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Browsing Health by Subject "Canada"
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Item Open Access HPV Vaccine Access and Cervical Cancer Policymaking Process: A Comparative Governmental Priority Setting Study of Ghana, Rwanda, and Canada(2023-12-08) Asempah, Eric; Wiktorowicz, Mary E.Cervical cancer is a global health issue that claims over 600,000 lives yearly. While high-income countries (HICs) record lower incidence rates of cervical cancer, the opposite is true for underserved regions, such as sub-Saharan Africa (SSA), where a significant burden of global cervical cancer cases are reported. Over 70% of all cervical cancer is caused by high-risk (strain 16 and 18) human papillomavirus (HPV). Currently, prophylactic vaccines, Gardasil® and Gardasil9®, manufactured by Merck; Cervarix®, manufactured by GlaxoSmithKline (GSK); and Cecolin® manufactured by Xiamen Innovax Biotech Co, prevent HPV-related cervical cancer. However, most low- and middle-income countries (LMICs) national immunization programs do not include these vaccines. The thesis explores governmental priority settings and the policymaking imperatives for nationwide HPV vaccination in Canada, Rwanda, and Ghana. Ghana, a LMIC, has a cancer policy that covers cervical cancer; however, it lacks a specific policy governing the prevention and control of the disease. Rwanda (also a LMIC), on the other hand, was the first country in sub-Saharan Africa to implement a nationwide HPV vaccine program that aims to reduce and eventually eliminate cervical cancer case incidence and mortality. Canada, one of the first Organization for Economic Cooperation and Development (OECD) nations to implement province-wide HPV vaccination programs, provides instructive health policymaking propositions. Primary and secondary data were collected to develop country-specific case studies on the imperatives for the HPV vaccination program/policy in each country. A comparative analysis supports understanding the similarities and dissimilarities in policymaking and the environment within which the HPV vaccine and cervical cancer program were planned, formulated, and organized for implementation as a health intervention instrument. The results show different policy convergence and divergence nodes among the countries studied as governments look for solutions to public problems. Because governments have myriad competing public problems to address, selectively solving some problems and leaving others may depend on priorities and available resources. Prioritizing and deciding to act by implementing public HPV vaccination programs in HICs, such as Canada, and LMICs, such as Rwanda, and not acting due to resource constraints reveals that governments can leverage creative approaches to act on a public problem successfully with or without plentiful resources.Item Open Access Medical Education and Financial Conflict of Interest Relationships with the Pharmaceutical Industry in Canada: An Analysis of Four Areas of Medical Education(2016-11-25) Shnier, Adrienne Rebecca; Lexchin, Joel. R.Financial conflict of interest (FCOI) relationships in medicine have been found to expose medical education in medical schools, medical journals, and continuing medical education (CME) hosted by professional medical associations (PMAs) to vulnerability to corporate bias. Institutional policy analysis concerning FCOI relationships and industry involvement in medical education in Canada is limited. Therefore, informed by neoliberal corporate bias theory and Mertonian norms of science, this dissertation contributes analyses of conflict of interest policies, disclosures, and opportunities for drug company involvement in the production and dissemination of medical knowledge. In a publication-based dissertation format, the first manuscript provides an evaluation of conflict of interest policies at the 17 medical schools in Canada. The second manuscript provides an analysis of the culture of corporate science, informed by neoliberal ideology, through an examination of the extensive and pervasive roles of the drug promotion industry in clinical trial research, interpretation, writing, and publishing in medical journals. The third manuscript offers an evaluation of policies concerning FCOI relationships and industry involvement in CME development and programming adopted by 60 professional medical associations in Canada. The fourth and final manuscript comprises an quantitative analysis of FCOI relationship disclosures in Canadian clinical practice guidelines. In general, these evaluative efforts found that the policy environment concerning industry involvement in various types of medical education in Canada is permissive and FCOI relationships are common among guideline authors. Positioned within the context of neoliberal corporate bias theory and Mertonian norms of science, these findings of general policy permissiveness indicate an alignment of goals between the pharmaceutical industry and medical education institutions. The necessity for increased transparency in terms of industrys roles in not only conducting, analyzing, interpreting, and publishing pharmaceutical research, but also data sharing is supported by existing literature on financial conflict of interest relationships with the pharmaceutical industry. Furthermore, the strengthening and enforcement of policies on industry involvement and FCOI relationships in these areas of medical education would help to ensure that medical education in the publics interest is achieved.Item Open Access Psycho-Social Contributions to Higher Type 2 Diabetes Mellitus Prevalence among South Asian Immigrants Living in Canada(2018-11-21) Kabir, Syeda Farahnaaz; Raphael, DennisThis thesis studies psycho-social aspects of the experiences of South Asian immigrants (SAI) in Canada and how these may be related to the elevated presence of type 2 diabetes mellitus (T2DM) in this group. It does so by examining the way in which variables such as education and income levels, the gap between education and income levels, and psycho-social variables related to stress, predict the presence of T2DM in this group as compared to two other social groups: Chinese Immigrants (CI) and Canadian born whites (CBW). The results of this research support the hypotheses laid out for this dissertation that exposure to education/income gap increases risk for T2DM, and that SAI have higher risk for T2DM compared to CI and CBW.Item Open Access Tackling Health Inequalities through Public Policy Action: Insights from Canadian Policy Academics, Activists, and