Introduction
The MSHT 601 course has given me the opportunity to develop and refine my professional identity through the creation of a professional e-portfolio showcasing graduate-level work and outlining my professional goals and interests. Through this refinement, I have gained valuable content curation skills and knowledge pertaining to health in Canada which can be used for real-world application throughout my Public Health career. By engaging in discussions with peers and having opportunities to receive and provide feedback on various works, the weekly discussion forums have made me value the importance of communication, collaboration, and honesty within a work setting by demonstrating how success can be achieved with usage of these values. Having taken the MHST 601 course at Athabasca University, I have learned many important concepts which need to be taken into consideration when analyzing health issues.
STBBIs
“STBBIs are sexually transmitted, and blood-borne infections that can pass from one person to another through the blood and other body fluids during sexual contact” (Ottawa Public Health, 2020, lines. 1-2).
Figure 1
STBBIs
Note. Source: https://www.hivnet.ubc.ca/knowledge-center/stbbis/
Social Determinants of Health
During my undergraduate degree where I studied Public Health at Ryerson University, I had taken a few courses which taught me basic concepts about the social determinants of health and the roles they play in health outcome production. My knowledge in this area has remained to be of a shallow nature throughout my degree because the courses mainly involved tests and exams where I had to use numerous textbooks to obtain and retain information, which left limited time for me to do extra research and pursue the literature for knowledge enhancement. Upon taking up higher education and pursuing my graduate degree, the MHST 601 course has provided me with ample time to do additional research, and numerous opportunities to dig deep into subject material by scoping out relevant scholarly peer-reviewed sources from well-known databases. I am now able to visualize the social determinants of health using a tree metaphor, a concept which I have only recently came across while conducting my own research (Hsieh, 2016; Human Impact Partners, n.d.). In this metaphor, society laws are on the tree roots, the tree trunk contains social determinants of health, the branches contain disease-provoking behaviors, and the leaves contain outcomes of disease (Hsieh, 2016; Human Impact Partners, 2022). This is a useful aid because I am a visual learner and the metaphor has made it a lot easier to break down and understand the impact and interconnectivity of the social determinants of health. “Researchers have determined that the social determinants of health can explain up to 80% of an individual's health status” (Altarum, 2021, para. 2; National Conference of State Legislatures, 2013, pp.1-15). Among health center clients, HIV, syphilis, gonorrhea, and chlamydia were a product of low education as opposed to high education according to a study (Slurink et al., 2021). This study highlights the need to prioritize the lower-educated through care and testing for STIs (Slurink et al., 2021). Problem-solving can be done through skills and knowledge obtained from education (Lear, 2019). Comparisons between healthy and unhealthy are understood, health literacy functions at a higher level, and information is processed at higher capacities with education (Lear, 2019). Healthcare system navigation will be easier, and informed decisions can be made (Lear, 2019). In comparison to Whites, minority groups experience STIs in a greater quantity according to research (CDC, 2020; Cunningham & Cornelius, 1995; Hogben & Leichliter, 2008 ). Minorities are affected by various social conditions which trigger these high rates (CDC, 2020).“STIs disproportionately affect people in social networks where high-risk sexual behaviour is common” (Office of Disease Promotion and Health Prevention, 2022, p. 1). A study found that in comparison to Whites, high rates were experienced by Blacks with respect to syphilis, gonorrhea, and chlamydia infections (Owusu-Edusei et al., 2013). Results indicated that “racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income” (Owusu-Edusei et al., 2013, pp. 910-916). This study highlights the need for equity through Black Ontarian health being addressed (Black Health Alliance, 2018). Health care providers may be seen as a source of discrimination causing distrust amongst ethnic minorities (CDC, 2020; Wiehe et al., 2011). As a result, STI treatment and testing can generate negativity (CDC, 2020; Wiehe et al., 2011). Health is affected by housing instability where infectious disease is disproportionate (Williams & Bryant, 2018). STI stigma, substance abuse, mental illness, co-morbidities, sex education of a minimal nature, and STI treatment and prevention limitations allow for communities of homeless and low-income individuals to experience STIs at high rates (Johnson, 2020). Amongst homeless adults, 2.1%-52.5% was the noted prevalence of STIs according to a systematic literature review (Williams & Bryant, 2018). This study emphasizes the "necessity of addressing STI prevention needs of homeless adults" (Williams & Bryant, 2018, pp. 494-504).
