Dr. Andrew Boozary: The Need to Recentre Humanity in Healthcare

Cover art for episode 74 of Healthcare Change Makers with Dr. Andrew Boozary

(Access show transcript) Dr. Andrew Boozary and his team at University Health Network (UHN) are battling health inequities in Canada and creating a proactive approach to health through the Gattuso Centre for Social Medicine.

Summary

Health is driven by more than what happens in a clinic or the operating room, it is driven by long-standing system decisions. One of the ways Dr. Andrew Boozary and the UHN are impacting health equity is through the inception of Dunn House, Canada’s first hospital-led supportive housing initiative. This unique model couples health and social care by improving health outcomes for unhoused Torontonians, embedding concreate solutions to UHN’s most vulnerable patients. 

“This brings a wholistic approach to healthcare, that it’s not just about access to physicians and nurses, that there’s really a more integrated way to think about health, and Dunn House is real action on that kind of thinking and philosophy.”

In this exciting episode of Healthcare Change Makers, learn more about UHN’s social medicine program, the impact of Dunn house, and the value of partnership with community organizations.

And stay tuned until the end to hear Dr. Boozary’s take on medical TV dramas and which musician helps give him an energy boost.

Mentioned in this Episode

Transcript    

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.

Michelle Holden: Hey, listeners, it's Michelle here from HIROC. Our team was so excited to sit down with Dr. Andrew Boozary for this latest episode of Healthcare Change Makers. Dr. Boozary is a primary care physician at the University Health Network and founding executive director of the Gattuso Centre for Social Medicine. On the episode you'll hear from myself, from Abi, and from Philip. Abi, do you want to give listeners a little bit more about what they'll hear?

Abi Sivakumar: Yeah. So you'll hear about social medicine, Canada's first hospital-led supportive housing initiative known as Dunn House, a bit about mentorship, and for the TV fans out there, Philip has been loving the new medical drama called The Pit. He couldn't resist the urge to chat with Dr. Boozary about it, and after we stopped recording, Dr. Boozary tells us he's a fan of a show called The Knick, a hospital show that aired in 2014. We're going to dig up some past episodes.

Michelle Holden: I can't wait to watch it. Before we go, Abi, we should mention that we're putting the pieces together for HIROC's 2025 AGM and Conference. So for now, save the date for April 28th. And now on the episode. Hi, Dr. Boozary, thanks for being with us on Healthcare Change Makers today.

Dr. Boozary: Thanks so much for having me.

Michelle Holden: Yeah. For listeners who may not be familiar with you, can you just share a bit about the work you do and the focus of your role?

Dr. Boozary: Yeah, thank you. The work that I've been doing here at the University Health Network, I'm the executive director of the Gattuso Centre for Social Medicine and Population Health, and really, I think the way that I've seen my role is about how to improve health outcomes for marginalized populations or for people who have not been able to access healthcare the way I think we've envisioned. And what does that mean in terms of having a healthcare system perform better, be even higher quality for everyone in our system? I think that's really the universal aspect about the work. How do we think about integrating various parts of health and social care in the way we deliver care? And, I'm sure which will be a theme of the conversation today, how do we re-center humanity in healthcare for those of us who work in the system, for families, for caregivers, and most ultimately, for patients?

Michelle Holden: That's a very big challenge that you're taking on and especially for this conversation today, but I really do love it. Now, the thing I wanted to ask you next was that the field of social medicine is rapidly evolving, so what's one shift or trend that you find particularly important right now?

Dr. Boozary: The origins of social medicine go back hundreds of years. So I think when we really try to unpack where the patterns and dynamics are with respect to the idea that health is driven by more than what can happen in a clinic or in an operating room, I think we've started to see some important shifts or I would really hope that many of us are trying to push and promote real shifts that we've seen come through the pandemic.

