Renate Ysseldyk, Department of Health Sciences

By Ariel Root

Religion. Ethnicity. Gender. Age. All of these groups influence one’s sense of belonging. One’s self-image. These factors, and others, can give us a sense of social identity. They can influence how we manage our social world, and can have profound impacts on our health. “Social identities reflect our group memberships…and are often helpful in coping with stressful life experiences, and also in [healthy] aging.”

Renate Ysseldyk is an Assistant Professor in the Department of Health Sciences at ĐÓ°ÉÔ­´´ University, where she is interested in the influence of psychosocial factors, like social identities, on stressful experiences such as religious discrimination or transitions associated with aging. Her research focuses on the social determinants of health, particularly among vulnerable populations, and how social identities can influence physical and mental health.

Ysseldyk indicates that many of her research challenges relate to the sample populations within her studies. Vulnerable populations, in her research, have included women who have experienced abuse, and older adults who are living with dementia. “But these [challenges] are also some of the most rewarding experiences, because you’re really making a difference for people who need it,” she explains. Ysseldyk recalls a project she worked on recently, led by Artswell and in collaboration with the Alzheimer Society of Ottawa and Renfrew County, Bruyère Continuing Care, and the Community Foundation of Ottawa, called “”. Community participants living with dementia gathered weekly with their caregivers to build a new social identity based on making music, reminiscing about the past, and connecting with each other.

Using a combination of observational measures (designed specifically for people living with dementia), interviews, and survey questionnaires, Ysseldyk and her students evaluated the cognitive and mental health benefits of the Music Matters program, finding that it was also an extremely rewarding project. “Seeing people who were originally quiet, but later opened-up and sang and danced… you can see on their faces that [the program] is improving their life… it’s really fun,” she explains. And the benefits of the program were equally evident among the caregivers, who developed a sense of social identity with the group over time, and this had personal, social, health, and even spiritual impacts.

Combining aging, identity, religion, stress and coping, Ysseldyk acknowledges that a lot of her projects are intertwined – they have to be. And so there are many projects that stand out for Ysseldyk. She recounts her PhD work when she first considered the relationship between social identity and religious affiliation, exploring the psychological implications and outcomes of individuals coping with various threats to their religious identity. From there, Ysseldyk completed a CIFAR post-doctoral fellowship with the University of Exeter in the UK, and later a SSHRC post-doctoral fellowship with the University of Queensland in Australia, both under the guidance of Drs. Alex and Cath Haslam. Here is where she was “really introduced to doing research on some of the social determinants of health in older adults.” Ysseldyk credits these experiences to having evolved her research and demographic interests. And so, despite having several “different lines of research, they all overlap. There’s no one big goal” for Ysseldyk. In fact, it’s about “trying to figure out the little ways to improve peoples’ health, well-being, and overall quality of life.”

“The concept of social determinants of health can be abstract, and discovering the “causes of the causes” requires digging” – and a lot of it. More digging will always lead to more questions, and more answers. In deciding where to research next, Ysseldyk says her next step is often built on what she did last: “What did I learn in the last project that will lead to my next question?” Ysseldyk says she’s always had an interest in both health and psychology. And through her graduate studies and post-doctoral work, she was able to merge those two, as well as overlap with social neuroscience.

Several of Ysseldyk’s next projects will similarly require an interdisciplinary research team, as she continues to investigate the role of various social factors on the health and well-being of older adults. With colleagues from neuroscience as well as several community partners, including Bruyère Continuing Care and Riverstone Retirement Communities, they will consider the links between valued social identities and both mental and physical health outcomes, such as depressive symptoms and telomere length.

But regardless of the question—or the answer—for Ysseldyk, it’s about the journey. “I love the teaching and the research. Finding new things that interest me and that might help improve the health and well-being of others, that’s what drives me to work every day, and to answer these questions… it’s that I truly want to be here and to make some positive difference—great or small—in people’s lives.”

To find out more about Renate Ysseldyk, click here.

By Susan Braedley, Associate Professor, School of Social Work

Is it truly a sunnier day for health equity in Canada? It seems so. On Sunday, April 3, 2016, a packed hall at the War Museum listened attentively as Jane Philpott, federal Minister of Health, outlined her plan to address health inequities through a social determinants of health approach. Harnessing the capabilities of the Public Health Agency of Canada and Health Canada, she hopes to identify upstream drivers of health inequities, reduce regional disparities and address the needs of vulnerable populations. A hum of pleased surprise came from the knowledgeable audience as she referenced Vincente Navarro, world famous expert and progressive voice on the political and economic determinants of health.

