Healthy and Safe Cities

Where do the MacChangers themes come from?

The MacChangers themes are based on four  "Our Future Hamilton"  themes. “Our Future Hamilton” is a 25-year vision created by the City of Hamilton in consultation with the Hamilton community. Approximately 55,000 Hamilton community members were consulted through focus groups, mail lists, vision cards, and pop-ups across the city to collaborate on this shared vision. “Our Future Hamilton” co-developed a  Public Engagement Charter  that outlines the City’s responsibility to involve and engage citizens to problem solve and plan for the future of Hamilton. 

What is the intended use for this guide?

This guide is meant to introduce you to community-informed challenges in a way that reflects the needs of the community as identified through interviews with various community members. The MacChangers Program greatly values lived experiences, hence, you may notice limited stats or references in this guide as many challenges are born from the lived experiences of community members. Furthermore, this guide is meant to provide you with context, inspiration, and a place to kick start your research. We suggest you bookmark this site and use it frequently to assess if your project aligns with the needs of the community, the UN Sustainable Development Goals, the project's expectations, and the laws and regulations of the City of Hamilton.

At MacChangers, we strive to align ourselves with the United Nations Sustainable Development Goals (UN SDG). During the course of the program, you will be identifying and aligning your project with UN SDG targets. Watch the video below to better understand the UN SDGs and why they are important.

This years questions are outlined below! Each question contains a context paragraph, some media for inspiration, and links to jumpstart your research. As you follow the process for human centered design, your group will narrow and refine your chosen question. 

Trigger Warning: Substance use

 Research  has shown that  supervised safe consumption sites  are a vital part of  reducing the harmful consequences  of the toxic drug policy crisis. Not only do these sites have trained staff present to help in the case of an emergency, but  people who use drugs often find solace in the fact that they can exist in a welcoming and supportive environment.  Additionally, many supervised safe consumption sites can introduce users of illicit drugs to addiction treatment or harm reduction strategies. Despite this, many people who use drugs find themselves unable to partake in supervised consumption for reasons outside of their control. Take a moment to envision the following scenario:

You are a person who smokes fentanyl. Typically, the only place you have been able to consume your drugs is in public alleyways, where you smoke quickly to avoid being harassed. However, you deserve to be afforded the dignity to consume as safely as possible. You have friends who have died from fentanyl overdose while smoking their drugs, and you are afraid it will happen to you. After some consideration, you decide to try out the supervised safe consumption site in Hamilton. You build up the courage to make the nerve-wracking journey to the site - with illicit substances on your person, no less.  Yet, when you arrive, you are informed that you cannot inhale drugs at this site, and you are turned away. Defeated, you feel that your options are limited, at your own detriment. You can’t help but feel that the system has failed the people whom it was meant to support. 

Currently, across Canada, users of inhaled drugs are facing this exact barrier.  The vast majority of supervised safe consumption sites cannot support users of inhaled drugs.  This is the case for the site in Hamilton, meaning our citizens who consume by inhalation continue to be at a higher risk of overdose than those who consume via other methods. Furthermore, those who are looking to move from injection to inhalation (potentially  a safer route of consumption ) must make the impossible choice between a safer method of consumption or a safer environment to consume in.

You are being asked to design an ideal safe inhalation consumption site with the needs of all people who use drugs in mind. Consider the following:

1. How will other people (clients, workers, etc.) at the site be protected from inhaling smoke? How will their need for protection from the fumes be reconciled with the need for staff to access each user of inhaled drugs at a moment’s notice if an overdose occurs?
2. How do people who use drugs wish to be able to use their drugs in a safe consumption site? How will you provide them with dignity, safety, and privacy?

Topics to inspire you!

•  The supervised inhalation site at ARCHES , North America’s first regulated supervised inhalation site. The site opened in 2019 in Lethbridge, Alberta and remains one of the only sites of its kind on this continent.

Helpful links to start your research!

