Search

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure. [ABSTRACT FROM AUTHOR]

The lack of affordable housing in Canada affects a growing number of female heads of single-parent families, and the current political economy presents significant obstacles to develop more social housing in response. This paper seeks to understand the extent to which new housing programmes led by community providers comply with or resist neoliberalisation. We draw on feminist ethics of care to explore and deepen the ideas, interests, institutions, and networks involved in creating social housing for female heads of single-parent families in Montreal, Toronto, and Vancouver, Canada. The cases reveal that neoliberalisation is not eliminating care in the social housing sector. On the one hand, communities that embrace and engage with the principles of care comply with state rollback by stepping up to meet pressing needs despite the inadequacies or unavailability of public programmes. On the other hand, care ethics lead them to design programmes and spaces centred on family needs, which resist the climate that hampers social housing development and orients it toward market-driven solutions and neoliberal expectations. We conclude with a critical reflection on the inequalities in communities' capacity to create housing with care to meet the identified needs and thereby resist the neoliberalisation of social housing. [ABSTRACT FROM AUTHOR]

Retail food environments are an important setting for promoting healthier diets and reducing the global burden of diet-related disease. The purpose of this 2-year community–university partnership was to develop a health promotion intervention for stores in a rural and remote region of British Columbia, Canada. This article reports on the qualitative interviews that were conducted with retail operators as part of an intervention planning process. Seven in-depth, semistructured interviews were conducted with store owners and managers of small- and medium-sized stores in a rural and remote region. Interviews were analyzed using thematic analysis to identify business operations and practices relevant to intervention planning and implementation. Relevant considerations for health promotion planners included the unique business models of rural stores; the prominence of regional travel and "outshopping" in rural and remote regions; challenges balancing between choice, value, and profitability; relationships with suppliers; and using local products to attract and retain customers. Involving retailers in settings-based approaches to improve population nutrition may help to mobilize existing practices and ensure that interventions are responsive to local context. [ABSTRACT FROM AUTHOR]

Despite significant engagement with new and emerging issues in public health practice, the public health literature has few theoretical explanations for how new practices emerge, take root, and become institutionalized. In this contribution, we utilize Pierre Bourdieu's sociological concepts of field, habitus and capital, and in-depth interviews with public health practitioners to document and describe the emerging field of public health adaptation to climate change Ontario, Canada. In doing so, we identify and explain three types of climate change action and associated practices – 'wait and see', repackaging existing actions and championing new actions – that practitioners relate to climate change adaptation in Ontario (i.e. business as usual, repackaging existing actions and championing climate new actions). We discuss the typology in relation to the dominant and emerging logics that practitioners ascribe to promoting practical action on this sub-field of environmental health practice to promote a discussion of how social change occurs within a well-established field of professional practice. Findings suggest, that change and innovation can result from exogenous shocks that force practitioners to adopt new practices (e.g. the increasing frequency and intensity of climate-related impacts on health), how the 'rules' of a given field are interpreted by practitioners and made actionable, and through the negotiation of new rules by practitioners with a 'radical habitus' who champion particular issues, albeit resulting in significant professional risk. We discuss these findings in relation to Bourdieu's theory, concluding there is significant room for practitioner agency to cultivate normative dispositions and influence the adoption of policy and practice-change. [ABSTRACT FROM AUTHOR]

Dialogue and story-telling are essential elements of many qualitative methodologies and action research itself, reflecting the constructivist paradigm in which qualitative research (QR) and action research (AR) are grounded, and the co-construction of knowledge that takes place amongst research participants (in group settings) and researchers. This paper reports on the adaptation of a structured story-dialogue method for research with social movement activists undertaken in the form of a series of regional weekend workshops animated by researchers and attended by Transition movement leaders and participants from multiple locales, as part of a larger study (www.transitionemergingstudy. ca). We draw upon participant observation, animator reflections, research team meetings, participant feedback, as well as workshop materials, in relation to two different adaptations of Labonte and Feather's original formulation (1996) and subsequent reflections (2011), setting this in the context of a broader literature on structured story-dialogue methods with groups. The potential of structured story-dialogue methods for research on, with and for social movements is highlighted. [ABSTRACT FROM AUTHOR]

Originating in the UK in 2006, the Transition movement is oriented to local grassroots citizen-led efforts that prepare for and support a societal energy transition to a low-carbon future in response to climate change, peak oil, ecological degradation, and economic instability. Overlapping significantly with relocalization, degrowth/slow growth, local food, and related movements, and based on permaculture principles and a distributed network model, it embraces the opportunity to turn crisis into an opportunity to build more resilient, convivial, and vibrant local communities, declaring that "if it's not fun, it's not sustainable". The Transition approach has spread rapidly around the world, including initiatives in over 100 communities and cities in Canada. This paper reports on the methods and results of a Canadian community-based research study aimed at understanding how and where the movement has taken root across the country, what Transition practice looks like, challenges and opportunities encountered, and lessons learned that could be applied within the movement and by others interested in the role of citizen-led initiatives for sustainability transition. Utilising a practice theory lens, drawing on an extensive web-scan of the movement's online presence, a survey and interviews with initiative (co)founders, an e-survey of Transition members/participants, regional "structured story-dialogue" workshops, and key informant interviews, and informed by input from a Movement Advisory Group, we describe the research process and explore what success and impact mean to those most active in the movement. [ABSTRACT FROM AUTHOR]

