CPHS Fellows 2008-9

 Sara Allin| Roger Chafe|Lisa Forman| Regine King|Leah Shumka | Heather Spielvogle| Patrick Zylberman|

Sara Allin
CPHS & CHSRF Post-Doctoral Fellow

“Socioeconomic Status, Access to Health Services, and Health Outcomes”

Biography: Sara Allin is a Research Fellow and PhD candidate at the London School of Economics and Political Science in the research institute of LSE Health within the department of Social Policy. Her PhD thesis is entitled “Equity in the use of health services in the Canadian health system: an examination of provincial variation, prescription drug insurance and unmet need”. This research has methodological and policy-relevant findings, such as the possible equity implications of extending prescription drug coverage, and the complexity of subjective measures of access barriers. As a staff member with LSE Health and the London hub of the European Observatory on Health Systems and Policies, Allin regularly works on comparative projects for national and international organizations on themes related to health care access, public health policies, and health status and inequalities. She has also been involved in teaching, both facilitating seminars on MSc courses and delivering occasional lectures. Over the past five years Allin has presented her work in several policy and research settings and has published in peer-reviewed journals.

Project Abstract: The research plan for Sara Allin's postdoctoral fellowship is to develop her doctoral research on equity in order to address some key health policy questions relevant to Canada. She will be based in the University of Toronto’s department of Health Policy, Management and Evaluation, and affiliated with both the Ontario Ministry of Health and Long Term Care and the Comparative Program on Health Policy, Munk School of Global Affairs. Drawing on two types of data sources – survey data and patient-level data of health care utilization, this project will address several research questions related to equity in the Canadian health system. For example: What are the characteristics of different population groups with self-reported barriers to accessing health care? Are there differences across population subgroups and health regions in the extent to which needed preventive services for chronic conditions are accessed? What is the impact of unequal health service use in the population and among people with chronic conditions on health outcomes? Being interested in international comparative research as well, Allin hopes to explore opportunities for comparative work on equity both across Canadian provinces, and extended to other countries.

Roger Chafe
CPHS Research Associate & CHSRF-CIHR
Post-Doctoral Fellow

“Examining Variations in Cancer Drug Coverage Across the Country”

Download Roger Chafe's CPHS Seminar Series Presentation

Biography: Roger Chafe is currently a CHSRF-CIHR post-doctoral fellow in the Department of Health Policy, Management and Evaluation at the University of Toronto and the Cancer Services and Policy Research Unit at Cancer Care Ontario. He holds PhD in Medicine and a MA in Philosophy from Memorial University of Newfoundland. His PhD thesis focused on cases of health resource allocation decision making in Alberta, Saskatchewan and Newfoundland. He is also currently an Adjunct Professor in Dalhousie University's School of Health Services Administration. His research interests include healthcare decision-making, resource allocation, coverage decisions, the use of evidence and public participation. Some of his current research involves examining cancer drug coverage decision making, including examining the factors influencing variation in coverage across the country; the use of deliberation as a means of combining clinical, economic and value evidence in drug and health technology reviews; examining ways of increasing the uptake of health technology assessments within regional health authorities; decision-making around colorectal cancer screening; and methods of involving the public in making coverage and resource allocation decisions. He has also previously taught health policy and health care decision making within the Atlantic Regional Training Centre Program, a degree program offered jointly by Dalhousie University, Memorial University, University of New Brunswick and the University of Prince Edward Island.

Project Abstract: The focus of my post-doctoral program is on healthcare decision making, particularly in the area of cross-institutional comparisons of coverage and health resource allocation decision making. There are two main projects I will be involved with during my period as a research associate at the Munk School. Factors Influencing the Adoption of New Cancer Drugs within Different Institutional Contexts
(Peter Coyte - PI) examines variations in cancer drug coverage in Canada. This project includes key informant interviews with providers and decision-makers in British Columbia, Ontario, and Newfoundland to better understand the factors driving variations in cancer drug coverage across the country. Designing Deliberative Processes for the CHSRF Decision-Support Synthesis Program (PI - Mark Dobrow) is studying examples of deliberative processes in Australia, Canada, the UK, and the
US to further explicate the role deliberation can have in combining heterogeneous forms of evidence in giving policy guidance. For this project, I will be conducting key informant interviews with representatives of CADTH (CAN); the Centers for Medicare and Medicaid (US); the Environmental Protection Agency (US); the National Health and
Medical Research Council (AUS); National Institute for Health and Clinical Excellence (UK) and Transport Canada (CAN). These cross institutional comparisons will allow for greater understanding of why institutions come to different coverage decisions even though they presumably draw on the same scientific evidence-base in making these
decisions. These projects will also hopefully identify best practices in how to make difficult coverage and allocation decisions.

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.