Figure 2
Social Determinants of Health; Tree Metaphor
Socio-Ecological Model of Health
Upon reflection, I have realized that my volunteer experience at the Region of Peel- Healthy Sexuality Meadowvale Clinic had incorporated aspects of each of the different levels of the socio-ecological framework within my job duties and job setting. Prevention and STBBI risk can be understood through the socio-ecological model (CDC, 2022).
Individual Level
At the Region of Peel- Healthy Sexuality Meadowvale Clinic, I was involved in the preparation and distribution of educational pamphlets pertaining to the topic of sexual health. I was tasked with using online and hardcopy resources to compose brochures filled with information to raise awareness about STBBIs, risky behavior, and safe sex practice. By providing a means for informed decision-making via skill and knowledge development, I contributed to the individual level of the socioecological model (Lumen Learning, n.d.).
Relationship Level
I used knowledge gained from the brochure composition process to disseminate pertinent health information to friends and family (Lumen Learning, n.d.). In this sense, I was able to contribute to the relationship level through the provision of advice and educational discussion (Lumen Learning, n.d.). These discussions served a positive purpose as my friends and family took time to listen, and those who were sexually active immediately started booking STI testing appointments, and going out to purchase condoms (CDC, 2022; Lumen Learning, n.d.).
Organizational Level
Volunteering at the Region of Peel- Healthy Sexuality Meadowvale Clinic has made me appreciate the value of the people who work within these organizations, and the work that they do. Upon spending time there, I realized that needle exchange services are offered by the clinic, where a harm reduction philosophy is adopted (Region of Peel, 2022). Drug use can cause harm where Hepatitis C, Hepatitis B and HIV blood-borne infections can be transferred through drug equipment and/or needle-sharing (Region of Peel, 2022). For blood-borne disease reduction; needle disposable containers, injection equipment, stems and new needles are provided at the clinic (Region of Peel, 2022). Piercing kits and safe inhalation kits are also provided (Region of Peel, 2022). “Harm reduction aims to decrease the adverse health, social and economic consequences of substance abuse, for the user and the community, without requiring abstinence” (Region of Peel, 2022, p.1).
Community Level
Health promotion at schools was worked on by the Peel District School Board and Region of Peel’s Healthy Sexuality Program in 2000, where critical health issues were identified by school administrators and superintendents (Region of Peel, 2007). The Physical and Health Education Program had incorporated Healthy Sexuality upon implementation of Curriculum guidelines for Ontario schools (Region of Peel, 2007). Healthy sexuality was declared a study unit by Peel Health, due to educational resource restrictions provoking frustration amongst sexual health teachers in classrooms (Region of Peel, 2007). This illustrates the community level of health promotion by organizations working together ( Lumen Learning, n.d. ;Phalloo, 2022; Region of Peel, 2007). “In communities with higher STD rates, sexually active people may be more likely to get an STD because they have greater odds of selecting a partner who is infected” (Centers for Disease Control and Prevention, 2020, p.1; Hogben & Leichliter, 2008, pp.13-18; Laumann & Youm, 1999, pp.250-261)
Public Policy Level
Even though my duties at the Region of Peel- Healthy Sexuality Meadowvale Clinic did not physically involve me conducting work at the policy level, working at a public health department reminded me of the need to consider STBBI specific laws in Ontario (Lumen Learning, n.d.). Partner notification of reportable STBBIs must be ensured by Ontario Public Health Departments as per Ontario Public Health Standards and the Health Protection and Promotion Act (City of Toronto, 2022; Health Protection and Promotion Act, 1990; Ministry of Health and Long-Term Care, 2019; Ministry of Health and Long-Term Care, 2021; Toronto Public Health, 2020). Complications of a serious nature can be reduced, disease transmission can be prevented, health can be maintained and treatment can initiate as soon as possible with partner notification (City of Toronto, 2022).
