RESEARCH FOR A HEALTHY START TO LIFE

 

Mission

Empower creative thinkers to solve great challenges in development, maternal and child health.

To solve these challenges we must:

Question differently: reframe problems and data; use systems thinking; invite perceptions; trust intuition; check our certitude

Stretch to progress: create safe conditions for exploration; take risks; execute carefully and with urgency; be agile; reflect often; learn from discomfort; integrate rather than compartmentalise

Create value: generate knowledge that is valuable; commit to effective, multimodal communication for science and society; inspire people to act 

and develop these traits in others.

Explore

“Business cannot prosper in a society where the potential and talents of the future generation are denied at birth”

— Prof James Heckman, Nobel laureate economist

Environment

Optimal growth and development in the first 2000 days of life from conception contributes to the immediate survival of the newborn, establishes a strong immune system in the infant, supports brain development and function, and promotes a healthy metabolism. The environments experienced by a mother before, during, and after pregnancy can shape the health of that pregnancy and the lifelong health of the mother. These same environments are also experienced by the fetus in the womb and the child after birth, and can therefore shape a child’s growth and lifelong immune, metabolic, and brain health.


Statistics

  • Obesity

    Over 30% of Canadian women of reproductive age are overweight or have obesity.

    Globally, 42 million children under the age of 5 are overweight and over 20% of children in Canada are overweight or have obesity.

  • Malnutrition

    Undernutrition and hidden hunger remain global burdens. In Canada, 1 in 8 households experience food insecurity.

    More than 1/3 of child deaths and 11% of total disease burden world wide are due to maternal and child undernutrition.

  • Preterm Birth

    Maternal underweight, obesity and inflammatory conditions are also risk factors for preterm birth and low birthweight babies. Preterm birth affects 8-12% of all pregnancies.

    Having low birthweight babies, early deliveries, and C-sections increases newborn care costs in Canada nearly 150 times.

In Canada, obesity and its comorbidities, including type 2 diabetes, result in a $4.6-7.1 billion annual financial burden to the Canadian economy. Despite that these diseases are preventable, only a small proportion of Canada's health care spending is dedicated to prevention.


DOHaD

Research in the field of Developmental Origins of Health and Disease (DOHaD) aims to understand how experiences during development shape disease risk and resiliency throughout the lifecourse.


Risk Factors

A risk factor is any attribute or exposure that alters an individual’s chances of developing a disease. Some of the key risk factors for preterm birth, poor growth in early life, and metabolic diseases in later life include:

  • Poverty

  • Malnutrition

  • Stress

  • Infections

  • Genetics

But not everyone who is exposed to these factors will be born too early, or grow poorly, or get diseases in later life. Interactions between the environment and the individual are critical for determining who is vulnerable and who is protected or resilient.

The Challenge

Despite incredible advances in biomedical sciences, critical aspects of female biology, maternal and pregnancy health, and fetal and child development, remain unclear. This means we have limited ability to predict health trajectories at an early stage, to enrich for resiliency and prevent adverse health outcomes.

Additionally, the increased incidence of non-communicable diseases (NCDs) later in life raises questions about the origins of these disorders and the factors operating in early life that influence development around the time of conception, in the womb, and after birth.

To prevent suboptimal development in early life and poor health across the lifecycle, we need to understand how early experiences set the developmental path of the child.

We also need new and timely interventions to modify risk factors and optimise early environments.

Solving these challenges requires us to integrate multiple systems, methods, disciplines and partnerships.

Investigate

Answers are not the end of an effort

Research

Our research uses a systems approach to understand the pathways that lead to poor maternal health, suboptimal development, and chronic disease risk, and to optimise development and health across the lifecycle.

We investigate interactions between the environment, the host, and its resident microbes, using animal models and human cohorts. We aim to understand how suboptimal environments including poor nutrition and maternal disease states shape the pregnancy and risk for adverse pregnancy outcomes. We also aim to understand how these environments impact development of the placenta and fetus (particularly the gut and brain) and the growth of the infant postnatally, resetting the metabolic, endocrine, and immune mechanisms that contribute to chronic disease.

Our research is dedicated to developing:

• novel ways to predict individuals at-risk for adverse pregnancy outcomes, suboptimal development, and later chronic disease
• novel interventions to optimise maternal health and early developmental trajectories, and reduce the incidence of non-communicable diseases.

