When epidemiology PhD student Jean-Paul Soucy checked his email while munching on lunch with his fellow graduate students on a Monday afternoon, he fell silent.

It was the first day of what was supposed to be a usual workweek, and an email with the words “Letter of Offer’’ could have applied to a mundane range of things. He passed his laptop to a colleague. “See if it says what I think it says,” he remarked.

It said just that. He had become part of the newest selection of Canadian doctoral students to be named Vanier Scholars. The Vanier scholarship is a highly prestigious award for doctoral students that is granted by the Government of Canada.

The award will provide Soucy with $50,000 per year for three years while he works with his colleagues at the Dalla Lana School of Public Health to conduct research and develop community-based solutions to rein in the excessive prescription of antibiotics in Canada.

In particular, Soucy’s research focuses on developing “antimicrobial stewardship” programs to facilitate best practices in antibiotic prescription by family physicians. 

Why Soucy’s research field is critically important to global health

A 2014 World Health Organization (WHO) report warns that the world may be entering a “post-antibiotic era, in which common infections and minor injuries can once again kill.”

While harmful bacteria have a natural ability to develop resistance to antimicrobial drugs, the way that healthcare providers across the globe have prescribed these drugs has accelerated drug resistance.

Misuse and overuse of antibiotics facilitates the exposure of bacteria to drugs for longer than necessary to treat infection. This exposure allows microbes the conditions that foster the evolution of drug resistance.

Soucy illustrated an example of misuse with the prescription of antibiotics for the treatment of respiratory tract infections — such as the common cold and flu.

“Respiratory tract infections… are commonly caused by viruses,” said Soucy. “[But] antibiotics can’t do anything against [viruses].”

“Unfortunately, in a lot of cases, we have respiratory tract infections being treated by antibiotics.”

The consequences of the misuse and overuse of antibiotics

Such misuses of antibiotics have led to a weakened effectiveness of treatments against potentially lethal diseases.

Research reported by the WHO identifies conditions such as pneumonia and urinary tract infections as being in urgent need of new treatments, due to the advent of antibacterial resistance.

Forms of tuberculosis resistant to at least four drugs have been identified in 105 countries, while strains of gonorrhea resistant to last-resort antibiotics have been identified in 10 countries, including Canada.

In addition to accelerating the resistance of microbes to drugs, inappropriate antibiotic prescriptions can also increase the vulnerability of patients to particular infections.

“In the hospital setting, we have this nasty Clostridium difficile [bacterium],” said Soucy. “When your microbial ecosystem is disrupted by taking antibiotics, especially these broad-spectrum antibiotics that target a lot of [bacteria] at once, it creates a hole in that ecosystem that C. difficile may then enter,” he explained.

Antibiotic stewardship as a solution to excess prescription of antibiotics

Soucy’s project will revolve around antibiotic stewardship. “Antibiotic stewardship is basically the idea of making sure that we use antibiotics in a judicious way, that we’re preserving our [antibiotics’] efficacy by not giving unnecessary prescriptions, and making sure we give the right prescriptions [for microbial infections] as soon as possible,” he said.

Stewardship programs have found a footing in hospitals, but not in the community where there is a lack of comparable infrastructure. More importantly, an overwhelming majority of Canadian antibiotics — a whopping 92 per cent — is prescribed by family physicians and dentists.

The project will develop an online tool to provide “feedback to family physicians about their prescription practices,” helping them compare their own prescription practice with local guidelines and with other physicians in the area.

Soucy emphasized the importance of community-based solutions for tackling antibacterial resistance. By facilitating stewardship programs without requiring the infrastructure of a hospital, the tool will be adaptable to a wider range of less resource-intensive healthcare systems.

The path that led Soucy to epidemiology research

Soucy’s multiple interests led him to conduct research in infectious disease epidemiology. His undergraduate degree trained him in ecology, evolutionary biology, and mathematics, fostering his expertise in the mathematical modelling of infectious diseases.

