Tag Archive for: health

Behind the Science: Indigenous practices at WISE Women’s College

Interviewee: Lisa Richardson | Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: April 19th, 2023

What was the motivation to get the Centre for Wise Practises in Indigenous Health started at Women’s College? 

The initial motivation was based on observing the experiences of Indigenous peoples in the healthcare system, both those seeking care and Indigenous learners being trained as healthcare professionals. There was a desire to have a place where people would feel supported and not have to deny their Indigeneity but be in a place where that’s valued and seen. We wanted to create a place where one can have access to traditional cultural supports if needed and where they can be supported as a whole person – mind, body, spirit, and emotion in that model of care and well-being. 

Additionally, the Centre emerged at the time that it did because the Truth and Reconciliation Commission of Canada (TRC) had come up with specific health-related Calls to Action. I had been involved in writing a report around how healthcare institutions could incorporate those calls to action specifically, and so we sought to do that at Women’s College Hospital.

 

How are healthcare providers educated on Indigenous health?

We have some amazing online modules that exist for cultural safety. But there is also a need to come together in small groups and talk through some of what was heard.  We sometimes debrief provider and patient interactions.  For instance, if there was an incident where a patient felt uncomfortable, we want to ensure that the patient is supported but also consider how to make things better for next time.  This might include a specific healing session, facilitated by an Elder, where a provider and a patient come together and try to emerge from it in a restorative way. We also have speakers for important events like the Missing and Murdered Indigenous Women and Girls annual day of recognition and the National Day for Truth and Reconciliation. Through dialogue, small groups, and one-on-one conversations we try to educate healthcare providers on Indigenous health.

Since its opening in 2018, what have been the major outcomes of this initiative?  

One of the teachings that I had from an Elder on our Decision-Making Council was “Lisa, build a small fire and people will want to come.” I interpreted it as “don’t start by wanting to build this great big program. Just start by doing the work within Women’s College and eventually, people will want to participate if it’s done in a good way.” We have very strong community partnerships. We have an Elder-in-Residence who has a Traditional Medicine clinic. We have hired a Patient Relations advocate–an Indigenous peer support and a patient and relations advocate who will sit with patients to accompany them on their journey and connect them to resources both within and outside the hospital. We additionally have a team that goes into community organizations, meets with individuals and tells them about what we’re doing. I feel very strongly about recruiting and supporting the next generation of Indigenous people in health care–advocates, leaders, providers, and scientists, and so we have a lot of Indigenous learners who do their placements or work on projects with us. We have a collaboration with the medical school, which means that Indigenous medical students come and hang out in our space where they can be surrounded by Indigenous peoples, and connect with community members and Elders. We also have an amazing summer camp program for grades 9-10 Indigenous learners. Beyond the hospital, we have worked on outreach programs to help support Indigenous primary care practitioners who are working in isolation and on the reserves. We have specialists who are going out to the reserves to provide consultations as needed. 

 

When incorporating Indigenous voices, how do initiatives and foundations avoid non-meaningful engagement and prevent tokenism? 

I think building something slowly and carefully and led by Indigenous peoples has been important for us as well. This is the opposite of having a single person in a single role and on their own trying to transform a whole institution, which is generally not successful. Importantly, we have Indigenous people in senior leadership roles overseeing everything we do for accountability purposes.  I think one important structural aspect of the Centre is the dual accountability within my role. I report both to the CEO and to our Decision-Making Elders. I do my check-ins with both and thus am held accountable by leaders in our community who can advise me on what would and wouldn’t be appropriate. This is essential for me because it helps ensure that the work is grounded in the needs of our people.

 

Why the focus on women’s health? 

There’s a reason why we’re centred at Women’s College Hospital. It’s a hospital that cares for all people but understands some of the specific needs of women and gender-diverse peoples in healthcare.  At our Centre, we understand that for our communities and for the future generations to be healthy, we need women, children and families to be healthy.

