PHIRN: Population Health Improvement Research Network

PHIRN Proposals 2009-2010

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Based on the selection criteria described in the Call for Proposals, PHIRN is proud to congratulate the following principal applicants for successfully garnering funding for this year’s call for proposals:


Title: Unmet Need in Mental Health Care: Exploring Social Determinants Using Intersectionality

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Dr. John Cairney PhD Departments of Family Medicine; Psychiatry and Behavioural Neuroscience,
McMaster University
Co-Applicant(s) Title(s) Institutional Affiliation(s)
Dr. Paul Kurdyak PhD Centre for Addiction and Mental Health
Dr. Terrance Wade PhD Brock University
Dr. David Streiner PhD Baycrest Centre for Geriatric Care


Mental health and addiction problems are among the most pressing and pervasive health concerns of our time; roughly one in five Canadians will have a mental health or addiction problem at some point in their lives. Even though there are numerous, efficacious treatments for most major mental disorders affecting Canadians, existing research suggests that fewer than 50% of individuals with mental disorders seek help from physicians or mental health specialists. This has been referred to as unmet need. However, such estimates of unmet need like the one above, and the factors responsible for it, are not well understood because virtually all data are based on self-reports. Self-reports of service use are influenced by factors like recall (memory) and the stigma associated with mental health concerns. Recently, Canada's first national survey of mental disorders - the Canadian Community Health Survey 1.2 - has been linked to health administration data in Ontario, allowing us to explore the association between mental disorder and service use that depends on actual medical records and not self-reported data.

Although it is important to have precise estimates of the percentage of individuals with mental health problems who do not seek care, it is equally important to know who in our society has a greater risk for unmet need. Most research in this area has focused on specific social groups, which fails to recognize that all of us occupy a number of different social positions in our communities, and that our combined social status positions may be as or more important for our health and well-being. We also do not know which combination of social factors will help us to identify those individuals who are the least likely to seek help for mental health problems.

Our study therefore has the following objectives:

  1. Use this linked data to estimate the number of Ontarians who meet diagnostic criteria for one or more of the following - depression, anxiety, substance/alcohol abuse - but who did not seek care in the past 12 months from a health care professional.
  2. Identify high risk groups that may be more likely to have unmet need for mental health and addiction problems.

This will be the first study to use Canada's only national mental health survey linked to Ontario health administrative records to estimate both unmet need and the social factors associated with it.


Title: Addressing Mental Health Disparities Among Marginalized Groups: Learning From the Most Exceptional Innovators in our Community

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Sean A. Kidd PhD, C.Psych. Centre for Addiction and Mental Health $55,000
Co-Applicant(s) Title(s) Institutional Affiliation(s)
Kwame McKenzie PhD Centre for Addiction and Mental Health


Recent literature reviews and community meetings across Canada have documented the unique challenges and disparities in mental health and healthcare access for stigmatized groups. Developing effective means of addressing the disparities in mental health and service access is a daunting task given the tremendous diversity within and across groups, in addition to the interaction of cultural and individual histories, policy barriers, shortcomings in service delivery models, discrimination, and socioeconomic factors. However, the resiliency of individuals in communities and the creativity of lay services to meet the challenges are increasingly being recognized. Documenting effective community-based solutions to disparities in mental health in marginalized populations is a first step to harnessing them as part of the system of care. In a climate of scarce resources understanding how they work and what they add to the system will be important so that services are not duplicated and to ensure that they are properly incorporated in pathways to care.

Employing an approach derived from Bill Drayton's pioneering work in identifying and supporting social entrepreneurs, we intend to identify individuals and organizations who are successfully addressing inequity in the area of mental health. We will focus upon four groups who have been highlighted as being at the greatest risk: Immigrants/refugees, homeless persons, Native Canadians, and sexual minorities. Hospital-based mental health services will be another area of focus. We will develop a selection committee with representation from each group and, through our respective networks, engage in a search process that will identify one exceptionally effective individual, group, or organization in each area. Following the selection process three steps would occur. First, each person and/or group would participate in an in-depth case study to highlight the components of their work that make it effective in their particular sociocultural context. Second, all of the identified individuals/groups will participate in a showcase event to which key policy makers, service leaders, and the media will be invited to learn about their innovative efforts and engage in a discussion about how their work could be furthered through service and policy change. Third, the case study profiles will be disseminated through academic publication, an e-publication through an open-access book, and postings for specific communities on

This project will highlight innovative interventions and their mechanisms across a range of stigmatized groups, and will provide an effective process of knowledge transfer across several sectors. It will also provide exposure and recognition to key persons and groups driving innovation and transformation.