Advocates(2022-12-14) Borras, Arnel Mercado; Raphael, DennisDespite numerous public policy proposals and interventions to address preventable health inequalities, that is, health inequities among and within countries, this societal problem persists. This research addresses how and why health inequities, especially class, race/ethnicity, and gender health inequities, persist in Canada and how to reduce such differences through public policy action. First, I performed a theoretical and critical realist review of existing literature focusing on pluralism, discursive institutionalism, and critical political economy approach to health and policy change. Then I conducted a thematic analysis of the interview data corpus gathered from 23 semi- structured interviews with leading and influential Canadian policy academics, activists, and advocates to address the research questions. Reflexivity also forms part of my methods. The main findings demonstrated that health inequities or the avoidable health inequalities in Canada are primarily caused by 1) the capitalist economic system; 2) the co-constitutives of capitalism, namely colonialism, racism, and sexism; and 3) maldistributive public policies. Health inequities are further sustained by 1) power, interest, and ideology trumping evidence-based research and policy ideas; 2) unequal wealth and power among competing interests and advocacy groups; 3) the dominance of the business and corporate sector in health politics and public policymaking processes; 4) neoliberal governing authorities; and 5) fragmented and weak labour unions, civil society groups, and social movements. Canada’s health inequities reduction efforts necessitate 1) pushing for redistributive public policies; 2) uniting and strengthening labour unions, civil society groups, and social movements; and 3) engaging in electoral politics. The core strategies to realize these health equity goals are the ensemble of information, education, advocacy, organization, and mobilization. Reducing health inequities in general and class, race/ethnicity, and gender health inequities, in particular, may involve struggling within and against capitalism and struggling for socialism. This study may provoke social actions toward emancipatory social change to achieve health justice.Item Open Access The Adaptation Experiences of Transnational Physiotherapists in Ontario, Canada: A Grounded Theory Approach(2022-08-08) Andrion, Jeffrey John; Lum, Lillie L. Q.In both research and policy, much attention has been given to further understand how inter-nationally educated professionals integrate in Canada. However, little attention has been given to the reintegration experiences of physiotherapists who were educated and trained internationally. Using the constructivist grounded theory (CrGT) method, the main study objective was to generate a theory to further explore these issues. Following the CrGT approach, transnational physiotherapists were invited to share their Canadian integration experiences. The participants’ reflections about their lived experiences, feelings, and thoughts led to the identification of the contextual elements (micro, meso, and macro) as the dominant themes of “Facilitators” and “Barriers”. Further analysis revealed that a specific set of structural barriers and facilitators point to the five integration stages and six adaptation identities. In this study, identity adaptation (IA) emerged as the core theory that explained the participants’ successes and challenges. The contributions of this study are the first to be reported in the physiotherapy-immigration discourse. These include identifying the various social structures and processes that impact the integration of the transnational physiotherapists. Some of these examples include the positive effect of social networks and the negative implications of the “Canadian experience” (CE) requirement. The results have implications for more successful professional integration at the education, policy, and practice levels.Item Open Access Youth Substance Use: A Critical Analysis of Tensions Between Federal Policy Discourse and Frontline Service Provision in Ontario(2021-07-06) Ali, Farihah; Chaufan, ClaudiaSubstance use ranging from experimentation to problematic use and addiction is most common among youth and young adults. Evidence shows that the earlier in life individuals begin to use substances, the higher the risk for substance misuse. Adolescence and young adulthood are life stages when behaviours and habits become established. They are also periods of social and developmental change as youth navigate through challenges and transition through social roles. In order to respond to substance use issues in Ontario, the substance use service provider arena is guided by federal policies and offers a range of services from both public and private domains, intended to support youth experiencing substance use issues. My dissertation had three objectives: 1) to assess the experience of frontline service providers to shed light on their perspectives on challenges faced by youth who use substances; 2) to critically evaluate representations of substance use among youth in a federal substance use strategy document that informs provincial level practice; and 3) to assess the policy implications of the tensions between dominant representations of substance use in policy documents and the lived experience of frontline service workers in the field of substance use for policy, practice and equity. To achieve these objectives, I conducted an online survey of Ontario service providers recruited from youth-oriented addiction substance use treatment organizations, I followed up with qualitative key informant interviews of a sub-sample of willing survey participants, and I assessed dominant representations of the problem of substance use using the critical policy approach of WPR (Bacchi, 1999), through an examination of the National Canadian Drugs and Substance Use Strategy (CDSS). My findings revealed significant tensions between theory and practice. While frontline providers expressed the need for harm-reduction, non-pharmacological and prevention initiatives for youth, the National Strategy downplayed this need, as well as the significance of the social determinants of health, while largely framing the behaviours of users of substance as falling under the jurisdiction of the criminal justice system. I offer policy recommendations on how to reduce the identified gaps between dominant representations and practice and propose strategies to encourage policy makers to develop youth-appropriate substance use reduction policies.