CPHS Fellows 2006-7

 Ron Bouchard| Lauren Classen| Lisa Forman|
Maritt Kirst|Paul Jackson|Angela Loder | Monir Moniruzzaman| Maureen Murney| Daniel Sahleyesus| Leigh Turner| Leah Walz |

Ron Bouchard
CPHS Research Associate

“Systems Analysis Model for the Production, Construction and Use of Scientific Evidence in Drug Regulation”

Biography: Ron Bouchard was called to the bar in 2000 and is currently an SJD student in the Faculty of Law. Prior to entering graduate studies in law he practiced intellectual property law, with an emphasis on biotechnology and pharmaceutical inventions. He has been involved in the prosecution, acquisition, financing, distribution and litigation of intellectual property rights, appearing before the Federal Court of Canada on both trial and appeal matters, and the Supreme Court of Canada. Before entering law, Ron completed a PhD in Pharmacology & Therapeutics and a Post-Doctoral Fellowship in the area of ion channel biophysics and intracellular ion imaging. He has worked for several years as a consultant in this area and as a management consultant on matters pertaining to technology commercialization, technology valuation and other intellectual property and policy issues relevant to government and the life sciences industry.

Project Abstract: Recent controversies illustrate that significant financial interests in the outcome of medical research can compromise research integrity. Various regulatory tools have been proposed or introduced by various agencies and professional organizations, but these largely ad hoc remedies do not address the operation of the system as a whole and thus their success remains limited. My doctoral work in law uses an interdisciplinary systems approach to unravel the complex forces at play in the establishment of scientific evidence and develop recommendations for regulatory change at the national and international levels. In particular, I am interested in testing four hypotheses: Hypothesis 1: There is a crisis of confidence with respect to the integrity of medical data. This crisis is particularly strong in the context of the development of pharmaceuticals, where there is a perception of conflict between public and private interests in the structures and processes involved in drug research, commercialization and regulation. Hypothesis 2: This conflict between public and private interests is associated with significant regulatory policy shifts associated with the commercialization of research: (a) the shift from a concept of a “scientific commons” to a private-public co-funding model of research; (b) the influence of intellectual property law and associated international treaties such as TRIPS; and (c) accompanying changes in the regulatory landscape underpinning the drug approval process. Hypothesis 3: The impact of policies and regulations on independent medical research and scientific inquiry is significant, complex and multidirectional. Policy changes and regulations impact how scientific research is being conducted and these shifts in the conduct of science also impact further on other aspects of the regulatory environment. Hypothesis 4: Improving or restoring the integrity of medical research requires a regulatory approach that addresses the complex nature of the interaction between these different factors.

Lauren Classen
Lupina/OGS Doctoral Fellow

“Appropriate Evaluative Approaches for Integrated and Eco-Health Projects: Assessing the Efficacy of 'Participation' for Providing Representative and Reliable Indicators for Measuring Project Impact”

Biography: Lauren Classen is a 28 year-old PhD student at the University of Toronto, who is delighted to be studying in the field of Medical Anthropology, which emphasizes the value of a multidisciplinary approach to examining global health issues. Lauren works at the interface of the natural resource management, agriculture and health.

By day, Lauren aims through her research to enhance livelihoods, food security and health for HIV/AIDS-affected youth in northern Malawi (see research abstract for more details). Further enhancing her development experience (not to mention her frequent flyer point balance), Lauren also continues to work with a participatory agricultural project in north-central Honduras that she first became involved with during her master’s research in the field of Rural Anthropology and International Development at the University of Guelph. Upon completion of her degree, Lauren worked as an impact assessment consultant in Honduras for the International Centre for Tropical Agriculture for two years. Currently, she is collaborating with farmers in Honduras to write a book chapter on their experiences and perceptions of ‘participatory development’, due for publication in fall 2007. By night, Lauren is an aspiring chef, working towards a Culinary Arts Certificate at George Brown College. In her spare time Lauren likes to run and cycle and enjoys getting out of the city to camp, kayak and canoe Canada’s incredible natural landscape.

Lauren’s passion for working in the field of rural development was cultivated from birth, as was her taste for delicious and nutritious food! Having grown up on a grain farm in southern Manitoba, Lauren is keenly aware of the vulnerability of agricultural livelihoods and is dedicated to improving the viability and sustainability of agriculture worldwide.