Our work aligns with international and national priorities

  • Our work aligns with the goals to “ensure responsive, inclusive, participatory and representative decision-making at all levels” and promote inclusive societies

  • Our work tackles malnutrition (including anaemia), food insecurity, child growth, and the needs of girls and pregnant people, and aims to enhance coherence and collaboration in nutrition interventions

  • Our work aims to understand outcomes including maternal and child mortality and morbidities (including congenital anomalies), reproductive health, communicable and non-communicable diseases, and the risk and protective factors underlying these

  • Our work strives to ensure women’s empowerment and their “full and effective participation and equal opportunities” in decision making and their health

Priorities from: United Nations Sustainable Development Goals Report 2019 & Global Affairs Canada 2018 & 2023 Agendas for Implementing the Sustainable Development Goals

Our research is transdisciplinary and translational

  • We explore our questions at many levels: from genes, to cells, organs, organisms, and populations

  • We apply diverse methods and in new ways, and are adaptive with our approaches — from ‘omics’ to cell biology, to animal models, human cohorts and trials, to data science and machine learning, through to stakeholder engagement and knowledge mobilisation

  • We have expertise in many disciplines, and prioritise integrating ideas and findings across disciplines

  • We empower, coordinate, mobilise and collaborate with diverse partners in the lab, locally, nationally and globally, including scientists, clinicians, people with lived experience, social enterprises, non-governmental organisations, governments, and the public

  • Maternal malnutrition, metabolic state, and placental defence and transport

    Maternal malnutrition (under- and overnutrition) and suboptimal metabolic status can induce changes in the metabolic, hormonal and immune systems in the body. If these changes target intrauterine tissues (the placenta and fetal membranes), they may hinder the ability of these tissues to protect against microbes commonly associated with the onset of preterm labour and other adverse pregnancy outcomes. These changes may also alter the transport of nutrients and other molecules to the fetus that are critical for its development. We are investigating how maternal malnutrition and metabolic and pro-inflammatory states influence placental defence and transport. These studies are part of our larger goals to understand how early life environments influence risk for preterm birth and suboptimal feto-placental development, and to develop nutrition-focused and microbe-targeting interventions to prevent these adverse outcomes and improve maternal-child health.

  • Gut development and function in response to maternal adversity

    Gut bacteria have been linked to human health and disease states including obesity and diabetes, and can shape our response to the foods we eat or the medications we consume. We are investigating how common adverse conditions before and during pregnancy (maternal malnutrition, underweight and obesity, and infection) impact the integrity of the maternal and offspring intestinal barriers and the composition and function of their gut microbiomes, and how these conditions may impair the maternal-fetal interface. We are also testing novel microbe-based and microbiome-targeted interventions to improve pregnancy health and fetoplacental development. These studies are part of our larger goal to understand how the gut plays a role in coordinating exogenous signals from our environment (nutrition), and endogenous signals in our bodies (pro-inflammatory and metabolic factors), to influence maternal health and increase vulnerability to poor growth and metabolic diseases in offspring.

  • Early life environments and neural tube defects

    Disruptions in fundamental developmental processes, such as cell growth and proliferation, can result from inadequate nutrient supply, leading to congenital anomalies. Neural tube defects (NTDs), such as fetal spina bifida, remain amongst the most common congenital anomalies. Specific nutrients, including B vitamins, play a critical role in the formation of the neural tube and are also essential for the high rates of DNA synthesis and cell proliferation that accompany periods of rapid fetoplacental growth and development. A key contributor to healthy nutrient levels is the gut microbiome. A healthy microbiome also supports nutrient absorption and produces other molecules that may influence placental function and nutrient delivery to the fetus. We are investigating the role of the maternal gut microbiome in the development of fetal spina bifida and its comorbidities, including poor placental development and function. These studies are part of our larger goals to understand how inadequate supply, uptake, transport and/or metabolism of key nutrients from the mother to the developing embryo/fetus may contribute to the pathogenesis of NTDs and increase risk of placental maldevelopment and dysfunction, fetal growth restriction, and preterm birth.

