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Historically, there is a documented lack of support for women leaving their communities to give birth. Due to an over-emphasis on risk discourse (no distinction between low- or high-risk pregnancies with options to birth at home, the large geographical distances to regional centres within circumpolar regions, remoteness of communities, lack of qualified staff, and limited resources), women are forced to travel great distances to give birth. In Canada until 2017, women travelled alone or bore the burden of paying out of pocket for someone to travel with them for support with the births of their babies. A recent policy change has allowed for one paid escort to accompany a pregnant woman. The purpose of this paper is to provide an outcome assessment of the perinatal transport and non-medical escort policy implemented by the federal government in Canada. The paper utilises a narrative literature review along with preliminary Indigenous photovoice results to illuminate the perspectives of Indigenous families. There are numerous challenges women face when travelling for birth including feelings of loneliness and fear, stress and separation from their children, lack of community connection, financial concerns, and a loss of self-determination. Women are given an opportunity in decision-making about who will travel with them as an escort. This does little to address the disparity of delivering their babies away from their families and communities, the burden of figuring out who cares for the children at home, and the impact their absences have on health of their families. Although, additional support has been provided for birthing women in northern Canada, there continues to be little effort to return to community birthing creating safety for Indigenous families through traditional practices, Indigenous midwifery, and community ceremonies and changing the disproportionate burden of poor outcomes experienced by Indigenous women. [ABSTRACT FROM AUTHOR]

Family members are essential contributors to the quality of life (QoL) of persons living in residential long-term care (RLTC). This paper analyzes how the system enables or inhibits family involvement with residents in RLTC. Our analysis of 21 policies that regulate long-term care in four Canadian Provinces reveal differences in their portrayal of residents' families. Family roles are characterized procedurally (task-oriented) or relationally (interactive). Operational standards linked to licensing of RLTC homes employ more formal terminology, while RLTC program guidelines, use facilitative language to engage families and build relationships. Examples of orientation procedures, care protocols, living at risk, and end-of-life care reveal inter-provincial variations. We argue that there are opportunities to further engage families within the current regulatory framework and improve their continued contributions in the post-pandemic era. [ABSTRACT FROM AUTHOR]

This paper used a structural perspective to examine unmet healthcare needs in women at risk for eating disorders in Canada utilizing the Canadian Community Health Survey. The results revealed that body dissatisfied women had reported significantly higher unmet needs compared to body satisfied women (χ 2(1) =29.31, p <.05). Body dissatisfied women were also more likely to identify structural reasons for unmet needs. Considering the high costs associated with eating disorders, barriers creating inequitable health services need to be addressed in clinical practice, organizational structures, policy, and in research to improve treatment pathways. [ABSTRACT FROM AUTHOR]

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes. Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses. Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants. Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth. [ABSTRACT FROM AUTHOR]

The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated. [ABSTRACT FROM AUTHOR]

This paper discusses state-medicine relations in Canada and Britain as an expression of medicine's perceived dominance of the health policy field. The two main questions addressed by the paper are: how do institutional frameworks affect the outcome of state-medicine conflicts, and how does the medical profession react to challenges to its policy monopoly? These questions are considered in two instances where determined state actors enacted legislation in the face of widespread and vocal medical opposition: the 1984 Canada Health Act and the 1990 NHS and Community Care Act. Contrary to much of the literature on professional dominance this paper highlights the predominant role of the state in the state-medicine nexus and shows the conditional and ephemeral nature of medicine's policy monopoly and this monopoly's reliance on a co-operative and acquiescent state actor. The paper further shows that institutional factors, such as centralisation, do not offer a greater opportunity for the solidification of the medical policy monopoly. [ABSTRACT FROM AUTHOR]

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services. [ABSTRACT FROM AUTHOR]

In the past decades, public health has increasingly addressed what has been called the children's obesity 'epidemic', most notably through large-scale initiatives promoting physical activity. Through a discourse analysis the current paper critically examines such efforts in Canadian and Australian public health. Public health websites in Canada and Australia were examined for information concerning children's health, physical activity and obesity and explored for how these issues were represented in the discourse. Bacchi's (2009) 'What's the problem represented to be?' approach to discourse analysis guided our interrogation of the taken-for-granted assumptions underlying Canadian and Australian public health discourse, the ideological and political influences involved in its construction, and the knowledge base upon which it rests. The article calls for critical reflection on how children's physical and leisure activities are being advanced. [ABSTRACT FROM AUTHOR]

