Epidemiology and public health are grounded by the use of core demographic statistics, such as mortality rates and life expectancy. Indicators such as mortality rates are usually presented as tables or basic charts; however, there is significant potential in data visualization techniques to improve understanding and dissemination of these statistics. This project aims to use interactive visualizations to interpret Canadian mortality indicators by age, sex, socioeconomic status, and cause of death. 

Methods: Visualizations were developed using compositional Lexis surface diagrams, age-wise plots, and plots of small-multiples. Recent and historical data on deaths by age, sex, and selected cause and population counts were sourced from the Human Mortality Database and Statistics Canada Vital Statistics files. Data cleaning and analysis were conducted using R and RStudio, with open-source code shared via GitHub. For each visualization type, interactive applications were developed using Shiny and made available publicly online via open access.

Results: Four interactive Shiny applications were produced: (1) a Lexis Surface Plot from 1921-2022; (2) Small Multiples Plot from 1950-2019; (3) Multiple Lexis Surface Plots from 2002-2021; and (4) Age-Wise Plots 1950-2019 and 2002-2021. Each plot includes written evidence-based descriptions on the association between mortality and other factors. These tools will be useful to provide insight into longitudinal mortality patterns for students, researchers, public health agencies, and the general public. 

Conclusion: Interactive visualizations provide enhanced insight into mortality analysis. Visualizations can be modified to include features that improve accessibility for diverse audiences. Future research can expand the use of Lexis diagrams to create applications at disaggregated levels to support health research and policy.

Loading…

No file posts are available.

Report: Data Visualization of Complex Health Information

Interactive applications are available via the following links:

The post Data Visualization: Lexis Diagrams and Mortality appeared first on Determinants.

This project aims to map existing research on the internal migration, spatial mobility or residential relocation of older adults in Canada. It focuses especially on the determinants of internal migration between urban and non-urban regions of Canada that are motivated or driven by health, health care needs, or other health-related reasons reasons.

This protocol has been registered with Open Science Foundation: .

Increasing life expectancy and declining birth rates have led to increases in the median age for many countries, including Canada. In this context, preparing for and meeting the needs of an aging population is a growing challenge [1]. While older age is not a direct indicator of poor health, older adults are disproportionally represented among those with chronic diseases and have a greater probability of suffering falls and injuries and having age-related decreases in immunity [2][3]. As such, they are more likely to be high users of the health system when compared to their younger counterparts [4][5].

Problems in accessing health care for this age group are often exacerbated in areas with less healthcare resources [6][7]. Rural and remote regions, for instance, often contend with scarcity of services and difficulties in retaining health workers [8][9]. Rural communities in Canada have low population density and less diversified services compared to urban communities [10]. Additionally, compared to urban areas, they have been shown to have a trend of out-migration of young people, in-migration of older individuals [11], and consequently, a higher proportion of older adults [12].

Existing studies cite a wide array of motivations for older adults’ migration within Canadian borders, including health-related issues [13][14][15]. In Canada, usually this group’s motivations to migrate include the search for lower cost of living, the wish to be closer to nature, or to live in age-friendly neighbourhoods after retirement [13]. Edmonston and Lee [13] identified health as one of the five most common reasons for the relocation of older adults.

This review seeks to quantify and describe research on the internal mobility of older adults in Canada for health-related reasons, with a special focus on relocations across the rural-urban axis.

We use the terms “older adults”, “rural” and “internal mobility” and their synonyms to describe the different ways in which studies in the area define each of these concepts. The definition of “rural” is complex and can be based on a variety of indicators, from idealized conceptions [16] to objective measures such as concentration of services and population density [17]. In Canada, rurality is often operationally defined as region with population density of less than 400 habitants per square kilometer [12], but many studies offer their own definitions. The concept of “older adults” as well does not have a clear definition in the literature, with initial age cut points ranging from approximately 45 to 65 years. “Internal mobility” is generally understood as residential relocation within national borders, but it can also include changes of residence within shorter distances such as the same neighbourhood, or the same city, for instance, and long-distance relocations or migrations. Different conceptualizations of “rural”, “mobility”, “older adults”, as well as “health”, will be categorized and described in the review.

A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted. The economic [18] and health-related [19] consequences of older adult migration were discussed in some reviews, as well as the specific healthcare challenges of aging in rural areas of Canada for older adults [20]. However, to our knowledge no current or in-progress scoping reviews or systematic reviews about the specific topic of health or healthcare influence on migration for older adults in Canada were identified.