Figure 3
The Socio-Ecological Framework
Chronic Disease
The MSHT 601 course has reminded me of the need for chronic disease consideration when interpreting the importance of STBBIs (National Institute of Allergy and Infectious Diseases, 2022). “Almost 80% of Ontarians over 45 have a chronic condition and of those, 70% suffer from two or more chronic conditions” (Ministry of Health and Long-Term Care, 2018, p.1). Healthcare planning and disease care management becomes difficult in the presence of multimorbidity (Steffler et al., 2021). Certain cancers can be caused by STIs, and cancer is documented as a chronic disease (Government of Canada, 2019; National Institute of Allergy and Infectious Diseases, 2022). "Chlamydia trachomatis and ovarian cancer risk appeared to be stronger when a woman was also seropositive to Mycoplasma genitalium or HSV-2” according to a prospective epidemiologic study (Fortner et al., 2019, pp. 855-860). STI exposure in the past amongst men were indicative of high prostate cancer rates in a meta-analysis study (Taylor et al., 2005). Detection and prevention of STIs at early points in time are justified through these studies (Fortner et al., 2019; Taylor et al., 2005). Amongst Canadian adults, 8% is the documented cancer prevalence rate. (Government of Canada, 2019). Living conditions and income can depict cancer survival due to cancer care disparities being a product of the social determinants of health (Snow, 2020). Individuals who are disadvantaged and/or have low-incomes suffer more chronic illnesses (The Center for Biosimilars, 2006). The low-educated,uninsured and unemployed suffer chronic illness severity at higher levels (The Center for Biosimilars, 2006). Health issues are triggered by unaffordable care, and the use of alcohol and tobacco due to stress and conditions of living amongst low-income individuals (Cunningham, 2018). Evaluation and planning with respect to chronic disease is guided by Ontario’s Chronic Disease Prevention and Management Framework and chronic disease prevention and management logic model (Ministry of Health and Long-Term Care, 2018). Community action, supportive environments, healthy public policy, self-management supports, and information systems are features of the framework used for barrier elimination, inequity identification, knowledge enhancement, skills development, and health promotion (Ministry of Health and Long-Term Care, 2018). Indicators of performance are generated, and outcomes of health status in relation to various activities are presented through the logic model (Ministry of Health and Long-Term Care, 2018). There is a necessity for prevention that is coordinated and intensive as chronic disease can result in rates of mortality and morbidity that are high (Barondess, 2014). 33% was identified as the multimorbidity prevalence rate in a cross-sectional study of Canadians with chronic disease (Geda et al., 2021). This study justifies priority for healthy lifestyle promotion through programs and policies (Geda et al., 2021). My volunteer experience at the Healthy Sexuality clinic has provided me with a snapshot of work done by Public Health Educators, and has made me realize my passion for health promotion, healthy lifestyle education, and infection prevention, thus contributing to my desire of working within the feild of Public Health Education.
