Issue11| October 28, 2021
Monthly Bulletin of the Alliance's Learning Health System
Community-Based Vaccination
Climate Change and Health Equity
Learning Events & Programs
Get Involved: Research & Sharing
New Tools &
Community-Based Vaccination Programs
Advancing Vaccine Equity Together
In early 2021, as vaccines were coming into view, Alliance members realized it would be essential for the people and communities most affected by COVID-19 to have equitable access to and uptake of them. Vaccine promotion and delivery would need to be tailored to specific populations and grounded in community. In the spring of 2021, with funding from the Public Health Agency of Canada, the Alliance launched the Community Vaccination Project (CVP) with eleven member centres from across the province who had identified needs and gaps in their communities.

The bulk of the CVP funding has gone directly to the participating member organizations to support their local work, including door-to-door outreach, telephone help lines, and community events. The Alliance is also facilitating the exchange of knowledge and practical resources centrally through our members-only web portal, a listserv, and an emerging community of practice, as well as evaluation and knowledge-sharing with national and interprovincial partners.

What have we learned?

Here are a few of the successful strategies the CVP participant members have used to increase vaccine confidence and uptake in communities with higher degrees of hesitation and distrust and barriers to accessibility:

  • Having community ambassadors attend community-development and health-promotion programs and engage people in friendly, one-on-one vaccine conversations.

  • Providing private spaces and non-publicized opportunities for individuals to receive vaccination that protect their confidentiality.

  • Holding events in familiar community spaces and leveraging trusted relationships with community leaders, such as faith leaders.

  • Ensuring meeting and vaccination spaces are accessible to those with physical, social, and digital barriers, such as transportation, child care, language, and digital inequity.

  • Engaging with small local employers and presenting to their employees as a group.

By the numbers

We're a third of the way into the project so far, and here are some outcomes we have already observed in just six months:

  • 43 online or in-person public events held in communities.

  • 2380 targeted outreaches to individuals and families by phone, text, or home visits.

  • 4871 individuals and families reached directly.

  • 130,253 individuals reached indirectly through social media and local advertising.

  • 1,393 individuals who agreed to vaccination, booked vaccination appointments, and/or were vaccinated at event sites directly as result of project activities.

These activities are part of the “last mile” effort, as health providers aim to reach the approximately 13% of people in Ontario who have not yet been vaccinated due to hesitancy, distrust in their communities, or other barriers.

Participating members are preparing to pivot and respond to emerging need, as vaccine approval for children 5-11 years old are on the horizon, and booster shots are being rolled out for people who are medically or structurally vulnerable. The resources and knowledge developed in response to COVID-19 will remain relevant long after the fourth wave subsides. As uptake of routine vaccinations has been waning over recent years, we hope that this project will glean promising practices and lessons learned that will inform immunization promotion and uptake among priority populations in the long-term.

Stay tuned next month for a follow-up article about COVID-19 vaccination for children. 
Health Equity through Climate Action
Supporting the Ecological Determinants of Health

The impacts of our climate crisis are already deepening pre-existing health inequities in Canada. It is too late to reverse climate change, so we need to respond with efforts to reduce the speed and severity of climate change and to support people and communities in adapting to the changes that can no longer be reversed or prevented. These two strategies – mitigation and adaptation – are at the heart of an ethical response to the climate crisis.

Global commitments

At the recent COP26 conference, nations and organizations issued 29 statements and declarations calling for or committing to specific actions and strategies. Many of these are commitments to divest from or phase out fossil fuels, although no across-the-board agreement on this was reached. Three of the others are proposals for advancing knowledge, transforming healthcare, and supporting equity:

  • The Adaptation Research Alliance, a group of over 100 organizations in 35 countries, have committed to supporting research that will help communities build climate resilience.

  • The COP26 Health Programme includes a commitment by 52 nations to building sustainable, low-carbon health systems, and by 460 healthcare organizations to prioritizing advocacy for climate-change mitigation and adaptation.

