Research and publications

Permanent URI for this collectionhttps://hdl.handle.net/10315/32385

This collection consists of journal articles, pre-prints, conference papers and other research and scholarship by graduate students and faculty associated with the School of Health Policy and Management, which includes the Graduate Program in Critical Disability Studies and the Graduate Program in Health.

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Now showing 1 - 20 of 63

Access status: Open Access ,
They Deserve Better. The Long-term Care Experience in Canada and Scandinavia
(Canadian Centre for Policy Alternatives, 2009) Armstrong, Pat; Banerjee, Albert; Szebehely, Marta; Armstrong, Hugh; Daly, Tamara; Lafrance, Stirling
“They Deserve Better.” These words of one worker capture the essential message we heard in researching this book, words that can apply equally to residents and to those who are employed in long-term residential care. Long-term residential care has long been a crucial part of Canada’s care system and it is becoming increasingly so as more people live into old age and with severe disabilities. Even though the emphasis in recent years has been on care at home, many will still need residential care. Yet not much policy or research focuses on long-term residential care, and even less starts from the perspectives of the mainly female workers or recognizes the critical relationship between the quality of working conditions and the quality of care. This book seeks to fill this gap by beginning with the perspective of those who are employed in long-term residential care in Nova Scotia, Manitoba and Ontario and starts with the assumption that the conditions of work are the conditions for care. By comparing our results with those from a parallel study in four Nordic countries, we show both that the way we organize the work too often leads to poor conditions for care and that there are choices to be made in organizing, funding and delivering care. Both Canada and the Nordic countries have lots of room for improvement but by comparison, the Canadian system is over-burdened, under-funded, and short-staffed. In short, this sector is neglected. They Deserve Better examines the consequences of this neglect for both workers and residents and clearly demonstrates that there are alternatives.
Access status: Open Access ,
Exercising Choice in Long-term Residential Care
(CCPA, 2017) Armstong, Pat; Daly, Tamara; Armstrong, Pat; Daly, Tamara
Expanding choice has long been a central feature of health care reforms, with a focus on choices for individual patients and residents. However, choices are structured by factors often beyond the control of individuals or even particular care homes and by the extent to which staff or unpaid providers can build relationships that provide the basis for appropriate decision-making. Moreover, there is a fundamental tension between the need for routine, for evidence-informed decision making and for safety on the one hand and on the other, responding to individual choices and events that disrupt routines on a regular basis. Based on our team research on long-term residential care in six high income countries, Exercising Choice in Long-Term Residential Care identifies conditions that set the context for exercising meaningful choices for residents, staff, families and managers in long-term residential care. We start from the assumption that there will be events and choices that do not conform to routine patterns. And we assume that the conditions of work are the conditions of care.
Access status: Open Access ,
Liberal/Individualized Versus Materialist/Structuralist Approaches to Addressing Social and Health Inequalities: Education and Income as Social Determinants of Health
(SAGE Publications, 2025-01-26) Ervin, Avery; Raphael, Dennis
Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as a social determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes. Purpose: We offer a broader view, seeing these differing emphases as indicative of contrasting views of the nature of society and means of responding to these inequalities with emphasis on education representing a liberal reformist view of the issue while an emphasis on income representing a materialist structuralist view. Research design and study sample: We examine, the validity of this hypothesis through an analysis of content of five representative publications that consider educational attainment as a social determinant of health and five that do so for income. Analysis and results: We find that the emphasis on education as a social determinant of health focuses on the attributes of the individual and is generally accepting of the structures and processes of the existing economic and political order. In contrast, an emphasis on income - when placed within a materialist analysis - views existing systems as inequitably distributing income and other resources thereby requiring their reform or transformation. Conclusion: Considering evidence of deteriorating living and working conditions for many in Canada and elsewhere, we see the latter emphasis as more useful for understanding and addressing these disturbing developments.
Access status: Open Access ,
Canada and the Three Public Policy Taboos: Promoting Health Equity in Difficult Times
(Ontario Tech University, 2025-09-15) Raphael, Dennis; Suthakaran, Khirisha
Political scientist Julia Lynch outlines three aspects of modern capitalist welfare states that determine the extent of health inequalities: redistribution (transfer of income and wealth from rich to poor); social spending (state expenditures on benefits and assistance as well as social infrastructure); and managing the market economy (legislating working conditions, benefits, and employment security). These processes mediate the contradictions inherent in capitalist societies between capital accumulation or profit making and social reproduction or the ongoing functioning of society. Increasingly, these three public policy directions are seen as taboos by governing authorities, that is, practices to be avoided, and this is especially the case in nations identified as liberal welfare states. In this paper, we explore how Canada – and other liberal welfare states – stand in relation to other Organization for Economic Cooperation and Development countries in its willingness to violate these taboos, thereby reducing health inequalities. Reasons for Canada’s profile are presented as are means of overcoming these taboos in the service of promoting health equity.