Similar to other global cities, Toronto (Canada) is addressing conflicting energy concerns in the form of the need to consider energy sustainability while concurrently continuing to expand urban development in response to high levels of immigrant population growth. We argue that energy solutions and policy interventions cannot be successful unless they are sensitive to the social, spatial, and economic concerns of Toronto's diverse communities. Drawing on interview findings of a three-year study 'Who has the power? The energy crisis and environmental justice in Toronto,' this paper considers whether current Toronto-based environmental non-governmental organization (ENGO) strategies to enhance awareness of energy problems and environmental sustainability are framed in a manner that includes Toronto's many marginalized and racialized residents. Findings also highlight the extent to which ENGOs are adopting environmental justice as both a discourse for environmental change and a set of principles to guide energy-related programming, policy, and partnerships. La justice environnementale dans le monde des organisations environnementalistes non gouvernementales de Toronto (Canada) À l'instar des autres métropoles du monde, Toronto (Canada) est aux prises avec une problématique énergétique qui oppose la nécessité de viser la durabilité énergétique à la poursuite de son développement urbain relié à la croissance de la population immigrante. Nous faisons valoir que les solutions énergétiques et les initiatives politiques n'atteindront leurs cibles que si elles sont en phase avec les préoccupations sociales, spatiales et économiques des diverses communautés de Toronto. À partir des résultats d'entrevues menées dans le cadre d'une étude triennale « À qui le pouvoir? La crise énergétique et la justice environnementale à Toronto », cet article vise à établir si les stratégies mises de l'avant par des organisations environnementalistes non gouvernementales torontoises afin de renforcer la sensibilisation aux problèmes énergétiques et à la durabilité environnementale, sont élaborées en intégrant les communautés marginales et raciales. Les résultats mettent également en évidence la manière dont ces organisations adoptent l'idée de justice environnementale, tant dans leur discours lié aux changements environnementaux que dans les principes directeurs des programmes, des politiques et des partenariats en matière énergétique. [ABSTRACT FROM AUTHOR]

Spatial disparities in environmental quality and practices are contributing to rising health inequalities worldwide. To date, the field of health promotion has not contributed as significantly as it might to a systematic analysis of the physical environment as a determinant of health nor to a critique of inequitable environmental governance practices responsible for social injustice—particularly in the Canadian context. In this paper, we explore ways in which health promotion and environmental justice perspectives can be combined into an integrated movement for environmental health justice in health promotion. Drawing on Canadian experiences, we describe the historical contributions and limitations of each perspective in research, policy and particularly professional practice. We then demonstrate how recent environmental justice research in Canada is moving toward a deeper and multi-level analysis of environmental health inequalities, a development that we believe can inform a comprehensive research, policy and advocacy agenda in health promotion toward environmental health justice as a fundamental determinant of health. Lastly, we propose four key considerations for health promotion professionals to consider in advancing this movement. [ABSTRACT FROM AUTHOR]

As we move further into the twenty-first century, there is growing realization that the relationship between humans and the wider environment is crucially important, and a recognition that unfettered globalization linked to an increasingly dominant consumer culture has wrought devastating impacts. Within this context, and catalyzed particularly by concerns about climate change, there has also been increased appreciation that public health and the health of the planet are closely interrelated. This article focuses on the opportunities and potential value of encouraging joined-up thinking and integrated action in the settings where people live their lives. Having set the broad context regarding health, equity and sustainability, we scope current activity in relation to 'greening' settings before honing in on two concerns: that few such initiatives reflect the holistic and ecological perspective that underpins a settings approach to health promotion, and that work on sustainability and work on health have largely been developed in parallel rather than in an integrated manner. Having discussed these concerns, we propose six principles for progressive practice as a means of grounding a healthy and sustainable settings approach, before concluding by looking to the future and highlighting the likely need and benefits of daring to make more radical changes to our individual, community and working lives. [ABSTRACT FROM AUTHOR]

Warning: this article contains strong language. This paper focuses on the ways in which social context structures smokers' views of, and reactions to, tobacco control. This exploratory study examined the interactions between tobacco control and smokers' social contexts and how this may be contributing to inequalities in smoking. We found in our sample that higher socio-economic status (SES) smokers are more likely to positively respond and adapt to tobacco control messages and policies, viewing them for their future health betterment. Lower SES smokers in our study, on the other hand, are in conflict with tobacco control and feel intransigent with regard to the effects that tobacco control is having on their smoking. A better understanding of how social context structures people's perceptions of tobacco control may help us to understand why social inequalities in smoking are deepening, and potentially what can be done better in tobacco control to decrease them. [ABSTRACT FROM AUTHOR]

Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. A number of attempts have been made to systematize evidence regarding the effectiveness of interventions in different types of settings (e.g., school-based health promotion, community development). Few, if any, attempts have been made to systematically develop a template or framework for analyzing those features of settings that should influence intervention design and delivery. This article lays out the core elements of such a framework in the form of a nested series of questions to guide analysis. Furthermore, it offers advice on additional considerations that should be taken into account when operationalizing a settings approach in the field. [ABSTRACT FROM AUTHOR]

The home is a significant source of environmental tobacco smoke (ETS) exposure for many children and, therefore, increasingly a focus of intervention, although evidence of effectiveness remains equivocal. However, little is known about the nature, genesis, and micro-social context of self-imposed restrictions on smoking in the home. In this exploratory study, interviews were conducted in 15 diverse households that had resident children in Toronto, Canada. The results suggest that households cluster into three distinctive groups, from a high degree of restrictions to a lack of consistent measures. Attempts to control ETS exposures in homes often emerge as a result of protracted negotiations and must be understood in the context of situated relationships within the family. Implications for policy and practice, as well as recommendations for future research, are addressed. [ABSTRACT FROM AUTHOR]

This paper draws from a qualitative study of tobacco use by young women in Toronto, Canada. Narrative interviews were used to understand the multiple roles and functions of smoking within the everyday lives of female adolescents. Guided by a Bourdieusian theoretical framework this study employed the core construct of cultural capital in order to position tobacco and other substance use as field-specific capital that young women accumulate while navigating the social worlds of adolescence. Departing from the psychosocial or peer-influence models that inform the majority of tobacco research with young people, this analysis provides a nuanced understanding of how smoking, drinking, using drugs are much more than simple forms of teenage experimentation or rebellion, but can also serve as key resources for defining the self, acquiring status and making social distinctions within adolescent social worlds. In this context it is also argued that initiation into substance use practices is a way that young women demonstrate and develop social and cultural competencies. [ABSTRACT FROM AUTHOR]

The provision of "closer-to-patient" services has increased in most industrialized countries. However, the migration of services in non-traditional health care settings implies redefining the role of technical and human entities and transforming the nature and use of technologies and places. Drawing on various scholarly efforts to conceptualize space, place, and technology, this paper compares and contrasts satellite and mobile dialysis units implemented in two regions in the province of Quebec, Canada. The satellite units were hosted in two small, local hospitals where nursing staff had been recently trained. The mobile unit was a bus adapted to host five dialysis stations; nurses traveled back and forth between a university teaching hospital and two sites located within a radius of 7.6 miles. In both projects, nephrologists supervised from a distance via a videoconferencing system. Our aim is to illustrate the ways in which the displacement of technical and human entities gives shape to new forms of emplacement in non-traditional health care settings. The satellite and mobile units contributed to the culture of dialysis care and transformed the identity of nurses, doctors, patients, and technologies. By contrasting two projects involving different spatial and clinical logics, we analyze in what ways certain forms of recombination of human and technical entities can prove incomplete but nevertheless acceptable to providers and project managers. [ABSTRACT FROM AUTHOR]

Abstract: A clear emphasis on the patient''s view is discernible in the health services research literature of the past decades. Such a switch to patients’ perspectives has been greatly facilitated by a wider acceptance and use of qualitative methods. In particular, focus groups are often used to uncover the range and depth of experiences of health services users and chronically ill individuals. Although this method contributes to a better understanding of patients’ perspectives and practices, a number of analytical considerations have been overlooked. The aim of this paper is to consider how to conceptualise and analyse interactions in focus group research. We argue that focus groups are social spaces in which participants co-construct the “patient''s view” by sharing, contesting and acquiring knowledge. Focus groups conducted with home care patients in Quebec, Canada (on antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy) are used to illustrate three interactive processes at work in focus groups: (1) establishing oneself as experienced and knowledgeable; (2) establishing oneself as in search of information and advice; and (3) validating or challenging one another''s knowledge claims. We develop an analytical template focused on the subtle dynamics underpinning the various and at times competing claims of patients. This template acknowledges the processes through which participants attribute authority to the claims of others, including the focus group moderator. We find that focus group research does not derive epistemological authority simply from the identity of its participants. Rather, an emerging consensus about what constitutes the patient''s view is the result of context-dependent social interactions that need to be scrutinised. [Copyright &y& Elsevier]

This article reviews the main epistemological approaches within health psychology. It considers the approach based on critical realism and various strategies for linking health psychology with social action. It argues that critical health psychology has a distinct contribution to make in promoting public health as part of the broader movement for social justice and health. [ABSTRACT FROM AUTHOR]

