On March 23, 2023, MAP hosted the second Solutions for Healthy Cities Symposium at the beautiful Symes in Toronto. Almost 200 researchers, service providers, policymakers, students and community experts gathered to explore and discuss this year’s theme: the science and practice of implementation success.
About the 2023 Symposium
A healthier, more equitable future depends on policy and service innovation – doing things differently – across sectors. However, even the most promising new approaches can, and often do, fail to create their intended impacts. How can we beat the odds and give equity interventions the best shot at implementation success?
Participants joined us to gain the knowledge, skills and tools needed to be more successful in advancing, improving and scaling up complex interventions; use proven strategies and tools from the field of implementation science to avoid and overcome common implementation roadblocks; and be more effective in fostering and benefiting from crucial partnerships with scientific, service provider, and community partners.
2023 Keynote: Dr. Ibram X. Kendi
Dr. Ibram X. Kendi joined the event virtually, in conversation with MAP Director Dr. Stephen Hwang and followed by a Q&A with the audience. The thoughtful and moving discussion explored how racist ideas and assumptions can shape policies, research questions, and health care experiences. Dr. Kendi emphasized the importance of antiracist interventions that address the social determinants of health.
Presentations were focused on implementation: turning strong evidence into successful policies, programs and services. Step by step, each learning session walked participants through a stage of the Active Implementation Framework, illustrated by presenters’ real-life experiences, challenges and lessons learned. All sessions included a special focus on equity and partnerships in the context of implementation – elements that are challenging to get right and are crucial to an intervention’s success.
Presenters
Dr. Patricia O’Campo, Tier 1 Canada Research Chair in Population Health Intervention Research
Cathy Watts, Co-Founder, Peer2Peer Consultants
Karen McDonald, Research Manager, Centre on Drug Policy Evaluation
Matt Johnson, Health Promoter, Safe Consumption Services, Parkdale Queen West Community Health Centre
Dr. Sean B. Rourke, Director, CIHR Centre for REACH in HIV/AIDS
Dr. Stephen Hwang, Director, MAP Centre for Urban Health Solutions, Unity Health Toronto
Kathryn Gibb, Program Manager for Supportive Housing, SHIP (Services and Housing In the Province)
Dr. Stefan Baral, Director, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health
In Participants’ Words
“All of the speakers were amazing! Great blend of disciplines and topics.”
“The program progression and accompanying guide were really helpful, no matter what stage, focus or level of expertise.”
“There was such a diversity of people in attendance – excellent to meet people in all types of work.”
“I loved the thoughtful planning to connect the different projects. Really excellent and seamless event!”
“A highlight was the opportunity to ask questions of Ibram X. Kendi – fantastic!”
“I appreciated the breaks, food, and care for us so that we could be fully present to learn.”
“The affordability was amazing and really opened doors for access.”
“I loved that all the presentations were focused on equity-seeking projects.”
Thank You
This symposium was made possible thanks to Even the Odds (a partnership of MAP and Staples Canada), the St. Michael’s Foundation, and the generous contributions of our visionary donors.
Annual fundraising campaign runs until May 7; all fundraising efforts raised more than $2.1 million in 2022
RICHMOND HILL, ON, April 17, 2023 – What would a future that’s fair for everyone look like? Staples Canada and leading research centre MAP have once again partnered to Even the Odds, raising awareness of inequity in Canada and funding the development of program and policy solutions via in-store and online donations.
“One of Staples Canada’s core beliefs is that everyone should be given the opportunity to thrive,” said Wanda Walkden, Chief Human Resources and Communications Officer, Staples Canada. “With this in mind, we’re so proud of our partnership with MAP. We have made great strides since Even the Odds launched in 2021, and we are ready to continue building this momentum to drive positive change and make a true impact within our communities.”
Since its launch in 2021, the Even the Odds campaign has raised more than $3.3-million – surpassing its campaign goals in 2021 and 2022 thanks to the support of Staples’ customers, associates, and vendor-partners as well as corporate match donations.
In Canada, income, education, and experiences of discrimination strongly affect our odds of staying healthy. That’s because social and economic status determine how easy it is to access the resources that are essential for good health. Even the Odds will continue making an impact by funding research and solutions throughout Canada, focusing on four core projects in 2023:
Expanding Our Healthbox to three additional provinces: In early 2023, Our Healthbox launched “smart” vending machines in several Eastern Canadian communities, dispensing free HIV self-tests, naloxone kits, COVID-19 rapid tests and other health supplies on demand. Even the Odds will support an additional expansion throughout 2023 to three additional provinces.