Philpott wants action, but she has some worries. Echoing a theme from Cindy Blackstock’s opening address, she described a recent meeting with indigenous leaders who expressed deep frustration with federal government incrementalist policy approaches that ignored and discounted indigenous peoples’ lives and suffering. She quoted Martin Luther King (another reference not heard recently from federal politicians). “This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism” where “the wait has almost always meant never”. My impression was that Philpott has an uphill battle to convince her Cabinet colleagues about the need for radical action. The “social determinants of health are not infrequently mentioned at the Cabinet table”, she told us, but is there sufficient support to pay the bill to tackle health inequities? Arguing that the social determinants of health must be the responsibility of the entire government, she pleaded for help in building public support for “health as the determinant of society”.

Philpott’s talk was just one of many at “Closing the Gap: action for health equity” an event organized by Upstream, a high octane non- partisan organization. Founded by family physician Ryan Meili, whose 2012 book  has sold over four thousand copies across Canada, Upstream aims to contribute to “a movement to create a healthy society through evidence-based, people-centred ideas”, by “refram[ing] public discourse around addressing in order to build a healthier society” (thinkupstream.net). Thus, Upstream assembled an impressive list of speakers. The day ended with the eminent and entertaining Sir Michael Marmot, whose definitive research reveals undisputable links between health inequalities and both political and economic drivers – compelling research that kept the crowd riveted long into the evening.

But the day’s big question was Philpott’s concern. Is there sufficient political will and public support for the feds to bite the health equity spending bullet? Which policy directions can both address health inequalities and attract the political support necessary to make them achievable in the longer term? On the one hand, the evidence on health equities is clear. Poverty is the most significant determinant of health, but poverty is never simple nor does it work in isolation from other social determinants – food insecurity, homelessness and systemic racism were three issues covered by the day’s speakers. Danielle Martin, a physician and researcher at Women’s College Hospital in Toronto, argued for the potential of a targeted guaranteed annual income, indexed to inflation and available to all Canadians, as both a politically feasible and affordable approach to improving health equity. On the other hand, programs that benefit only low-income Canadians may not garner sufficient political support. Armine Yalnizyan, senior economist with the Canadian Centre for Policy Alternatives and Vice-President of the Canadian Association for Business Economics, recommended instituting a wide range of social programs that would benefit low, middle and even high income Canadians. She argued that this menu of programs, including universal affordable child care and other benefits, would be both lower in cost and more politically achievable for the longer term, garnering broader-based public support from the wide range of Canadians who benefitted and tackling health inequities.

Photo by Ariel Root

Settling this debate will not be easy. For health and health care researchers, however, the good news is that evidence-informed policy at the federal level is now a distinct possibility. It is our job to continue to identify policy alternatives that can address these health inequities, to get the evidence to those who can use it to advocate for change and to educate the public about the benefits and costs of policies. This includes the alarming costs associated with the status quo. Gender, racialization and immigration were mostly ignored at this illustrious meeting, indicating both a need for more knowledge mobilization and advocacy on these important determinants of health and a possible problem within the health equity community. However, the day attracted a power-crowd of movers and shakers who do understand these issues, including activists, advocates, researchers and policy makers. Seated around me were many familiar faces: Monique Begin, former federal Minister of Health and Welfare and the “mother of medicare”, as she was hailed from the stage, Linda Silas, President of the Canadian Federation of Nurses’ Unions, Beth Jackson and many others from Public Health Agency of Canada, Cheryl Stadnichuk, senior healthcare researcher at CUPE, Maureen O’Neill, President of the Canadian Foundation for Healthcare Improvement and Barbara Neuwelt, Director of Ottawa Diabetes Education Program.

Are we seeing a movement rise up on the health equity front? It seems entirely possible.

By Frank Welsh, Director of Policy, Canadian Public Health Association

Your health and quality of life is determined by a wide range of factors. These social determinants of health (SDH) are broadly defined as “the conditions in which people are born, grow, live, work and age” and include education, income, housing, gender, physical environment, social environment, access to health services and healthy childhood development. In order to optimize the health and well-being of communities across Canada, public health authorities are tackling these unique challenges by developing innovative programs to address this complex intermingling of factors. In a country as large and diverse as Canada, it’s essential that we have a way of sharing our successes – and our failures – so that other can learn from our experiences and build on them to develop more effective interventions. The purpose of (FLH) is to share those stories with the public health community across Canada.

At its simplest, FLH is an online collection stories overlaid on a map of Canada about communities that have had success in addressing the SDH. The stories are told in the voice of those who develop and manage these programs, and they integrate text, podcasts, pictures and video to provide a human context and make them accessible to a general audience.

FLH is the result of three partners coming together to address a knowledge exchange need of the public health community. With initial funding from Astra Zeneca, the Canadian Public Health Association conceptualized and managed the Atlas’ development and preparation of the stories, while research and development for the site was provided by the (GCRC), ĐÓ°ÉÔ­´´ University. Using their open-source mapping software, Nunaliit, coupled with the Couch open source database, GCRC designed an interactive Atlas that provides the functionality needed to capture the stories with an interface that highlights the human nature of the project.  Preparation of broadcast quality podcasts was provided by , an Ottawa-based content development and communications firm. Without the unique contribution of each of the three partners this project would not have succeeded.

