Research Impacts

Centre for Research on Inner City Health - Keenan Research Centre

Below, you'll find examples of CRICH research in action: testing solutions, raising awareness and developing tools to support social innovations for equity in health. We focus on social innovations that help ensure everyone has the same chance to be healthy and make healthy choices, regardless of how much we earn, where we live or where we've come from. To learn more, read our 2010/2011 Impact Report.

Recent Impacts:

photo

Better health care at Ontario's largest homeless shelter

In 2007-08, CRICH Researcher Dr. Vicky Stergiopoulos and her team conducted a client needs assessment at Toronto's Seaton House emergency shelter. Read more.

The report showed that 80% of Seaton House clients experience severe to moderate disabilities - a level of need that the shelter was never designed to address. Evidence from the CRICH report was tabled by the City of Toronto Housing Opportunities Action Plan for Affordable Housing, in its proposal to demolish and rebuild Seaton House. In late 2009, Toronto City Council approved the plan. The new Seaton House will offer enhanced services to address the specific needs identified in the CRICH report, including long-term care, infirmary and health care beds, supportive housing and expanded programming space.

photo

Changing HIV testing

Does it make sense to test everyone for HIV as part of their regular health care, or should testing focus only on people who think they are at risk? Read more.

A CRICH study asked that question and calculated that universal HIV testing would increase the life expectancy of HIV-infected patients. Universal testing is also cost-effective compared to current practice (i.e. testing based on risk). This is mostly due to the serious risks - and costs - linked to untreated HIV. The study team included scientists from Stanford University and Duke University.

Based on research including our study, the U.S. Centers for Disease Control and Prevention (CDC) wrote new HIV testing guidelines for health care providers to test all adult patients for HIV. These guidelines have been adopted in the states of New York and California. This year, an HIV testing program in Vancouver, B.C. adopted a similar approach. Read the revised guidelines here.

photo

Helping health care workers ask questions about abuse

Sometimes it takes a direct question, asked in a safe place, to encourage a victim of abuse to come forward and seek help. Read more.

Health care workers have the opportunity to ask all patients if they're being abused by a partner, and can connect victims with needed services. Until now, however, policy-makers felt that there wasn't enough evidence to start regularly asking all female patients if they're facing abuse.

CRICH teamed up with health care providers and woman abuse service agencies to re-evaluate the evidence on universal, health care-based intimate partner violence (IPV) screening programs. Our findings represent a major reversal in thinking: universal IPV screening can be very effective in health care settings, but only when the right supports are in place for staff. Supports such as ongoing training and quick access to referrals can make a big difference in how many victims are identified and referred to services.

We shared what we learned with woman abuse networks and health care workers across Ontario. St. Michael's Hospital is using our findings, along with Registered Nurses’ Association of Ontario protocols, to inform their own IPV screening program. Read the study here.

photo

Coordinated access to care for homeless Torontonians

Could you recover from an illness without bed rest, a place to store medications and nutritious foods, and regular follow-up care? If you’re homeless, these needs can be almost impossible to meet. Read more

In partnership with Toronto Community Care Access Centres, Toronto North Support Services and Inner City Health Associates, CRICH developed and launched the “Coordinated Access to Care for People Who are Homeless” program (“CATCH”). The program connects homeless people with the supports they need to get better.

In our first year, CATCH linked almost 200 people who were homeless and recovering from illness to services like family medicine, psychiatry, case management, transitional housing and peer support. CATCH is the first program of its kind in Canada. For more information, call 1-877-482-4595.

photo

Health beyond health care: a resource for policy-makers

In Canada and around the world, governments are looking for ways to improve health and well-being while lightening the burden of health care. Read more

"Health in All Policies" is an increasingly important strategy that makes health a priority in a range of different policy sectors. It also involves measuring the impacts of social, environmental, economic and other policies on health and health inequities. "Health in All Policies" is an attractive idea, but it's not easy to put into practice. To help policy-makers learn from one another, CRICH is producing an online database of research on "Health in All Policies," in collaboration with the World Health Organization.

We launched this project at the request of the Ontario Ministry of Health and Long-Term Care (MOHLTC), to see how "Health in All Policies" could work for Ontario. Download the report here.

photo

Sounding the alarm: Canada’s hidden housing emergency

People with unstable housing situations face the same severe health problems and danger of assault as people who are homeless. Read more.

A new report by the CRICH-based Research Alliance for Canadian Homelessness, Housing and Health (REACH3) has revealed a hidden emergency: people who don’t have a healthy place to live - regardless of whether they’re vulnerably housed or homeless - are at high risk of serious physical and mental health problems and major problems accessing the health care they need.

Advocacy groups across Canada are using our evidence to push for a national affordable housing strategy, including the Canadian Nurses Association, RedTents, Ottawa Alliance to End Homelessness and Women’s Legal Education and Action Fund. Download the report here.

photo

Fairer access to cancer care

Breast, colorectal and cervical cancer can all be successfully treated - if they’re found at early stages. Read more.

When fully developed, these cancers can be deadly. Cancer "screening" programs aim to test everyone in certain age groups for cancer or pre-cancerous conditions, to make sure that necessary treatment can start as early as possible. Although cancer screening saves thousands of Canadians' lives every year, these programs aren't reaching everyone. For example, South Asian women in Ontario are much less likely than the average female Canadian to get screened for cervical and breast cancer.

CRICH is working with Cancer Care Ontario, Peel Public Health, Punjabi Community Health Services and a wide range of community members to explain what's sustaining this inequity and how to resolve it. The project's unique mix of partners means we're prepared to respond at the provincial as well as local level. To learn more about our work in Peel, contact LobbR[at]smh.ca.

photo

TorontoHealthProfiles.ca

Some Toronto neighbourhoods are healthier than others. How healthy is your neighbourhood? Read more.

