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Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care. [ABSTRACT FROM AUTHOR]

Objectives. To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population. Study Design. Review. Methods. We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995-2005 using search terms to reflect different names used to refer to Canada's Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods. Results. Based on the 96 papers reviewed, the results show an under-representation of Métis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods. Conclusions. Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples. [ABSTRACT FROM AUTHOR]

Inuit Canadians are on average about 20 years younger and have a 10-year lower life expectancy than other Canadians. While there have been improvements in Inuit health status over time, significant health disparities still remain. This paper will review the peer-reviewed literature related to Inuit child, youth, and maternal health between 2000 and 2010, investigate which thematic areas were examined, and determine what proportion of the research is related to each group. Establishing areas of research concentrations and scarcities may help direct future research where it is needed. We followed a systematic literature review and employed peer-reviewed research literature on child, youth, and maternal health which were selected from 3 sources, MEDLINE, CINAHL, and the Circumpolar Health Bibliographic Database. The resulting references were read, and summarized according to population group and thematic area. The thematic areas that emerged by frequency were: infectious disease; environment/environmental exposures; nutrition; birth outcomes; tobacco; chronic disease; health care; policy, human resources; interventions/ programming; social determinants of health; mental health and wellbeing; genetics; injury; and dental health. The 72 papers that met the inclusion criteria were not mutually exclusive with respect to group studied. Fiftynine papers (82%) concerned child health, 24 papers (33%) youth health, and 58 papers (81%) maternal health. The review documented high incidences of illness and significant public health problems; however, in the context of these issues, opportunities to develop research that could directly enhance health outcomes are explored. [ABSTRACT FROM AUTHOR]

Applying tenets of legal origin theory, this paper traces the origins of banking financial accountability resting behind paragraphs 78 to 82 of the First Schedule of the Companies Act 1862 (UK), where the timely disclosure of a balance sheet and statement of income and expenditure to stakeholders are scrutinised. Comparative legal analysis of 503 banking enactments of the US, Canada and England during the eighteenth and nineteenth centuries reveals that expectations of formal accounts raised by the Companies Act 1862 (UK) were informed by the Colombia Banking Act 1817 (CO) in the US, the Canadian Mauritius Regulations 1830 and the Joint Stock Banks Act 1844 (UK). [ABSTRACT FROM AUTHOR]

Place-based social-ecological research is often designed to improve local environmental governance, but it can also inform decisions at larger scales or in other places. However, the focus on local perspectives in such research creates challenges for transferring insights to other locations, and for aggregating understanding to larger scales. In this paper, we discuss how ResNet, a new pan-Canadian network of researchers working on place-based social-ecological case studies via ecosystem services, will face (and hopefully overcome) these challenges while taking advantage of the unique benefits of a place-based approach. Drawing on insights from the literature and from the first 10 years of the Programme for Ecosystem Change and Society (PECS), we outline solutions to six key challenges to multi-scale knowledge integration across place-based cases, and explore how ResNet is employing some of these solutions. [ABSTRACT FROM AUTHOR]

This paper considers the Canadian Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2) a visionary document when viewed in comparison with the ways ethics review is enacted in New Zealand. New Zealand has unequivocal guidelines for indigenous research. The indigenous guidelines in Chapter 9 of the Canadian document are particularly innovative, in that they prescribe indigenous consultation for some, but not all researchers. In New Zealand, according to the Health Research Council Te Ara Tika guidelines, all research in New Zealand warrants indigenous consultation. This paper suggests that progress around improving the practice of consultation and engagement with Māori could be made if the consultation requirements for mainstream research were to be paper based, and reviewed by an ethics committee without actual expectation of mandatory consultation conditions. On the other hand, Māori centred research should require actual and detailed evidence of consultation that would be tied to an explicit articulation of the mutual understanding of the benefits accruing from this relationship. [ABSTRACT FROM PUBLISHER]

Global research on new immigrant destinations prioritizes the study of places experiencing rapid demographic change. Immigration is increasingly promoted, however, as a policy tool to encourage stability in peripheral regions, cities, and communities. This paper introduces the concept of the aspiring gateway to describe locations that attract few immigrants but proactively aspire to become welcoming communities. We make this case through an examination of the geographies of immigrant receptivity in Atlantic Canada. Our findings are based on 22 interviews with participants in the immigration sector in Newfoundland and Labrador, New Brunswick, Nova Scotia, and Prince Edward Island (PEI). Highlighting the powerful role of nonstate actors and public discourses, our analysis considers the ambiguities and mixed messages of the place-based immigration policies of this region. We argue that a more pluralistic understanding of immigrant gateways must include peripheral spaces that are relatively isolated from international migration flows. Aspiring gateways require a rethinking of assumptions formed in and about new immigrant destinations. [ABSTRACT FROM AUTHOR]

