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Purpose: Varying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada's provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship. Design/methodology/approach: The arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada's healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada. Findings: Here, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health; developing a citizenship-based system of care; addressing identity-related disparities; employing youth community health workers within services; adapting and delivering citizenship-based interventions; and connecting youth in care to civic-oriented organizations. Originality/value: This paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis. [ABSTRACT FROM AUTHOR]

Purpose: Over the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies. Design/methodology/approach: The study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995. Findings: At the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern. Social implications: The implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed. Originality/value: This paper is the first study of the kind using Canadian data. [ABSTRACT FROM AUTHOR]

Purpose: Health systems are progressively stressed by health spending, which is partially explained by the increase in the cost of health technologies. Countries have defined processes to prioritize interventions to be covered. This study aims to compare for the first time health technology assessment (HTA) processes in Canada and Chile, to explain the factors driving these decisions. Design/methodology/approach: This is a health policy analysis comparing HTA processes in Canada and Chile. An analysis of publicly available documents in Canada (for CADTH) and Chile (for the Ministry of Health (MoH)) was carried out. A recognized political science framework (the 3-I framework) was used to explain the similarities and differences in both countries. The comparison of processes was disaggregated into eligibility and evaluation processes. Findings: CADTH has different programmes for different types of drugs (with two separate expert committees), whereas the MoH has a unified process. Although CADTH's recommendations have a federal scope, the final coverage is a provincial decision. In Chile, the recommendation has a national scope. In both cases, past recommendations influence the scope of the evaluation. Pharmaceutical companies and patient associations are important interest groups in both countries. Whereas manufacturers and tumour groups are able to submit applications to CADTH, the Chilean MoH prioritizes applications submitted by patient associations. Originality/value: Institutions, interests and ideas play important roles in driving HTA decisions in Canada and Chile, which is demonstrated in this novel analysis. This paper provides a unique comparison to highly relevant policy processes in HTA, which is often a research area dominated by effectiveness and cost-effectiveness studies. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a study of the transformation of First Nations’ health governance, describing the development of partnerships between First Nations and provincial and federal governments for co-creating solutions to address First Nations’ health inequities in British Columbia (BC). The paper frames this transformation in the context of a Canada-wide reconciliation initiative stimulated by the Truth and Reconciliation Commission.Design/methodology/approach This qualitative case study was a joint initiative between Simon Fraser University and the BC First Nations Health Authority (FNHA), involving interviews with senior leaders within the BC health system, FNHA and First Nations communities. In addition, a policy roundtable was held in February 2015 which gathered 60 participants for further dialogue on the process.Findings Key themes included: partnership and relationships, governance and reciprocal accountability, First Nations perspectives on health and wellness, and quality and cultural safety. Findings indicate that significant transformational changes have happened in the relationship between First Nations and the mainstream health system. The creation of the FNHA has led to more representation for First Nations people at all levels of governance and health service planning, which will ultimately lead to more culturally safe health services that incorporate a First Nations perspective of wellness.Social implications The transformation of First Nations health governance in BC can serve as an example in other indigenous health settings both within Canada and internationally.Originality/value This paper describes a transformative health governance process in First Nations communities that is an historical first in Canada. [ABSTRACT FROM AUTHOR]

Purpose: The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada. Design/methodology/approach: Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings). Findings: The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence. Originality/value: The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.Design/methodology/approach A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.Findings The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team's empathetic view of patients, anchored in the service's history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team's values, changes in refugee healthcare coverage strengthened the service's culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.Originality/value This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to examine the progress of the Mental Health Commission of Canada (MHCC) over the first five years of its existence toward stated goals while existing outside the constitutional framework of health care funding. Design/methodology/approach – The paper is a review of the outputs of the MHCC with emphasis on its first-ever mental health strategy for Canada, knowledge exchange network, anti-stigma initiatives, randomized controlled trial of housing-first initiatives for the homeless mentally ill, as well as other completed projects. Findings – Consultation and collaboration are essential aspects of working successfully with people with lived experience of mental illness, their families, health professionals, and governments. At the same time, when expectations are high, needs are great, and opinions are varied, disappointment and frustration are inevitable. Research limitations/implications – Although the MHCC initiatives include the largest single funded research project in mental health in Canadian history, and evaluation is built into other initiatives, the political dimension of its work does not lend itself to research evaluation. Practical implications – The creation of an organization outside the constitutional framework of health care funding may allow for a catalytic role in precipitating change. Social implications – The emphasis on anti-stigma campaigns targeted at defined populations (youth, health professionals, workforce, journalists) may combat the discrimination people with mental illnesses and their families experience. Originality/value – The paper shows that the Canadian experience is, to date, largely undescribed in the peer-reviewed literature and may influence other jurisdictions. One of its interventions is already being replicated internationally. [ABSTRACT FROM AUTHOR]

