Author: Samira Prasad

From the AJMC article

Built environments can shape how active an individual is, while policy decisions made decades ago impact health disparities today. To address these critical social determinants of health, experts are calling for increased cooperation between urban planners and the public health field.

In the world of real estate, location is everything, serving as a major driving force behind both rent prices and mortgage rates. But a growing body of research highlights that when it comes to health outcomes, location may also affect disease risk, and where you reside can impact how you live.

One analysis included in the review revealed that between 2001 and 2012 in Ontario, Canada, higher neighborhood walkability was associated with a stable prevalence of overweight and obesity, and decreasing diabetes incidence. By 2012, all 3 rates were significantly lower compared with less walkable areas, where levels of obesity continued to rise.²

But geographic and population density alone does not account for this association, as destinations also influence the advantages of neighborhood walkability, explained Gillian Booth, MD, MSc, of the Department of Medicine at University of Toronto in an interview with The American Journal of Managed Care^® (AJMC^®).

Booth is a scientist at the MAP Centre for Urban Health Solutions within the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and coauthor of the aforementioned studies.

Factors outside of design, density, and destinations affect neighborhood-specific health outcomes, and can even negate the benefits of living in highly walkable areas, she stressed.

Based on their research, Booth and colleagues found those living in areas with low levels of traffic-related air pollution reaped greater benefits from walkability with regard to hypertension and diabetes risk.

“But if there [were] really high concentrations of air pollution, the benefit of walkability was completely eliminated, because air pollution itself is a risk factor for diabetes,” she said. “It’s not enough to just build [environments] right.”

Apart from pollution, additional influences can sway the extent to which individuals take advantage of walkability and the neighborhood’s capacity to enact environment-level improvements. Safety, sidewalk conditions, crime rate, and transportation options all function to encourage or dissuade walking, regardless of a space’s design.

“We always have to think about where people live and the neighborhood environment as a whole, and what makes the neighborhood healthy and what doesn’t,” Booth said. “There’s a lot of interest now into, not only how do we make healthier designs, but about how do we make more equitable decisions in terms of where to invest.”

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Op-ed in the Toronto Star by Dr. Nav Persaud

Pharmacare announcements have not made people healthier before. The confidence-and-supply agreement between the Liberals and NDP promises only a plan for pharmacare by 2025. So we will hear more announcements about pharmacare, but will medicines ever be included in our publicly funded health system?

Money is the reason dental care was promised but pharmacare was not. Pharmacare will save billions of dollars by reducing the price for each pill. The current patchwork system ratchets up drug prices as private insurance companies, which provide employer-based plans enjoyed by around 60 per cent of Canadians, take a percentage of each claim. So high drug prices are incentivized in Canada where medicines are less expensive in countries such as New Zealand, Australia and the United Kingdom.

Lower prices were supposed to arrive in Canada. Five years ago the Trudeau government promised to tackle high prices for patented drugs by using prices in countries like New Zealand to set price ceilings. Implementing this change was supposed to be a step toward pharmacare. Five years ago then-Health Minister Dr. Jane Philpott said “Canadians are going to see that we are going to be able to save [them] in the order of billions of dollars per year.”

L’annonce du programme d’assurance médicaments ne garantit pas une baisse des prix

Article d’opinion du Dr Nav Persaud dans le Toronto Star

Les annonces faites au sujet de l’assurance médicaments n’ont jamais amélioré la santé de la population. L’accord de confiance entre les libéraux et le NPD ne prévoit qu’un plan pour l’assurance médicaments d’ici 2025. Nous continuerons de recevoir des annonces concernant l’assurance médicaments, mais posons-nous la question : les médicaments seront-ils un jour pris en charge par notre système de santé publique?

Pour des raisons financières, on a promis des soins dentaires, mais pas l’assurance médicaments. En réduisant le prix de chaque comprimé, l’assurance médicaments permettrait d’économiser des milliards de dollars. L’actuel système fragmenté fait grimper le prix des médicaments. Les compagnies d’assurance privées, qui fournissent les régimes d’employeur dont profitent environ 60 % des Canadiens, prélèvent un pourcentage sur chaque demande de remboursement. Le Canada favorise donc les prix élevés des médicaments, alors que les médicaments sont moins chers dans des pays comme la Nouvelle-Zélande, l’Australie et le Royaume-Uni.

Une baisse des prix était censée se produire au Canada. Il y a cinq ans, le gouvernement Trudeau avait promis de s’attaquer aux prix élevés des médicaments brevetés en utilisant les pratiques de pays comme la Nouvelle-Zélande pour fixer des prix plafonds. La mise en œuvre de ce changement était censée être une étape vers l’instauration de l’assurance médicaments. Il y a cinq ans, la ministre de la Santé de l’époque, la Dre Jane Philpott, avait déclaré : « Les Canadiens vont constater que nous sommes en mesure de leur faire économiser des milliards de dollars par an. »

From TVO The Agenda with Steve Palkin

Watch the full interview here.

