Titled The Equestrian, the life-sized sculpture depicts a horse at rest atop a rough stone base with a small robin perched on its back. Rather than presenting the horse in the heroic pose associated with traditional equestrian monuments, Vickerd鈥檚 work focuses on stillness, sensitivity and rest.听

The sculpture is expected to be installed on the grounds of the new West Lincoln Memorial Hospital in early November, with an official unveiling planned for Nov. 24.

鈥淒eveloping public art for a health care context is a unique challenge, as the artwork needs to be therapeutic in nature,鈥� says Vickerd. 鈥淐ommunity members visiting or working at the hospital can be facing acute stress; in this context, an artwork can be employed to create a calm and therapeutic presence, relieving stress and providing a reprieve." 

The project draws on Grimsby鈥檚 agricultural history and the surrounding landscape. Horses played an important role in the development of the area, from its early agricultural communities to transportation, military history and recreation. 

For The Equestrian, Vickerd chose a quarter horse, a breed known for its muscular build, versatility, intelligence and calm temperament. Seen resting on the stone, the animal appears less like a monument and more like a horse that has wandered in from one of the surrounding farms and settled down. 

The robin and locally sourced stone further connect the work to the natural environment of the Niagara Escarpment. 

Vickerd was selected to create the sculpture through a juried public art competition for the redevelopment of West Lincoln Memorial Hospital. He then met with members of the Grimsby community to hear their perspectives on the region and their hopes for the artwork that would become part of the hospital site. 

The resulting work is a physically and conceptually accessible sculpture that creates a welcoming presence for patients, visitors, staff and members of the surrounding community. For Vickerd, creating accessible art that people can encounter in a shared public space for free was an important consideration for a health care setting. Public art is more than an exhibit, he says, and can influence how people experience the spaces around them and offer moments of connection, reflection or relief. 

The Equestrian builds on Vickerd鈥檚 ongoing work at the intersection of public art and health. 

In 2020, his Monument to the White Squirrel was installed at the Centre for Addiction and Mental Health (CAMH) in Toronto as part of its Therapeutic Art Program. The six-foot sculpture draws on the story of the white squirrels associated with Toronto鈥檚 Queen Street West neighbourhood, using a familiar local symbol as a point of connection within the CAMH community. 

Vickerd is also developing a new work for CAMH鈥檚 Therapeutic Art Initiative that is planned for the exterior of its Secure Care and Recovery building. The project, titled Overcast Tranquility, is expected to be installed in Summer 2027. 

Together, the works reflect Vickerd鈥檚 broader exploration of the relationship between public art and its contributions to the social and emotional experience of shared spaces. 
 
Learn more about and Vickerd鈥檚 . 
 

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The five-year , funded by the Canadian Institutes of Health Research (CIHR), brought together more than 61 Inuit youth researchers, Elders, cultural advisors, musicians, artists and voice actors to co-create a psycho-educational video game grounded in Inuit knowledge and culture.

Led by Professor Yvonne Bohr at 91亚色's , the initiative was developed in partnership with communities across Nunavut and was guided by Inuit youth for everything from the game's story and artwork to its music, voice acting and wellness content.

Inspired by Inuit Qaggiq, a traditional Inuit gathering space for learning and community renewal, the game combines Western therapeutic strategies (such as cognitive behavioural therapy) with Inuit Qaujimajatuqangit (IQ), a set values based on Inuit philosophy, Elder teachings and other tactics shared by Inuit youth.

During the game, players follow a young protagonist named Alaasua through seven quests exploring wellness topics identified as important to Inuit youth, including interpersonal conflict, substance use and relationship loss. 

Between October 2025 and July 2026, 276 Inuit youth from 37 communities across Canada tested the game and provided feedback through surveys, interviews and evaluation workshops. 

Bohr says the findings suggest the game is both safe and beneficial for participating youth. The research team found improvements in participants' confidence and ability to manage difficult emotions, challenge negative thoughts and use coping strategies such as seeking support from others. 