The concept of e-health has come to assume a key place within a larger Canadian governmental discourse that lauds the benefits of supplying Internet-based services to as wide an audience as possible. In order to fulfil its vision of a connected public accessing services cheaply and easily through electronic media, the federal government has assumed that the potential exists for all Canadians to use the Internet and has done its best to achieve this result through programmes aimed at ameliorating accessibility issues. There is particular enthusiasm over the possibility of moving some health services online, thus reducing costs incurred through personal patient-practitioner meetings while ostensibly creating more informed, proactive and healthy Canadians. This paper discusses whether or not the enthusiasm of the government, and of individual users, regarding e-health practices is merited, focussing particularly on the consumption of online health information by patients. Numerous consequences and conflicts can accompany such practices, but this paper specifically addresses the negative aspects of promoting informed health choices through a medium inaccessible to all members of Canadian society, such as the aged, the poor, rural dwellers and some ethnic minorities. The paper also assesses the potential risks of acting upon incorrect information provided online and addresses the possibility that health professionals' workloads will increase rather than decrease. However, as this paper also notes, e-health does contain potential for improving the delivery of medical services in Canada if contained within clearly defined parameters, and if alternatives still exist for those who cannot or will not benefit from such technology. [ABSTRACT FROM AUTHOR]

This paper compares the advocacy of mothers and intended mothers in the fields of autism and infertility. Mothers and intended mothers have developed a special competence in dealing with professionals, and in negotiating the delicate balance between expert medical discourses and expertise grounded in their situated knowledge and experiences. Drawing on the social movement and public policy literature, we seek to disrupt taken-for-granted assumptions about the gendered role of women and mothers in these complex and emotionally charged policy fields. We argue that (intended) mothers are far more likely than other women to take on the major advocacy role considering their need to respond to bodily, social, and/or cultural 'failures' imposed on them by the medical establishment. Issues of access to fertility treatments and care for autistic children not only provide a vantage point from which to study their experience in the policy arena, but also to ask broader questions about the role of the welfare state and the shifting authority of experts in policy processes. [ABSTRACT FROM AUTHOR]

There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 ‘grey literature’ reports were identified, most in the US or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviours contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardised sexual risk assessment measures, targeted data collection in lower- and middle-income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviours and engage local FTM communities. [ABSTRACT FROM AUTHOR]

Healthcare in Canada, as elsewhere, must adapt in order to better meet the needs of the chronically ill. Such adaptations are happening locally, but healthcare decision- and policy-makers require channels and mechanisms for sharing project outcomes and spreading or scaling up successful approaches. Without formal mechanisms, there is a risk of losing the rich knowledge produced by improvement projects; of compromising the efficient use of healthcare resources; and of negatively impacting the further distribution of potential outcomes and impacts. This paper profiles three Canadian collaborations, supported by the Canadian Foundation for Healthcare Improvement (CFHI), which supports healthcare leaders in working together to develop, share, implement, and sustain evidence-informed and systems solutions. The collaborations are team based and particularly relevant to patient engagement and chronic disease care. They illustrate early lessons on how collaborative partnerships, with a shared vision and ownership, can co-address multiple components, conditions and communities, using evidence-based approaches and embedding performance measurement and evaluation. They also demonstrate the role organizations such as CFHI can play in facilitating a collaborative approach to accelerating healthcare improvement within and across organizations or systems. [ABSTRACT FROM AUTHOR]

While the clinical promise of much stem cell research remains largely theoretical, patients are nonetheless pursuing unproven stem cell therapies in jurisdictions around the world—a phenomenon referred to as “stem cell tourism.” These treatments are generally advertised on a direct-to-consumer basis via the Internet. Research shows portrayals of stem cell medicine on such websites are overly optimistic and the claims made are unsubstantiated by published evidence. However, anecdotal evidence suggests that parents are pursing these “treatments” for their children, despite potential physical and financial risk. Physicians are in a unique position as they can be expected to be involved in, or privy to, such decisions. In this paper, we consider what duties physicians may have toward minor patients whose parents/guardians wish to engage in stem cell tourism on their behalf. We use the Canadian perspective to address the broadly relevant issues raised by this trend. [ABSTRACT FROM AUTHOR]

This paper explores the role of social movements in the policy process and, in particular, the ways in which movements interact with, access, and deploy expert knowledge. In the technocratic model, citizens are conceptualized as undifferentiated, rather than considered in terms of distinctive identities or interests. Their inclusion in policy-making is viewed as a technical problem to be 'solved' through forms of citizen engagement, rather than viewing citizens as active agents in the mobilization of distinctive knowledges. Citizens, we argue, are more than the undifferentiated lump that appears in the technocratic model under the guise of citizen engagement. Drawing on a case study of autism activism in Canada and the US, we demonstrate the range of ways in which civil society actors both deploy and contest expert knowledge in the policy process, and discuss the implications for how we conceptualize knowledge mobilization in policy processes. [ABSTRACT FROM AUTHOR]

