SPRING 2011 · VOL.13, NO.1
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Measuring cities
World Bank teams up with U of T for urban metrics powerhouse by Paul Fraumeni


Dhaka, the capital of Bangladesh, is the poorest city in the world. Given its geographical location at or under sea level, it is at great risk for flooding as climate change intensifies. Still, it is growing fast — with more than 12 million people, experts believe it could become the largest city on the planet.

Despite all its mighty challenges, Dhaka has an upside — it is a global leader in textile manufacturing.

"Look at what you're wearing right now. It was probably made in Dhaka. They are totally hooked into the global economy and driving an international market around the garment industry that most people just don't know about," says urban planning expert and political science professor Patricia McCarney.

McCarney believes firmly that we should be paying much more attention to the power of cities in the new economy. In fact, she doesn't see how we can ignore them.

"Cities are vital drivers of the economy. If you look at the top 100 economies of the world, among multinational corporations, countries and cities, about 37 on the list are cities. They are generating 70 per cent of the world's gross domestic product. So when economists think about how we move forward and overcome the financial crisis, it's essential to include cities."

The problem is a lack of city data conforming to a standardized methodology that can ensure sound global comparison and learning across cities. How does domestic water consumption in Sao Paulo compare to Bogota? How is Richmond Hill, Ont., dealing with hospital care compared to Surrey, B.C.?

That was until McCarney met up with officials of the World Bank (where, before joining the University, she had worked on projects designed to strengthen city governments in Africa). The World Bank was working on developing a globally standardized methodology for indicators that would allow cities to be accurately compared and asked McCarney if she and U of T would be interested in making Toronto the headquarters for a research facility. "It seemed like such a good idea," she says.

That good idea has become the Global City Indicators Facility (GCIF), of which McCarney is director.

Working with two full-time staff (and a number of interns when they are available) McCarney has enlisted 130 cities from every continent to submit data to the GCIF website on an annual basis in key areas of urban activity. In the transportation category, for example, cities are submitting data on such important factors as the number of kilometres of high capacity public transit per 100,000 people, the number of personal automobiles per capita and the annual number of public transit trips per capita. She is working with the World Bank now to develop a mobility index for cities globally.

"We are accumulating data that enable cities to plan with the knowledge of what others are doing." To ensure cities are comparing themselves in an apples-to-apples fashion, the GCIF puts them into peer groups. "Comparing cities of similar size — such as Amman, Jordan, and Cali, Colombia — makes the measurements more accurate when they describe, for example, ambulance response times. We want cities to be able to learn from each other and this is how to do that effectively."

While building enthusiasm for the GCIF took a lot of legwork ("For the past two years, I've been on a plane visiting city officials," McCarney notes), it has its own momentum now and cities continue to sign on.

Supporting the growth of the GCIF is a blue chip team of partners on its board of directors, including officials from the World Bank, UN Habitat, Canada's International Development Research Centre (IDRC), the Organization for Economic Cooperation and Development (OECD), the International Council for Local Environmental Initiatives (ICLEI), U of T and mayors of six cities — Amman, Durban, King County (the area surrounding Seattle), Milan, Sao Paulo and Toronto. McCarney is also developing an international corporate advisory board, so GCIF can access specialized expert-ise such as information technology and data visual-ization from, for example, global industry partners such as Cisco and Philips.

"This has become a knowledge hub of 130 cities here at U of T. That's a pretty cool thing. It's gone beyond a mere database. The GCIF has also become a network of cities where real partnerships are growing. With cities playing such an important role in global affairs today, the connectivity of cities is vital. That's what we're providing."

Patricia McCarney. Photo by John Hryniuk



Bridge builders
Aron Shlonsky and his partners focus on children and their families
by Susan Pedwell (with files from Paul Fraumeni)


Aron Shlonsky. Photo by John Hryniuk

Between 1993 and 2003, the number of confirmed cases of child maltreatment in Ontario nearly tripled. "The province, however, doesn't have a viable information system," says Aron Shlonsky, Factor-Inwentash Chair in Child Welfare at U of T's Factor-Inwentash Faculty of Social Work. "We're unable to tell the story of how children and families make their way through the foster care system, making it difficult to improve services."

To address this need, Shlonsky is helping develop the Ontario Child Abuse and Neglect Data System (OCANDS). "The database will enable agencies to more effectively manage and deliver services for our most vulnerable children," says Shlonsky, who also co-chairs the Social Welfare Group of the Campbell Collaboration, an international organization developing a world library of systematic reviews.

The Factor-Inwentash Faculty of Social Work is about to boost its international reputation as a hub of child welfare research. When Shlonsky and his team complete the data system in 2014, it will be Canada's first long-itud-inal research database of child maltreatment services. "We are also building a laboratory that will house this and other key child welfare databases. Once it is built, the lab and databases will generate timely and relevant evidence used to inform and guide policy makers and practitioners from across Ontario as they contend with the multiple complex challenges faced by maltreated children."

Shlonsky believes partnership is key to creating effective social work research that can be applied to practice. That's why he is collaborating with several top child welfare scholars and Ontario's children's aid societies. "The partnership approach to research is necessary for the field of social work. While scholarship for its own sake has its merits, social work research should generate the type of information that can be readily used to improve lives."

His research partners agree and praise Shlonsky for his collaborative approach.

"Aron builds sustainable research bridges between academia and the field, funders and community partners," says Deborah Goodman (pictured above), manager of research and program evaluation at the Toronto Children's Aid Society.