Given the disparities in the distribution of health services in Canada, especially between rural and urban areas, fully understanding the patterns of internal migration of older adults within Canadian borders is important for attaining a more equitable distribution of resources, and especially relevant for the promotion of aging-in-place policies.

The post Protocol: Health-Related Determinants Of Internal Migration Among Older Adults In Canada appeared first on Determinants.

Robyn Wright, Vanessa DeClercq, Christie Burton, Nicole Roslin, Alex Chan, Paul Arnold, Paul Peters, Russell Schachar, Jennifer Crosbie, Morgan Langille

Abstract

The factors influencing the oral microbiome during childhood and adolescence remain under-explored at the population level. We characterised the saliva microbiomes of 4,812 children aged 5-18 years within the Spit for Science cohort collected at the Ontario Science Centre (Toronto, Canada), making this the largest population cohort of the paediatric oral microbiome to date. Exploration of participant genotyping and more than 50 variables encompassing the demographics, health, diet, socioeconomic status and living environment of participants revealed that almost all of the investigated variables were associated with overall community structure and/or the abundance of specific bacterial genera. However, most of these associations were modest, while the strongest determinants of oral microbiome composition were shared household environment, age, and ethnicity. We further show that the oral microbiome is more consistent with more core taxa among children than adults, and that microbial differences attributed to ethnicity and diet are likely intertwined. These findings highlight the complex interplay between social, environmental, and biological factors in shaping the developing oral microbiome. This underscores the importance of inclusive, demographically diverse cohorts in microbiome research and presents a reference for the variables that are important to account for in paediatric oral microbiome studies.

Download at Research Square: .

The post Preprint: Population-based characterisation of child and adolescent oral microbiomes appeared first on Determinants.

Evaluating the impacts of the Tłı̨chǫ Highway on food security and other determinants of health in Whatì, NWT.

Sarah Jones, PhD

Abstract

Many Indigenous populations across Canada experience inequalities in the determinants of health and well-being and health outcomes compared to non-Indigenous populations. These inequalities are related to historic and contemporary structural and systemic inequities linked to processes of colonization. In Canada, inequities are compounded in isolated and remote communities by large geographic distances to the nearest administrative and service centres and, in many cases, socio-economic marginalization. The development of new transportation infrastructure is often used as an instrument for government policy to bridge this distance and improve determinants of health and well-being for isolated communities. 

In 2021, the Tłı̨chǫ community of Whatì in northern Canada was fundamentally transformed by one such development, the Tłı̨chǫ Highway, which connected the isolated community of Whatì to other communities in Northwest Territories (NWT) and to southern Canada. The objective of this research was to investigate the ways in which the Tłı̨chǫ Highway has changed the community of Whatì. Through a community-based participatory research methodological approach in partnership with Tłı̨chǫ Government (TG) Department of Culture and Lands Protection (DCLP), this research investigated the impacts of the highway on food security and food sovereignty, mobility, and economic, social, and cultural determinants of health and well-being for community members in Whatì. It also investigated how impacts may be experienced differently across sub-populations in the community and identified programs and initiatives that could address negative impacts of the highway and improve determinants of health and well-being for community members in Whatì. 

Using dirt research as a research method, the researcher took up research residence in Whatì for several months in 2023, and conducted follow-up visits throughout 2024 and 2025. Together with two community research coordinators from Whatì, the researcher conducted a total of 50 semi-structured interviews with 55 community members, a focus group, and a workshop with high school students in 2023. This research also employed an analysis of documents submitted to the Mackenzie Valley Environmental Impact Review Board (MVEIRB) for the environmental assessment review process of the Tłı̨chǫ Highway to compare predicted and post-construction impacts of the highway specific to the market food system in Whatì. The methods used to conduct this research then shifted from observational to action-oriented to facilitate conversations between key stakeholders regarding the eligibility of the Whatì Community Store to receive a retail subsidy through the Nutrition North Canada (NNC) program, which depends on lack of year-round surface transportation to a community. This shift was grounded in t community-based participatory research methodology and driven by the researcher’s commitment to reciprocity and responsibility for ethical community engagement. 