•  Supervised safe consumption sites save lives.  
•   Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilities.  
•  Supervised inhalation is an important part of supervised consumption services. 
•  Review of Supervised Inhalation Sites in Canada 

There is a growing health concern in Hamilton that not many people are aware of: sexually transmitted and blood borne infections (STBBIs). Try not to scroll away too quickly - while sometimes awkward and uncomfortable, conversations around STIs are necessary and important to our community. Syphilis, for example, has been  on the rise in Hamilton  for a number of years. The number of Chlamydia and Gonorrhea infections tend to spike in the McMaster community after Welcome Week and both reading weeks each year. Lately, in the already limited number of tests there has been a high positivity rate, suggesting that the problem is even more dire than it may seem. Though getting a positive test result can be worrying, it isn’t a cause for shame! Many STIs are treatable and it is not shameful to have one! What is most worrying though, is the amount of people going untested, and potentially putting others at risk. It is so important to know and promote healthy conversations around STIs, so that you can protect yourself and your community. To protect the public from contracting or spreading one of these infections, access to STI testing and treatment is crucial. Yet, testing numbers remain low in Hamilton. What gives?

A multitude of barriers may be limiting Hamiltonians from accessing the sexual healthcare they need. Imagine you are:

• A teenager who suspects they have an STI. You would like to get tested – and treated if necessary – but you are afraid that your doctor will share your test results with your family even though this is against strict guidelines, something you are unaware of. Without the understanding of how to access testing at a sexual health clinic, you feel helpless. Your only solution, it seems, is to hope your symptoms disappear on their own. 
• A McMaster student without personal transportation. You would like to visit a sexual health clinic, where you know you will be able to access confidential testing – but between your studies and part time job, you feel you do not have time to bus there and back. You think that if transport to the clinic were more convenient, you’d surely get tested! Additionally, many of the clinics that were offering STI testing before the pandemic have been redistributed to provide COVID-19 vaccines. Even if you did have the time, you’re not even sure where to go.
• A member of a community or culture where discussing sexual health or seeking testing or medical advice related to sexual activity is seen as inappropriate, taboo, or offensive. This may have led to limited knowledge of sexual health practices, including sexually transmitted infections and how to test for them.

Because of real or perceived barriers like these, many preventable and treatable infections continue to spread through Hamilton. Furthermore, if left untreated,  STIs can cause chronic pelvic pain, an increased risk of catching another STI and even infertility . Without easy-to-access, symptomatic and asymptomatic STI testing, many Hamiltonians will continue to suffer in silence. However, all hope is not lost! Research has shown that  people are more likely to accept sexual health advice when it comes   from their peers.  Thus, the McMaster community would greatly benefit from a student-led initiative aiming to increase access to STI testing.

Consider the following barriers that citizens may face:

1. COVID-19 has impacted the way that many of us access healthcare. For example, many public health run clinics and their employees have been redeployed to administer COVID-19 vaccines. Limited locations and hours of operation may impact how and when people are able to get tested for STIs.  
2. The message delivered to the public encouraging them to be tested for STIs needs to acknowledge and consider: barriers to testing access, what implications an increase in testing may have on lab and public health capacity, and clearly explain STIs testing methods (such as swabs, urine tests, and blood tests). Think about real versus perceived barriers, and who may be at a high risk.
3. The stigma surrounding sexually transmitted infections prevents many people from seeking help. In an ideal world, talking about STIs would be as normalized as any other conversation about health.  

Topics to inspire you!

•  Pee4Pizza , a joint campaign between the Student Wellness Centre and Public Health Ontario. 
•  Peer HIV Testing , a group of events held in British Columbia that aimed to encourage HIV testing and treatment.

Helpful links to start your research!

•  What’s an STI? 
•  Sexually Transmitted Infection Statistics in Hamilton. 
•  Barriers and enablers to sexual health service use among university students. 

Imagine you are 85 years old and while working around your home, you fell and broke your hip. You have been admitted to the hospital and have been staying there for a while to monitor your recovery. Everything is going well, and you are set to be released soon! Until, that is – you become infected with the bacteria known as C. difficile. You are moved to an isolation room, where you spend almost all of your time alone. Doctors and nurses are required to follow droplet isolation precautions, which requires them to don the appropriate personal protective equipment (PPE) and to minimise unnecessary contact with your room. The hospital offers you some magazines as entertainment, but the print is too small for you to read and you seem to have misplaced your glasses yet again. You would love to video call your family, but you do not know much about technology. Separated from the people you care about, and without anything to help pass the time, your quality of life and mental health are severely declining.