For many involved, the impact extended beyond gameplay. Inuit youth who co-created the game gained experience in research, leadership and mental health advocacy, while sharing Inuit culture and advancing traditional IQ principles.

"We have learned that young people in Nunavut have a great passion for supporting mental wellness in their communities," says Bohr. "While youth leaders and Elders are eager to evaluate Western mental health interventions for youth, Inuit knowledge about healing must be front and centre in those interventions. Ideally, any mental health intervention should be developed by youth themselves with the support of their communities."

The game鈥檚 success is attracting attention. Earlier this month, Virtual Qaggiq was featured by CBC News for its innovative approach to supporting Inuit youth mental health through culturally relevant digital spaces. 

"What excites me most about the Virtual Qaggiq project is the promise the game has shown as a culturally grounded mental health resource for Inuit youth," says project coordinator and 91亚色 research assistant Yogita Singh. "Seeing Inuit youth on the team grow from project council members into research assistants and emerging leaders in mental health and research has been incredibly inspiring." 

The research team is working with the Nunavut Department of Education to explore making Virtual Qaggiq available to youth through schools and afterschool programs across the territory. The team is also considering future initiatives that build on the project's community-led model to address other priorities identified by Inuit youth. 

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The project 鈥淒eveloping LGBTQI+ Health Surveillance Capacity in Canada: Longitudinal Linked-Data Analyses of Primary Care, Prevention, Chronic Disease, Disability, and Unmet Need鈥� aims to generate evidence that can help reduce health inequities and improve health care services, programs and policies for sexually and gender-diverse communities. 

The study is led by Antony Chum, associate professor in 91亚色's , with co-principal applicant Yihong Bai (University of Manitoba) and co-principal knowledge user Jennifer Rayner (Alliance for Healthier Communities). The team also includes co-investigators from 91亚色 and partner institutions, including 91亚色 graduate鈥嬧�� Alex Abramovich and 91亚色 postdoctoral research fellow Peiya Cao, as well as Brittany A. Jakubiec, Caley B. Shukalek, David Brennan, Devan Nambiar and June Lam. 

Previous research on 2SLGBTQIA+ care has largely focused on mental health and sexually transmitted and blood-borne infections, including HIV. As a result broader health needs remain understudied. Addressing this gap is important because stigma, discrimination and barriers to inclusive care can delay screening and treatment, contributing to poorer outcomes, says Chum. 

The project aims to develop public health surveillance capacity for 2SLGBTQIA+ populations in Canada using census, survey and health administrative data, the team will track the outcomes of millions of Canadians over periods of up to 20 years. The findings will provide a comprehensive picture of their health and examining primary care access, cancer screening and incidence, vaccination, chronic disease, disability, and preventable emergency department visits and hospitalizations. 

The findings will identify when and where gaps in care emerge and who is most affected. Working with community and health system partners, the team will use this evidence to inform improvements in primary care, preventive services and chronic disease management for 2SLGBTQIA+ people across Canada. 

The funding was awarded through CIHR鈥檚 Advancing 2S/LGBTQI+ Health Through Research program. 

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The ESR is a comprehensive review of 91亚色鈥檚 policies, practices and workplace culture. It aims to examine how systems across the employee lifecycle 鈥� from recruitment and hiring to career advancement and retention 鈥� guide equity outcomes. 

鈥淭he goal is to better understand where 91亚色 does well and where there remains room for improvements in our continuous efforts to foster an inclusive working environment,鈥� says Parissa Safai, interim vice-president equity, people and culture. 鈥淚nput from 91亚色鈥檚 faculty and staff is essential to advancing equity across the University.鈥� 

The survey provides an opportunity for employees to share experiences, observations and perspectives on how systems are working in practice, and insights will be used to inform recommendations related to employment equity. 

91亚色 staff and faculty members are invited to complete this survey regardless of whether they identify as a member of an equity-deserving group.  However, those who self-identify as part of five equity-deserving groups 鈥� women, racialized persons, Indigenous Peoples, persons with disabilities and members of the 2SLGBTQIA+ community 鈥� will have the opportunity to express interest in follow-up engagement opportunities, such as focus groups or one-on-one conversations.  