Continued investment in Clinique Mauve: In 2022, Université de Montréal and the Centre de Recherche en Santé Publique partnered with Staples Canada and MAP to launch a research project for Clinic Mauve, a specialized clinic in Quebec designed to meet the needs of racialized and migrant communities who are LGBTQI+.
Expanding APPLE Schools, an award-winning health promotion project: In 2022, Even the Odds brought a tailored version of APPLE Schools to kids in underserved school communities across Alberta. In 2023, Even the Odds will expand the program to schools in Ontario.
Launching an innovative outreach program for homeless hospital patients in British Columbia: The Navigator Program helps patients who are homeless to stay well after a hospitalization, by connecting them with health care and social services in the community.
“The growth and progress Even the Odds has seen over the past two years has made an incredible difference in the impact we’re making in communities across Canada,” said Dr. Stephen Hwang, Director, MAP. “We’ve set big goals for the year ahead and are very proud to continue doing this meaningful work with Staples.”
Staples customers can donate Even the Odds at any one of Staples Canada’s 300+ stores or online at Staples.ca/EvenTheOdds.
About MAP
MAP is a world-leading research centre dedicated to creating a healthier future for all. Through big-picture research and street-level solutions, MAP scientists tackle complex community health issues—many at the intersection of health and equity. MAP’s 34 scientists and over 130 staff and students work in partnership with communities, researchers, and government leaders across Canada to address issues such as homelessness, unequal access to health care and medicine, and the lifelong effects of childhood poverty. MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto. For more information, visit maphealth.ca.
About Staples Canada
Staples Canada is The Working and Learning Company. The privately-owned company is committed to being a dynamic, inspiring partner to customers who visit its 300+ locations and staples.ca. The company has two brands which support business customers: Staples Preferred for small businesses and entrepreneurs, and Staples Professional for medium to large-sized enterprises, as well as seven Staples Studio co-working facilities across Canada. Through Solutionshop, Canadians can access a variety of pack and ship options, as well as a broad suite of business services. Staples is a proud partner of MAP through its Even the Odds campaign, which aims to tackle inequities in communities across Canada and helps make a future that’s fair for everyone. Visit staples.ca for more information or engage with us at @StaplesCanada on Facebook, Twitter, Instagram, LinkedIn, TikTok or Pinterest.
We are excited to announce that the next Solutions for Healthy Cities Symposium will be in Toronto on March 23, 2023! Join us for a full day of talks, discussion and Q&As with MAP scientists and exciting guest speakers. Connect with others who are working to implement new programs and practices in their communities, and learn from leaders in implementing equity-focused interventions.
Keynote: Dr. Ibram X. Kendi, the founding director of the BU Center for Antiracist Research and author of How to Be an Antiracist
Date: March 23, 2023, 9:30-5pm
Venue: The Symes, 150 Symes Rd, Toronto, ON
Cost: $35.00 ($39.55 incl. HST). Fee includes breakfast, lunch and reception. If this fee is cost prohibitive, please contact alex@sparkinc.net.
Program led by St. Michael’s Hospital to dispense free HIV self-testing kits, harm reduction, sexual health supplies
The east coast launch of Our Healthbox is funded by Even the Odds, a partnership between Staples Canada and MAP.
TORONTO – Machines that dispense free self-testing kits for HIV and COVID-19, naloxone kits, new needles, condoms and other essential harm reduction and sexual health supplies will soon appear in communities across Canada.
The ‘smart’ machines, called Our Healthbox, work like a vending machine, and also provide health information and a service directory for people to find much-needed health care and supports in their community. The initiative, led by researchers at St. Michael’s Hospital, a site of Unity Health Toronto, will launch in four communities in New Brunswick on Jan. 23, with plans to launch up to 50 machines across Canada in 2023. The goal is to install 100 machines over the next three years, and to evaluate how well they support people with their health needs.
The initiative launches as new HIV cases in Canada rise and the country’s opioid crisis claims the lives of 20 Canadians each day. Providing access to harm reduction and health care supplies for free to people in spaces they frequent is a strategy experts consider as key to reaching people who are underserved and who have barriers to accessing testing, harm reduction materials, treatment, care and prevention due to racism, homophobia, stigma and discrimination.
“Everyone in Canada deserves to have what they need, when they need it, to take care of their health. But we know that this is not the case, and so we are doing everything we can to bridge that gap in ways that work for each person in their community,” said Dr. Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions, a world-leading research centre housed at St. Michael’s Hospital, and the Director of REACH Nexus, a national research group working on how to address access and treatment for HIV, Hepatitis C and other sexually transmitted and blood-borne infections.