Regine King
CPHS Research Associate

“Evaluating a Community-Based Mental Health Model in Post-Genocide Rwanda"

Biography: Regine King is a PhD student in the Factor-Inwentash, Faculty of Social Work, University of Toronto. She obtained her Masters of Education (M.Ed.) from OISE in 2003. Regine’s work experience has been in the area of community-based mental health in Canada and Rwanda. Prior to her graduate studies, she worked in Rwanda as a coordinator of a psychosocial program and a facilitator of psychological healing workshops, and in Canada as a community support worker and a mental health counselor. As a PhD student, Regine has worked as a research assistant on various projects and a teaching assistant at undergraduate universities. She has also worked as a volunteer in different local and international organizations. Her research interests include finding appropriate mental health approaches for survivors of massive violence and models leading to the reconstruction of healthy communities in post-conflict situations.

Project Abstract: In Rwanda in 1994, an estimated 800,000 Tutsis were murdered by their Hutu neighbors in a period of only 100 days. Rwandans were subjected to acts of physical and emotional cruelty that resulted in death, mass displacement and multiple distressing social issues including poverty, HIV/AIDS, collective trauma and interethnic tensions. Emotional and psychological problems resulting from these social factors continue to affect the mental health of individuals and their communities. Despite the staggering effects of the 1994 Rwandan genocide, there has been a scarcity of mental health interventions in the country. Approaches introduced by foreign NGOs have been criticized for being based on western theories that are not fully applicable to post-conflict situations and to post-genocide in particular. Most importantly, these programs have overlooked contextualized models developed within the country. Such criticisms have led to suggestions that they may actually do more harm than good. There has been an absence of systematic monitoring and evaluation of the existing programs and lack of scholarly attention to contextualized models. King's research will begin to address these gaps by examining the impact of The Healing of Individual Emotional Wounds and Community Rehabilitation Model (THIEWCRM) on promoting individual psychological healing and its potential to help rebuild the Rwandan community. King will utilize a mixed method approach to describe the model and assess its impact on a group of widows from one province of Rwanda. The findings of my research will contribute to knowledge in community-based mental health and to post-conflict reconstruction.

Leah Shumka
Lupina/OGS Doctoral Fellow

“Visualising Embodiment: Gender, Agency and Corporeal Experience Working in the Sex Trade”

Biography:Leah Shumka is a doctoral student in the Department of Anthropology at the University of Toronto, working across the sub-disciplines of Medical and Socio-Cultural Anthropology. Leah holds a Master’s degree in Anthropology from the University of Victoria. Her professional interests include: gender, the health of vulnerable populations, all things relating to the body and embodiment, subjectivity and agency, research ethics, qualitative methods, and transdisciplinarity. Leah is especially concerned with making her research practical and relevant to the people she works alongside, namely, people who work in the sex industry. In recent years Leah has been working for the Women’s Health Research Network, a Health of Populations Network located in British Columbia. Through her association with the WHRN she has been given the opportunity to ‘take the pulse’ of what research is being done across Canada in regards to girl’s and women’s health. At the same time, this experience has pointed to the myriad health concerns that still need to be addressed with focused research and changes in the policy environment. Leah feels honored to have received the Lupina/OGS fellowship, alongside other recent scholarships .

Project Abstract: The purpose of my doctoral research is to bring a nuanced understanding to the heated and polarizing debate taking place in Canada as to whether prostitution should be decriminalised. That is, whether the laws against consensual adult sexual activity should be repealed in commercial and non-commercial contexts. Pro-rights movements led by feminists, civil libertarians, and sex work advocacy groups suggest that social and legal reform of this sort will reduce the stigma attached to the sex trade and improve the overall health, safety, and security of those working in it. Other more conservatively minded groups suggest that decriminalisation will further subjugate women and perpetuate the social problems already of concern to many Canadians. What is missing in these debates is ethnographically rich, comparative research to better inform people’s opinions. To fill this knowledge gap and contribute meaningfully to this debate, my doctoral research will compare the experiences of women working in the sex trade in Canada, where prostitution operates under quasi-illegal constraints, with those in New Zealand, which decriminalised prostitution in 2003. The overarching purpose of this research, then, is to understand the relevant contours of the sex trade, including the connection between the socio-legal environment and the mental, emotional, and physical health and safety of Canadian sex trade workers. This includes an explicit focus on stigma and its links to health. In particular, asking questions about how stigma shapes a person’s subjectivity, their disposition to act or exert agency, and how these experiences might, in turn, become embodied as specific health outcomes.

Heather Spielvogle
Lupina/OGS Doctoral Fellow

“Understanding and Addressing Barriers: Engagement in Child Mental Health Treatment”

Biography: Heather Spielvogle is a doctoral candidate in the Factor-Inwentash Faculty of Social Work. She received her Master of Social Work degree from the University of Pittsburgh and worked as a research clinician at the Depression Prevention Program, University of Pittsburgh Medical Center (UPMC). Heather currently works at Baycrest Geriatric Hospital’s Kunin Lunenfeld Applied Research Unit as a research associate and web-based psychosocial support group facilitator. The Drs. Faye Mishna (social work), Cheryl Regehr (social work), and Paula Ravitz (medicine) supervise her research. Heather’s primary research interest centers on treatment engagement in mental health services. While at the UPMC, Heather’s clinical work addressed the multiple barriers to mental health services experienced by mothers with depression from low socioeconomic backgrounds. Subsequently, this work led to the development of a manualized mental health treatment engagement intervention (see: Swartz et al., 2007, Professional Psychology: Research and Practice). Heather’s thesis research focuses on adolescents’ perceptions of mental health treatment and the barriers they encounter entering services.

