Why Equity, Diversity and Inclusion Matters at Western

A keynote talk on diversity at Western by Dr. Isaac Luginaah of the Department of Geography and the Environment. Reporting of the keynote talk was done by students of the GHS class 2021

Association of ambient air pollution with respiratory hospitalization in a government-designated “area of concern”: the case of Windsor, Ontario

This study is part of a larger research program to examine the relationship between ambient air quality and health in Windsor, Ontario, Canada. We assessed the association between air pollution and daily respiratory hospitalization for different age and sex groups from 1995 to 2000. The pollutants included were nitrogen dioxide, sulfur dioxide, carbon monoxide, ozone, particulate matter 10 microm in diameter (PM10), coefficient of haze (COH), and total reduced sulfur (TRS). We calculated relative risk (RR) estimates using both time-series and case-crossover methods after controlling for appropriate confounders (temperature, humidity, and change in barometric pressure). The results of both analyses were consistent. We found associations between NO2, SO2, CO, COH, or PM10 and daily hospital admission of respiratory diseases especially among females. For females 0-14 years of age, there was 1-day delayed effect of NO2 (RR = 1.19, case-crossover method), a current-day SO2 (RR = 1.11, time series), and current-day and 1- and 2-day delayed effects for CO by case crossover (RR = 1.15, 1.19, 1.22, respectively). Time-series analysis showed that 1-day delayed effect of PM10 on respiratory admissions of adult males (15-64 years of age), with an RR of 1.18. COH had significant effects on female respiratory hospitalization, especially for 2-day delayed effects on adult females, with RRs of 1.15 and 1.29 using time-series and case-crossover analysis, respectively. There were no significant associations between O3 and TRS with respiratory admissions. These findings provide policy makers with current risks estimates of respiratory hospitalization as a result of poor ambient air quality in a government designated area of concern

Impact of air pollution on hospital admissions in Southwestern Ontario, Canada: Generating hypotheses in sentinel high-exposure places

<p>Abstract</p> <p>Background</p> <p>Southwestern Ontario (SWO) in Canada has been known as a 'hot spot' in terms of environmental exposure and potential effects. We chose to study 3 major cities in SWO in this paper. We compared age-standardized hospital admission ratios of Sarnia and Windsor to London, and to generate hypotheses about potential pollutant-induced health effects in the 'Chemical Valley', Sarnia.</p> <p>Methods</p> <p>The number of daily hospital admissions was obtained from all hospitals in London, Windsor and Sarnia from January 1, 1996 to December 31, 2000. We used indirect age adjustment method to obtain standardized admissions ratios for males and females and we chose London as the reference population. This process of adjustment was to apply the age-specific admission rates of London to the population of Sarnia and Windsor in order to yield expected admissions. The observed number of admissions was then compared to the expected admissions in terms of a ratio. These standardized admissions ratios and their corresponding confidence intervals were calculated for Sarnia and Windsor.</p> <p>Results</p> <p>Our findings showed that Sarnia and Windsor had significantly higher age-adjusted hospital admissions rates compared to London. This finding was true for all admissions, and especially pronounced for cardiovascular and respiratory admissions. For example, in 1996, the observed number of admissions in Sarnia was 3.11 (CI: 2.80, 3.44) times for females and 2.83 (CI: 2.54, 3.14) times for males as would be expected by using London's admission rates.</p> <p>Conclusion</p> <p>Since hospital admissions rates were significantly higher in 'Chemical Valley' as compared to both London and Windsor, we hypothesize that these higher rates are pollution related. A critical look at the way ambient air quality and other pollutants are monitored in this area is warranted. Further epidemiological research is needed to verify our preliminary indications of harmful effects in people living in 'Chemical Valley'.</p

Influence of the Natural and Built Environment on Personal Exposure to Fine Particulate Matter (PM2.5) in Cyclists Using City Designated Bicycle Routes

Urban cyclists are exposed to many traffic-related air pollutants including particulate matter (PM) that may increase vulnerability to health effects. This study investigates second-by-second personal exposure to PM2.5 (fine particulate matter that is 2.5 microns in diameter and less) along bicycle commuting paths, and assesses elements of the natural and built environment for the relative importance of these factors in understanding the variability in PM2.5 personal exposure. Urban cyclists were carrying high resolution PM2.5 monitors (placed in a backpack) in combination with portable GPS trackers to provide a spatial identity to each one-second pollutant measurement. The results of this study indicate that daily averages of PM2.5 concentrations from all bicycle routes were weakly correlated with meteorological variables, however, a strong influence of regional levels of PM2.5 was observed. Geospatial analysis of PM2.5 personal exposure concentrations showed a considerable variation within routes, correlated with land use (with lower concentrations in parks and higher in industrial areas) and clustered at four areas: busiest bridge, heavily trafficked road segments, the downtown urban core, and two construction sites. This study has found many incidences of personal exposure to PM2.5 exceeding the provincial guidelines for healthy activity (e.g., very poor (PM2.5 \u3e 91 μg/m3) pollution concentrations are clustered in three regions: approaching the bridge in the west part of the city; the downtown urban core; and two under construction spots), which suggests behavioural and infrastructure modifications in balancing the health benefits of cycling with the environmental exposure to air pollutants

Air pollution and general practitioner access and utilization: a population-based study in Sarnia, ‘Chemical Valley’

Background: Health impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada. Methods: Residents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2), sulphur dioxide (SO2) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes. Results: The results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO2- Odds Ratio [OR]: 1.16, p \u3c 0.05) and sulphur dioxide (SO2- OR: 1.61, p \u3c 0.05). Low household income was a stronger predictor of having no family doctor in areas exposed to high concentrations of NO2 and SO2. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, p \u3c 0.05) than their low exposure counterparts (OR: 1.11, p \u3e 0.05). Conclusions: This study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada

The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions

Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places

Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation therapy. Results: Women in Ontario received more optimal care in communities well supplied by primary care physicians. They were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (rate ratio = 1.65) and communities lacking specialist physicians (rate ratio = 1.33). Canadian advantages were explained by better health insurance coverage and greater primary care access. Conclusions: Policy makers ought to ensure that the newly insured are adequately insured. The Medicaid program should be expanded, as intended, across all 50 states. Strengthening America’s system of primary care will probably be the best way to ensure that the Affordable Care Act’s full benefits are realized