
Erica Di RuggieroUniversity of Toronto | U of T · Dalla Lana School of Public Health
Erica Di Ruggiero
MHSc, PhD, RD
About
175
Publications
27,941
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2,311
Citations
Introduction
Skills and Expertise
Additional affiliations
August 2001 - December 2016
Publications
Publications (175)
Background
To date, no studies have assessed how the World Health Organization’s (WHO) work operationalizes health equity in practice. To fill the gap, this study investigates the WHO’s Urban Health Equity Assessment and Response Tool (Urban HEART) that focuses on assessing and responding to inequities within cities. This qualitative research answe...
In Ontario, collaborations between Public Health Units (PHUs) and faith-based organizations (FBOs) and other community organizations were implemented to deliver interventions aimed at building trust in vaccines among ethnoracial communities. This research sought to explore the processes of PHU engagement with FBOs, and challenges encountered. A qua...
Delphi studies are rapidly gaining prominence in global health research. However, researchers’ modifications to the Delphi method are often not well-described or justified, limiting opportunities to systematically learn from these studies when the methods are applied to other topics and settings. This paper aims to describe an approach to implement...
Background
Since COVID-19 emerged in 2020, the promotion of health equity, including in research, has further been challenged worldwide by both global health governance (GHG) processes and decisions, and national public health control measures. These global and national decisions have also led to the ‘covidization’ of health research agendas where...
Background
Scholarly critiques have demonstrated that the World Health Organization (WHO) approaches the concept of health equity inconsistently. For example, inconsistencies center around measuring health inequity across individuals versus groups; in approaches and goals sought in striving for health equity; and whether considerations around healt...
Background
Equitable access to vaccination remains a concern, particularly among population groups made structurally vulnerable. These population groups reflect the diversity of communities that are confronted with structural barriers caused by systemic racism and oppression and result in them experiencing suffer disadvantage and discrimination bas...
Objectives
The objective of this study was to explore how Ontario Public Health Units (PHUs) partnered with faith-based organizations (FBOs) and other community-based organizations (CBOs) to promote COVID-19 vaccination among ethnoracial groups made structurally vulnerable during the pandemic, and to understand how PHUs perceive the effectiveness o...
Background
The World Health Organization recommends exclusive breastfeeding (EBF) for the first six months after delivery. However, the EBF rate in the Philippines is only 29%. Existing literature suggests that the influence of infant formula marketing (IFM), communication channels, and traditional health beliefs are possible contributors to low EB...
Background: Newcomer populations in urban centers experienced an exacerbated effect of COVID-19 due to their precarious living and working conditions. Addressing their needs requires holistic care provisioning, including psychosocial support, assistance to address food
security, and educational and employment assistance. Intersectoral collaboration...
Background
Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and...
Background
The interdependent and intersecting nature of the Sustainable Development Goals (SDGs) require collaboration across government sectors, and it is likely that departments with few past interactions will find themselves engaged in joint missions on SDG projects. Intersectoral action (IA) is becoming a common framework for different sectors...
Faith-based vaccine initiatives are of growing interest to public health agencies who are looking to increase vaccine confidence among ethnoracially minoritized populations. Despite evidence that support faith-based organizations’ (FBOs) partnerships with public health agencies (PHAs) to increase vaccine confidence, reviews on the scope and efforts...
Introduction
An organisation’s ability to learn and adapt is key to its long-term performance and success. Although calls to improve learning within and across health organisations and systems have increased in recent years, global health is lagging behind other sectors in attention to learning, and applications of conceptual models for organisatio...
Context
The 2008 Public Health Agency of Canada’s (PHAC’s) “Core Competencies for Public Health in Canada” (the “Canadian core competencies”) outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in C...
Background: COVID-19-related global health governance (GHG) processes and public health measures taken influenced population health priorities worldwide. We investigated the intersection between COVID-19-related GHG and how it redefined population health priorities in Canada and other G20 countries. We analysed a Canada-related multilevel qualitati...
Background
The World Health Organization (WHO) has focused on health equity as part of its mandate and broader agenda—consider for example, the “health for all” slogan. However, a recent scoping review determined that there are no studies that investigate the WHO’s approach to health equity. Therefore, this study is the first such empirical analysi...
Introduction
Faith-based organisations (FBOs) and religious actors increase vaccine confidence and uptake among ethnoracially minoritised communities in low-income and middle-income countries. During the COVID-19 pandemic and the subsequent vaccine rollout, global organisations such as the WHO and UNICEF called for faith-based collaborations with p...
Since the declaration of the COVID-19 pandemic, the promotion of health equity including the health of various population sub-groups has been compromised, human rights jeopardised, and social inequities further exacerbated. Citizens worldwide, including in the Group of 20 (G20) countries, were affected by both global health governance (GHG) process...
Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapi...
Background
Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the publ...
Background
Co-production is an umbrella term used to describe the process of generating knowledge through partnerships between researchers and those who will use or benefit from research. Multiple advantages of research co-production have been hypothesized, and in some cases documented, in both the academic and practice record. However, there are s...
Traffic-calming measures (TCMs) are physical modifications to the road network aimed at making the roads safer. Although studies have reported reductions in road crashes and injuries tied to the presence of TCMs, they have been criticized for their pre-post designs. This study aims to complement our knowledge of TCMs effectiveness by assessing thei...
Street-connected young people face tremendous social, economic, and health inequities, as well as myriad barriers to accessing health and social services and supports. However, there are few evidence-based health and social programs for street-connected young people in low- and middle-income countries such as Kenya. This is an opportunity to apply...
Introduction
Universal health coverage (UHC) is an emerging priority of health systems worldwide and central to Sustainable Development Goal 3 (target 3.8). Critical to the achievement of UHC, is quality of care. However, current evidence suggests that quality of care is suboptimal, particularly in low- and middle-income countries. The primary obje...
Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought...
Objective:
To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP), and to examine associations between household food insecurity and breastfeeding practices to six months.
Design:
Cohort investigation pooling data from two stud...
We examined the association between adolescents’ sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands inte...
Background
Given the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties.
Methods
This study uses baseline quantitative...
The procurement and provision of expert-driven, evidence-informed, and independent science advice is integral to timely decision-making during public health emergencies. The 2019 coronavirus disease (COVID-19) pandemic has underscored the need for sound evidence in public health policy and exposed the challenges facing government science advisory m...
Background
There have been longstanding calls for public health systems transformations in many countries, including Canada. Core to these calls has been strengthening performance measurement. While advancements have been made in performance measurement for certain sectors of the health care system (primarily focused on acute and primary health car...
Several Canadian cities observed a shift from public transit use to private cars and active transport modes during the COVID-19 pandemic. At a moment where pre-pandemic public transit users are reconsidering their travel options, studies describing their attitudes toward cycling are lacking. Because most trips in urban areas involve short- and mid-...
Background
Co-production is an umbrella term used to describe the process of generating knowledge by bringing together researchers and those who will use research to work in partnership. Multiple benefits of research co-production have been hypothesized, and in some cases documented, in the academic and practice record. However, there are significa...
The extent to which power, resources, and responsibilities for public health are centralized or decentralized within a jurisdiction and how public health functions are integrated or coordinated with health care services may shape pandemic responses. However, little is known about the impacts of centralization and integration on public health system...
To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selecte...
Background
Anti-Indigenous racism is a widespread social problem in health, social work, and education systems in English-speaking Colonized countries such as Canada, with profound negative impacts to the health and education of Indigenous peoples. In 2015, Canada’s Truth and Reconciliation Commission recognized the legacy and impact of Colonizatio...
Background
Refugees, asylum seekers, and migrants without status experience precarious living and working conditions which disproportionately expose them to COVID-19. In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors e...
Despite governmental efforts to close the gender gap and global calls including Sustainable Development Goal 5 to promote gender equality, the sobering reality is that gender inequities continue to persist in Canadian global health institutions. Moreover, from health to the economy, security to social protection, COVID-19 has exposed and heightened...
Context:
The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice.
Objective:
To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of pu...
Introduction
Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women’s careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or la...
Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women...
Introduction
This article reports on the results from a scoping review and a modified e-Delphi survey with experts which aimed to synthesize existing knowledge and identify research gaps on the health and health equity implications of informal employment in both low- and middle-income countries (LMICs) and high-income countries (HICs).
Methods
The...
Objectives:
To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months.
Design:
Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in T...
Human trafficking is increasingly recognized as a significant global public health issue. Human trafficking (HT) exists in all nations, including Canada, and is estimated to impact 25 million people globally. HT is a crime that is not always visible. It is associated with a myriad of deleterious health outcomes arising from adverse living and worki...
Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion an...
To better understand the online information-seeking behaviors and health literacy levels of Canadian post-secondary students, a cross-sectional online bilingual survey was initiated during the first wave of COVID-19 in Canada. The survey was administered to Canadian post-secondary students from 1 July 2020, to 30 September 2020, through email invit...
Introduction:
With the rapid spread of online coronavirus-related health information, it is important to ensure that this information is reliable and effectively communicated. This study observes the dissemination of COVID-19 health literacy information by Canadian postsecondary institutions aimed at university students as compared to provincial a...
Background
Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and...
Objectives Financial risk protection (FRP) is an indicator of the Sustainable Development Goal 3 universal health coverage (UHC) target. We sought to characterise what is known about FRP in the UHC context and to identify evidence gaps to prioritise in future research.