鈥淭he Employment Systems Review reflects 91亚色鈥檚 ongoing commitment to employment equity, human rights and continuous improvement, aligned with the University鈥檚 DEDI Strategy, the Action Plan on Black Inclusion and the Indigenous Framework,鈥� says Safai. 

The survey opens Oct. 5 and closes Nov. 5 and is available online.听

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After two decades as a registered nurse in geriatrics, medical-surgical nursing and high-acuity care, one factor has stood out as essential for patient outcomes.

"I recognized the critical role of empathy in effective clinical practice," she says. "I also recognized it as a clinical skill that can be taught, practised and strengthened."

Research, Peisachovich says, has shown that when patients feel understood by their health care providers (HCPs), they are more likely to communicate openly, adhere to treatment plans and report improvements in their overall well-being. Support from caregivers with higher understanding and higher empathy scores has also been shown to lower complication rates, hospital readmissions and pain perception.

Peisachovich has spent years exploring ways for pracitioners to cultivate patient-centred care, particularly because few training programs focus on developing it. More recently, she has turned to AR as a way to enhance care for people living with dementia.

Dementia, says Peisachovich, is a growing global health priority that places increasing demands on caregivers and HCPs who may not understand what the condition feels like from another person's perspective.

In response, Peisachovich has developed Augmented Reality Education Experience (AREduX), a prototype that simulates some dementia-related symptoms, alongside associate professors Celina Da Silva and Fay Dastjerdi and collaborators from Ontario Tech University.

The goal, she says, is to put providers in the shoes of those they serve to transform dementia care education and improve quality of life for people living with dementia and their caregivers.

鈥淲e wanted to give providers and caregivers an embodied, first-person understanding 鈥� not just a conceptual one 鈥� of what living with dementia can feel like,鈥� she says. 鈥淎ugmented reality made it possible to create that 鈥榲isceral鈥� perspective-taking experience.鈥�

AREduX users wear an aging suit 鈥� designed to mimic physical challenges associated with aging 鈥� and a Microsoft HoloLens 2 AR headset that runs the program. Participants are asked to complete everyday tasks, such as making a sandwich, opening drawers or setting a table. Computer-generated objects and effects 鈥� such as visual distortions, background noise and simulated movement challenges 鈥� are then introduced through AR to recreate sensory, cognitive and physical obstacles those living with dementia may encounter.

The situations users experience while immersed with AREduX were informed by focus groups including caregivers, HCPs and experts in cognitive health and aging. Researchers then tested and refined the scenarios, examining usability and workload while also measuring participants' empathy levels before and after using AREduX.

The findings suggest participants engage more deeply, reflect more authentically and demonstrate measurable growth in compassion and communication skills. For many, the simulation also resonated on a deep emotional level. A defining moment for Peisachovich was when a woman emerged from the AR headset visibly moved, realizing for the first time what her husband may have felt while living with dementia.

Peisachovich and her team plan to pursue further validation of the prototype with larger and more diverse participant groups, address technical limitations of current AR headsets and recruit more training facilitators to run sessions.

Although AREduX was created with dementia care in mind, she believes its applications have wider potential.

鈥淭he same model could extend to rehabilitation and competency-based education more broadly, and to experiential training for other physical and rehabilitation scenarios,鈥� she says, citing stroke rehabilitation, sensory and motor impairment simulations, and disability awareness training as examples.

Her team is pursuing funding to expand the platform across disciplines, build more advanced immersive learning environments and broaden access to the technology.

For Peisachovich, the future of AREduX offers 鈥渢he ability to connect with patients and colleagues on a human level, which is vital for delivering high-quality care.

鈥淲e want to see experiential, empathy-building simulation become a standard part of HCP education rather than a one-off exercise,鈥� she says.