I think the idea that health and so much of protection in society are system choices or policy choices and that, really, it's not about individual failures, but how resources, how protection and power and privilege really play roles in who's exposed to more disease, who has worse health outcomes, the environments people are brought into, the air people breathe. These are not individual choices or failures, these are long-standing system decisions that, for many cases, can be decades or centuries. And that's one of the things that I find heartening about this work, is that I think we're starting to see some shift in understanding that we really need to take a more holistic approach in the way we think about health and well-being in the way that we can enable people to make those choices for themselves.

Michelle Holden: I think that's important as well and just something that having you undertake is pretty large. I just wanted to take a step back, talk about your career, because we want to get to know you on Healthcare Change Makers a bit as a person as well. So in the early years of your career, what were some of the key experiences that shaped your approach to healthcare and particularly how you're speaking now about this shift towards social medicine?

Dr. Boozary: Yeah. Ultimately, going back beyond the career start, obviously my family has shaped a lot of my thinking around health and social justice, and particularly my mother made a lot of sacrifices and has taught me so much around this push and fight for fairness, whether it's in the health system, the legal system, or broadly about women's rights. I think this is something that I really feel was embedded in my DNA through my family's life and struggle.

But having the privilege of being born in downtown Toronto, I think there was a lot of experiences early being in St. Jamestown, seeing so much diversity. I think at one point it was the most diverse square kilometer in Canada, and I think that has just shaped my life and thinking around the fact that so much of this is luck, not the fact that there's some superiority or this sort of moral righteousness in how people can advance or get through certain situations, but really the importance of community, of help, of the ideas that many of us really receive lucky breaks.

I think when we look at it from my career perspective, I was just been so fortunate for mentors in my life, and especially early on when I was in Ottawa as a medical student, working with Inner City Health with Dr. Jeff Turnbull and Wendy Muckle, people who've spent decades dedicating their lives to improving the health of people who are unhoused or surviving homelessness. I think as a first-year medical student, that definitely had a profound effect on the way I thought about universal healthcare, the way I've thought about how we need to change the way we deliver healthcare.

And I think throughout my career, it was never planned, but these opportunities of working in the Ministry of Health, spending time in the US where I did my graduate health policy training during a time of Obamacare, or the Affordable Care Act. This was a major shift in change in the US of wanting to see healthcare delivery innovation, to coming back and being recruited back to work in the ministry, which is a totally different vantage point about all of both the inequities, but also areas for improvement and to sort of bridge some of these gaps. So I've been fortunate for the mentorship, but also I think taking some risks or some unconventional paths early on in my career that I think have really helped guide some of my thinking, as we're at some really important junctures right now when it comes to health equity and population health.

Michelle Holden: That sounds a little bit like your career, while very well planned, is also taken a lot of turns just by chance and just by the way things kind of fell, which is important also to remain open. But you mentioned a little bit about some mentors and mentorship early in the career and some of those that you worked with. So in terms of leadership development, what's one lesson that you've carried forward from a mentor or colleague?

Dr. Boozary: There's so much gratitude that I have for so many mentors and dear friends, especially over the last five years. I think we've been trying to square and reconcile so many inequities, so many challenges that people have faced, and the support to be able to do this work, it's never one person alone trying to grapple with all this.
But I'd be remiss not to mention Dr. Paul Farmer who passed away far too soon, a few years ago, who I had had the great fortune of spending a lot of time with in Rwanda where I did some global health work, but also working with him on coursework and teaching in Boston. I think the part and the wisdom, I think, that continues to come from Paul on so many levels, but one, I think this idea about how expensive it is to deliver poor-quality care or low-quality care for poor people in a rich country. And I think that is something that continues to sit with me.

Obviously one of his most known sayings, and I think real lessons, is the idea that some lives matter more than others, is the fundamental issue or injustice that we face in the world. And so I think carrying that with me in the work and knowing that this is a long arc to try to bridge many of these injustices, I do try to hold onto that more and more knowing that it continues now to be a few years that we lost Paul, but obviously his work and I think his philosophy and his wisdom stays with so many across the world.

Michelle Holden: And even now that you're sharing it as well here with us today and in the stories that you've told, I'm sure it continues to make that effect moving forward. Just kind of looking and thinking about your career as a young professional at the time now many young professionals are looking to make an impact in health equity, so what advice would you give those to just starting out?