Social capital has been the focus of considerable academic and policy interest in recent years. Despite this interest, the concept remains undertheorized: there is an urgent need for a critical engagement with this literature that goes beyond summary. This paper lays a foundation for a critical dialogue between social capital and health promotion, by examining problematics in the conceptualization and practice of social capital building and linking these to models of community development, a cornerstone health promotion strategy. In so doing, the paper contributes to the existing literature by providing a theoretical exposition and critique of various threads in social capital discourse, and linking these threads explicitly to community development practice. Distinctions between communitarian, institutional and critical approaches to social capital are elaborated, and the relationships between these three approaches and three models of community development -- social planning, locality development, and social action -- are discussed. The existing social capital literature is then critically examined in relation to three key themes common to both literatures: community integration, public participation, and power relations. This examination suggests that social capital cannot be conceived in isolation from economic and political structures, since social connections are contingent on, and structured by, access to material resources. This runs counter to many current policy discourses, which focus on the importance of connection and cohesion without addressing fundamental inequities in access to resources. This paper posits that approaches to community development and social capital should emphasise the importance of a conscious concern with social justice. A construction of social capital which explicitly endorses the importance of transformative social engagement, while at the same time recognising the potential negative consequences of social capital development, could help community organizers build communities in ways that truly promote health. [ABSTRACT FROM AUTHOR]

Collaboration between hospitals and community organisations has been promoted over the past 20 years by various levels of government, hospital associations, health promotion advocates, and others at the state/province, national and international levels as a way to improve the‘efficiency of the system’, reduce duplication, enhance effectiveness and service coordination, improve continuity of care, and enhance community capacity to address complex issues. Nevertheless, and despite a growing literature on interagency collaboration, systematic documentation and empirical analysis of hospital−community collaboration (HCC) is almost completely lacking in the literature, particularly as regards collaborations that address the determinants of health beyond the hospital walls. In this paper, we describe the methodology and key findings from a research study of HCC. TheHospital Involvement in Community Action(HICA) study undertook detailed qualitative case studies (in four urban, suburban, rural and northern locations) and a telephone survey (of 139 community organisations in a large urban centre) in order to learn about the range of collaborations and working relationships that exist between hospitals and community agencies in the province of Ontario (Canada), and the factors that influenced (enabled and/or hindered) HCC. Particular attention was paid to barriers and enablers at three nested levels of context (policy, hospital and community) and, drawing primarily on the qualitative case studies, it is this aspect that is the focus of this paper. That such collaborations continue to be widespread despite a generally unfavourable policy environment and hospital institutional culture that poses significant barriers, suggests that the extent to which HCC flourishes (or exists at all) crucially depends on the presence and ongoing enthusiasm/commitment of one or more‘champions’ within the hospital, and the commitment of both parties to overcome the marked cultural differences between hospital and community. We conclude with a discussion of implications for policy and practice. [ABSTRACT FROM AUTHOR]

The Community Action in Public Health Study explored how public health managers, frontline staff, and community participants interpret, implement and receive policy guidelines urging collaboration with community groups in public health work. In-depth case studies of 6 public health units in Ontario, Canada focussed on 19 community development projects in 3 program areas (107 interviews). In the absence of formal policy guidelines on community development at provincial or local levels, informal policy predominated. Local senior management frequently set the tone, distinguishing health units in which community development was a basic philosophy underlying a broad spectrum of public health practice from those in which it was seen as only one among many possible strategies. Uncertainty and risk associated with informal policy lead many frontline staff to adopt strategies intended to preserve autonomy in community work, including "seeking forgiveness rather than permission" and maintaining relative "invisibility." [ABSTRACT FROM AUTHOR]

Presents a study which explores potential interpretations of silence in qualitative research. Information on silences embedded in interview transcripts; How these transcripts are perceived and managed by researchers and participants; Limitations of interview transcripts; Examination of the role of context from an epistemological, theoretical, and methodological orientation.

Focuses on the potential sources and types of threats to transcription quality. Error in transcription as socially constructed and open to multiple interpretations; Assessment of the trustworthiness of transcripts as routine practice in qualitative research; Challenges to transcription quality; Strategies for maximizing transcription quality.

Examines the ascendancy of the `population health' perspective on the determinants of health, while highlighting the role of economics and social status on the acquisition of adequate health care. Reference to some of the social determinants of health status; Details on the ratio of health care expenditures to the gross national product.