  • 16 countries committed to ensuring a just transition towards net zero, minimizing the risks for marginalized people that are inherent in any major economic or social transformation.

Local interventions

At the local level, primary healthcare organizations in Canada are working with clients and communities to develop health interventions that support climate-change mitigation and adaptation while also improving individual and community health and wellbeing. In Addressing Ecological Determinants of Health,” a paper recently published in the Alliance for Healthier Communities research library, a group of researchers explore such health initiatives at ten community health centres across the country. Common approaches include:

  • Indigenous-led teaching and healing to connect the health of the land with clients’ health.

  • Promoting healthy settings, for example through cleanup of contaminated soil, water, and air.

  • Outdoor physical activity (with equipment loans to minimize barriers).

  • Food-related programs connecting people to growing, sharing, cooking, and eating together.

As the authors note, these organizations are addressing the ecological determinants of health “in a broader set of ways than mainstream healthcare” by focusing on nature-based solutions that link people with land and community. If your organization is looking for ways to support the ecological determinants of health, advance climate-change mitigation and adaptation, and support an equitable transition to a greener economy, you might find inspiration in the examples highlighted in this paper.

As a sector, the Alliance is urging the Healthcare of Ontario Pension Plan (HOOPP) to divest from fossil fuels. If you are a HOOPP member, consider signing the open letter to HOOPP here. If you are a member of another pension fund, consider using this form from Shift Action to send a letter to your plan's administratiors.

Learn more

  • For more information about how climate change impacts health and health equity, and for tools to help you talk to your clients, colleagues, and community about it, check out the National Factsheet from the Canadian Association of Physicians for the Environment (CAPE), or this series of infographics from the American Medical Association.

  • Curious about how health considerations can motivate climate action? Join a fireside chat hosted by the Smart Prosperity Institute on November 25.
Learning Events & Programs

November 18, 1:00-2:00 pm Webinar: A green health recovery from COVID-19. Learn about the potential for a green economic recovery to advance health outcomes. Registration and information here.

November 25, 1:00-2:00 pm – Webinar: How can health considerations drive climate action? Panelists from the Canadian Association of Physicians for the Environment, the Canadian Coalition for Green Health Care, and the Clean Air Partnership will explore how to build a case for climate action based on benefits to human health. Register here.

November 22-26 – Diabetes Canada/CSEM Processional Conference: Let’s End Diabetes. Schedule and information here. Registration here.


December 2, 12:00-1:00 pm Webinar: Using Data & Measurement for Improvement Initiatives in Palliative Care. Are you working on improvements to palliative care in your organization based on the Palliative Care Quality Standard? Join Ontario Health's Palliative Care Community of Practice as they explore answers to the question, “How will I know that a change is an improvement?” Register here.

December 8, 8:30 am - 12:00 pm Webinar: Community Resilience: Rolling Up our Sleeves. Resilience is much more than our personal capacity to overcome adversity. It is a reflection of how well communities work together to create conditions in which everyone can flourish. Community resilience can be a powerful protective factor against the effects of adverse childhood experiences (ACEs). If you work in an Alliance member organization and want to learn more about this vision of resilience and how to help make it a reality in your community, please join us for this free workshop, hosted by our ACEs & Community Resilience Community of Practice.

December 13, 12:00-1:00 pm – Webinar: How the BETTER approach can help empower your clients in their health journeys. BETTER is an innovative, person-centred, and evidence-informed program that can help people aged 40-65 reduce their risk of cancer and chronic disease. Register now for a special Lunch 'n' Learn webinar about how this program can support your team's prevention work.


BETTER Prevention Practitioner Training Institute: Prevention Practitioners are interprofessional primary care team members who support clients in taking actions to reduce their risk of cancer and chronic disease. Training for BETTER Prevention Practitioners is available to Alliance members on a cost-recovery basis. See the prospectus and website for more details, or email Carolina Fernandes.
website to learn more and sign up your team.

