Author: Emily Holton

In an announcement by the Government of Canada earlier today, Dr. Gillian Booth was awarded a prestigious Tier 1 Canada Research Chair.

An endocrinologist and internationally recognized researcher, Dr. Booth investigates and designs evidence-based solutions to address the socioeconomic, environmental and health-care factors behind Canada’s diabetes epidemic.

“I’m so grateful to have been nominated by St. Michael’s Hospital and the University of Toronto,” said Dr. Booth. “This CRC will enable me to answer questions that we haven’t been able to answer yet, about the complex relationships between our built environment, our health, and health inequities – and about how best to intervene through strategic policy change.”

Dr. Booth’s research has already revealed important links between neighbourhood characteristics (such as walkability, retail food options, socioeconomic status) and residents’ risk of obesity and diabetes. However, she says that we are just beginning to understand how these different exposures work together to influence our health.

“For example, walkability is associated with better health outcomes,” said Dr. Booth, “But our research has shown that if you live in a walkable area with a lot of traffic-related air pollution, that pollution negates a lot of those benefits. It’s not always a simple cause-and-effect equation.”

The solutions Dr. Booth’s research points to are often at the level of public policy – particularly those related to urban planning and the built environment. As part of her CRC, Dr. Booth and her team will design tools (e.g. data maps, cost/benefit predictive models) to help policy makers weigh the potential health benefits of different policy options for different contexts, and to assess how much investment is required in order to make a meaningful impact on the health of a population.

As a further catalyst, she is leading a national network to help built-environment research teams learn from each others’ experiences to help accelerate the implementation of evidence into policy.

“I’m concerned that although there’s more and more focus on healthier neighbourhood design in Canada, these interventions are likely to end up in neighbourhoods that are wealthier and healthier to begin with,” said Dr. Booth. “We need to learn more about how policy making can be more equitable and impactful. This CRC is a really exciting step in my work to help make that happen.”

MAP is now home to seven Canada Research Chairs in total:

• Dr. Gillian Booth: Canada Research Chair in Policy Solutions for Diabetes Prevention and Management
• Dr. Ann Burchell: Canada Research Chair in Sexually Transmitted Infection Prevention
• Dr. Sharmistha Mishra: Canada Research Chair in Mathematical Modeling and Program Science
• Dr. Patricia O’Campo: Canada Research Chair in Population Health Intervention Research
• Dr. Nav Persaud: Canada Research Chair in Health Justice
• Dr. Janet Smylie: Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada
• Dr. Darrell Tan: Canada Research Chair in HIV Prevention and STI Research

Learn more about Dr. Booth’s research:

COVID-19 and diabetes: Clinical Outcomes and Navigated NEtwork Care Today (CONNECT)

Solutions Network: Urban Design for Better Health

CBC NEWS

Researchers are hoping to recruit participants starting next week for a study that will look at how big a problem COVID-19 is among people experiencing homelessness in Toronto.

Dr. Stephen Hwang, director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital, will lead a research team on what is being called the COVENANT Study.

The year-long project has received $1.9 million in federal funding through the COVID-19 Immunity Task Force, a organization formed by the federal government in late April to track virus spread in Canada.

“People experiencing homelessness are at greatly increased risk of getting COVID-19. However, we don’t know what proportion of the homeless population has been exposed to COVID over the last year,” Hwang said on Wednesday.

The specialist in general internal medicine said the study aims to gather evidence that will guide public health measures across the country to curb spread of COVID-19 among unhoused people. The research team will include university and hospital experts in epidemiology and lab testing.

“It’s really important that we obtain this information so that we can intervene to control the infection and also understand the importance of potentially prioritizing this population for the vaccine when it’s available,” Hwang said.

THE GLOBE AND MAIL

After years of living in shelters and other precarious housing, Dawn Hill found permanent refuge and the mental-health support she needed after being chosen to participate in a ground-breaking study based at St. Michael’s Hospital.

Her tiny basement apartment in Toronto’s east end is a haven, a place to finally call home.

Dawn (not her real name) spent her early teenage years in group homes – which, she says, “had no patience” with her behaviour, caused in large part by undiagnosed depression and obsessive-compulsive disorder. By 16, she was on her own, working however she could to earn a living.

Her greatest sorrow was losing custody of her son and daughter 15 years ago, due to her mental-health challenges. “That was the worst thing that ever happened to me,” she says. “I lost my kids, and I lost my way.”

Recruited while she was staying at a shelter, Dawn, now 45, was chosen in 2011 to participate in At Home/Chez Soi, a large-scale randomized controlled national study to evaluate Housing First, a solution designed to end chronic homelessness among people with mental illness.

