By Yasmine Elmir
Dr. Anne Andermann joined the McGill University Department of Family Medicine in 2008 as a staff physician with the Family Medicine Centre at St. Mary’s Hospital. She had completed both her undergraduate and medical education at McGill University, earning a Bachelor’s degree in Honours Molecular Biology in 1994 and her MDCM in 2002. She then completed a certification in Family Medicine in 2004 and another one in Public Health and Preventive Medicine in 2006. “I often ventured off the straight and narrow path,” says Dr. Andermann. “During my undergraduate degree, I took courses in medical anthropology, literature and biomedical ethics. Prior to starting medical school, I completed a Master’s degree in History and Philosophy of Science at Cambridge University.” During medical school, Dr. Andermann was awarded a Rhodes Scholarship and spent three years at Oxford University completing a doctoral degree in Public Health, where she learned about patient expectations and risk communication in primary health care. During residency, she completed a certificate at Université de Montréal in Health Administration. “These detours provided me with the wider perspective and breadth of experience needed to help me better appreciate the big picture.”
Family medicine and primary care
“Primary health care is the cornerstone of the health system, providing comprehensive and continuity of care, close to where people live and work. It promotes better health and more equitable patient outcomes,” says Dr. Andermann. Her main focus throughout her career has been to support marginalized and underserved populations - from patients and families with rare and orphan diseases to Indigenous health, women and child health and the health of persons experiencing poverty and homelessness. “The common thread across my work has been to better understand what frontline health workers can do to promote health equity and improve health outcomes.” As a public health physician and family doctor, she would often supervise public health residents who were rotating through St. Mary’s Hospital during their clinical years. She would, in particular, support them in their scholarly research projects. “Each year there is something new, and it has been a real learning curve and a great way to combine my interest in family medicine and clinical practice with my research in health equity and action on the social determinants of health.”
Dr. Andermann is the founding director of the CLEAR Collaboration, a global health research platform that has attracted and engaged like-minded graduate students, medical trainees and research partnerships. “Over a decade ago, I was a visiting professor at the Princeton School for Public and International Affairs when I was approached by a fellow researcher from Pakistan who had an interest in researching gender-based violence and child labour,” she recalls. “We embarked on a global health research initiative that aimed to address intergenerational health inequities using preventing child labour as the initial entry-point.” Those who join the CLEAR Collaboration are interested in exploring how frontline primary health care workers can better support underserved populations, while creating the structural changes required to prevent inequities in the first place. “Over the years, new projects and research partnerships have emerged, and the CLEAR Collaboration has evolved, always with the aim to equip frontline primary health care workers as change agents to promote health equity, which is a fundamental backbone of primary health care,” adds Dr. Andermann. The various topics and focus of research have broadened, always adapting to the specific interests of the many graduate students in the Department of Family Medicine.
The CLEAR Collaboration has developed the CLEAR Toolkit, available free of charge and in almost 20 languages, which guides busy clinical staff on the frontlines to treat the presenting clinical problem, to ask about underlying social challenges, to refer to local support resources, and to advocate for broader structural change. Dr. Andermann welcomes requests for new translations, as this tool has been increasingly in demand internationally.
Homelessness and the role of family physicians
As a member of the Canadian Homeless Health Research Network (HHRN) and the National Advisory Council on Poverty (NACP), Dr. Andermann has also been focusing her efforts on caring for patients who are experiencing homelessness. “Over the years, the work of the CLEAR Collaboration was becoming more known and I was also getting to know a small number of family doctors across the country who shared similar interests in equipping frontline primary health care workers to address the social determinants of health,” she shares. “A group of family doctors at St Michael's Hospital, in Toronto, had been developing the Poverty Toolkit and the "IF IT HELPS" approach to social history taking. At this point, we started to work more collaboratively.”
“Family doctors are already doing such important work - busy in their clinics, or working in emergency rooms and hospital wards,” says Dr. Andermann. “However, my research journey of co-discovery with my graduate students and residents, patients and community organization partners, has been eye-opening. It has illustrated that what we see in the clinic is only part of the picture, and what gets charted and documented in a clinical encounter can miss a lot of layers just under the surface.” When Dr. Andermann and her team started researching homelessness in Côte-des-Neiges, they noticed that the official homeless count in Montreal had identified only six homeless people in the neighbourhood. On the other hand, local police were aware of 47 people who were experiencing unsheltered homelessness and living on the streets. “Family doctors need to be aware and to engage in active case finding, to pick up on cues and get to know the whole person in their context.”
Since the COVID-19 pandemic hit the province of Quebec in March, Dr. Andermann has been very busy, being on call for public health, while trying to keep up her research and teaching commitments. She recently joined a working group at the Steinberg Centre for Simulation and Interactive Learning (McGill SIM Centre), which focuses on how to use new technologies and approaches to teach students. Early next year, Dr. Andermann will be teaching a short course on social inequities and health for the new Max Bell School of Public Policy at McGill. “I am also wanting to turn my attention to the issue of global governance, which has long been on my mind and an issue made more urgent by the uneven impact of the recent pandemic,” she says. “Today it is COVID-19, but this is just a wake-up call - with the threat of climate change and growing global injustice, we need to be thinking several steps ahead. It's all interconnected, from the local clinical level to the national and global levels, we need to juggle progress on multiple fronts to succeed in promoting equity and improving patient outcomes.”