This paper describes the extent and variation in health disparities between Indigenous and non-Indigenous people within Alaska, Greenland and the northern regions of Canada, Russia and the Nordic countries. We accessed official health statistics and reviewed research studies. We selected a few indicators of health status, health determinants and health care to demonstrate the health disparities that exist. For a large number of health indicators Indigenous people fare worse than non-Indigenous people in the same region or nationally, with the exception of the Sami in the Nordic countries whose health profiles are similar to their non-Sami neighbours. That we were unable to produce a uniform set of indicators applicable to all regions is indicative of the large knowledge gaps that exist. The need for ongoing health monitoring for Indigenous people is most acute for the Sami and Russia, less so for Canada, and least for Alaska, where health data specific to Alaska Natives are generally available. It is difficult to produce an overarching explanatory model for health disparities that is applicable to all regions. We need to seek explanation in the broader political, cultural and societal contexts within which Indigenous people live in their respective regions. [ABSTRACT FROM AUTHOR]

The illicit tobacco trade accounts for 10% of the global cigarette market and results in US$31 billion in lost tax revenues annually. Despite legal prosecution of tobacco companies, and the introduction of new policy responses, the trade has reached an all-time high. Previous research documents how transnational tobacco companies have sought to influence government responses to the illicit trade in various countries through multiple means, including influencing of news media framing. This paper extends this analysis to Canada where the illicit trade is particularly problematic in scale and political complexity. Articles in Canadian newspapers, published from 2010–2015, were systematically searched (n = 177) and analysed to identify dominant frames, frame sponsors and policy positions related to the illicit tobacco trade. The results show that the most common frames present the issue in ways favourable to the industry. The most common non-governmental sponsors of these frames frequently have links to the tobacco industry, which are rarely disclosed. Findings indicate the need for Canadian media to be critical in its use of data sources amid industry efforts to shape public policy, and the importance of reframing policy discussions in public health terms based on independent evidence. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. Results: We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. Discussion: These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care. [ABSTRACT FROM AUTHOR]

In cold region environments, any alteration in the hydro-climatic regime can have profound impacts on river ice processes. This paper studies the implications of hydro-climatic trends on river ice processes, particularly on the freeze-up and ice-cover breakup along the Athabasca River in Fort McMurray in western Canada, which is an area very prone to ice-jam flooding. Using a stochastic approach in a one-dimensional hydrodynamic river ice model, a relationship between overbank flow and breakup discharge is established. Furthermore, the likelihood of ice-jam flooding in the future (2041–2070 period) is assessed by forcing a hydrological model with meteorological inputs from the Canadian regional climate model driven by two atmospheric–ocean general circulation climate models. Our results show that the probability of ice-jam flooding for the town of Fort McMurray in the future will be lower, but extreme ice-jam flood events are still probable. [ABSTRACT FROM AUTHOR]

The higher religiosity of women in the Western Christian societies is one of the best documented findings in the religious scholarship. In spite of the recent vibrancy of secular movements in North America, the higher religiosity of women appears persistent. As a result, the gender ratio is greatly skewed in the secular groups in favour of males. For instance, for every atheist female in North America, there are at least three males. Using the Canadian General Social Surveys of 1985–2014, this paper examines how the gender religiosity gap has evolved among the Canadian-born. Throughout the period, Canadian-born women are found less likely to be unaffiliated and show a greater frequency of religious attendance. The religious attendance gap is found to be closing. The unaffiliation gap, on the other hand, seems to have widened in the 21st century. Limiting the analyses to the gainfully employed respondents only reduces the religious attendance gap. For the high earners, the attendance gap effectively disappears, while a large unaffiliation gap persists into the 2010s. This pattern is best explained by the recent literature asserting that men and women are differentially socially sanctioned for the adoption of a secularized identity. The alleged sexism of the new secular movements is also noted as a potential explanation. The examination of the recent Canadian data on perceived religious and gender discrimination produces evidence congruent with both of these potential explanations. [ABSTRACT FROM AUTHOR]

Using two recent nationally representative Canadian surveys, this paper investigates how secularization affects civic participation, inclusive of political engagement and philanthropy. Three mutually exclusive categories of secularized individuals are considered. The analysis suggests that Canadian secular groups are relatively less engaged with politics and volunteer fewer hours, compared with the actively religious. They are, however, found to contribute significantly more money to secular causes, controlling for a wide range of individual attributes. Various explanations are explored. [ABSTRACT FROM PUBLISHER]