(News4Jax, 2021)
Vulnerable/Key Populations
Through engagement in peer discussions and content curation, the MHST 601 course has further increased my knowledge of the different types of vulnerable populations that exist, and as the semester closes, I have understood the necessity of dedicating increased attention to vulnerable populations, who “are at greater risk for poor health status and healthcare access, experience significant disparities in life expectancy, access to and use of healthcare services, morbidity, and mortality” (The Center for Biosimilars, 2006, pp. 348-351). STBBI vulnerability may be increased for sex workers, drug users, mental health sufferers, and marginalized groups (Government of Canada, 2019). Sexual behavior is of a high risk nature amongst mental health patients (Dutra et al., 2014; Meade & Sikkema, 2005). Discrimination, stigma, and the social determinants of health can lead to syndemics (epidemic overlaps) amongst key populations impacted in a disproportionate manner by STBBIs (Government of Canada, 2019). “A study in 2009 showed that stigma caused a 50% decrease in the probability of someone getting tested for STIs” (Cotter, 2022, p.1). Experiences within the economic and social realms leads to complex health needs amongst vulnerable populations (The Center for Biosimilars, 2006). This justifies the essence of needs assessments within Public Health Educator duties (Human Services, 2022). Chronic disease patients, lower educated individuals and minorities are vulnerable populations where the prevalence is high with respect to health literacy inadequacy (Dewalt et al., 2004; Egbert and Nanna, 2009). Health outcomes tend to be poor due to health information implementation, comprehension, and access challenges (Fransen et al., 2013). In this instance, health information can be communicated effectively through diagrams, drawings, pictures, and other visuals (CDC, 2022). "Health literacy interventions are more likely to be successful if they are theory-based, multi-faceted and use person-centered operational components such as skill-building, goal setting and active discussions" (Stormacq et al., 2020, pp.1389-1469). The Region of Peel- Healthy Sexuality Meadowvale clinic that I volunteered at catered to vulnerable populations as services are independent of disability, religion, age, race, gender, and/or sexuality (Region of Peel, 2022). Due to this, service is granted with the absence of discrimination based on one’s status (Region of Peel, 2022).
Figure 4.
Vulnerable Populations
Note. Source: https://humanrights.berkeley.edu/programs-projects/past-projects/vulnerable-populations
Future Directions
Patient connectivity in care delivery and organization is addressed through Ontario Health Teams (Ministry of Health and Long-Term Care, 2019; Tait, 2020). Caregivers, families and patients are the center of this care system (Ministry of Health and Long-Term Care, 2019). “Under Ontario Health Teams, health care providers (including hospitals, doctors and home and community care providers) work as one coordinated team - no matter where they provide care” (Ministry of Health and Long-Term Care, 2019, para. 2). System navigation will become easier as local services will be strengthened (Ministry of Health and Long-Term Care, 2019). With respect to Ontarian health, value-based care is a key priority (Tait, 2020). Health teams can meet objectives by using digital health (Tait, 2020). A health system becomes coordinated through interoperability and integration (Tait, 2020). Patient care continues to evolve with digital health (Tait, 2020). Prognosis and treatment quality can be improved due to healthcare services being received at faster rates with digital platforms (Risk Medical Solutions, 2021). Through self-care provision from digital health; hospitals, clinics and healthcare professionals will not be greatly burdened (Risk Medical Solutions, 2021). The future of Ontario will contain digital health and Ontario Health teams (Tait, 2020). As I look into the future, I picture a world with complete health equity and a low prevalence of chronic disease where advancements in technology allow for disease diagnosis and treatment to be carried out by robots (Faccini, 2022). I believe that Ontario currently has strong health systems and policies in place, and with continuous quality leadership and the development of technology, Health in Canada will continue to improve. I am hoping that a cure for Cancer and AIDS is on the horizon!! Cheers to great Health!
(The Alliance, 2016)
References
Altarum. (2021). Social determinants of health. https://www.healthcarevaluehub.org/cost-and-
quality-problems/browse-cost-driverquality-issue/social-determinants-health#notes
Barondess, J. A. (2014). Scanning the chronic disease terrain: prospects and opportunities.
Transactions of the American Clinical and Climatological Association, 125, 45–56.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112689/#:~:text=A%20striking%20decrease%20in%20infectious
Black Health Alliance. (2018). Social determinants of health.
Canadian HIV Trials Network. (2022). Why STBBIS?. [Image]. Google images.
https://www.hivnet.ubc.ca/knowledge-center/stbbis/
Centers for Disease Control and Prevention. (2020). STD health equity.
https://www.cdc.gov/std/health-
disparities/default.htm#:~:text=Research%20shows%20that%20there%20are,minority%20groups%20compared%20to%20whites.&text=It%20is%20important%20to%20understand,likely%20to%20affect%20minority%20groups.