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At 91亚色, Johnson鈥檚 research in the Faculty of Graduate Studies' Department of Critical Disability Studies, has examined challenges education, health care and public services experienced by Ontarians who are Deaf.

Among her projects was one led by Professor Rachel da Silveira Gorman that explored medical inequality affecting Deaf, disabled, racialized, women and trans communities and other equity-seeking groups in Canada.

The project resonated with Johnson, who is a Child of Deaf Adults (CODA). She discovered that several members of the research team also had personal connections to blind, disability and other marginalized communities.

鈥淲e knew, from these connections and experiences, that there are urgent barriers to care faced by deaf and disabled people that must be dismantled,鈥� she says.

Yet, Johnson also recognized that many of those experiences had not beend adequately documented in health-equity research.

鈥淭he health and well-being of DDBBPS people and communities remains profoundly under-researched,鈥� says Johnson. 鈥淚t is important to better understand the barriers to care and the policy and practice decisions behind them so that we can intervene in and improve access to care.鈥�

To address those gaps, Johnson and her co-authors , supervised by Gorman and building on her broader research. The study aimed to centre the perspectives and knowledge of DDBBPS populations, rather than relying solely on external academic interpretations.

The team reviewed academic literature alongside community and organizational reports, advocacy publications, presentations and other materials created by and for DDBBPS communities.

Johnson and co-authors Yoonmee Han and Iffath Unissa Syed identified six recurring sources of inequity within the health care system.

Communication barriers emerged throughout the research. Studies described interpreter requests being ignored, denied or replaced with alternatives that failed to meet patients鈥� needs. Johnson also found that important health information is often delivered in formats that are difficult or impossible for some patients to use, including printed forms, written materials and videos without accessible alternatives.

The review also highlights reports of health care providers dismissing communication needs, assuming they understood what accommodations patients required or focusing more on a person鈥檚 disability than the issue that brought them in for care. Over time, these experiences can discourage people from seeking care, contributing to poorer health outcomes.

Beyond those interactions, the researchers found a shortage of health care providers with shared lived experience or sign-language fluency, limiting access to culturally and linguistically appropriate care. They also identified gaps in accessible community-based services, health education and preventative care, leaving some people with few options outside hospitals and emergency departments.

The findings reinforce what Johnson and her colleagues had long suspected from their personal experiences and community connections. Rather than isolated incidents, the literature pointed to broader systemic issues embedded within health care systems; for example, many policies and practices continue to prioritize hearing and sighted experiences.

The researchers recommend improving communication through reliable interpreter services and accessible information formats, expanding health care training to include concepts such as ableism, audism and disability justice, and working directly with DDBBPS groups to co-design policies and practices.

They also argue that future research should look beyond hearing or vision loss to examine factors that shape health outcomes, such as housing, education, employment, income and access to care. Research, they say, should also include those most affected by what is being studied.

鈥淯sing a community-based and participatory approach, future research can commit to working with communities, including co-developing policies and other interventions alongside community leaders, experts and researchers,鈥� says Johnson.

That approach, she says, brings the work back to where it began: recognizing that lived and community knowledge can reveal barriers and shape efforts to address them.

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For Ela Veresiu (BBA 鈥�09), a marketing professor at 91亚色鈥檚 , the sudden surge in visibility raised an intriguing question: what happens when a long-taboo life stage becomes a marketplace?

鈥淲e want to understand what gives menopausal women 鈥� a demographic that鈥檚 traditionally been ignored in society 鈥� a genuine sense of belonging in the consumer marketplace,鈥� she says.

To answer that question, Veresiu launched a multi-year study on what she calls 鈥渢he menopause economy,鈥� examining how products, services and marketing shape women鈥檚 experiences of inclusion and belonging.鈥�

Backed by a 2024 Social Sciences and Humanities Research Council of Canada (SSHRC) Insight Grant, her research builds on her previous work studying age-inclusive marketing and products for older women. The $92,763 grant funds four years of research on the project titled 鈥淐hampioning Belonging and Inclusion of Ageing Menopausal Consumers in Canada's Marketplace.鈥�

Her interest in the topic emerged at a time when menopause remained largely absent from public conversation. A 2022 report published by the Menopause Foundation of Canada found that more than half of women still viewed the biological transition as a taboo topic, while 72 per cent said the information and advice available to them was unhelpful.