  • Early interventions to improve nutrition and women’s and infants’ health

    Globally, mineral and micronutrient deficiencies are common in children and in women in their reproductive years, including during pregnancy. Inadequate nutrition is predictive of suboptimal lifelong health and profoundly influences development and health trajectories in the next generation. Given the intergenerational cycle of nutrient deficiencies, there is a window of opportunity to replenish minerals and micronutrients to prevent suboptimal health and adverse pregnancy and developmental outcomes. However, we are still falling short in our efforts to prevent hidden hunger and improve the nutritional status of women and children, thus new strategies are urgently needed. We are testing novel interventions to improve mineral and micronutrient status in women. These studies are part of our larger goals to improve maternal-child nutrition and our understanding of the mechanisms that contribute to nutrient transport, absorption and metabolism.

    We are also evaluating programmes that aim to improve nutrition knowledge and reduce iron deficiency and anaemia (ID/IDA) in women, and are engaging with stakeholders from communities through to national governments and NGOs to better understand the people, health systems, and environments that influence hidden hunger and its treatment. These efforts are part of our goal to co-design frameworks for improved treatment and prevention of ID and IDA across the lifecycle.

  • THRIVE: a lifecycle health promotion and knowledge mobilisation tool to advance health literacy, health communication, and health span

    Although the Developmental Origins of Health and Disease (DOHaD) recognises the importance of early exposures in the development of chronic conditions, our ability to harness this knowledge before irreversible processes affect health trajectories remains limited. Using machine learning approaches we are making a comprehensive catalogue of early influential risk and protective factors across social, environmental and biomedical fields, and developing a model for precise and personalised lifecycle health information. These studies are part of our larger goal to instrumentalise our understanding of DOHaD and develop a tool to identify resilience and risk trajectories to optimise health decision making and interventions.

  • Early investments, lasting impact

    It is well known that there are major health gaps between men and women, largely driven by a lack of knowledge into the biology of women’s health and disease, and other social, environmental, and systemic factors that differentially affect genders and influence health outcomes. Critically, these health gaps also affect future generations. We believe closing the gap in funding for women’s health and health research will improve health outcomes for women and their children, and likely provide the best return on investment for governments seeking to make an impact in preventing, diagnosing and treating health conditions. We are capturing data on health funding, interventions, and outcomes, to better understand health gaps and opportunities to close these. This work is part of our larger advocacy efforts for improving women’s and lifecycle health, and is done in collaboration with Dr. Tim Regnault at Western University.

  • Postnatal nutrition and infant development following HIV exposure in utero

    Rates of HIV transmission from mother to child are decreasing. Whether there is a lasting impact of maternal HIV infection on the development of the HIV negative infant remains to be explored. Further, little is known about the impact of pre- and postnatal nutritional environments on the growth, development and health of the HIV exposed but uninfected infant. We are investigating nutritional environments and infant growth in the context of HIV. Our work includes engaging with stakeholders to better understand the environments that shape health outcomes in mothers and infants affected by HIV, and studies investigating how maternal HIV infection alters the composition of nutrients, immune molecules and bioactive metabolites in breast milk, and if maternal HIV status, breastfeeding practices, and factors present in breast milk are associated with infant growth and health. These studies are part of our larger goal to improve the lifelong immune and metabolic function in HIV exposed infants.

 

Participate

 

If you want to go far, go together.

Our research spans disciplines from maternal health, fetoplacental and pregnancy physiology, child development and nutritional sciences, to biomedical sciences, molecular and systems biology, and microbiome sciences, to quantitative survey design and analysis and programme evaluation, to biostatistics, bioinformatics, and epidemiology. We integrate methods and techniques across these disciplines through our use of animal and cell culture models, human cohorts and large datasets.

We are always looking for great people.

Due to our collaborative and transdisciplinary approach, the Connor Lab seeks talented individuals with expertise in health and nutritional sciences, biomedical sciences, and data sciences. We provide the mentorship, facilities, and collaborative and networking opportunities for success in each team member's research project, and tailored to their career plans. Check out some of the exciting questions we are investigating. We encourage you to drop us a line if you want to join in. Send us a statement of your research interests and how you think our lab can help you achieve your professional goals, and a CV highlighting your relevant skills.

