Health Futures - Global Futures in Focus with Dominic Barton

The world has emerged from a pandemic, but beyond the obvious impact of this global health issue and other chronic diseases, there are broader forces at play transforming our health. In this episode, Dominic Barton delves into the physical and social determinants of health that profoundly affect our quality of life.

We hear from young innovators and leading researchers including Dr. Donna Strickland, Nobel laureate and Dr. Anita Layton, Canada’s 150 Research Chair in Mathematical Biology and Medicine.

Featured in order of appearance:

Dr. Vivek Goel
Dr. Anita Layton
Dr. Donna Strickland
Jeremiah Hyslop
Seun Adetunji
Dr. Carrie McAiney
Dr. Dillon Browne

Dr. Anita Layton: If we never asked those questions, we'd be all dead by now.

Dominic Barton: Current health-care systems are much maligned for their shortcomings. They are often viewed as too complex and seemingly unsustainable. They're constantly under pressure from escalating costs and shortages in health professionals. There are many physical and social determinants of health that contribute to our well-being, yet too many individuals and communities aren't able to achieve an optimal health status. To compound the problem, there is a global divide when it comes to positive health outcomes and access to care within different populations.  

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Dominic Barton: The world has emerged from the pandemic, but beyond the obvious impact of this global health issue and other chronic diseases, there are broader forces at play transforming our health futures. Social determinants of health like the environments where people live, learn, work and age profoundly affect our quality of life. Inequities in accessing clean water and air, safe agricultural practices and supportive communities have created a global health divide. A shortage of health-care professionals is plaguing many countries around the world. Many western nations are experiencing an aging population that is putting an increasingly large strain on the system. Finding solutions to all of these combined challenges is not just the work of doctors and health-care professionals. It also requires the work of engineers, researchers, governments, scientists and mathematicians. The development of new technologies and advancements in policy and processes will take a whole ecosystem of players often working together to infuse innovation into how we care for one another. 

This is Global Futures in Focus from the University of Waterloo. I'm Dominic Barton.

Dominic Barton: You may know the University of Waterloo for engineering and computer science, but since my time getting to know the institution, I've seen a rich ecosystem when it comes to health as well. Take a look at the Faculties of Health, Arts and Science and you can see research and teaching in optometry, pharmacy, social work, psychology, public health, and kinesiology, just to name a few. When I think about the global futures, I see a Venn diagram. The futures of societal, technological, health, economics and sustainability are distinct, but they are interconnected. Each impacts the others. The world's population is getting older. An aging population in Canada and many other countries around the world is shining a spotlight on how these futures are overlapping, especially when it comes to health. How can we help people age in place, grow older in their homes and communities, and how can we keep people as healthy as possible for as long as possible? As an older person myself, I'm very interested and hopeful in how these questions will be answered. Across Waterloo’s Faculties, technology, society and health futures weave seamlessly together, providing researchers, students and partners with a truly unique opportunity to change the health-care landscape. I've seen these collaborations first hand, and they're extraordinary. I'll share some of these stories in this episode. Someone who understands the health sector extremely well is University of Waterloo President Vivek Goel. He is a leading public health researcher, health services evaluation expert and champion for the use of research evidence in health policymaking.

Dr. Vivek Goel: If we think of the traditional biomedical model that most academic health science centres focus on, it's about fixing people once they get sick. So, we think about in quantum and nano, so many of the applications that are emerging are in the health space. So many of our companies that we see coming out in Velocity and other programs have applications in the health space using those technological areas of strength. At the same time, moving those technologies forward also require us to look at other social aspects, you know, how are these technologies used, how do we pay for them, how are they reimbursed in our health-care system. So, it's not just the technologies, but also bringing in again those societal aspects into thinking about how we address these big health challenges before us.

Dominic Barton: Digital health innovations often fail because they don't meet both the needs of patients and frontline health providers. Other innovations succeed because they take a broader approach. For instance, look at the work of Dr. Anita Layton, a professor and Canada 150 Research Chair in mathematical biology and medicine. She leads a diverse and interdisciplinary team of researchers who use computational modelling tools to better understand aspects of health and disease. They collaborate with physiologists, biomedical engineers and clinicians to formulate detailed models of cellular and organ function. Dr. Layton seeks to answer questions like, how should blood pressure medicine be prescribed differently for men and women? Is it better to take one's medication in the morning, or at night? Or does it matter?

