Major Research Papers - Health

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Open Access
'Fat' or Fiction: Examining the Role Political and Economic Forces Play in Driving the Concern over Obesity
(2015-08-25) Ali, Ahmednur; Raphael, Dennis; Pilkington, Beryl
This paper attempts to examine the present focus on obesity by government officials, the private sector, and the general public. More specifically, this paper argues that there is a hyper-concern with obesity that stems more from well-established power dynamics and societal structures than a result of medical concern over public health. The role of political and economic forces is argued as being the reason for this hyper-concern. A critical analysis of the literature is presented to identify the underlying relevant factors that drive this hyper-concern with obesity. Finally, this paper considers the implications this hyper-concern with obesity can potentially have on the distribution of wealth, power, and influence within the public and private sector. This paper will also attempt to critically assess the clinical practice guidelines created to address obesity by the Registered Nurses' Association of Ontario, the Canadian Medical Association, the American Medical Association, and the Australian government. The argument that these clinical practice guidelines lack the breadth and depth to adequately and effectively address obesity will be put forth and highlighted in the context of six specific concerns.
Open Access
Let's Talk About 'fat': Conceptualization of Obesity in Canada, the Role of Social Determinants of Health & Neoliberal Policies
(2015-08-26) Medvedyuk, Stella; Raphael, Dennis; Daiski, Isolde
In the last twenty years, obesity has become a major concern in the public health and academic literatures. Most of this literature stems from a biomedical and behavioural/lifestyle perspective. However, parallel to this view emerged a different approach which questioned the validity of the obesity ‘epidemic’. This Major Research Paper (MRP) focuses on how obesity is conceptualized in Canada by analyzing two governmental and one non-government report through use of qualitative content analysis. A critical analysis of these reports will use Labonte’s (1993), supplemented by Raphael, framework of biomedical, behavioural/lifestyle, socio-environmental and critical structural approaches. It explores whether social determinants of health play a role in these reports. And lastly, a political economy approach is used to explore how the Canadian political climate with its neoliberal public policy reforms formulates and influences strategies proposed to ‘treat’ obesity.
Open Access
Towards Equitable Health Policy: A Critical Approach to Canadian Housing Insecurity and Homelessness as Informed by Political Economy and Social Determinants of Health
(2016-09-30) Borras, Arnel Mercado; Raphael, Dennis; Gaetz, Stephen
Housing insecurity and homelessness is a complex phenomenon. Its causes are found in processes at the micro, meso, and macro-levels. In Canada, the rise of economic globalization and neoliberalism contributed to the decline of the welfare state with retraction of the national housing program and the transfer of housing responsibility from the federal to provincial and territorial governments, all of which contributed to the rise of Canadian housing insecurity and homelessness. The state of housing insecurity and homelessness in Canada is a national crisis. It is well established that housing insecure and homeless people have a higher prevalence of mortality and morbidity than the general population. Yet, Canada remains without national anti-poverty, affordable housing, and homelessness strategies, thus, the crisis persists. The current federal government housing and homelessness strategies may not be the best solutions to prevent and end housing insecurity and homelessness. What is required is the adoption of “A Critical Approach to Canadian Housing Insecurity and Homelessness as Informed by Political Economy and Social Determinants Of Health” that takes into account the broader economic, political, social, and cultural factors that shape housing insecurity, homelessness and health inequities. In the long term, this should prove to be a more promising policy approach to the housing insecurity and homelessness issue.
Open Access
The State and Community: Issues in Mental Health Reform in Ontario
(2016-12-08) Di Pierdomenico, Kaitlin; Reaume, Geoffrey; Wiktorowicz, Mary
Mental health reform in Canada is imperative. Evidence shows that nearly half of Canadians with mental health and addiction problems are unable to access the care they require. Inequities to mental health and addictions care have been created by the passive privatization of critical mental health and addiction supports and services, not protected under the Canada Health Act, such as psychological services. The two-tiered system of care fosters inequities, as individuals of lower income, often with poorer social determinants of health, are denied access. The public and personal costs associated with umnet mental health and addiction needs are too significant to ignore. Mental health and addictions cost the Canadian economy $51 billion annually, and rates of suicide and homelessness amongst individuals unable to secure access to care are high. Decades of policy reports have endorsed investing in community mental health to provide a comprehensive continuum of services for individuals with mental health and addiction problems. Despite an increase in mental health funding, investments in the community have not been prioritized. This paper explores transformations in forms of governance of the liberal state and the impact on mental health reform. Using Ontario as a case study, the paper employs the Power Resource Theory guided by Quality of Government to examine the neoliberal influence on welfare state retrenchment, in order to expose the delay in mental health reform and resulting inequities to care.