Centers for Disease Control and Prevention. (2022). The social-ecological model: a framework for
prevention. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
Centres for Disease Control and Prevention. (2022). Visual communication resources.
https://www.cdc.gov/healthliteracy/developmaterials/visual-
communication.html#:~:text=Visuals%2C%20such%20as%20pictures%2C%20drawings,written%20or%20spoken%20health%20messages.
City of Toronto. (2022). Partner notification responsibility for health professionals.
professionals/sexual-health-info-for-health-professionals/partner-notification/
Cotter, R. (2022). Stigma and misconceptions about STI testing. Patientpop Inc.
https://www.reneecottermd.com/blog/stigma-and-misconceptions-about-sti-testing
Cunningham, P. J., & Cornelius, L. J. (1995). Access to ambulatory care for American Indians and
Alaska Natives; the relative importance of personal and community resources. Social Science
& Medicine, 40(3), 393–407. https://doi.org/10.1016/0277-9536(94)e0072-z
Cunningham,P. (2018, Sep 27). Why even healthy low-income people have greater health risks
than higher-income people. The CommonWealth Fund.
risks
David B. Rein, P., Lynda A. Anderson, P., & Kathleen L. Irwin, M. D. (2004). Mental Health
Disorders and Sexually Transmitted Diseases in a Privately Insured Population. The American
Journal of Managed Care, 10(12). https://www.ajmc.com/view/dec04-1965p917-924
DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and
health outcomes. Journal of General Internal Medicine, 19(12), 1228–1239.
Dutra, M. R. T., Campos, L. N., & Guimarães, M. D. C. (2014). Sexually transmitted diseases
among psychiatric patients in Brazil. The Brazilian Journal of Infectious Diseases, 18(1), 13–
20. https://doi.org/10.1016/j.bjid.2013.04.004
Egbert, M., Nanna, M.K. (2009). Health literacy: challenges and strategies. The Online Journal of
Issues in Nursing, 14 (3). https://doi.org/10.3912/OJIN.Vol14No03Man01
Faccini, C. (2022). What will the future of healthcare look like? Mira Rehab.
like/#:~:text=Hospitals%20are%20likely%20to%20have,sent%20to%20the%20doctor%20instantly.
Fortner, R. T., Terry, K. L., Bender, N., Brenner, N., Hufnagel, K., Butt, J., Waterboer, T., &
Tworoger, S. S. (2019). Sexually transmitted infections and risk of epithelial ovarian cancer:
results from the Nurses’ Health Studies. British Journal of Cancer, 120(8), 855–860.
https://doi.org/10.1038/s41416-019-0422-9
Fransen, M. P., Harris, V. C., & Essink-Bot, M.-L. (2013). [Low health literacy in ethnic minority
patients: understandable language is the beginning of good healthcare]. Nederlands
Tijdschrift Voor Geneeskunde, 157(14), A5581.
https://pubmed.ncbi.nlm.nih.gov/23548185/
Geda, N. R., Janzen, B., & Pahwa, P. (2021). Chronic disease multimorbidity among the
Canadian population: prevalence and associated lifestyle factors. Archives of Public Health,
Government of Canada. (2019). A-Z Chronic Diseases. https://www.canada.ca/en/public-
health/services/chronic-diseases/a-chronic-diseases.html
Government of Canada. (2019). Prevalence of chronic diseases among Canadian adults.
adults-infographic-2019.html
Government of Canada. (2019). Reducing the health impact of sexually transmitted and blood-
borne infections in Canada by 2030: A pan-Canadian STBBI framework for action.
sexually-transmitted-infections/reports-publications/sexually-transmitted-blood-borne-infections-
action-framework.html
Health Protection and Promotion Act, 7 RSO §§ 2-9 (1990).
