Compassion meets communicable disease

Photo by Raine Radtke Art & Design

“Stay home.” These two short words echo from the mouths of health professionals and even blink on traffic signs — a simple instruction.

Simple, that is, if you have a home. People experiencing homelessness have a greater chance of contracting COVID-19 and an increased risk of becoming severely sick, according to the Canadian Medical Association Journal.

But COVID-19 is not the only communicable disease disproportionately affecting those experiencing homelessness. Amber Heyd, a U of A public health master’s student, knows this all too well. She dedicated her thesis work to researching latent tuberculosis in people experiencing homelessness. 

“Tuberculosis is really an expression of inequality. Although it’s a biomedical disease, it has such a social aspect to it,” says Heyd.

Many might see tuberculosis as a disease of the past, but people who are experiencing homelessness are at increased risk of contracting it. A 2012 study found that in the United States, tuberculosis is about 46 times more common among people experiencing homelessness.

Heyd interviewed individuals diagnosed with latent tuberculosis and their health-care professionals in Edmonton and Fort McMurray, Alta. Because treatment can be a challenge for those experiencing homelessness, Heyd worked to find out what either deters or facilitates the completion of the treatment regimen for these patients.

This study offered a relatively new treatment for latent tuberculosis — one that takes less time and fewer doses than previous regimens. This treatment is a dose of pills once a week for 12 weeks, which removes the inactive bacteria from the body to eliminate risk of developing active tuberculosis disease later.

Heyd found that patients’ competing priorities interfered with treatment — things like searching for employment, lacking food or dealing with addictions. On the other hand, patients who had positive relationships with their health-care workers were more likely to complete the treatment.

“It’s a really meaningful research project,” says Heyd. “It’s critical to engage with populations that are sometimes labelled as more difficult to reach. They’re not always included in the research process.”

Her work was noticed. Heyd received the Dr. John Waters Memorial Graduate Award in her second year. The endowed award, established by the provincial non-profit Alberta Public Health Association, is given to a student interested in controlling communicable disease — something John Waters pursued in his own career, serving as Alberta’s provincial health officer for more than 20 years. This role is comparable to the one Deena Hinshaw, ’97 BSc, ’04 MD, ’08 MPH, holds today as Alberta’s chief medical officer of health.

Thanks to APHA, Heyd could decrease her hours as a part-time nurse and direct more energy towards her research. And, beyond easing financial stress, the award shone a light on her topic of study. “It’s validating for the work you’re doing. It shows somebody else supports this research and thinks it’s important.”

Heyd successfully defended her thesis this fall, and is now compiling her research into a manuscript to share with the medical community. She’s also creating posters to hang in shelters, which will provide practical information on the disease and point to resources to learn more.

This kind of work leads to better patient care and a more compassionate approach to health, says Heyd. After all, social factors — such as income, education, race and childhood experiences — all contribute to wellness, which is at the heart of public health.

“Health inequalities are essentially societal inequalities,” says Shanthi Johnson, dean of the School of Public Health. “There is no sector of society untouched by health inequalities — every person and organization can make a positive contribution.”

Something that has become abundantly clear in the light of the current health crisis, she says.

“Public health has never been more important.”