Dr. Boozary: I think it's a great question, because I think the realities are there is no shortage. And to your question being about health equity, unfortunately, we are now dealing with compounding crises from climate change, what we're seeing happen in California in the most tragic and horrific way, to what we've seen play out for elders and seniors in long-term care, we see play out with people accessing primary care, can't access primary care, lots of the decades and centuries of systemic discrimination facing people and continuing to drive what we talk about today, worse and worse health outcomes.

I think my advice would be whatever it is that compels you or speaks to you on this issue of health equity to really just pursue that. I don't think there's any way to try to game the system of thinking, "What's going to be the health equity issue du jour? What's going to be the trending issue or topic?" I think whatever it is that grips you, that you lose sleep over, that makes your blood boil, whatever it is that you feel this sense of injustice, to not lose that feeling and energy and to pursue it however you can. And I think, again, as we mentioned, it's to have mentors. So many mentors have been able me unpack these feelings, these ideas, these strategies of how to try to advance this work, being able to connect with peers about what can be done to try to mobilize.

But I think there's so much that's happening that you can understand how people can feel a bit numb, that you can try to shut down or try to think "hyper strategically". I would urge to push against that and say, "What is pushing and pulling you? What is it that you feel is fundamentally unfair?" And then I think all of the other elements of the work, as people who are young professionals who are serious about this, want to learn more, will fall into place or you'll make it work into place with the dedication and energy that you have. So that's where I've been so heartened to see that and continuing to teach and teaching undergrads to folks at the graduate level that there is such a sense of justice of integrity that young people do not want to see lost or actually want to see redeemed, and I think just trying to follow that as authentically as you can, to me, I think, hopefully will continue to bode well for those who take on this kind of work.

Michelle Holden: And speaking of authenticity and kind of carrying it through your own career, I think that's great advice for others, just, what can you impact? And it doesn't even apply just to physicians, but to all types of providers, anyone in the field or outside of it. There's something that everyone can be passionate about. Before I pass it to my colleague Abi, I just wanted to transition a little bit to talk about UHN where the idea of social medicine has grown significantly. So how did the program that you're in take shape and what was the catalyst for its development?

Dr. Boozary: Yeah. When you look at the University Health Network, there's been so much innovation that's taken place here from transplant to some of the early work in the university around diabetes care. And so I think when you look at its history as a real place of scientific innovation, I think the hope and the work and the sort of catalyst to start to see this shift was, if the UHN, or the University Health Network, is really serious, which they are, about advancing health and not being the University Healthcare Network, but truly about health, we need to be able to take different approaches IN how we reach people and have these innovations. Reach people who need it most.

I really never really imagined or saw what the connection would be in terms of working at UHN earlier in my career. Again, have huge amounts of respect and admiration for colleagues who do so much of this cross-cutting work, but really, the recruitment to come back from Boston to be able to be home and do this work in my hometown in Toronto where we've seen so many of these divides or access gaps for people.

With Kevin Smith as CEO, I think, really, the idea that we needed to do things differently to believe in the vision that if we really want to be the highest performing hospital and hospital network in the country or globally, that we need to have one of the leading social medicine and population health programs, that this is where we see huge amounts of value unlocked for people. And I think part of it was trying to bring the evidence and the data into action. I think that's a part where we really we're not looking to be... There's great research institutes that look at health equity and health inequities across the country that have really helped lay a lot of the groundwork to much of the work that's been happening in communities about how people can access various care. But for a highly specialized network to do this, how can we start to really bridge both evidence that's needed, the data, to the kind of partnership and action and really seeing this from a delivery or implementation perspective.