This thesis presents a scoping review to map the extent, nature, and distribution of studies on the impacts of transportation infrastructure development on the determinants of health and well-being for remote communities in the circumpolar north, Australia, and New Zealand. It also presents the results of community-based participatory research, document analysis, and engagement with key stakeholders. Key findings of community-based participatory research illustrate the importance of situating food security in place and, that while the highway has improved dimensions of food security at the individual and household levels, it has negatively impacted food sovereignty at the community level in Whatì. The highway has provided marked increases in the mobility of community members in Whatì, limited short-term economic benefits, and the potential for medium- and long-term economic development and employment opportunities. However, increased connectivity has also resulted in a substantial increase in substance use in the community and changes to community safety, and has the potential to contribute to the erosion of Tłı̨chǫ Nàowo, or way of life, in Whatì. These impacts were assessed alongside efforts to mitigate food insecurity of community members and negative impacts of the highway, and to improve food sovereignty and the determinants of health and well-being in Whatì. 

Results of document analysis found that the environmental assessment review process for the Tłı̨chǫ Highway lacked discussion on the predicted impacts of the highway on the Whatì Community Store in relation to the NNC retail subsidy. As a result of engagement with key stakeholders, the Whatì Community Store received an extension of the retail subsidy and contingency funding from the NNC Community Food Programs Fund to support its transition to a road-based supply chain using the Tłı̨chǫ Highway. Results of the investigation into the interactions between the environmental assessment review process and institutional supports or barriers for the market food system also yielded four policy recommendations. These, along with the results of community-based participatory research, can inform environmental assessment review processes for proposed new roads to isolated communities in Canada including mitigative strategies specific to sub‑populations that may be disproportionately impacted by this infrastructure. Results of community-based participatory research support TG’s regulatory reporting requirements for the Tłı̨chǫ Highway to the MVEIRB. Lastly, this thesis contributes to critical population health praxis and community-based participatory research as a methodological approach to research with communities, discussing the relationship between research and advocacy for researchers external to, but partnering with, communities.

Read the Dissertation: .

Citation

Jones S. Evaluating the Impacts of the Tłı̨chǫ Highway on Food Security and other Determinants of Health and Well-Being in Whatì, NWT [dissertation on the Internet]. Ottawa (ON): �Ӱ�ԭ�� University; 2025 [cited 2025 Oct 1]. Available from: https://doi.org/10.22215/etd/2025-16782

The post PhD Success: Sarah Jones appeared first on Determinants.

Reyhaneh Golestani, Farideh Khalajabadi Farahani, and Paul Peters

Abstract

Background: The aim of this study is to explore young rural women’s perceived barriers in accessing healthcare services with a focus on the interrelation between three marginalization criteria: age (youth), gender (female), and place of residence (rural areas) in Australia, Canada, and Sweden.

Methods: Using a qualitative interpretive approach, we conducted semi-structured in-depth interviews with 31 young women aged 18 to 24 in selected rural communities. Data collection took place from May 2019 to January 2021, and the qualitative data were analyzed using NVivo software.

Results: Self-perceived barriers for access to healthcare services among young women living in rural and remote areas encompass various challenges across individual, institutional, and structural levels. Individual barriers include limited knowledge about available health services, negative attitudes toward healthcare, psychological discomfort when seeking assistance, and economic affordability issues. Institutional challenges involve limited healthcare resources, gender insensitivity among providers, judgmental attitudes from healthcare staff, inadequate time management of services, and a lack of privacy and confidentiality within facilities. Structural barriers further compound these issues through socio-cultural and gender norms, insufficient coverage of universal health insurance, low budget allocations for health facilities in rural and small urban areas, and the geographic distance to healthcare providers. Addressing these multifaceted barriers is crucial to improving healthcare access for rural population.

Conclusions: Appropriate strategies and policies must be introduced to promote access to healthcare services in rural and remote areas even in most high-income countries.

Read the article:

Citation

Golestani, R., Farahani, F.K. & Peters, P. Exploring barriers to accessing health care services by young women in rural settings: a qualitative study in Australia, Canada, and Sweden. BMC Public Health 25, 213 (2025). https://doi.org/10.1186/s12889-025-21387-2

The post New Article: Exploring barriers to accessing health care services by young women in rural settings: a qualitative study in Australia, Canada, and Sweden appeared first on Determinants.

Presentation to Central OHT Collaborative June 13, 2024.

The link between communities, places, and health is well-established in the scientific and public health literature. Differences in the characteristics of places can help explain differences in health inequalities. Place-based analysis offers a lends to better understand the health needs of local communities, evaluate gaps in health service accessibility, and show where opportunities to intervene exist. Access to care should not be determined by where people live.