Title: Labour Market Policies and Social Determinants of Health: A Review to Establish Priorities for Ontario

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Carles Muntaner MD, PhD Psychiatry and Addictions Nursing Research, Centre for Addiction and Mental Health, University of Toronto $65,000
Co-Applicant(s) Title(s) Institutional Affiliation(s)
Haejoo Chung PhD Department of Healthcare Management, College of Health Sciences, Korea University
Ted Schrecker MA Institute of Population Health, University of Ottawa


The proposed research will synthesize the best available evidence in support of using labour market policy as a strategy for health promotion through action on social determinants of health. The principal investigator served as co-chair of the Employment Conditions Knowledge Network (EMCONET) of the WHO Commission on Social Determinants of Health, and the conceptual framework developed in EMCONET’s final report is adopted here.

Research on the aggregate level has shown that high levels of unemployment in both societies and neighborhoods are correlated with poor health and increased mortality. Precarious employees also suffer a variety of adverse health effects. The physiological effects of psychosocial stress associated with economic insecurity and lack of control are an important pathway in addition to material deprivation. Despite substantial research evidence in support of the relation between labor market conditions and health, not enough is known about the range of ‘best practices’ (policies and interventions) that have the potential to reduce health inequities by addressing labour market conditions. Our work will update the findings of the EMCONET report and subsequent “Marmot review” in the United Kingdom, with a specific focus on high-income jurisdictions and a ‘finer-grained’ review of relevant policies and interventions – including those without clear links to health outcomes, but with clear effects on social determinants of health - than was possible for the Network. Based on this review, we will suggest priority options for further exploration and intersectoral action in Ontario.

The current economic downturn makes a review of such options especially topical and urgent. Unemployment has risen substantially in Ontario (close to 300,000 jobs lost since October 2008), and although data are not yet available it is reasonable to assume an acceleration of the existing trend toward insecure employment and flexible employment relations (e.g., the 43,000 jobs gained in January 2010 were part-time) – both with potential negative impacts on health. Since employment and the labour share of domestic income consistently recover more slowly than GDP in the aftermath of economic crises, it cannot be expected that even robust recovery will resolve the current situation in an acceptable time frame.


Title: Food for Health Equity in Diverse Communities: Creating Pathways to Advantage Through Food Innovation Networks

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Cameron Norman PhD Youth Voices Research Group,Dalla Lana School of Public Health, University of Toronto $24,904


Food sits at the nexus between nutrition, culture, social wellbeing, and human performance, and is both vital for human life and as a medium to bring diverse groups together. There are few things that provide a better expression of human culture than food. Yet timely access to foods that are nutritious, culturally appropriate, affordable, and of personal acceptability -- food security -- is not guaranteed in Canada. The means to support cultural independence and with it human health and dignity is often reduced due to the absence of appropriate food availability or knowledge about how to use the foods that are available in a manner that is healthful. Food plays a significant role in health equity among and between groups new to Canada and working to find ways to integrate the experiences of a country and culture of origin and their new adoptive homeland. The myriad factors that influence food security and stability make this a complex health issue – with no single cause or uniform solution -- and thus, one that will best be understood using methods that take into account such complexity. Such an approach views food security not as an issue independent of social context, but rather as a lever in which to support a broader agenda towards health equity.

New Canadians and recent immigrants face challenges to food security and cultural independence. Despite its size and relative diversity, many residents of dense neighborhoods like St. James Town in Toronto struggle to find appropriate, affordable, nutritionally adequate foods. Youth, aged 12-24, can serve as a means to facilitate this change by serving as bridges between the home culture and that of the wider community. They also have the energy, interest and skills to leverage social capital if supported by adults.

This proposal will implement a three study research program that uses social network analysis to map the pathways of influence that youth and youth serving organizations create in developing food innovation networks to support health equity. These studies are informed by systems thinking and complexity science and blend social epidemiological, sociological and community psychological approaches to understand the role of networks on health equity promotion. Through a coordinated, systems-oriented approach to addressing a large complex problem, relatively small-scale programs can create a large-scale change, if there is appropriate feedback mechanisms created through mediums like online social network tools, and an evaluation model that is responsive to the system (community).