Project Abstract: Entering the second year of her PhD in Medical Anthropology, Lauren is working in collaboration with the Soils, Food and Healthy Communities Project in central Malawi to engage HIV/AIDS-affected youth in developing a framework for improving livelihoods and safeguarding health. Lauren’s research will combine a variety of participatory and visual anthropological research approaches to explore the preservation and transmission of agricultural, nutrition and health knowledge in families differently affected by HIV/AIDS. Recognizing that the traditional bilateral approach to development aid has been inadequate in meeting the needs of the poor, Lauren will also examine the appropriateness of south-to-south collaboration between youth in different developing countries for breaking down power structures embedded in the conventional model of ‘development’ and promoting local expertise and capacity building. She will facilitate communication and collaboration between youth engaged in a participatory agriculture research project in north-central Honduras (Comites de Investigacion Agricola Local) and youth in Malawi and will use participatory methods to measure the extent to which the exchange fosters ongoing multi-stakeholder collaboration and knowledge generation.

Lisa Forman
CPHS & CIHR Post-Doctoral Fellow

“Integrating Human Rights Standards into
Trade Law and Policy: Theoretical Linkages
and Practical Mechanisms”

Biography: Lisa Forman qualified as a lawyer in South Africa with a BA and LLB from the University of the Witwatersrand. Her graduate studies include a Masters in Human Rights Studies from Columbia University, and an SJD from the University of Toronto, Faculty of Law. Her doctoral dissertation explored the role of human rights in increasing access to AIDS medicines, focusing on South Africa as a case study. For the past decade, she has specialized in the area of human rights and HIV/AIDS. Forman has published several academic articles and book chapters in these and related areas, and has presented her research at international and national conferences.

Project Abstract: Forman's research focuses on international human rights law relating to HIV/AIDS, health and medicines, and their normative and coercive power to ensure better public health outcomes. Her doctoral research explored this question from the perspective of essential AIDS medicines, an inquiry which also noted the impact of international and bilateral trade rules on medicines access, and the notable lack of interaction between trade and human rights in international law. This research provided the groundwork for her postdoctoral research, which will explore methods of ensuring this interaction and in particular, how human rights can be utilized to ensure better public health outcomes in the formulation and implementation of trade policies. Her research will explore the theoretical relationship between trade and human rights in international law, as well as examine practical mechanisms for ensuring that trade rules do not restrict human rights, including the potential use of a right to health impact assessment mechanism.

Maritt Kirst
Lupina/OGS Doctoral Fellow

“The Influence of Social Capital on Drug Use-related Health Behaviours: A Comparison of Injection Drug Users and Crack Smokers”

Biography: Maritt Kirst is a doctoral candidate in the Sociology Department at the University of Toronto, and is also a member and student representative of the Collaborative Program in Addiction Studies. She holds a Masters degree in Criminology from the University of Ottawa, and an Honours BA from McMaster University. Her research interests pertain to substance use and misuse, harm reduction, social capital, social networks, protective health behaviours, and crime and deviance. Maritt has worked in the addiction research area for 7 years, and her doctoral research examines the influence of social capital on the drug use-related health behaviours of illicit drug users in Toronto.

Project Abstract: Many illicit drug users are aware of the health risks associated with certain drug use behaviours, but some users continue to engage in risky behaviours, such as needle-sharing, drug sharing, and other drug use equipment sharing, despite this knowledge Health risk behaviour stems not only from an individual’s knowledge and beliefs, but is also shaped by processes of influence and constraint operating within social relationships. The analysis of users’ social relationships is therefore important to understand engagement in drug use-related risk behaviours, and protective health behaviours. Kirst’s study examines how social capital within the networks of injection drug users (IDUs), and crack smokers (CSs) influence drug use-related health behaviours.

This research is timely as the prevalence of infectious disease, overdose experiences, and other drug use-related health problems among this population remains high in many Canadian cities. Such a high prevalence of drug use-related health problems presents a broader public health risk of morbidity and mortality related to infectious diseases such as HIV, Hepatitis B and C, and creates costs to Canadian society, such as economic costs related to health care and law enforcement (Rehm, Baliunas, Brochu et al. 2006). This research is also important because it explores the access to and effects of social capital among a marginalized population such as illicit drug users. Previous research on social capital has focused its attention on access to and effects of social capital among more privileged social groups, and has insufficiently recognized that marginalized populations can also generate social capital that can produce positive individual and group benefits. The findings of Kirst’s study will add to the understanding of how network structures may be harnessed to improve harm reduction approaches that will help users to minimize the individual and public health harms associated with illicit drug use in Canada.

