The Agenda with Steve Paikin (Audio) - How Has Medicine Advanced Since 2006?

Episode Date: June 26, 2025

Since its launch 19 years ago, The Agenda With Steve Paikin has highlighted scientific discoveries and new insights into health. So what's changed over the course of over two decades-and what kinds of challenges and breakthroughs do experts anticipate seeing in the decades to come? To discuss, we're joined by Keith Stewart, University Health Network vice-president, cancer, and director of the Princess Margaret Cancer Centre; Raywat Deonandan, epidemiologist and associate professor with the Faculty of Health Sciences at the University of Ottawa; Saskia Sivananthan, neuroscientist and affiliate professor in the Department of Family Medicine at McGill University; and Ghazal Fazli, epidemiologist and assistant professor with the Department of Geography, Geomatics and Environment at the University of Toronto Mississauga.See omnystudio.com/listener for privacy information.

In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner and I'm back with season three of On Drugs. And this time it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. Since its launch 19 years ago, the agenda has highlighted scientific discoveries and new insights into health. What's changed over the course of two decades and what kinds of challenges and breakthroughs do experts anticipate seeing in the decades to come? Let's find out. As we ask in London, England, Keith Stewart, University Health Network Vice President for Cancer, Director, Princess Margaret Cancer Center. And with us here in studio, Rewat D'Anandan,

Epidemiologist and Associate Professor in the Faculty of Health Sciences at the University of Ottawa. Saskia Sivanathan, Neuroscientist and Affiliate Professor in the Department of Family Medicine at McGill University. And Ghazal Fazli, Epidemiologist and Assistant Professor with the Department of Geography, Geomatics and Environment at UTM, the University of Toronto Mississauga. Great to have you three here in our studio.

You for the first time. Yes, that's correct. You certainly waited a long time before showing up here. What's the story? Only 19 years. Only 19 years. There we go. And Keith Stewart over in London, England,

we thank you for joining us as well on our program tonight. I want to start with this. Keith, maybe you could get us started. Have any of the fundamental assumptions of your field changed in the past 19 years? You know, Steve, there's so many changes. I mean, reflecting on the question, it's just been an amazing two decades.

It started really with the human genome project being completed in 2003, which I think has really revolutionized care across many fields, including rare diseases and cancer. So, and since then, the ball has just kept rolling and escalating and just been so many good changes. So, whatever it was that you thought you were doing two decades ago literally has been turned on its head? Well, cancer, I think, is true in the field of both precision oncology, which is, you know, using genetics to drive our therapeutic choices, our decision-making, our ability to detect cancers early.

But more importantly, I think in the field of immunology and immunotherapy, it has completely revolutionized how we treat cancers today compared to two decades ago, for sure. Gotcha. Okay, we'll dive in as we continue along. Tosca, how about for you? I'd say there are three areas that have shifted over the past 20 years really because of investments that we're now starting to see the the fruits of those labors. Diagnostics and treatment options for dementia. The second is in our understanding of the underlying causes of dementias which for a long time had stayed within one general hypothesis and has now shifted and just thinking about brain health

more broadly. The third is how we think about dementia. Usually when people get the diagnosis, it's often seen as almost like a living death sentence. It's go home and get your affairs in order. And there's a lot more in terms of how we now think about dementia from a rehabilitative approach. But there's a fourth that has not shifted despite those investments and

that's in terms of our system ability to build out clinical pathways for dementia. We don't have that coordination yet. We have made strides in other major diseases and I think we're due for dementia. Ray Watt. Well I'm a global health epidemiologist, first of all. So a lot has changed in that field. First, if you look at the Millennium Development Goals, since 2019, 2015, we've improved the number of people

living under the poverty line by 50%. Kids, now 90% of kids are in school, which is a huge improvement. Internal mortality rates have improved. Things that have not improved, though, which is a huge improvement. Internal mortality rates have improved. Things that have not improved, though, inequality is at an all-time high. Climate change still remains a huge ordeal. And the way we think about health at a population level has also changed.

