Research Projects

Mapping the Equity Dimensions of Artificial Intelligence in Public Health
Lead: Maxwell Smith

Artificial intelligence (AI) has the capacity to either eradicate or exacerbate health inequities. Thus, for the use of AI in the health system to be ethical, it will be critical to identify, anticipate, and evaluate the novel equity questions, dimensions, and challenges that are posed by AI approaches in this context. This project engages diverse groups of researchers in ethics and AI, in addition to representatives from industry (AI), public health and health care policy and practice, and from populations who may traditionally be considered marginalized or disadvantaged relative to innovations in health technology, to identify and examine the unique equity dimensions of AI approaches in public health.

Reducing Health Inequities through Intersectoral Action
Lead: Maxwell Smith

Social policies outside of the health sector—in domains like education, labour, finance, transportation, and housing—contribute to the background social conditions that shape the population’s health and mediate the effectiveness of health policy, health care, and public health interventions. As such, strategies to reduce health inequities will require collaboration with non-health sectors if they are to successfully achieve their aims. Yet, opportunities for ‘intersectoral’ collaboration are not entirely straightforward. For instance, the values and aims undergirding the health sector’s pursuit of health equity may be at odds with social policies in other sectors, which may consider the reduction of health inequities to be peripheral to, if not incompatible with, their own values and objectives. In order to support intersectoral action on health inequities, this project involves interviews with policy-makers involved in both the health and education sectors in order to identify areas where sectoral values related to health equity cohere and conflict. To this end, this project also involves literature reviews that examine the meaning and role of ‘equity’ across different literatures in health, education, environment, immigration, and other areas of social policy.

Related publication: Reducing Health Inequities Through Intersectoral Action: Balancing Equity in Health with Equity for Other Social Goods. International Journal of Health Policy and Management. 8(1): 1–3.

Modelling Ethical Criteria of Health Equity for Canadian Adults using the Diabetes Population Risk Tool (DPoRT)
Lead: Maxwell Smith

Two key groups of public health researchers and practitioners work in parallel on health equity—one on the descriptive component (epidemiologists) and one on the ethical component (ethicists)—yet a significant gulf exists between their respective research. In order to better understand how different ethical criteria of health equity might ultimately produce the most ethically desirable population health outcomes, this research project involves a collaboration between epidemiologists and ethicists to empirically model public health interventions, and, namely, their capacity to reduce health disparities, according to the different ethical criteria of health equity. In particular, this project uses data from the 2017-18 Canadian Community Health Survey (CCHS) to empirically model hypothetical ‘what-if’ counterfactual scenarios to estimate the impacts of introducing distinct equity-oriented interventions on diabetes in Canada.

Multiple-Case Comparison of Implementation of Integrated Care for Chronic Disease Management
Lead: Shannon Sibbald

Chronic Obstructive Pulmonary Disease (COPD) is expected to become the third leading cause of death by 2020, with health care utilization increasing as disease severity progresses. Research suggests that care for these patients is fragmented and lacks coordination. Integrated patient-engaged teams are needed to support care for patients with COPD. This requires coordination across the patient journey: primary care, acute care, home and community care, long-term and palliative care, and when done well it can foster a comprehensive, collaborative, person-centered health care system. In order to understand the barriers and facilitators to implementing team-based integrated care models for patients with COPD, we are working on a multiple-case comparison of teams implementing chronic care models. We use primarily constructivist case study methodology including mixed methods (focus groups, environmental scan, conceptual mapping and observation) to develop a rich description of the implementation process. Throughout the project, we will be exploring ethical, legal, and policy dimensions/issues with an overall aim to share lessons more broadly with the HELP Lab research team.