Purpose Almost 20 years after the Royal Commission on Aboriginal Peoples, indigenous peoples living in Canada continue to pursue their legitimate aspirations for greater control over factors affecting their lives. The purpose of this paper is to summarize two major policies (the Royal Commission on Aboriginal Peoples and the Truth and Reconciliation Commission (TRC)) that aimed to create equity for indigenous peoples’.Design/methodology/approach Commentary and rapid communication to inform and clarify evolving high-priority policy and governance issues related to indigenous peoples’ of Canada.Findings A need exists to create a platform for implementing the TRC actions to protect and promote education, language and culture, justice, youth programming, and professional training and development.Research limitations/implications Innovative intervention research needs to develop solutions to multi-generational disparities in health and well-being for indigenous peoples of Canada and globally.Practical implications Failure to implement longstanding changes to improve indigenous health and well-being will result if a growing burden of premature morbidity and mortality among indigenous population of Peoples’ of Canada, the fastest growing population group with the most challenging health status in Canada.Social implications Indigenous peoples continue to experience profound health vulnerability leading to high health risks, growing health disparities and unequal access to health care services.Originality/value Connecting policy over two decades, for implementation to proceed, sharing of knowledge is essential to formulate innovative approaches, to engage research and build capacity to implement policy actions related to closing educational gaps, to developing culturally appropriate curricula acknowledging and protecting Aboriginal languages, as well as skills-based training in intercultural competency, conflict resolution and respect for human dignity and human rights equality in settings of anti-racism and free of all forms of prejudice and discrimination. [ABSTRACT FROM AUTHOR]

Purpose - There is much evidence of bias in research on the effectiveness and efficacy of drugs as a result of the influence of the pharmaceutical industry. The purpose of this paper is to present the views of those involved in a major evidence-based policy initiative from Canada and examine the adequacy of existing academic conflict of interest (COI) rules. Design/methodology/approach - Data came from the Alzheimer's Drug Therapy Initiative in British Columbia, a coverage with evidence development (CED) initiative, where a form of action research collected insights from the authors' experiences, combined with qualitative interviews with members of the research team. Findings - The majority of researchers perceive the influence of pharmaceutical manufacturers as problematic. Even when the strictest of COI rules are followed, extending well beyond disclosure, the reach of industry is so great that existing COI rules lag far behind their expanding influence. Practical implications - The authors support others who call for the funding of independent research, enforcement of existing disclosure rules, and unfettered publication rights. In addition, the authors urge the education of all research team members, including clinicians, on the evidence indicating the variety of forms through which industry influence is exerted. The authors believe that this awareness-raising can help toward minimizing that influence in the analyses that are conducted. Originality/value - Consideration of pharmaceutical influence on CED research is important. There may be an untrue assumption that CED is functioning at arms-length from the drug companies. [ABSTRACT FROM AUTHOR]