The website features neighbourhood health profiles and maps that make it easy to see differences in health outcomes across communities in Toronto and Ontario. Communities and health planners can use this information to make sure that the programs they develop will meet local residents' specific health needs. The right policies and programs could help give all communities the same opportunities for good health.

Torontohealthprofiles.ca is the result of a data-sharing partnership between CRICH, Toronto Public Health, Access Alliance Multicultural Health and Community Services, Toronto Central Local Health Integration Network, Wellesley Institute and South East Toronto Organization (SETo). It's continually refreshed with the newest available health-related information from the Census, OHIP, hospital and emergency department data, Vital Statistics, Toronto Public Health and other sources. In 2011, we're teaming up with Wellbeing Toronto, a new web application that allows users to map and explore the social, economic and cultural attributes of Toronto neighbourhoods. Watch torontohealthprofiles.ca for more details.

photo

"Housing First"

"Housing First" is an innovative idea that's based on simple, common sense: it's much easier to manage a mental health problem when you have a stable place to live. Read more.

The "Housing First" approach provides safe, quality housing to people who are homeless and live with mental health issues, to help clients better focus on recovery. To demonstrate how and how well "Housing First" works in Canada, the Mental Health Commission of Canada launched the "At Home/Chez Soi" national demonstration project.

CRICH is the research lead on the Toronto arm of the 5-city study. We meet with participants every three months to hear how they're doing with their health and housing. We're also looking at whether "Housing First" helps to reduce the amount of time clients spend in hospitals and jails. Project partners Across Boundaries, City of Toronto, COTA Health and Toronto North Support Services provide specialized supports and help clients manage day to day.

Funding for this project runs out in 2013. Our biggest challenge now is to make sure that the health, housing and social benefits of "At Home/Chez Soi" can be sustained after the research funding ends. For more information, visit the At Home page.

photo

BioDiaspora.com

Infectious diseases are spreading across the globe faster today than at any other time in history. Bio.Diaspora is a web application that analyzes airline routes in real time to predict the international spread of infectious diseases. Read more.

Governments around the world can use this knowledge to develop targeted, strategic countermeasures to better prepare citizens and protect their health. We’ve used Bio.Diaspora to help countries anticipate and react to the spread of disease at mass gatherings such as the Olympic Games, FIFA World Cup, the annual Hajj pilgrimage in Saudi Arabia and the upcoming Olympic Games in London, England.

This year, an exciting new collaboration with the U.S. Centers for Disease Control and Harvard University will integrate Bio.Diaspora with healthmap.org, a technology that monitors public websites and global online media for news of emerging diseases. Bio.Diaspora was developed by CRICH in collaboration with Ryerson University, the University of Manitoba and the world’s largest commercial airport and air transport organizations. Learn more at biodiaspora.com.

photo

Equipping MOHLTC to Respond to Equity Implications of New Physician Reimbursement Models

In the past 10 years, Ontario has undergone one of the world’s largest short-term voluntary shifts in physician... Read more.
reimbursement, from fee-for-service models to “capitation” models (in which physicians are paid a fixed fee for each patient in their roster). However, there is little evidence on how capitation models affect patient outcomes or equity of access to health care. In 2009, CRICH Researcher and family physician Dr. Rick Glazier conducted a study that found that patients in capitation practices are healthier and wealthier than expected – important findings, in light of Ontario’s efforts to expand use of primary care services and to ensure equitable access to services. In early 2010, based on these findings and Dr. Glazier’s subsequent recommendations, the Ontario Ministry of Health and Long-Term Care (MOHLTC) Physician Services Committee requested that Dr. Glazier take next steps and investigate adjusting capitation payments based on patients’ needs. His work is now part of the current MOHLTC-Ontario Medical Association agreement.
photo

Put to the Test: Evaluating Ontario's Guidelines for HIV Testing and Counselling

30-40% of people who are HIV positive don’t know their status. In 2010, CRICH Director Dr. Patricia O’Campo... Read more
and other CRICH researchers completed a 2-year collaboration with the Ontario Ministry of Health and Long-Term Care (MOHLTC) AIDS Bureau, Ontario HIV test practitioners, and the Ontario Central Public Health Laboratory to evaluate HIV testing and counselling activities across Ontario. We found that Ontario providers are following guidelines and clients are highly satisfied with the services they receive. However, we also identified some important areas of concern; for example, stigma around HIV continues to be a major barrier to reaching high-risk populations. The study confirmed that men who have sex with men, injection drug users and people born in HIV endemic countries are at highest risk in Ontario and would benefit the most from targeted programs to improve testing rates. This study was performed at the request of the MOHLTC, and funded by the MOHLTC Applied Health Research Program.

Healthier neighbourhoods in the Region of Peel

Peel is one of Ontario’s fastest-growing regions, with massive suburban development underway. Read more

CRICH, Peel Public Health and the Region of Peel have come together to make sure that these changes in the urban landscape will help support residents’ health. The result? A “healthy development” tool that city planners and developers can use to design and build healthier neighbourhoods.

Given that diseases related to inactivity, such as diabetes and hypertension, are becoming major problems in Peel, the tool promotes neighbourhood features that encourage physical activity. For example, the presence and quality of sidewalks and the location of shops and services can affect residents’ decisions about whether to walk or drive.

The region’s Planning Department now uses our tool to check the potential health impacts of every new development application. It’s also been used to guide changes to Peel’s land-use policies and engineering standards. Read a case study of the tool’s implementation, published by the Canadian Institutes of Health Research.