It used to be about keeping people from dying. Now we measure things like suffering, discomfort, disability, and we also include things like democracy and equity and employment as measurements of health. You would not necessarily think of those first and foremost as things that people measure in the health care system, but you do now. We do now and we need to do so more. Fascinating. Okay, Ghazal. Yeah, I mean there's a lot of changes that have happened in understanding type 2 diabetes burden. The first I would say is the lot of changes that have happened in understanding type 2 diabetes burden.

The first I would say is the availability of data. We now have population-based data that helps us understand trends, patterns. We're also diving more deeply into the risk factors of type 2 diabetes. We have a better understanding around social determinants of health, the environmental determinants of health, the environmental determinants of health. We are getting a better lens about what is making individuals more sick and what's entering them in the healthcare system. So that's really worked very well for us. It's going back to the point about underlying causes of type 2 diabetes. However, I would say one thing that has not changed and it's alarming for our health care system is the rise in type 2 diabetes.

This is a global pattern. It's a pattern we're seeing more locally. But more recently we're seeing that younger adults are developing type 2 diabetes. That's distressing. That's distressing and it's a warning system because as younger adults are developing type 2 diabetes it means that they're going to remain longer in the chronic disease stage. They're going to need more care, more management. It's going to cost more for the health care system, but it also has implications for the economy as well in the future.

Keith, maybe you could tell us what you believe to be the greatest either discovery or breakthrough in your experience over the last 19 years? Well, I think one of the biggest discovery in the cancer world, I think, has been the recognition that we can use the human immune system to control cancers and deliver therapies much less toxicity and high efficacy. It's across a range of cancers where actually treatments have dramatically improved, survivals have prolonged. And of course, there are more cancer patients in the population as we age and live healthier, there are more people surviving the cancer. So the volume of cancer is actually high, but the survival rates are much better. And it's, I think the biggest advantage other than the human genome has really been understanding how we harness the human, our own immune systems to control cancer and actually

eradicate it in many cases. I mean quite spectacular results recently with a single infusion of genetically engineered T lymphocytes which are the cells in your blood that are the killer cells that control viral infection and malignant cells and just really a cure to therapies which are emerging through those discoveries rooted in basic research and basic understanding of the immune system. Ray Watt, in your field, greatest breakthrough of the last 19 years. It's a tough one. First of all, I want to echo that sentiment around the precipice

of a new era of immunotherapy in my opinion, so I'm quite excited by this. The last 19 years, it's hard to say exactly. If I could extend that a little bit, I'm really excited by the development of an indicator called the DALY, D-A-L-Y, which you talk about casually in medical sciences now. It stands for the Disability Adjusted Life Year. Prior to its development, we measured only

things that killed you. The Disability Adjusted Life Year allows you to measure things that kill you and impair you. So that allowed diseases like depression, mental illnesses of a variety of types to enter the conversation as things we must tackle globally. Before that, we only focused on things that killed. And now we have a much broader perspective

of what population health is. In your field, greatest breakthrough of the last couple of decades? It's building on the shoulders of, I think, a lot of what was just echoed by Keith and Rewath. But if there were one piece, I think it's our understanding of the underlying risk factors that contribute to brain health and therefore

to neurodegenerative diseases. And how interlinked they are to heart health, how interlinked they are to social determin, how interlinked they are to social determinants of health. So things like with brain health, we've always known exercise, certain types of exercise and cognitive engagement is good for your heart, good for your brain, et cetera. But now we know things like social isolation, the pandemic was an experiment in a sense of exactly how that impacts the brain and can impact

that decline and the neurodegeneration of it. Also understanding how sleep and stress are linked to neurodegeneration. So I think understanding brain health and the preventative mechanisms that we can start taking to be able to slow the growth. We know that we're expecting about a million Canadians in the next five years who'll be living with dementia and at least one person as a caregiver for every person who's living with dementia. So the impact is huge but taking that preventative approach can delay the onset of a person developing it and therefore their quality of life can continue for a longer period of time.