Paul Jackson
Lupina/OGS Doctoral Fellow

“Cities, Fear, and the Nature of Disease: Toronto's Position in an Infectious World”

Biography: Paul Jackson is a doctoral candidate in the Department of Geography at University of Toronto. Paul is fascinated in the culture and politics that arises from highly infectious diseases and the urban political ecologies that give rise to said diseases. Paul received his undergraduate from York University completing a double major in Political Science and Urban Studies. Continuing at York, his Masters' work in the Faculty of Environmental Studies investigated the heated politics around Toronto's Greenbelt between environmentalists, planners and farmers. Paul has had the fortune to work with three collaborative SSHRC funded projects looking at the Oak Ridges Moraine, SARS, and presently Toronto's waterfront. Topics of research interest include: nature, commodities and capitalism; urban security and bio-terrorism; 19th century industrialization and pollution; urban planning and neoliberalism; theories of degeneration, eugenics and abnormal bodies; sanitary social movements and sewer infrastructure; the state's management of urban populations; and the history of medicine and science.

Project Abstract: Paul Jackson's contention is that the filthy choleric city of the 19th century was a geography where fear, science, and politics were pooled together. The fear of the filthy city allowed urban reformers' imaginations to run wild, amalgamating biology, race, and remote places. The image of filth became a channel where these associations could be dumped, publicly digested and read into local landscapes. Diseased peoples and diseased places became sites where the bacteriological city could be tackled and eradicated. Therefore urban political ecology cannot be separated from the social, cultural and political transformations of the 19th century. The repeated cholera epidemics of the 1800s saturated the geographic imagination of Canada, Europe and throughout the entire colonial project. There was the correlation of urban and natural spaces in India, Europe and North America by the very physicality of geographies and bodies. In one corner of the British Empire, the industrial development of Toronto’s waterfront transformed Ashbridges Bay. Ashbridges Bay--at the mouth of the Don River, directly adjacent to the growing city--was a swampy ecology, a site of growing industry and increasingly residential homes. Concerns over water purity and disease were vital in the drive to reshape the shoreline for industry. This connection between disease, filth and Ashbridges Bay may have remained just an inferred relationship; however the assertion of this project is that, in the summer of 1832 when cholera entered Toronto, this political and cultural rupture gave validity and urgency to the reconstruction and sanitation of Toronto's waterfront. This research is an attempt to explore the interstitial spaces between these places and the practices around disease. How fear and morality along with the materiality of disease became productive-- a 'positive evil' as one Toronto industrialist labeled cholera.

Angela Loder
Lupina/OGS Doctoral Fellow

“Greening the City: Exploring the Relationship Between Health, Well-being, and the Perception of Nature in the Workplace”

Biography: Angela Loder is in the third year of her Ph.D. at the University of Toronto in the department of Geography and the Centre for the Environment. Her primary research focus is the relationship between health, well-being, and perceptions of urban greening projects, looking specifically at green roofs in the workplace. She is particularly interested in the possibilities green buildings and green roofs can bring to the ecological city, as well as how nature informs our sense of place and belonging in an urban context. Angela’s work experience in the green roof industry, combined with her academic background in political science and philosophy, inform her research. She has presented papers on green roofs, smart growth, and infill development, as well as critiques of current research on our relationship with nature and our well-being. She is also developing policy documents for Environment Canada on integrating green roof policy into Ontario’s Smart Growth objectives. Angela is heavily involved in her departmental student’s union and the Graduate Student’s Union as well as the Toronto contemporary dance community.