Hogben, M., & Leichliter, J. S. (2008). Social Determinants and Sexually Transmitted Disease
Disparities. Sexually Transmitted Diseases, 35(12), 13–18.
https://doi.org/10.1097/olq.0b013e31818d3cad
Hsieh, I. (2016). Determinants of health- illustration. [Image]. WordPress.
https://blogs.ubc.ca/iv86eportfolio/2016/03/16/cultural-competent-care/
Human Impact Partners. (n.d.). Talking about health, place and policy- tree exercise.
social-determinants-of-health-tree-exercise/file
Human Services. (2022). Public health educator
Johnson, K. (2020, June 9). STD rates among the poor and homeless in alabama. UAB Institute for
Human Rights Blog. https://sites.uab.edu/humanrights/2020/06/09/std-rates-among-the-
poor-and-homeless-in-alabama/
Kent, A., Loppie, C., Carriere, J., MacDonald, M., & Pauly, B. (2017). Xpey’ Relational
Environments: an analytic framework for conceptualizing Indigenous health equity. Health
Promotion and Chronic Disease Prevention in Canada, 37(12), 395–402.
https://doi.org/10.24095/hpcdp.37.12.01
Laumann, E. O., & Youm, Y. (1999). Racial/Ethnic Group Differences in the Prevalence of Sexually
Transmitted Diseases in the United States: A Network Explanation. Sexually Transmitted
Diseases, 26(5), 250–261. https://doi.org/10.1097/00007435-199905000-00003
Lear, S. (2019, Oct 4). Education is a modifiable risk factor: let’s look to improving education to rid
ourselves of health inequities. British Journal of Sports Medicine.
improving-education-to-rid-ourselves-of-health-inequities/
Lumen Learning. (n.d.). Core principles of the ecological model.
https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/core-principles-
of-the-ecological-
model/#:~:text=The%20Socio%2DEcological%20Model%20takes,%2C%20Community%2C%20and%20Public%20Policy.
Meade, C. S., & Sikkema, K. J. (2005). HIV risk behavior among adults with severe mental illness:
A systematic review. Clinical Psychology Review, 25(4), 433–457.
https://doi.org/10.1016/j.cpr.2005.02.001
Ministry of Health and Long-Term Care. (2019). Ontario health teams.
Ministry of Health and Long-Term Care. (2021). Ontario public health standards: requirements for
programs, services and
accountability.https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Ontario_Public_Health_Standards_2021.pdf
Ministry of Health and Long-Term Care. (2018). Preventing and managing chronic disease.
https://www.health.gov.on.ca/en/pro/programs/cdpm/#:~:text=Ontario's%20Chronic%20Disea se%20Prevention%20and,preventing%20and%20managing%20chronic%20disease
Ministry of Health and Long-Term Care. (2019). Sexual health and sexually transmitted/blood-
borne infections prevention and control protocol, 2019.
https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Sexual_Health_STIBBI_Protocol_2019_en.pdf
National Conference of State Legislatures. (2013). Racial and ethnic health disparities.
https://www.ncsl.org/portals/1/documents/health/HealthDisparities1213.pdf
National Institute of Allergy and Infectious Diseases. (2022). Sexually transmitted diseases (STD)
disease- specific research. https://www.niaid.nih.gov/diseases-conditions/std-research
News4Jax. (2021, March 25). STDs can lead to certain types of cancer. [Video]. Youtube.
Office of Disease Promotion and Health Prevention. (2022). Sexually Transmitted Diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases
Ottawa Public Health. (2020). What are STIs and STBBIs? The Link.
https://www.thelinkottawa.ca/en/sexual-health/what-are-stis-and-
stbbis.aspx#:~:text=What%20are%20STBBIs%3F-,What%20are%20STBBIs%3F,body%20fluids%20during%20sexual%20contact.
Owusu-Edusei, K., Chesson, H. W., Leichliter, J. S., Kent, C. K., & Aral, S. O. (2013). The
Association Between Racial Disparity in Income and Reported Sexually Transmitted Infections.
American Journal of Public Health, 103(5), 910–916.
