Profile
Keywords: Economics, labour markets, human resources for health, health policy, retirement, public pensions
Arthur Sweetman is a professor in the Department of Economics at McMaster University in Canada, where he holds the Ontario Research Chair in Health Human Resources. His interests focus primarily on empirical economic issues related to the labour market, and especially the health labour market. Beyond health economics, his research includes economic aspects of issues such as: immigration, education, employment insurance, and social policy more broadly.
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Then and Now: Assessing Labor Market Disparities Between Immigrant and Canadian-born Seniors in Canada Title of Conference: “Enhancing and Celebrating Diversity, Equity and Inclusion (EDI)” (Dec 5 & 6, 2023). Memorial University
TRS2 1.4 Activity 2023-12-05 Moyosore Sogaolu
TRS2 1.4 Low income among Canadian seniors: interactions between immigration status, racial identity and gender Purpose Population aging is prompting concern over the viability of public pension systems in many Organisation for Economic Co-operation and Development (OECD) nations. In Canada, over the past 2 decades, one response has been to significantly increase immigration, increasing the immigrant share of the population. However, policy and academic analyses have largely overlooked the aging of the immigrant population. This study aims to document disparities in low-income rates and labour market outcomes between immigrants and non-immigrants at older ages, focusing on the intersectionality of immigration status, racial identity and gender. Design/methodology/approach We employ the 2021 Canadian Census to undertake a descriptive analysis of low-income patterns and the underlying income sources. Findings Compared to non-racialized non-immigrant men, seniors’ low-income rates increase with each of immigrant, racialized and female status – and the effects are cumulative. Low-income differences are linked to variations in prime-age employment and earnings, and access to pension benefits for immigrants. To a large extent, the gaps are driven by variations in Canada Pension Plan (CPP) benefits, mostly due to limited years of Canadian residency. Originality/value We characterize differences in low income across eight population subgroups and examine the complete set of tax-relevant income sources to understand how each underlying income stream is associated with the observed differences in low income. We emphasize the intersectionality between immigration status and racial identity, and how both vary by gender. Publication 2025-02-17 Historically Disadvantaged Groups: Are Wage Deficits an Exclusively Private Sector Phenomena? Conference presentation
Presentation Title:
TRS2 1.4 Activity 2023-12-05 TRS2 1.4 Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario. Health Policy, Publication 2023-04-01 Internationally trained healthcare professionals Due to Canada’s growing healthcare demands, aging population, and persistent labor shortages in the healthcare industry, international trained healthcare professionals (ITHP) are considered important resources that can fill gaps in the labour market. However, many ITHPs face various challenges in the labour market. This session starts with a macro-level study reflecting the labour market outcomes of ITHPs and changes in the professions over time. It is followed by presentations on various aspects of the topic, using a variety of methods, including a case study on pre-arrival services, a comprehensive review of barriers and enablers in the ecosystem, and policy recommendations. TRS2 2.2 Toronto Metropolitan University, Activity 2025-03-14 TRS2 2.2 Trends in obesity defined by body mass index among adults before and during the COVID-19 pandemic: a repeated cross-sectional study of the 2009–2023 Canadian Community Heath Surveys The COVID-19 pandemic affected health behaviours and the social determinants of health. We sought to describe trends in the prevalence in body mass index (BMI) categories before and during the COVID-19 pandemic among adults in Canada. We conducted a repeated cross-sectional study of adults in the 2009-2023 Canadian Community Health Surveys. We compared changes after the onset of the COVID-19 pandemic (April 2020 to December 2023) to an 11-year prepandemic period (January 2009 to March 2020). We calculated odds ratios (ORs) and absolute percentages from, respectively, weighted logistic and linear regression models. Our unweighted analytic sample included 746 250 adults from the 2009-2023 