This paper compares the ways in which governments in Canada and New Zealand have attempted to pursue reforms in two major health policy arenas - cost control and primary health care - in the period 1992-2005. The framework for comparison is drawn from the “modes of governance” literature that deals with hierarchies, markets, provider-based networks and communities as means of steering policy. Recent literature has argued that governments are increasingly mixing and matching different modes of governance. This comparison shows that governance versatility applies in New Zealand, but not Canada, and this is primarily attributable to the differences in health policy institutions. [ABSTRACT FROM AUTHOR]

Despite Canada's leadership in the field of population health, there have been few successes in reducing the country's health inequities. There is an increasing recognition that regardless of the progress made to date, significant gaps remain in comprehending fully the root causes of inequities, including the complex ways in which the determinants of health relate, intersect and mutually reinforce one another. Calls are being made to draw on the theoretical insights of critical social science perspectives to rethink the current framing of health determinants. The aim of this paper is to contribute to the theoretical project of population health by exploring the innovative paradigm of intersectionality to better understand and respond to the 'foundational' causes of illness and disease, which the health determinants perspective seeks to identify and address. While intersectionality has taken hold among health researchers in the United States, the United Kingdom and Canada, the transformative potential of this approach in the context of health determinants is largely unexamined. [ABSTRACT FROM AUTHOR]

A literature review regarding the social support of immigrant mothers of disabled children in Canada was undertaken with a focus on settings where supports need to be shored up. An integrative review of published papers and policy reports concerning key aspects of social supports for immigrant mothers and disabled children was undertaken. Immigrant mothers experience numerous barriers to social supports for themselves and their disabled children. Maternal immigrant populations experience unique challenges in the setting of childhood disability as well as the challenges of mothers in the dominant culture. There are negative impacts on maternal health as a result of inadequate policy offerings. Public health policy needs to be refashioned in light of weak systems and supports for both immigrant mothers and disabled children and to acknowledge that the current system poses concerning implications for the long-term health of both groups. [ABSTRACT FROM AUTHOR]

This article examines how older motherhood and older mothers are problematised and represented in key Canadian policy texts on 'delayed childbearing' and 'advanced maternal age'. Drawing on critical disability studies and feminist scholarship on motherhood, we identify three kinds of representations of older mothers in these texts: as risk-producing subjects, as unnatural mothers, and as irresponsible reproductive citizens. We argue that dominant discourses of older motherhood are structured by both ageism and ableism, which undergird policy documents. These discourses frame older women as disabled by the 'burden' of late parenthood and cast them as risky subjects who might give birth to 'abnormal' offspring. Within this discursive terrain, older women are not only othered: they are held responsible for their infertility and for their reduced propensity to reproduce 'healthy,' non-disabled offspring. [ABSTRACT FROM AUTHOR]

This article uses the social construction of target populations (SCTP) approach to examine the social construction of naturopathic medicine in the Canadian media at a time of policy change. It uses an original dataset of newspaper articles during a period (2013–2017) that involved increased scrutiny about naturopathic medicine due to a high-profile criminal trial. It finds that naturopathic medicine was far more likely to be portrayed negatively than positively, and that the trial increased the frequency of negative stories of the profession. This demonstrates that naturopathic medicine has not been able to withstand a negative social construction in Canada in spite of concrete public policy gains in many provinces. It further demonstrates the need for scholars using the SCTP approach to emphasize the role of the media in influencing target populations' social constructions. [ABSTRACT FROM AUTHOR]

Unmet needs for assistive technologies (ATs) exist and the need for ATs is growing owing to demographic changes worldwide. Little comprehensive research has examined equity of access to ATs in Canada. Our study elucidates perspectives of policymakers and stakeholders on challenges and solutions for enhancing equitable access to ATs to advance policy discussions. We conducted a qualitative interview study with a purposive sample of policymakers and stakeholders. Stakeholders were from non-profit organisations; private insurance companies; ageing or technology industries; and advocacy, consumer, and support groups. We used thematic analysis to develop themes that summarised and facilitated data interpretation. We conducted 24 interviews involving 32 participants. We present three themes: (1) User experiences, detailing challenges experienced by AT system users; (2) System characteristics: Challenges and solutions, outlining governance, financial, and delivery arrangements that create challenges for accessing AT, as well as participants' proposed solutions; and (3) Shifts in models and principles, for approaches that may foster equitable access to ATs. We consolidate results into a set of valued qualities of a system that can enhance equitable AT access, and relate results to relevant national and international activities. This is the most comprehensive study of Canadian policymaker and stakeholder views on AT access to date. Identified challenges and solutions point to opportunities for policy action and to support work to create a national vision for AT access that strengthens the potential for ATs to enable daily activity participation, independence, and societal inclusion of seniors and people with disabilities. AT use supports daily activity participation, independence, and societal inclusion of seniors and people with disabilities. There is an urgent need to ensure that those who need ATs have access to them, considering the benefits of their use, current unmet needs for ATs, and the anticipated demand for ATs because of the ageing population and increased prevalence of chronic disease and disability. A comprehensive understanding of policymakers' and stakeholders' perspectives on challenges and potential solutions for enhancing equitable access to ATs is critical to support development of evidence- and values-informed policies. Understanding challenges and solutions identified by diverse policymakers and stakeholders can lead to national and local opportunities for policy action and support work to create a national vision for enhancing equitable access to AT. [ABSTRACT FROM AUTHOR]