Osteoporosis in Canadian Women: Building Strong Bones for a Healthy Life

Author: Shali Tayebi, MSc Global Health, University of Copenhagen | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: February 12th, 2021

Osteoporosis is a metabolic bone disease that is a major public health issue. It also places a tremendous physical, emotional and mental burden on those who it afflicts. Over 200 million people worldwide are affected by osteoporosis. There are 2.2 million people with osteoporosis in Canada; a country with a growing and ageing population [3,7]. 

The disease is characterized by weakening bones, which increases the risk of fractures. Most often, people live with bone loss for many years without knowledge of their condition until their first fracture — most commonly in their hip, wrist, or spine. Physical consequences can include reduced mobility, disability, chronic pain, loss of height, and premature death [7]. 

Subsequent psychological effects can follow. This includes depression in reaction to living with a chronic condition and anxiety stemming from a fear of future injuries and falling. People may experience a social decline through the loss of social duties and social isolation [7]. 

Causes

The causes of osteoporosis are grouped into primary and secondary classifications. The primary group mainly consists of older individuals experiencing changes in hormone levels after reaching menopause and from chronic low dietary calcium. In the secondary group, low bone mass is a side effect of other health conditions [3]. 

Risk Factors

More than 80% of cases in Canada are women. This increased risk is due to several factors. First, women tend to have thinner, smaller, and less dense bones than men. Women often also have longer life spans than men and are more likely to make up a bigger portion of those with osteoporosis in older demographics. Lastly, a bone mass loss can be attributed to the sex-exclusive biological event of reaching menopause due to dramatic hormonal changes.

Other notable co-risk factors include small body size (weighing less than 127 pounds), eating disorders, missing menstruation for at least three consecutive months (amenorrhea), and genetics. Ethnicity affects the prevalence of osteoporosis through the correlation of bone mineral density (BMD) [3]. In one study conducted by Keen and Reddivari (2020) in the United States, the highest prevalence rates were noted in Indigenous Americans with 11.9%, Asians 10%, Hispanics 9.8%, Caucasians 7.2%, and Black Americans 4% [3].

Prevention

Building strong bones and using preventative strategies is essential in maintaining good health later in life. New bone generation slows down with age compared to bone loss, so early prevention is critical. By 18 years of age, women have already developed 90% of their bone mass. Thus, it is crucial to minimize health problems that impede building bone mass early in life, such as eating disorders, poor diets, and lack of physical activity. Once reaching adulthood, it is important to adopt healthy habits and activities so that the natural degradation of the bones is reduced. Exercise, especially weight-bearing activities that work the body against gravity, such as dancing, tai chi, yoga, running, and walking, help build strong bones and prevent bone loss.

Mitigation strategies include lifestyle changes, such as cessation of smoking, reducing alcohol consumption, and adequate calcium and vitamin D intake. The amount of calcium one needs depends on the person’s age. Since the body does not produce calcium, it needs to be consumed through foods such as milk, cheese, tofu, soy-milk, breakfast cereals, and leafy green vegetables. If the daily calcium intake is insufficient, the body uses calcium found in the bones which weakens them over time. 

Vitamin D assists the body to absorb calcium from the consumed foods and supports bone growth and reformation. The skin can naturally make vitamin D through sun exposure. But the amount needed varies depending on one’s skin tone, use of sunscreen, the season, and age. Foods such as salmon, tuna, and egg yolks can also be a good source of vitamin D. Notably, Health Canada recommends that people over 50 years of age take daily vitamin D supplements, since obtaining sufficient vitamin D exclusively through diet and sunlight can be difficult [7]. 

Burden in Canada  

In a report by the Canadian Institute of Health Research (2016), the national costs attributed to osteoporosis fractures in 2011 cumulated to $4.6 billion. This is an 83% increase since the previous 2008 report [2]. The increase in expenditures are explained by the rise in admissions for acute care, rehabilitation, and complex continuing care [2]. Such findings also underlie the necessity of using more healthcare resources and preventative care for this disease [2]. 