So I think part of it when I started was to try to work both with the hearts and minds around the organization of what is it and how can we focus these efforts that make sense for UHN patients, but also the broader community? And one of the things, again, not being as familiar with University Health Network when I started early in just coming into 2020, was, as a researcher, I looked at the data and it became really clear that, one, in many, many ways, UHN was operating as, yes, a place of global innovation, but also a social safety net hospital. That there was people, a huge amount, that, when WE looked at some of the regional data, some of the highest proportion of patients who were unhoused or in shelter system coming to both Toronto Western and Toronto General Hospital. That was surprising for folks. It was surprising for me. But being able to look and examine the data that was out there, that, how can we start to build this into the MO of UHN and really the mission of UHN?

The other part that became, I think, really clear when we looked at the emergency department as the last thread of the social safety net, is there are about 234 patients back in 2020 that made up over 15,000 emergency department visits. And I think that really left a lot of parts of the organization in real shock and awe, that the realities of how the system failures were impacting both the performance of UHN, but most importantly health outcomes for people that we are all here to serve.

We will get into this I think a little bit later in the conversation, but trying to really marry the data to the lived experience, to this importance of storytelling as to why this matters, I think has really helped shift it. And then, really, the incredible vision of Emmanuelle Gattuso of the philanthropy to see this kind of work early when we wanted to say, "Look, we have to move upstream if we're serious about health and not just healthcare alone," and them being able to read commentaries or articles about the decision very early in our mandate for social medicine to dedicate public resources to housing for people who were cycling in out of emergency departments with nowhere else to go. So I think there's really a confluence of leadership, of people, of data that came together, I think, to help see us at the place we're at, but obviously a lot more to be done.

Michelle Holden: Thank you. Yeah. I'm going to pass it to my colleague Abi now who's going to ask you a few questions and I guess we'll get more into the Gattuso Centre of Social Medicine and kind of what's happening next. So go ahead, Abi.

Abi Sivakumar: Yes. Hi. It's so great to meet you. I've been enjoying listening in on the conversation so far. So since we're on the topic of UHN, Dunn House recently launched as Canada's first hospital-led supportive housing initiative. Can you walk us through how this model works and its early impact

Dr. Boozary: Yeah. For Dunn House, which has just opened up now a few months ago, this took years of work. I mean, really, the initiative started in 2019 and 2020. And the idea around this goes, as sort of following the thread of this conversation, is that housing and health are inextricably linked. So when you look at the data, we talked about some of the utilization data, that there's a small cohort of patients that make up a lot of emergency department visits, not because they want to be there, but because they have nowhere else to go or that their health care conditions are really worsening. That's an element that we knew had to be addressed differently and that there needed to be different interventions to try to interrupt that cycle, that sort of doom loop that continues to play out for people on a daily or nightly basis.

So the thinking around Dunn House, the idea of this social medicine housing initiative, was can we leverage partnerships both with the public land that's there, with every level of government? So UHN dedicating some of the land with the city of Toronto to bring in an investment from the federal and provincial government to build a four-story 51 housing unit structure for the first time for people who were unhoused, like we talked about, we met 51 people who made over 3000 emergency department visits, to access housing for many of them for the first time in years where we see a lot of complexity from their health and social conditions. 

Again, no fault of their own, but because of this chronic neglect or this chronic inability to access housing.
And this is what I think is really the secret sauce, is the partnership and the willingness to think differently about the solution. That the Band-Aid fixes are not going to work, that there is a moral distress that becomes imposed on health workers seeing the same revolving door, whether it's outside of the general medicine ward or coming through the emergency department, and how can we start embedding building concrete solutions for people?

And this is where Dunn House, with Fred Victor, the supportive housing agency, that has been able to bring health and social care together. So they are a longstanding agency with experience for caring for people that are unhoused for almost 100 years or more being a partner and really the united way about thinking about food prescribing, about income insecurity that's in place to really bring, which we talked about at the top half of the conversation, this holistic approach to healthcare. That it's not just about access to physicians and nurses, that there's really a more integrated and holistic way that we can think about health, and Dunn House is just real action on that kind of thinking and philosophy that we know has been out there for a little while.

