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This chapter analyzes governmental responses to the COVID-19 pandemic in a highly decentralized federal country. Canada has a decentralized approach in many policy areas, including health care, in which provinces are the primary decision-makers and service providers. This decentralized health-care system allowed provinces to respond according to regional and local contexts and needs. The capacity building and the policy learning related to previous crises and horizontal coordination were key to policy responses to the pandemic. Moreover, unlike other countries, Canada did not centralize decisions throughout the pandemic, and did not reinforce competition and uncoordinated actions. The federal government also has had a central role coordinating COVID-19 policy responses. Nevertheless, Canada faced some challenges stemming from the lack of uniformity across the country, especially related to regional and local restrictions, enforcement mechanisms, testing, and travel restrictions.

Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers.

The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically.

The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system.

Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.

Canada’s visible minority population is increasing rapidly, yet despite the demographic significance of this population, there is a surprising dearth of nationally representative health data on visible minorities. This is a major challenge to undertaking research on the health of this group, particularly in the context of investigating racial/ethnic disparities and health disadvantages that are rooted in racialization. The purpose of this paper is to summarize: mortality and morbidity patterns for visible minorities; determinants of visible minority health; health status and determinants of the health of visible minority older adults (VMOA); and promising data sources that may be used to examine visible minority health in future research.

A scoping review of 99 studies or publications published between 1978 and 2014 (abstracts of 72 and full articles of 27) was conducted to summarize data and research findings on visible minority health to answer four specific questions: what is known about the morbidity and mortality patterns of visible minorities relative to white Canadians? What is known about the determinants of visible minority health? What is known about the health status of VMOA, a growing segment of Canada’s aging population, and how does this compare with white older adults? And finally, what data sources have been used to study visible minority health?

There is indeed a major gap in health data and research on visible minorities in Canada. Further, many studies failed to distinguish between immigrants and Canadian-born visible minorities, thus conflating effects of racial status with those of immigrant status on health. The VMOA population is even more invisible in health data and research. The most promising data set appears to be the Canadian Community Health Survey (CCHS).

This paper makes an important contribution by providing a comprehensive overview of the nature, extent, and range of data and research available on the health of visible minorities in Canada. The authors make two key recommendations: first, over-sampling visible minorities in standard health surveys such as the CCHS, or conducting targeted health surveys of visible minorities. Surveys should collect information on key socio-demographic characteristics such as nativity, ethnic origin, socioeconomic status, and age-at-arrival for immigrants. Second, researchers should consider an intersectionality approach that takes into account the multiple factors that may affect a visible minority person’s health, including the role of discrimination based on racial status, immigrant characteristics for foreign-born visible minorities, age and the role of ageism for older adults, socioeconomic status, gender (for visible minority women), and geographic place or residence in their analyses.

The purpose of this paper is to use a descriptive case study to establish how collaboration, innovation and knowledge‐management strategies have scaled‐up learning and development in rural, remote and other resource‐constrained Canadian delivery settings.

Intervention design was realized through a one‐time, collaborative, national capacity‐building project. A project portfolio of 72 sub‐projects, initiatives and strategic activities was used to improve access, enhance quality and create capacity for palliative and end‐of‐life care services. Evaluation was multifaceted, including participatory action research, variance analysis and impact analysis. This has been supplemented by post‐intervention critical reflection and integration of relevant literature.

The purposeful use of collaboration, innovation and knowledge‐management strategies have been successfully used to support a rapid scaling‐up of learning and development interventions. This has enabled enhanced and new pan‐Canadian health delivery capacity implemented at the local service delivery catchment‐level.

The intervention is bounded by a Canada‐specific socio‐cultural/political context. Design variables and antecedent conditions may not be present and/or readily replicated in other nation‐state contexts. The findings suggest opportunities for future integrative and applied health services and policy research, including collaborative inquiry that weaves together concepts from adult learning, social science and industrial engineering.

Scaling‐up for new capacity is ideally approached as a holistic, multi‐faceted process which considers the total assets within delivery systems, service catchments and communities as potentially being engaged and deployed.

The Pallium Integrated Capacity‐building Initiative offers model elements useful to others seeking theory‐informed practices to rapidly and effectively scale‐up learning and development efforts.

Due to ongoing inequities in the social determinants of health and systemic barriers, homelessness continues to be a significant concern that disproportionately impacts racialized communities. Despite constituting a small proportion of the population, Black individuals are over-represented among people experiencing homelessness in many Canadian cities. However, although Black homelessness in Canada is a pressing issue, it has received limited attention in the academic literature. The purpose of this paper is to examine the reported prevalence of Black homelessness across Canada.

By consulting enumerations from 61 designated communities that participated in the 2018 Nationally Coordinated Point-in-Time Count and two regional repositories – one for homeless counts supported by the government of British Columbia and another from the Rural Development Network – this paper reports on the scale and scope of Black homelessness across Canada.

Significantly, these reports demonstrate that Black people are over-represented among those experiencing homelessness compared to local and national populations. These enumerations also demonstrate significant gaps in the reporting of Black homelessness and inadequate nuance in data collection methods, which limit the ability of respondents to describe their identity beyond “Black.”

This research provides an unprecedented examination of Black homelessness across Canada and concludes with recommendations to expand knowledge on this important and under-researched issue, provide suggestions for future iterations of homeless enumerations and facilitate the development of inclusive housing policy.

Canadian epidemiological data suggest an increasing number of HIV infections among people from HIV-endemic countries, including sub-Saharan Africa. Currently, there are few studies that focus on the lived experience of HIV illness among Canadian residents of African ancestry. The purpose of this paper is to study the lived experiences of African immigrants living with HIV in Canada, using narrative inquiry methodology.