The greatest breakthrough in your time? Well, as an epidemiologist, I would say that our focus is on population health and we want to see the greatest benefits on whole populations rather than individuals. And so I would say that going back to the point around data, we have developed population based risk prediction tools. Researchers at University of Toronto have mapped out to what extent with certain risk factors such as unhealthy eating, physical inactivity, higher levels of BMI, food insecurity, all of these factors to what extent they can predict future cases of diabetes. What it does at the local level,

municipal level, as well as the local level, municipal level, as well as more regional level, it prompts municipalities, as well as public health units, provinces, to steer their directions towards those modifiable risk factors. To what extent, if we target food insecurity, if we build more walkable neighborhoods, if we open more opportunities for physical activity,

to what extent, what benefits can we see in the longer term in reducing the risk and burden of type 2 diabetes? And it has more implications for our quality of life, longevity, and the focus really is not just focusing on specific age group populations, but the impact would be on populations across all ages, because we're seeing type 2 diabetes occur at earlier ages. So I would say that these risk prediction tools really have been, from a population

health perspective, have really provided us an opportunity to steer our efforts as well as funds to target these specific risk factors. Gotcha. I mean, this being journalism, we of course have to look at the negative side of the equation as well. So we'll flip the coin over and ask Ray Watt, what thing that you thought we'd have in place by now? What discovery or what advancement that you thought we'd have by now didn't pan out?

I'm going to give you a fairly abstruse answer to that. That is, I thought the trajectory of public buy-in into science would be linear, if not explosive. But we have a retreat from public buy-in. COVID changed everything. COVID changed the way that the population views science and scientists. It slowed the public buy-in into public investment into science. And we're still struggling to understand what that means going forward.

So COVID changed the role of information and how we think about, communicate with each other and media and the public. And it's changed how we incorporate new technologies like AI, frankly. I'm sure we're going to talk about AI in a bit because that's a big change. But that's my answer. I think COVID was a big transformational moment that really reversed a lot of gains in relationships with the world. Keith, how about in the field of cancer? What was promising and didn't pan out?

Well, I think we're always, as physicians, we're always excited by new technologies and seeing them adopted quite rapidly. And I think what we haven't really seen is any acceleration of the ability to adopt those, those new technologies into our practice. And they become increasingly expensive and harder for a public health system to bear the cost of so we haven't really cracked that nut yet, I would I would say is one of the biggest challenges we've come across. And, you know,, somebody told me once,

stop being so impatient that healthcare changes slowly. And I think that hasn't really changed. I think it's a conservative industry and people take their time, which I think would be nice with things like AI tools and new technologies to see that moving a bit, getting into the hands of the public and public awareness of all the advances happening more quickly.

Saskia, biggest disappointment in your field? Drug treatments. Drug treatments? Drug treatments. And I know that sounds, given where we are now with some of the first classes of drugs coming out for Alzheimer's specifically, it was 20 years of disappointments, 20 years of not enough investment in the field and so if you looked at the treatments that were available they're really only managing symptom management and not very

effectively and I think that we had not invested enough early enough to have seen what those drug developments could be. We now have the first class of type of drugs that are trying to get at the underlying cause. They slow cognitive decline by about six months, so we're still not talking the kind of change that would be able to really change the field. And then the second has been, there's been good investment in diagnostics, the use of technology, etc. but we cannot scale that in our current system because we have not built the kinds of infrastructure that would support a pathway for dementia. Let me do a quick follow-up.

Did you expect by the year 2025 we would actually have a drug that would reverse the effects of dementia? Not reverse it, but that we would have a couple of options, a cocktail of drugs as you would for any other major disease, that would at least be viable options for a larger proportion of the population. And with the current class it's for a very small segment of people who are living with early stage Alzheimer's that this can have the impact. Got it. Ghazal, how about for you? What didn't pan out?