Abi Sivakumar: Wow, this is such an amazing initiative. And as I was doing research on it and even hearing more about it now, I keep thinking, "Wow, it's not only impactful, but it's so revolutionary for Canadians." So I'm excited to see what's to come and its continued impact. Are there any projects, organizations, or global models that inspire your team's approach to tackling health inequities?

Dr. Boozary: Definitely. I think when you look at the work of social medicine, again, as we mentioned, this has been in place for hundreds of years. There's been leadership and real innovation in social medicine and community health in this country for decades to centuries. One, I think it's really important to shout out the incredible work of community health centers that have been leading social medicine work for 50 years or more, going all the way back to the Hastings Report. And this is the real wave, in the '50s and '60s as well, to be thinking about health and social care together. About, how do you ensure that care is out where people are at? How do you build health into communities with community? And so I'm just a huge proponent of the community health center model. This is work across the country that has helped save lives.

More locally, of course, have been really fortunate to work with leaders like Angela Robertson at Parkdale Queen West Community Health Center. And there's so much CHC leadership and I really hope it's a model and I really continue to advocate for it as a model that we need not only for primary care, but for improving community health out where people are at.

I think the other place where I think of from a lot of that work that's been going on is Finland when we think about trying to tackle the other inequities of homelessness. That's something where there's a country that had worse rates of homelessness than we did in the 1980s, and that coming into it, they actually had a huge amount of homelessness, of real political challenges. And they now, in 2025, I mean, we've gotten in almost completely different directions than Finland, and we have seen now a homelessness crisis at a rate that has just never been here before, to where Finland is close to eradicating chronic homelessness. So I think they're really a global model. They show that this can be done and that does not mean you cannot start from a place of crisis. Which they did. They actually had lost people to the harsh Finnish winter given how many people were unhoused.

And I think the other place where we also draw a lot of working inspiration, which might be surprising, but I think the realities are when you look at a healthcare system that does not have universal access but does a lot of great work is the Camden Coalition in the US in New Jersey in Camden, a really sort of hard-done-by neighborhood and city where there's been just great leadership over the last 10 to 20 years really trying to advance these ideas that we can do more for people if we actually cut across sectors, cut across silos, and use data to better advance these healthcare models.

So from a local to an international to a global scale, I think those are just three examples that come to mind. And obviously there's so many folks doing inspiring work in this area, but I think it's really important to try to shout out this great work and continue to learn from where people have been able to bridge some real serious health equity gaps.

Abi Sivakumar: Yeah, so important. And I'm sure those listening will be drawing inspiration from everything you just mentioned, and we'll be linking the people and the organizations you mentioned in our episode so listeners can learn more about it. Lastly, as a healthcare provider who pays close attention to patients while in care and after they leave your care, I imagine this can get overwhelming to constantly have on the brain, so how do you prevent burnout?

Dr. Boozary: I wish I had a silver bullet answer for you. I know that it's a major issue understandably for health workers across the country. I think that many of the things that people talk about, I think obviously you try to do, whether it's about protecting sleep or self-care, and obviously I think having a support network of people you can trust to talk to about, the things that you see or the challenges of you're trying to overcome for patients and communities is really helpful.
But I think one thing, to be completely honest, that I'm not necessarily beginning to embrace, but I think has shifted, is I think earlier in my career I felt that the sadness and grief that comes with this work was somehow my own failure, that I wasn't protecting myself enough or that there had to be different ways to kind of ensure that there's the self-care. But I think the realities of this work being really immersed in preventable and avoidable deaths that take place daily is that you will feel some sadness and grief. And I think the part that I'm trying to learn is how do you hold some space for that amidst everything that's happening?

A dear colleague also listed that having hope is a privilege that has denied many of the people that we serve. But I think being able to not see your own emotions or the fact that there is grief and trauma in trying to push on this seemingly Sisyphean push, that it's okay. That you can hold space for it, that it can allow you to connect with the people you work with, that you work for. And I think that's kind of where I'm trying to have that help prevent some of these feelings of despair or burnout, is that understanding that this is part of the work, and how do you hold and create space for some of it? Because trying to deny it or push it out or discount it has its own downsides as well.