Implementation of Community Paramedicine as a Model to Support Integrated Care
Lead: Shannon Sibbald

Community paramedicine (CP) is a recent initiative undertaken by various regions across Ontario and throughout Canada to aid in improving care for patients with complex needs. CP brings care closer to the home for patients with COPD and other chronic diseases. Through a deeper understanding of systems-based approaches to integrated care, we want to understand the role community paramedics play in improving patient health outcomes, care provided, and reducing healthcare expenditures. We are working with local stakeholders to better understand the CP program and how it is implemented. We are using mixed methods to explore the implementation process and the overall impact of the CP program. The goal of this project, and the CP program, is to reduce unnecessary emergency room visits and provide better care for patients closer to the home.

Palliative Care Services and Practices for Patients with Non-Cancer Chronic Diseases
Lead: Shannon Sibbald

The purpose of this study is to inform the development of a framework for optimal practices in palliative care services for patients with COPD and other non-cancer chronic diseases. This mixed methods study involves: an environmental scan, scoping reviews, and interviews with stakeholders and key informants. We are in the process of developing a deeper understanding of gaps in palliative care within Southwestern Ontario. Understanding the shortcomings of the current palliative models of care will help us work toward the development of a comprehensive framework that improves the patient’s experience of palliative care. We also hope to enhance the continuity of care they receive from their health care providers and support systems.

Selling Health: How do Pharmacists Consider their Ethical Conduct in Relation to Front-of-Store Sales?
Lead: Jacob Shelley

Community pharmacists are highly accessible, well-trusted sources of health information whose retail product offerings may implicitly suggest approval by a health care professional. Retail products like tobacco seem to be at one end of the “ethical to sell in pharmacies” spectrum because of solid evidence of health harm. Despite this, debate and conflict among community pharmacies still arose when policies prohibiting its sale were introduced. To date, no research has examined pharmacists’ perspectives on the relative appropriateness and ethical acceptability of selling a variety of health damaging (or perceived to be health damaging) front-of-store products for which evidence may be incomplete or mixed. This study will offer important insights into how we might support pharmacists in effectively navigating tensions that may arise at the intersection of health care provision and business sustainability. This study will also inform the development of population health interventions taking into consideration pharmacy retail settings as potential health-promoting retail environments. This project examine community pharmacists’ perceptions around factors driving front-of-store product selection in light of ethical and legal frameworks in which they operate, with a focus on exploring pharmacists’ perspectives on the overlaps, tension and/or ethical conflicts between their roles as health care providers and as retailers.

Law as a Public Health Tool
Lead: Jacob Shelley

Law plays a central role in shaping health and health equity. The field of public health law examines how legal frameworks and practices enable or hinder conditions for population health, both locally and globally. However, traditional legal scholarship and methods of legal research are limited in their ability to assess law's role as a public health tool. This project will examine the role for empirical and experimental research methods in the study of law's role in public health. It develops an innovative and internationally collaborative social science research program that explores the role for evidence-based (or evidence-informed) law and practice (ELP), drawing from the experience of other disciplines that have embraced the evidence-based movement, such as evidence-based health care. Four research themes of the project are: (1) the use of scientific evidence in public health law; (2) empirical research in public health law and with legal institutions; (3) experimental innovation in public health law; and (4) values and politics in evidence-based law.

The Role of Municipalities in Public Health
Lead: Jacob Shelley

Municipal law is increasingly recognized as having a critical role to play in public health. This project will examine how the municipalities in Ontario and Alberta have responded to top primary behavioural risk factors for chronic disease in Canada, with a particular focus on: tobacco use, alcohol use, physical inactivity, and poor diet. These risk factors are identified given their correlation with my own research agenda and because they are areas that municipalities are actively working in. Once the policies are identified they will be subject to content analysis to determine, among other things, context, the policy issues/problem being addressed, the relevance of evidence, and the policy option used. Additionally, the identified policies will be assessed using existing policy analysis frameworks, including the PLACE Research Lab Intervention Ladder Policy Analysis Framework. A subsample of policies will be researched further (e.g., examining council meeting minutes, news reports, etc) to further explore the context of how the policy was developed and why.