Yet within just a few years, the conversation shifted. Menopause moved from the margins into mainstream media, creating new opportunities for businesses eager to reach an underserved demographic.

Veresiu observed that transformation firsthand at the inaugural National Menopause Show in 2024, where thousands of attendees gathered at the Metro Toronto Convention Centre, during her fieldwork.

What she found was a sprawling: rows of booths offering medical consultations and online platforms promising personalized care plans. There were vendors selling cooling pillows and night-sweat clothing, and displays on hormone replacement therapy alongside vitamin stands.

And then there were the tables laid out with crystals, handbags and jewelry 鈥� lifestyle products with only the faintest connection to menopause.

The experience highlighted how quickly the menopause economy is expanding and prompted new questions about who benefits from it.

Veresiu is collaborating with co-author Marie-Agn猫s Parmentier, a marketing professor at HEC Montr茅al, to map how this emerging industry is taking shape and how to educate women to be informed consumers.

Together, they鈥檝e attended two menopause-themed shows to observe and document the events from their perspectives as attendees 鈥� a method called ethnography 鈥� and spoke to nearly 60 exhibitors about what they were offering menopausal consumers.

These exhibitors included virtual health providers, consulting companies, brand managers, small businesses and non-profits.

Based on their initial data, Veresiu and Parmentier identified three main risks in the expanding new market, which experts predict will grow to at least $24 billion by 2030.

The first is that businesses will put a 鈥減ink tax鈥� on menopause-related products and services. 鈥淚t鈥檚 a long-established tradition of charging more for women鈥檚 beauty and grooming products than men鈥檚 counterpart,鈥� Veresiu says.

This leads to the second risk: that the menopause market will exclude female consumers who can鈥檛 afford to engage in it.

The third risk is that menopausal women may lack the consumer education to know which products are safe and effective. 鈥淎re they truly tested and data-driven or are they just snake oil?鈥� Veresiu says. 鈥淭rade shows are sometimes used to legitimize a new market, but there鈥檚 a feeling of information overload as an attendee. You don鈥檛 know what to believe.鈥�

Veresiu鈥檚 broader aim is for older women 鈥� menopausal and beyond 鈥� to feel they belong in the marketplace because it represents their needs and experiences.

In an aging society where the older generation may have substantial purchasing power, she says, there鈥檚 a strong business case for embracing this demographic.鈥�

To see how these risks are developing among consumers, Veresiu and Parmentier will recruit attendees at the 2026 National Menopause Show for in-depth interviews.

鈥淲e鈥檙e interested in how they view the new menopause market,鈥� Veresiu says. 鈥淒o they feel that companies are truly catering to their needs and providing valuable products? Has the market contributed to opening up conversations about menopause? Or do those we'll interview just feel inundated and overwhelmed?鈥�

She sees answers to those questions as crucial for what happens next in the market.

鈥淐ompanies are now jumping on the menopause bandwagon, but are they going to stay on it?鈥� she asks. 鈥淲e hope this study will offer them a blueprint for authentic inclusion while also determining the best ways for non-profits and government organizations to guide menopausal consumers through the current chaos of products and information.鈥�

Contributed by Megan Easton

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Claudia Vergara, 91亚色 PhD candidate, is investigating how women in Ontario's correctional system navigate those challenges and where opportunities exist to strengthen care.

Her work has earned provincial recognition through the 2026 Ontario Women's Health Scholars Award, which supports university researchers advancing knowledge, health services and health outcomes for women. She is one of three doctoral scholars selected by Ontario's Universities to receive funding of up to $35,000 to advance her work.