As part of our collaboration between the and ‘s , we presented to representatives of Ontario Health Teams from across the province. This work demonstrates a pilot project for our place-based geographic analysis of the factors influencing mammography screening at the local level, and builds on our prior collaborations.

The objective of this project was to see how geoanalytic results can be used in health system planning and point-of-care, with the goal of improving the health of local populations. For this project, the mammography screening use-case makes use of existing data that can be integrated with local-level data on social determinants and health accessibility. Building from our prior work with geographically weighted regression, this project facilitated the creation of an interactive geospatial visualization tool to provide OHTs a resource for developing upstream engagement strategies.

The project demonstrated how a data-centred, place-based approach enhances understanding of an OHT’s attributable population.

The mammography screening interactive tool is .

The post Collaboration: Place-Based Analysis to Understand Health Seeking Behaviour appeared first on Determinants.

Dissanayake A, Dupuis A, Burton CL, Soreni N, Peters PA, Gajaria A, Arnold P, Crosbie J, & R Schachar. (2024) “Racial/Ethnic Disparities in Youth Mental Health Traits and Diagnoses within a Community-based Sample.” Canadian Journal of Psychiatry. .

Abstract

Objective

The post New Article: Racial/Ethnic Disparities in Psychiatric Traits and Diagnoses within a Community-based Sample of Children and Youth appeared first on Determinants.

Madeleine Sheppard-Perkins, Tomoko McGaughey, Paul Peters, & Francine Darroch.

Abstract

Geographic methods of inquiry are being increasingly employed to discern and visualize geographical patterns associated with increased risk of sexual- and gender-based violence (SGBV). As such, this scoping review systematically collated academic literature and subsequently synthesised (1) the time trend of studies employing geographic methods to understand SGBV, (2) the context in which geographic methods are being used to understand SGBV (i.e. objectives), (3) study characteristics, and (4) the methods and data sources used. A total of six databases were searched: Gender Studies, PsychINFO, Scopus, PudMed, Cochrane, and Campbell. Following title-abstract (n = 3354) and full-text screening (n = 159), 42 studies met data extraction criteria. From our review, there is clear momentum in the use of geographic methods to understand trends in SGBV. The majority of studies stated objectives aligning with assessing risk of SGBV (n = 35, 83.3%), while the remaining aimed to assess SGBV service availability. As research expands, there is notable focus on urban and suburban areas and a dominant dependence on institutional data sources (e.g. hospitals and police data), which hold certain caveats when it comes to structural barriers to SGBV data collection, such as fear of reporting and historic distrust in institutional services. Dovetailing the employment of big data sources with community-facilitated SGBV data collection methods may be a promising avenue for neighbourhood-specific efforts to inform policy and practice.

Download the article: .

Citation

Sheppard-Perkins, M. D., McGaughey, T., Peters, P. A., & Darroch, F. E. (2025). Exploring the use of geographic methods to understand sexual- and gender-based violence: a scoping review. Gender, Place & Culture, 32(3), 313–341. https://doi.org/10.1080/0966369X.2024.2307583

The post New Article: Exploring the use of geographic methods to understand sexual- and gender-based violence: a scoping review appeared first on Determinants.

Addressing Health Inequities and Enhancing Population Health Management Strategies Through GeoAnalytics

The link between communities, places, and health is well established in the scientific and public health literature, and differences in the characteristics of places can help explain differences in health inequalities. Place-based analysis, as illustrated in this project, offers a lens to better understand the health needs of local communities, evaluate gaps in health service accessibility, and show where opportunities to intervene exist.

The Ontario health system has become more locally oriented with the introduction of , providing a vital link between health policy makers, health service providers, and local communities. OHTs are sources of expertise in data collection, analysis, and evidence-based approaches to improve population health and health equity. As such, there is tremendous potential for these organizations to conduct analyses that are relevant and impactful for local health services and health outcomes.

This project reviewed the potential role of geoanalytics for Ontario Health Teams via an examination of place-based analytic approaches at the local level, examination of use-case scenarios for emergency department visits and mammography screening, and an evaluation of the potential for geoanalytics within a population health framework.

Importantly, we are concerned here with how the analytic results can be used in health system planning and point-of-care, with the goal of improving the health of local populations. For this project, use-cases have been selected to make use of existing data available to and for those that can lead to impactful interventions and upstream engagement strategies in the short-term.