When the world was hit with a novel coronavirus two years ago, it was one of the handful of times this pathogen has been present. Or was it? Epidemiologist Dan Werb, author of “The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure,” discusses the world’s history with the coronavirus, the intersection of outbreaks, science, and the business of finding vaccines and treatments.

From the CJRU 1280AM radio show

Toronto harm reduction workers magnify the need for additional supports in their roles and for a regulated, less toxic drug supply

Juno Zavitz, program coordinator of Breakaway Community Services’ grief, loss, and wellness initiative (GLoW) discusses additional support for harm reduction workers.

Haley Thompson, project manager of Toronto’s Drug Checking Service, highlights policy-related barriers to harm reduction present in the city. Last episode we heard that drug checking revealed high levels of contamination in the unregulated drug supply. Contamination refers to the addition of a drug to the original substance that drug using people do not expect to be present. The program informs those drug using people who submit samples what is in their drugs and alerts clinicians who treat drug using patients to potentially harmful substances in the drug supply.

Thompson calls on the need for regulation and decriminalization of the unregulated drug supply to combat the opioid poisoning crisis.

“There are a few safer supply programs popping up across the country but they tend to have rather stringent eligibility criteria. We’re supportive of the decriminalization of drugs for personal use because it separates drug use from criminality. But it’s definitely not sufficient because it does nothing to address the toxic drug crisis or the toxic drug supply, which is what we know is harming people,” says Thompson.

Op-ed in TIME Magazine by Dr. Dan Werb

In 1985, the first HIV vaccine trial was launched with great fanfare. The previous year, Margaret Heckler, the U.S. Secretary of Health and Human Services, confidently declared that an HIV vaccine would be created within two years. But almost four decades after the initial discovery of the HIV virus, there is still no viable HIV/AIDS vaccine. That doesn’t mean, though, that there is no cure. The grueling and largely thankless work of trialing an HIV/AIDS vaccine has continued steadily over the past four decades (the most recent one launched in January 2022, using Moderna’s mRNA technology), making it the longest-running modern pandemic.

But failure, in the hands of scientists, doesn’t mean the end. Instead, it is a sturdy foundation for scientific discovery. Rather than giving up, the failure to create a viable HIV vaccine spurred scientists to develop a whole new strategy to end the AIDS pandemic. Without vaccines available to teach human immune systems to kill the virus, scientists were forced to find other ways to keep infections at bay. And here’s where four decades of scientific failure was transformed into a radical approach to pandemic control, with direct implications for the future of the global effort to end COVID-19.

From the CBC News article

Ontario’s chief coroner is investigating several cold-related deaths among Toronto’s homeless population and evaluating whether to hold an inquest on the issue.

An advocacy group has requested an inquest, Dr. Dirk Huyer said. At least two homeless people have died as a direct result of the cold in Toronto this winter, but advocates believe there are more.

“The inquest request is being evaluated by our regional supervising coroner,” Huyer said in an interview.

Health experts and advocates say there’s a lack of centralized data on homeless cold-related deaths and injuries, which they say makes it harder to push for changes to support those who live outside.

Those deaths and cold-related injuries don’t currently go into any central repository, said Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network.

There’s also currently no legislation that mandates systematic reporting of hypothermic injuries, unlike COVID-19 or tuberculosis cases, he said.

“I’m not sure if the problem of hypothermic injuries and deaths has got better or worse over the last year compared to previous years,” he said.

Hwang sought to get a better sense of hypothermic injuries and deaths in Toronto on his own several years ago. He had to comb through records of emergency departments and coroner records between 2005 and 2015.

He found 79 hypothermic injuries, such as severe frostbite, and 18 deaths in Toronto during that stretch.

MAPmaking brings you Canada’s leading voices on the health equity issues that affect us all.

Together, we will discuss and explore the scientific evidence and real-world solutions that we believe have the potential to transform our country. Our vision is a Canada where everyone has the opportunity to thrive.

In this first season of MAPmaking, we are exploring the recommendations from MAP’s Equity Roadmap Report, a set of 13 recommendations for a more equitable COVID-19 pandemic recovery in Canada.

Episode one features Gautam Mukherjee, Executive Director of Houselink and Mainstay Community Housing. Gautam has worked in the housing and homelessness sector for 20 years and is a passionate advocate for social justice, inclusion and housing for all. In this episode, Gautam and MAP Director Stephen Hwang discuss and explore a recommendation from MAP’s Equity Roadmap Report: the expansion of permanent supportive housing programs with high fidelity to the Housing First approach.

Dr. Tara Kiran speaks with CBC White Coat, Black Art’s podcast The Dose

Listen to the podcast episode here.

The pandemic interrupted routines for health, work and family — including regular checkups.

So if you haven’t been to see your family doctor since before March 2020, now may be the time. 

“There’s a lot of diseases still going on,” Dr. Peter Lin, a Toronto-based family doctor and a director at the Canadian Heart Research Centre, told CBC podcast The Dose.

“If you have diabetes, high blood pressure, all of those things need some fine-tuning.”

Those who have a chronic illness or new pain should see their health-care provider right away, he said.