Title: Pathways to Income Security and Health for Racialized Families

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Yogendra Shakya PhD

Access Alliance Multicultural Health and

Community Services

Co-Applicant(s) Title(s) Institutional Affiliation(s)
Dr. Grace-Edward Galabuzi PhD Ryerson University

Dr. Patricia Landolt


University of Toronto (Cities Centre)

Lisa Brown Community Health Worker Black Creek Community Health Centre
Ruth Marie Wilson MSW

Access Alliance Multicultural Health and Community Services


Census data and other evidence indicates that compared to people from European backgrounds, racialized groups in Canada face higher levels of unemployment and poverty, are more likely to be concentrated in low-paying, unstable jobs, and are more likely to live in low-income neighborhoods with sub-standard housing and inadequate services. Health literature highlights that poverty, employment insecurity, and discrimination have adverse physical and mental health impacts. The Income Security, Race and Health (ISRH) team is a multi-collaborative research group established under Access Alliance with the goals of investigating the systemic causes of, and the relationship between, the growing racialized inequities in employment, income, and health. Evidence from the previous two phases of research has generated rich evidence about the types of systemic barriers that racialized groups experience in the labor market and the impacts these have on their health.

The objective of the next phase of research is to identify the 'critical nodes' of inclusion/exclusion and empowerment/disempowerment in the everyday pathways, policies, and services available for racialized families to use in order to address the systematic barriers and discriminations they face in achieving income security and health for their families. We plan to use a mixed-method, longitudinal action research methodology with 10-12 racialized families living in Black Creek, one of the City's 'priority' neighborhoods. The project will be grounded on an 'anti-oppressive intersectional lens' to shed light on the multiple and mutually reinforcing effects of discrimination and inequalities; and a social determinant of health (SDOH) approach to explore the relationship between health and core determinants including employment, discrimination and access barriers. The project includes multiple capacity building opportunities for Black Creek residents and participants throughout all phases of the project. This includes Black Creek residents employed as 'peer researchers,' implementation of the Income Security and Health Fair, and the 'Building Pathways to Income Security' workshop series.

The project will engage in broad level knowledge exchange activities targeting community, service providers, policy makers, academics/students, and media. The findings generated from this project will provide the much needed evidence to guide changes to a number of important policies including policies related to recognition of foreign credentials, employment training programs, social assistance programs, and healthcare services. We plan to use the evidence to push for strong anti-discrimination/anti-racism policies and processes in each of these sectors.


Title: Promoting a Population Level Intervention to Enhance Participation in Physical Activity: The Role of Marketing and Peer Ambassadors

Principal Applicant Title(s) Institutional Affiliation Funding Amount
Dr. Brenda Bruner PhD Queen's University $50,000
Co-Applicant(s) Title(s) Institutional Affiliation(s)
Dr. Lucie Levesque PhD Queen’s University


Canada's Physical Activity Guide for children and youth recommends 90 minutes of moderate-to-vigorous daily activity. However, 93% of adolescents aged 15-19 years are not meeting activity guidelines which is concerning as type 2 diabetes and coronary artery disease are now affecting our youth, and low levels of PA tend to persist into adulthood thus perpetuating health risks as individuals’ age. Adolescents consistently report cost and lack of access to recreational facilities as barriers to PA. Reducing facility user-fees, thereby addressing the most prominent barriers, has the potential to increase PA levels among adolescents.

Kingston Gets Active (KGA), a partnership between municipal, education, health, social, and recreation sectors launched the Grade 5 Community Physical Activity Pass in 2005. The Pass provides students in Kingston and surrounding townships with free access to public pools, arenas, and the local YMCA. The success of this initiative prompted KGA to develop a similar pass for Grade 10 students in 2007 and for Grade 9 students in 2008. Evaluation of the Grade 10 Pass revealed only 16% of students used their Pass which was contributed to low student awareness due to a lack of promotional activities. Therefore, the purpose of this project is to determine the effectiveness of an intervention using enhanced promotion via peer ambassadors.

Six schools participating in the Community PA Pass will be enrolled in the study. The schools will be matched according to size, location and socioeconomic status and then randomized to the intervention group (Peer Ambassadors and Enhanced Promotion) or the comparison group (Standard promotion). Participants will include Grade 9 students from the selected schools in Kingston. These students will receive the Pass that provides free access to 11 PA facilities at designated times for 8 months. Students in the intervention schools will have a custom-developed campaign in addition to the use of Peer Ambassadors who will act as positive role models for PA, and increase awareness of PA and its benefits. KGA Ambassadors will be paired with Peer Ambassadors in the selected schools to help facilitate promotion of the Pass. Physical activity, Pass use, facility use, barriers to facility use, accompaniment for activity, promotional campaign awareness, and peer ambassador capacity and effectiveness will be assessed to evaluate the effectiveness of the program. Schools in the comparison group will receive the standard Pass promotion which typically consists of class announcements and letters. The findings will help guide program decisions and refine community-wide strategies to enhance PA.

Last Updated ( Wednesday, 09 June 2010 10:28 )  

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