Design Scoping overview of reviews using the Arksey & O’Malley and Levac & Colq...
Ce rapport présente les résultats d’une revue de la littérature commandée par le Bureau de l’administratrice en chef de la santé publique (ACSP) à l’Agence de la santé publique du Canada pour informer le rapport 2021 de l’ACSP. L’objectif général de cette revue était de repérer des options pour renforcer la gouvernance de la santé publique et d’éno...
This report presents the findings from a literature review that was commissioned by the Office of the Chief Public Health Officer (CPHO) at the Public Health Agency of Canada to inform the 2021 annual CPHO report. The overall objective of this review was to identify options for strengthening public health governance, and to inform a bold vision for...
Introduction
Étant donné la diffusion rapide de l’information en ligne sur la santé liée au coronavirus, il est important de s’assurer que cette information est fiable et communiquée efficacement. Cette étude traite de la diffusion de l’information relevant de la littératie en matière de santé par les établissements postsecondaires canadiens à l’in...
Hospital discharge is a key transition in a patient's care pathway, providing an effective point of intervention to address a patient's ongoing health and social care needs. Addressing these needs may prevent hospital readmissions. The hospital discharge process for people experiencing homelessness who have been admitted for medical conditions has...
Background
Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and...
Governments deploy comprehensive strategies to address complex social problems with various New Public Governance and horizontal initiatives. Minimal attention, however, has focused on developing evidence‐informed strategy design for such initiatives. Using a systematic literature review, five strategy design principles were identified: 1) proper s...
The COVID-19 pandemic rapidly forced Canadian post-secondary students into remote learning methods, with potential implications on their academic success and health. In recent years, the use of social media to promote research participation and as a strategy for communicating health messages has become increasingly popular. To better understand how...
Abstract The global crises of ecological degradation and social injustice are mutually reinforcing products of the same flawed systems. Dominant human culture is morally obliged to challenge and reconstruct these systems in order to mitigate future planetary harm. In this commentary, we argue that doing so requires a critical examination of the val...
Background
The Food, Environment, and Health (FEH) program of the International Development Research Centre (IDRC) aims to improve the health of low- and middle-income country populations by generating evidence, innovations, and policies that reduce the health and economic burdens of preventable chronic and infectious diseases. A predominant focus...
Introduction
Sustainable financing of immunisation programmes is an important step towards universal coverage of life-saving vaccines. Yet, financing mechanisms for health programmes could have consequences on the design of universal approaches to immunisation coverage. Effective implementation of immunisation interventions necessitates investigati...
Introduction
The Canada Prenatal Nutrition Program (CPNP) supports community organizations to provide maternal–infant health services for socially/economically vulnerable women. As part of our research program exploring opportunities to provide postnatal breastfeeding support through the CPNP, we investigated the sociodemographic and psychosocial c...
Introduction
Le Programme canadien de nutrition prénatale (PCNP) soutient les organismes communautaires qui fournissent des services de santé maternelle et infantile aux femmes vulnérables sur le plan social et économique. Dans le cadre de notre programme de recherche visant à explorer les possibilités en matière de soutien à l’allaitement par le b...
This paper examines the application of Complexity Theory constructs to a research-for-development program evaluation and presents an overview of the implications and promising approaches for evaluating complex programs. We discuss lessons learned from an evaluation completed for the International Development Research Centre's Food, Environment and...
Objectives
A main component of discharging patients from hospital is identifying an appropriate destination to meet their post-hospitalization needs. In Canada, meeting this goal is challenged when discharging people experiencing homelessness, who are frequently discharged to the streets or shelters. This study aimed to understand why and how the a...
Exclusive breastfeeding (EBF) for 6 months is a global public health goal, but measuring its achievement as a marker of population breastmilk feeding practices is insufficient. Additional measures are needed to understand variation in non-EBF practices and inform intervention priorities. We collected infant feeding data prospectively at seven time...
Setting
The Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social in...
Background
Only one-third of Canadian infants are exclusively breastfed for the first 6 months of life as recommended. Skilled lactation support in the early postpartum period is one strategy for improving breastfeeding outcomes by building breastfeeding self-efficacy and resolving difficulties. Access to such support is limited among vulnerable wo...
Objectives
Pumping and feeding expressed breastmilk (EBM) in the early postpartum period are common but may not support longer-term breastfeeding outcomes. Our objectives were to examine in a cohort of vulnerable mothers of term-born infants: i) the prevalence of EBM feeding; and ii) associations between EBM use at two weeks and any and exclusive b...
South Korea has one of the highest occupational injury fatalities among the OECD countries over the past decades. It was in this context that the ‘Corporate Killing’ Movement was initiated in the early 2000s with the aim of radically reframing recurring fatal workplace injuries as a social problem by claiming that ‘a worker’s death is a corporate k...