Research in Action: Dr. Ingrid Tyler

A ‘clinician-scientist’ for health equity: understanding the impact of programs, policies and systems on the determinants of health

Five years ago, the World Health Organization’s Commission on Social Determinants of Health identified health inequities – unfair and avoidable differences in health status ― as the most correctable health crisis of the 21st century.

That idea inspires Dr. Ingrid Tyler, a PHO physician and researcher. Her research reflects a passion for health equity and determination to reduce health inequities between population groups. Many causes of health inequities relate to social and environmental determinants, including income, social status, gender, education, and the physical environment.

“It’s a simple fact that groups who are less advantaged in different ways ― lower income, lower education, in some cases social-cultural barriers ― have poorer health. This is unnecessary and avoidable,” says Dr. Tyler, who is also an assistant professor at the Dalla Lana School of Public Health and the Faculty of Medicine at the University of Toronto.

Dr. Tyler says her research informs ― and is informed by ― the work she does as a public health physician in PHO’s Health Promotion, Chronic Disease and Injury Prevention team. This includes running training sessions on the use of the Health Equity Impact Assessment (HEIA) tool. HEIA identifies how a program or policy will impact population groups in different ways, and reveals any unintended potential impacts.  Dr. Tyler was involved with Ontario’s Ministry of Health and Long-Term Care (MOHLTC) in developing the HEIA tool, and PHO supports its implementation through providing training workshops and other initiatives.

“When I go out to train public health units, I see what their challenges are and then I undertake research to try to solve these problems,” she says. “You could call me a ‘clinician-scientist’ in public health and health equity research.”

One of Dr. Tyler’s studies, funded by the Canadian Institutes of Health Research (CIHR), focuses on the use of HEIA tools, which have been implemented in a number of jurisdictions worldwide. Encouragingly, a report by the Sudbury & District Health Unit identified these assessments as one of ten promising practices for reducing social inequities in health at the local public health level. Yet early experience suggests that public health practitioners who use these tools want more guidance when it comes to incorporating evidence, information and data into their equity assessments, says Dr. Tyler.

To understand these practical challenges and come up with solutions, she and her collaborators will study how three Ontario health units and one health authority in British Columbia go about conducting health equity impact assessments.

“We want to help find ways to make it easier to incorporate evidence and information, and local community knowledge,” explains Dr. Tyler. The ultimate goal: to develop specific materials to help practitioners use health equity knowledge when they conduct program assessments.
Collaboration is key to Dr. Tyler’s studies. Her partners include other PHO researchers, MOHLTC staff, public health units, specialists in evaluation and early childhood, and other researchers and practitioners across Canada.

In another CIHR-funded study, Dr. Tyler is zeroing in on health equity for children. Specifically, she wants to understand the components of ‘social pediatrics,’ a model of care that includes understanding a young person’s social circumstances and community.

“Our purpose is to describe the ‘moving pieces’, so that those who are trying to create integrated health and developmental care for young children will be better informed as to what works, for whom and under what circumstances.”

Dr. Tyler’s interest in health equity was sparked while training to become a physician and then practicing at a downtown Toronto health clinic.

“I quickly learned that to truly make a lasting difference in the health status of individuals or the population, some of the fundamental determinants of health need to be addressed.”

She is excited about the potential impact on practice – and on people’s health. “Our work will enable public health and other practitioners to respond to a call by the World Health Organization for action to reduce health inequities.”