Access status: Open Access ,
Critical Analysis of Jane Philpott's Health for All
(Ontario Tech University, 2025-05-26) Raphael, Dennis
Jane Philpott's Health for All is the most recent contribution to policy discourse related to health care and social determinants of health. Unfortunately, the volume is sadly lacking in critical analysis of the current economic and political environment in which health policy is being made.
Access status: Open Access ,
Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht
(2023-06-21) MacGregor, William; Horn, Martin; Raphael, Dennis
Bertolt Brecht’s poem “A Worker’s Speech to a Doctor” is frequently cited as a means of raising awareness among health workers of the effects of living and working conditions upon health. Less cited is his trilogy of poems entitled Call to Arms which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article we show how “A Worker’s Speech”, with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Calls to Arms Trilogy: “Call to a Sick Communist”, “The Sick Communist’s Answer to the Comrades”, and “Call to the Doctors and Nurses”. We also show that while “A Worker’s Speech” has been applied in the training of health workers, its accusatorial tone towards health workers’ complicity in the system the poem is critiquing risks alienating them. In contrast, the Call to Arms Trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a “communist” risks estranging these health workers, our analysis of the Call toAction poems nevertheless indicates their use can contribute to move health workers’ educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.
Access status: Open Access ,
Youth-Serving Organizations’ Inclusivity of LGBTQ Newcomers in Canada – A Content Analysis
(Journal of Gay & Lesbian Social Services, 2021-03-09) Flett, Joseph
For LGBTQ newcomer youth lacking support at home and in school, youth-serving organizations provide various services and socialization that can effectively address their 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 subpopulation specifically. Stage 1 findings demonstrate that few organizations displayed inclusion of, and supports for, LGBTQ newcomers. Stage 2 findings show that programs and services offered to this subpopulation can be categorized into four themes: cultural and linguistic sensitivity, skills development & education, socialization & community connections, and health & well-being. Recommendations for best practices are discussed.
Access status: Open Access ,
Tell me about Food Justice with Cheyenne Sundance. HLST 1011: Health on the Front Lines, School of Health Policy & Management, York University.
(2022-10-25) Vorstermans, Jessica
Tell me about food justice with Cheyenne Sundance. Video filmed for HLST 1011: Health on the Front Lines, School of Health Policy & Management, York University. Producer: Jessica Vorstermans. Filming: Regenesis.
Access status: Open Access ,
Tell me about immigration status & health with jade guthrie. HLST 1011: Health on the Front Lines. School of Health Policy & Management, York University.
(2021-11-12) Vorstermans, Jessica
Video with jade guthrie from Food Share. Produced for Health on the Front Lines (HLST1011), School of Health Policy & Management, York University. Producer: Dr. Jessica Vorstermans. Filming: Regenesis.
Access status: Open Access ,
HLST 1011 Keynote Speaker Dr Naheed Dosani interviewed by Azeezah Jafry
(2021-10-22) Vorstermans, Jessica
Interview with Dr. Naheed Dosani on his work as a palliative care physical working with street involved folks. Dr. Dosani is a health equity and justice advocate. He is interviewed by Azeezah Jafry.
Access status: Open Access ,
Ritualizing Madness: Case Files as Sites of Enforced Performativity, 1894-1950
(Canadian Journal of Disability Studies, 2021) Smith, Kira A.
In this article, I argue that case files kept by doctors, nurses, and attendants in Canadian Asylums, act as sites of performative madness enforced by the observer. In applying Foucauldian and performance theories, I look at the production of knowledge, and influence of power, which allow for the encoding of madness as a ritualized behaviour that is repeatable outside of the individual being recorded as mad. To illustrate this point, I use several case files from the Brockville Asylum to highlight how certain physical characteristics and behaviours were pathologized to support the medical argument that the inmate in question was in fact mad and belonged in the asylum. I suggest that one is not born mad, but they become mad through enforced ideas of madness, which enforced by the observer’s categorization of a physical characteristic or behaviour as mad.