Open Access
Analyzing Health Financing and the Implications on Health Access and Equity in Canada, Nigeria and Ghana
(2017-09-01) Onilude, Yemisi; Schraa, Ellen; Raphael, Dennis
This major research paper examined health financing and the implications for health equity and access to care in North America and Sub-Saharan Africa (SSA) countries with emphasis on Canada, Nigeria and Ghana. Relevant scholarly journal articles and books were reviewed to meet the objectives of this paper. Literature analysis was used to examine the data obtained for this study. Research findings show that health financing is driven by free market economy (neoliberalism) in both SSA and Canada. Moreover, in making comparison of health financing in the developed and developing nations from 2000 to 2014, the study revealed that the total health expenditure as a percentage of GDP for both Nigeria and Ghana is less than half that of Canada. Also, the government of Ghana is stronger than Nigeria in terms of public health care funding, although both countries are making positive progress in health financing. Generally, the public health financing in Canada is larger than in both Ghana and Nigeria. In the perspective of global health financing, this indicates the presence of inequality in government health expenditure in HICs and LMICs. Furthermore, the analysis shows there are many barriers to the attainment of health financing objectives. This study recommends reform of health care financing systems and giving higher priority to health in government budgetary allocations in various countries as a way of addressing these barriers. In conclusion, it is appropriate for governments of every nation to utilize resources efficiently and equitably for healthcare and ensure prudent spending of money for proper policies in health finance and enhanced health care delivery.
Open Access
A Critical Literature Review of the Impact of Precarious Work on the Mental Health of Immigrant Women in Canada
(2017-09-29) Umaigba, Karina; Raphael, Dennis; Tompa, Emile
This critical review draws on existing literature on the discourse of precarious work within the Canadian nation-state. The goal of this research work is to critically examine the impact of precarious work on the lives, well-being and mental health of immigrants with a specific focus on immigrant women. Given that most research works have been mainly focused on the way in which precarious work creates health inequalities, this paper aims to throw light on the way in which precarious work can affect mental health. Also, the paper will examine the Canadian public policy response to this issue. The paper argues that Canada’s policy response is a reflection of the dominant political ideology within this nation-state. The dominant political ideology of neoliberalism seeks to justify minimal state intervention in policies that directly affect health and more broadly citizen’s life. The following principal questions will guide this critical review. 1) Why are immigrants, particularly immigrant women of color disproportionately situated in precarious forms of labour within the Canadian nation-state? 2) How does precarious work affect the mental health of immigrant women? 3) How and to what extent has capitalism and neoliberalism within the Canadian nation-state helped to perpetuate precarious working conditions for racialized immigrant women? By interrogating Canada’s neoliberal policy agenda as it affects immigrants through entrenched legislations of immigrant classes, the primary goal of this paper is to advance the construction that immigrants/migrants exist for economic exploitation and gain. The main theoretical framework that will guide this analysis is based on a post-colonial feminist scholarship that analyzes how inequities grounded on gender, race, class, and migratory status intersect to create complex and diverse labour market results for racialized immigrant women in Canada. A common theme that emerged throughout the critical review of several scholarly and grey literatures is that more women than men are situated in precarious work, and of those women in precarious forms of employment, women who identified as members of a visible minority group were even more disproportionately situated in precarious forms of work. Also, it was observed that the Canadian nation-state has to date failed to respond appropriately to this social and economic situation. Since employment and working conditions, unemployment and employment security -- described as some of the most crucial social determinants of health -- are significantly correlated to income and its security, allowing precarious work has only served to reinforce high-levels of income inequality, income insecurity and poverty within Canada.