Dr. Anita Layton: I put together a mathematical equation that said, ‘OK if this is the composition of the blood, this is how the cell will function.’ So based on that prediction, you know, I can kind of look at what the cells in the kidney are doing. What computer simulations do is not to replace clinical trial, but to focus their resources into drugs that are more promising. So given our understanding of you know, what's causing the disease, we think that the drug that has this property, this is the property that you need to look for in a compound, therefore an effective drug. So that property, you know, you may be able to find it in 25 different proteins. So, which one should you focus your money on, right? Clinical trials are very expensive. It can cost you know, a couple of billions—it’s billion, not million— billions of dollars. A lot of them actually fail. Like Alzheimer's drugs. More than 99 per cent of them fail. It will be really difficult to persuade any pharmaceutical company to run clinical trials on all 25 candidates. However, it’ll be a lot cheaper to run computer simulations on all 25 of them, pick out the top candidates in terms of efficacy and safety. You don’t want something that works, but then, you know, kill the patient in some other way. And then just run trials on those top, I don't know, top two candidates. So simulation can help you focus your resource, and then you know, in that way, speed up the discovery of promising drugs.

Dominic Barton: We can't afford to get stuck on trying to simply address the problems of today. We need to imagine and anticipate the needs and demands of tomorrow. As a result, being able to do deep research has never been more important. Dr. Layton asks those deeper theoretical and fundamental science questions within her work to help uncover the seemingly unimaginable.

Dr. Anita Layton: So, think of COVID. So, we now have a vaccine. We can track the evolution of COVID variants. How do you think we're able to do that? Because for decades, we invested money in fundamental science, trying to understand the genome, the secret of life. So that's fundamental science, but fundamental science has a lot of application, you know, medical application and way beyond that. So it is really important to ask fundamental questions. 

Dominic Barton: Waterloo physics professor and Nobel laureate Dr. Donna Strickland champions this idea of the importance of fundamental research. She emphasizes the need to undertake basic science, the kind that doesn't necessarily have an obvious, practical application. Dr. Strickland was awarded the Nobel Prize in Physics in 2018 for developing chirped pulse amplification. At the time of her breakthrough decades ago, it did not have an application. But it inspired new research, and now has several applications within industry and medicine, including the use of lasers in eye surgery. She anticipates her work will continue to impact countless fields in the future. She spoke to journalist Kate Lunau at a campus event soon after the Nobel ceremony.

Dr. Donna Strickland: The point is we can't keep coming up with new applications if we don't keep having better understanding of the world around us. Einstein is the one in 1917 who laid down the laws for the laser. He is the one who wrote the equations for absorption, stimulated emission and spontaneous emission, the three processes that go on in a laser. So that was 1917 and yet we didn't have a working laser until 1960. It takes a long time and it takes a lot of people. It wasn't just Einstein and then everybody else doing nothing for 50 years. It is an amazing amount of work that goes on in between having that idea and the laser. And then when the laser came along, all of a sudden, it showed that you could have these nonlinear effects, which we use in umpteen different ways now. But if somebody hadn't invented the laser, we wouldn't have understood you could have these nonlinear effects, right? Well, of course, Maria Goeppert Mayer thought them up without even seeing it, but nevertheless, we couldn't have them. And again, CPA came along and not because we were trying to do new eye surgery, I was just trying to see, can I get an atom to absorb nine photons or not, and we came up with the CPA laser. And then it showed that actually the way we thought it would interact with matter is not the way it interacted with matter, and we had to rethink again how does light interact with matter. And it was from that understanding that a whole lot of new things that came along,

Dominic Barton: I can tell you from presiding over dozens of graduation ceremonies over the past five years, University of Waterloo students and alumni are changemakers. They are leaders who faced a challenging curriculum that calls for thinking outside the box, working with teams and exploring diverse subject matter while seeking solutions. The lessons they learned continue to serve them well as they face a world that needs solutions to complex and challenging issues. I think of optometry student Jeremiah Hyslop. In only his second year, he asked why outdated language from the 1960s was still on standardized cards used to test our near vision during eye exams. That question and the ensuing follow-up led to change. It led to health-care practitioners facing important cultural safety topics and patient compassion head on.