Meet the Team

Dr. Kristin Connor

Dr. Kristin Connor is an Associate Professor of Developmental Origins of Health and Disease in the Department of Health Sciences at Carleton University. She is passionate about improving and supporting maternal, fetal and child health. Her expertise lies in understanding how early life nutrition, including hidden hunger, and maternal health states influence maternal and pregnancy health, and shape the developmental and health trajectories of the fetus and child. Her research focuses on novel ways to predict individuals at-risk for adverse pregnancy outcomes, suboptimal development, and later chronic disease, and novel interventions to optimise maternal health and early developmental trajectories to reduce the incidence of adverse pregnancy outcomes, poor infant growth, and chronic diseases in later life.

Dr. Connor has expertise in convening, capacity building, and systems thinking for innovative problem-solving through her work in Canada and globally. She brings together academics, clinicians, policy influencers, people with lived/living experience, public health experts, NGOs, governments and enterprises for knowledge exchange and mobilisation to facilitate action and create value.

Amongst other roles, she is a member of the Advisory Board for the Canadian Institutes of Health Research Institute for Human Development, Child and Youth Health, and an Associate Editor for the Journal of Developmental Origins of Health and Disease.

  • Aleyna Akgun

    Aleyna’s research revolves around developing a holistic health prediction tool to assist health professionals in identifying early life health trajectories for earlier and more targeted interventions. This includes investigating environmental, biological and social determinants of health. She is currently exploring the attitudes and behaviours of health care providers towards such a prediction tool.

    Recent grad!

  • Ayshia Bailie

    Ayshia’s research focuses on women’s health funding and its implications for health outcomes. She aims to synthesise clear data on women’s health funding, interventions, and health outcomes to use in advocacy efforts for policy influencers and other stakeholders. Ultimately, these efforts aim to improve investments in perinatal health research and the health of women and children across the lifecycle.

  • Clara Miller

    Clara’s background includes genomics-based research and data science. Her research aims to understand how the adverse effects of micronutrient deficiencies can be prevented in women of reproductive age. Specifically, she is investigating the effectiveness of a sustainable micronutrient intervention for the treatment of mineral deficiencies.

  • Hailey Scott

    Hailey’s background is in pregnancy complications and placental development, with a particular focus on preterm birth and maternal underweight and obesity. Her research aims to understand placental maldevelopment and dysfunction in response to adverse early life environments. She is also interested in understanding the impact of early interventions to improve maternal, pregnancy and child health. She plays a key role in research coordination and direction in the lab.

  • Hasan Abdo

    Hasan’s research focuses on how different environmental, metabolic, and health factors, such as obesity and infection, can affect the fetal environment, leading to adverse outcomes for the mother and offspring. He is specifically interested in the analysis of placental samples that may have been impacted by such factors, using various imaging tools and analyses.

    Recent grad!

  • Hauna Sheyholislami

    Hauna’s background is in health sciences and bioinformatics. Her research focuses on the role of the gut microbiome and novel interventions in the health of reproductive aged and pregnant women and their infants. She is particularly interested in how the maternal gut microbiome and metabolome are altered in complex pregnancies. She is also exploring how a micronutrient intervention may alter the gut microbiome and metabolome in reproductive aged women.

  • Jayden Arif-Pardy

    Jayden is focused on studying the complex gene-nutrient interactions in pregnancies where a fetus has a neural tube defect. He is specifically interested in how external supplementation and diet interacts with genetic factors to effect nutrient transport and fetal development.

    Recent grad!

  • Dr. Jessie Burns

    Jessie’s research investigates how early nutritional exposures impact markers of long-term health and chronic disease risk. Her graduate training examined the relationships between early exposure to omega-3 polyunsaturated fatty acids and markers of inflammation in both human and animal models. Currently, she is interested in better understanding the role of nutrition in early life by addressing nutritional deficiencies in reproductive age women.

  • Lucas Carvalho Cardoso

    Lucas’ interest is to study the effects of maternal nutrition on fetal development and how changes in the intrauterine environment affect adult health. His research attempts to understand the changes that malnutrition, associated with an episode of infection, can cause during pregnancy, focusing on relationships between the maternal/offspring guts, placenta, and fetal development.

  • Dr. Marina White

    Marina’s research investigates how maternal health and the placenta influence fetal and infant development, with a focus on pregnancies complicated by maternal HIV infection or fetal congenital anomalies. Specifically, she is interested in understanding how the early nutritional environment and alterations in placental phenotype in these pregnancies may affect growth and neurodevelopmental trajectories.