Our Healthbox is the latest phase of work led by Rourke to connect those with complex health and social circumstances to testing, treatment and prevention. In 2019, Rourke spearheaded a cross-Canada clinical trial which evaluated and proved the accuracy of HIV-self tests – Health Canada approved the tests for use in November 2020 based on the results of the trial. In June 2022, Rourke launched the I’m Ready research program, distributing 10,000 free HIV self-testing kits across Canada to reach people who are undiagnosed and get them connected to care, with the goal of identifying the factors that affect access to testing and care.
Rourke and his team will work with local community-based organizations, public health authorities, and health centres to host and maintain Our Healthbox program. Each agency determines the supplies needed in the machines to serve the people in their community. The east coast launch of Our Healthbox is funded by Even the Odds, a partnership between Staples Canada and MAP Centre for Urban Health Solutions.
“Our Healthbox will ensure underserved individuals in the community have low barrier access to resources that not only reduce their risk of infections, but in fact save their lives,” said Deborah R. Warren, Executive Director at ENSEMBLE, a community-based organization in Moncton, N.B. that works to address complex social issues by providing support, education and prevention initiatives. “We are currently in the midst of a substance use crisis that sees the death of one New Brunswicker every four days. Providing access to free naloxone will save many lives.”
Our Healthbox is funded by the Canadian Institutes of Health Research (CIHR), the Public Health Agency of Canada, the Canadian Foundation for AIDS Research (CANFAR), the St. Michael’s Hospital Foundation, and Even The Odds (Staples Canada and MAP).
About MAP Centre for Urban Health Solutions
MAP is a world-leading research centre dedicated to creating a healthier future for all. Through big-picture research and street-level solutions, MAP scientists tackle complex community health issues—many at the intersection of health and equity. MAP works in partnership with communities, researchers, and government leaders across Canada to address issues such as homelessness, unequal access to health care and medicine, and the lifelong effects of childhood poverty. MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto. For more information, visit maphealth.ca.
About Unity Health Toronto
Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit unityhealth.to.
About Even the Odds
Staples Canada and MAP have come together to create Even the Odds: an initiative to raise awareness of inequity in Canada and to help build vibrant, healthy communities. The partnership is based on the shared belief that everyone should have the opportunity to thrive. Even the Odds will support MAP’s research and programs across Canada. It is a bold commitment to make a difference in Canada’s unique and diverse communities through corporate donations, fundraising and awareness. For more information, visit staples.ca/eventheodds
Des distributeurs automatiques de fournitures de réduction des méfaits et des risques seront installés partout au Canada
Un programme dirigé par l’Hôpital St Michael destiné à distribuer gratuitement des trousses d’autodépistage du VIH, ainsi que des fournitures de réduction des méfaits et des risques et de santé sexuelle.
Le lancement de Notre Boîtesanté sur la côte Est est financé par À chance égale, un partenariat entre Bureau en Gros et du Centre MAP.
TORONTO – Des machines distribuant gratuitement des trousses d’autodépistage du VIH et de la COVID-19, des trousses de naloxone, des nouvelles aiguilles, des condoms et d’autres articles essentiels à la réduction des méfaits et des risques et à la santé sexuelle feront bientôt leur apparition dans les communautés à travers tout le Canada.
Ces machines « intelligentes », appelées Notre Boîtesanté, fonctionnent comme des distributeurs automatiques. Elles fournissent également des informations en matière de santé et un répertoire de services qui permet aux individus d’obtenir, dans leur communauté, d’indispensables soins de santé et services de soutien. L’initiative, dirigée par des chercheurs de l’Hôpital St Michael, un établissement d’Unity Health Toronto, sera inaugurée le 23 janvier au sein de quatre communautés du Nouveau-Brunswick, et il est prévu d’installer jusqu’à 50 machines à travers le Canada en 2023. L’objectif est d’installer 100 distributeurs au cours des trois prochaines années et d’évaluer dans quelle mesure ils apportent une réponse adaptée aux besoins des individus en matière de santé.
Cette initiative est lancée alors que le nombre de nouveaux cas de VIH au Canada est en augmentation et que la crise des opioïdes coûte la vie à 20 Canadiens chaque jour. Fournir aux personnes un accès gratuit à des fournitures de réduction des méfaits et des risques et à des soins de santé au cœur des espaces qu’elles fréquentent est une stratégie que les experts considèrent comme essentielle pour rejoindre les personnes habituellement mal desservies ou qui se heurtent à des obstacles pour accéder au dépistage, au matériel de réduction des méfaits et des risques, aux traitements, aux soins et à la prévention. Ces barrières à l’accès peuvent survenir en raison du racisme, de l’homophobie, de la stigmatisation ou de la discrimination.