I think I would say for me it's the pace of translating evidence to policy and practice. It takes a long time to conceptualize an idea, receive funding, test it, and then we get stuck in that testing and piloting phase. And so we know what interventions have worked in other settings and other populations, but to implement it in our settings, it takes a long time. So I really hope that changes, because we know what we need to do. It's simple to say we just need to do it,

but we need to move a little faster from evidence to practice. All right, let's look at something a little more hopeful now, in which case I want to find out what's on all of your wish lists. I want to find out what you dream about. And Keith, I want to go to you first. What is the number one thing, the number one advancement you hope to see over the next 20 years in the field of cancer?

You know what, even though we're making a lot of progress, Steve, I think there are some cancers that remain very difficult to treat pancreatic cancer, glioblastoma, which is a brain tumor. So the advantages we've seen, I mentioned earlier, in immunotherapy, particularly cellular immunotherapy, have really come in the blood cancers. They haven't really penetrated what we call the solid tumors, are you know, the liver though the lung Kidney whatever and I think I'd really love to see us crack that Code and better understand how we can get those therapies working across a broader spectrum cancers

particularly those that are very difficult to treat and I suppose I could add a quick follow-on to that which is And it's sort of reminded me when we were talking about dementia too, the trick is finding it early. I'm sure dementia is much more controllable if you find it early. Diabetes is the same, and I think cancer's the same story. If we find it early, we can cure it often.

So the technologies to find it as early as possible so we can intervene would be another wish. Giselle, what's on your wish list? My wish list is more integrated approaches between the health care and the community. So identifying interventions that will lower the cases of type 2 diabetes, whether that involves testing and detecting in the community, whether that involves identifying which populations to target for screening. We need to identify who's at risk first.

And then taking those approaches and linking it with population-wide community-based approaches where we could identify ways we can improve access to healthy food options, improve physical activity levels, improve access to programs, health promotion programs. So having more integrated approaches where we're moving away from silos and we're working together as one system. That would be my dream. That has not happened in my lifetime. Why would you expect that to happen over the next 20 years? One can be hopeful. Okay, I did say dreamless. That's true. Okay. Ray, what's on your dream list?

I got a few things. One, I want a universal high-efficacy flu vaccine. Two, I want what's called a mucosal pansorbicovirus vaccine. What is that, you say? That's a anticipated question. It's an inhalable COVID vaccine that will work on all variants and stop transmission. Three, I would like to see an immunotherapeutic dementia

vaccine. And people are working on these things. And in a broader sense, I want to see an all hands on deck, society level attempt to control medical mis and disinformation. I think we have the tools and the motivation we haven't got as the organization yet. Saskia, how about you? What's on the dream list?

Thank you for asking it because we just actually are releasing a report that asked that question. How could we improve care for dementia and what can that look like over the next 10 to 20 years? And what we actually looked at were strides that were made in cancer, in diabetes, and in stroke. And what that meant was having accountability, data, being very clear about what is it that we want, what do we want to achieve, and setting those targets to be able to support it. And we don't do that for dementia. We don't even really know the diagnostic rate, how many people are living with dementia versus actually being

diagnosed with dementia. So my dream would be over the next five years that we have coordinated dementia care in every province and that it is coordinated with support at the federal and the provincial leadership engagement and it's possible because we've done it for other major diseases. Yes, there's always room for improvement, but we can at least move that needle in terms of the kinds of access that people have to when these diagnostics and therapeutics come out can then be scaled, they can access and leverage those and you can support the kind of rehabilitative approach where people don't see dementia as a

death sentence because you live on average for eight years with this and coming back to the DALYs that Roy Webb mentioned wanting better quality of life living with a disability. Now he called it DALYs you call it DALYs which is it? Yes. You say potato? A potato, tomato, tomato, you called it dailies, which is a, you say potato, I say potato. A potato, potato, tomato, tomato. Sheldon, can I get, yeah, this is a good shot here, and can I see Keith up on the screen at the same time? Can we do a kind of a split screen

so I can see all the guests at once? Because I'm trying to find out, you've all put your, thank you, you've all put your wish lists forward over the next 20 years, what you and your wildest dreams would love to see happen. Can I see a show of hands as to how many of you think those things you just advanced will happen? Oh my gosh every hand went up. You think all of these things will happen. Not just are doable but will happen. Absolutely. Keith why are you so confident?