This commentary addresses barriers to care among older adults living with neurodiversity (ND), and their aging family carers in the context of the COVID-19 pandemic in Canada. Factors contributing to inequities are described and the significant negative consequences of current policy decisions on the social and mental health of older adults with ND and their aging family carers are highlighted. The commentary calls for a collective social work response that highlights the critical role of support and advocacy necessary to redress social exclusion. [ABSTRACT FROM AUTHOR]

This paper tests the hypothesis of market disequilibrium and supplier-induced demand in the market for physicians services using Canadian data from the period prior to the introduction of National Health Insurance. The results support the hypothesis of disequilibrium, with rapid upward adjustment of fees in the face of excess demand and extremely slow downward adjustment of fees in response to excess supply. They do not support the hypothesis that physicians induced demand in the face of an excess supply of services. [ABSTRACT FROM AUTHOR]

The First Nations in Manitoba, Canada, are calling for active recognition and incorporation of holistic traditional healing and medicine ways and approaches by the mainstream healthcare system that has hitherto tended to ignore all but biomedical approaches. This request for recognition requires elaboration on areas of opportunity for collaboration that could positively influence both Indigenous and allopathic medicine. We discuss pathways to an integrated healthcare system as community-based primary healthcare transformation. A community-based participatory research approach was used to engage eight Manitoba First Nations communities. One hundred and eighty-three (183) in-depth, semi-structured key informant interviews were completed in all communities. Grounded theory guided data analysis using NVivo 10 software. We learned that increased recognition and incorporation of traditional healing and medical methods would enhance a newly envisioned funded health system. Elders and healers will be meaningfully involved in the delivery of community-based primary health care. Funding for traditional healing and medicines are necessary components of primary health care. An overall respect for Indigenous health knowledge would aid transformation in community-based primary health care. Recognition of and respect for traditional healing, healers, medicines, therapies, and approaches is also recommended as part of addressing the legacy and intergenerational impact of assimilative policies including Indian residential schools as the Truth and Reconciliation Commission of Canada has stated in its Calls to Action. [ABSTRACT FROM AUTHOR]

Mental health researchers and practitioners alike have recognized that there are special considerations and challenges involved in diagnosing and treating mental illnesses in athletes. However, very few clinical psychologists and psychiatrists in Canada specialize in sport, representing a significant gap in mental health care service provision for this population. In this study, a group of expert sport and mental health stakeholders (n = 17) employed a Participatory Action Research approach to design a specialized sport-focused mental health care model integrated within the Canadian Centre for Mental Health in Sport (CCMHS). Stakeholders engaged in focus group discussions to perform an environmental scan of the Canadian sport and mental health care contexts that laid the foundation for a Group Concept Mapping (GCM) exercise. Using the Concepts Systems software, stakeholders individually produced statements that described the elements to include in a sport-specific mental health care model implemented within the CCMHS. A total of 106 unique statements were organized into 6 themed clusters, focusing on: (1) service delivery [40 statements], (2) communications and promotion [20 statements], (3) business, policy, and operations [19 statements], (4) partnerships [9 statements], (5) research [6 statements], and (6) education and training [6 statements]. These findings were operationalized to establish a sport-centered mental health care model and the CCMHS itself - the first Centre of its kind in Canada. GCM is seldom used to conduct sport research, thus the validity and reliability of this methodology was assessed. Lay Summary: In this study, 17 sport and mental health expert stakeholders participated in group concept mapping to design a sport-focused mental health care delivery model. The group produced 106 unique statements that were organized into six strategic priority areas and operationalized to establish the Canadian Centre for Mental Health and Sport. [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]