Launched and led in Toronto by St. Michael’s Hospital’s Dr. Stephen Hwang, it is one of several initiatives he has spearheaded aimed at improving the health of people who are homeless or vulnerably housed. Director of the hospital’s MAP Centre for Urban Health Solutions, Dr. Hwang is one of the world’s leading researchers in the field of homelessness, housing and health.

He joined St. Michael’s 24 years ago, as its first research scientist focused on the social determinants of health. Over the years, he says, the hospital has developed into “an international powerhouse” in the field. “It’s been a remarkable transition,” he says.

Dr. Hwang, who is also St. Michael’s Chair in Homelessness, Housing and Health, explores the intersecting health crises that affect people who lack adequate housing, particularly relevant today as COVID-19 turns a spotlight on the problems of homelessness.

UNIVERSITY OF ALBERTA

A University of Alberta clinical trial will screen 1,500 people with point-of-care dual HIV and syphilis test kits in an effort to combat the syphilis outbreak in Edmonton and northern Alberta.

Alberta Health Services declared the outbreak last year after 12 stillborn births and 1,753 newly diagnosed cases of syphilis, 68 per cent of them in the Edmonton area.

Syphilis is a highly infectious sexually transmitted infection with symptoms ranging from genital sores to vision and hearing loss, heart attack and dementia, depending on how long it is left untreated. When women acquire syphilis during pregnancy, it is almost always passed on to the baby, leading to stillbirth or developmental delays. Syphilis can be cured with penicillin.

“The advantage, if these tests work, is that you could provide treatment at the same visit if the test result was positive,” said principal investigator Ameeta Singh, clinical professor of medicine in the Faculty of Medicine & Dentistry and infectious diseases specialist at the Royal Alexandra Hospital and the Edmonton Sexually Transmitted Infections Clinic.

“That would be fantastic because we can prevent the patient from developing further complications and we can also prevent ongoing spread,” said Singh, who is also a member of the Women and Children’s Health Research Institute. “Penicillin renders syphilis non-infectious within 24 hours.”

Canadian-made tests could help prevent future outbreaks, infant deaths

Alberta has one of the highest rates of syphilis in the country, Singh said. Syphilis screening usually involves taking a blood sample and sending it to a lab, where the serum is separated using a centrifuge and then tested. It can take up to two weeks to get results.

“Syphilis affects populations who are at times hard to reach—they may be transient, have unstable housing or may have mental health or addictions issues,” Singh said. “Because of their unstable social situations, they sometimes don’t return for followup.”

The point-of-care tests in the clinical trial allow health-care staff to test for both HIV and syphilis with a simple finger prick blood test, much like the test for blood sugar. Results are returned within five minutes and treatment with penicillin can be provided immediately.

Singh said it is important to test for both syphilis and HIV at the same time because syphilis increases a person’s chances of acquiring or passing on HIV if they are exposed to both infections at the same time.

“This is exciting work that Dr. Singh is leading, ‘implementation science’ that we hope will have a life-changing impact on the health and well-being of moms and their infants,” said Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions at St. Michael’s Hospital of Unity Health Toronto, and director of the CIHR Centre for REACH in HIV/AIDS, which is the major funder of the trial along with strategic funding from the Canadian Foundation for AIDS Research (CANFAR).

A major aim for REACH is to bring new testing technologies, including self-testing, point-of-care and multiplex testing, to market in Canada to reach those undiagnosed with HIV, HCV and other STIs (including syphilis). It is also building teams with community stakeholders and affected key populations to ensure that the testing innovations are implemented in the right way to reach those who need them the most, and in ways that provide cultural safety and support.

Rourke recently generated the evidence required by Health Canada to approve the first HIV self-test kits in the country. His collaboration with Singh at the U of A and Alberta Health Services is part of a joint effort to get more tests licensed in Canada. Both test kits that are being evaluated are made by Canadian manufacturers and have been licensed for use in other countries but are not yet approved for use in Canada. As part of this partnership, the companies have committed to apply for Health Canada licensing of their medical devices if the U of A study results are positive.

During the trial, individuals at risk for syphilis and HIV—such as gay and bisexual men, people from Indigenous communities experiencing a resurgence of syphilis, and those experiencing homelessness, mental health issues or addictions—will undergo testing at homeless shelters, the Edmonton Remand Centre, the emergency departments of the Royal Alexandra Hospital and Northeast Community Health Centre, and other community clinics.

All of the participants will also get the standard laboratory test to confirm the accuracy of the trial test kits. Singh said she is hoping to see 90 per cent accuracy.