Frontline Health, however, is much more than the technology; it is about the stories. There are currently 19 stories, each of which represents one community’s effort to respond to a local challenge that was rooted in a particular social determinant of health. The FLH stories describe how communities have responded to these needs for a particular at-risk population. They range from one about how a community in the Northwest Territories is improving food choices by its residents, to another concerning a program that reaches out to pregnant women living on Toronto’s streets.

The Atlas is clearly resonating with the public health community, as the number of “hits” recorded and the residence times of visitors are above average, given the type of site and target audience. In addition, informal comments are strongly supportive of the content, as well as the Atlas’ look and feel. There are however challenges, the greatest of which are identifying and developing the stories in a timely fashion, and maintaining a contemporary, user-friendly look and feel to the site.

The collaborative efforts of CPHA, GCRC and Smarter Shift have provided a unique Atlas that tells the stories of how some communities are addressing the needs of specific populations. The Frontline Health Atlas can be found at: , then click on the map of Canada.

A permanent population of 16,000. One Walmart. Three grocery stores. A long history of various mills. One beautiful Lake of the Woods. And about a million gorgeous small lakes within a stones throw. With rock cuts on every part of the highway, cell phone reception was spotty at times. Locally owned and brewed coffee cost $2.75. And finding and buying a spaghetti squash was unlikely. Regardless, it was obvious that I was going to easily fall in love with “lake life.” It also became obvious that there was a lot of unspoken history; a lot that I wanted to know more about.

I was dispatched to my first fire before the end of my first week in Kenora. Basemap 36555—that’s all I knew. Small white smoke. Values to the west. Pumping distance: 200 ft. The radio chatter was overwhelming. Where were we going? How long will we be staying there for? As we flew over the community, I remember feeling confused. Seemingly unorganized dirt road-networks joined small houses with yards full of garbage and abandoned vehicles. The fire itself was right beside someone’s house…in their yard. Even after we landed, community members would drive, walk, or quad by, completely unfazed by the fact that four MNRF (Ministry of Natural Resources & Forestry) employees were suppressing a fire in their neighbour’s yard. Gangs of children biked by, wearing no helmets; isn’t this a school day? The home homeowner sat on her porch, and watched us working. This was an ordinary occurrence. This was no big deal. My crew leader told me to keep an eye on our jerry of gas; there were a couple curious people hanging around our pump site. Why did I have to hang around the pump gas? Why did no one seemingly care about the fires on their properties? Why were there so many dogs running around the town? Was I missing something? A few other fires started nearby that day. Mainly grass fires. All human-caused fires. Basemap 36555 marks the First Nations community of Wabaseemoong, just northwest of Kenora. I soon learned to anticipate spending most of my springtime fire fighting in basemap 36555.

The summer months brought heat and cottagers. The population doubled, and the streets were filled with sun-kissed shoulders. And homeless people. There always seemed to be people hanging around outside the Laundromat, No Frills, and some of the government-owned housing. While the homeless population didn’t seem to faze locals, it wasn’t something that I associated with small towns. Alcohol and drug abuse was something that bad people did. Unemployment was a tragedy that was short-lived. Needle drugs were seen in movies. And residential schools were something that I might have heard about, once, somewhere, maybe. And yet here, in this beautiful, quaint, little town, there were always people, wandering the streets, or passed out in public spaces somewhere around the town. I often heard people playing it off as a joke—“Oh those are just the drunk natives.” It wasn’t something that I was accustomed to seeing in a small town. It was something that I had only ever associated with the downtown of big city centers. And it was never a joke. Online sources describe Kenora as the Muskoka of the north. But I knew there was more to the story that I was interested in learning about. I wanted to know why.

I’ve spent three summers and one winter in Kenora, having worked at the bowling alley, the library, the high school, the pool, and of course, as a forest fire fighter for the MNRF in the summer months. I am constantly inquiring and learning the stories and histories from local First Nations residents from in and around the town. People from the nearby communities, Wabaseemoong, Grassy Narrows, Rat Portage, Shoal Lake, Whitefish Bay, and Sabeskong all bring forward different stories, different experiences, different explanations, though commonalities in historical events, racism, and inequities in available services persist, contributing to the continual tensions. From my time in Kenora, I’ve used the power of observation and inquiry to learn more about the First Nations communities living within the Treaty 3 district. It’s been a wild ride so far; one that I don’t anticipate ending anytime soon.

Author Ariel Root is currently in Kenora in her fourth season working as a forest fire fighter for the Ontario Ministry of Natural Resources and Forestry.  She has a BSc in Food Science & Nutrition from ĐÓ°ÉÔ­´´ University in 2012, and is currently a graduate student in the Health Science, Technology and Policy program at ĐÓ°ÉÔ­´´ University. She has been featured on APTN’s new hit TV show, Playing with Fire, Season 2.

Come back for next week’s instalment on homelessness.

Photos by Ariel Root

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