Last chance! Applications close December 6 for TUTOR-PHC 2022-2023. Transdisciplinary Understanding and Training on Research – Primary Health Care (TUTOR-PHC), is a one-year capacity-building program for inter-disciplinary research. It is open to graduate students, post-doctoral fellows, mid-career clinicians, and decision makers from across primary health care. Participants receive research training, university credit, feedback on their own research, and opportunities for mentoring and networking from TUTOR-PHC alumni. For more information, see the flyer here (en français ici).

Doing research and need help designing your end-of-grant KT plan? Consider registering for this self-paced online course from the KT program at St. Michael’s hospital. Enroll whenever it is convenient and get access to the materials for two months. Email Meghan Storey for more information.
Research & Sharing Opportunities
Calls for Abstracts

Action Now! Building Equitable Futures Together: The Alliance's annual comprehensive primary health care conference returns in-person in June 2022. Submit proposals for learning sessions by January 10. Priority themes, formats, and evaluation criteria here.

Networking and Collaborative Learning

Obesity Canada Action Teams: Obesity Canada is working on creating a framework as part of a National Obesity Strategy and is looking for experts and students from various disciplines to apply to their Action Teams. These are small working groups that will focus on conducting strategic research that will support the creating of a national framework. Each has a different area of focus: Research/training, Education, Policy, and Community Engagement. Lots of information and link to apply here.

SPIDER Learning Collaborative: De-prescribing dangerous medications. Can data-driven QI activities help de-prescribe potentially harmful medications, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative, starting this fall. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.

Study Participants & Stories Wanted

Your expertise can help make other lung-cancer screening programs more equitable: People living with low incomes often miss out on lung cancer screenings, and this costs lives. A research team led by Dr. Ambreen Sayani and Dr. Aisha Lofters from Women’s College Hospital is working to close this equity gap. They’re looking for expertise from clinical and interprofessional providers at CHCs, AHACs, CFHTS, and NPLCs to help them build a trauma-informed and equity-based e-learning module for family physicians. Flexible scheduling is available to accommodate busy clinic schedules. See their letter of invitation for more details. Email Dr. Ambreen Sayani if you have questions or want to participate. Please share this opportunity with the clinicians and interprofessional healthcare providers in your organization!

SPARK better screening and intervention for social and material determinants of health: The Screening for Poverty And Related determinants and intervening to improve Knowledge of and links to resources (SPARK) study will improve processes for collecting socio-demographic data and addressing poverty at the point of care. You can connect community members with the SPARK team to share their thoughts about healthcare providers asking people about their identities (gender, race, education level) and social needs (income, housing). Participants will be invited to complete two surveys and an interview, all in one online session of 60 to 90 minutes, and they will be compensated. Contact for more information. Share the call for for participants and recruitment poster with your clients - in English, French, Chinese, and Punjabi.

Has your organization been involved in new, cross-sectoral initiatives for newcomers in the context of COVID-19? Tell us about them! Researchers from the University of Toronto, University of Montreal, Access Alliance, and Crossroads Clinic are collecting information about cross-sectoral work that emerged in Ontario during the pandemic to continue serving vulnerable newcomers. Submit your examples here. Find more information about this CIHR-funded project here.

Tailored messages about COVID-19 vaccines for your hesitant clients: The Canadian Primary Care Information Network (CPIN) is looking for physicians and NPs to participate in a study that will use the CPIN platform to communicate with clients who feel hesitant about the COVID-19 vaccines. Participating providers will receive CPIN services free for one year and will be compensated for their time. For more information, see the research flyer (English and French) or email the study team.

Share your experiences working with uninsured migrants. Researchers want to hear from health care providers who have experience providing health care services to uninsured migrants. What they learn will inform policy recommendations and will be shared through community events. Confidential interviews will be conducted over Zoom. Email Melissa Anderson to participate or learn more.

