Search results

Social science and media depictions of youth living on our city streets typically focus on their “risk behaviours,” especially illicit drug use and unprotected sex, the social environmental challenges they face, in particular higher likelihood of sexual and physical assault and homicide (Tyler, Hoyt, & Whitbeck, 2000; Auerswald & Eyre, 2002; Pedersen & Hegna, 2003; Brooks, Milburn, Rotheram, & Witkin, 2004; Ensign & Bell, 2004; Raleigh-DuRoff, 2004; Hyde, 2005; Witkin et al., 2005) and their delinquent/criminal behaviour (Hartnagel, 1998). This focus on the multiple “risks” that street youth face has been accompanied by the search for determinants of the risk factors for street involvement, such as parental substance abuse and child neglect. Female street youth have been depicted as particularly vulnerable, partly because once on the street, they come under the control of male recruiters who make the girls drug-dependent and force them into trading sexual favours for money or in-kind goods. According to Bagley and Young (1987, p. 23), “the girl who finally tries prostitution is one who is already degraded and demoralized, in a state of psychological bondage, with grossly diminished self-confidence.” Adults who exploit these female street youth are believed to take advantage of their feelings of disconnectedness and low self-esteem and isolation (Silbert & Pines, 1981, 1982a, 1982b) and addiction to substances (Green & Goldberg, 1993). Yet, many females who were victims of childhood physical and sexual abuse do not end up on the street, nor do all those who were abused and end up on the street (male as well as female) become involved in prostitution, and, finally, many males and females who become involved in prostitution have no history of early abuse (Hagan & McCarthy, 1997).

Drawing on closed and open-ended interview data (n=79), this paper explores the health care experiences of a purposive sample of sex industry workers in a medium-sized metropolitan area of British Columbia, Canada. The respondents reported high average health care utilization and many reported satisfactory access to health care, including a positive relationship with a regular health provider. However, several respondents reported feeling intimidated and shamed in health care settings (felt stigma) and many choose to withhold information relevant to their health care due to fear of discrimination (enacted stigma) by health professionals.

The purpose of this study was to examine the prevalence of social suffering among a non-random sample of Canadian women working in socially and economically marginalized “frontline” service occupations. Participants identified a number of health concerns that they link to the everyday suffering they endure – i.e. feeling inadequate, incompetent, lonely, self-conscious, disenfranchised or dissatisfied. The complex etiology of these women's suffering bars many from finding appropriate health care. As a result, there are health disparities among our vulnerable populations. While they often articulated a desire for alternative/complementary care, the Canadian health care system does not currently fund these services and many of the women are unable to afford the out-of-pocket costs.

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates.

Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland.

Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices.

Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals.

Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.