Abi Sivakumar: Wow. I really appreciate you answering this so honestly, and I'm sure people listening will relate to your answer on holding space for even the hard parts of being a provider, and that sometimes preventing burnout is more about the understanding and the accepting. So thank you for that.

Philip De Souza: I've been loving this conversation. I'm just getting so much of it and I'm so appreciative you mentioned Dr. Paul Farmer. I know Dr. Paul Farmer through a charity I worked with many moons ago, many years ago, and he helped actually build a hospital that we were raising funds for in Haiti. Anyways, he's just an individual who has inspired me and continues to do so. So happy you brought up his legacy.

Speaking of legacy, you started our conversation by re-centering humanity and enabling people, and for some reason, that gave me chills and called to me. And so I wanted to ask you, if you had a magic wand, we gave you a magic wand, we said, "Dr. Boozary, you can help put action to what you're speaking to about such a amazing cause," what would you do to democratize care for the average citizen, no matter where in the world? Is there something you think you would do?

Dr. Boozary: Well, thank you for the comments and the comments about Paul, and thank you for everything you've been doing to fundraise and all the work that you do. I think I love the idea of magic wands and I wish people like Paul and all of the saints that work amongst us and that we look to would have more magic wand time. I think, for me, on the reality, the pieces that, if it's to a decision maker, I think it's to be clear we don't need a magic wand. We need real investment in people and that we can see magical outcomes if actually dedicate that focus.

And it goes back to what Paul had said. If we really do treat every life equally, if we are clear about the fact that we need to see some changes, we talked about the shift, well, we need to stop putting the onus on individuals and blaming them for bad health outcomes when people are born into staggering conditions, into terrible outcomes from the beginning.

So I think, to me, the shift would be, or if it's a sort of a wand of focus or investment, it would have to be in eradicating the pathologies of poverty, which we can actually do. So whether that's through basic income, whether that's housing for all. What continues to drive me up the wall is how we will blame people and shift all of the focus into individual failures as opposed to examining where and how we are investing as a society, as a collective if we're serious about wanting to advance health for all. So that means housing is a human right. That means ensuring that we are addressing the pathologies of poverty. And look at the evidence around the world, the outcomes are magical. You start seeing shifts. Disparities disappear. Neighborhoods have higher net health and wellbeing. And so, to me, I think it's just really being dead-on about what needs to be done, what the evidence is clear about, but really having the political will to do it. And that's what I think continues to be the major disconnect.

Philip De Souza: Okay. In seven years we've asked that question to a variety of people and you're the first person in seven years to reframe it and reframe it in a way that's like, "Wow, this, it's not rocket science. We can do this." And like you said, it's about that real investment and just thinking differently. Wow. Again, you gave me chills.

My second question for you is you talked a bit, I'm so happy that Abi brought it up, about burnout and how holding space. My team will tell you I'm a big TV junkie and that includes medical dramas. I recently watched a show called The Pit, and in it they hold space for healthcare providers who are still going through trauma of what they had to endure during pandemic and other things as well. They've kind of focused on these few first-year students in the show. I wanted to ask you, what was the misconception you may have had in your first year in a hospital or working with your soon-to-be mentors, et cetera? Was there something that kind of opened your eyes?

Dr. Boozary: Yeah, it's a great question. I think trying to unpack it in real time, it's a lot.

Philip De Souza: I know I gave you a lot there.

Dr. Boozary: No, no. I want to do your question justice. I think that when you think about the misconceptions, and you talked about this in terms of burnout, I guess when I started, my hope was that we would've held more space and had support for the really horrific things that people see coming through healthcare and continue to see in healthcare. That, I think, continues to be surprising for me.

When I think about all of the sacrifice that nurses, physicians, personal support workers, the whole healthcare system, and I mean that both inside, outside the hospital, put on the line for the last five years, I still think about the fact, when I was leaving volunteering at a long-term care home at the height of one of the COVID waves in a facility or a home that had lost over 82 people, you don't really train you for a mass casualty event, you don't really train for a humanitarian crisis in medical school or nursing. And when I left, I really believed, I felt it in my bones, I mean, it was the dead of winter, it was just around Christmas, and you feel it to where you have tears of conviction that, "We're not going to betray our elders and seniors like this again." And it didn't even become an election issue months later.