Project Abstract: Green roofs have been proven to reduce and clean stormwater runoff, reduce the urban heat island effect, reduce cooling costs for buildings and provide habitat for birds and insects. Green roofs are often part of green building projects, and by minimizing the ecological impact of their construction and maintenance, contribute to a more ecological city. With green buildings has come a focus on how the physical environment affects the productivity and well-being of workers, seen in recent daylighting and ventilation studies. What has not been studied is the potential relationship between green roof projects and worker’s health and well-being, despite the popular sentiment that people like them and feel good around them. Furthermore, though the human relationship to nature and well-being has been extensively studied by environmental psychologists, there is very little that examines why people feel or think the way they do about nature, and no research has looked at green roofs as a potential case study. Understanding some of the ideals, concepts, and emotions behind people’s perception of urban nature I argue is essential for understanding its link with health and well-being, as well as ensuring successful greening projects. Through qualitative interviews and quantitative surveys of office workers’ perceptions of green roofs in three case studies in Chicago, Toronto, and London, all cities with significant green roof implementation, my research addresses both the potential benefits to worker’s well-being from urban greening projects, thus contributing to the ecological and healthy city literature, as well as using the theoretical insights from the social construction of nature debate to better understand why we feel the way we do about urban nature.

Monir Moniruzzaman
Lupina/OGS Doctoral Fellow

“Human Organs for Sale: An Exploration of the
Kidney Bazaar in Bangladesh”

Biography: Monir Moniruzzaman is a PhD candidate in the Department of Anthropology, University of Toronto. He received his MA from the University of Western Ontario of Canada and MSS and BSS (Hon's) from Jahangirnagar
University of Bangladesh. Monir taught three years as a full time faculty in the Department of Anthropology at Shahjalal University in Bangladesh. His major research interests include: new biomedical technology, kidney commodification, healthcare services in post-tsunami Thailand, perception of poverty, and educational curricula in Bangladesh. One of his articles has been accepted to be published from Bangladesh and the other one was from India. Monir has presented numerous papers in international conferences, such as renowned American Anthropological Association, Canadian Anthropological Society, and Society of Medical Anthropology. He has been awarded Ontario Lupina Graduate Scholarship, HCTP Research Grant, Lorna Marshal Fellowship, Dipty Chakravarty Scholarship, Edward W. Nuffield Travel Grant, and U of T
Faculty of Arts and Sciences Student Award. Currently he is writing up his research findings to defend the dissertation.

Project Abstract: Improvements in transplant technology, the global commercialization of health care, and the increasing divide between rich and poor have created conditions for a thriving and growing trade in human organs. The price quoted on the open market for a kidney is CAN $2000 in Bangladesh, a nation which serves as an
organ bazaar for both national and international wealthy bodies. My doctoral research analyzes the contexts and conditions of human organ commodification in Bangladesh. Specifically, two key questions are explored: i) How do Bangladeshis participate in the illegal marketing of organs; and ii) how do the sellers experience the lived realities of kidney commodification? In spite of facing tremendous difficulties in accessing people secretly involved in the illegal trade of human organs in Bangladesh, I interviewed 33 kidney sellers as well as other research subjects (including patients, health personnel, and organ brokers) between September 2004 and July 2005. Like the debate over "Female Genital Mutilation," the issues surrounding the "extraction" of organs from impoverished bodies are complex and contentious. By analyzing the local contexts of organ commodification, my research will explore important questions as to whether it is ethical to purchase an organ to strive toward longevity, and whether the sale of one's organ is an appropriate means of fighting poverty. My research will contribute to the broadening debate of human rights, health and dignity, and will show the ways in which an anthropological perspective can contribute to understanding and perhaps resolving aspects of these disputes.

Maureen Murney
Lupina/OGS Doctoral Fellow

“Navigating (In)Appropriate Femininity: Motherhood, Addiction and ‘Transition’ in Western Ukraine”

Biography: Maureen Murney is a doctoral candidate in social-cultural anthropology in the Department of Anthropology at the University of Toronto. She received an MA in anthropology from the U of T and a B.Sc. in biology from the University of Western Ontario. Maureen draws upon social-cultural, medical and linguistic anthropology as she explores gendered notions of health, illness, morality and citizenship. Her masters research entailed a critical discourse analysis of North American prevention literature regarding fetal alcohol syndrome. Her doctoral research has focused upon addiction, stigma, reproduction, nationalism, and the ambiguities involving access to and the utilization of medical knowledge in western Ukraine. Maureen has presented her findings at several national and international conferences. She enjoys teaching, and aside from being a teaching assistant, she has guest lectured at the University of Toronto and in Ukraine.