"I am incredibly honoured to receive the Ontario Women鈥檚 Health Scholars Award and appreciate the recognition of the importance of this research," says Vergara. "This work is deeply meaningful to me and grows out of my years of frontline experience in birth work, prisoner health advocacy and community harm reduction. The award will allow me to meaningfully engage with people with lived experience of incarceration and other community birth workers to shape more accessible and community-based approaches to care."

A doctoral student in 91亚色鈥檚 , Vergara is studying how stigma, institutional practices and barriers to services shape reproductive health and well-being in correctional environments.

The project examines access to reproductive health services through interviews with women who were formerly incarcerated, correctional staff and community birth workers. By bringing diverse perspectives together, the research aims to deepen understanding of how care is delivered and identify ways policies, programs and partnerships can improve to support women in custody.

Vergara is interested in the role community-based doulas and birth workers could play in addressing gaps in care. Doulas and birth workers provide support before, during and after pregnancy. and the study will look at how these services might contribute to more accessible, person-centred care.

The research also considers how experiences may differ for Indigenous and racialized women, whose interactions with health systems and correctional institutions can be shaped by distinct social and systemic factors.

As part of the project, Vergara is examining prison doula programs in the U.S. to determine whether similar models could be adapted for Ontario. The study will assess how these approaches could help improve continuity of care and support reproductive health outcomes.

Vergara says she hopes the findings generate evidence that can inform future policy and practice, while contributing to more equitable access to care for women in correctional settings.

"This research will strengthen our understanding of the reproductive health needs of incarcerated people and the barriers they face in accessing care. By identifying gaps in existing services and exploring community-based approaches, the findings can inform policies, programs and partnerships that improve access to safer, more affirming care for incarcerated people in Ontario," she says.

Vergara holds a MES and a graduate diploma in refugee and migration studies from 91亚色 and is a certified full-spectrum doula.

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鈥淎 lot surprised me,鈥� she says of her findings published in the . 鈥淚 think this paper is actually very shocking.鈥�

The idea for the study 鈥� part of a five-paper series 鈥� grew out of Granek's previous research on career satisfaction among pediatric surgeons. During that work, she noticed that women described experiences that differed significantly from their male colleagues. It inspired her to pursue a study focused exclusively on female surgeons, concentrating on two of the most male-dominated specialties: neurosurgery and cardiothoracic surgery.

鈥淭here鈥檚 just no information on this whatsoever,鈥� says Granek, noting there is little research on the topic. 鈥淚t鈥檚 not just filling a gap. It鈥檚 filling a chasm.鈥�

Granek wanted to understand how women navigate pregnancy, parenthood and surgical careers in specialties where years of training often overlap with prime childbearing years. While previous research has documented higher rates of infertility, miscarriage and pregnancy complications among female surgeons, she wanted to explore the experiences behind those statistics and the role workplace culture may play in shaping them.

To do this, Granek adopted a qualitative approach centred on hearing directly from surgeons about their experiences.

鈥淲ith qualitative, you鈥檙e really trying to understand people鈥檚 experiences from their own perspective,鈥� she says. 鈥淚t was very important to me.鈥�

Through professional networks across North America, Granek recruited female neurosurgeons and cardiothoracic surgeons. Participants were required to be fully trained doctors rather than residents, making the study notable given the limited research focused on women surgeons after training.

Interviewees were asked about pregnancy, maternity leave, balancing family life and surgery, as well as experiences of discrimination and harassment connected to motherhood.

Similar themes surfaced across both specialties in Granek's findings, and she says many of the experiences reported were shocking.

What emerged was a common experience of a workplace culture that many participants found difficult to navigate while pregnant or raising children. One woman described feeling so concerned about how a pregnancy would be perceived that she hid it from colleagues for months, wearing oversized clothing and leaving patient rounds to vomit in private. Another recalled going into labour unexpectedly and being yelled at by a colleague when she called to arrange coverage for an emergency case. Even as contractions began, she still completed rounds before checking herself into hospital.

Other stories were equally troubling. One surgeon returned from leave to discover colleagues had voted to reduce her salary by five per cent. When she asked whether anyone else鈥檚 pay had been cut, she was told no. Another participant recalled learning that while she was away on leave, her department Chair had replaced her in a leadership role. When she objected, she recalled being told she needed to decide whether she wanted to be a neurosurgeon or a mom.

