Reminiscing on residency with Dr Jasmine Pawa: ‘I didn’t know that the public health specialty existed when I started medical school’

Even though public health is so much more than communicable disease, for Dr. Jasmine Pawa and other public health physicians, the COVID-19 pandemic work was almost all-consuming. Dr. Pawa held a position as president of the Public Health Physicians of Canada—the national specialty society for Public Health and Preventive Medicine Specialists and public health physicians—at the time, and worked as a public health physician for Nunvavut. With teams, she worked on case and contact management, and she worked closely with epidemiology teams on how they tracked and reported on the pandemic and the response. A few years after the pandemic’s zenith, her typical day still involves multiple tasks and contact with various teams. “There’s a lot of data that we study as well as looking at health protection and promotion, and we still work with a lot of epidemiologists, nurses, and other teams,” says Dr. Pawa. As a public health and preventive medicine specialist physician she works—under various titles—in different jurisdictions including Nunavut and Ontario. She also works as a public health physician consultant to a range of public sector organizations and has provided locum coverage for the deputy chief public health officer role for Nunavut. All of this has given her a deeper understanding of how systems in healthcare, public health and inter-sectoral policy interact with and influence each other, something that drew her to take an elective in public health in the first place. While completing medical school at the University of Alberta, Dr. Pawa found a number of electives in the public health field. “I didn’t know that the public health specialty existed when I started medical school,” says Dr. Pawa, who took a couple of electives offered there. “I’m really grateful to one or two physicians in Ontario who took me on (for an elective) without meeting me.” The electives, she says, broadened her understanding of how much our health is shaped by things outside of one to one healthcare including a person’s home and community—and what actions we can take to improve the health of the population. She continued her pursuit of public health into her residency years at the University of Toronto. UofT’s public health program allowed her time to work at St. Michael’s Hospital in Toronto, where she also obtained her family physician’s license. During residency, she also completed a master’s degree in the United Kingdom. Dr. Pawa refers to the program—joint between the London School of Economics and the London School of Hygiene and Tropical Medicine—as one of the most interesting personal and professional years of her life. “It helped me round out some of my perspectives, and helped me understand a lot of the patterns I had seen during my training, and gave me tools to do something about it,” she says. All these points of training shaped her perspective on public health and healthcare policy today, spurring her advocacy for thoughtful reflection in policy.“I say this with great respect for the work, time and effort we put in as physicians . . . at the same time I wish we could have a conversation as a community about how we show up for the public and contribute to the health system’s financial strain,” she says, referring to how federal and provincial and territorial tax dollars are allocated to healthcare. According to a 2024 report from the Canadian Institute for Health Information (CIHI), federal and provincial and territorial governments have allocated 7.5% of the publicly funded healthcare budget to public health initiatives—compared to 63.7% to curative care. “Most people have heard of social determinants of health, what people don’t talk about as much is structural determinants of health—societal economic, ecological and political structures—and how those shape people’s health,” she says.When it comes to advocating for more of that spending going towards public health, she says that her own field has an opportunity for improvement. “We as [people working in public health] need to get better at demonstrating what we do and how we help to prevent illness, and promote well-being,” she says. These reflections are something she’s passing on to future health professionals she teaches at both NOSM University and the University of Toronto.1. What is the biggest thing that residency taught you about being a doctor? Residency reframed how I thought about leadership. I don’t think leadership means talking the most or being the loudest, humility goes a long way. It’s about listening deeply, being open to difficult conversations, and reorienting to what the goal is at hand. All of this is especially true in times of uncertainty. Part of what taught me this was seeing where people struggled, and struggling myself. 2. What is something you've learned further down in your career?There’s a lot of talk about evidence-informed practice, but a term I would like to explore more is practice-based evidence—studying and learning directly from existing practice, as opposed to some research findings which may be less well-adapted to the context. Sometimes in public health and in healthcare, we as health providers can go into communities and think that what the research tells us or what we know, will work best. I believe that people living through things day-to-day, those community members, know a lot, and we can listen and learn from these perspectives, alongside the type of expertise we bring. 3. What is your number one tip for residents?Learning how to partner with others or being a good partner is a skill in itself, especially for those interested in public health. Understand how to share power and money and pieces you have access to, and how that impacts the communities and health outcomes around you. Take steps to understand those spaces better, not just the content you’re interested in, but who the other actors and players are and what their interests are. Understand the processes for how change works, and how, for example, public sector systems function. And then really thinking about the context. I love the Economist’s Intelligence Podcast, because it helps me expand how I've been thinking about the world and gives context to the communities I live and work in, and what sort of current narratives and stories being told are and where the system came from, and taking time to understand that, I think, can make any of us working in public health more effective.

Reminiscing on residency with Dr Jasmine Pawa: ‘I didn’t know that the public health specialty existed when I started medical school’

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