« Pour prendre soin de sa santé, tout le monde au Canada mérite d’avoir accès à ce dont il a besoin, quand il en a besoin. Mais nous savons que ce n’est pas le cas, alors nous faisons tout ce que nous pouvons pour combler ce fossé avec des moyens qui fonctionnent pour chaque individu au sein de sa communauté », a déclaré le Docteur Sean B. Rourke, chercheur au sein du MAP Centre for Urban Health Solutions, un centre de recherche de calibre mondial situé à l’Hôpital St Michael, et directeur de REACH Nexus : un groupe de recherche national travaillant sur la façon de gérer au mieux l’accès aux soins et aux traitements pour le VIH, l’hépatite C et d’autres infections transmissibles sexuellement et par le sang.
Notre Boîtesanté est le plus récent développement du travail mené par le Docteur Rourke afin de connecter les personnes confrontées à des circonstances sanitaires et sociales complexes au dépistage, aux traitements et à la prévention. En 2019, le Docteur Rourke a dirigé un essai clinique pancanadien qui a évalué et prouvé la fiabilité des tests d’autodépistage du VIH – Santé Canada a approuvé l’utilisation de ces tests en novembre 2020 sur la base des résultats de l’essai. En juin 2022, le Docteur Rourke a lancé le programme de recherche I’m Ready/J’AGIS, visant à distribuer gratuitement 10 000 trousses d’autodépistage du VIH partout au Canada pour rejoindre les personnes non encore diagnostiquées et les arrimer aux soins. Ce programme a permis de déterminer les facteurs qui influencent l’accès au dépistage et aux soins.
Le Docteur Rourke et son équipe visent à travailler avec des organismes communautaires locaux, des autorités de santé publique et des centres de santé afin de mettre en place et faire fonctionner le programme Notre Boîtesanté. Chaque organisme déterminera les articles qu’il faudra mettre dans les machines pour répondre au mieux aux besoins des personnes de sa communauté. Le lancement de Notre Boîtesanté sur la côte Est est financé par À chance égale, un partenariat entre Bureau en Gros et le MAP Centre for Urban Health Solutions.
« Notre Boîtesanté permettra à des personnes mal desservies de la communauté d’avoir un accès à faible barrière à des ressources qui non seulement réduisent leurs risques d’infections, mais qui peuvent carrément leur sauver la vie », a déclaré Deborah R. Warren, directrice générale d’ENSEMBLE, un organisme communautaire de Moncton, au Nouveau-Brunswick, qui s’efforce de résoudre des problèmes sociaux complexes en offrant des services de soutien, d’éducation et de prévention. « Nous sommes actuellement au beau milieu d’une crise de toxicomanie qui entraîne la mort d’un Néo-Brunswickois tous les quatre jours. L’accès gratuit à la naloxone sauvera de nombreuses vies ».
Notre Boitesanté est financée par les Instituts de recherche en santé du Canada (IRSC), l’Agence de la santé publique du Canada, la Fondation canadienne de recherche sur le sida (CANFAR) et la Fondation de l’Hôpital St Michael, et À chance égale (Bureau en Gros et MAP).
À propos du Centre MAP
Ce centre de recherche de premier plan à l’échelle mondiale se consacre à la création d’un avenir plus sain pour tous. Grâce à des recherches qui donnent une vision d’ensemble et à des solutions concrètes, les scientifiques du Centre MAP s’attaquent à des problèmes de santé communautaire complexes, dont bon nombre se situent au croisement de la santé et des inégalités. Le Centre MAP travaillent en partenariat avec des communautés, chercheurs et dirigeants gouvernementaux partout au Canada pour s’attaquer à des problèmes tels que l’itinérance, l’accès inégal aux soins de santé et à la médecine, et les effets à vie de la pauvreté chez les enfants. Le Centre MAP fait partie du Li Ka Shing Knowledge Institute de l’hôpital St. Michael’s d’Unity Health Toronto. Pour obtenir plus de renseignements, consultez le site maphealth.ca/fr.