Abstracts were then assessed to ensure they met the following inclusion criteria: 1) spoke of land in relation to Indigenous peoples and their learning/education; 2) brought people onto the land in an Indigenous way for learning, healing, spiritual, or community-building purposes; and 3) centred Indigenous ways of knowing, being, and learning of the land. While these practices vary to match the diversity of the land and its people, Indigenous education has always centred around land as first teacher (Streit and Mason 2017). Land informs reflective practices because everything, including pedagogies and stories, starts with and returns to the land (Styres 2011). Keywords: land-based learning; land-based education; Indigenous knowledges; decolonization; apprentissage axé sur le territoire; éducation axée sur le territoire; savoir autochtone; décolonisation EN land-based learning land-based education Indigenous knowledges decolonization FR apprentissage axé sur le territoire éducation axée sur le territoire savoir autochtone décolonisation 132 140 9 06/23/21 20210601 NES 210601 Introduction Land-based learning has been practiced by Indigenous peoples across Turtle Island since time immemorial. [Extracted from the article]

This article is about a mode of scholarly practice we call critical social science with public health. The article responds to our dissatisfaction with established approaches to social science engagement with public health that have developed out of Straus' early distinction between sociology in and of medicine. By critical social science with public health we mean a set of research practices that orients to epistemological and political differences between social science and public health as productive opportunities. We draw on Mouffe's notion of agonism to ground our argument conceptually and on our collaborative research with tobacco control to substantively illustrate our case. As we imagine it, critical social science with public health unsettles knowledge relations that position social science either as a conceptual resource for public health or as a source of negative critique of public health activities. Critical social science with public health engages directly with public health actors, while remaining committed to the specificity of social science theory and methodology. It aims to transform public health, often by seeking to lessen the harmful effects of public health practice, while, at the same time, contributing to critical social science scholarship. [ABSTRACT FROM AUTHOR]

In this paper, we reflect on and explore what remains to be done to make the concept of supportive environments—one of the Ottawa Charter's five core action areas—a reality in the context of growing uncertainty about the future and accelerated pace of change. We pay particular attention to the physical environment, while underscoring the inextricable links between physical and social environments, and particularly the need to link social and environmental justice. The paper begins with a brief orientation to three emerging threats to health equity, namely ecological degradation, climate change, and peak oil, and their connection to economic instability, food security, energy security and other key determinants of health. We then present three contrasting perspectives on the nature of social change and how change is catalyzed, arguing for an examination of the conditions under which cultural change on the scale required to realize the vision of ‘supportive environments for all’ might be catalyzed, and the contribution that health promotion as a field could play in this process. Drawing on sociological theory, and specifically practice theory and the work of Pierre Bourdieu, we advocate rethinking education for social change by attending more adequately to the social conditions of transformative learning and cultural change. We conclude with an explication of three key implications for health promotion practice: a more explicit alignment with those seeking to curtail environmental destruction and promote environmental justice, strengthening engagement with local or settings-focused ‘communities of practice’ (such as the Transition Town movement), and finding new ways to creatively ‘engage emergence’, a significant departure from the current dominant focus on ‘risk management’. [ABSTRACT FROM PUBLISHER]

Planetary health provides a perspective of ecological interdependence that connects the health and vitality of individuals, communities, and Earth's natural systems. It includes the social, political, and economic ecosystems that influence both individuals and whole societies. In an era of interconnected grand challenges threatening health of all systems at all scales, planetary health provides a framework for cross‐sectoral collaboration and unified systems approaches to solutions. The field of allergy is at the forefront of these efforts. Allergic conditions are a sentinel measure of environmental impact on human health in early life—illuminating how ecological changes affect immune development and predispose to a wider range of inflammatory noncommunicable diseases (NCDs). This shows how adverse macroscale ecology in the Anthropocene penetrates to the molecular level of personal and microscale ecology, including the microbial systems at the foundations of all ecosystems. It provides the basis for more integrated efforts to address widespread environmental degradation and adverse effects of maladaptive urbanization, food systems, lifestyle behaviors, and socioeconomic disadvantage. Nature‐based solutions and efforts to improve nature‐relatedness are crucial for restoring symbiosis, balance, and mutualism in every sense, recognizing that both personal lifestyle choices and collective structural actions are needed in tandem. Ultimately, meaningful ecological approaches will depend on placing greater emphasis on psychological and cultural dimensions such as mindfulness, values, and moral wisdom to ensure a sustainable and resilient future. [ABSTRACT FROM AUTHOR]

Homelessness is an experience of being displaced. Once removed from their personal places, homeless people are barred access to healthy places in which to be. Health clinics for people who are experiencing homelessness offer an opportunity to create health-promoting places. In this study, we explore how place is experienced within a community health clinic for people who are experiencing homelessness. A critical ethnographic methodology was used. Results illustrate how clients and providers contested the space of the clinic. Discourses of safety, health promotion, and privacy were enacted, altered, and resisted in a constant practice of culture-making. Physical components of the space became conceptual components of how place and power in place were understood by clients and providers. Results point to the importance of conceptualizing service users as the key stakeholders in their care, considering how places may be more or less health promoting, and rethinking how safety is conceptualized. [ABSTRACT FROM AUTHOR]