Open Access
A Seed Will Grow In Proper Soil: Education and Health Literacy as the Starting Points for Structural Reformation Through the Addressing of the Social Determinants of Health within Canada
(2017-09-29) Waddington, Nathan; Raphael, Dennis; Chaufan, Claudia
The purpose of this paper is to show that due to the lasting effects it has on health, well-being, critical thinking skills, and political advocacy, the structure of education in general and a focus on health literacy in particular should be a fundamental starting point when attempting to improve and promote the health of Canadians. Of special attention should be understanding the pathways by which public policy and the social determinants of health shape health and well-being. Possessing an adequate level of education and possessing critical health literacy are important determinants of health which improve other social determinants throughout the life course. To properly address the health problems we now face in Canada, we must acknowledge the effects of the social determinants of health and public policy, as well as promote education and political activism on these factors. Improvements in education and critical health literacy can create a better environment for emancipatory ideas and strategies to promote health and alter the structure of society. Exposing the public to such concepts will help gain social and political support for the structural changes that are needed in Canada to address these complex and lasting problems in society now and in the future.
Open Access
Competing Approaches to Household Food Insecurity in Canada
(2017-10-11) Mendly-Zambo, Zsofia; Raphael, Dennis; Daly, Tamara
Household food insecurity (HFI) impacts over 1.1 million households, adversely impact the health and well-being of individuals and families. Despite the recognition of the right to food by several international covenants, indicating that Canadian governments are obliged to reduce HFI, little has been done by the Canadian government to defend this right. The Canadian Government’s failure to address HFI has resulted in the creation of a number of non-governmental means of managing the problem, which have not been successful in redressing HFI. Furthermore, non-governmental responses may have served to depoliticize the issue of HFI, allowing governments to obfuscate their responsibility in addressing HFI. Four competing approaches of HFI in Canada, nutrition and dietetics, community traditionalism, social determinants of health and political economy complicate solutions by differently conceptualizing and framing the causes and appropriate responses to HFI. I argue that the political economy framework–which views the rise in HFI as precipitating from the skewed distribution of economic and social resources as a result of imbalances in power and influence–best explains the causes of food insecurity and presents the most effective means of responding to its presence in Canada by acknowledging the larger political and economic structures that shape and precipitate HFI.
Open Access
The World Bank, Development Policy, and the Promotion of Gender Equality: New Ways or Old Tricks?
(2018-01-18) Power, Luke; Daly, Tamara; Chaufan, Claudia
Alongside the United Nations’ (UN) Sustainable Development Goals (SDG), the World Bank’s (WB) 2015 Gender Equality Strategy may be described as a major endeavour by the global community to promote sustainable development through poverty eradication and gender equality. As succinctly articulated within the document “no society can develop sustainably without transforming the distribution of opportunities, resources, and choices for males and females so that they have equal power to shape their lives and contribute to their families, communities, and countries. Promoting gender equality is smart development policy” (2016:7). Thus, as posited within this quote it may be stated that through gender equality and the promotion of female empowerment the World Bank, amongst other international/ national institutions, is attempting to refocus its developmental programs towards social investment- a clear distinction from the programs endorsed during the 1970s/80s. This reorientation within developmental policy has be termed the Post-Washington Consensus (Birshall and Fukuyama 2011). Incidentally, of critical importance to this investigation is the distinction between equality and equity. Whilst, equality relates to the equal distribution of resources, one for one, equity focuses upon the distribution of resources according to need- need here being a product of a social environment characterized by power differentials and hierarchal structures. The documents failure to comment upon this distinction, and its preoccupation with the former, is telling. Whilst the dominant narrative embedded within the document may be seen as inherently emancipatory and premised upon the development of a socially just system, a plethora of literature challenges these claims (Cammack 2002, 2003, 2004; Harvey 2005a, b; Navarro 1999, 2000, 2014; Peet 2003). Alternatively, these authors propose that the strategies which characterize this apparent ‘reorientation’ are a continuation of past development practices. This is reflected within their proclivity towards the proletarianization of the global work force, the transformation of non-capitalist