That sentiment surfaced repeatedly throughout the interviews, says Granek. Several participants reported feeling there was never a 鈥渞ight鈥� time to have children, while others delayed pregnancy because they worried it would be perceived as less committed to their careers. Some said they felt pressure to hide pregnancies from colleagues or supervisors, fearing they would be treated differently if they disclosed them.

The consequences of these experiences affected more than their careers. Participants described infertility, miscarriage and complications, including preeclampsia, placental abruption and premature birth. Some believed long hours, overnight call schedules, physically demanding work and a lack of opportunities to rest during pregnancy contributed to those outcomes.

The interviews also revealed a less visible but recurring challenge: many women were expected to arrange their own coverage before taking maternity leave. Rather than being treated as an institutional responsibility, participants described the task as something they had to organize themselves, often while preparing for childbirth.

鈥淭here鈥檚 no kind of understanding within the job that a woman is going to go off to have a baby and that somebody needs to cover,鈥� says Granek. 鈥淭hat鈥檚 very different than every other workplace.

鈥淭hey just really don鈥檛 have any policies or procedures or any thought whatsoever to surgeons who become pregnant,鈥� she says.

Instead, several women shared they felt responsible for ensuring their work was covered before they left. Granek says some described maternity leave as though it were viewed within their departments as a personal absence rather than an expected part of professional life.

Women also frequently described receiving few accommodations while pregnant, even as they continued working in highly demanding specialties. Some reported taking on extra on-call shifts before giving birth in anticipation of the time they would later spend away from work. Others recalled a lack of basic accommodations, such as opportunities to rest, eat, drink water or reduce physically demanding responsibilities late in pregnancy.

鈥淭his is probably part of the reason why there鈥檚 so many worse outcomes, because they鈥檙e just exhausted,鈥� says Granek. 鈥淭hey don鈥檛 have any accommodations in the workplace to eat, to drink, to take breaks, to put their feet up, to cut down on-call [shifts].鈥�

The stories of these women point to a need for both cultural and policy change, Granek argues. One of the study鈥檚 central recommendations is stronger support for pregnant surgeons and new mothers, beginning with formal accommodations during pregnancy and more consistent maternity leave policies.

It further argues that pregnant surgeons should not have to navigate accommodations on an ad hoc basis. Among other measures, the study recommends reducing physically demanding workloads in later stages of pregnancy, limiting overnight on-call responsibilities and ensuring access to basic supports such as breaks, parking and lactation facilities.

Granek and the study's collaborators call for stronger leave protections, including extended paid leave, phased return-to-work options and protections against professional penalties associated with having children. The authors also argue that responsibility for arranging leave coverage should rest with institutions rather than individual surgeons.

Granek believes many of the challenges participants described stem from a workplace culture that has not fully adapt to the realities of pregnancy and parenthood. She argues these experiences should be recognized as a normal part of a surgeon鈥檚 career.

The researchers call on institutions to better educate staff about pregnancy discrimination, hold leaders accountable for discriminatory behaviour and create mentorship networks that support surgeons throughout pregnancy and parenthood.

鈥淲hen we have policies in place without a cultural change, people don鈥檛 adhere to them or feel comfortable taking those policies,鈥� she says. 鈥淐ulture and policy have to come hand-in-hand. They can鈥檛 be just one or the other.鈥�

The issue is also tied to who enters, remains and advances within these specialties. Although more women are entering surgical training than in the past, they remain significantly underrepresented in many surgical fields and leadership roles.

鈥淲e see more women in residency than we did in the past for some of these surgical specialties, but it鈥檚 still very low,鈥� she says. 鈥淭he main reason for that is that the culture is so inhospitable to women.鈥�

That is why Granek says the goal is not simply to improve maternity leave policies, but to create a surgical culture where having a child is viewed as compatible with a successful career. For her, supporting pregnancy and parenthood is not only a matter of physician well-being, but also an important step toward improving gender equity and ensuring women remain and advance within some of medicine鈥檚 most demanding specialties.