She noted that while every pregnant woman in Alberta is supposed to be tested for syphilis, often vulnerable women don’t access prenatal care until the time of delivery, when it is too late to avoid transmission to the infant.

“What we are hoping with this project is that if we can reach women in field settings and offer testing in the field, we might eventually be able to reach and treat more women who are infected, thus preventing or reducing the harmful effects of syphilis on both the mother and her unborn child,” she said.

Singh expects the study to take up to 18 months to complete. The project is also supported by Alberta Health Services and Indigenous Services Canada.

THE HAMILTON SPECTATOR

Dr. Annalise Trudell has witnessed the pandemic deepen fault lines across society. As a gender-based violence (GBV) researcher and manager of education, training and research at ANOVA — London, Ontario’s women shelter and sexual assault service provider — Trudell, has seen first-hand the unique challenges and complications brought on by COVID-19.

“From the starting line, we were behind,” she says. “As a GBV sector, we seem dispensable. When there are cuts to be made, we seem to be first up.”

Trudell — who works closely with shelters and rape crisis centres across Ontario — sees how GBV hasn’t kept pace with better-resourced front-line sectors. With the arrival of COVID-19, this reality left the GBV workforce in a precarious situation. “When the pandemic hit, the system just broke open,” she says.

…Dr. Ahmed Bayoumi, physician and scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, is… conducting research to better understand community responses to the pandemic, across a variety of marginalized populations.

“Our society is not structured in such a way that everyone who needs resources gets access to those resources,” he says. “Health inequities have been highly prevalent for a very long time. And what this pandemic has done is exacerbated them and made them more obvious. It has shown we weren’t well prepared to deal with many of these.”

Using a collaborative, mixed-methods, community-engaged model, Bayoumi and his research team have been working with community organizations serving marginalized groups to determine what is working well during COVID, what can be improved upon, and what can be implemented elsewhere.

One of the projects Bayoumi is evaluating focuses on violence against women. Through engagement of those with lived experience, the study seeks to understand how some Toronto-based GBV organizations have adapted to the pandemic, how contextual factors have influenced processes, and how service adaptations have affected both staff and survivors.

He believes this type of evaluative research will produce positive solutions for those experiencing the greatest need, and quickly. “I’m always hopeful,” he says. “Working with communities committed to change is always invigorating. We are putting forth a tremendous amount of energy and effort to make a change.”

VIDEO: Projections show if we don’t do more to flatten the curve now, we could experience upwards of 60,000 new COVID-19 cases a day in Canada. Flattening the curve in hotspots involves understanding who in those neighbourhoods are most affected by COVID-19, says Dr. Farah Mawani, an epidemiologist at MAP Centre for Urban Health Solutions at St. Michael’s Hospital. Dr. Mawani adds the data shows that low-income people and racialized people are most affected by COVID-19 in the GTA, and many of them are in work situations that prevent them from protecting their safety. Resourcing the public health system to ensure we have capacity for testing, contact tracing, supports for people to isolate as necessary and supports such as paid sick days are key measures that would help protect people most affected by COVID-19, says Dr. Mawani.

Watch this interview

When Calvin Little died, no one noticed for a while.

For the last two years of his life, the 63-year-old Torontonian lived in a nondescript east-end apartment — alone, save for a rotating cast of animals he would watch for periods of time.

Little had lived inside the building since August 2018: a place for him to land after a decade of episodic homelessness.

He was funny, friendly and charming, those who knew him said. But he kept his past close to his chest. Sometimes, he’d disappear for a day or two, or venture out to panhandle in the Beaches. When he died, he died in his apartment, quietly and alone.

…Cancer and cardiovascular disease are the most common causes of death among older people who have been homeless, said Dr. Stephen Hwang, director of St. Michael’s MAP Centre for Urban Health Solutions, who described stark inequalities.

“The life expectancy of someone who is homeless is comparable to someone living back in the Great Depression, before we had antibiotics or pretty much any of the effective medical treatments that we have today,” he said.

From the Toronto Star article:

…Dr. Farah Mawani, a social and psychiatric epidemiologist, said that’s the sort of systemic racism that has put racialized people — and particularly new immigrants — at greater risk during this pandemic.

“We know that there’s a very high portion of racialized immigrants who are highly trained and skilled, but very underemployed. So they’re forced to work in manufacturing because they can’t get other jobs,” she said.“

She said the issue is even worse for temporary foreign workers, whose migration status is tied to their employment at a certain company.

If they complain about poor working conditions, Mawani said, they risk losing not only their income but their place in Canada.