Add to this his interest in the social factors that cause disease to spread, and the field of infectious disease epidemiology formed the right fit. 

In parting, Soucy emphasized the role played by research mentors, friends, and the community he found through extracurriculars, which enabled him to pursue his passions. These people have helped him through “all sorts of research opportunities,” keeping him motivated and resolute throughout the challenging years of research.

When asked for advice for budding researchers, he recommended students to adamantly challenge their fears.

“The way that I get past that feeling that says, ‘You can’t do this, you can’t figure this out,’ is [that] I just commit myself to doing it,” he said. “Then I have to do it — I have to figure it out.”

U of T has launched the Centre for Vaccine Preventable Diseases at the Dalla Lana School of Public Health to address vaccine hesitancy. According to the World Health Organization, vaccine hesitancy is one of the top 10 threats facing public health in 2019, and has led to outbreaks of diseases that were previously eliminated, such as measles.

The Director of the centre, Dr. Natasha Crowcroft wrote, “The Centre will be (as per our vision) catalyzing cutting-edge research and education that maximizes the health benefits of immunization for everyone.”

According to Crowcroft in an interview with U of T News, “Unlike other provinces, Ontario has had no centre of excellence to work in this space. We are filling this gap with some of the best minds in the country.”

Crowcroft also highlighted the need for resources to attract and retain the researchers working on vaccine prevention. She mentioned that “there are great people working in Canada, but Ontario has lagged behind in not having a resource like this Centre before. And we always need new people to bring new energy and new ideas.”

To help reach its goal, Crowcroft hopes for U of T’s new centre to be an “internationally-recognized centre of excellence in vaccine preventable disease and immunization research and education.” She also lays out goals for cross-disciplinary work and increasing access to education on vaccine preventable diseases and immunization.

In an email to The Varsity, Crowcroft wrote, “A strong unified and harmonious voice speaking up for vaccines and more broadly for science is really important. Institutions and students from across Canada need to be on the same side. The battle against vaccine skeptics is never going to end.”

Cuts to public health funding by the Ontario government announced in April have taken the media by storm, leading a tripartisan group of previous Ontario Health Ministers to urge the government to reverse its decision.

But is this political treatment of public health a new phenomenon, or is this appended to a long history of budgetary cuts and perceived underfunding of its practice and research?

Another event in a long-lasting pattern

Dr. Steven J. Hoffman — the Scientific Director of the Canadian Institutes of Health Research’s Institute of Population & Public Health — and his colleagues would agree with the latter. In a timely paper published in May, the authors argue that public health in Canada is underfunded.

They assert that the 5.5 per cent of total Canadian health spending allocated to public health practice fails to sufficiently fund the range of work that public health practitioners are expected to undertake — from food and drug safety, to occupational health, to health inspection, and more.

More importantly, Hoffman and his colleagues point out that the current rise in the frequency of chronic disease, mood disorders, and anxiety disorders in Canada has failed to garner a “significant” increase in budget allocation to the appropriate venues of public health.

They say that this results from the public health community lacking an appreciation for the process of policymaking, which causes them to fail to account for the reasons why public health isn’t a clear win from a political perspective.

As a solution, the authors propose developing knowledge of political tools and processes among public health officials.

Public health saves lives

Public health efforts are focused on long-term goals, such as preventing, rather than curing, illnesses, or on analyses of statistical trends within the field. Often, its work seems intangible to the public, and is not exploitable by politicians.

Attempts to pull down the 28.1 per cent Canadian adult obesity rate, for example, would require public health officials to target multiple industries. They may need to advocate for businesses to change food labelling, health care providers to provide more expansive training programs, or ask municipalities to adjust local regulations, according to the 2011 Obesity in Canada federal report.

Such efforts aim to change individual behaviour on a large scale through multiple forms of societal intervention. However, it is difficult for non-experts to trace their effects back to conscious public health efforts.

The more these efforts are hidden from voters, the less clout they gather on the political agenda of politicians, who are already wary of being unable to reap rewards from these efforts within the timeframe of the election cycle.