locations into capitalist ones, and the ascendency of market principles into societal arrangements which they have been historically absent from for example. welfare arrangements. In particular Harvey (2005a) posits that the development practices, both historic and contemporary, are a concerted effort to promote capital accumulation – specifically primitive accumulation- during periods of crisis. In relation to its contemporary form, Harvey maintains the promotion of market liberalization/ privatization, deregulation, and depoliticization (promoting civil society over party based politics) represents both historic tendencies and contemporary issues. These historic tendencies relate to the necessity of accumulation whilst contemporary issues relate to the social/ class based forces which limit the capacity for the historic tendency to occur. Whilst this crisis relates to the World Bank’s promotion of market values over social justice as embodied within structural adjustment programs (Kolko 2002) – it similarly relates to the crisis in accumulation. Roberts and Soederberg (2012) reiterate this point in their critical examination of the World Bank’s 2012 development report. Utilizing a feminist Marxist position these authors posit that the dominant proposition of financial integration embedded within the report is a product of failed accumulation within this sector. More specifically, Roberts and Soederberg note that this is a product of the 2007/ 08 financial crisis and the subsequent decline in asset productivity that followed this. According to these authors, the development report, and by consequence the World Bank, is focused upon supporting and stabilizing capital accumulation during and through periods of systematic crisis. Thus, through a contextual examination into the current political and economic climate one may argue that this apparent reorientation towards a social investment model is a direct reaction to the simultaneous crisis in both legitimacy and accumulation (Toussaint 2008). Simply, the World Bank is focused upon damage control. Accordingly, in relation to the critical propositions detailed above, we need to critically examine the World Bank and the development strategies that they propose- specifically when they refer to emancipatory goals and the alleviation of social injustices/ inequalities. In order to provide a comprehensive and critical examination of the World Bank’s gender equality strategy, specifically in relation to its health consequences, one must situate it within a historical and political context and highlight both its discursive dimensions and practical implications.
Open Access
NAFTA - The Politics Behind Drug Production
(2018-02-16) Mohamed, Faisal Ali; Chaufan, Claudia; Raphael, Dennis
In the year 1993, the Canadian federal government ratified the North American Free Trade Agreement (NAFTA), with the ostensible purpose of improving trade relations and economic prosperity for the country. For ratification to proceed, and in response to pressure from the pharmaceutical industry, between 1987 and 1993 significant changes were made to Canada’s Patent Act. Changes included the elimination of a system of compulsory licensing and the strengthening of intellectual property rights (IPRs). Compulsory licensing allows competitors to produce drugs still under patent without the consent of the patent holder, if public interest, such as a public health emergency, warrants it, thus challenges drug monopolies and leads to lower prices, whereas intellectual property rights have the opposite effect – they lengthen patent protections, thus shielding patent holders from competition and leading to higher prices. The pharmaceutical industry strongly opposed compulsory licensing, and lobbied for strong IPRs, arguing that research and development (R&D) required for pharmaceutical innovation involved high risks and costs and that weak IPRs (weak by their standards) undermined job creation by the industry. Since then, R&D risks, in Canada and elsewhere, have all but decreased, the promised jobs are nowhere to be seen, and increasing drug prices have led to medication non compliance on the part of a growing number of Canadians, with significant impact on the public’s health. This paper argues that to ratify NAFTA, laws were changed by the federal government to align with US IPR laws and serve the interests of transnational drug corporations, by creating an environment in which they could easily monopolize the national drug market, thus undermining the interests of the vast majority of Canadians. In so doing, the federal government has done an injustice to taxpayers, who were de facto made to subsidize unreasonable prices for Big Pharma, while the promises of increased Canadian R&D investments or job creation were never fulfilled. I aim to answer three questions: 1) Why is drug development treated as a market good rather than a public good or service? 2) How do provisions within NAFTA, a treaty signed by representatives of the Canadian state, deal with the tension between private corporate interests and public needs? 3) What discursive mechanisms within NAFTA legitimize private intervention and drug development and production? I perform a critical discourse analysis (CDA) on relevant key provisions from Chapter 17 of NAFTA as a means of answering these questions.