In this paper we contend neo-liberal education policy which supports the creation of schooling choices in public education systems is reshaping, conflating and branding ethnicity. We make these points in reference to school choice in Toronto, Canada, and the establishment of an Africentric ethno-centric school. We argue that one of the registers within which education and ethnicity in Toronto operates relates to the conflation of commodification, ethnicity and geography, and that this conflation indicates one of the limits of school choice as a possible way to redress Black student disadvantage. We suggest education policy, which enables the establishment of ethno-centric schools, enters the realm of other debates about race, equity and difference that include the practices of marketing and branding. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Quantifying a proposed project's greenhouse gas (GHG) emissions and scrutinizing their effect on climate change are increasingly required in Canadian environmental assessment (EA) processes. This paper investigates to what degree an EA authority's intention for the inclusion of GHG considerations has resulted in implementation into environmental impact statements (EISs) by proponents and how these considerations influence the achievement of GHG reduction targets. Fifteen projects across five Canadian jurisdictions were reviewed. The examination revealed that well-developed intentions by EA authorities did not necessarily result in proponents following guidelines for GHG consideration in their EISs due to the absence of regulation or clearly defined policies. Conversely, even though intentions by an EA authority are underdeveloped in some jurisdictions, EISs sometimes exhibited thorough GHG assessments due to mechanisms in the EA process through which GHG consideration by the proponent could be compelled. The examination did not reveal how GHG consideration in EA currently assists in meeting reduction targets. A GHG emissions limit imposed during the EA process could link EA to success in meeting these targets. [ABSTRACT FROM AUTHOR]

When combined with therapeutic plasma exchange (TPE) and immunosuppression, upfront universal administration of caplacizumab was shown to be effective in the management of immune thrombotic thrombocytopenic purpura (iTTP). However, access to this drug remains challenging in many jurisdictions. We retrospectively review results of a single-institution experience with caplacizumab over a 3-year period. During the study period, we treated 48 patients with iTTP, of which 11 (23%) received caplacizumab. Eight of these 11 patients (73%) were female; the median age was 45 years (IQR 37.0-58.5). All received TPE within 24 h of admission (median 9 exchanges, IQR 7.0-12.5), and high-dose steroids. Caplacizumab was initiated for a median of 6 days after admission (IQR 2.5-8.0) and continued for a median of 26 days (IQR 14.0-33.0). Five patients (45%) had refractory disease at caplacizumab initiation. Ten patients (91%) survived, reaching clinical remission. Platelet normalization was reached with a median of 4 days following caplacizumab initiation (IQR 1.5-4.0). Complications included minor bleeding (n = 1) and local allergic reaction (n = 1). No patients experienced TTP exacerbation; relapse occurred in two patients (18%) over 1-5 years of follow-up. Caplacizumab appeared to be effective and safe, despite delayed initiation and in the setting of refractory disease. [ABSTRACT FROM AUTHOR]

Background. Among circumpolar populations, recent research has documented a significant increase in risk factors which are commonly associated with chronic disease, notably obesity. Objective. The present study undertakes a scoping review of research on obesity in the circumpolar Inuit to determine the extent obesity research has been undertaken, how well all subpopulations and geographic areas are represented, the methodologies used and whether they are sufficient in describing risk factors, and the prevalence and health outcomes associated with obesity. Design. Online databases were used to identify papers published 1992-2011, from which we selected 38 publications from Canada, the United States, and Greenland that used obesity as a primary or secondary outcome variable in 30 or more non-pregnant Inuit ("Eskimo") participants aged 2 years or older. Results. The majority of publications (92%) reported cross-sectional studies while 8% examined retrospective cohorts. All but one of the studies collected measured data. Overall 84% of the publications examined obesity in adults. Those examining obesity in children focused on early childhood or adolescence. While most (66%) reported 1 or more anthropometric indices, none incorporated direct measures of adiposity. Evaluated using a customized quality assessment instrument, 26% of studies achieved an "A" quality ranking, while 18 and 39% achieved quality rankings of "B" and "C", respectively. Conclusions. While the quality of studies is generally high, research on obesity among Inuit would benefit from careful selection of methods and reference standards, direct measures of adiposity in adults and children, studies of preadolescent children, and prospective cohort studies linking early childhood exposures with obesity outcomes throughout childhood and adolescence. [ABSTRACT FROM AUTHOR]

Reconciling diverse forest values within policy and decision-making processes is an ongoing challenge in forestry. The use of environmental impact assessment (EIA) provides potential for improving forest management and making it more responsive to diverse interests. This paper examines EIA in Canadian and Finnish forest planning. In Finland there has been a reluctance to see EIA as a tool for forest planning while in Canada some provinces have long applied EIA to forest management. Ontario, Canada, provides one example of applying EIA to forest planning at a range of scales in order to advance integrated planning and help conflict management. The paper provides a brief analysis of the Finnish forest planning system, an illustration of the Ontario EIA forest management experience, and then considers the application of EIA to Finnish forest management. The paper concludes that EIA may be workable for Finnish state forests and would likely enhance planning and management, but given the existing institutional frameworks EIA would be difficult to apply to private forests. [ABSTRACT FROM AUTHOR]