Solutions to the lack of political will for public health funding

To solve this problem, the authors ask for members of the public health community to better appreciate the policy-making process and the actors involved in it, so that public health agencies can adapt strategies to the kind of policy-making network relevant to specific healthcare issues.

They similarly argued for improved understanding of policy instruments — regulation, communication, taxing, and spending — so that the regulatory tools used for public health can be better used. Increased efforts to spread awareness of public health efforts may counter its lack of priority in the voter base.

In the wake of the opioid overdose crisis, mental health crisis, and spread of preventable chronic diseases forming the leading causes of death in the province, public health cannot be more vital in addressing our most urgent needs. Whether the output of a work is deemed tangible or not by some individuals should not make the verdict over the survival of that field of work.

Nonetheless, concerted effort to engage with the political system in the push for improved funding and policy can ultimately win over politicians and policymakers.

W hat does a scientist look like? For many, the answer involves white lab coats, goggles, and beakers. Yet the people who pursue science are just as diverse as the field itself. Scientists can be activists, athletes, artists, or all of the above. Science can happen indoors or outdoors, under the night sky, or on the internet. Read about the journeys of seven student researchers at U of T.

ASHIMA KAURA/THE VARSITY

“As a little girl, I saw a shooting star, and that made the night sky my favourite view. I thought a lot about what was up there and how cool it would be to go to space. This led to my studying physics and astronomy in undergrad and I have never looked back since then.

I currently seek to understand the early universe and how it transitioned to the stars and galaxies we see today. Specifically, what happened in the [epoch] of re-ionization. The epoch of re-ionization is a period in the universe’s history over which the matter in the universe ionizes again.

[My dad] taught me always to strive for more, that there could always be a way if there is a will. He taught me to never give up and to always ask questions. My curiosity in life and career comes from him.”

— Margaret Ikape, first-year PhD in Astronomy and Astrophysics, email

ASHIMA KAURA/THE VARSITY

 “I have always been interested in science, but also equally interested in the arts. I went to an arts middle school and high school where half my day was spent doing art and not academics. I spend a lot of my time outside of school engaging in the arts. I still consider myself an artist as much as I consider myself a scientist. It took me a while to come to terms with the fact that I can [be] both.

When I decided I wanted to go to university, I chose to study science since I liked it and was good at it. Moving into my later years of my undergrad I found that I was drawn to ecology courses, field courses, and also really liked the people I met in those classes.

I am interested in the pollutants, that comes from roads, such as road salt, and how it impacts the animals that live in nearby streams. I also study other pollutants that come from roads, such as metals, polycyclic aromatic hydrocarbons, and small bits of car tires (tire dust).”

— Rachel Giles, first-year Master’s in Ecology and Evolutionary Biology, email

“Initially I had my heart set on being a professional dancer and veterinarian (a very practical dual career). Science had been my academic focus for some time, but it took several years after completing my BSc for me to realize that I passionately loved research and applying the scientific method to various questions of animal behaviour and cognition. I had this epiphany while I was juggling three jobs as a lab manager, veterinary assistant, and dog trainer. Out of all of those, I found research to be fulfilling and exciting and it was something I could see myself doing for the rest of my life.

I want to know how [dogs] perceive the world and how they process cues and information present in the environment. I am motivated by the hope that my research can possibly help change how people view dogs, give greater value to them through the recognition of their mental abilities and ultimately lead to greater wellbeing and better access rights in North America.”

— Julia Espinosa, second-year PhD in Cognitive Psychology, email

Julia Espinosa (left) and Madeline Pelgrim (right) work with dogs like Loki to determine animal behaviour. ASHIMA KAURA/THE VARSITY

“Julia Espinosa, the graduate student in my lab, has had the greatest influence on my career. She has been endlessly patient with me since we began working together in the fall of 2016, and has pushed me to advocate for myself and not be afraid to try something new. I would not be at this point in my career without her sage advice and constant confidence.