This article uses comparative historical analysis to explore physicians' involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build consensus around and promote specific policy ideas, and how federal institutions shape physicians' mobilization. In both countries, physicians' mobilization shaped the emergence of universal health care coverage, but in quite different ways, because of the differing federal institutions. Although the Brazilian medical lobby was far more heterogeneous than the Canadian profession, one faction was able to mobilize at the local level to pursue policy ideas favorable to universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Cannabis (marijuana) has been legalized for recreational and/or medicinal use in many US states, despite remaining a Schedule-I drug at the federal level. As legalization regimes are established in multiple countries, public health professionals should leverage decades of knowledge from other policy areas (e.g., alcohol and tobacco regulation) to inform cannabis policy.Objectives: Identify policy lessons from other more established policy areas that can inform cannabis policy in the United States, Canada, and any other nations that legalize recreational cannabis.Methods: Narrative review of policy and public health literature.Results: We identified six key lessons to guide cannabis policy. To avoid the harms of "a medical system only in name," medical cannabis programs should either be regulated like medicine or combined with the recreational market. Capping potency of cannabis products can reduce the harms of the drug, including addiction. Pricing policies that promote public health may include minimum unit pricing or taxation by weight. Protecting science and public health from corporate interest can prevent the scenarios we have seen with soda and tobacco lobbies funding studies to report favorable results about their products. Legalizing states can go beyond reducing possession arrests (which can be accomplished without legalization) by expunging prior criminal records of cannabis-related convictions. Finally, facilitating rigorous research can differentiate truth from positive and negative hype about cannabis' effects.Conclusion: Scientists and policymakers can learn from the successes and failures of alcohol and tobacco policy to regulate cannabis products, thereby mitigating old harms of cannabis prohibition while reducing new harms from legalization. [ABSTRACT FROM AUTHOR]

Policy reforms targeting organizational structure, expansion of interprofessional teams, inclusion of collaborative practices, and shifting provider remuneration models have resulted with substantial change for providers and leaders with primary health care settings in Canada, USA, and elsewhere. Discourse analysis provides a theoretical lens that can help build an understanding about the implications of different modes of communication on the implementation of new policy initiatives like new models of primary health care. This study applies discourse analysis to determine the modes of communication that were used to relay policy expectations underpinning a newly emerging interprofessional model of primary health care. We conducted a secondary analysis of a qualitative study conducted between 2010 and 2011 with primary health care leaders and policy informants during a period of health care reform in Canada. In-depth semi-structured interviews were conducted with seven key policy informants (PIs) and 29 primary health care leaders (physicians, executive directors, and non-physician clinical leaders). Discourse analysis is useful in the investigation of the meanings of health, health policy, and health care settings. [ABSTRACT FROM AUTHOR]

This article explores how multiple contexts - professional knowledge (e.g. case management), institutional practices (e.g. New Public Management), and mental health policies and legislations (e.g. Mental Health Act) - under neoliberal governance (re)produce ways social workers interact with their clients in moment-to-moment interactions. It is part of a larger process and outcome research project on cross-cultural social work practice in outpatient community mental health settings in an urban Canadian city. Using transcripts of audio-taped sessions between social workers and clients with severe mental illness, and inspired by critical theories of language, knowledge and power, we illustrate how neoliberal themes (re)position clients and social workers in negotiating session tasks in everyday interactions, and how these interactions shape the clients and social workers as desirable and undesirable neoliberal subjects. These detailed studies in micro-interactions can be used as practice examples in considering how social workers can be critically reflective of our own micro practice and resist the governing neoliberal ideology in the macro level. [ABSTRACT FROM AUTHOR]

Based on a critical review of the obesity and health literature we provide five models of how the hypothesized obesity and health relationship is conceptualized. We then apply these models to make sense of how recent Canadian public health reports and clinical practice guidelines conceptualize the issue of obesity, its causes and health effects, and appropriate responses. We show how conformity to dominant models of the obesity and health relationship by health sciences researchers, public health workers, and the media lead to activities that rather than promoting health, actually threaten it. These dominant models - and the activities derived from them - do so by diverting attention from the far more important issues of the quality and distribution of the social determinants of health. These approaches also stigmatize heavy individuals, doing little to promote their health. For these reasons, we call for an end to seeing obesity as a significant health issue. [ABSTRACT FROM AUTHOR]