Purpose: This review aims to examine the literature on refugees' and asylum seekers' resilience, its historical evolution, key principles, assumptions and recommendations, while focusing on the Canadian context. Design/methodology/approach: A narrative literature review has been applied to this manuscript. This approach allows the integration of a wide scope of literature and perspectives, from academic literature to grey literature (e.g. governmental reports and dissertations). Nevertheless, the limitations of this type of review were also discussed. Findings: In spite of the gaining popularity of the resilience lens, which emphasizes an individual's ability to overcome adversities and stressful events, more work is required for its effective integration into health practice, programs and policies, particularly as it relates to refugees' and asylum seekers' mental health care. Originality/value: Careful consideration of refugees' and asylum seekers' mental health needs and Canadian mental health service delivery and policies is a critical first step in reaching such a goal. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe divergent recent developments in provision of reproductive health services to North Americans. Design/methodology/approach – Narrative review. Findings – Two North American countries with very different histories present similar governance challenges today. The challenge is to provide all women with the full range of reproductive health options to which they are legally entitled now. In Canada, those contraception and abortion options are covered under the medical service plan insurance but not always available in convenient locations. In USA, those options are not uniformly covered under health insurance plans due to statutory limitations. In Canada, where federal law limiting abortion was struck down as unconstitutional, the leader of one of its three major federal political parties sees the way forward being to limit his party to pro-choice candidates. In USA, where new laws limiting abortion have been introduced at an unprecedented rate, the judiciary is being asked to define the way forward. Originality/value – Clinical governance needs to balance the moral beliefs of individual providers against the rights of patients to have their lawful choices available within reasonable convenience. Progress has been made but needs are still not adequately met, in these North American examples. [ABSTRACT FROM AUTHOR]

Purpose: Integrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care. Design/methodology/approach: The scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes. Findings: Overall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used. Research limitations/implications: Despite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended. Originality/value: The originality of this study is to provide evidence on integrated oral healthcare during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: A global pandemic, non-occupational noise-induced hearing loss (NIHL) is a completely preventable public health problem, which receives limited air time. This study has dual purposes: to contribute to scholarly literature that puts non-occupational NIHL on the global priority map and to effect change in the City of Vancouver's policies toward noise. Design/methodology/approach: Experts in public health and hearing health were contacted in addition to a scoping literature search on PubMed. Information pertaining to both developed and developing countries was obtained, and comparison was made to Canada where possible. The authors met with elected officials at the City of Vancouver to inform them of the win–win aspects of policies that promoted better hearing. Findings: Non-occupational NIHL is an underappreciated issue in Canada and many other countries, as seen by the lack of epidemiological data and public health initiatives. Other countries, such as Australia, have more robust research and public health programs, but most of the world lags behind. Better hearing health is possible through targeted campaigns addressing root causes of non-occupational, recreational noise – positive associations with loud noise. By redefining social norms so that soft to moderate sounds are associated with positive values and loud sounds are negatively attributed, the societies will prevent leisure NIHL. The authors recommend widespread national all-age campaigns that benefit from successful public health campaigns of the past, such as smoking cessation, safety belts and others. Soft Sounds are Healthy (SSH) is a suggested name for a campaign that would take many years, ample resources and sophisticated understanding of behavior change to be effective. Research limitations/implications: A gap exists in the collection of non-occupational NIHL data. Creating indicators and regularly collecting data is a high priority for most nations. Beyond data collection, prevention of non-occupational NIHL ought to be a high priority. Studies in each region would propel understanding, partly to discern the cultural factors that would predispose the general population to change favorable attitudes toward loud sounds to associations of moderate sounds with positivity. Evaluations of these campaigns would then follow. Practical implications: Everyday life for many people around the world, particularly in cities, is loud. Traffic, construction, loudspeakers, music and other loud sounds abound. Many people have adapted to these loud soundscapes, and others suffer from the lack of peace and quiet. Changing cultural attitudes toward loud sound will improve human and animal health, lessen the burden on healthcare systems and positively impact the economy. Social implications: Industries that create loud technologies and machinery ought to be required to find ways to soften noise. Regulatory mechanisms that are enforced by law and fines ought to be in place. When governments take up the banner of hearing health, they will help to set a new tone toward loud sounds as undesirable, and this will partially address the root causes of the problem of non-occupational NIHL. Originality/value: Very little public health literature addresses NIHL. It is a relatively ignored health problem. This project aims to spurn public health campaigns, offering our own infographic with a possible title of Soft Sounds are Healthy (SSH) or Soft Sounds are Sexy (SSS). The study also aimed to influence city officials in the authors' home, Vancouver, and they were able to do this. [ABSTRACT FROM AUTHOR]

Purpose--Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity-building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity-building effort and to identify various implications for the future. Design/methodology/approach--This analysis of capacity-building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis. Findings--More than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity-building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at aft stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations. Originality/value--Using concrete examples of capacity-building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems. [ABSTRACT FROM AUTHOR]