Well, I just think science is moving very quickly these days and team science across the world, people working together. And somebody alluded to artificial intelligence earlier. The other thing that's really changing our ability to answer questions quickly is we have access to massive amounts of data now. And we have machine learning tools that can help people talk to early about risk profiling and looking at,

you know, undetectable causes and doing rapid calculations. So I think we've, it's just the pace of change is just accelerating all the time. Raywa? Well, the vaccines I mentioned are already being worked on. So there's an expectation that they'll get done in the next few years. And my wish for a societal level attempt to control this information, we have to do that. There's no choice.

So if society wishes to sustain itself, well, that has to happen. So I expect it to happen. Otherwise we're looking at an apocalyptic reality, and I'm not willing to accept that yet. OK, fair enough. You did mention artificial intelligence a while ago, so let's move our discussion there for a second. Saskia, when you think about the potential applications for AI

in your world of dementia treatment, what comes up? It is going to touch every aspect of dementia treatment from the diagnostics. So the current ways in which we diagnose dementia is still fairly subjective, shall we say. So you would go in to see your family doctor, they would do some exclusionary blood tests, but really what they use is a cognitive test. It's a series of questions to test your verbal fluency, recall, that sorts of things. With the advent of technology and AI, the kinds of data sets that we would have access to would allow us to be far more predictive, but also much more concise and

objective in our diagnosis. The same thing would apply for treatment options. When we're looking at the ranges, there are over 100 different types of diseases that are under that umbrella of dementia. So again, the sort of precision medicine, the sorts of specificities that we could apply to treatments. And then if you're looking, again, at living well with dementia, technology and AI have already rapidly advanced, robotics have advanced to be able to support rehabilitation, caregiving, instead of only requiring a human workforce

being able to supplement and support that in a much more engaging way. So it absolutely has impact. Ghazal, AI in your world. Oh, I mean, there's the one thing to really notice around here is that the shared risk factors for many of these chronic diseases, whether it's cancer, dementia, and tepid diabetes, what AI will help us do is to identify to what extent are these shared risk factors predictive of these outcomes. They are all very related, right? They're all very, if a patient has type 2 diabetes, we should also be looking at whether

they are at risk of developing dementia, right, or vice versa. So AI, what it's helping us to do is what we were doing previously, but much faster and more efficiently. And it's helping us to determine where should we focus our efforts, which population, what age group, and it's more or less focusing on the risk factors. But in our field, we're also looking at neighborhoods. Many of the interventions that we're targeting right now, we're trying to identify high priority populations. So if they have those shared risk factors, and if it's communicated in the healthcare system, if it's communicated to their care providers and along their care pathway, there's a lot of changes that can be implemented much earlier. And I'm always thinking about how much would it save and

impact people's lives, impact their lives, but also have an impact in saving costs to the healthcare system. Which the healthcare system loves to hear about. Keith, how about for you? The impact AI could have on cancer treatment? Well, this is already impacting us. We've trained machines to do radiation planning. We're using for scheduling, ambient listening to take our notes when we're seeing patients. But I think that probably the biggest impact will be in selecting the right therapy for the right patient at the right time.