Project Abstract: In my doctoral research, I examine how multiple barriers impact adolescent mental health service attrition. By understanding these barriers, I will develop a treatment engagement intervention tailored to address the concerns of teens. Treatment attrition is a cardinal concern in adolescent mental health services where drop-out rates range from 40 to 75%. The literature, which has primarily examined demographic variables associated with drop-out, has consistently linked socioeconomic and ethnoracial status to higher levels of attrition in these services. Few studies, however, have examined why adolescents and their families are more likely to drop-out of treatment. A small body of research has identified parent-defined barriers to adolescent mental health treatment. These potential barriers fall into three general domains: logistic (e.g., lack of transportation/time), psychological (e.g., stigma, past negative experiences with healthcare providers), and cultural (e.g., incongruent values/communication patterns). Parent-defined barriers may partially reflect the adolescent’s experience, but do not fully describe the unique obstacles teens experience entering mental health services; particularly since teens are often brought to services involuntarily and are developing independence from the family system. My research will use an ethnographic methodology to explore adolescents’ perceptions of this encounter. The interviews will be completed shortly before the teen begins treatment at two Toronto-based mental health centres. Concurrently, this interview will be used to engage teens in treatment by using techniques to enhance self-efficacy, autonomy, and therapeutic alliance. In turn, I expect that higher levels of these three factors will predict greater treatment retention rates. I hope the results of my research will enhance service delivery within child mental health clinics and build theory about barriers to treatment defined by teens from diverse ethnic backgrounds.

Patrick Zylberman
CPHS Distinguished Visitor

“Gathering Stormes: The United States and Europe Face Microbial Threats”

Biography: Patrick Zylberman is senior researcher at the Centre de Recherche Médecine, Sciences, Santé et Société (CNRS, INSERM, EHESS, Paris). He is Deakin Fellow of the St-Antony’s College (Oxford), and Rockefeller Fellow in the Humanities. His recent publications include the following: “Civilizing the State: Borders, Weak States and International Health in Modern Europe,” in A. Bashford (ed.), Medicine at the Border. Disease, Globalization and Security, 1850 to the Present (Palgrave, 2006); “Fewer Parallels than Antitheses: René Sand and Andrija Stampar on Social Medicine, 1919-1955,” Social History of Medicine, 17, 1 (2004); “Making food safety an issue: Internationalised food politics and French public health from the 1870s to the present,” Medical History 48, 1 (2004); “A Holocaust in a holocaust: the Great War and the 1918 ‘Spanish’ influenza epidemic in France,” in H. Phillips and D. Killingray (eds), The Spanish Flu Pandemic in 1918. New perspectives (Routledge, 2003); and (co-authored with Lion Murard) L'Hygiène dans la République, la santé publique en France ou l'utopie contrariée, 1870-1918 (Fayard, 1996). His book, (co-edited with Susan Gross Solomon and Lion Murard), Shifting Boundaries of Public Health: Europe in the Twentieth Century has come out in August 2008 at the Press of the University of Rochester.

Patrick Zylberman is currently working on bioterror and antipandemic scenarios which imposed new images of microbial threats that might affect the management of epidemic crises. In collaboration with Antoine Flahault, he is charged with the scientific direction of the exhibition Des épidémies et des hommes (“Plagues and Peoples”) on display at the Cité des sciences et de l’industrie, Paris-La Villette, October 2008 - June 2009.

Project Abstract: Governments are increasingly resorting to scenarios and tabletop exercises, such as TOPOFF 2000, Dark Winter (2001) or Atlantic Storm (2005). Western governments share scenario-based strategies (September 2003 Global Mercury exercise). There is compelling evidence that recent health crises have had a more far-reaching impact on emergency preparedness and response ahead of health surveillance and outbreak management in governments’ agendas. Gathering Storms. The United States and Europe Face Microbial Threats (1989-2006) approaches governments’ attempts to train the citizenry in vigilance, alertness and response. Zylberman explores how Washington, Brussels and Paris have responded to health disasters, how they perceived SARS and avian flu, how they organized emergency preparedness and response schemes, and how they launched new R&D policies on health security. In short, Gathering Storms would propose a comparative study of new conceptual and political frameworks that governments in Europe and North America are adopting to deal with the threats of emergent infectious diseases and bioterrorism.
The intended purpose of Zylberman's visit to Toronto is to control findings upon Europe by enquiries about North American parallel developments. Canada was an important instance of how response to a pandemic raises conflicts sweeping through the different levels of governance. Interviewing people responsible for communicating with WHO during the SARS epidemics matters enormously. Zylberman will also seek interviews with people in the National Planning Agency in Washington, as well as the authors of Dark Winter and Atlantic Storm.