Background:In 1998, the province of Ontario, Canada implemented price-cap ‘70/90ʹ regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics’ price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of the first or subsequent generic entrants. This study assessed the impact of such price-cap regulations on market entry by generic firms using the formulary database from 9 provinces (January 2004-March 2013). Methods:A logistic regression was estimated to compare the probability of entry during the three policy periods in Ontario (‘70/90ʹ, ‘25ʹ, versus ‘50ʹ). Since different price-caps were subsequently introduced in other provinces, Alberta, British Columbia, New Brunswick and Saskatchewan, difference-in-differences was used to compare market entry. Results:In Ontario, compared with the period ‘50ʹ, generic firms were 76% and 63% less likely to enter markets in the periods ‘25ʹ and ‘70/90ʹ, respectively. The difference-in-differences showed that the entry probability decreased the most in Ontario during the ‘25ʹ period from the ‘50ʹ period. Conclusion:Lowering the price-cap level to 25% leads to a significantly lower probability of market entry by generic firms. [ABSTRACT FROM PUBLISHER]

Introduction: Provincial drug-program policies for the reimbursement of testosterone replacement therapy (TRT) vary across Canada, which may result in marked regional variability in use.Methods: We conducted a population-based cross-sectional analysis of provincially funded TRT spending and utilization in eight provinces across Canada in 2012. We reported the annual cost per user, total cost, and rate of use of TRT overall and by formulation.Results: We identified 23,544 provincially-funded recipients of TRT in 2012 in the eight provinces studied. Average annual cost per person varied by 3-fold, ranging from $173 (Prince Edward Island) to $485 (Ontario). Ontario also had the highest rate of use (1,105 users per 100,000 eligible) and the most liberal listing. Provinces with more restricted access (Alberta, British Columbia, and PEI) had lower annual costs per user ($293, $206, $173, respectively).Conclusions: Differing reimbursement policies for TRT products across Canada are likely contributing to variation in the rate of use and cost per recipient. [ABSTRACT FROM AUTHOR]

In January 2012, the National Advisory Committee on Immunization (NACI) of Canada recommended that males aged 9-26 years receive the human papillomavirus (HPV) vaccine to protect against genital warts and HPV-associated cancers. Estimated HPV vaccine uptake rates for Canadian males are extremely low. Using a content analysis of Canadian newspaper articles, this study investigated what information about the HPV vaccine was relayed to the public, and how this content was portrayed following the 2012 male HPV vaccine recommendation. A search was conducted using Proquest Canadian Newsstand Complete for newspaper articles published between January 1, 2012, and September 1, 2014. Researchers coded 232 articles on several relevant dimensions: article information; epidemiological information; public policy information; article topic; article and title tone; and informant testimony. The majority of articles (93%) mentioned that girls are eligible for the HPV vaccine, whereas only half (49%) mentioned male eligibility. While most articles associated HPV with cervical cancer (85%), fewer indicated its relation to other HPV-associated cancers (59%) or genital warts (52%). Most articles (60%) were positive or neutral (22%) in tone toward the HPV vaccine, while few had mixed messages (11%) or were negative (6%). Less than 5% of articles reported on issues of morality, suggesting that fears that the HPV vaccine causes promiscuity have largely subsided. Notably, article tone toward male vaccination became progressively more positive over time. However, half of the articles did not mention the vaccine's approval for males, and articles tended to report HPV's relation to cervical cancer over other HPV-associated cancers. The Canadian public may thus be unaware of male eligibility and the importance of HPV vaccine for males. The collaboration of researchers, health care providers, and policymakers with journalists is critical in order to disseminate complete and accurate HPV and HPV vaccine information. [ABSTRACT FROM AUTHOR]

Refugees immigrating and settling into new countries face several factors that negatively impact their mental health and general wellbeing. Accompanying this, refugees encounter various barriers impacting their access to social support, mental health assistance, and healthcare services. In Canada, there is a call for healthcare professionals working with refugees to implement more culturally appropriate methods to form the necessary human connections that will foster refugees' access and utilization of mental health services. This column discusses how leaders and policy makers in Canada, or in similar settings, may want to consider including refugees in the decision-making and action plans aimed to address barriers impacting their mental health. Investing in patient-orientated research may assist leaders in Canada, or in comparable locations, to develop culturally appropriate and relevant policies that may address the refugee's mental health needs. [ABSTRACT FROM AUTHOR]

The author presents a response to insights about his paper on policy development for health care decision making in critical-care settings. Topics covered include the importance of enabling the maintenance of trust among parties in decision making, the capacity of health professional organizations in developing authoritarian policy statements for critical care and the use of the scope of customary critical care practices plus as part of a dispute resolution process.

The article discusses the experiences of indigenous children with disabilities with provincial and federal jurisdictional and funding disputes in Canada. Topics covered include the country's adversarial legal and policy techniques to delay funding and implementation of the Canadian Human Rights Tribunal action called Jordan's Principle. Also mentioned are social work practice, social work education, and ethnic minorities.