This paper explores the lessons to be learned from why the neighbouring banking systems of Canada and the United States, that share numerous commonalities, fared so differently during two major financial crises. The explanations are deeply rooted in different tolerances for industry concentration and state involvement, and the divergent routes of the development of their financial systems, founding institutions, on-going governance and regulation, and competitive structures. Canada's success during the more recent 2007-09 financial crisis is attributed to more effective regulation and conservative banking practices, including (self-) imposed stricter limits on bank leverage, much stricter limits on unconventional mortgages, and less reliance on the use of more 'creative' investment types (e.g. subprime lending) and structured products. [ABSTRACT FROM AUTHOR]

There is growing recognition of the positive role that integrated assessments (IAs) can play in improving decision-making processes for public and private sector projects. Because IAs can help secure both the regulatory and the 'social' license to operate, an increasing number of companies, including Royal Dutch Shell, now require their undertaking for major projects. There are, however, limited published case studies to test IA theory and execution, and to provide practical lessons for others. The purpose of this paper is to summarize the undertaking of an IA for a heavy oil pilot project proposed by Shell in northern Alberta and to identify critical success factors. The paper explores key innovations in: (1) the organizational approach to the IA; (2) the scoping and impact evaluation processes; and (3) external communication of results and internal integration of the findings. The paper also provides lessons for industry, regulators, consultants and communities. [ABSTRACT FROM AUTHOR]

Carboniferous rocks in the Joggins area, Nova Scotia, and the Maringouin Peninsula, New Brunswick, are world renowned for their well-preserved macroflora, but this paper is the first detailed study of the palynoflora. The section is comprised of the Mississippian Windsor and Mabou groups overlain disconformably by the Lower Pennsylvanian Cumberland Group. The Windsor Group rocks proved to be barren of palynomorphs but the Mabou Group yielded spores and pollen of Brigantian (late Visean) to Arnsbergian age (early Namurian = early Serpukhovian). The assemblages are assigned successively to the Schopfipollenites acadiensis-Knoxisporites triradiatus, the Grandispora spinosa-Ibrahimispores magnificus, and the Reticulatisporites carnosus Zones. A major palynofloral change takes place between the Mississippian Mabou and the Pennsylvanian Cumberland assemblages. This is believed to reflect a significant regional hiatus in the Joggins section and elsewhere in eastern Canada. The Cumberland Group is characterized by an abundance of Lycospora spp. and monosaccate gymnosperm species of Yeadonian? (Late Namurian = middle Bashkirian?) to late Duckmantian (late Bashkirian?) age. The palynological succession is divided into the Raistrickia saetosa, the Raistrickia fulva, and the Vestispora magna zones. Age determinations of the zones, based on comparisons with Western Europe and the North Sea, are tentative because the Cumberland assemblages lack diversity and many taxa diagnostic in Western Europe are absent in the assemblages of the Joggins area, possibly due to environmental and climatic differences. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The terrorist attacks of 11 September 2001 had an immediate impact on Canada–U.S. relations. Whereas security became foremost among U.S. concerns, Canada became preoccupied with ensuring that the newly fortified border would not impede trade. Within days of the attacks, Canadian analysts argued that the only way to guarantee open access to U.S. markets would be to negotiate some form of deeper North American economic integration. Previous proposals for a North American Monetary Union were revived, while new initiatives such as a customs union or a“strategic bargain” also emerged. These schemes were designed to forge a“new economic space” in North America. Business think tanks and interest groups played a central role in pushing forward a platform of deeper integration, but the ideas have also made their way into the policy platforms of the Canadian federal government. This paper draws upon discourse analysis and theories of governmentality to interrogate the rhetoric of inevitability that has underpinned these proposals. The fatalism has been justified by allusions to the shifting North American geopolitical relations in the post-September 11 context and the fear and risk that have prevailed since the terrorist attacks. It also, however, resonates more broadly with neoliberal and globalizing narratives that externalize and naturalize market forces, and, therefore, limit alternative futures. More importantly, the logic and language of inevitability have provided advocates of deeper integration with a strategic manoeuvre to downplay concerns regarding the loss of political sovereignty and the transformations to state-society relationships that would result from the new North American economic space that is being imagined. [ABSTRACT FROM AUTHOR]

This paper presents data on and discusses the degree of postglacial stability of the northern Canadian tree limit. Holocene climatic changes have been both directional and synchronous for this region, though deteriorations/ameliorations either (1) lagged from west to east, (2) were buffered by local geographic factors, or (3) were not registered in the fossil record owing to the inherent persistence of the vegetation at some sites. The present northern tree limit in eastern Canada is in equilibrium with the prevailing climate, with the tree populations successfully regenerating both sexually and vegetatively. These tree stands are still occupying their maximum Hypsithermal positions. In contrast, the tree limit, tree line, and intervening forest-tundra ecotone in central and western Canada are out of equilibrium with today's climate. These populations are not sexually regenerative and apparently became established during warmer climates where the tree line was north of its present position. As such, they are susceptible to destruction by further climatic deterioration or anthropogenic disruption. [ABSTRACT FROM AUTHOR]