This qualitative study focussed on the experiences of sub-Saharan African immigrants living with HIV in Alberta, Canada. Using the philosophical underpinnings of narrative inquiry methodology (Clandinin, 2013), three African immigrants living with HIV in Alberta contributed to this study over an extended period of time. Between five and six interviews were conducted with each participant, over a period of 12 months. Interviews were digitally recorded, transcribed, and negotiated with each participant during analysis to uncover the experience and meaning of living with HIV as African immigrants in Canada.

The researchers found several narrative threads related to: stigma, social, and family exclusion; as well as HIV illness as a complex personal, familial, and social experience. Also, narratives across different geographic and social spaces shaped the complex experience among African immigrants living with HIV in their new host country of Canada.

The authors recognize that the sample size, though appropriate for narrative inquiry study, was small. The intention with this research was not to generalize findings to the broader African immigrant community that is affected by HIV illness in Canada. Rather, the intent was to demonstrate a deeper understanding of lived experience, among African immigrants living with HIV in Canada.

The findings show the complex personal, familial, and societal factors that shape the experience of living with HIV and HIV-related stigma among African immigrants. It is important to understand such factors and the experience of HIV-related stigma because such experiences impact access to health and social services, as well as health and social outcomes of immigrants living with HIV.

This is the first Canadian study to examine lived experience of African immigrants living with HIV in Canada. This study demonstrates a deep understanding of lived experience, among African immigrants living with HIV in Canada. Complex personal, familial, and societal factors shape the experience of living with HIV and HIV-related stigma. Based on the findings of this study, further research is needed to: study more closely the familial contexts of African families affected by HIV in Canada; explore the social and political landscapes that impact the experience of HIV illness and related stigma in Canada, in the context of migration and settlement; and examine the relationship between these experiences and the health and social outcomes of African immigrants living with HIV in Canada.

Food insecurity (FI) is an important social determinant of health and is linked with higher health care costs. There is a high prevalence of FI among recent migrant households in Canada. The purpose of this paper is to evaluate the prevalence of FI in Sub-Saharan African and Caribbean migrants in Ottawa, and to explore determinants of FI in that population.

A cross-sectional study was conducted among 190 mothers born in Sub-Saharan Africa or the Caribbean living in Ottawa and having a child between 6 and 12 years old. Health Canada’s Household Food Security Survey Module was used to evaluate participants’ food security in the past 12 months. χ² tests and multivariate logistic regression analyses were used to measure determinants of FI (n=182).

A very high rate of FI (45.1 percent) was found among participants. When numerous determinants of FI were included in a multivariate model, household FI was associated with Caribbean origin, low education attainment, lone motherhood, living in Canada for five years or less and reliance on social assistance.

These findings highlight the need for FI to be explicitly addressed in migrant integration strategies in order to improve their financial power to purchase sufficient, nutritious and culturally acceptable foods. Enhancing migrants’ access to affordable child care and well-paid jobs, improving social assistance programs and providing more affordable subsidized housing programs could be beneficial.

The foreign-born skilled immigrant population is growing rapidly in Canada but finding a job that utilizes immigrants’ skills, knowledge and experience is challenging for them. The purpose of this paper is to understand the self-perceived health and social status of skilled immigrants who were working in low-skilled jobs in the service sector in Ottawa, Canada.

In this qualitative study, semi-structured interviews with 19 high-skilled immigrants working as taxi drivers and convenience store workers in the city of Ottawa, Canada were analysed using a grounded theory approach.

Five major themes emerged from the data: high expectations but low achievements; credential devaluation, deskilling and wasted skills; discrimination and loss of identity; lifestyle change and poor health behaviour; and poor mental and physical health status.

The study demonstrates the knowledge between what skilled immigrants expect when they arrive in Canada and the reality of finding meaningful employment in a country where international credentials are less likely to be recognized. The study therefore contributes to immigration policy reform which would reduce barriers to meaningful employment among immigrants reducing the impacts on health resulting from employment in low-skilled jobs.

This study provides unique insights into the experience and perceptions of skilled immigrants working in low-skilled jobs. It also sheds light on the “healthy worker effect” hypothesis which is a highly discussed and debated issue in the occupational health literature.

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.

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.

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.

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.

The creation of an organization outside the constitutional framework of health care funding may allow for a catalytic role in precipitating change.

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.

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.

This paper aims to describe the process to create an inventory of the facilities in Canada designated to incarcerate women and girls, health service responsibility by facility, facility proximity to hospitals with maternity services and residential programmes for mothers and children to stay together. This paper creates the inventory to support health researchers, prison rights advocates and policymakers to identify, analyse and respond to sex and gender differences in health and access to health services in prisons.

In spring 2019, this study conducted an environmental scan to create an inventory of every facility in Canada designated for the incarceration of girls and women, including remand/pretrial custody, immigration detention, youth facilities and for provincial and federal sentences.

There are 72 facilities in the inventory. In most, women are co-located with men. Responsibility for health varies by jurisdiction. Few sites have mother-child programmes. Distance to maternity services varies from 1 to 132 km.

This paper did not include police lock-up, courthouse cells or involuntary psychiatric units in the inventory. Information is unavailable regarding trans and non-binary persons, a priority for future work. Access to maternity hospital services is but one critical question regarding reproductive care. Maintenance of the database is challenging.

Incarcerated women are an invisible population. The inventory is the first of its kind and is a useful tool to support sex and gender and health research across jurisdictions.