Despite considerable population declines, smoking has become increasingly socially stratified, a trend that emerges as salient when examining smoking according to gender. However, there is a dearth of comparative research with regard to smoking inequalities among men and women. The goal of this exploratory study was to examine how three elements of the social context (identity, body, agency) are gendered and the way in which they differentially shape men's and women's smoking practices. In-depth qualitative interviews were conducted with 23 adult smokers living in Toronto and Montreal, Canada stratified by socio-economic position and gender. Our results show that: (1) women express considerable dissonance between gender identities and smoking behaviour, whereas men's gender identities seem to reinforce smoking behaviour; (2) women's smoking was tied to gendered representations of the body, with the fear of weight gain factoring into their smoking maintenance, whereas concern about the body was absent among men; (3) women suggested wanting, but not having agency over their smoking behaviour while men suggested having agency but little urgency to quit smoking. Our exploratory study points to the possibility that gender remains important for shaping smoking practices among adult smokers and that smoking among some women may be characterised by a greater sense of dissonance and tension than among some men. Addressing gender inequalities in the health discourse surrounding smoking may help reduce the current gender disparities in smoking patterns. [ABSTRACT FROM AUTHOR]

Objective: To describe homeless youths' experiences of food insecurity and examine the relation between chronic food deprivation and food acquisition practices. Design: A cross-sectional survey of homeless youths was conducted in 2003 to assess their nutritional vulnerability and describe their food acquisition practices. Setting: Toronto, Canada. Subjects: Two hundred and sixty-one youths, aged 16-24 years, who had spent ten or more of the past thirty nights sleeping in a temporary shelter, public space or friend's place, because they had no place of their own. Most participant recruitment (70 %) occurred outdoors, but 30% were recruited in drop-in centres. Results: Over the past 30 d, 28% of males and 43% of females experienced chronic food deprivation (i.e. reduced food intake for ≥10 d), and 32% of females and 48% of males reported problems obtaining water to drink. Most youths routinely obtained meals at charitable programmes and panhandled for money for food, and many routinely stole food or ate day-old food obtained from restaurants. In contrast, eating food discarded by others and postponing debt payments were strategies of desperation, more common among youths experiencing chronic food deprivation. Additionally, for males, deliberately seeking the company of friends, relatives or acquaintances to obtain food, and for females, borrowing money or trading sex for food, were associated with chronic food deprivation. Conclusions: The pervasiveness and severity of food insecurity experienced by the youths and their desperate means of food acquisition highlight the need for more effective responses to the plight of homeless youths in Canadian cities. [ABSTRACT FROM AUTHOR]

The uneven distribution of environmental hazards across space and in vulnerable populations reflects underlying societal inequities. Fragmented research has led to gaps in comprehensive understanding of and action on environmental health inequities in Canada and there is a need to gain a better picture of the research landscape in order to integrate future research. This paper provides an initial assessment of the state of the environmental health research field as specifically focused on vulnerable populations in Canada. We present a meta-narrative literature review to identify under-integrated areas of knowledge across disciplinary fields. Through systematic searching and categorization, we assess the abstracts of a total of 308 studies focused on the past 30 years of Canadian environmental health inequity research in order to describe temporal, geographical, contextual and epistemological patterns. The results reveal that there has been significant growth in Canadian research documenting the uneven distributions and impacts of environmental hazards across locations and populations since the 1990s, but its focus has been uneven. Notably, there is a lack of research aimed at integrating evidence-based and policy-relevant evaluation of environmental health inequities and how they are created and sustained. Areas for future research are recommended including more interdisciplinary, multimethod and preventive approaches to resolve the environmental burden placed on vulnerable populations and to promote environmental health equity. [ABSTRACT FROM AUTHOR]

Abstract: The professional claims and struggles involved in the design of non-traditional health care places are rarely problematized in applied health research, perhaps because they tend to fade away once the new design is implemented. This paper offers insights into such professional tensions and their impact on health care delivery by examining the design of two dialysis service delivery models in Quebec, Canada. The satellite units were hosted in two small hospitals and staffed by recently trained nurses. The mobile unit was a bus fitted to accommodate five dialysis stations. It was staffed by experienced nurses and travelled back and forth between a university teaching hospital and two sites. In both projects, nephrologists supervised from a distance via a videoconferencing system. In this paper, we draw mainly from interviews with managers (mostly nurses) and physicians (n=18), and from on-site observations. Nephrologists, medical internists, and managers all supported the goal of providing “closer-to-patient” services. However, they held varying opinions on how to best materialize this goal. By comparing two models involving different clinical and spatial logics, we underscore the ways in which the design of non-traditional health care places opens up space for the re-negotiation of clinical norms. Instead of relatively straightforward conflicts between professions, we observed subtle but inexorable tensions within and beyond professional groups, who sought to measure up to “ideal standards” while acknowledging the contingencies of health care places. [Copyright &y& Elsevier]

andrews g.j., holmes d., poland b., lehoux p., miller k.-l., pringle d. & mc gilton k.s. (2005) International Journal of Older People Nursing in association with Journal of Clinical Nursing 14, 8b, 109–120 ‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice With the geographical literatures and issues outlined in the first paper very much in mind, this paper focuses specifically on the places in the concepts and locales of gerontological nursing practice. Particular attention is paid to the role of nurses in the making of long-term care institutions and to some fundamental priorities of care. Consideration is also given to some broader impacts of neighbourhood and community as an important spatial context to nursing practice based both in institutions and the community. In the final section, the paper makes some observations on how place-sensitive practice and research might contribute to the uptake of evidence for practice. These discussions set the scene for the final paper in this special section focused on the future research agenda for place and older people nursing. [ABSTRACT FROM AUTHOR]