Shlonsky worked with Goodman and others to evaluate the Ontario Risk Assessment Model (ORAM) that the province's social workers were using. Such tools are intended to pinpoint elements in a family's story that alert social workers to the likelihood that a child will continue to be victimized. "Our analysis found the tool to be neither reliable nor valid in predicting which children will be re-abused," says Goodman, who is also an adjunct assistant U of T social work professor. "The Ministry of Children and Youth Services ceased using ORAM based on our research, as well as field experience."

Now Shlonsky and his partners are using that knowledge to build a better tool. "It's a complex project," he says. "And that's how partnership plays a valuable role. The more expertise on an initiative like this, the more likely we are to design a database that will have a truly positive impact on the children and families we serve."



Better teeth, brighter smiles
Herenia Lawrence works with Native communities to reduce childhood
tooth decay — and the inequities that come with it by Jenny Hall


Herenia Lawrence. Photo by John Hryniuk

Eighty per cent of aboriginal children in Canada aged six to 11 have tooth decay, compared to 24 per cent among their non-aboriginal counterparts.

Herenia Lawrence, professor of dental public health, has made it her mission to lessen this disparity and is embarking on an ambitious new study in partnership with dozens of communities, including First Nations communities on Manitoulin Island and in the Sioux Lookout Zone in Ontario, the Norway House Cree Nation in Manitoba and urban First Nations groups in Toronto and Winnipeg.

It's a mistake, says Lawrence, to think of tooth decay as simply an aesthetic problem. "We think of the mouth as detached from the rest of the body," she says. In fact, tooth decay interrupts normal child development, affecting sleep and eating patterns. It's also linked to infectious diseases such as ear infections.

"This is a chronic disease that is highly prevalent among Aboriginal Peoples in Canada," she says. "It progresses rapidly and if left untreated becomes a tooth abscess. These children live in remote communities so access to dental care is an issue. To treat the child you travel to a centrally-located hospital and the child is operated on under general anesthetic." This is both expensive and traumatic — and can be avoided.

Lawrence's work with Native communities began in 1999 when the University of Toronto was approached by health care workers in the Sioux Lookout Zone for help evaluating an oral health program they were administering. "The results indicated we needed to increase preventive care," says Lawrence.

From there, Lawrence worked with communities on several studies, one of which achieved a 28 per cent reduction in the need for dental treatment under general anesthetic.

She thinks she can do better, though. Her new study, set to begin enrolling pregnant women this spring, will combine four previously-tested interventions in one package. The study will combine prenatal dental care for mothers, fluoride varnish for children and two counseling techniques shown to help people change their behaviour. These interventions will be delivered in collaboration with partners within the aboriginal communities.

"The partnership is important because it will ensure sustainability of the interventions. We call this partic-ipatory action research. It's not us telling them what to do. We use what is called an Indigenous Analytical Framework that respects aboriginal ways of knowing. We want to weave in traditional and Western practices."

Lawrence's ultimate goal isn't simply to improve oral health among aboriginals, it's to tackle some of society's toughest and most enduring social problems.

"Our mission in dental public health is to reduce inequalities arising from dental disease. Our target populations are vulnerable and marginalized people."



How can a supermarket work with a university?
David Jenkins partners with Loblaws to create healthy foods
by Jenny Hall (with files from the Toronto Region Research Alliance)


David Jenkins. Photo by John Hryniuk

You are what you eat, the old saying goes.

Well, maybe not exactly, according to David Jenkins of the Department of Nutritional Sciences.

As the developer of the Glycemic Index — a scale that ranks foods in terms of how much they raise blood sugar levels — Jenkins has learned that nutrition isn't just about the chemical composition of food, it's about how the body digests food and assimilates it into its tissues. Take dietary fibre, for example: it isn't a nutrient itself, but its presence in food means that it will be digested more slowly, which in turn means that blood sugar levels don't spike. High levels of blood sugar are associated with diabetes, heart disease and cancer.

Jenkins, who holds the Canada Research Chair in Nutrition and Metabolism and directs the Clinical and Risk Factor Modification Centre at St. Michael's Hospital, has spent more than two decades researching the relationship between food and disease.

He and colleagues have conducted many studies, including one in 2008 that was one of the largest ever to assess the effect of a low glycemic index diet in type 2 diabetic patients who were already treated with drugs. The study showed that a low glycemic index diet including beans, peas, pasta and oatmeal, improved blood sugar levels and lowered the risk for heart disease.

But underlying all these studies are clinical trials, where in most cases volunteers must select their own diets.

"However, in 1990 we had a very difficult project funded by the National Institutes of Health," says Jenkins. "We had to feed diets to people for a very long time — four months — and they could eat nothing other than what we gave them. This was an almost-horrific task. No one would want to do this sort of study if the foods weren't palatable."

Enter Loblaws, one of Canada's largest grocery chains.

"I went to Loblaws and they decided that they would develop foods according to the specifications we gave them — high fibre foods that lowered cholesterol," says Jenkins. "They would give us these foods and let us try them, and in exchange they would then use those foods as part of a new product line, which was called 'Too Good to be True.'" That study was later published in the New England Journal of Medicine.

Today, many of those foods are part of the company's new Blue Menu line, which Jenkins and his research group also helped develop.

"We've had a long relationship with Loblaws, and we're very proud of that. They have been a major partner, stronger than anyone could have imagined."

Jenkins's hope is that people will begin to think not only about diets but also about "functional foods," which are foods with disease-preventing properties.

To watch videos about Dr. Jenkins and his work, visit the Toronto Region Research Alliance website.


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EDGE · SPRING 2011 · VOL.13, NO.1