Open Access
The Reproduction of Patriarchy and the Politics of Gender in Medical Practice: A Critical Discourse Analysis Across Training, Career and Life
(2018-09-10) McDonald, Jennifer; Chaufan, Claudia; Morrow, Marina
Women physicians and women physician-researchers (WP/WPR), in Canada and in the United States, do not experience the same professional success, inclusion, and work-related health outcomes as their male colleagues despite current medical school acceptance parity. They work harder than the latter to meet clinical benchmarks, comply with professional imperatives, and live up to societal standards. These benchmarks, imperatives and standards are designed and reproduced by male physicians, when not reproduced by female physicians themselves. The hardships that contribute to the distress and burnout experienced by women physicians and physician researchers – including yet not limited to multiple-role demands impinging on women’s physical and emotional well-being – are acknowledged, yet not critiqued, by the medical community. Indeed, the dominant narrative within the profession frames these hardships as caused by gender-specific lifestyle and behavioural choices, using them as examples of how individual choices by women physicians and physician-researchers lead to career successes or failures, while neglecting to identify, much less challenge, the male-dominated construction of medical practice. Patriarchal structures, tendencies and biases embedded in the profession of medicine normalize and reinforce gendered institutional policies, professional practice, and societal values that favour male success in medicine and reproduce the distress and disadvantages experienced by women physicians and physician-researchers. Using a discourse analysis approach that illuminates how the discourse of medicine tends to reproduce the social order by excluding its critical appraisal, this paper examines the medical and healthcare policy literature to reconstruct the boundaries of the debate around gendered inequities in medical practice. I discuss these inequities and their impact on the health and well-being of women in medicine, and propose policies with the potential to both address these inequities and contribute to the integration of women in medicine. In so doing, these policy courses may also have significant, positive implications for health care delivery, in Canada, the United States and elsewhere.
Open Access
The Politics of Reproductive Health and Women's Rights: A Critical Discourse Analysis of Family Planning 2020
(2018-09-18) Wootton, Amanda; Chaufan, Claudia; Gonzalez, Miguel
Global population policy has been a recurring topic on foreign policy and international development agendas since the end of World War II. Since its inception, initiatives have taken many forms, but all have included a family planning element. Prior to the 1994 International Conference on Population and Development (the “Cairo Conference”), population policy was justified and applied under the premise of population control, which sought to limit fertility in poor countries with the goal of moving them forward on the traditional development trajectory (i.e. toward industrialization). In the years following, justifications and practices surrounding population policy shifted, and women and girls, reproductive health, human rights and empowerment were positioned at the center of narratives. Family Planning 2020 (FP2020), which is the most recent iteration of population policy to capture global consciousness, reflects this new way forward. In actuality, FP2020 has many of the same features as population control but is presented with new socially-acceptable discourse. Essentially, FP2020 exemplifies the intersection of the development industry, neoliberal ideology, private philanthropy in health governance, and population policy. In this paper, I argue that FP2020 reproduces narratives of elite global health and development institutions, like the United Nations Population Fund (UNFPA) and the Bill and Melinda Gates Foundation (the Gates Foundation), to push agendas that reflect their own ideologies and interests, including the unobstructed pursuit of global capital. Among others, these narratives include an emphasis on harmonious multisector collaboration, and the realization of women’s human rights and empowerment. This discourse acts to subdue and counteract potential criticism and drive support from various stakeholders, including those traditionally critical of population policies, such as grassroots women’s health movements. In doing so, FP2020 does injustice to those it claims to serve, which are primarily women and girls living in low and middle-income countries (LMICs). Guided by critical development theory, the method used in this paper is critical discourse analysis (CDA), which was performed on six key documents produced by FP2020.
Open Access
Pathologizing Abuse: Examining Public Health Approaches to Addressing Intimate Partner Violence in Canada
(2018-10-24) Nandakumar, Manasi; Raphael, Dennis; Ahmad, Farah
This paper aims to examine the medicalization of intimate partner violence (IPV) using critical political economy, feminist political economy and Foucault’s theory of power. A critical discourse analysis of publications released by public health and medical associations reveal explanations of IPV that avoid addressing the socio-political context in which family violence takes place. Additionally, the limiting epistemological frameworks guiding medical and public health disciplines give rise to professional and societal discourses that remain uncritical of larger political and social structures that perpetuate inequalities. Biologically and psychologically rooted theorizations of violence are shown to perpetuate a victimization model that places the locus of change at the individual. Drawing from concepts of decommodification and defamilisation, the MRP will explore the role of the Canadian welfare state in facilitating women’s dependency on the family. I argue that current approaches and initiatives proposed in the Chief Public Health Officer’s (CPHO) Report on the State of Public Health in Canada 2016: A Focus on Family Violence in Canada, A Year in Review: Canada’s Strategy to Prevent and Address Gender-Based Violence, the Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable adults: U.S. Preventive Services Task Force Recommendation Statement and the Intimate Partner Violence Consensus Statement by the Society of Gynecologists and Obstetricians of Canada fails to address the overall poor social standing of women that arises from inequitable macro-social policies. Findings of the analysis elucidate the ways in which abused women are further disenfranchised by policies informed by medical and public health discourses.