Wellbeing in buildings is often approached by practitioners and researchers as the aggregate result of individual interactions between building occupants and building features. This sum-of-the-parts approach, however, ignores the ways in which broader social (i.e. sense of ownership and belonging) and symbolic (i.e. what it means to be 'well' in a specific culture at a particular place and time) components of wellbeing influence occupant experience of the built environment. A social practice perspective on wellbeing in buildings is proposed that accounts for these elements. Beginning with discussions of how wellbeing has been assessed and the foundations of social practice theory, it is suggested that occupant wellbeing is emergent not just from individual interactions with building features but also from broader social and symbolic elements. [ABSTRACT FROM AUTHOR]

Abstract: This paper problematises the emergence and functioning of the recent phenomenon of ‘supervised injection sites’ (SISs) as a case study of post-welfarist governmentality. We propose that SISs arose as an unprecedented intervention in the late 20th century to deal with the increasing challenge of ‘urban drug scenes’ towards public order interests ‘entrepreneurial city’. Under predominant discourses of ‘public health’ and ‘harm reduction’, SISs became possible within a wide variety of political interests as a technology for purifying public spaces of ‘disorderly’ drug users to present the ‘new city’ as an attractive consumption space. Thus, SISs can be meaningfully understood as one element of socio-spatial ‘exclusion’ of marginalised populations from urban cores to ghettoised, peripheral spaces, even as they more benignly seek to better meet the unique needs of drug user populations. Further, the inner workings of SISs illustrate these facilities as powerful surveillance and discipline sites, defining the drug user as an agent of omnipresent risk being responsibilized in the care of the self and body, but also multiple aspects of behaviour and lifestyle reaching beyond drug use; thus construing the drug user as a ‘normalised’ citizen/consumer. We suggest that pressures to answer to powerful interests promoting ‘order’ are concretised as practices of ‘risk management’ ‘on the shop floor’, raising serious questions about the extent to which the ability to meet user needs is compromised in the interest of social control, surveillance, ‘management’, ‘education’, and ‘rehabilitation’, particularly in the current socio-political context (characterised as it is by a persistence, and indeed concomitant hardening, of repressive measures ‘on the street’). [Copyright &y& Elsevier]

There is a need to widen the practice of health psychologists to include the theories and methods of community psychology and an awareness of contemporary issues in community health. The aim of such a community health psychology would be both to deepen our understanding of the aetiology of health and illness in society and to develop strategies that will contribute to a reduction in human suffering and an improvement in quality of life. The aim of this article is to review the background and assumptions of community health psychology and to consider some values that would underlie such an approach. [ABSTRACT FROM AUTHOR]

Often the goal of health and social development agencies is to assess communities and work with them to improve community capacity. Particularly for health promoters working in community settings and to ensure consistency in the definition of health promotion, the evaluation of health promotion programmes should be based on strengths and assets, yet existing information for planning and evaluation purposes usually focuses on problems and deficits. A model and definition of community capacity, grounded in community experience and focusing on strengths and assets, was developed following a 4-year, multi-site, qualitative action research project in four Toronto neighbourhoods. There was significant community involvement in the four Community Advisory Committees, one for each study site. Semi-structured, open-ended interview and focus groups were conducted with 161 residents and agency workers identified by the Community Advisory Committees. The data were analyzed with the assistance of NUDIST software. Thematic analysis was undertaken in two stages (i) within each site and (ii) across sites, with the latter serving as the basis for the development of indicators of community capacity. This paper presents a summary of the research, the model and the proposed indicators. The model locates talents and skills of community members in a larger context of socioenvironmental conditions, both inside and outside the community, which can act to enable or constrain the expression of these talents and skills. The significance of the indicators of community capacity proposed in the study is that they focus on identifying and measuring the facilitating and constraining socioenvironmental conditions. [ABSTRACT FROM AUTHOR]

The rapid growth of the Internet is increasingly international with young people being the early adopters in most countries. However, the quality of Internet access looms as a major barrier hidden behind Internet use statistics. The goal of this study was to provide an in-depth evaluation of young people''s perspectives on using the Internet to obtain health information and resources (e-health). Using an inductive qualitative research design, 27 focus groups were conducted in Ontario, Canada. The 210 young participants were selected to reflect diversity in age, sex, geographic location, cultural identity and risk. A major finding was how the quality of Internet access influenced young people''s ability to obtain health information and resources. Quality of Internet access was affected by four key factors: 1. Privacy, 2. Gate-keeping, 3. Timeliness and 4. Functionality. Privacy was particularly relevant to these young people in getting access to sensitive health information (e.g. sexual activities). Variations in access quality also impacted participation in mutual support, fostering social networks and getting specific health questions answered. These results serve as a warning about using Internet penetration statistics alone as a measure of access. Concerted attention is needed on improving the quality of Internet access for achieving the potential of e-health. This is imperative for addressing the digital divide affecting populations both within countries and globally between countries. [Copyright &y& Elsevier]