surveys. The prevalence of BMI-defined obesity increased from 24.95% in 2009 to 32.69% in 2023 (absolute increase 7.74%). The COVID-19 pandemic period was associated with an adjusted annual increase in the relative odds of obesity that was 1.02 (95% confidence interval [CI] 1.01-1.04) times greater than the prepandemic period. The absolute rate of increase of BMI-defined obesity nearly doubled during the pandemic, with an annual average excess rate of 0.44 (95% CI 0.14-0.74) percentage points. Class II and III obesity increased at a greater absolute rate than class I, indicating a shift toward more severe obesity. The relative increase in class III obesity was greater among young adults and females. Since the COVID-19 pandemic, the prevalence of BMI-defined obesity, and especially class III obesity, increased at a faster rate than before the pandemic. Some groups that historically had lower levels of obesity were disproportionately affected during the pandemic. Publication 2025-07-13 Long-term trends in the labour supply and productivity of pharmacists in Canada Background: The pharmacist labour supply affects patient access to pharmacotherapy, immunization, and other primary health care services. There is little published evidence on the pharmacist labour supply in Canada, yet these data are needed for pharmacist workforce planning. We evaluated long-term trends in the number of pharmacists in Canada, their average hours worked, and how demographic and other factors affect hours worked. We also examined trends in community pharmacist productivity. Methods: Data on the number of licensed pharmacists were obtained from pharmacist regulatory agencies. Statistics Canada’s Labour Force Survey identified pharmacists’ hours worked per week to be between 1987 and 2023. Regression models were used to estimate the impact of pharmacist demographic characteristics, worksite type, region of residence, and secular trends on hours worked. IQVIA data on community pharmacist prescription dispensing were used to examine productivity. Results: The number of pharmacists relative to population doubled over the past 4 decades. This growth was partly offset by reductions in average hours worked per week. This appears to be driven by increases in the female share of the pharmacist workforce and the declining number of hours that male pharmacists work. On net, however, the total number of weekly hours worked—the average weekly hours worked per pharmacist times the number of pharmacists—has increased in both absolute and per capita terms. This expansion in the pharmacist labour supply was reinforced by an increase in pharmacist productivity, at least in the community pharmacy sector. Interpretation: The pharmacist labour supply in Canada has expanded markedly over the past 4 decades; this has occurred despite a decline in the average weekly hours worked by male pharmacists. It is unclear, however, whether this increase is commensurate with the increased responsibilities and workloads being placed on pharmacists. Province-level data on the forecasted demand for pharmacist services and the pharmacist personnel needed to provide these services are required for pharmacist workforce planning. Publication 2025-06-11 Minimal Impact of Prior Common Cold Coronavirus Exposure on Immune Responses to Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination or Infection Risk in Older Adults in Congregate Care Common cold coronaviruses were a frequent cause of respiratory infections in older adults living in congregate care homes before the coronavirus disease 2019 pandemic, which may influence immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and infection. We investigated humoral and cellular immune responses to prior common cold coronaviruses and SARS-CoV-2, how they are affected by SARS-CoV-2 vaccination and infection, and their associations with Omicron BA.1 SARS-CoV-2 infections in residents of long-term care and retirement homes. In SARS-CoV-2 infection-naive residents with 3 monovalent messenger RNA SARS-CoV-2 vaccinations, we measured serum anti-receptor binding domain (RBD) immunoglobulin (Ig) G and IgA antibody titers against SARS-CoV-2 and common cold human coronavirus (HCoV) NL63, HCoV-OC43, and HCoV-229E; ancestral and Omicron BA.1 neutralizing antibodies; and CD4+ and CD8+ T-cell activation responses to membrane, nucleocapsid, and spike proteins. We examined the relationships of common cold coronavirus and SARS-CoV-2 humoral immune responses, whether antibody and T-cell responses changed after SARS-CoV-2 messenger RNA vaccination or