    Recent grad!

  • Melissa Watton

    Melissa’s research focuses on how maternal metabolites influence fetal growth and development, particularly the developing brain. She is specifically interested in the placenta-fetal brain axis and which influential metabolites and pathways may contribute to altered developmental trajectories, including of the developing brain. She also aspires to connect her research to testing future therapeutics that can optimise maternal health and prevent adverse health trajectories in offspring.

  • Miguel Massiris

    Miguel's research investigates, develops, and tests automatic and semi-automatic knowledge graph text models based on medical research. He aims to create virtual assistants for use in neonatal and paediatric clinics, where relevant information can be accessed by and shared with medical professionals and other stakeholders. These assistants can help to establish communication channels and disseminate information amongst various stakeholders, ultimately for more informed and shared health decision-making. Miguel is undertaking his PhD in Engineering through Universidad Nacional del Sur, Argentina, and is co-supervised by Dr. Kristin Connor and Dr. Claudio Delrieux from the Department of Electrical and Computer Engineering, Universidad Nacional del Sur.

  • Olivia Wilding-Davies

    Olivia’s background is interdisciplinary health science, including social and early life determinants of health. As a Zimbabwean with interest and expertise in global health, Olivia’s research aims to understand the individual, community, and external factors that influence success of community-based interventions for the prevention and treatment of iron deficiency in West Africa. Ultimately, her goal is to inform intervention design and provide evidence for adapting and scaling interventions that tackle hidden hunger to suit local and population needs.

  • Romika Subedi

    Romika’s research focuses on determining and analysing relationships between preconception, prenatal, and postpartum health funding and maternal health outcomes. She is particularly interested in public health and preventive medicine, aiming to contribute valuable insights that can improve interventions for women’s health and ensure better health outcomes.

  • Sadra Mohammadkhani

    Sadra’s research investigates the impact of maternal obesity and episodes of viral infection on pregnancy and offspring development. He is particularly interested in changes at the maternal-fetal interface and placental pathways involved in poor pregnancy outcomes. He is also an aspiring pharmaceutical researcher, specifically in the field of drug development for diseases related to prions.

  • Thaina Ferraz

    Thaina’s research focuses on how maternal obesity and episodes of viral infection during pregnancy may create an opportunity for poor pregnancy health and offspring development via changes at the maternal-fetal interface. She is particularly interested in placental genes/pathways associated with nutrient transport and inflammatory response and fetal/offspring growth and postnatal inflammatory phenotype. She is also investigating whether a microbe-based intervention to the mother during critical windows of fetoplacental development may correct poor gestational tissue development and function and optimise fetal growth.

Collaborations

Dr. Enrrico Bloise, Department of Morphology, Instituto De Ciencias Biologicas, Universidade Federal De Minas Gerais, Brazil

With Dr. Bloise and his team, we are investigating how maternal underweight and obesity impact gut and placental transport systems in an animal model, and impact intrauterine tissue function and defence and risk for preterm labour in a human cohort. We are grateful to have the this work supported by the National Sciences and Engineering Research Council of Canada (NSERC) and an International Research Seed Grant through Carleton University’s Research and International office.

Dr. Tim Van Mieghem, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto

With Dr. Van Mieghem, we are investigating the role of the gut microbiome in the pathogenesis of fetal spina bifida and testing novel interventions for the prevention of this condition. We are grateful to be supported by the Canadian Institutes of Health Research (CIHR) for this work.

Dr. David Grynspan (Vernon Jubilee Hospital and University of British Columbia)

Our team works closely with Dr. Grynspan on studies to better understand placental pathologies and placental development. We are grateful to be supported by the Molly Towell Perinatal Research Foundation, CIHR, and the Faculty of Science at Carleton University for this work.

THRIVE: Drs. Laurent Briollais (Lunenfeld-Tanenbaum Research Institute, Toronto), John RG Challis (Simon Fraser U, Vancouver), Sandra T. Davidge (U Edmonton, Edmonton), Claudio Delrieux (Universidad Nacional del Sur Argentina), Isabel Fortier (McGill U, Montreal), Daniel Goldowitz (UBC, Vancouver), Pablo Nepomnaschy (Simon Fraser U, Vancouver), Ashley Wazana (McGill U, Montreal)

With the THRIVE (Towards Human Resiliency In Varying Environments) team, we are developing a tool to identify resilience and risk trajectories to optimise health decision making and interventions. We are grateful for support from CIHR to seed the foundational work.