Access status: Open Access ,
ICT-Based Interventions for Women Experiencing Intimate Partner Violence: Research Needs in Usability and Mental Health
(BMC Public Health, 2020-09-07) El Morr, Christo; Layal, Manpreet
Intimate Partner Violence is a “global pandemic”. Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).
Access status: Open Access ,
Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety
(BMJ, 2018-11-28) Zaheer, Shahram; Ginsburg, Liane; Wong, Hannah; Thomson, Kelly; Bain, Lorna
Background: There is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain—for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety. Purpose: The impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario. Methods: Cross-sectional survey data were collected from nurses, allied health professionals and unit clerks working on intensive care, general medicine, mental health or emergency department. Results: Hierarchical regression analyses showed that perceptions of senior leadership (p<0.001) and teamwork (p<0.001) were significantly associated with overall perceptions of PS. A non-significant association was found between perceptions of supervisory leadership and the outcome variable. However, when staff perceived poorer senior leadership support for safety, the positive effect of supervisory leadership on overall perceptions of PS became significantly stronger (p<0.05). Practice implications: Our results suggest that leadership support at one level (ie, supervisory) can substitute for the absence of leadership support for safety at another level (ie, senior level). While healthcare organisations should recruit into leadership roles and retain individuals who prioritise safety and possess adequate relational competencies, the field would now benefit from evidence regarding how to build leadership support for PS. Also, it is important to provide on-site workshops on topics (eg, conflict management) that can strengthen working relationships across professional and unit boundaries.
Access status: Open Access ,
Models of Concurrent Disorder Service: Policy, Coordination, and Access to Care
(Frontiers, 2019-02-19) Wiktorowicz, Mary; Abdulle, Aber; Di Pierdomenico, Kaitlin; Boamah, Sheila A.
Background: Societal capacity to address the service needs of persons with concurrent mental health and substance-use disorders has historically been challenging given a traditionally siloed approach to mental health and substance-use care. As different approaches to care for persons with concurrent disorders emerge, a limited understanding of current models prevails. The goal of this paper is to explore these challenges along with promising models of coordinated care across Canadian provinces. Materials and methods: A scoping review of policies, service coordination and access issues was undertaken involving a review of the formal and gray literature from 2000 to 2018. The scoping review was triangulated by an analysis of provincial auditor general reports. Results: Models of concurrent disorders service were found to have evolved unevenly. Challenges related to the implementation of models of collaborative care and local networks that foster service coordination and policy accountability were found to inhibit integrated care. Conclusion: Emergent models of coordinated care were found to include collaborative care, regional networks with centralized access to care, clinical information-sharing, cross-training, improved scope of care to include psychologists and alignment of physician incentives with patient needs to better support patient care.
Access status: Open Access ,
Women in clinical trials: a review of policy development and health equity in the Canadian context
(Biomed Central, 2019-04-15) Yakerson, Alla
Health equity in pharmaceutical research is concerned with creating equal opportunities for men and women to partake in clinical trials. Equitable representation is imperative for determining the safety, effectiveness, and tolerance of drugs for all consumers. Historically, women have been excluded from participating in clinical research leading to a lack of knowledge regarding drug effects and their consequences. This paper examines the changes made since the implementation of Canadian policies on the representation of women in clinical trials, the analysis of sex and gender, as well as the discourses that are prominent among researchers. A feminist ethics framework is used to examine the structures that endeavor to elucidate women’s involvement in trials, as experienced under extensive patriarchal history. Scholarly literature and Canadian government policy documents are used to explore the development of clinical trials as pertaining to sex and gender. Findings suggest that women continue to be underrepresented or excluded from important research, highlighting ongoing ethical and justice concerns. Improvement recommendations for policies are outlined. Keywords: Women, Clinical trials, Underrepresentation, Feminism, Sex, Gender, Policy
Access status: Open Access ,
Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence
(Biomed Central, 2018-08-22) Wiktorowicz, Mary; Moscou, Kathy; Lexchin, Joel