I think that's probably where we'll see it have its most broadest impact, I would imagine. Ray Watt. I'll give you two examples. My first job post-PhD was working for the NIH answering random questions from the... National Institutes of Health. Yes, in the USA. So I get a call from a senator asking to know how many diabetic women who are Mexican origin

have migraines on Tuesdays. And I got to figure out how to answer that question using existing data sources. I can ask an AI that now and get an answer in seconds. It doesn't require a team of researchers anymore. So the ability to interrogate data and get a reasonably accurate answer is astoundingly powerful and good. The second example I'll give you is in document analysis. Currently I use AI, I feed it to a number of policy documents, I ask it to summarize it for me, find the gaps, find the overlaps, and suggest to me improvements where I can suggest how

policy can be modified. Imagine that writ large. So changing how we do things infrastructurely and policy-wise, we haven't even touched the tip of iceberg yet on how that's gonna change everything. Fascinating. Okay, 14 years ago on this program, because we have covered healthcare

a couple of times in the past here, we did talk about personalized medicine, which we have not talked about yet tonight, but which we shall now. Leroy Hood was our guest and here is what Leroy Hood had to say in talking about this fascinating, very future-looking subject. Roll it please, Sheldon. Number one, it's going to be all about quantifying wellness. That is, as we move forward more and more we're going to focus on wellness rather than disease. And number two, it's going to be using enormous amounts

of information. I would argue in the future every patient will have a virtual cloud of billions of data points to be able to demystify whatever diseases they might have and fashion appropriate treatments for each. How much, Keith to you first, how much of this approach to personalized medicine is already happening? I think Dr. Hood summarized it well, and I think we've covered the fact we have big data, we have access to it, we can personalize therapy based on it. So I think he was prescient. He was always known as, and is known as a forward thinker. So I think he got the nail in the head there, I believe. Saskia, in your view,

how much of the vision has been realized already? Some of it has certainly come to fruition when we're talking about wellness, particularly as he mentioned. When we're talking about dementia now, not thinking of it as a condition or a disease now not thinking of it as a condition or a disease but thinking of it from a brain health perspective and a heart health perspective you know to to your point about all of the risk factors

that are interlinked and people are taking a preventative approach to dementia in their 30s and in their 20s so that by the time they've gotten to the age where risk increases significantly they've done as much as they can to be able to manage that. And I think that's a holistic wellness approach. Are we, Raywat, I guess I should put it this way, how close are we right now to regularly tailoring individual personalized treatments to whatever ails your patients? In my opinion, not close at all.

So I've heard these claims before going back 30 years or so. First it was the proteomics revolution, then it was the human genome project. It was supposed to kickstart the whole revolution of personalized care. It didn't happen for a number of reasons. I think the reason it won't happen at scale, again, is one, we're more focused now on population appeasement or amelioration because of economic reasons. It may not be economically feasible

to be investing that much in personalized care, except when it is. When it is economically, improvement, I'm trying to say, when it is an economic advantage to do so, then we will do so. We don't want to waste money, for example, on giving therapies that have no impact on individuals. And so if we can tailor make it to that extent, it's useful.

But I'm skeptical that this will be something that is a transformation in the next 10 years or 20 years. Gazala should ask you, are you a skeptic like him or are you a booster like Dr. Hood? I'm hopeful. I'm in the middle. Only because type 2 diabetes impacts individuals' quality of life. So I do believe in the wellness piece. If we can personalize care for individuals

once they're diagnosed, what their prognosis looks like? What is their risk of developing cardiovascular diseases, kidney failure, down the road blindness, and lower extremity amputations? If individuals know what is their risk trajectory and if they understand what needs to happen at different stages, it really equips them with information and knowledge. And knowledge is power, especially when we're dealing with a chronic disease that is occurring at younger ages. That means individuals will be living longer with

that disease. So I'm hopeful that it will prompt us to focus our efforts in the right direction by giving individuals the right care at the right time but also mapping out what their care journey could really look like. Next topic for you four, research and innovation. It has always been the conventional wisdom in this country that we are just, I was going to say miles, but let's say kilometers and kilometers behind the United States because they just have such a massive post-secondary, mostly based ability to do research and innovation development and so on. So I want to find out what you think the situation is like right now and going ahead, going forward

for research and innovation in Canada. Keith get us started. Look, we punch above our weight as a smaller country. I think we do extremely well for the size of the country and the research output. I mean, just yesterday there was a paper in the New England Journal, potential cure for diabetes, and the lead author was from Toronto General Hospital.