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As cardiovascular disease remains one of the leading causes of illness and death worldwide, cardiac rehabilitation (CR) programs have been shown to reduce mortality, lower hospital readmissions and improve quality of life.

Despite its proven value, significant gaps remain in who is referred to cardiac rehabilitation and who ultimately participates, particularly in parts of the world where cardiovascular disease places a disproportionate burden on health systems and patients.

"Even when CR programs are available, patients still face barriers to being referred, accessing programs and affording care," says Carson. "Understanding these gaps helps identify where changes in health care systems and policies could improve access, particularly in lower-resource settings.鈥�

Previous studies had tracked barriers to cardiac rehabilitation and identified disparities in participation across countries and health care systems. However, the COVID-19 pandemic significantly disrupted CR delivery and access worldwide, says Carson. As a result, the global cardiac rehabilitation landscape had not been comprehensively assessed in the years since, with little recent data available on referral practices, wait times, funding models and the costs individuals face when seeking care.

"An updated audit was therefore needed to understand what CR looks like globally today, where progress has been made, and where gaps in referral and access persist,鈥� says Carson.

Under the supervision of 91亚色 Professor Sherry L. Grace and Adjunct Professor Gabriela Ghisi, Carson conducted a global survey of CR programs in 2025 examining referral practices, limitations to participation, wait times, strategies to improve entry to treatment, funding models and patient costs.

The researchers ultimately received survey responses from 1,505 CR programs across 90 countries. Program leaders completed questionnaires about how care is delivered, how people utilize services and the financial challenges both patients and providers face. The researchers then analyzed the results by country income level.

Among the study's observations was the limited adoption of systematic referral systems, which automatically refer eligible individuals to cardiac rehabilitation rather than relying on a clinician to manually make the referral.

"It was striking that systematic referral, despite being an effective way to increase CR use, was implemented in only about one-fifth of programs globally," says Carson.

The finding also reflected one of the study's broader themes: inequity in access. Systematic referral was far more common in high-income countries than in middle- and low-income countries, with programs in high-income countries estimating that roughly 80 per cent of eligible patients were referred to rehabilitation compared with about 50 per cent in middle-income countries.

The study also found that access was shaped not only by referrals, but by whether patients could afford to participate.

"One finding that stood out to me was the magnitude of the financial barriers," says Carson. "Programs globally estimated that 50 per cent of indicated patients may forego CR because of out-of-pocket costs."

Nearly half of surveyed programs relied on direct patient payments as a source of funding. When patients were required to pay, they covered an average of about 60 per cent of rehabilitation costs themselves. In lower-middle-income countries, patients often paid the entire cost of care out of pocket.

Together, the findings point to a broader inequity. Many of the countries carrying the greatest burden of cardiovascular disease also face some of the greatest barriers to rehabilitation, meaning access to treatment known to improve survival and quality of life can depend on where patients live and what they can afford.

The study also highlighted efforts already underway to improve participation. Researchers found that many programs are taking steps to make cardiac rehabilitation more accessible, including by providing information in multiple formats, offering plain-language educational materials, tailoring services to diverse populations and making resources available in different languages with the support of multilingual staff or interpreters.

Building on this progress, the researchers say addressing the persistent inequities identified in the study will require broader policy action. They recommend stronger public investment in CR, expanded health care coverage to reduce out-of-pocket costs and wider use of systematic referral systems to help more who are eligible for care. Those changes could extend the benefits of cardiac rehabilitation to more patients who need it and ultimately help reduce cardiovascular illness and death.

For Carson, the hope is that her work will help inform practical changes that improve access to care for patients around the world.

"I hope these findings help inform changes in policy and clinical practice that make CR more accessible and affordable," says Carson. "Ultimately, improving referral processes and reducing financial barriers could allow more patients to benefit from cardiac rehabilitation."

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