The final evaluation further discusses the potential for spread and scale of the analytic frameworks, data systems, and tools at the Provincial level. Looking towards future digital infrastructure, a geoanalytics approach has strong potential to integrate with existing health data systems and provide a much-needed link between often-inaccessible health administrative data and locally relevant population statistics.

Loading…

No file posts are available.

GeoAnalytics Project Evaluation

ArcGIS StoryMap

– this StoryMap presents the geoanalytic results for the emergency department and mammography screening use-case scenarios. This StoryMap was created as part of the Rural R:ISK project funded by the Social Sciences and Humanities Research Councile (SSHRC).

Health geoanalytics can support public health organizations such as OHTs in making informed decisions, optimizing resource allocation, and improving the efficiency of their operations. This may lead to cost savings by reducing waste, targeting interventions effectively, and improving overall health outcomes in the population.

Infographics of Health Indicators for Southlake Community OHT

Steering Committee Members

This project was guided with the expert input from a steering committee and contributing stakeholders.

The post Collaboration: Southlake OHT GeoAnalytics appeared first on Determinants.

ShelterCare: The Integration of Health and Housing Services as an Evidence-Based Shelter Model

Ayshia Baile, April 23, 2023

Homelessness is a multifaceted issue which is incredibly prevalent across Canada. It was estimated in 2016 that at least 35 000 individuals experience homelessness on any given night, with more than 235 000 Canadians every year (Gaetz et al., 2016). This estimate does not include ‘hidden homelessness’ which is thought to be up to 50,000 people per night nationwide encompassing those who do not have permanent housing and temporarily stay with friends, relatives, in their vehicles, or other undocumented spaces, avoiding unsheltered homelessness (Gaetz et al., 2013). Due to the Covid-19 pandemic, routine homelessness enumerations have been delayed, although studies have projected a rising incidence in homelessness since the onset of the pandemic with estimated continued growth considering the impeding recession if no effective interventions are implemented (Falvo, 2020). This issue runs deeper than lack of stable housing as there are many social, economic, and systemic barriers faced by individuals who experience homelessness, making it a complex problem which requires comprehensive solutions. Of utmost concern, are the severe health impacts of poor housing and homelessness. Homeless populations have been described in literature as being vulnerable to the ‘tri-morbidity’ of social marginalization being mental illness, addiction, and physical illness highlighting the main health risks associated with homelessness (Gicas et al., 2020). Lack of stable housing decreases overall quality of life, exacerbates chronic health conditions and medical complications, and presents significant barriers to health access which negatively impacts individuals who experience homelessness and public healthcare systems. Homelessness requires immediate interventions and should be a priority for all governing bodies in Canada but, as housing is a key social determinant of health, it should be a critical priority for health and healthcare decision makers. With the multitude of proposed models and pilot projects being conducted to address health inequities afflicting the homeless population, which solutions have promising measurable benefits and should be prioritized by health policymakers?

ShelterCare is a housing intervention that was originally thought to be a utopian model for ending chronic homelessness but was given the opportunity to demonstrate its potential as an incredibly impactful evidence-based intervention due to the COVID-19 pandemic. These pilot projects have exemplified the need for the program to address systemic barriers to housing for homeless populations and drastically improve the health of marginalized individuals. Demonstrating similar positive outcomes to other evidence-based housing interventions like Housing First, but while considering the state of housing and escalating opioid crisis, this model can fill significant gaps and better support individuals who have experienced chronic homelessness to secure and maintain permanent housing.

This paper reviews current housing and shelter interventions and evaluate the overall improvements to health and quality of life of the homeless population. Based on currently piloted housing initiatives and comparing to previously explored solutions, the ShelterCare model will be reviewed in-depth for its impact on health. The perspectives and impact of key stakeholders will be considered including municipal and provincial governing bodies, regional public health, hospital, and community health officials, related non-profit and community advocacy leaders, social services sector, and clients themselves, as cross-sector collaboration is required to effectively implement this intervention. An approach to engaging with these stakeholders as well as a model for continuous evaluation of its impacts will be outlined, highlighting the gaps this service would fill and how it could be implemented effectively.

Loading…

No file posts are available.

ShelterCare Final Paper

The post ShelterCare: The Integration of Health and Housing Services appeared first on Determinants.