Like many other students, I had a bit of a rough transition into University in my first year. Adjusting to life away from home (my hometown is a 10 hour drive from Toronto) and everything that comes with living on your own for the first time caused my academics to suffer. When I first applied to join my lab, I was confident that I would not be accepted because of my marks. I am very thankful for my Principal Investigator — Dr. Buchsbaum — and the lab manager at the time — Kay Otsubo — for taking a chance on me and overlooking my performance first-year.”

— Madeline Pelgrim, fourth-year Bachelor’s in Psychology and Biology, email

ASHIMA KAURA/THE VARSITY

“There are definitely a lot of challenges throughout a PhD. I would say the biggest one for me were the mental challenges at the early stage of my PhD. How do I keep being confident in front of the language barrier, failure experiments, competitions, and where is my direction for the future? Having been through such a mental struggling stage, I am now clearer of myself, and ready for unknowns.

I always want to help bring positive impacts to our future world. I like the discovery and innovation side of research studies and its potential impact on our better world. My research is to design advanced photo-responsive nanomaterials that can store solar energy into chemical energy by catalyzing the conversion of greenhouse gas carbon dioxide to useful chemicals and fuels. It is a promising solution to reduce the usage of fossil fuels and global warming caused by greenhouse gas.”

— Yuchan Dong, fifth-year PhD in Materials Chemistry, email

ASHIMA KAURA/THE VARSITY

“As a child while it was true that I was always curious about nature and the world around us — Asking questions like why is the sky blue? How are clouds formed? etc. It was only when I got older and started to understand ‘what is science? what are scientists? How is science performed?’ that I gained a tremendous passion for it.

This notion that with a few chemical reactions, chemists can ‘creatively’ and rationally generate a molecule which when administered to human can halt disease progression, pain and even extend life — was a very powerful catalyst for my interest in medicinal chemistry. My work mainly focuses on the development of novel small-molecules that specifically target disease-causing cellular components which have been shown to cause certain cancers.

I think as with any budding student of science, whether in graduate studies, professional programs or even out in the workforce, the biggest challenge is to become comfortable with and know how to effectively deal with failure and hardship. As a scientist, at times we learn more from failed experiments than successful ones.”

— Yasir S. Raouf, third-year PhD in Organic and Biological Chemistry, email

ASHIMA KAURA/THE VARSITY

“I’ve been both playing sports competitively and going to school since I was six years old. Honestly, if I didn’t play water polo I don’t know what I would be doing in the evenings — I think I would just be sitting on my phone doing nothing. I love to represent Canada, and it’s a really exciting opportunity to do so on an international stage. Looking forward to the future, it would be an honour to represent Canada at the Olympic Games. U of T has opened so many doors for me, with research and athletics.

Initially I came to U of T and I wanted to do Genetics and Cell & Systems Biology — all that nitty gritty stuff. Then I took BIO230, and I was like this is not for me. I was trying to figure out a field where I could apply Life Science techniques, but without wet lab stuff. I had the opportunity to do an ROP [Research Opportunity Program] in Pascal Tyrrell’s lab — which is focused on medical imaging and statistics — and just fell in love with it.”

— Rachael Jaffe, third-year Bachelor’s in Global Health, Statistics, and Economics, spoken

A Globe and Mail article published late January revealed the difficulties of obtaining data in fields such as public health and energy economics.

‘Data gaps’ are the “areas at the national level in which data [is] not collected or readily accessible.” This includes inconsistent data collection, which makes it difficult to compare data, and data that is not updated on a regular basis.

For example, the article reports that data gaps have impeded research in a study on whether the American rise in “deaths of despair” — deaths of the white, middle-aged working class — can be observed in Canada as well.

One reason for data deficits lies in the appropriate collection of data. And even if data has been collected appropriately, barriers to accessing the data may remain.