And so many people, so many people in healthcare, have had similar to even more daunting experiences of seeing people that they know did not need to die or that we failed or that was avoidable, It was preventable. What Paul had called 'stupid deaths". I think the stupidity is on us and the cruelty is on us, and I think it's really this push around how can we continue to advocate, continue to be there for each other where so many of us have seen things that we had never visioned, believed was possible? And to have that kind of empathy for each other.

But also when we talk about the humanity piece, that's what it is. We can't get to a place where we're just going to have electronic medical records and AI and everything run and clicks and screens run healthcare. What ultimately the social medicine is about is the human connection and for each other as teams and for the people that we serve. And so that's the thing that I am not a Luddite to be against the advances that we've seen in AI or machine learning, but my real fear and where I hope we don't even more surprise is of siphoning away the human element of medicine or of healthcare delivery that I think is ultimately what has allowed us to have hope in this profession.

Philip De Souza: Absolutely. And you yourself are catalyst for change today, because you told our listeners about when you said earlier, whatever grips, you don't lose that feeling, take it with you and make that action. So thank you for being that change as well. I remember many years ago I was at an event or somewhere, it was in the US, and they were talking about, "Wouldn't it be cool if one day there's a health facility in a community and this health facility provided bikes for people to go to appointments with." And they gave all these different examples, and I forget who it was, it was, I want to say, a healthcare organization that was hosting this talk. It was a very interactive and it was blowing my mind like. It was like, "Oh, the community can do all of this. They can bring groceries to somebody who just left, had a surgery, and so that they wanted to be at home with their child." And this is all part of the care, how you mentioned about re-centering. And it was just mind blown. I was like, "Wow."

But as you and all your colleagues at UHN and all the other HIROC subscribers, it's very clear that, like you said, this can be reality. So I'm happy that this kind of came full circle in this conversation about making things happen and not just talking about them.

Dr. Boozary: Thank you.

Philip De Souza: I'm so glad that you're here just to help push that.

Dr. Boozary: Thank you. Again, this is such collective work and it's been happening for years, and I think being able to feel like we're starting to see some things come into action and feel concrete. Still, for me, the idea of seeing Dunn House where it was a parking lot when I started and it's now homes for people, it's a real home. It's not going to end the homelessness crisis that we're facing each night, but my hope is that it can propel some change or the idea, to your point, that there are different solutions and actions that we can choose to take. And I think it goes back to this real thing about choices, and that these are really these system choices and not shirking it onto people for choices they've never even really had.

Philip De Souza: No, Dunn House and the work that you and the team are doing is an amazing model that can be scaled. Obviously it took you all from 2019 to now, which is actually not that long.

Dr. Boozary: Right. Just the ideas. The construction didn't start in 2019, just to be clear, because I'll get into trouble for that.

Philip De Souza: Yeah, 100%.

Dr. Boozary: The brain concept or the intellectual concept was in 2019.

Philip De Souza: Yes. Absolutely.

Dr. Boozary: But obviously trying to get this amidst the pandemic and everything was a huge amount of collective work and teamwork across different organizations to make it happen.

Philip De Souza: Absolutely. And that's why we heard about it, we said, "We need to amplify this." Because it's an amazing accomplishment. And I know you're obviously being humble, because obviously it's true, it hasn't solved the crisis in one snap of a finger, but it's something that's actually happening that's making a difference.

Dr. Boozary: I appreciate it.

Philip De Souza: But that said, I'm going to pass it back to Michelle and Abi for the lightning round and hear your answers on that.

Dr. Boozary: Thanks, Phil.

Michelle Holden: Thank you. Our lightning round on Healthcare Change Makers is quick questions, short, short answers, and we will not try not to put you on the spot, but we may have a few personal questions at the end.

