In Conversation with Dr. Leanne De Souza-Kenney: Education, Preventive Medicine, & Systemic Barriers
With the new academic year well underway, the University of Toronto Chapter of the Institute of Healthcare Improvement (UTIHI) would like to introduce our 2022-23 Speaker Series.
The goal for this series is to build upon the spirit of both the Interprofessional Education (IPE) Seminar workshops and the annual Quality Improvement & Patient Safety (QuIPS) conferences that are hosted throughout the year in order to explore diverse topics related to how people experience healthcare. Through a combination of written and video interviews, UTIHI will engage with thought leaders, industry professionals, and students alike to delve deeper into the approaches being used and initiatives taking place in today’s healthcare landscape.
We aim for this series to showcase a holistic approach where the topics included are not solely concerned with direct patient care but also include those areas that intersect with the planning and delivery of care, such as enabling technologies for greater effectiveness or novel grass-roots organizations promoting best practices. If you have any ideas for topics you would like to be explored, please email us at firstname.lastname@example.org or reach out to our team via our social media platforms.
With this, please enjoy the first installment in our 2022-23 speaker series.
Dr. Leanne De Souza-Kenney is a public health scientist and an assistant professor the teaching stream at the Department of Human Biology and the Health Studies program at University College and is Cross-appointed to the Institute for Life Course and Aging at the Factor-Inwentash Faculty of Social Work at the University of Toronto. Her research focuses on chronic disease prevention examining precursors and modifiable risk factors related to the social determinants of health, leading to health outcome disparities in marginalized populations. She is a passionate educator, with an emphasis on experiential learning and innovative thinking.
Dr. De Souza-Kenney earned her PhD from the Institute of Medical Science at the University of Toronto studying early detection of risk factors for metabolic disease in pregnancy and thereafter, and her MSc from the Department of Nutritional Sciences at the University of Toronto studying the effects of complementary alternative medicines on blood glucose control and insulin sensitivity.
Dr. De Souza-Kenney holds the inaugural Fulbright Canada Research Chair, Race and Health Policy at the Cecil C. Humphreys School of Law, University of Memphis, Tennessee, where she examines the impact of structural inequities and health disparities in the underserved.
Can you tell us a bit about yourself and how you entered this field?
It certainly wasn't a linear path - some things came naturally and other things I worked really hard towards, and yet other things were passions and volunteer work that I had no idea would eventually factor into my future.
During my undergrad at UTM, I did a teaching assistantship, but I didn’t think about teaching being in my future, nor did I have any clue whether I would be good at it. But I kept it going through my master's because it was something that I enjoyed and felt fulfilled working with young people and learning about how they learn. Little did I know that it would later come to fruition as a career.
After completing my MSc, I managed the research program in the Women's Health Care Center at St. Michael’s Hospital. I eventually had the opportunity to spearhead projects and run my own research, which prompted my interest in doctoral studies. My focus at Institute of Medical Science (IMS) was again on diabetes, but this time moving upstream to look at the precursors to diabetes, diabetes prevention, and how to modify risk factors. I was increasingly interested in the prevention side of medicine.
How do you balance having a family and working as a researcher and professor?
You know, we always hear that as a woman in science you have to make a choice. There are certainly a lot of sacrifices to be made, but I wasn't going to live a life where I am a scientist or whatever I do for a career, and nothing else. I knew that I wanted to have a family, I did not know that four children would be in my future, but that’s what we were blessed with. During my last maternity leave, I looked for work at U of T and other universities nearby because I knew I wanted to stay in the city near my family and continue my research here. And that’s how I came across the assistant professor position I have now.
A lot of students are very focused on a very linear route, it’s fascinating to see how you went through so many different paths.
One of the things we often forget is our passion projects. The hobbies, the volunteerism, those things that you think of as ‘extra’ aspects of your life- peripheral to your main goals. It was when I volunteered at the Salvation Army that I realized I wanted to work directly with the people I serve. I was just there to support services, but listening to the stories of people in the community were deeply affecting me. They [the people and their stories] were building me up, they were breaking my heart, it was everything I didn't know I needed.
Those things you don’t put a lot of stock in, that you think of as ‘extracurricular’, can end up being some of your most powerful experiences. So, I tell my students: don't give up on your daydreams, your passion projects, your side hustles; they are just as important and they serve a bigger purpose.
...don't give up on your daydreams, your passion projects, your side hustles; they are just as important and they serve a bigger purpose.
How do you encourage innovation and experiential learning in your teaching?