À propos de Unity Health Toronto
Le groupement Unity Health Toronto est composé du Providence Healthcare, du Centre de santé St Joseph et de l’Hôpital St Michael. Il s’efforce de faire progresser la santé de chacun dans nos communautés urbaines et au-delà. Notre réseau de santé dessert les patients, les résidents et les clients pour l’ensemble de la gamme des soins, notamment les soins primaires, les soins communautaires secondaires, les services de soins tertiaires et quaternaires pour la phase postaiguë, par la réadaptation, les soins palliatifs et les soins de longue durée, tout en investissant dans la recherche et l’éducation qui sont toutes deux de classe mondiale. Pour de plus amples renseignements, visitez unityhealth.to.
À propos de À chance égale
Staples/Bureau en Gros et MAP ont uni leurs forces pour créer « À chance égale », une initiative visant à sensibiliser le public aux inégalités qui subsistent au Canada et à bâtir des collectivités dynamiques et saines. Le partenariat est fondé sur la conviction partagée que chacun devrait avoir la possibilité de s’épanouir. À chance égale soutiendra la recherche et les programmes du MAP partout au Canada. Il s’agit d’un engagement audacieux à faire une différence dans les collectivités uniques et diversifiées du Canada au moyen de dons d’entreprises, de collectes de fonds et de sensibilisation. Pour de plus amples renseignements, visitez bureauengros.com/achanceegale.
In 2022 our team of scientists, investigators and affiliate scientists grew to more than 40, and our MAP research staff now total approximately 130. We brought on two new community scholars, and delivered the second year of our successful BIPOC student program.
Progress on the research front has been exceptional. Our scientists are truly exemplars of MAP’s research pillars of world-leading science and innovation; street-level scalable solutions; and long-term community and policy partnerships.
We are also extremely proud of our national initiative to raise awareness and funds through MAP’s Even the Odds partnership with Staples Canada. Funds raised support MAP’s work in three areas: access to care, ending chronic homelessness, and a healthy start for kids.
I am humbled to lead this amazing enterprise and very grateful for your interest and support. I look forward to what we will achieve in 2023!
Dr. Stephen Hwang Director, MAP Centre for Urban Health Solutions Chair, Homelessness, Housing and Health, St. Michael’s Hospital, Unity Health Toronto
2022 Research Highlights
Dr. Nav Persaud led a task force of MAP scientists to launch the Equity Roadmap report, a set of thirteen recommendations for governments at all levels across Canada. The recommendations outline the interventions/policy changes most likely to address COVID-19-related inequities during Canada’s pandemic recovery period. MAP launched an accompanying podcast series.
Dr. Sharmistha Mishra and Dr. Darrell Tan were among the first to sound the alarm re: the equity implications of mpox public health responses and related stigma, and the importance of global vaccine equity. They worked quickly to launch and complete a mpox vaccine modelling study that provided a roadmap for vaccination.
Dr. Katerina Maximova, the Murphy Family Foundation Chair in Early Life Interventions, led the scale-up of APPLE Schools – A Project Promoting Healthy Living for Everyone in Schools – an internationally recognized “best practice” for school-based interventions for healthy eating, physical activity and mental health in children from socioeconomically disadvantaged communities. Dr. Maximova is bringing a tailored version of the program to 10 new elementary schools in western Canada, with more planned in Ontario.
Dr. Tara Kiran launched and completed the first phase of OurCare, an ambitious national survey and public consultation platform to capture new perspectives and possibilities for primary care in Canada. The detailed survey garnered >9,000 responses nationally as well as outstanding media coverage.
Dr. Stephen Hwang’s St. Michael’s Hospital Navigator Project expanded to a new site: St. Joseph’s Health Centre in Toronto. The innovative program pairs patients who are homeless with an outreach worker, to help prevent readmission to hospital and ensure a better recovery. The program served approximately 90 unhoused patients in 2022, and was highlighted by the Globe and Mail as a creative, “outside the box” solution to improve access to care.
Dr. Sean Rourke was awarded two large, five-year Public Health Agency of Canada grants for I’m Ready, Our HealthBox and his Positive Effect project to end HIV stigma. I’m Ready also reached a major milestone of >10,000 HIV self-tests distributed across Canada. Dr. Rourke’s new project, I Am, also launched an exciting partnership with Starbucks Canada.
Dr. Dan Werb’s drug-checking service in Toronto has now checked over 7,000 samples of drugs since it launched in Oct. 2019, the majority (50 per cent) of which is fentanyl. Werb’s recent research indicates that more of these kinds of drug-checking services are urgently needed.
Dr. Naomi Thulien premiered Searching for Home, a companion documentary to her Transitioning Youth Out of Homelessness study. The short documentary follows the lives of three young people who are transitioning out of homelessness, and highlights the potential of portable rent subsidies as a novel and promising intervention to help end homelessness.