Dr. Boozary: You calling it lightning round makes me believe it's going to be on the spot, but here we go.

Michelle Holden: It does, yeah. My first question for you is your biggest misconception about healthcare and homelessness.

Dr. Boozary: My biggest misconception?

Michelle Holden: What you feel is the biggest misconception.

Dr. Boozary: I think it goes back to just about choices, that people somehow don't want to pursue health and wellbeing. And I think that continues to be out there. Or that this is really about mental health and substance use, not about a housing crisis. I think that's a real and serious misconception when I think all of us working in the system see hundreds of people's phone calls for a shelter bed each night go unanswered.

Michelle Holden: Yep. So you took my very long question and made it into a short answer. See? So you're already getting the lightning round.What's one policy change that could have the biggest impact on health equity?

Dr. Boozary: Housing for all and basic income. I'll do two.

Michelle Holden: I love it. A book or article that's influenced your approach to healthcare?

Dr. Boozary: Scarcity by Sendhil Mullainathan and Eldar Shafir, the idea that chronic poverty has serious detriments to cognitive function and it's akin to being on call for 36 hours and trying to function the next day. And that's the real pathology of poverty taking place from a health perspective.

Michelle Holden: Okay. What's one underappreciated factor that drives health outcomes?

Dr. Boozary: Let's say human connection. Or the opposite of that, loneliness.

Michelle Holden: Yeah. What's more powerful for system change, data or storytelling?

Dr. Boozary: I will say that data is necessary, but not sufficient. You need both, I would say. For policy change, I think you need good data, but you need to tell the story. And if you don't, someone else will do it for you. And that's not the story you want to tell.

Michelle Holden: Yeah. And if you had 30 seconds with a policymaker, what's one thing you'd say?

Dr. Boozary: The status quo is not working and that we can actively choose to improve health from both a human rights perspective and an economic one. And then I would give the one to two to three examples that we have from income to housing for all to ensuring that we can actually ensure everyone has access to primary care, because my last plug on this will be we have to stop saying we have universal healthcare in Canada when over 6.5 million people don't have access to primary care.

Michelle Holden: Okay. So this is a little bit of a different question, but what was your first job ever?

Dr. Boozary: First job ever.

Michelle Holden: Before medicine.

Dr. Boozary: I delivered newspapers. It's the first I remember. Yeah. And I was not very good because I believed I had some sort of athletic ability that I could throw newspapers, which got me into some trouble, but I thought I was pretty accurate, actually. But you have a few errant newspaper throws and you are not exactly in the good books. But yeah, that was one of the earliest memory, I think, of having the newspaper route.

Michelle Holden: I hope you didn't lose some of your income to placing windows with the good throw.

Dr. Boozary: No, no. I never hit A window, never hit an animal or pet. I just want people full disclosure on that. Just apparently it was not close enough to the door as people would like.

Michelle Holden: Oh.

Dr. Boozary: And that's okay. That's the reality. I learned that you've got to run out and back no matter how much faith you may have in your arm.

Michelle Holden: That was one of my first jobs too, so I get it. It's a tough one. What is your get pumped up song? So what makes you feel good if you need a song to get there?

Dr. Boozary: This is terrible, because I don't want to create any divide in Toronto, but I think it'd have to be something by Kendrick Lamar. I hope this doesn't create any major division or divide.

Philip De Souza: No divide.

Dr. Boozary: I'm sorry. Just again, I promise I'll be honest with my one-word answer, so I'll leave that there.

Michelle Holden: Okay. That's the perfect way to leave it and also to leave our episode, I just wanted to thank you, Dr. Boozary, For speaking with us today, sharing all those powerful messages, and really kind of taking us along for the journey on where you've been with your project, with Dunn House, with the Center for Social Medicine, all of that. Thank you so much.

Dr. Boozary: Thanks so much for the conversation. Thanks so much for thinking of me. It really matters and I really enjoyed this conversation. Thanks again.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website, hiroc.com, and on your favorite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at [email protected]. We'd love to hear from you.