An international research collaboration answered, “Can equity in perinatal health for migrant women be measured for comparison across countries?” In nine countries, perinatal databases were assessed for the availability of equity indicators. Equity data were also sought from women and health records. Optimal sources of data differed depending on the migrant perinatal health equity indicator. Health and migration data, required to capture equity, were often not reported in the same location. Migration indicators other than country of birth were underreported. Perinatal health equity can be measured for international comparisons, although a standardized protocol is required to capture all indicators. [ABSTRACT FROM PUBLISHER]

With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003–2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient–provider–system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed. [ABSTRACT FROM AUTHOR]

maladjustedwas a participatory play produced by Theatre for Living and directed by David Diamond, with 18 theatre showings in Vancouver, Canada. The play explored the mechanization of mental health services and the possibility of “human-centred care.” Patients and caregivers developed and acted in the play. Using the interactive strategies of Forum Theatre, 2020 audience members had opportunities to role-play and suggest policy, resulting in a condensed 32-point policy report. Both subject pertinence and insistence on high quality theatre led to success. Engaged audiences resulted in a form of innovative problem solving that was then linked to policy makers and health care organizations. [ABSTRACT FROM AUTHOR]

Health opportunities and risks have become increasingly global in both cause and consequence. Governments have been slow to recognise the global dimensions of health, although this is beginning to change. A new concept – global health diplomacy (GHD) – has evolved to describe how health is now being positioned within national foreign policies and entering into regional or multilateral negotiations. Traditionally, health negotiations have been seen as ‘low politics’ in international affairs: however, attention is now being given to understanding better how health can increase its prominence in foreign policy priorities and multilateral forums. We sought to identify how these efforts were manifested in Canada, with a focus on current barriers to inserting health in foreign policy. We conducted individual interviews with Canadian informants who were well placed through their diplomatic experience and knowledge to address this issue. Barriers identified by the respondents included a lack of content expertise (scientific and technical understanding of health and its practice), insufficient diplomatic expertise (the practice and art of diplomacy, including legal and technical expertise), the limited ways in which health has become framed as a foreign policy issue, funding limitations and cuts for global health, and lack of cross-sectoral policy coordination and coherence, given the important role that non-health foreign policy interests (notably in trade and investment liberalisation) can play in shaping global health outcomes. We conclude with some reflections on how regime change and domestic government ideology can also function as a barrier to GHD, and what this implies for retaining or expanding the placement of health in foreign policy. [ABSTRACT FROM PUBLISHER]

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation. [ABSTRACT FROM AUTHOR]

The primary purpose of this article is to demonstrate how immigrant/refugee women's access to health services is influenced by both immigration and health policies. The author argues that the wheel of health care must revolve along with the wheel of immigration. The application of health immigration policies that existed preconfederation, as well as health care interventions based on Eurocentric principles, limit minority women's accessibility to health services. An integrated dialogue between all levels of government, health care professionals, policy makers, researchers, and immigrant groups is critical to provide equitable access to health care to foster immigrant settlement in Canada's smaller communities and rural areas. [ABSTRACT FROM AUTHOR]

The authors examine the politics of health-promotion dissemination in health policy using provincial cases from the Canadian Heart Health Initiative (CHHI)-Dissemination Phase, a nationwide chronic disease prevention initiative that took place between 1994 and 2005. Drawing on an analysis of health policy documents and key informant interviews from three provincial CHHI projects, the authors highlight the challenges to incorporate health-promotion strategies oriented toward collective approaches to health within variably “individual” oriented policy climates during a time of health reform. In doing this, the authors uncover a “politics of scale” where researchers developed very different strategies to advance chronic disease prevention within a contested political terrain. What emerged were strategies unique to provincial context. Understanding the politics of scale within health policy development provides insight into how health-promotion strategies should be shaped to achieve maximum effect. [ABSTRACT FROM PUBLISHER]

In response to the mental health disparities experienced by Aboriginal peoples, and related inequities regarding the accessibility to appropriate mental health care, there has been a shift in health policy to endorse ‘By Indigenous for Indigenous’ health care delivery models. In Canada, this has resulted in the creation of new mechanisms for Aboriginal participation in health care planning by health authorities with the goal of fostering culturally safe mental health and addictions care. Yet, there is a growing concern about the effects of neo-liberal cost concerns in health policy on the effective implementation of such progressive reform ideas. Drawing on a critical policy review and ethnographic interviews with four community-based Aboriginal organisations and one health authority, this article uses ‘cultural safety’ as a critical lens to discuss emerging tensions within the context of regional Aboriginal mental health care reform in British Columbia. The findings of this study draw attention to the intersecting ways that dominant socio-historical and political ideologies undermine cultural safety in decision-making and funding practices, thereby creating situations of cultural risk for both Aboriginal people working within the area of Aboriginal mental health and by extension for Aboriginal people who are seeking mental health and addictions care. The insights gained from this research contribute to the ongoing dialogue regarding how to foster culturally safe mental health policy and practice, and for action in the political realm. [ABSTRACT FROM PUBLISHER]