In assessing Canada’s different elements of osteoporosis care, the health care system performs generally quite well – there are short wait times for hip fracture surgery and integration of various risk assessment algorithms [1]. However, further initiatives could be taken, such as a nation-wide fracture database to track incidence rates and monitor the delivery of healthcare. Osteoporosis is also not officially recognized as a health priority in many provinces [1]. 

Most importantly, there is a salient gap in best-known practices of care and the actual services that are provided [7]. Of those with an osteoporosis-related injury, less than 20% received a BMD diagnosis test or any medication within one year of the fracture [7]. 

Factors contributing to this inadequacy are multidimensional. In the context of the patient, there is compromised access to proper testing and treatment, lack of recognition of risk, and lack of healthcare provider awareness.  At a health system level, there is an insufficient alliance between hospitals and community health systems, and poor communication between clinicians over secondary prevention of fracture responsibilities [7]. 

Osteoporosis disease is a heavy burden on public health and women’s health in particular. It is important to raise awareness around the risk factors and encourage women to make long-term lifestyle changes to prevent osteoporosis. Exercising and reducing harmful behaviours such as smoking and drinking alcohol are essential steps in maintaining strong bones. Osteoporosis prevention and treatment need to be a strategic priority within the public health system throughout the country. 

References

1. Amgen Canada. (2020, October 20). New Scorecard Reveals Critical Need to Make Osteoporosis a National Health Priority. Cision. https://www.newswire.ca/news-releases/new-scorecard-reveals-critical-need-to-make-osteoporosis-a-national-health-priority-806500026.html

2. Hopkins, R. B., Burke, N., Von Keyserlingk, C., Leslie, W. D., Morin, S. N., Adachi, J. D., … & Tarride, J. (2016). The current economic burden of illness of osteoporosis in Canada. Osteoporosis International, 27(10), 3023-3032.

3. Keen, M. U., & Reddivari, A. K. R. (2020). Osteoporosis In Females. StatPearls [Internet].

4. National Osteoporosis Foundation. (2020, December 21). What Women Need to Know. https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/

5. “Osteoporosis Canada.” Osteoporosis Canada |, 4 Jan. 2021, osteoporosis.ca/. 

6. Osteoporosis | Womenshealth.gov. (2019, May 20). Womenshealth.Gov. https://www.womenshealth.gov/a-z-topics/osteoporosis

7. Public Health Agency of Canada. (2020, November 27). Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System 2020 – Canada.ca. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoporosis-related-fractures-2020.html

Photo by Lucas Favre on Unsplash

Women’s Health in Review: 2020

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators)

Published: January 15th, 2021

With the dawn of a new year, many are hoping to move past the tumultuous events of 2020. But who can blame them? 2020 will be memorialized in future history books as the year the world came crashing down. In particular, women felt the strain with increases in domestic violence and economic consequences disproportionate to men. For much of the past year, the news and social media painted a grim picture of the world. So it begs to question, did anything good happen in 2020? Is there hope that 2021 will be any better?

In fact, there were many triumphs in women’s rights and health in 2020. While 2020 was a year of unprecedented challenges, the year also highlighted the resilience of women across the globe. Below, we’ve highlighted several successes in 2020 worth celebrating as we begin the new year. 

Argentina legalizes abortion

After 12 hours of debate and tension, Argentina’s Senate voted and legalized abortion. Historically seen as a conservative region, this decision is a major victory for women and activists fighting for the right. It is believed that hundreds of thousands of underground abortions are performed in Argentina every year. The new abortion laws would legalize the procedure and ensure safe practices for women choosing to undergo it. The arrival of these new laws also brings hope for surrounding Latin American countries, in the desire that they will follow suit and also legalize the procedure. 