LIFe and Dr. Bénédicte Fontain-Bisson (U Ottawa)

With Dr. Fontain-Bisson, we are testing novel interventions developed by Lucky Iron Fish Enterprises to tackle the hidden hunger of iron deficiency. We are grateful to be supported by LIFe in these efforts.

Ontario Birth Study, Drs. Alan Bocking, Stephen Lye, Cynthia Maxwell

Through the Ontario Birth Study, we aim to understand the role of the microbiome in shaping metabolic health and disease trajectories in mothers and their offspring. To do this we have developed the MATaDOR (Microbial Approaches Targeting Diabetes and Obesity Risk) Early Life Study. We are grateful to have this work supported by the Garfield Westin Foundation and the Canadian Foundation for Women’s Health, and the McLaughlin Centre at the University of Toronto.

MIREC Cohort, Dr. Tye Arbuckle

We are collaborating with a team of investigators across Canada through the Maternal-Infant Research on Environmental Chemicals (MIREC) cohort to understand the relationships between maternal weight before and during pregnancy, and heavy metal exposure, on infant cognitive outcomes. We are also interested in determining whether the early life nutritional environment modifies these relationships. We are grateful to have this work supported by the Faculty of Science at Carleton University.


Past Connor Lab Members

  • PDF & Research Associates

    Dr. Samantha Benton

    Dr. Constance Nana

  • PhD

    Marina White

    Lilian Martinelli (Co-supervisor; PhD Cell Biology, Federal University of Minas Gerais, Brazil)

  • MSc Health Sciences

    Hailey Scott

  • MSc Health: Science, Technology & Policy

    Aleyna Akgun

    Hauna Sheyholislami

    Ayah Abdul-Hussei

    Ayesha Kareem

    Shrankhala Tewari

    Jamie Strain

    Zoe West

    Iryna Demchenko

    Lee Clark

    Morgan Belsek

    Queena Chen

    Jenna Coles

    Makenzie Weekes

  • Undergraduate Researchers

    Oluwatomike Aribaloye

    Israa Zareef

    Eleanor Duffley

    Christopher Roche

    Elia Palladino

    Sebastian Srugo

    James Bilyk

    Madison Donoghue

    Claudia Sendanyoye

Chronicle

What we’re up to

and other cool stuff

References

1. Gotay et al. (2013) Updating the Canadian obesity maps: An epidemic in progress. Canadian Journal of Public Health 104:e64-e68
2. WHO (2013) http://www.who.int/dietphysicalactivity/childhood/en/
3. Institute for Health Metrics and Evaluation (IHME) (2013) GBD Cause Patterns. IHME, University of Washington, Seattle
4. NCD Risk Factor Collaboration (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 387:1377–1396
5. Tarasuk et al. (2014). Household food insecurity in Canada, 2012. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from http://nutritionalsciences.lamp.utoronto.ca/
6. Black et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382:427–451

7. Black et al. (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371:243–260
8. Han et al. (2011) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. International Journal of Epidemiology 40:65-101
9. Cnattingius et al. (2009) Maternal obesity and risk of preterm delivery. JAMA 309:2362-2370
10. Challis et al. (2009) Inflammation and pregnancy. Reproductive Sciences 16:206-215
11. Goldenberg et al. (2008) Epidemiology and causes of preterm birth. Lancet 371:75-84
12. Canadian Institute for Health Information (CIHI) (2006). Giving birth in Canada: The costs. CIHI, Ottawa
13. Canadian Institute for Health Information (CIHI) & Public Health Agency of Canada (PHAC) (2011) Obesity in Canada: A joint report from PHAC and CIHI, Ottawa

14. Kendall et al. (2010) Investing in Prevention: Improving health and creating sustainability: the Provincial Health Officer’s special report. Office of the Provincial Health Officer/British Columbia, September 2010. Downloaded October 2011 from www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevention_improving_health_and_creating_sustainability.pdf
15. Canadian Public Health Association (2016) Making the Economic Case for Investing in Public Health and the social determinants of health. Accessed July 10, 2016 from http://www.cpha.ca/en/programs/social-determinants/frontlinehealth/economics.aspx#f5