The United States and Canada are rather similar in social orientation. However, this is not reflected in health care. Firstly, Canada implemented the principle of universal coverage much earlier than the United States. Secondly, U.S. health care continues to rely much more on private funding and private managing, while Canadian health care relies more on cost containing public funding and governmental budgeting. These differences can be explained, among other things, by their different paths of development since the American Revolutionary War: the United States followed an independent path while Canada was oriented on Europe (for a long period of time). The different governance structures of health care and associated institutions such as lobbying result in a much higher health care expenditure in the United States than in Canada. [ABSTRACT FROM AUTHOR]

The field of arts and health is rapidly gaining momentum in Canada despite the challenges of integration across a vast geography, two official languages and multiple interdisciplinary cultures. Although the field is young, there is a solid foundation of innovative work and great enthusiasm on the part of diverse practitioners about the field's salience and impact. This article provides an overview of the arts and health in Canada and considers work that spans health policy, healthcare practice, individual and community health promotion, health professional education and arts-based health research. A final section offers reflections and recommendations on arts and health in Canada. We provide an online appendix through the journal's website that refers the interested reader to Canadian programs, resources, networks and other materials on the arts and health. [ABSTRACT FROM AUTHOR]

Worldwide, policymakers are critically examining the escalating costs of health care. One proposed solution has been to move away from a centralized “general hospital”-type of treatment in favor of a family-based model emphasizing health as well as treatment. While I agree that such approaches constitute an innovative outlook on health care, I draw on a social ecological approach in order to attract attention to and lay out the argument for future research examining the unacknowledged and unstudied impact that such proposed policies will have on women. Undoubtedly, it is they who will bear the brunt of the proposed health-related responsibilities offloaded by governments. I examine the implications of such proposed policies on Canadians, particularly Canadian women, although the Canadian system is but an exemplar of the changing dynamics of caregiving in a broader world situation. [ABSTRACT FROM AUTHOR]

High-quality child care is a boon for children and buffers some of the long-term negative effects of growing up in straitened circumstances. Yet, just one in seven Canadian children has access to regulated care. Within this, poor children have worse access and are over-represented in lower-quality care arrangements. Canada's policy architecture, as reviews of Winnipeg, Quebec, and Vancouver demonstrate, generates inequities of access and quality that reproduce neighborhood socioeconomic gradients of class and racialization. Poor children are systematically disadvantaged by a national approach that relies on privatized partnerships with the voluntary sector to implement public child care policy. Equalizing poor children's access to quality child care remains a pressing Canadian challenge, and will require policy and delivery redesign. [ABSTRACT FROM AUTHOR]

Health reform remains the most contentious policy issue in Canada. Medicare is subject to the same political forces that demand state retrenchment in other areas, but it has escaped wholesale reorganization because of the commitment of Canadians to the principles of medicare, because the provinces and the federal government remain locked in a battle about provincial autonomy, and because the existing system serves the interests of various professional groups including organized medicine. Nevertheless, reform and, especially, expansion of coverage is essential if the existing system is to be sustained. The most encouraging aspect of current debate is the recognition that we can look beyond the U.S. for reforms more consistent with the underlying values of Canadians than is the U.S. system. [ABSTRACT FROM AUTHOR]

This article investigates the health care access among gay, lesbian, bisexual, and Two-Spirit (glbt-s) people in Canada. Up until recently, little documentation existed on the health needs and experiences of gay, lesbian, bisexual and glbt-s people outside the realm of HIV prevention and treatment for gay and bisexual men. As a result, health care practitioners and policy makers know very little either about the global health and well-being of glbt-s people or about how best to develop appropriate and relevant gay-positive health and social services for them. In addition, while gay, lesbian, bisexual and Two-Spirit communities have much anecdotal information and personal experience to thaw upon with respect to health and health care issues facing glbt-s communities, they have little hard data with which to argue for the adaptation of health systems and institutions to better meet their needs. The absence of documentation on the global health needs of glbt-s people can be traced to the historic and current oppression they face within society generally and within health and social service institutions specifically. Because glbt-s people have historically been socially defined within medical terms as mentally ill, the health care system has been one of the primary arenas through which control over theft lives was exerted.