The existing literature on convergence in Canada largely ignores the underlying geographical dimensions of regional disparities. By using income measures developed from census micro-data files to analyze patterns of convergence across census divisions, we show that regional disparities are increasingly clustered across the Canadian space-economy along (1) East–West and (2) urban–rural gradients. Rural census divisions in the Eastern provinces, in particular, are showing increased signs of distress in terms of differences in levels and growth rates of incomes with other regions in the country. Such findings have important policy implications which are briefly discussed. [ABSTRACT FROM PUBLISHER]

Invasive Haemophilus influenzae type a (iHia) disease was detected in Alaska and Northern Canada in 2002 and 2000, respectively. From 2006 to 2017, 164 iHia cases (Alaska=53, Northern Canada=111) were reported. Rates of iHia disease per 100,000 persons were higher in Northern Canada compared to Alaska and were significantly higher in Indigenous (Alaska 2.8, Northern Canada 9.5) compared to non-Indigenous populations (Alaska 0.1, Northern Canada=0.4). Disease rates were highest in Indigenous children <2 years of age (Alaska 56.2, Northern Canada=144.1) and significantly higher than in non-Indigenous children <2 (Alaska 0.1, Northern Canada 0.4). The most common clinical presentation in children <5 years was meningitis of age and pneumonia in persons ≥5 years old. Most patients were hospitalised (Alaska=87%, Northern Canada=89%) and fatality was similar (Alaska=11%, Northern Canada=10%). MLST testing showed sequence types ST23 and ST576 in Northern Canada and ST576, ST23 and ST56 in Alaska. Alaska and Northern Canada have high rates of iHia disease. A vaccine is needed in these regions to protect young children. [ABSTRACT FROM AUTHOR]

Indigenous peoples in Canada and in the Circumpolar North face a higher disease burden leading to end-stage organ failure and face geographic and systemic barriers to accessing health-care services, including those for end-stage organ failure and organ donation and transplantation (ODT). To address these issues, I present a think tank model used in Saskatchewan, Canada, which focused on ODT and recommended research and policy changes that address inequitable Indigenous access to ODT, most specifically in northern and remote regions. Over the past three years, think tank members, comprised of Indigenous cultural leaders, elders, and persons with lived experience in ODT, and complemented by medical and advocacy exports, have highlighted equity and utility issues as key concerns, and discussed ways in which these issues can be addressed. Recommendations include culturally-safe methods for documenting and tracking Indigenous identity, development of training to address culturally specific needs, and additional funding to support Indigenous transplant donors and recipients. [ABSTRACT FROM AUTHOR]

Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants' release. Data were thematically analyzed. The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of 'take-home' OAT medications were common barriers. Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options. [ABSTRACT FROM AUTHOR]

Death by suicide and attempted suicide among Inuit youth is now considered a public health emergency of epidemic proportion, with rates among the highest worldwide. A strong sense of cultural identity and pride, as well as social capital, has been identified as being protective against suicide. The Canadian Institute for Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People call for communities to be included in the conception, planning and implementation of research. The authors took first steps towards sharing the responsibility of designing a community initiative with the youth of Naujaat, Nunavut, a community located directly on the Arctic Circle. With the objectives of promoting open listening and exploration of community needs and enhancing self-determination and sustainability, we postulated a youth resiliency project that will be co-authored by the community. This paper describes the joint work process. We recount how Inuit youth take ownership of the project with the guidance of Ms. Elizabeth Haqpi, a Naujaat Elder. The article will particularly reflect on the process of balancing the different perspectives and expectations while enjoying the richness of mutual learning through keeping each other accountable. [ABSTRACT FROM AUTHOR]

Background: Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians. Methods: A narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic. Main findings: Regarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix. Conclusion: Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests. [ABSTRACT FROM AUTHOR]