Want more research updates?
Subscribe to MAP’s Junction e-newsletter for short, monthly updates on our studies, our solutions, and the issues we study. You can also follow MAP on Twitter and LinkedIn, and subscribe to our MAPmaking podcast. MAP scientist were quoted in more than 130 media articles in 2022 – check out the coverage here.
Mise à jour du directeur : bilan de l’année 2022 du MAP
Alors que l’année 2022 touche à sa fin, je suis ravi de vous présenter une mise à jour de l’activité et des progrès du MAP au cours de l’année écoulée.
L’année a été extrêmement productive, avec quelques réussites et étapes importantes à célébrer! Nous avons grandi en tant que centre, avons travaillé aux côtés de nos partenaires communautaires pour faire progresser de nombreuses innovations et solutions passionnantes, et nous avons consolidé nos partenariats et nos impacts politiques.
En 2022, notre équipe de chercheurs, d’enquêteurs et de scientifiques affiliés est passée à plus de 40, et notre personnel de recherche du MAP compte désormais environ 130 personnes. Nous avons engagé deux nouveaux boursiers et nous avons assuré la deuxième année de notre programme d’étudiants PANDC.
Les progrès réalisés dans le domaine de la recherche ont été exceptionnels. Nos scientifiques du MAP sont de véritables exemples des fondements de la recherche de la science et de l’innovation de pointe dans le monde, des solutions évolutives sur le terrain et des partenariats communautaires et politiques à long terme.
Nous sommes également extrêmement fiers de notre initiative nationale de sensibilisation et de collecte de fonds par l’intermédiaire du partenariat À chance égale du MAP avec Bureau en Gros. Les fonds recueillis soutiennent le travail du MAP dans trois domaines : l’accès aux soins, la fin du sans-abrisme chronique et un départ sain pour les enfants.
C’est avec humilité que je dirige cette entreprise extraordinaire et je vous suis très reconnaissant de votre intérêt et de votre soutien. Je me réjouis déjà de ce que nous réaliserons en 2023!
Dr Stephen Hwang Directeur, MAP Président, Homelessness, Housing and Health, hôpital St. Michael’s, Unity Health Toronto
July 29 2022 – At the 24th International AIDS Conference, the world’s largest conference on HIV and AIDS, MAP scientist Dr. Sean Rourke has unveiled a tool that not only eliminates barriers to HIV testing, but connects people to care.
Minister of Health Jean-Yves Duclos stopped by to learn how the new Our Healthbox HIV self-testing kit vending machine functions and how it will help increase access to health care and reduce stigma.
Our Healthbox is “smart”, interactive dispensing machine that provides free, 24/7 access to self-testing kits for HIV as well as COVID-19, naloxone kits, and other essential harm reduction, sexual health and hygiene supplies. The machine also provides health information and a support services directory for people to find the health care they need—in their community.
Dr. Rourke’s REACH Nexus group is planning to launch 25-30 machines nationally this year, with a goal of 100 machines deployed over the next three years. The machines will be hosted and maintained in partnership with local community-based organizations, public health authorities, and health centres across the country.
In Canada, one out of 10 people who have HIV don’t know it. To reach the undiagnosed, Dr. Rourke’s REACH Nexus group launched the I’m Ready program one year ago, an app that enables free, easy access to HIV self-testing kits and support. Since then, the program distributed more than 10,000 self-tests across Canada. However not everyone has a phone, so Our Healthbox was designed to close that gap and meet people where they are.
Our Healthbox and I’m Ready are also health research programs. To access the resources, participants must register and answer a few questions about themselves. The information that is collected remains private and confidential and will help the REACH research team evaluate how well the programs are working.
If you are a community organization and want to place Our Healthbox in your neighbourhood, email ourhealthbox@unityhealth.to.
By Sean Rourke, Trevor Stratton, Notisha Massaquoi And Bill Flanagan
Today in Montreal, Canada’s political leaders are participating the AIDS 2022 conference, bringing the world together to accelerate the fight to end HIV and AIDS globally. Unless their words can be translated into political will and action, we will be no further ahead in ending HIV in Canada.
The number of new HIV cases in Canada has been on the rise over the past five years, and in 2020 (our most recent national estimates of HIV surveillance), four people were infected with HIV every day. However, this is likely an underestimate – we expect to see a higher rate of new HIV infections in 2021 and 2022 because COVID-19 significantly restricted access to HIV testing and treatment.
It is shameful that we are still not getting testing and treatment to those who need it most.