The unfortunate truth is that this is a reality for many patients. Those in isolation face an increased burden on their mental health and well being. In such cases, patients are confined to their rooms unless absolutely necessary. Because any entertainment – like books and magazines – that patients are given cannot be passed on to others without being completely sanitised, they often must be given to the patient instead of loaned. Studies have shown that  people in isolation appreciate being able to stay connected with family and friends, having access to recreational activites and spiritual care, being provided with updated information about their care plan and having access to good news from the outside world.  However, providing these supports becomes increasingly difficult as more complications are present in a patient’s condition. Consider how isolation care might look different for a patient with hearing loss, a language barrier, cognitive impairment or any physical disability in addition to the medical need that has landed them in the hospital. When developing potential solutions, students should create something that would be effective for a patient with at least one complication in addition to the condition they are being isolated for.

We challenge you to:

1. Consider how access to entertainment might be improved for patients in isolation, in a way that is easy for someone with little background knowledge in technology to use. 
2. Consider how a patient’s need for social connection might be met, while ensuring the safety of all people in the hospital.

Topics to inspire you!

• The  Lean on me program offered by CBI Health , a Canadian community healthcare provider. In this initiative, a team of workers schedule phone or video calls with seniors who live alone in order to facilitate much-needed social interaction.
• A Norwegian company has created a  one-button computer named Komp  for seniors who are not comfortable with technology to be able to receive pictures from family and participate in video calls.

Helpful links to start your research:

•  Needs and concerns of patients in isolation care units - learnings from COVID-19: a reflection.    
•  Preparing for next time: Don’t let patients linger in lonely isolation. 

What does the MacChangers journey look like?

The MacChangers program follows the Stanford process of Human-Centered Design. To properly implement human-centered design, you will use the "How Might We" questions as a jumping off point. Through your own research and in further consultation with the community members, your goal is to develop a deeper understanding of the problem in your HMWQ. Then, you will focus in on one aspect of the problem for which you could develop a tangible idea for a solution.

What does a completed MacChangers project look like?  

A final MacChangers project is a proposed solution discovered through the human-centered design process and is financially viable, well-researched, inclusive, and innovative. Past successful MacChangers projects have included the proposal for an app, a social media page, infrastructure proposals, policy recommendations, and businesses. In addition to the relationships and skills you’ve built, finishing the MacChangers program will look like creating a business plan, not launching a business; proposing a policy plan, not changing a policy; showcasing an app demo, not creating an app. The project is one that presents a well-thought-through idea that could be carried through by you or picked up by a community member. In some cases, students have been able to bring their idea to grants or mentorship programs to begin implementing their idea.   

What does “Innovative” mean?

Our definition of innovative means “new to the City of Hamilton,” or any idea, practice, or object that is perceived as new by the Hamilton community. For example, p op-up parking patios  had been implemented by Nova Scotians long before the idea came to Hamilton. Basing a proposed solution on case studies from other places tends to produce more implementable ideas, as the constraints and successes of the proposal are better known. That said, the design thinking process allows for completely innovative ideas. If you do base things off of a case study, ask yourself to think about how to best adapt these ideas to Hamilton specifically. In other words, try to elevate these ideas to best suit the Hamilton community.

One question you want to ask yourself when solving a problem is, “Who has the authority to implement my idea?” As a MacChangers student, you are constrained to developing ideas that can either be implemented or approved by the municipal government. For example, one of the priorities identified by “Our Future Hamilton” is to reduce the average public-school class size. As education is overseen by the Provincial government in Ontario, this problem is considered outside of the City of Hamilton’s jurisdiction. Do some research to understand what authority the City of Hamilton has over the problem you are addressing to help you scope your ideas once you start solution finding. (Read more:  Government of Canada  &  Federal, Provincial and Municipal Responsibilities ) 

Some actions you may take to familiarize yourself with the scope of your problem include: 

1. Ask yourself: who has the authority to implement my idea?
2. Understand how by-laws work and how they can be introduced or affected or changed. Research what by-laws, Provincial laws, and Federal laws currently exist and how they may be impacting the problem. (For a well-organized resource, consider  this document  created in Saskatchewan. For a local resource, review the  City of Hamilton website .)