Open Access
Persistent Childhood Poverty in Canada: A Political Economy Analysis of its Causes
(2018-11-13) Duru, Catherine; Raphael, Dennis; Morrow, Marina
Child poverty is a global phenomenon, although with different rates among nations. It is high in the developing nations, but even in some developed countries, high child poverty rates have been recorded. The primary characteristic of child poverty is depriving children of the basic necessities of living. Child poverty is deepening in Canada, as in many other nations, and this calls for concern since this vulnerable group has limited opportunities for normal physical and mental development. About half of the world’s population that lives in extreme poverty are children, and in many countries, children live in more poverty than adults. Poverty in a developed country such as Canada, with well-articulated governmental structures and policies backed up by a growing economy, appears to be a misnomer but is a reality. More disturbing is the fact that child poverty determines the lifelong health outcomes of this vulnerable group. Later improvements in life circumstances have limited effect on already ingrained poor health. If Canadian children are to achieve their full potential, there is an urgent need for policymakers to revisit the issue of child poverty and prioritize children in their policy-making decision processes.
Open Access
Contracting Care: Evaluating the effects of the "Second Generation Health System Strategy' on the contracting environment for community organizations in the Downtown Eastside of Vancouver
(2019-04-11) Wood, Tesia; Daly, Tamara; Armstrong, Pat
This paper examines the impacts of the Downtown Eastside ‘Second Generation Health System Strategy’ (2GHSS) on the contracting environment for community organizations and programs receiving funding from the regional health authority, Vancouver Coastal Health (VCH). The 2GHSS was designed by VCH and implemented in 2015 with the aim of removing siloed services and providing a more integrated and responsive health system in the Downtown Eastside (DTES). The 2GHSS represents a significant reorientation of government priorities in the community and the accompanying funding shuffles and cuts – primarily directed at non-clinical programs and organizations – have shifted the landscape of the DTES third sector. Informed by the theoretical framework of feminist political economy, and through the use of thematic analysis, this paper identifies trends in the DTES contracting environment between 2015 and 2019 that reflect the intensification of medical dominance and indirect neoliberal governance, including: funding cuts to organizations without links to the formal health system; use of market-based competitive tendering; valuing health services for their clinical rather than their social components; and contributing to an environment of fiscal precarity. It is concluded the 2GHSS is an extension of the neoliberal ideological orientation that has long directed the priorities of the BC health sector.
Open Access
Creating Complex Systems: The Implications of the Immigration System Reforms for Refugee Health (2012)
(2019-05-17) Pak, Negeen; Hynie, Michaela; Daly, Tamara
In June 2012, the Canadian federal government introduced a new legislature, which drastically reformed the Canadian immigration system. During this time the Conservative government reformed the Interim Federal Health Program (IFHP), completely transforming health coverage for asylum seekers. This overhaul created a hierarchy, whereby asylum seekers would qualify for different levels of coverage based on their claimant status. This study explores the impacts of this policy change and outlines the inequity consequential to the reforms of 2012. It includes secondary thematic data analysis of interviews conducted with medical health professionals regarding the impacts of the 2012 decision. The study provides a comprehensive look at the implications of patchwork policies through three prominent themes: potential risks to women’s health; barriers to healthcare access (language, fear, cost); significant medical bills and delays lead to additional health problems. Finally, I conclude with policy recommendations for future federal and provincial governments.
Open Access
Youth-Serving Organizations' Inclusivity of LGBTQ Newcomers - A Content Analysis
(2019-08-09) Flett, Joseph; Morrow, Marina; Ahmad, Farah
LGBTQ newcomer youth in Canada experience unique challenges due to their intersecting identities which may negatively impact their well-being and development. For those lacking support at home and in school, youth-serving organizations provide various services and socialization that can effectively address these challenges. In a two-stage content analysis, this study explored LGBTQ newcomer inclusivity in 39 youth-serving organizations in Toronto and Vancouver, as well as programs and services offered to this population specifically. Stage 1 findings demonstrate that few organizations displayed inclusion of and supports for LGBTQ newcomers. Stage 2 findings show that approaches to programs and services offered to this population can be categorized into four themes: cultural and linguistic sensitivity, skills development & education, socialization & community connections, and health & well-being. The efficacy of their approaches is largely supported by the literature. Recommendations for best practices are discussed, with an emphasis placed on the importance of inclusive policies that incorporate an intersectional understanding of youth.