We are among the worst of the G7 countries in making significant progress in achieving the UNAIDS 95-95-95 targets of diagnosing 95 per cent of HIV cases, getting 95 per cent of those people on life-saving treatment, and getting the virus levels of 95 per cent of that group to “undetectable” levels so they can live healthy lives. Most concerning are recent numbers from 2020 that show women are doing worse than men overall in access to testing and treatment – and Indigenous Peoples (First Nations, Métis and Inuit), racialized communities, including African, Caribbean and Black people, and people who use substances and inject drugs, are doing the worst overall.
Having HIV is no longer a death sentence, but people who are infected need to be tested and have access to treatment that will suppress the virus. Unfortunately, one out of 10 people living with HIV is undiagnosed (they have HIV but don’t know it). That’s more than 6,500 people in Canada who are not able to benefit from antiviral treatment. If they don’t get access to testing and are not properly diagnosed, they will get very sick at some point and develop AIDS. And those undiagnosed and without their virus suppressed may also unknowingly infect others.
We have all of the tools and knowledge we need to correct these shortcomings.
In November 2020, we worked to get the first HIV self-test approved in Canada, and then research programs were developed and implemented to provide low barrier access to home testing using technology platforms. But our governments have yet to take up these successful initiatives and scale them sufficiently to reach all of those who are undiagnosed across Canada.
June 1, 2022 — Throughout her nearly 29-year career in research and medicine, Dr. Janet Smylie has focused on addressing health inequities faced by Indigenous peoples in Canada. At its core, her work is about using knowledge to propel change through action.
“In the modern world, we can get away with a focus on knowing and knowledge but where I come from, as a Métis Cree woman and from an Indigenous knowledge perspective, the gap between knowing and doing doesn’t exist,” she says. “The key to reconciliation is bridging the gaps between what we know and what we do. It’s the key to life and to solving most problems.”
Now, the first Strategic Lead of Indigenous Wellness, Reconciliation and Partnerships at Unity Health, Dr. Smylie is bringing that focus into this new role. Over the next seven months, she’ll lead several projects that support Unity Health’s ongoing efforts to develop a strategy and framework for the advancement of Indigenous health and reconciliation across the network.
We sat down with Dr. Smylie, who holds a Tier 1 Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada, to learn more about her new role and the challenges Unity Health faces repairing relationships with Indigenous peoples as a Catholic health care network.
What drew you to this role?
Like many people, I was deeply impacted in June 2021 when the first unmarked graves of Indigenous children were confirmed at a residential school in Kamloops, B.C. At the time, I committed to doing three things – helping address the role of the Catholic Church in the residential school system, marking Indigenous History Month at Unity Health and throwing my hat in the ring for this role. As I get older, having worked in health care for some time, I really try to think about the future. What can I do now to make it better? This role gets at that. But most of all, I was really inspired by those children and their families.
This role was designed with the support of Unity Health’s First Nations, Inuit and Métis Community Advisory Panel (CAP) and is intended to be collaborative in nature, working with the Indigenous community in Toronto. Why are these collaborative efforts so important?
Nothing about us without us. In the Canadian Constitution, First Nations, Inuit and Métis peoples are granted the right to live in a way that builds on the continuity of their respective cultural and societal norms. There’s also a domestic and international legal requirement to involve Indigenous peoples in decisions that affect them. It’s also simply more effective to work with the Indigenous community. No one knows what Indigenous people need more than the Indigenous community.
Do you have any specific goals or priorities in your first couple of months in this role?
One of my first priorities is to build a human resources plan for the network. We’ve heard from the First Nations, Inuit and Métis Community Advisory Panel (CAP) and other community leaders that to become a preferred place for Indigenous peoples to seek care, we need to recruit a team of people who can advance transformational change. This might include an Elder, a cultural coordinator, care navigators and a clinical care lead. Indigenous people often expect that they’ll experience differential or unfair treatment when they visit a hospital. We want Unity Health to be a place where Indigenous people feel safe accessing care.
Another priority of mine is building Indigenous care pathways within our hospitals. Defined referral pathways can be really helpful as they provide comfort and build on the notion of trust relationships.
I’ll also be doing some work with the CAP to develop a renewed terms of reference and explore how we can harmonize the efforts of the CAP and Unity Health’s Council on Anti-Racism, Equity and Social Accountability (CARESA). When working with Indigenous communities, it’s important that we establish a leadership structure and governance model to provide clarity and build trust. I’m working on that too.
Many of your research projects and foundational contributions in Indigenous health have relied on data collection. For instance, you co-led Our Health Counts, a collaborative research project that brought to light missing population-based health information on First Nations adults and children in urban settings. Where did this interest in data collection come from and why is it important?