Project Abstract: My research explores the relationship between discourses of normative behaviour, health seeking practices within and outside official healthcare institutions, and the daily lived experiences of Ukrainian women who are addicted to alcohol (especially women of reproductive age). The project is based upon 13 months of ethnographic fieldwork in Ukraine with healthcare providers, development workers, and women and men who self-identify as alcoholics.

Particularly in western Ukraine, the traditional seat of Ukrainian nationalism and religion, the pagan goddess Berehynia and the Christian Virgin Mary are being referenced to characterize the “authentic” Ukrainian woman as protector of family and nation. A difference is recognized between acceptable social suffering, that which provides laudable evidence of strength and endurance (e.g., coping with a husband’s or son’s addiction), and the unacceptable social suffering of those who have “fallen,” who have not overcome their personal circumstances to embody the Berehynia. Accordingly, women who become addicted to alcohol are seen to have (consciously) rejected the very essence of Ukrainian womanhood. As such, alcohol dependent women are often reluctant to “confess” and seek treatment. A common facet of healing entails adopting the modernist notion that addiction is a disease. Simultaneously, another facet involves experiencing a shift from the marginalized social periphery to the moral centre as a process of personal redemption. Both aspects of healing reify individual responsibility while overlooking disruptive social, political and economic forces. My research therefore explores the gendered relationship between substance dependence and social vulnerability.

Daniel Sahleyesus
CPHS Research Associate

“HIV/AIDS, Orphans and Vulnerable Children in sub-Saharan Africa: The Case of Ethiopia”

Biography: Daniel Sahleyesus is currently a SSHRC Post-Doctoral Fellow at the Centre for International Health at the University of Toronto. He received his PhD from the University of Western Ontario and has also studied in Ethiopia, Germany and Canada. Daniel worked for several years for the public and the non-profit community in Ethiopia and is co-founder of a successful school project in Jimma, a town in southwest Ethiopia, where he completed his high school education.
Project Abstract: Children orphaned due to AIDS and those whose survival and well-being are endangered by the epidemic are facing the greater risk of psychosocial, emotional, health, and physical problems. In the context of HIV/AIDS, orphan and vulnerable children are forced to witness the prolonged illness and death of parents or other family members. Following these events, children also experience stigma and discrimination within their community. Psychosocial distress about their future, the risk of HIV/AIDS itself, and exposure to sexual and other forms of exploitation are some of the challenges that orphan and vulnerable children are facing (Hunter and Williamson 1997).

Ethiopia has one of the most severe epidemics in sub-Saharan Africa. Currently, about 1.3 million people are living with HIV/AIDS and there are about 745,000 orphaned children as the result of AIDS (MOH-HAPCO, 2006). By combining both quantitative and qualitative research approaches, Daniel’s research aims to explore the following major questions. How is the well-being of orphan and vulnerable children affected by the HIV/AIDS epidemic? Does the impact of the epidemic vary at the different stages of the child’s age and according to gender? To what extent does the morbidity and mortality experience of children differ for those with either or both parents are living with the virus or died of AIDS and for the rest of the population? To what extent is there an association between perceived risk of HIV/AIDS and risky sexual behavior in the population?

Leigh Turner
CPHS Distinguished Visitor

“Globalization, Bioethics, and Transnational Migration of Health Care Providers”

Biography: Leigh Turner is an Associate Professor in the Biomedical Ethics Unit and Department of Social Studies of Medicine at McGill University. He Chairs the Biomedical Ethics Unit’s Master’s Specialization in Bioethics and teaches such courses as Religion and Medicine, Bioethics &World Religions, and Bioethics Theory. In 2003-2004, Turner was a Member of the School of Social Science at the Institute for Advanced Study in Princeton, New Jersey. From 1998-2000, Turner was an Assistant Professor at the University of Toronto Joint Centre for Bioethics and a clinical ethicist at Baycrest Centre for Geriatric Care and Sunnybrook & Women’s College Health Sciences Centre. In 1999, Turner was a National Endowment for the Humanities/Sealy & Smith visiting scholar at the Institute for the Medical Humanities, University of Texas Branch in Galveston. From 1996-1997, Turner worked as a Research Associate at the Hastings Center in Garrison, New York. Turner received his PhD in 1996 from the School of Religion and Social Ethics at the University of Southern California. The View from Here: Bioethics and the Social Sciences, edited by Raymond De Vries, Leigh Turner, Kristina Orfali, and Charles Bosk, will be published by Blackwell in 2007. Turner’s current interests include ethical issues related to migration of health care providers, globalization and international health, and medical tourism. His research within the Comparative Program on Health and Society at the University of Toronto’s Munk School of Global Affairs will explore ethical, social, and economic concerns related to migration of health care personnel from relatively poor societies to comparatively wealthy nations.