Phalloo, K. (2022, March 8). Mom said I shouldn't let anyone in while she is out... quick, lock the
doors!! STI is on her way! Kristina Phalloo.
out-quick-lock-the-doors-sti-is-on-her-way
Region of Peel. (2007). About helping teens. https://www.peelregion.ca/health/helping-
teens/about/index.htm
Region of Peel. (2022). Clinic and programs.
https://www.peelregion.ca/health/sexuality/clinics/
Region of Peel. (2022). NEP overview. https://www.peelregion.ca/health/needle-exchange/
Risk Medical Solutions. (2021, May 7). What are the main benefits of digital health? RetinaRisk.
https://www.retinarisk.com/blog/what-are-the-main-benefits-of-digital-health/
Rosenbloom, L.A. (2008). The socio-ecological framework. [Image]. Google Images.
individual-inner-oval-are_fig2_23423498
Slurink, I. A., Götz, H. M., van Aar, F., & van Benthem, B. H. (2021). Educational level and risk of
sexually transmitted infections among clients of Dutch sexual health centres. International
Journal of STD & AIDS, 32(11), 1004–1013.
https://doi.org/10.1177/09564624211013670
Snow, S. (2020, Aug 13). How do social determinants of health affect cancer patients? Family
patients/
Steffler, M., Li, Y., Weir, S., Shaikh, S., Murtada, F., Wright, J. G., & Kantarevic, J. (2021). Trends
in prevalence of chronic disease and multimorbidity in Ontario, Canada. Canadian Medical
Association Journal, 193(8), 270–277. https://doi.org/10.1503/cmaj.201473
Stormacq, C., Wosinski, J., Boillat, E., & Van den Broucke, S. (2020). Effects of health literacy
interventions on health-related outcomes in socioeconomically disadvantaged adults living in
the community. JBI Evidence Synthesis, 18(7), 1389-1469.
https://doi.org/10.11124/jbisrir-d-18-00023
Tait. (2020). The future of Ontario healthcare. https://blog.orionhealth.com/the-future-of-ontario-
healthcare/#:~:text=OHTs%20and%20digital%20health%20will,the%20quality%20of%20patient-%20care
Taylor, M. L., Mainous, A. G., & Wells, B. J. (2005). Prostate cancer and sexually transmitted
diseases: a meta-analysis. Family Medicine, 37(7), 506–512.
https://pubmed.ncbi.nlm.nih.gov/15988645/
The Alliance. (2016, Sep 27). What is digital health? [Video]. Youtube.
https://www.youtube.com/watch?v=Gtl-cuwwqXQ
The Center for Biosimilars. (2006). Vulnerable Populations: Who are they? AJMC, 12 (13), 348-
351.
https://cdn.sanity.io/files/0vv8moc6/ajmc/7156d97747bada738caf6bb3e702169373491cc8.pdf/A166_Nov06VulPopS348to352.pdf
Toronto Public Health. (2020). Communicable disease reporting. https://www.toronto.ca/wp-
content/uploads/2020/03/964d-tph-CDSU-Reportable-Disease-List-Mar-2020.pdf
University of Alabama. (2020, June 9). STD rates among the poor and homeless in Alabama. UAB
Institute for Human Right Blog. https://sites.uab.edu/humanrights/2020/06/09/std-rates-
among-the-poor-and-homeless-in-alabama/
University of California, Berkeley. (2022). Vulnerable Populations. [Image]. Google Images.
Wiehe, S. E., Rosenman, M. B., Wang, J., Katz, B. P., & Fortenberry, J. D. (2011). Chlamydia
Screening Among Young Women: Individual- and Provider-Level Differences in Testing.
Pediatrics, 127 (2), 336–344. https://doi.org/10.1542/peds.2010-0967
Williams, S. P., & Bryant, K. L. (2018). Sexually Transmitted Infection Prevalence among Homeless
Adults in the United States. Sexually Transmitted Diseases, 45(7), 494–504.
https://doi.org/10.1097/olq.0000000000000780
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