Dr. Elizabeth Rael, Ontario Ministry of Health and Long-Term Care

CARRFS eNews profiles Dr. Elizabeth Rael who has a Doctorate in Epidemiology from University of Toronto and works for the Ontario Ministry of Health and Long-Term Care as Senior Epidemiologist.

First Published, January 2013

Dr. Elizabeth Rael works for the Ministry of Health and Long-Term Care (MOHLTC) as Senior Epidemiologist. In this position she provides tools to support the decision-making process and an understanding of the epidemiology concepts.

Dr. Elizabeth Rael works for the Ministry of Health and Long-Term Care (MOHLTC) as Senior Epidemiologist. In this position she provides tools to support the decision-making process and an understanding of the epidemiology concepts.

What is your background?

I have an undergraduate life sciences degree, and I did my masters and doctorate in epidemiology at the University of Toronto. Before I did my academic journey, I had a number of different jobs in the “real” world including Halton Police dispatcher, service representative for Bell Canada and manager trainee for Kmart. Interestingly, each of the jobs built my perspective of the importance of systems and processes that are efficient, flexible to document, and prepare for what lies ahead and how to respond. So, for example at Kmart, after we got the Christmas cards in, the process of choosing the next year’s Christmas cards began the first time we did an inventory review. The top sellers would get notes such as: sparkly, hot seller, sold out very fast, triple the order for next year, etc. It was a practical way of saying: What do you know; what decisions do you make in that moment when the information is right at hand!?  You are not going to remember it down the road. It was a wonderful exposure to the importance of documenting the important things that you know in respect to the action that you need to take.

What do you spend the most time on in your current position?  

It varies widely depending on the season and the activities. I have been very much involved with public health, account-ability agreements for health promotion indicators, including target-setting processes etc. It functioned well from the perspective of the epidemiology and surveillance information, which I was able to summarize and to provide Decision Aid and Support Interactive (DASI) Tools to support the decision-making. Now, I am working with other tools to support other decision–making, where people need to understand epidemiology concepts such as Geoffrey Rose’ prevention paradox.  This paradox has application and profound implications for policy decisions about which “high-risk” population one might choose to focus on, or to focus on the entire population. I also consider analysis and research reports that would be pertinent to support our emerging policy development needs.

What inspired you to become an epidemiologist?

When I was doing my undergraduate in life sciences, I was referred to a summer job with Dr. Patrick MacLeod in medical genetics at Queen’s University. The project for the summer was a prevalence study on Huntington disease. It included going back to the microfiche of the 1851 census, to see if we could find any evidence of Huntington disease in specific families. At that time the “surveillance system”, the census, actually included notations for some [ancestors of] families who currently have Huntington in their family, that a particular member of the family was a “lunatic”. For me, this was a very powerful lesson that there is information in places where you don’t necessary expect it. At the end of the summer, Dr. McLeod encouraged me to go into epidemiology. I wasn’t sure at that time, but this is how it all began. 

How do you see CARRFS’ current role in Canada today?

One of the most wonderful things with the CARRFS is how they have been able to identify ways for people across Canada who are involved in surveillance, to be aware of a common place and a common space for connecting, learning, sharing and to identify resources that they will not otherwise know about. It has been wonderful for me to be able to refer colleagues who have shown interests in surveillance, or people who are new to surveillance, to refer them to CARRFS for an understanding and appreciation of how big a deal health surveillance is in Canada. 

You are not currently active involved in CARRFS - what might help you to become involved in CARRFS?

I am one of the least technologically adept people that I know - although I admire technology and have great respect for it. I am slightly terrified by it, and I especially find it difficult to remember all of my passwords - I have to look them up in my secret book.  That is one of the things that prevents me from going on the website - I know that seems like a trivial and inconsequential thing… but it is a bit of a deterrent for me besides of course my workload. I don’t know how to initiate this [portal/ thread/ blog] process - even if I were able to get on to the website. I don’t know what to do. Does one put up one’s hand, and wave a flag and say: “Hi, is there anybody else who develops inter-active tools and do you want to talk about it with me?” I wonder if one could initiate some coaching or some mentoring or some introduction or tutoring sessions for a small group. I am missing a sort of CARRFS professional match-making service.

What are the opportunities for CARRFS? 

I think CARRFS has some really interesting prospects, and I am not sure how they should pursue it. It seems to me that there are some areas that are ripe for CARRFS to play a leadership role. One is the area of data and data visualization. As we develop more and more information about risk factors I am hoping that there are ways of using that data and displaying those data in publicly accessible websites, that don’t require a password and that people would be able to run animations showing patterns over time and space - perhaps examine the interplay with risk factors and outcomes or determinants and outcomes. Something similar to what professor Hans Rosling does with big data visualization. I am not thinking of throwing a whole pack of data into a fancy software program. I am thinking strategically: What are the key messages we want to make; which risk factors are a priority in terms of preventing chronic diseases, preventing complications, reducing mortality and morbidity of those chronic diseases? 

I am interested to see something that takes the very best of the research community and links it with the surveillance data that are available and creates or displays teaching packages. Develop tiny short two - four minutes packages that present powerful lessons on health promotion, population health, prevention, protection and those kinds of things.

What knowledge and experience do you think you can bring to CARRFS?

One of the things I would love to be involved with is that kind of thinking - how to strategically use surveillance data to inform policy and program decision making and to think about seeing themes that transcend individual jurisdictional concerns. To use data from Canada and show patterns and relationships that will inform the decision-making. Perhaps with more sophisticated modeling to explore possibilities. Perhaps there would be opportunities for workshops to come up with a few plans - a short list of key players to say: “Hey guys, let’s get the game up! Let’s do something that is going to YouTube. Let’s do something that is important and has a powerful population health message.” <>