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Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal. [ABSTRACT FROM AUTHOR]

The scholarship on state-building has devoted a significant amount of attention to the role of taxation in building state institutions and capacities. It has also emphasised the crucial role of taxation in driving state-society relations. Scholars have argued that the linkage between taxation and state building also applies to the area of social policy. In this paper, we draw on a fiscal-centred perspective on welfare state development that highlights the fiscal policy role of social insurance as a revenue raising institution to study the fiscal relationship between social insurance and state-building in Israel and Canada – two 'most dissimilar cases' that nonetheless feature strikingly similar patterns with regard to this relationship. As our findings show, in both cases, social insurance programmes were introduced, designed, and utilized to advance fiscal and economic policy capacity and thereby promote state building. Using these programmes and the commitments they created, political actors could legitimize the generation of revenues, build institutional infrastructure for tax collection, and create capital reserves for investing in the economy. [ABSTRACT FROM AUTHOR]

• The Finnish Baby Box provides parents of newborns with a wide range of infant clothing and other basics. • The cardboard box in which the infant can sleep was emphasized by the media and commercial companies outside Finland. • The box preventing SIDS was advanced by private companies and the media. • This was less the case in Wales and Scotland, a result of their being governed by authorities with a "left" orientation. For over 80 years the Finnish state has provided expectant mothers with a cardboard box containing an extensive collection of clothing, bathing products for the baby, nappies, bedding and a small mattress. Numerous jurisdictions have implemented it in some form. We investigated through a critical case study methodology whether its translation into the liberal welfare states of Canada, UK, and USA experienced message distortion (the box as a means of preventing SIDS), commercialization, watering down of content; and separation from the complex of Finnish welfare state policies that support families with children. We find that only Scotland and Wales recognized the decommodification and equity roles played by the baby box. This study identified numerous barriers to building progressive public policy in Canada, UK, and USA: the structures and processes of the liberal welfare state, commercial interests that skew public policymaking and media logic that limits news reporting to the concrete and simple, eschewing complex analysis. [ABSTRACT FROM AUTHOR]

Through its audits and recommendations, Canada's Office of the Auditor General (OAG) has promoted financial probity and good governance for over a century. While OAG recommendations may have inherent value, their full value is realized only when implemented by government. By investigating implementation rates and the OAG's interaction with Parliament, this paper evaluates whether OAG performance and interactions with Parliament have changed over time. [ABSTRACT FROM AUTHOR]

Employing critical discourse analysis (CDA), this paper examines the attempt to bridge a Canadian adult second language policy with an employment skills policy. The result is a third policy intended to improve language education and employment skills training for immigrants. The analysis reveals that the knowledge economy and human capital theory are the predominant discourses embedded in the policy documents. The paper argues that predominant discourses perpetuate power imbalances and essentialize worker and migrant subjectivities. Engaging in postcolonial theories of second language learning, the paper proposes another way of conceiving adult second language learning and its potential for policy development. [ABSTRACT FROM AUTHOR]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision. [ABSTRACT FROM AUTHOR]

Despite attention to the impact of mental health issues on employment, little attention has been directed to Canadian policy regarding psychiatric disabilities, and how these policies influence workplace practices. This paper reviews federal Canadian disability policy related to work, using the lens of mental illness, to answer the following questions: • With regard to psychiatric disability, what are expected outcomes in the employment domain? • How is psychiatric disability defined and described? • How is the relationship between work and psychiatric disability developed? Notions about work and psychiatric disability found in federal policy documents, implications of these notions, and recommendations for future policy development are presented. [ABSTRACT FROM AUTHOR]

Health equity in pharmaceutical research is concerned with creating equal opportunities for men and women to partake in clinical trials. Equitable representation is imperative for determining the safety, effectiveness, and tolerance of drugs for all consumers. Historically, women have been excluded from participating in clinical research leading to a lack of knowledge regarding drug effects and their consequences. This paper examines the changes made since the implementation of Canadian policies on the representation of women in clinical trials, the analysis of sex and gender, as well as the discourses that are prominent among researchers. A feminist ethics framework is used to examine the structures that endeavor to elucidate women's involvement in trials, as experienced under extensive patriarchal history. Scholarly literature and Canadian government policy documents are used to explore the development of clinical trials as pertaining to sex and gender. Findings suggest that women continue to be underrepresented or excluded from important research, highlighting ongoing ethical and justice concerns. Improvement recommendations for policies are outlined. [ABSTRACT FROM AUTHOR]