Equity in Focus
Speaker Series

Dr. Doug Manuel introduced the CCHS’ purpose, design, and study base. Although CCHS is the largest and longest ongoing health survey in the world (and has more linkages through ICES to other health data than any other survey in the world), users must appropriately consider which populations are excluded, how complex survey design and weighting methods may influence findings, and how differences between survey cycles affect our ability to harmonize. He also described some nuances explored in a case example exploring the intersection of immigration and racialization. 

Key resources and tools: (also linked in the presentation slides)

• The most complete public collection of CCHS documentation, which includes historic items that are no longer available from Statistics Canada 
• The dictionary builder 
• The Open Science forum cchs flow 

Dr. Jennifer Rayner contextualized the importance of including CHC data alongside other data when asking equity-related questions about primary care in Ontario. Rich, individual-level, self-reported sociodemographic variables are available in the CHC data, including gender, sexuality, race, language, household income, household composition, education level, housing status, and more. Notable limitations, such as data linkage issues for CHC clients who do not have OHIP, were also mentioned. 

Angela Robertson described the impact of these data on planning and monitoring an equity-focused COVID vaccine rollout strategy. Dr. Lesley Plumptre and Cynthia Damba described an ICES case example, showcasing race-disaggregated analyses, rich descriptions of numerous other social characteristics of the identified racialized cohorts, and integrated community and knowledge user involvement for impact. 

Dr. Baiju Shah described how this algorithm was developed for optimized specificity, making it useful to define cohorts of South Asian and/or Chinese individuals for studies where this is the primary exposure of interest. Due to its low/moderate sensitivity, SURNAMES is not appropriate to define ethnicity as an adjustment variable or covariate.

This exemplary case study on the association between Chinese or South Asian ethnicity and end-of-life care showcases appropriate use of SURNAMES for cohort creation, thoughtful interpretation leveraging existing sources of qualitative research, and nuanced descriptions of SURNAMES’ limitations.

Dr. Flora Matheson described changes to the 2021 version of ON-Marg. Trevor van Ingen described considerations for use, including limitations of the census, practicalities when using area-level measures, and the need to recognize that inequities observed using ON-Marg are caused by underlying social/structural factors (context). Laura Ferreira-Legere further outlined the Public Advisory Council’s recommendations for contextualization: read more here

Dr. Susitha Wanigaratne contextualized immigration as a structural determinant of health in Canada. Dr. Hong Lu described the variables in IRCC’s Permanent Resident Database that ICES project teams can use to examine immigration and related constructs. Disaggregation by various intersections is encouraged, as appropriate to study objectives.

Dr. Arjumand Siddiqi presents a primer on key concepts in the scientific literature on health inequities. It is imperative to dismantle the misconception of impacts of biological ‘race’ on health and focus instead on the impacts of socially-defined race, racism, and other social determinants of health.

Dr. Astrid Guttmann and Laura Ferreira-Legere provide an overview of the Guidance Document and Framework for Anti-Racist Approaches to Research and Analytics at ICES. To support implementation, Dr. Arjumand Siddiqi expands on the state of anti-racist research in Canada: it’s the study of “racism” (not “race”). She further describes the importance of race and related data and analytics.

ICES convened a Peoples’ Panel of 54 diverse Ontarians to guide our approach to using race and related data. In this session, five participants discuss how the appropriate collection and use of contextualized race and ethnicity-based data can impact access to care and outcomes in equity-deserving communities. View the full report here.

Dr. Hilary Brown and Laurie Proulx co-present both the qualitative and quantitative aspects of an ICES project focused on understanding the pregnancy health outcomes and care experiences of people living with disabilities in Ontario. They reflect on how public partners had input and decision-making power during the research process.

Dr. Aisha Lofters shares insights and lessons learned from her experience engaging community with an equity lens in two research projects involving immigrant communities. She emphasizes the importance of recognizing that communities are not homogenous and that their lived expertise is invaluable to contextual richness of the research.

Dr. Susitha Wanigaratne and Manvir Bhangu describe lessons learned around best practices, successes, and challenges of working in an academic-community partnership. They demonstrate how community partnerships improved the contextual richness of their research and improved the effectiveness of knowledge translation activities. They also demonstrate how community partnerships can amplify the benefits and mitigate the harms of policies that are influenced by research.