Background: Canada has experienced a distinctly bifurcated pattern of (strong) opioid utilization post-2000, with multifold increases rendering it one of the world's highest opioid consumption rates, followed by subsequent substantive declines since 2011/2012. Several interventions to control especially high-risk opioid use have been implemented post-2010 at different levels, yet with their effects assessed mostly for overall opioid utilization. Little knowledge exists for over-time patterns of individual opioid formulations. Methods: Raw information on community-based prescription opioid dispensing for years 2005–2020 were obtained from a large national database based on a stratified sample of 6500 retail pharmacies across Canada (IQVIA/Compuscript), These data were converted into Defined-Daily-Doses/1000 population/day (DDD/1000/day) for individual (strong and weak) opioid formulations—specifically: fentanyl, hydromorphone, hydrocodone, morphine, oxycodone, codeine—per standard methods. Descriptive data on individual opioid dispensing were computed, and segmented regression (or 'broken-stick') analysis was applied to the overtime dispensing towards assessing potentially significant 'breakpoints' interrupting linear utilization trends. Akaike information criterion (AIC) values were computed to assess the resulting models' quality-of-fit. Results: Five of the six opioid formulations featured a lower dispensing level in 2020 compared with 2005, but mostly with peak values in years between, contributing to the overall inversion pattern. For five of the six opioid formulations, a three-segmented model emerged as the best fit for the dispensing observed; only hydrocodone presented a linear (downward) dispensing trend. Among the five interrupted trend models for individual formulations, four (fentanyl, morphine, oxycodone, codeine but not hydromorphone) indicated their initial breakpoint during 2011–2014 introducing a downward dispensing trend. Inconsistently, morphine also featured a recent breakpoint (2018) towards a dispensing increase. Conclusions: While all opioids showed marked declines, we found heterogeneous patterns of dispensing for individual opioid formulations. While we cannot estimate direct causal effects, opioid control interventions appear to have had differential impacts on dispensing of individual formulations. The earliest breakpoint occurred towards substantive decreases for oxycodone dispensing in 2011; subsequently, there were increases in dispensing of hydromorphone and fentanyl likely due to substitution effects, followed by across-the-board declines post-2015/2016. Recent 'safer opioid' distribution programs to reduce illicit/toxic opioid exposure linked with high levels of poisoning fatalities seem to fuel resurgences in select opioid (e.g., morphine) dispensing. [ABSTRACT FROM AUTHOR]

The Canadian Environmental Assessment Act 2012, which came into force on 6 July 2012, virtually eliminates the core of federal-level environmental assessment in Canada. Under the new law, federal environmental assessments will be few, fragmentary, inconsistent and late. Key decision-making will be discretionary and consequently unpredictable. Much of it will be cloaked in secrecy. The residual potential for effective, efficient and fair assessments will depend heavily on requirements under other federal legislation and on the uneven diversity of provincial, territorial and Aboriginal assessment processes. This paper reviews the key characteristics of the new law in light of 10 basic design principles for environmental assessment processes, and considers the broader international implications of the Canadian retreat from application of these principles. [ABSTRACT FROM PUBLISHER]

This paper explores policy action taken by the federal government in Canada to test the potential for substitution of the federal process to regulatory bodies as a means of encouraging environmental impact assessment (EIA) efficiency. Our purpose is to present the experiences of people who participated in the EIA of the Emera Brunswick Pipeline in order to gauge the impact of such process substitutions on meaningful public participation. Our approach included document reviews and a focus group session with some of the public participants in the Emera Pipeline hearings. We find that the National Energy Board hearing process substituted in the case did not meet many of the key requirements of meaningful participation and left some public participants feeling disrespected and marginalized. [ABSTRACT FROM PUBLISHER]

Ultimately, the enhancement we need to deliver through environmental assessment is confidence that every approved undertaking will move us positively towards a desirable and durable future. In Canada, the most promising steps in this direction have been in several major project assessment reviews with public hearings and independent panels that applied a contribution to sustainability test. The most recent and advanced case is the review of a proposed C$16.2 billion natural gas infrastructure undertaking in the Northwest Territories. The Panel's application of the contribution to sustainability test compared the cumulative effects, equity and legacy implications of a range of project pace and scale alternatives. The Panel concluded that the project would offer positive overall contributions only if 176 recommendations were implemented. While the Panel's process was slow and the governments accepted only the most modest recommendations, the Panel's review set a new standard of analytical practice. This paper examines how the review was done and assesses its strengths and limitations, with particular attention to the design and application of the contribution to sustainability test. [ABSTRACT FROM AUTHOR]

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This paper examines the experience with regional cumulative effects assessment (CEA) in the Great Sand Hills, Saskatchewan, Canada, and the lessons that emerge for better practice. The benefits of a regional approach to CEA are widely discusssed; however, in practice, regional CEA, particularly in Canada, has fallen short of its potential. Part of the reason for this, arguably, is the lack of strategic frameworks to support good practice. Most attempts at regional CEA have been constrained by the strong influence of project-based environmental assessment, and are focused on modeling past and present stressors and responses, rather than on projecting cumulative trends and systematically identifying and evaluating desirable futures. Regional CEA is inherently futures-oriented. This requires a supporting SEA framework, structured scenario-based analysis, a multi-scaled perspective, and an integrated approach to CEA and regional plan development. [ABSTRACT FROM AUTHOR]

The James Bay Agreement reinforces the rights of the Crees to 500,000 km² of territory in the boreal forest and taiga of northern Quebec. In it, consultation and environmental assessment (EA) mechanisms were set up to ensure the Crees' direct involvement in environmental decisions. This paper addresses three matters: the influence of Native involvement in the EA process; updating the EA process under the Agreement to in-corporate the apparently new tools of strategic environmental assessments (SEAs); and adaptation of the concept of SEA to the Native context. Our analysis focuses on the experience gained from large hydroelectric development projects, recent and planned mining developments, and forestry operations. [ABSTRACT FROM AUTHOR]