Clients who are planning a pregnancy are invited to participate in a randomized controlled trial of a new initiative that may help them improve their health and health-seeking behaviour. The Healthy Life Trajectory Initiative (HeLTi) Canada study is part of a global project evaluating the effectiveness of technology-based care provided by specially-trained public health nurses. Visit HeLTI Canada's website to learn more, or follow @HeLTICanada on social media.
New Tools and Resources
Funding and Awards

2021 SPOR Evidence Alliance Seed Grant. This year's theme is Knowledge Dissemination and Implementation with Patient Partnership Using an Equity, Diversity, Inclusion and Social Justice Lens. Apply by December 6.

Nominations now open for the Transformative Change Awards 2022! The Alliance is looking for leaders, innovators, and collaborators who have created transformative solutions to advance health and wellbeing for people in Ontario. Check out the nomination guide for more information. Deadline to apply is January 14, 2022.

Guidance & Tools to Support Practice

Just launched! Indigenous Cultural Safety Training from the Indigenous Primary Health Care Council. The training series is called Anishinaabe Mino’ayaawin – People in Good Health; the first course in the series, Foundations of Indigenous Cultural Safety, has been created in partnership with the IPHCC's Indigenous Knowledge Keepers' Circle, bioethicists, and Indigenous patient navigators from across Ontario. It is grounded in a two-eyed-seeing approach to knowledge. This online, multi-media course that takes about three hours to complete. Enrolment is free for individuals and organizations. Email the IPHCC ICS Team for more information or to register. If your organization provides care for Indigenous clients, has Indigenous staff, or works with Indigenous community partners, consider also using the free Ne'iikaanigaana ("All My Relations") Toolkit to help you implement your cultural safety learnings and create safer environments for Indigenous people.

More support for reconciliation: Reconciliation Canada has released Community Action Toolkits to support reconciliation conversations in your organizations and communities.

Mental Health Toolkit: Speaking with your doctor about your mental health. This six-page workbook was developed to help primary healthcare providers support clients who have mental health concerns. It can be used during appointments to enhance communication and help guide conversations about mental health care. Find tips for using the workbook here.

New Content on the Ontario Community Health Profiles Partnership (OCHPP) website: 2018 Adult Health and Disease maps for diabetes, asthma, high blood pressure, mental health and addiction--related visits, COPD, and 2+ chronic conditions.

Knowledge exchange hubs for substance use and public health: The number of these resources has been increasing substantially over the last 2 years. If your organization is working in safer supply and/or other harm reduction approaches, or is thinking of starting one of these programs, these are great sources of information and guidance.

Monthly Reading List from Linkages: Osteoporosis & Falls & Fractures in Older Adults. Clinical practice guidelines for prevention; current evidence for screening, diagnosing, and pharmacological and non-pharmacological treatments of osteoporosis in older adults; plus nutrition, physical activity, fractures and falls prevention.

Recently Published Research

Afrocentric screening program for breas, colorectal, and crervical cancer among immigrant patients in Ontario. Hot off the presses! This brand-new paper describes a groundbreaking initiative at TAIBU Community Health Centre aimed at improving equity in cancer screening rates. Rates of breast, colorectal, and cervical cancer screening increased dramatically thanks to this Afrocentric program which consisted of provider audits, cancer screening education programs, a patient callback program, and a mammography promotion day.

Socio-demographic factors related to binge drinking in Ontario. This newly published study from researchers at Ontario Health examines the association between binge drinking and socio-demographic factors including age, gender, mental health, sexual orientation, household composition, rurality, and employment. Results can help primary healthcare providers make decisions about screening and care and can help decision-makers create supportive programs and policies. It's a great example of how improving our sociodemographic data collection can help us advance health equity!

Care coordination in interprofessional primary care during the COVID-19 pandemic: This poster by Alliance research & evaluation director Dr. Jennifer Rayner and partners shows that Community Centres and Family Health Teams excel in care coordination in general and continued to excel during the pandemic. However, it also identifies room for improvement. By using EMR data and validated tools to identify clients with complex needs, and by providing access to peer support networks, we can do even better.
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