infection, and their associations with Omicron BA.1 infection. Anti-RBD IgG HCoV-OC43 titers were positively correlated with SARS-CoV-2 anti-RBD IgG and neutralizing antibody titers. Common cold coronavirus anti-RBD IgA titers, but not anti-RBD IgG titers, increased after SARS-CoV-2 vaccination or infection, and many residents had cross-reactive T cells. Common cold coronavirus humoral immunity was similar in residents without and those with subsequent Omicron BA.1 infection. Despite frequent exposure, and associations of common cold coronavirus and vaccine-induced SARS-CoV-2 humoral immunity, preexisting common cold coronavirus immunity was not associated with Omicron BA.1 infection in residents of long-term care and retirement communities. Publication 2025-04-28 Jessica A Breznik, Braeden Cowbrough, Lucas Bilaver, Miriam Dushoff, Hannah D Stacey, Jann C Ang, Rumi Clare, Allison E Kennedy, Andrew P Costa, Ishac Nazy, Mark Loeb, Chris P Verschoor, Jonathan L Bramson, Matthew S Miller, Dawn M E Bowdish, Kevin Brown, David Bulir, Judah A Denburg, George Heckman, John P Hirdes, Aaron Jones, Janet E McElhaney, Nathan M Stall, Marek Smieja, Ahmad Von Schlegell, Kevin J Stinson,
Sweetman, A. , Gerard D Wright
A living critical interpretive synthesis to yield a framework on the production and dissemination of living evidence syntheses for decision-making Abstract Background The COVID-19 pandemic has had an unprecedented impact in the global research production and has also increased research waste. Living evidence syntheses (LESs) seek to regularly update a body of evidence addressing a specific question. During the COVID-19 pandemic, the production and dissemination of LESs emerged as a cornerstone of the evidence infrastructure. This critical interpretive synthesis answers the questions: What constitutes an LES to support decision-making?; when should one be produced, updated, and discontinued?; and how should one be disseminated? Methods Searches included the Cochrane Library, EMBASE (Ovid), Health Systems Evidence, MEDLINE (Ovid), PubMed, and Web of Science up to 23 April 2024 and included articles that provide any insights on addressing the compass questions on LESs. Articles were selected and appraised, and their insights extracted. An interpretive and iterative coding process was used to identify relevant thematic categories and create a conceptual framework. Results Among the 16,630 non-duplicate records identified, 208 publications proved eligible. Most were non-empirical articles, followed by actual LESs. Approximately one in three articles were published in response to the COVID-19 pandemic. The conceptual framework addresses six thematic categories: (1) what is an LES; (2) what methodological approaches facilitate LESs production; (3) when to produce an LES; (4) when to update an LES; (5) how to make available the findings of an LES; and (6) when to discontinue LES updates. Conclusion LESs can play a critical role in reducing research waste and ensuring alignment with advisory and decision-making processes. This critical interpretive synthesis provides relevant insights on how to better organize the global evidence architecture to support their production. Trial registration PROSPERO registration: CRD42021241875. Publication 2024-09-27 Cristián Mansilla, Qi Wang, Thomas Piggott, Peter Bragge, Kerry Waddell, Gordon H Guyatt,
Sweetman, A. , John N Lavis
A taxonomy of demand-driven questions for use by evidence producers, intermediaries and decision-makers: results from a cross-sectional survey Abstract Background Globally, a growing number of calls to formalize and strengthen evidence-support systems have been released, all of which emphasize the importance of evidence-informed decision making. To achieve this, it is critical that evidence producers and decision-makers interact, and that decision-makers’ evidence needs can be efficiently translated into questions to which evidence producers can respond. This paper aims to create a taxonomy of demand-driven questions for use by evidence producers, intermediaries (i.e., people working in between researchers and decision-makers) and decision-makers. Methods We conducted a global cross-sectional survey of units providing some type of evidence support at the explicit request of decision-makers. Unit representatives were invited to answer an online questionnaire where they were asked to provide a list of the questions that they have addressed through their evidence-support mechanism. Descriptive analyses were used to analyze the survey responses, while the questions collected from each