I think students rely too much on whatever is prescribed in the degree planner and then within courses they depend on course instructions/rubrics to guide their input and performance. They don't get to diversify, explore, learn from their mistakes, fail forward, all because they don't want to – and don’t know how to - take risks and to trust themselves. The whole school system is so grades-centered, rubric-aligned, and risk-averse, from K to 12, it's no surprise that these aspects hold students back in university. When students come into my class, and I ask them to risk it all on their imagination, supported by their skills and knowledge, they don't trust themselves. But this is precisely the type of practice of innovative thinking that students need to experience in order to make an impact in the world. We saw during the pandemic, that ingenuity, innovation, and collaboration – all the things that we are not proactively taught in or before undergrad – was what we needed and relied on and will continue to in the future as we tackle complex and so-called ‘wicked’ global problems.
Do you think the understanding of an underserved or marginalized population has changed as you worked in this field?
That's an interesting question. I don't know that it has truly changed. I think we all want to highlight the positive, but then there are ten other things that are not going well, or a policy that moves us forward in one direction that might move us backwards in another. I've seen changes but I don't know if they have been at the pace that they should be at or at the sustainable and systemic-level that is necessary. We're talking about decades of people’s lives being affected, and our children’s lives being impacted by preventable shortcomings or overt oversight, and the intergenerational effects are immeasurable.
I have hope because I see a lot more leaders and decision-makers starting to care about community engagement and the social determinants of health. I noticed that my students take a diverse set of courses and are exposed to different ways of thinking and different angles to a problem. If we continue on that trajectory, the social determinants of health won't just be a unit or chapter in a course, but rather they will be front and center of what we do and how we approach sustainable change, culture and paradigm shifts and dismantling of barriers when addressing the underserved. When we address the underserved in a systemic way upstream, everyone stands to benefit, the concepts of universal design enacted as effective public health measures.
A lot of modifiable risk factors are not what most people think of as medicine or health. Do you think there’s enough focus on them?
I think that we will be forced one day, if not already, to invest heavily in prevention medicine and public health. As we saw with the COVID-19 pandemic, healthcare systems are always treading close to capacity, if not past capacity at baseline without the pressure of outbreaks, epidemics, breakthrough infections, etc. The writing has been on the wall for a very long time and history has shown us repeatedly that preparation and prevention is needed, and we have to change before we are brought to our knees again.
We have to ask hard questions like why do we need food banks when there is record breaking food waste? Why are there prevalent micronutrient deficiencies in places where there is a diverse set of food options?
It's not that people in medical professions and research don't care about addressing social determinants of health upstream, it is just not really an integral part of their training. Even as medical researchers we are trained by quantitative researchers, and we train quantitative researchers; training in mixed methods and qualitative research is less common. Until these underused/underexamined skills/perspectives become a key part of training, we have to work each day a little beyond our scope of practice and take the time and initiative to collaborate across our disciplines, roles, responsibilities and institutions.
It's not that people in medical professions and research don't care about addressing social determinants of health upstream, it is just not really an integral part of their training. Even as medical researchers we are trained by quantitative researchers, and we train quantitative researchers...
As a woman of colour in STEM, are there any particular barriers or challenges that you have faced?
I have definitely felt the effects. I have amazing colleagues and amazing students, and yet the systems that we operate in are inherently constrained by colonial thinking. If you are from the BIPOC community and at the intersection of other vulnerabilities, regardless of your position, role, or rank, you will feel the effects in some way, shape or form.
I think it’s about understanding and teaching the next generation. We need to actively dismantle barriers one step at a time. This includes everything from bringing underrepresented people into the conversation, to making sure students have opportunities for experiential learning or work experience while in undergrad. It will take people in positions of authority and privilege to have this on their agenda, and to equitably enlist the support of people from those communities, before we can erode those systemic barriers.
How do we change the belief systems that we’re so used to?
I think mentorship is really important. I always encourage my students to find more than one mentor, because you're not always going to find a person who looks like you in the places that you work or study. Until that happens, you have to be proactive in seeking them [mentors] out and establishing relationships and initiating opportunities to have those tough conversations. People are much more receptive to tell their story and to offer some guidance on what worked for them, than we often think. A mentor is not a counselor, but a person that you can hopefully see a bit of yourself in and be influenced or inspired by their story and guidance. The mentorship relationship is mutually beneficial, and it is yet another example of the ‘extra’ aspects of our life that often materialize into some of life’s most important experiences.
A mentor is not a counselor, but a person that you can hopefully see a bit of yourself in and be influenced or inspired by their story and guidance.