Associate Professor Arjumand Siddiqi from the Dalla Lana School of Public Health explained in an email to The Varsity that, in her experience, data gaps occur in “groups for which we do not make a concerted effort to sample or identify.”

A summary on the evaluation of the Health Statistics Program between 2011 and 2015 highlighted that one of the recommendations made in the evaluation was regarding management.

The summary explained that for health statistics, which includes births, deaths, stillbirths, divorces, and marriages, the information would now be published 10–11 months after the reference period ended.

A recent blog post by Statistics Canada said that more, specific information on the population was needed to resolve the issue of data gaps.

Siddiqi suggested that statistics may be difficult to obtain as the “infrastructure or the mechanisms” regarding availability and accessibility of the information have not been facilitated by statistical agencies like Statistics Canada. For example, Statistics Canada’s Research Data Centres inhibit collaboration between researchers who are not near the centres in which the data they require is stored.

Data in the field of Siddiqi’s research, which is centred on the relationship between social and economic factors and health, are difficult to obtain.

Other areas in which researchers experience difficulty in studying health are racial inequalities.

“Existing surveys don’t have sufficient sample sizes of non-whites, nor are these samples representative of those populations,” said Siddiqi.

While one tool, like the census, would provide information on Canadians, there lacks a relationship between other sources for the collected data to be useful.

It is important for Canadians to know our statistics as “we need to know what’s happening in our society, who is benefitting, and whom we are failing,” said Siddiqi.

Canada’s transgender population continues to face challenges from transphobia and discrimination, which, among other factors, influences their health and development.

Recent efforts by the Canadian government and affiliated agencies address issues that LGBTQ+ communities face.

In 2016, the Canadian federal government passed Bill C-16, which amended the Canadian Human Rights Act to include gender identity and expression as one of the prohibited grounds of discrimination.

In the health care setting, LGBTQ+ individuals face multiple barriers that contribute to the disparities in the management and care of these individuals.

Alex Abramovich, Assistant Professor at the Dalla Lana School of Public Health and Independent Scientist at the Centre for Addiction and Mental Health (CAMH), has been studying the health care needs of LGBTQ+ youth for more than a decade.

From his experience working with young trans people, Abramovich wrote to The Varsity that this population has an unmet need for mental and physical care.

Many transgender individuals are “unable to come out and speak honestly about their identity and healthcare needs because they may not know whether or not it will be safe to do so,” wrote Abramovich, explaining how gender identity affects access to health care.

He added that some trans youth do not even have a family physician due to “previous experiences where their gender identity and sexual orientation were pathologized.”

To address the urgency for improved health care accessibility by trans populations, Abramovich recently co-authored an article in the Canadian Medical Association Journal (CMAJ) that provides comprehensive steps for physicians to follow to become more trans-inclusive and trans-competent.

One of the recommendations listed in the article was to privately ask all patients what name and pronoun they go by, instead of making assumptions based on perceptions of their voice, appearance, or name and sex listed on their health card.

Another key recommendation made in the article was to ensure that patients are addressed with a gender-affirming approach that does not view gender variance as pathological.

“These are just some of the things that health care professionals can implement immediately,” wrote Abramovich, expanding on the purpose of publishing such health care recommendations.

Staff Physician and Adolescent Medicine Specialist at St. Michael’s Hospital, Joey Bonifacio, argues in a review article recently published in CMAJ that adolescents’ mental health improves when they receive gender-affirming care.

Bonifacio mentions that primary care providers are equipped with some published medical guidelines on providing care for the transgender population. However, practice is hampered by a lack of experience and training in trans health issues.

He suggests that primary care providers support trans adolescents with gender dysphoria by facilitating discussions about the “timing of social transitioning, reviewing and overseeing the potential use of medical management, and connecting them with local community resources and supports.”

Besides improving the management and care of trans individuals, U of T-affiliated researchers suggest that routine data collection can “contribute to evolving norms in Canadian society regarding sexual orientation and gender identity.”

Currently, there is a lack of national and territorial data on trans populations, mainly because there is no standardized way of collecting and analyzing data about gender identity.