Having said that, funding for research in Canada is dramatically less than it has been in the United States before the recent administration decided to start making cuts. And so I think it's underfunded, but we do very well for the size of our population and the amount of funding we have, I think is probably the summary to date. Okay. Raywad? Funding for medical research in Canada is in the hundreds of millions, probably more so. We get about 14 million of that from the USA and with that funding disappearing the last six months ago, that is troubling. What I'm interested in is now that the Americans cannot be trusted, I'll use that word, to provide leadership in a variety of domains,

I think there's an opportunity here for us to sort of steal some of that capacity. In particular, vaccine policy. We've been relying upon them to a large extent to guide us in our decision-making processes around who gets what vaccine and what the efficacies are and so forth. But we have the expertise here currently to provide global leadership on that front. And I think we have to smash this opportunity

to show the world that we are actually capable of providing that leadership. And I'm hopeful I think that's going to happen. Saskia? I think as a researcher, research crosses boundaries. So I'd look at it for dementia specifically from a financial investment. If we talked five years ago, I probably

would have said we are below our weight. But there have been some major investments from the Canadian government in dementia research in particular, and that has helped kind of bring us to what would be expected for our population size. However, we as researchers do collaborate extremely well across the global spectrum. We work with, you know, every other G7 and other countries. And I think that has helped us to be able to move forward in terms of some of the major investments that we needed to make.

Could we make more? Always. Always. Gazelle. I would say that the change is happening for research at the national level, but as well as at the local level. We now have a national diabetes framework. Really what it does is it provides a clear overview of what we need to do to address

type 2 diabetes, the rising burden of type 2 diabetes. It focuses on prevention efforts and it focuses on management as well. But more at the local level, I work with the Network for Healthy Populations based at the University of Toronto. Their efforts are focused on improving access to care, improving the, addressing the community level determinants of health, but also upstream determinants, so environments, making environments more walkable, more accessible.

And the reason why they're focusing on that is because we've noticed that we need to learn what interventions work locally so that we can scale globally. We are literally down to a minute and a half to go here. So I want to give each of you 20 seconds to answer a very simple question. Are we healthier today than we were 20 years ago?

Keith. Yes. Well, I think that we're living longer. I think the, but there are a lot of, of course, obesity and bad habits we have. So I think some mixed opinion on that one. Saskia? Mixed opinion.

Yes, we are living longer. Are we living better? Is our quality of life better? Not necessarily. And from a dementia lens, no. We need to make much bigger and broader strides in terms of care and brain health investments to be able to really live better. Ghazal.

I would say yes, but it goes back to your point about quality of life. We should not measure in terms of how long we're living, it's about how well are we living. Are we living better? I would say so, yes. We're more aware about these risk factors that we've talked about, but there's still much work to do. Ray what? Put a bow on it for us. Obama once asked, if you couldn't choose your gender or your race, where and when would you want to live?

And the answer was right here, right now. Because in the history of humankind, there has never been a higher quality of life, all things considered. And I tend to agree with that. At a micro lens, we have some issues, absolutely. But the arc of history tends to bend towards improvement in health and well-being.

So that's where I'm going to leave it. That is a very hopeful, upbeat note on which to leave things. We did talk about some somewhat depressing things on this program, but overall, I love hearing where you think we're going, because that sounds very exciting. I want to thank our guests. Can I get a full shot?

Thank you very much, Mr. Director. Keith Stewart from UHN. We have Rawat Dianandan from the University of Ottawa, Saskia Sivanathan from McGill University, Ghazal Fazli from UTM. Thanks so much, everybody, for being on TVO tonight. Thank you. Thank you for having us, Steve.

Thank you.