Project Abstract: Through the 1990s and into the first decade of the 21st century, physicians and nurses emigrated in large numbers from such countries as Ghana, India, Malawi, Nigeria, South Africa, the Philippines, and Zimbabwe. Leading “destination” countries include Australia, Canada, the United Kingdom, and the United States. Numerous “push” and “pull” mechanisms propel health care providers from poor, developing societies to wealthy, resource-rich, developed nations. My research project will explore social dimensions of the transnational migration of health care providers, assess the many ethical issues generated by this complex process, and propose policy recommendations. The global integration of labour markets for health care providers is generating an exodus of health care providers from nations with limited economic resources, severe shortages of doctors and nurses, high infant and maternal mortality rates, and low life expectancy rates. Health care providers are relocating to countries with high per capita expenditures on health, low infant and maternal mortality rates, and high life expectancy rates. Migration patterns are increasing health inequities, damaging community health programs, and undermining the capacity of developing societies to treat individuals with HIV, tuberculosis, malaria, and other diseases. My project will examine migration patterns, relevant economic, social, and cultural factors, and related ethical issues while attending to the particularly important moral consideration that existing migration patterns risk exacerbating global health inequities.

Leah Walz
CPHS Research Associate

“Malta, Motherhood, and Infant Mortality: Integrating Biological and Sociocultural Insights”

Biography: Leah Walz is a PhD candidate in the department of Anthropology at the University of Toronto. As an undergraduate student at the University of Manitoba, Leah began to develop an interest in both the biological and sociocultural aspects of medical anthropology, which has carried over into her doctoral studies. Her current research interests include examining the social, cultural, and biological determinants of health; the impact of colonialism, globalization, and other global forces on patterns of health and disease; and exploring past and present medical systems and perceptions of health and illness.

Under the supervision of Dr. L.A. Sawchuk, a medical anthropologist and head of Health Studies at the University of Toronto at Scarborough, Leah has been involved in a number of projects looking at historical and contemporary aspects of health and disease. Current research includes: examining the contexts and determinants of adolescent substance use in Gibraltar, exploring discourses on prostitution and venereal disease in early 20th century Malta, and tracing the progress and effects of past epidemics of yellow fever in the Mediterranean.

In addition, Leah has had the opportunity to develop and teach a new course at UTSC, entitled ‘Health, Aging, and the Life Cycle’, which takes an interdisciplinary approach to the examination of (so-called) normal and pathological aspects of the aging process.

Project Abstract:l A central aim of Leah’s thesis project is to explore how the social milieu, political economy, and historical context informed and influenced the discourses surrounding—and the experiences of—infant mortality in the Maltese Islands. In her approach to this complex historical question, her objectives are as follows:

1. To employ the techniques of biomedicine to explore infant mortality: to utilize conventional biomedical analyses and indices to establish the level of infant mortality for Malta over time (1900–1950), the causes of the observed mortality, as well as the magnitude and nature of its spatial variation.
2. To examine some of the factors that may be involved in these trends in mortality, such as presence of health services, environmental health conditions, socioeconomic status, and education, and to measure the strength of the relations. She places great emphasis on ascertaining the role played by culturally rooted practices, such as breast-feeding, age and season of weaning, birth spacing, and family size, in the expression of infant survivorship—to thereby demonstrate the ways in which patterns of health, disease, and death reflect the interdigitation of cultural and biological phenomenon in human populations.
3. To interrogate these biomedical analyses by placing the statistical findings within the larger context of colonial domination: the political, economic, and social marginalization of the Maltese people—as captured by colonial discourses surrounding the Maltese, mothering, and the infant mortality rate—to show how this mediated colonial responses to infant death.