Most government emergency/pandemic response plans feature top-down decision making and communication strategies and a focus on 'hard' (physical) infrastructure. There is nothing about the importance of the ideas and communications originating from communities, the social infrastructure that supports their impact locally and their contribution to the central administration. In this study, we found that the 'soft' (social) infrastructure within communities and between communities and formal institutions is key to an inclusive and more equitable response to large-scale crises like the COVID-19 pandemic. Grassroots leaders in six Toronto neighbourhoods were interviewed between the first and second waves of the COVID-19 pandemic in Toronto about what helped or hindered community action. Three themes emerged: (1) Grassroots leaders and community organizations were able to act as key connection points in a two-way flow of information and resources with residents and service providers; (2) Grassroots leaders and groups were challenged to engage in this work in a sustained capacity without adequate resourcing; and (3) there was a disconnect between community-centred grassroots approaches and the City's emergency response. We conclude that there needs to be pre-disaster investment in community level planning and preparation that fosters two-way connections between all municipal emergency/disaster and pandemic preparedness plans and community-centred organizations and grassroots leaders working in marginalized communities. • Social infrastructure is as important as physical infrastructure in emergency response. • Emerging critical realist method identifies relational social fabric of communities. • When social infrastructure exists pre-pandemic, grassroots can be part of solutions. • Two-way connections needed between communities and municipal emergency administration. • Investment in supporting a connected community needed in emergency response plans. [ABSTRACT FROM AUTHOR]

Background Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs. Methods An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks' abilities to consistently achieve the standards of assistance they had established. Results Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventytwo percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly. Conclusions Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies' efforts to more fully meet clients' needs. Food banks have limited capacity to respond to the needs of those who seek assistance. [ABSTRACT FROM AUTHOR]

Recognizing the importance of health-promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client-provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client-provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic-level and broader social and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in-depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as 'good' or 'bad'. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers' and clients' negotiated relationships are explored, but this is couched within both local and system-level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. [ABSTRACT FROM AUTHOR]

Health promotion and social determinants of health approaches, when integrated, can better contribute to understanding and addressing health inequities. Yet, they have typically been pursued as two solitudes. This paper presents the key elements, principles, actions, and potential synergies of these complementary frameworks for addressing health equity. The value-added of integrating these two approaches is illustrated by three examples drawn from the authors' experiences in the Americas: at the community level, through a community-based coalition for reducing chronic disease disparities among minorities in an urban center in the United States; at the national level, through healthy-settings interventions in Canada; and at the Regional level, through health cooperation based on social justice values in Latin America. Challenges to integrating health promotion and social determinants of health approaches in the Americas are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we report the results of a three-year research project (2008–2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city. [Copyright &y& Elsevier]

We examine the heterogeneity among current and former smokers categorized by 'stage of change' with respect to their perceptions about tobacco and tobacco control. Current and former smokers (n = 846) from a general population sample of adults in Ontario, Canada, were subdivided according to the stages of change categories (precontemplation, contemplation, preparation, action, maintenance, and termination) and compared on measures of knowledge, attitudes, and support. Multivariate analyses were conducted adjusting for sociodemographic covariates. Adjusted overall increases across the six stages were observed for seven of eight knowledge items and for all attitude and support items. Among current smokers, adjusted increases across the three stages were detected for a majority of items. However, statistically significant differences from one stage to the next, across all three current smoker stages, were detected only for one item. Among former smokers, adjusted increases across the three stages were observed for a minority of items. The stages of change classification was useful for differentiating subgroups of current smokers with regard to knowledge, attitudes, and support for tobacco control measures. [ABSTRACT FROM AUTHOR]

Objectives. Trends in attitudes and current practices concerning smoking in the home were examined. Methods. Data from population-based surveys of adults in Ontario, Canada, were analyzed. Results. Between 1992 and 1996, the percentage of respondents who agreed that parents spending time at home with small children should not smoke increased from 51% to 70%. In 1996, 34% of the homes surveyed were smoke-free. Smoke-free homes were associated with nonsmoking respondents and with the presence of children and no daily smokers in the home. Only 20% of homes with children and any daily smokers were smoke-free. Conclusions. Efforts are needed to assist parents in reducing children's exposure to environmental tobacco smoke in the home. [ABSTRACT FROM AUTHOR]

Background: Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs, but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs.Methods: An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks' abilities to consistently achieve the standards of assistance they had established.Results: Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventy-two percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly.Conclusions: Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies' efforts to more fully meet clients' needs. Food banks have limited capacity to respond to the needs of those who seek assistance. [ABSTRACT FROM AUTHOR]