Jeremiah Hyslop: In one part of the card, it says “The art involved in popping corns is at least 5000 years old, perfected by the American Indians.” And in other part, it says, “There were three types of corn. Sweet corn for immediate eating, field corn for cattle feeding, and Indian corn, which has a sufficient water content for popping.” The issue with the word Indian is first of all, it's a centuries-old mistake. When Columbus came over to the Americas, as far as I understand it, he thought that he landed in India and that word kind of stuck around for a very long time. It's still used today as you can see. And another issue that people have with it is it's a symbol of colonization. It symbolizes and brings back terrible memories of all the terrible things that have happened to Indigenous peoples in all of North America throughout history. 

I contacted Dr. Lisa Christian, who is one of our professors and esteemed faculty member and then, with her support, I reached out to a company called Precision Vision located in Illinois that manufactures the cards. And then with the help of Dr. Lisa Christian and Dr. Natalie Hutchings, who is another one of our esteemed faculty members in the optometry program. We met with this company multiple times and we also enlisted the help of Elder Myeengun Henry, who is an Elder and knowledge keeper with the Faculty of Health. In further consultation with different Indigenous members back home and here in Ontario, we came up with a whole bunch of different possible substitutions, different words that we thought would be appropriate to use in that context that would be culturally sensitive. It is important because what might be just a word to somebody might be a trigger for trauma to somebody else. 

Dominic Barton: Waterloo gave Hyslop a platform to connect with his professors, a Faculty Indigenous knowledge keeper and industry. The result is change. New standardized eye exam cards—called continuous text cards—are now being circulated throughout Canada and the U.S. While it may seem a small change to some, it can mean the world to many patients. 

Research in the U.S. has shown that 50 per cent of patients do not understand their doctor. While another study indicated that up to 80 per cent of medical information is forgotten by patients immediately after a consultation or checkup. This lost-in-translation challenge is one just waiting on someone to offer a solution—someone like Seun Adetunji, who is pursuing a Master of Business, Entrepreneurship and Technology, or MBET, and is the founder of MedInclude. She launched an innovative web platform in May 2023 and partnered with a local Waterloo health-care provider. Her technology uses AI to translate medical jargon into language and information accessible to patients. 

Seun Adetunji: For the patients that I was working with, the were in and out of the hospitals on an average three times a month. They were seeing multiple specialists and doctors. They had a lot of health-care data reports and just a lot of medical information that oftentimes became overwhelming for them and their caregivers. And so in my trying to support those patients, I started to seek out tools and solutions that could help them manage the medical information, and also help them better understand the information that they were receiving. And, unfortunately, I came up with nothing in the course of my research. There are tools out there that help doctors better communicate with other doctors, doctors better communicate with specialists, with pharmacies, but nothing quite patient centred, thinking of the problem of health-care communication from the patient's point of view, to say, ‘How can we help patients more who are on the receiving end of this information not just have access, because that's the fourth point of call, right, you want to give them access. But we also want to help them better understand the information that they're receiving. And so that's, you know, how the idea of MedInclude was bred for me and MedInclude is essentially a contraction of two words, medical inclusion. Outside all my work with MedInclude and my studies at University of Waterloo, my professional background is in communications and diversity and inclusion. And so, I always bring the perspective of inclusion, and equitable systems, and equitable communities to the work that I do.

Dominic Barton: The future of the health system requires that patients play a more involved role. But in order to do so, those patients need to understand what is happening and how the system is supporting them. An older population, myself included, will put a lot of strain on the health-care system. New technologies and approaches won't necessarily come naturally to us. We need systems and supports that intuitively guide us. Research into dementia and living with dementia are crucial to supporting this new reality. Dr. Carrie McAiney is the Schlegel Research Chair in dementia. It's a role shared with the Schlegel-UW Research Institute for Aging, and the University of Waterloo’s Faculty of Health. She works alongside people with lived experience of dementia, to enhance well-being in a manner that more readily meets their preferences and is more likely to be effective.  