Open Access
Examining Mental Health Apps Potential in Providing Equitable Access to Care in the Global North and Global South: A Scoping Review
(2019-08-09) Rasendran, Raneeshan; Ahmad, Farah; Morrow, Marina
Promising, ongoing research on online mental health interventions or mental health applications (MHAPPs) has presented the global mental health care community with a potential solution to fill in the gaps in access to mental health care. Many of the MHAPPs have focused on conditions of depression and anxiety. Yet, it remains unclear whether such interventions can address the access to care gap in an equitable manner by reaching the diverse communities both in the global North and global South. The countries of Canada and United States were chosen as exemplars for the global North and China and India as exemplars for the global South. Using Arksey and O’Malley’s methodical framework, a scoping review was conducted on academic and grey literature published since 2015. Under critical social paradigm, the synthesis of review studies employed the social determinants of health lens along with role of macro forces like neoliberalism and collectivism-individualism. The results reveal that MHAPPs for depression and anxiety have been shown to be efficacious in studies both in the global North and global South, though few of the efficacious apps have been made freely available. Further, the guided-online interventions in the global North and global South are also found to facilitate program adherence, especially in rural settings. However, the review reveals that several barriers exist in the global South to make online interventions widely available and accessible. The identified barriers include mental health stigma and discrimination, financial and social challenges, difficulties in using the technology-based applications, and cultural barriers to ‘self-management’. In conclusion, this review has identified the potential of MHAPPs in broad settings; however, there is a need to design these programs by incorporating the social determinants of health framework to better address the structural barriers to access care. Policy makers should be cautious in steadily implementing MHAPPs in disadvantaged communities, as broader policies are needed to address the logistical capabilities of accessing online mental care. Further studies on MHAPPS are also needed with a bottom-up approach to adapt to various cultural context and reach marginalized communities. Given the specific focus of the presented review on Canada and United States as global North and China and India as global South, the findings need to be interpreted carefully. Further work by including additional geographic regions is needed to advance the scholarly understanding.
Open Access
The Problem of Power in ADHD: A Scoping Review
(2020-06-10) Joseph, Abraham; Morrow, Marina; Wiktorowicz, Mary
Attention deficit hyperactivity disorder (ADHD) has become the most diagnosed mental health issue for children worldwide. There are substantive critiques of the psychiatric basis for the conceptualization, diagnosis, and treatment that dominate the ADHD context. ADHD discourse and practice are largely influenced by the biomedical framework of mental health and illness. The pervasive, continued acceptance of the dominant biomedical ADHD narrative is problematic in terms of addressing mental health care needs as well as illustrative of the influence and power that psychiatry wields with respect to the ADHD landscape. Further, there is a lack of focus on the concept of power within the ADHD literature. This paper presents a power framework that locates the influence of psychiatric power vis-à-vis instrumental power, structural power, and discursive power. Operationalizing the dimensions of psychiatric power highlights the access points for resistance efforts aiming to counter and disrupt the status quo in ADHD from research to practice.
Open Access
The Problem of Power in ADHD: A Scoping Review
(2020-06-10) Joseph, Abraham; Marrow, Marina; Wiktorowicz, Mary
Attention deficit hyperactivity disorder (ADHD) has become the most diagnosed mental health issue for children worldwide. There are substantive critiques of the psychiatric basis for the conceptualization, diagnosis, and treatment that dominate the ADHD context. ADHD discourse and practice are largely influenced by the biomedical framework of mental health and illness. The pervasive, continued acceptance of the dominant biomedical ADHD narrative is problematic in terms of addressing mental health care needs as well as illustrative of the influence and power that psychiatry wields with respect to the ADHD landscape. Further, there is a lack of focus on the concept of power within the ADHD literature. This paper presents a power framework that locates the influence of psychiatric power vis-à-vis instrumental power, structural power, and discursive power. Operationalizing the dimensions of psychiatric power highlights the access points for resistance efforts aiming to counter and disrupt the status quo in ADHD from research to practice.