This paper reports the results of 107 radiocarbon age estimates at and around the vicinity of four archaeological site localities in southwest Manitoba, central Saskatchewan, and southeast Alberta. Age estimates are reported from archaeological excavations, geomorphological and geoarchaeological investigations of the sites and relevant post-glacial landscape features, and from paleoenvironmental investigations. Pertinent laboratory and contextual information is reported along with a summary of the relevance of age estimates and relationships among age estimates. [ABSTRACT FROM AUTHOR]

This study examines the relationships between financial knowledge, confidence, learning capacity, education and other sociodemographic information and financial behavior. A structural equation model is used to analyze the relationships between the study variables and to obtain a more comprehensive understanding of the factors linked to poor financial behavior among a large Canadian sample. The main findings showed that financial confidence plays a crucial role in explaining financial behavior and that learning capacity explains financial confidence. Overall, our results suggest that financial education should be considerably improved and that additional focus should be placed on financial confidence and individual's learning capacity in order to mitigate existing financial difficulties, prevent new problems from arising, and develop and implement constructive strategies to achieve specific financial goals. This study contributes to previous research on financial literacy by demonstrating the influence of learning capacity on financial confidence and financial behavior. [ABSTRACT FROM AUTHOR]

The Canadian province of Ontario provides full coverage for its residents (pop.14.8 M) for hospital-based diagnostic testing. Historical governance of the healthcare system and a legacy scheme of health technology assessment (HTA) and financing has led to a suboptimal approach of adopting advanced diagnostic technology (i.e. protein expression, cytogenetic, and molecular/genetic) for guiding therapeutic decisions. The aim of this research is to explore systemic barriers and provide guidance to improve patient and care provider experiences by reducing delays and inequity of access to testing, while benefitting laboratory innovators and maximizing system efficiency. A mixed-methods approach including literature review, semi-structured interviews, and a multi-stakeholder forum involving patient representatives (n = 1), laboratory leaders (n = 6), physicians (n = 5), Ministry personnel (n = 4), administrators (n = 3), extra-provincial experts, and researchers (n = 7), as well as pharmaceutical (n = 5) and diagnostic companies (n = 2). The forum considered evidence of good practices in adoption, implementation, and financing laboratory services and identified barriers as well as feasible options for improving advanced diagnostic testing in Ontario. Overarching challenges identified included: barriers to define what is needed; need for a clear approach to adoption; and the need for more oversight and coordination. Recommendations to address these included a shift to an anticipatory system of test adoption, creating a fit-for-purpose system of health technology management that consolidates existing evaluation processes, and modernizing the governance and financing of testing so that it is managed at a care-delivery level. The proposals for change in Ontario highlight the role that HTA, governance, and financing of health technology play along the continuum of a health technology life cycle within a healthcare system where decision-making is highly decentralized. Resource availability and capacity were not a concern – instead, solutions require higher levels of coordination and system integration along with innovative approaches to HTA. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach. [ABSTRACT FROM AUTHOR]

Canada has been a host country to migrants for decades through its attractive immigration policy. To enrich the literature, this article analyses the impact of immigration on the Canadian labour market at the regional level. For this purpose, 10 provinces of Canada have been selected for this study with the data spanning over 12 years from 2006 to 2017. Through the empirical analysis, the article finds there is a significant negative impact of immigration on the native employment level. Whereas the opposite results are found on the national level and the impact on the income of native workers is found to be negative and significant. The employed natives are also found to be migrating to other states at a higher rate in regions where immigration is higher. These results show that natives employees in the labour market tend to migrate and immigration hence offsetting the wage effects on the regional level. [ABSTRACT FROM AUTHOR]

Aims: Nivolumab has been approved for advanced squamous and non-squamous non-small cell lung cancer (NSCLC) following platinum-based chemotherapy in both Canada and Sweden. We aimed to determine the value-for-money of nivolumab versus docetaxel in a Canadian and Swedish setting based on 5-year data. Methods: These cost effectiveness analyses used partitioned survival models with three mutually exclusive health states: progression-free, progressed disease, and death. All clinical parameters were derived from two registration phase 3 randomized trials, CheckMate 017 and CheckMate 057, with a minimum follow-up of 5 years. Treatment duration was based on time-on-treatment data from the clinical trials. Costs were derived from published sources. The primary outcomes of the analyses were quality-adjusted life-years (QALYs), life-years gained, and incremental cost-effectiveness ratios (ICERs). The model input parameters for each analysis were chosen in line with guidance from the respective HTA authorities. Results: From a Canadian payer perspective, the ICERs were CAN$140,753 per QALY in the squamous population, and CAN$173,804 per QALY in the non-squamous population, assuming a 10-year time horizon and a 5% discount rate for both costs and outcomes. Sensitivity analyses demonstrated that changes to the discount rates for outcomes had the highest impact on the ICERs. In the Swedish analysis, the ICERs were SEK568,895 per QALY in the squamous population and SEK662,991 per QALY in the non-squamous population, assuming a 15-year time horizon, a 3% discount rate, and a 2-year maximum treatment duration for nivolumab. Sensitivity analyses demonstrated that the ICERs were most sensitive to changes in the discount rate for outcomes. Conclusion: These updated analyses, based on more mature trial data with a minimum follow-up of 5 years, generate more favorable ICERs versus the previously submitted HTA assessments that resulted in approval of nivolumab for patients with previously treated NSCLC in Canada and Sweden. [ABSTRACT FROM AUTHOR]