And if you’re overdue for an age-related cancer screening test, like a Pap smear, colonoscopy or a mammogram, get in touch with your family doctor.

If you’re unsure whether you need a checkup, several physicians told The Dose about what to consider before making an appointment. 

Who should book an appointment?

Contrary to its name, an annual checkup isn’t something most people need every year, said Dr. Tara Kiran, a family physician at St. Michael’s Hospital.

“That’s a little bit of a misnomer.”

Instead, most practitioners and their staff look at several factors before seeing someone. 

“What we do is really try and target preventive care based on people’s health history and their age, sex and the [medical] history of their family,” said Kiran, who is also the Fidani Chair for improvement and innovation at University of Toronto’s department of family and community medicine.

From the CBC News article

Health-care practitioners say this is the second difficult winter in a row for those who live outside. Pandemic pressures on an already-stretched shelter system as well as restrictions prohibiting eating — and getting warm — in fast-food restaurants have left many with nowhere to go on cold nights.

Toronto’s shelter system has been full or near capacity for years. This winter, Harrison and others say they have often called the city’s central intake office only to be told no beds are available.

Emergency departments have become ad hoc warming centres, says Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network. 

He says the network has an outreach worker who calls intake on cold nights in an effort to find spots inside shelters.

“There’s just been not enough space for people,” he says.

The city says it has added 400 new shelter spaces and 165 spots in warming centres this winter. It has also kept warming centres open since Jan. 7, instead of only during extreme cold weather alerts.

Advocates say that’s not enough. 

At least two homeless people have died as a direct result of the cold, although data on the subject is hard to come by.

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Op-ed in The Globe and Mail by Zoe Dodd, Eris Nyx, Corey Ranger, and Mark Tyndall

In December, the Alberta government set up a committee to consider the merits of providing access to a regulated supply of pharmaceutical-grade drugs, also called safe supply, in response to the continuing drug-poisoning crisis.

This crisis has killed more than 27,000 Canadians since 2015, and there is no end in sight. The introduction of fentanyl, unpredictable drug combinations and other deadly contaminants into the drug supply has resulted in a protracted massacre of people who were already being left behind.

As a group, we have declined the invitation to appear before the Alberta government’s committee. We feel that this is a deeply flawed process and that the conclusions have been predetermined. While we remain committed to saving lives through providing access to a safer drug supply, we refuse to lend any credibility to the process.

While governments across Canada have largely been sitting on the sidelines as this crisis has unfolded, Alberta’s United Conservative Party has taken an aggressive stance against people who use drugs by actively opposing harm-reduction interventions, targeting both evidence-based supervised injection sites and injectable opioid agonist treatment programs. The government has instead promoted abstinence-based treatment programs and tougher law enforcement.

Further, its safe-supply committee clearly lacks impartiality: It consists of only MLAs from the UCP. Members of the Opposition NDP walked away from the legislative committee. The party’s mental-health and addictions critic, Lori Sigurdson, described it as a “rigged process” after reviewing the list of more than 20 “experts” who were invited to present.

Le comité d’approvisionnement sûr de l’Alberta rate une occasion de protéger la population

Article d’opinion publié dans le Globe and Mail par Zoe Dodd, Eris Nyx, Corey Ranger et Mark Tyndall

En décembre, le gouvernement de l’Alberta a mis sur pied un comité chargé d’examiner les avantages d’un accès à un approvisionnement réglementé en médicaments de qualité pharmaceutique, également appelé approvisionnement sûr, en réponse au problème persistant des intoxications médicamenteuses.

Cette crise a tué plus de 27 000 Canadiens depuis 2015, sans que la fin ne soit en vue. L’introduction du fentanyl, de combinaisons de médicaments imprévisibles et d’autres contaminants mortels dans l’approvisionnement en médicaments a provoqué un carnage chez des personnes qui étaient déjà marginalisées.

En tant que groupe, nous avons décliné l’invitation à comparaître devant le comité du gouvernement de l’Alberta. Nous pensons que ce processus est profondément déficient et que les conclusions ont été préalablement établies. Alors que nous restons déterminés à sauver des vies en donnant accès à un approvisionnement en médicaments plus sûrs, nous refusons d’accorder une quelconque crédibilité à ce processus.

Alors que les gouvernements de tout le Canada sont restés en retrait face à cette crise, le Parti conservateur uni de l’Alberta (PCU) a adopté une position ferme à l’encontre des personnes qui consomment des drogues en s’opposant activement aux interventions de réduction des risques, ciblant à la fois les sites d’injection supervisés fondés sur des données probantes et les programmes de traitement des agonistes opioïdes injectables. Le gouvernement a plutôt encouragé les programmes de traitement fondés sur l’abstinence et l’application plus stricte de la loi.

De surcroît, son comité d’approvisionnement sûr manque manifestement d’impartialité : il est composé uniquement de députés du PCU. Les membres de l’opposition du NPD ont quitté le comité législatif. La porte-parole du parti en matière de santé mentale et de toxicomanie, Lori Sigurdson, a qualifié le processus de « truqué » après avoir examiné la liste de plus de 20 « experts » invités à faire une présentation.