Andrew Pinto, Assistant Professor in the Department of Family and Community Medicine at U of T and Staff Physician at St. Michael’s Hospital, tackled this challenge with his research group by examining how Canadian patients react to being asked routinely about sexual orientation and gender identity.

By administering a sociodemographic survey of all patients in the waiting rooms of St. Michael’s Hospital on a regular basis and later conducting semi-structured interviews with 27 patients, Pinto and his research group found that the majority of patients appreciated the variety of options available for both the sexual orientation and gender identity questions.

However, some patients felt discomfort in answering such questions, and some felt that their identities were not reflected in the options despite efforts to provide diversity in survey responses.

Based on these research findings, the authors suggest that an open-ended option such as “Identity not listed (please specify)” could be included in addition to prespecified options. They also suggest that health care organizations should set the stage for asking these questions by explaining how the data will be used and ensuring that clinics are LGBTQ+-positive spaces.

Pinto and his colleagues hope that further research will be done in a variety of Canadian and international settings in consultation with LGBTQ+ communities, as such data can help organizations identify health inequities and build a framework with improved and inclusive care.

Professors Ananya Banerjee and Jackie Bender decided in January 2015 that they were going to add something new to their three-hour lectures: for three minutes, they integrated everything from dance routines to stretching just to get their graduate students to move.

These regulated movement breaks received very positive responses from students. Now, the professors are hoping to take this feedback to the next level and study its effects on students and instructors in the undergraduate setting.

The idea of regulated movement breaks all started with a paper released in 2015 by U of T researchers from the Institute of Health Policy, Management, and Evaluation. “[This study] showed that individuals who are sedentary throughout their day, even though they are exercising regularly, have higher risk for various chronic diseases,” said Banerjee, a Registered Kinesiologist and professor at the Dalla Lana School of Public Health.

Upon reading this paper, Banerjee and Bender decided to integrate regulated movement breaks into their classes. “I’m trained to create exercise programs in different settings, and given that Dr. Bender and I… were teaching our graduate course that year… we decided that we really [needed] to implement movement breaks into the classroom to reduce sedentary behaviour among students,” Banerjee explained.

There’s a lot of science fueling support for fitness breaks in the classroom. “A number of studies have shown that movement breaks increase the levels of interactivity with other students and with the course instructor, and that this positively influences acts of collaborative learning, which also helps to improve student learning retention,” said Bender, also a professor at the Dalla Lana School of Public Health.

While introducing these fitness breaks in the graduate setting, the professors conducted a quality improvement survey. “Movement breaks were met with high rates of acceptability from students, with about 86 per cent of students reporting that they enjoyed these short bouts of movement,” said Bender.

Participants also noted that the breaks helped improve their engagement with other students and instructors. Other impacts extended beyond the classroom and increased students’ intention to be more active and less sedentary outside of class.

With a successful application to the Learning and Education Advancement Fund granted by the Provost’s Office at U of T, Banerjee and Bender are now launching a more extensive study in the undergraduate setting.

For the 2017–2018 academic year, they are planning to integrate and assess movement breaks across all three campuses and involve over 1,000 students from various faculties.

“We are conducting a quasi experimental pre-post design [with] certain classes being exposed to intermission and other classes not… and then we’re going to be looking at the impact of participating in these structured, three minute movement breaks, that are led by… videos of certified instructors,” explained Bender.

These videos, which will be streamed by lecturers in their 2–3 hour sessions, will range from mindfulness to Zumba and everything in between. While the focus of this study is on students, the professors will also be tracking feedback from instructors, who will also participate in these exercises throughout the year.

They hope to get more insight on the impact of fitness breaks on student and instructor engagement, student well-being, as well as physical activity and sedentary behaviours.

For both professors, it all comes down to helping students. “We [really just] expect that through these movement breaks, they’ll lead to more engaged students who will feel better, learn better, and develop positive relationships with instructors and other students,” said Bender.