Background: As a transnational policy network, the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) aligns international regulatory standards to address the pressures of globalization on the pharmaceutical industry and increase access to new medicines. Founding ICH members include regulators and pharmaceutical industry trade associations in the European Union, the United States and Japan. In this paper we explore the manner in which state interdependence fosters the conditions for regulatory harmonization by tracing the underlying parallels between ICH and member state pharmacogovernance to clarify emergent patterns in regulatory policy convergence. Results: A shift to the life cycle approach to pharmaceutical regulation corresponded with international convergence in pre-market standards as emphasis shifted to post-market standards where convergence remains unresolved. Transnational pharmacogovernance was found to concentrate regulatory authority within a coregulatory model of bilateral negotiation with pharmaceutical trade associations in defining safety and efficacy standards. Given a context of state interdependence, parallels were found between transnational and ICH member pharmacogovernance modes that guide policy development. Divergent modes of state regulatory governance that re-calibrate perceptions of risk and risk mitigation were found to coincide with post-market policy dissonance. Conclusion: Although interdependence fostered harmonization in pre-market standards and aligned with increased focus on post-market approaches, the confluence of divergent state governance modes and perceptions of risk may inspire improvisation in post-market standards. As the ICH expands to an ensemble with a greater global reach, further research is needed to clarify the manner in which interdependence shapes transnational pharmacogovernance and the conditions that foster policy convergence in the public interest. Keywords: Pharmaceutical regulation, Medicines policy, Transnational governance, Transnational regulation, Pharmacogovernance, Policy network, Policy convergence, Drug safety, Pharmacovigilance
Access status: Open Access ,
Regulating the fast-food landscape: Canadian news media representation of the Healthy Menu Choices Act
(BMC, 2019) Moghimi, Elnaz; Wiktorowicz, Mary
With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choices
Access status: Open Access ,
Diet, Physical Activity, and Emotional Health: What Works, What Doesn’t, and Why We Need Integrated Solutions for Total Worker Health
(BMC, 2019) Syed, Iffath
Background Current research advocates lifestyle factors to manage workers’ health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees’ lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector. Methods Drawing on qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker’s mechanisms for maintaining physical, emotional, and social wellbeing. Results The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important. Conclusions Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers’ health and wellbeing.
Access status: Open Access ,
Computer-assisted screening for intimate partner violence and control: a randomized trial
(American College of Physicians, 2009-07) Ahmad, F; Hogg-Johnson, Sheilah; Stewart, Donna Eileen; Skinner, HA; Glazier, Richard; Levinson, W
Background: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women. Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting. Design: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention. Setting: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada. Participants: Adult women in a current or recent relationship. Intervention: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (nÂ = 144). Control participants received standard medical care (nÂ = 149). Measurements: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits. Results: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (nÂ = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions. Limitation: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used. Conclusion: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients. Primary Funding Source: Canadian Institutes of Health Research and Ontario Women's Health Council.
Access status: Open Access ,
Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women
(Oxford University Press, 2002-04) Ahmad, F; Gupta, H; Rawlins, J; Stewart, Donna Eileen
Objective. The aim of this study was to investigate expressed preferences for family physician (FP) gender among Canadian European-descent (CED) and Canadian South-Asian (CSA) immigrant women. Method. An ‘on-site’ survey was conducted in community-based institutions in Toronto in order to determine preferences for the gender of FP under various health care scenarios: overall health care; gender-sensitive examinations; emotional problems; general ailments; and life-threatening conditions. Results. Ninety-four women responded to this survey (CED = 50, CSA = 44), response rate 77.3%. For all health care scenarios, CED and CSA women similarly expressed either a preference for a female FP or no preference. More than two-thirds of women preferred a female FP for gynaecological examinations (CED, 72.9%; CSA, 83.7%) or examinations with private body part exposure (CED, 72%; CSA, 81.8%). For ‘emotional problems', half of the women preferred a female FP and the other half had no preference. A similar pattern was observed for ‘overall health care', with some shift to female physician preference among CSA women (60.5%) compared with CED women (53.2%). For the ‘overall health care' scenario, CED and CSA women who preferred a female FP had a higher frequency of seeing female physicians within the last 5 years (CED, P ≤ 0.01; CSA, P ≤ 0.05), and attributed ‘positive' social skills more to female physicians (CED, P ≤ 0.01; CSA, P ≤ 0.01) compared with women with no preference for the gender of the FP. Yet, CED women with a female FP preference were more likely to have a concurrent female FP (P ≤ 0.01), and to rate past experiences with female physicians as high (P ≤ 0.01) and with male physicians as low (P ≤ 0.05) compared with CED women with no preference. In the CSA group, women with a preference for a female FP were more likely to be unemployed (P ≤ 0.01) and have low social support (P ≤ 0.01). Conclusions. Despite similar physician gender preference patterns, factors associated with these preferences show some differences between CED and CSA women.

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