A vast range of recent academic scholarships seek to theorize the recent convergence of neoliberal, anti-immigration, xenophobic and populist measures and practices since the Crisis of 2008. This paper analyses recent changes to the Canadian citizenship regime and it compares this changes to neoliberal and neoconservative trends in Europe. The authors argue that although it did not explicitly renounce its pluralistic orientation, the Canadian Conservative Party had already started its neoliberal and neoconservative reorientation of the Citizenship in Canada prior to the Crisis of 2008. Despite several similarities with European trajectories, the Conservative Party needs to deal with structural factors that are specific to the Canadian context: the electoral system; demographic trends; and a public opinion which, unlike in Europe, remains optimistic with regards to the economic contribution of immigration. [ABSTRACT FROM AUTHOR]

In 1782 it was agreed that the frontier between the United States and British North America should run from the east to the Lake of the Woods, wrongly perceived (on the basis of Mitchell's 1755 map) as the westernmost of the Great Lakes, and then due west to the Mississippi. Other cartographical errors and misapprehensions also played a role in the fixing of the border. Thus in 1804 President Jefferson seized on the 49th parallel as the line supposedly agreed on after the 1713 Treaty of Utrecht for the border between the British Hudson's Bay territories and French (now American) Louisiana, and it was eventually adopted. The discovery of what was thought to be a conspicuous line of continuous highland south of the St. Lawrence, and the renewed attention paid in the mid‐eighteenth century to the borders specified in King James VI's 1621 grant of Nova Scotia, helped frame the parameters of a dispute over what is now the Maine‐New Brunswick border—one that periodically disturbed Anglo‐American relations between 1783 and 1842. The negotiation of the Webster‐Ashburton treaty that ended the dispute in 1842 provides another example of the selective use of maps in diplomacy. [ABSTRACT FROM PUBLISHER]

Purpose: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. Methods: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. Results: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. Conclusions: Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities. [ABSTRACT FROM AUTHOR]

Indigenous Canadians have a life expectancy 12 years lower than the national average and experience higher rates of preventable chronic diseases compared with non-Indigenous Canadians. Transgenerational trauma from past assimilation policies have affected the health of Indigenous populations. The purpose of this paper is to comprehensively examine the social determinants of health (SDH), in order to identify priorities for health promotion policies and actions. We undertook a series of systematic reviews focusing on four major SDH (i.e. income, education, employment, and housing) among Indigenous peoples in Alberta, following the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Equity. We found that the four SDH disproportionately affect the health of Indigenous peoples. Our systematic review highlighted 1) limited information regarding relationships and interactions among income, personal and social circumstances, and health outcomes; 2) limited knowledge of factors contributing to current housing status and its impacts on health outcomes; and 3) the limited number of studies involving the barriers to, and opportunities for, education. These findings may help to inform efforts to promote health equity and improve health outcomes of Indigenous Canadians. However, there is still a great need for in-depth subgroup studies to understand SDH (e.g. age, Indigenous ethnicity, dwelling area, etc.) and intersectoral collaborations (e.g. community and various government departments) to reduce health disparities faced by Indigenous Canadians. [ABSTRACT FROM AUTHOR]

Mental illness is a predominant medical condition in Canada. Marginalized groups in the Canadian population such as those with low income, the poorly educated and ethnic minorities are susceptible to mental health disorders. Using mental health-related emergency department visits as an indicator of mental illness cases, we employ a Bayesian spatio-temporal regression model to estimate mental illness risk across the 35 public health units of Ontario, Canada from 2006 to 2017. The association between mental illness and the following marginalization-related factors: material deprivation, residential instability and ethnic concentration is also evaluated. Over the assessed period, the relative risk of mental illness ranged from 0.45 (95% CI: 0.44–0.46) to 3.29 (95% CI: 3.20–3.37). Health units with elevated levels of material deprivation and residential instability were positively associated with increased mental illness risk whilst areas with higher ethnic concentration were linked with lower risk. Findings showed that the temporal trend of risk continuously increased over the 11 year period, with health units in northern Ontario experiencing higher risk compared to southern units. The management of psychiatric disorders presents a significant challenge to the Canadian health-care system. An understanding of the geographic distribution of mental health risk across space and time can be useful for improved policy-making and public health monitoring. [ABSTRACT FROM AUTHOR]