Dr. Carrie McAiney: One of the projects that I've been working on is called Forward with Dementia, and it's something that's meant to support people after they've been diagnosed to give them information and resources, but also a sense of hope that they can live with dementia and live as best as they can with dementia. So how do we support their well-being and encourage them to continue to engage in, you know, healthy activities and social connections and doing things that they want to do for as long as they're able to do those things. We need to learn from people who are living with dementia and learn from their family members about the experience and not assume that we understand what that experience is, what the priorities are, what it is that people want from research or from services, or from health, their health care. So, if we really start with the person, and we kind of build out, then I think we're going to be able to, you know, meet the needs of those individuals and help to support them and their well-being.

Dominic Barton: One in five people in Canada are living with mental illness, and one in three people will experience mental illness in their lifetime. The Government of Canada is investing $200 billion into improving health care for Canadians. This funding includes increasing access to mental-health and substance-use supports. The stigma around mental health and substance abuse are rampant, and we need to continue to actively raise awareness. Dr. Dillon Browne is a professor of psychology and Canada Research Chair in Child and Family Clinical Psychology. His research seeks to better understand how stress, adversity and hardship disrupt life for entire families and across generations. Working alongside health-care practitioners, researchers like Dr. Browne are able to develop technologies and approaches informed by clinical models. Within this context, they're training future health professionals to meet current and future patient needs.

Dr. Dillon Browne: We try to make sure that our work is innovative in informing health policy and health practice. That means that we're not simply publishing in academic journals, which of course we do, we're also heavily invested in training the next generation of clinicians, specifically in clinical psychology, psychotherapy and social work, and making sure that these trainees who are going to be the leaders of tomorrow are well positioned to do so especially surrounding the intersection of social determinants of health, technology and mental health. 

Dominic Barton: Waterloo’s long-standing relationship with industry and community dates back to its founding. Today, that same willingness to interact and collaborate with partners flourishes. Dr. Browne's work with Keel Mind, a telehealth services platform has helped leverage new research with existing resources to launch a tool that incorporates AI-enhanced monitoring of clinical care along with live supervision for clinical trainees. He has also collaborated with First Nations as a clinical service provider by integrating traditional knowledge and approaches with new technology. 

Dr. Dillon Browne: So, one example here that we're really proud of is a partnership with the Pikangikum First Nation. Pikangikum First Nation invited us to be the clinical service provider specifically because an emphasis on family systems and family relationships as a whole, compared to the individual-focused western medical model, seemed to be both culturally congruent and also something where there was a need in the community. And now for over a year, we have been providing telehealth, trauma-informed family therapy in a community in northern Ontario that would otherwise not be available in terms of family therapy service provision. And so, then we have students who are not just learning how to use these new technological applications, they're getting to see how innovation in clinical science and technology is happening, and ultimately in a better position to become the sorts of leaders in the future to inform the intersection of clinical psychology, psychiatry, mental health and technology.

Dominic Barton: The University of Waterloo’s strengths lie at the intersection of health, technological and societal futures. Thinking outside the box and dreaming big are prompting unimaginable innovations. It starts from ideas and the fundamental science of researchers, such as Anita Layton and Donna Strickland, as they work on concepts is outcomes aren't necessarily on the horizon today. Those concepts are a stepping stone for the future. But change also comes into view when we see the unbelievable innovations of Waterloo students and alumni who are taking ideas and making them into reality. Projects like the culturally safe eye exam cards and MedInclude. While the future is somewhat uncertain, the possibility of what's out there, especially in the health sector, and health-care innovation are infinite. 

Thank you for listening to the health futures episode of Global Futures in Focus. I encourage you to listen to our other global futures episodes where we focus deeper into global transformations, cutting across the environment, society, technology and the economy. 

I hope they inspire you to make a difference in your own unique and perhaps unconventional way. I'm Dominic Barton.