Early in my career, I was working at an Indigenous health centre in Ottawa and we were trying to set up an information system that would help us understand who was coming into the clinic for care. But over time, I started to worry more about the people who don’t come to us or who only come on occasion and then we don’t see them. I wanted a way to identify these people and assess their health needs. I also just really like math. My dad was a theoretical physicist and I’m not afraid to use math as a tool. These factors motivated me to go back to graduate school at Johns Hopkins University. Then, a colleague introduced me to a new type of sampling that works well to count the people who don’t seek care. Everyone deserves to be counted.
Other early work of mine made sure that First Nations, Inuit and Métis identity was accurately recorded on infant birth and death registrations. Infant mortality is a key indicator of the broader population health of a community. We then discovered that the Canadian census was undercounting the size of Indigenous populations in Toronto by a factor of 3 to 5. Identifying that undercount had an immediate benefit, providing a better match between the unmet needs and aspirations for wellbeing of local First Nations, Inuit and Métis communities and the funding and resources made available.
What are some of the biggest barriers to health care for Indigenous peoples in Toronto?
There are approximately 90,000 First Nations, Inuit and Métis peoples living in Toronto and about 90 per cent are living under the low income cut off. Many of these individuals are young people or single caregivers, which can make it difficult to access care. For example, if you need to take the TTC with multiple children in-hand to access care, this makes it much more difficult than if you have a car and childcare. Another barrier, perhaps the biggest one, is a lack of trust in the health care system. There’s a lot of fear among Indigenous peoples that they’ll be treated differently because they’re Indigenous. Some other common barriers are a lack of access to regular primary care providers and not knowing where to seek care. There are also challenges navigating the transportation system.
It’s been nearly two years since Joyce Echaquan, a 37-year-old mother and member of Atikamekw Nation of Manawan, died in a Joliette, Que. hospital after staff dismissed her symptoms and subjected her to racist language and behaviour. A few days later, you co-authored an opinion piece in the Globe and Mail on racism in the medical system. Have we seen any improvements in the system since then?
No. Unfortunately, slow progress with respect to tangible change is a common challenge in systems transformation work – we could ask the same question about anti-Black racism and discrimination towards members of the 2SLGBTQ+ community. We know what works but we don’t have the political will to act on our knowledge. Human beings are funny that way – it’s hard for us to change our minds or act differently.
The Catholic Church was a leader in colonization and ran most of Canada’s residential schools. Unity Health Toronto is one of Canada’s largest catholic health care networks. How does our identity and affiliation with the church change the work we have to do?
First Nations, Inuit and Métis peoples have a complicated relationship with the church because of the role that the church played as a leader in the colonization of the Americas. Every person and community has navigated that relationship in their own way and we respect those ways of navigation. Some people feel safe and happy at Unity Health, while others could be triggered or feel uncomfortable given the legacy of multi-generational harms stemming directly from the policies and actions of the church. We need to figure out how to support that range of responses so that people say “Yes, this is a Catholic hospital but they did something good for my relative.”
Pope Francis is expected to visit Canada in July to meet residential school survivors and deliver an apology on Canadian soil for the church’s role in running residential schools. What does this visit mean to Indigenous peoples?
It’ll mean many different things to different First Nations, Inuit and Métis people. For some survivors of the residential school system and their families, it’ll bring healing and relief from pain. For others, it could bring pain and anger. I think it’s an important step though. If this visit helps anybody, it should happen. Where I come from, restorative justice is important; we need to acknowledge wrongdoing. I hope that’s what this visit represents. It’s what a lot of people wanted and a step in the right direction.
Do you have any advice for those who want to learn more about Indigenous history and culture or who want to help build and repair relationships but are afraid of offending others?
One of the best things people can do is learn more about cultural safety. The San’yas Anti-Racism Indigenous Cultural Safety Training Program, which many staff at Unity Health have completed, has shown to be better than a placebo when measuring how likely Indigenous patients are to recommend someone as a health care provider. I also encourage people to find a peer and read the summary report of the Truth and Reconciliation Commission. It’s painful but we need to be witnesses. It’s also good to attend events celebrating Indigenous people, if the community is willing to share. After the event, spend some time self-reflecting on what it was like to be there. And remember that this is a learning journey.
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Pfizer released a statement showing an effective and safe vaccine in children aged 5 to 11. Pfizer will soon submit the full data package to Health Canada and If the data is considered sufficient, and no concerns are identified, the vaccine could be approved for this age group as early as Halloween.
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