, Dr. Tara Gomes, scientist at the Li Ka Shing Knowledge Institute and the Ontario Drug Policy Research Network, argues for the need to manage pharmaceutical costs in Canada as innovative, but pricey drugs come to market.

We are likely entering a golden era of drug innovation, with the rise of new drug development technologies and biologics. Over the past decade, we have seen several record-breaking years in terms of the number of new therapies being developed and approved. In 2019 alone, just before the pandemic, Health Canada approved 58 new prescription drugs, many of which were the first of their kind to treat several rare diseases. The COVID-19 pandemic has also focused further attention on the value of investing in drug treatments and vaccine development.

But this progress has, of course, come at a cost. In 2020, Canada spent $32.7 billion on medications. And this amount continues to grow: year-over-year spending on drugs for the past two decades has outpaced inflation threefold, averaging more than 6 per cent growth annually. In fact, drug spending is consistently the fastest growing segment in health care.

These were the striking findings of a recently released analysis, where we looked at medication purchases across Canada over the past 20 years. We also looked ahead to the future to see what was likely to come down the pipeline. What we saw was notable: in the future, this rate of growth will almost certainly continue, if not accelerate.

On World AIDS Day, meet the advocates who are working to end HIV in Canada

CBC Radio

There are an estimated 8,000 people in Canada living with HIV, but they don’t even know it. That’s why scientists and advocates are working to end HIV in Canada by introducing more testing and better access to resources. On World AIDS Day, host Jeff Douglas spoke with Dr. Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto, and Dave Miller, the Atlantic HIV Stigma Index co-ordinator for REACH Nexus, about their efforts.

Listen to the interview here.

Exploring New Treatments on World AIDS Day

From TVO The Agenda with Steve Paikin

What’s the connection between AIDS research and the COVID-19 pandemic? We invite the following guests to give us some insight: Dr. Sharon Walmsley, director of clinical research, Immunodeficiency Clinic, Toronto Hospital, University Health Network; and Dr. Darrell Tan, infectious diseases physician, clinician-scientist and Canadian Institutes of Health Research (CIHR).

Decriminalize possession of small amounts of illegal drugs, Toronto’s top doctor recommends

From the CBC News Article:

Toronto should decriminalize the possession of small amounts of drugs as a response to the worsening opioid overdose crisis, recommends a new report from the city’s medical officer of health.

Under the Controlled Drugs and Substances Act, the federal Minister of Health can provide municipalities and provinces with an exemption from the provisions that criminalize drugs if there is a medical purpose or if it is deemed to be in the public interest.

Supervised consumption sites, where drug users consume drugs under the supervision of trained health workers, operate legally under similar exemptions.

Jeanette Bowles, a postdoctoral fellow at St. Michael’s Hospital with the Centre on Drug Policy Evaluation, said decriminalization will help reduce the stigma associated with drug use.

“Stigma can lead to shame. Shame can lead to folks using drugs alone. Using drugs alone is a very high risk factor for overdose death, as there’s no one around to intervene,” said Bowles.