unit were iteratively analyzed to create a mutually exclusive and collectively exhaustive list of types of questions that can be answered with some form of evidence. Results Twenty-nine individuals completed the questionnaire, and more than 250 submitted questions were analysed to create a taxonomy of 41 different types of demand-driven questions. These 41 questions were organized by the goal to be achieved, and the goals were grouped in the four decision-making stages (i) clarifying a societal problem, its causes and potential impacts; (ii) finding and selecting options to address a problem; (iii) implementing or scaling-up an option; and (iv) monitoring implementation and evaluating impacts. Conclusion The mutually exclusive and collectively exhaustive list of demand-driven questions will help decision-makers (to ask and prioritize questions), evidence producers (to organize and present their work), and evidence-intermediaries (to connect evidence needs with evidence supply). Publication 2024-07-05 Cristián Mansilla,
Sweetman, A. , Gordon Guyatt, John N Lavis
Impacts of COVID-19 on Physician Labour Market Activities Le fait de comprendre les changements à la main-d’œuvre en médecine pendant la pandémie de COVID-19 éclaire la planification des effectifs médicaux. À l'aide de données représentatives canadiennes, les auteurs ont observé une réduction des heures de travail pendant la première vague. Toutefois, les heures n’étaient pas différentes des normes prépandémiques lors des vagues subséquentes. Les réductions étaient concentrées chez les médecins de famille communautaires et les spécialistes, tandis qu'en moyenne, les médecins hospitaliers ont maintenu leurs heures prépandémiques. Notamment, les hommes et les femmes ont présenté des diminutions indifférenciables sur le plan statistique, mais légèrement plus marquées chez les hommes. Sauf chez les parents monoparentaux ayant des enfants, dont les heures n'ont pas diminué, les réductions observées étaient très semblables, compte tenu de la situation conjugale et chez les femmes et les hommes ayant ou non des enfants, même si ceux-ci étaient très jeunes. La situation d'immigration n'avait pas d'incidence sur la diminution des heures. Les médecins de plus de 60 ans ont réduit leurs heures davantage que les plus jeunes. Sous réserve de certaines variations, des tendances semblables ont été observées à l’égard des absences. Aucune donnée probante n'a soutenu la susceptibilité des médecins à arrêter d'exercer pendant la pandémie. Publication 2024-05-22 The Trajectory of Agency-Employed Nurses in Ontario, Canada: A Longitudinal Analysis (2011–2021) In Canada, reports of nursing staff shortages, job vacancies and the use of private agency nurses, especially in hospitals, have increased since the start of the COVID-19 pandemic. Media reports suggest the pandemic exacerbated nursing shortages among other issues, and nurses are leaving their traditional positions to work at such agencies. Public spending on agency nurses has increased appreciably. Using 2011 to 2021 regulatory college data on all registered nurses (RNs) and registered practical nurses (RPNs) in the province of Ontario, Canada, we investigated trends in the count and share of nurses working for employment agencies. We also examined the rate at which previously non-agency employed nurses transition to employment in at least one agency job. We found the prevalence of RNs and RPNs reporting agency employment was relatively stable from 2011 to 2019, and decreased slightly in 2020 and 2021. However, there was a small increase in transitions from non-agency employment to working at an agency job. We also found the mean hours of practice in all jobs reported by agency and non-agency nurses increased during the pandemic. Based on these findings, an increase in hours and/or prices for agency nurses may explain the increase in public funding for agency nurses, but it was not driven by an increasing share of nurses working for employment agencies. To fully understand employment agency activity, policymakers may need to monitor hours of work and hourly costs rather than only costs. Further research is required to investigate any long-term effects the pandemic may have had on agency-employment. Publication 2024-04-01 Long-term trends in the work hours of physicians in Canada Background: Physician work hours directly influence patient access to health care services and play a vital role in physician human resource planning. We sought to evaluate long-term trends in hours worked by physicians in Canada, overall and by subgroup. Methods: We used Statistics Canada's Labour Force Survey to identify physicians via occupation and industry coding information. We estimated descriptive statistics and performed graphical analysis of the average weekly hours worked by physicians over the 1987–2021 period. Results: Overall, weekly physician work hours remained stable from 1987 until 1997, after which they declined. Average weekly hours decreased by 6.9 hours (p < 0.001), from 52.8 in 1987–1991 to 45.9 in 2017–2021. Among male physicians, work hours declined notably after 1997, while those of female physicians remained relatively stable at around 45 per week. Hours worked by married physicians declined significantly, amounting to 7.4 fewer hours per week (p = 0.001). In contrast, unmarried physicians displayed a statistically insignificant decline of 2.2 hours (p = 0.3). The COVID-19 pandemic was associated with a sharp but brief disruption in weekly hours; by the end of 2020, physicians' work hours had returned to prepandemic levels. Interpretation: These findings may indicate a long-term shift in work preferences among Canadian physicians; male physicians may be seeking a better work–life balance, which, in turn, has narrowed the gap in hours worked by sex, with potential implications for pay equity. Policymakers and planners should carefully consider changes in hours worked, rather than just the total number of physicians, to ensure an accurate evaluation of the physician workforce. Publication 2024-03-24 Matching the right study design to decision-maker questions: Results from a Delphi study Research evidence can play an important role in each stage of decision-making, evidence-support systems play a key role in aligning the demand for and supply of evidence. This paper provides guidance on what type of study designs most suitably address questions asked by decision-makers. This study used a two-round online Delphi approach, including methodological experts in different areas, disciplines, and geographic locations. Participants prioritized study designs for each of 40 different types of question, with a Kendall's W greater than 0.6 and reaching statistical significance (p<0.05) considered as a consensus. For each type of question, we sorted the final rankings based on their median ranks and interquartile ranges, and listed the four study designs with the highest median ranks. Participants provided 29 answers in the two rounds of the Delphi, and reached a consensus for 28 (out of the 40) questions (eight in the first round and 20 in the second). Participants achieved a consensus for 8 of 15 questions in stage I (clarifying a societal problem, its causes, and potential impacts), 12 of 13 in stage II (finding options to address a problem) and four of six in each of stages III (implementing or scaling-up an option) and IV (monitoring implementation and evaluating impact). This paper provides guidance on what study designs are more suitable to give insights on 28 different types of questions. Decision-makers, evidence intermediaries (, researchers and funders can use this guidance to make better decisions on what type of study design to commission, use or fund when answering specific needs. Publication 2024-02-29 Cristián Mansilla, Gordon Guyatt,
Sweetman, A. , John N Lavis
A Scientific Approach to Addressing Social Issues Using Administrative Data Nous utilisons des données administratives en chaine sur l’éducation, la santé, les services sociaux et la criminalité en Colombie-Britannique, au Canada, pour documenter la relation entre le niveau de scolarité mesuré au secondaire et les indicateurs de résultats défavorables plus tard dans la vie. Les résultats défavorables s’observent principalement chez les décrocheurs et décrocheuses du secondaire. Nous documentons ensuite la capacité des caractéristiques observées en 4e année du primaire à prédire l’obtention du diplôme d’études secondaires, au moyen d’un modèle simple produisant une limite inférieure. Le modèle identifie directement plus d’un cinquième des futurs décrocheurs et décrocheuses avec une précision raisonnable. Les mesures non cognitives (en particulier les caractéristiques sociales et émotionnelles) sont de meilleurs prédicteurs du niveau de scolarité que les mesures cognitives. Nous examinons les implications de ces résultats dans le contexte du développement scientifique des interventions qui visent à prévenir les résultats défavorables plus tard dans la vie. Publication 2023-10-20 David A Green, Gaëlle Simard‐Duplain,
Sweetman, A. , William Warburton
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