Pakistan banned virginity tests

A few weeks ago, the high court of Lahore, Pakistan outlawed the use of virginity tests on female rape survivors. Justice Ayesha Malik stated that invasive tests had no legal basis or medical requirement for them to be carried out. Additionally, the practice was deemed a humiliating offense on victims with dangerous potential to re-traumatize them. While the judgement will only apply in the state of Pubjab, it was nevertheless a historic moment for Pakistani activists and the feminist movement. 

25th anniversary of the Beijing Declaration on women’s rights

This year marks the 25th anniversary of the Fourth World Conference on Women, which set a historic agenda for women’s rights. At this conference, over 30,000 activists and representatives from 189 countries adopted a declaration and platform to oversee the equal rights and opportunities of all women. However, other than celebrating this historic event, the anniversary is a wake-up call for countries committed to the declaration. No country has fully delivered or is close to the 2020 goals envisioned by the conference. With COVID-19 exacerbating inequalities and risks for women, it becomes even more essential to continue pushing for women’s rights and women’s health in the coming years. As Hillary Clinton so rightly phrased at this very conference 25 years ago, “Women’s rights are human rights, and human rights are women’s rights.”

Two women scientists awarded Nobel prize in chemistry

Emmanuelle Charpentier and Jennifer Doudna were awarded the 2020 Nobel Prize in chemistry for their work on gene-editing technology. Their tool, known as CRISPR-Cas9, has already had encouraging results in experimental treatments for sickle cell disease. The women mark the eighth and ninth women to ever receive this award since 1901. Despite previous history of women receiving the honour, Charpentier and Doudna make history as the first all-female winners for the Nobel’s chemistry stream. 

Vast improvements of sex inclusion in biological studies

Since the 1990s, the limitation of sex-biased studies and the need for the inclusion of females has been highlighted in research. A 2009 report by Beery and Zucker further highlighted sex-inclusive practices and policies that could mitigate biases and prompted the United States National Institutes of Health to implement a policy that required researchers to consider sex as a biological variable. The policy was intended to ensure equal representation of males and females in studies but received backlash by those who saw the change as unnecessary, time consuming, costly, and complicated. Now over ten years later, a follow-up study has found that the policy has significantly helped in increasing the number of sex-inclusive studies across most biological fields. While much work is still required, there is hope that the scientific community is aware and starting to understand the need for sex-inclusive research. 

Ground-breaking mRNA research is foundation to COVID-19 vaccine

Dr. Katalin Karikó is one of the co-developers of a method that utilizes synthetic mRNA to fight disease. Her discovery is now the foundation of the COVID-19 vaccine. But her story hasn’t been an easy one. After leaving her native Hungary in 1985, Karikó became a researcher at Philadelphia’s Temple University and later at University of Pennsylvania’s School of Medicine. For years she attempted to gain funding for mRNA research, which was deemed too financially risky to fund. She was later demoted from her position at UPenn and underwent a hard battle with cancer, but Karikó stayed true to her ideas. Eventually, she was able to make her discovery, alongside former UPenn colleague Drew Weissman, and is finally receiving recognition for her work. 

Oxford-AstraZeneca vaccine brings hope

Dr. Sarah Gilbert is a Professor of Vaccinology at the University of Oxford, who has recently made waves in the world with her team’s Oxford-AstraZeneca vaccine. Interim data showed that the highly effective vaccine provides 70% protection from COVID-19, but some believe that slight alterations can lead up to 90% protection. Dr. Gilbert’s team has been working to create vaccines for Ebola and MERS for several years. As such, their expertise with these viruses enabled them to design a COVID-19 vaccine soon after Chinese scientists had published the genetic structure of the virus. 

Moving forward into 2021

Without question, the events of 2020 disproportionately impacted women. The stories and events we’ve highlighted here are evidence of women’s determination to advance despite adversity.  While 2021 will undoubtedly bring many more challenges, as shown here, these writers are confident that women will continue to rise to the occasion.