Dr. Manisha Pahwa, the newly appointed Canada Research Chair in Social Equity and Health Policy Research at Trent University is uncovering interesting tensions in the role of social values in health policy in Canada. As the lead researcher of a study examining public attitudes toward lung cancer screening, she found strong support among participants for reducing lung cancer mortality. At the same time, some participants believed screening should be prioritized for people whose risk arose from occupational, environmental or genetic factors rather than smoking, despite smoking being one of the strongest risk factors for developing lung cancer. 

"The contradiction between public support for lung cancer screening, but not necessarily for people with a dependence on commercial tobacco smoking, was striking to me because it showed how social values don’t necessarily correspond with knowledge about disease risk in health policy,” says Professor Pahwa, who is also an assistant professor in the Trent/Fleming School of Nursing. 

The findings revealed that people bring their own ethical and social values to discussions about evidence-based health interventions. Canadians may recognize parallels in the debates that emerged during the COVID-19 pandemic, when decisions about masking, vaccines, social distancing, visitor restrictions, and vaccine prioritization exposed differing views about health risk, responsibility, fairness and personal freedom. 

With the support of $600,000 from the Social Sciences and Humanities Research Council, Prof. Pahwa is leading a nationally significant research program exploring the ethics and social values that influence health care decisions in an increasingly diverse Canada.  

"Dr. Pahwa's emerging research leadership at Trent is notable because of her important combination of global and public health experience, and health policy research with and for communities in Canada," says Dr. Tana Allen, vice-president, Research & Innovation at Trent University. "Her research is addressing health care questions that matter deeply to communities, practitioners and decision makers across Canada. She is also creating exceptional opportunities for students in the Trent/Fleming School of Nursing to learn directly from and contribute to leading research that is helping shape the future of the sector." 

Drawing on expertise spanning cancer epidemiology, health policy, and ethics, including work with the World Health Organization, Pahwa's research examines how health systems balance evidence, ethics, and equity. 

"By bringing research on ethics, lived experience, and community perspectives into health policy, we can build a health care system that is not only more effective, but also more inclusive and responsive to the diverse communities it serves," says Prof. Pahwa. 

From one-size-fits-all to inclusive, personalized care
A major focus of Prof. Pahwa's CRC research is breast cancer screening, an area where evolving approaches to prevention are raising important questions about equity and inclusion.   

Since organized breast cancer screening programs were introduced in Ontario in the early 1990s, eligibility has largely relied on age. Today, health systems are moving toward more personalized approaches that incorporate age with other variables using genetic testing, risk prediction models, and artificial intelligence to identify who may benefit from earlier or more frequent screening. Ontario's decision to expand screening eligibility in 2024 to include women as young as 40 reflects a growing recognition that prevention programs can evolve to better address population needs. 

"We need to understand whether new preventative and monitoring approaches benefit everyone equally or could unintentionally reinforce existing inequities," says Prof. Pahwa. "Marginalized communities tend to have greater exposure to cancer risk factors. This includes a lack of green space for physical activity, a lack of access to nutritious and healthy food, poor housing conditions, environmental exposures to carcinogens, as well as occupational exposures. Those issues are long overdue for consideration in prevention efforts." 

Prof. Pahwa is working with South Asian communities in Canada where disparities in breast cancer screening participation and outcomes persist. South Asian immigrant women were 20 per cent less likely to have a screen-detected breast cancer compared to long-term residents in Ontario and were more likely to be diagnosed with stages 2, 3 and 4 breast cancers compared to women in the remaining general population in Ontario. 

Through community-engaged research, she is examining how culturally diverse communities understand risk-based screening approaches and how those perspectives can help shape more effective and equitable health policies. The work reflects a broader belief that ethics and values evidence represent important forms of knowledge alongside clinical, economic and epidemiological evidence. 

"The goal is to ensure communities are not simply the subjects of research, but active contributors to it," says Prof. Pahwa. 

Building better health policy
Prof. Pahwa is also creating opportunities for students to work at the forefront of health policy research. They will contribute to community-engaged research, data collection, analysis, and knowledge mobilization while working alongside communities and decision makers entering the field as scholars and practitioners with forward-looking perspectives on fairer and more inclusive health care.  

Ultimately, Prof. Pahwa hopes her research will help create health systems that are not only evidence-based, but also more responsive to the people they serve. 

"Better policies begin with a better understanding of the people those policies affect," she says. "When diverse communities are included in decision-making, health systems become more equitable and effective." 

Learn more about Dr. Manisha Pahwa, Canada Research Chair in Social Equity and Health Policy Research.