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Prior to the COVID–19 outbreak, food insecurity was already a serious public health problem in Canada, impacting 12.7 percent of households. In recent years, activists, practitioners and researchers from a range of health–related disciplines, have debated the legitimacy of food banks and other charitable food programs, contending that policy and programs at the federal level must be prioritized to address the underlying root causes of poverty. This paper challenges the discourse that charitable food programs prevent or distract from Canada's social equity goals. Alternatively, this paper argues that programs and initiatives at the local level can emerge to bring short–term stability and self–sufficiency to local communities while also advocating for longer–term structural change. Drawing upon structuration theory and critical ecologies of anti–Black racism, we examine the work of BlackFoodToronto, a food sovereignty initiative, to illustrate the negotiation of power and agency, and how groups and networks react to and reshape confining and enabling structures through collaborative practice. In addressing Canada's food security crisis, this paper offers an alternative perspective of community–based, nonprofit and charitable programs, which in practice, can help inform future food security policy and related health equity and community development strategies. [ABSTRACT FROM AUTHOR]

Since the shift to legalizing recreational cannabis use in Canada in 2018, there has been increased attention on the consequences of cannabis use on women's reproductive and maternal health, with particular attention to the impact of cannabis in utero and through breastfeeding. This has resulted in an intense focus on the behaviors of individuals who consume cannabis during the perinatal period, which raises questions about the impact this has on women and mothers who have historically been under the surveillance of the Canadian public health, health and social care, and legal systems. Grounded in an intersectional feminist framework that acknowledges how race, ability, class, and other social positions impact and differentiate women's experience, this paper presents findings emerging from a participatory arts-based research approach called Photovoice with 23 mothers living throughout Canada. All participants consumed cannabis during pregnancy and breastfeeding and illustrated through photographs and individual and group discussion how their experiences of intersectional stigma and surveillance by health and social care providers resulted in barriers to accessing cannabis-related information and support. Implications arising from our inquiry suggest there is a dire need for public health, perinatal care, and social care responses that run counter to the current context where stigma and fear prevent parents from accessing cannabis information and support. [ABSTRACT FROM AUTHOR]

This paper describes how a study using institutional ethnography (IE) was used as a decolonizing method of inquiry in a rural Indigenous community in Canada. IE honors lived experience, reveals institutional and colonial practices, provides clear empirical evidence, and can offer clear recommendations that can benefit Indigenous communities. At the heart of decolonizing research is the task of shifting whose knowledge is privileged – from those with power (often researchers) to those who are being researched (those subject to the effects of colonization). To highlight how IE can be used as a decolonizing method of inquiry, the authors of this paper (a) point out common pitfalls of academic research and knowledge translation (KT) practices in Indigenous health; (b) highlight decolonizing research principles and how IE can be a decolonizing method of inquiry; and (c) share an example to illustrate how IE was used in a decolonizing health study in a First Nations community context. This paper also outlines critiques of mainstream research and KT practices, highlights principles for conducting research with Indigenous people in Canada, and further discusses how IE is well positioned to facilitate both decolonizing research and strategic KT. [ABSTRACT FROM AUTHOR]

The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated. [ABSTRACT FROM AUTHOR]

Dental pain reduces a person's quality of life and constrains the ability to perform routine day-to-day activities, yet its distribution in society is inequitable and significantly shaped by the social determinants of health. This paper explores this social phenomenon of dental pain using John Rawls' conception of justice as fairness. Several key concepts in Rawls' framework are examined, including the implications for: a person's right to fair equality of opportunity; a person's sense of self-respect; and, the dental profession's social contract. We conclude that the current distribution of dental pain in Canada and the United States breaks with the principles set out in Rawls' conception of a just society. [ABSTRACT FROM AUTHOR]

This paper explores how advice to mothers about raising healthy children differs in two distinct disease regimes as portrayed in articles in the pre-eminent Canadian women’s magazineChatelaineabout 50 years apart, 1928–1944 and 1990–2012. The paper compares intensive mothering, medicalization and the perception of risk. It suggests that both intensive mothering and medicalization are continuous from time period to time period (although the content of both mothering and medicalization differ in the two periods). Medicalization focused on the physical well-being and emphasized the importance of the routinized behaviours designed for conformity in the early period. In the latter period, there is a greater focus on individuality of children and their emotional well-being. This is linked to the rise of the discourses of the psy professions. With respect to risk, however, the paper documents an important change in the expansion of the degree to which life is considered risky. The substantive, theoretical and practical consequences of the findings are discussed. [ABSTRACT FROM PUBLISHER]

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services. [ABSTRACT FROM AUTHOR]

Healthy eating campaigns that promote unprocessed foods to children using character licensing and fun appeals hope to offset the aggressive marketing of highly processed, unhealthy foods to children. Such campaigns are equally premised on the assumption that fruits, vegetables, and other whole foods are not desirable enough in the current food environment and must be marketed as child friendly to be appealing. This paper examines how children in Canada classify foods and whether they think of whole, unprocessed foods as ‘for them.’ Children aged 7–12 (n = 183) completed a survey asking them to classify various foods (fruit, vegetables, milk, eggs, beef, whole grains) as for ‘kids’, ‘adults’ or ‘both’. Most children classified these foods as for both adults and kids, suggesting that promotional initiatives to convince children that whole foods are uniquely children’s fare may not be necessary. Given the questionable efficacy of marketing whole foods as fun and ‘for kids,’ alongside the ethical stakes of commercializing childhood, we recommend that public health initiatives reject attempts to market whole foods as kids’ foods. Instead a key opportunity exists to emphasize the message that good food is for everyone – which is the most conducive to a building a healthy food environment and positive food habits across a lifetime. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to examine how members of the public define the legitimacy of cognitive and behavioural enhancement. Our study involved a two-step multimedia-based deliberative intervention in which participants of different age groups pondered the desirability of a fictional enhancement technology: a sweater made of ‘smart’ textiles that provide ‘bio-psycho-feedback’ (PBF) to its user. A 3-min video clip presenting the fictional technology was used to stimulate deliberations in four face-to-face workshops (n = 38). A larger group of participants (n = 57) then discussed, in an online forum, two short stories illustrating dilemmas raised by the PBF sweater. Qualitative analysis of transcripts of the workshops and the forum identified patterns of moral argumentation in the reasoning processes by which participants challenge the PBF sweater’s legitimacy: (1) when a shift in purpose occurs – from therapeutic to enhancement – and (2) when it engenders a shift in the user’s sense of self – from an autonomous self to a socially coerced individual. These findings add nuance to current knowledge on public perceptions of cognitive and behavioural enhancement, providing insight into the ways that people conceive of the tension between autonomy and social coercion. [ABSTRACT FROM PUBLISHER]

As the number of older adults in the population increases, the rate of medical care use is expected to rise. As a result, geriatricians and gerontologists are researching predictors of medical care in later life, which includes ageism. Ageism within health care has been widely and frequently reported and it is thought to be a product of negative attitudes toward aging. The current review systematically explores the existing literature in this area and establishes seven themes within the research. From a predominantly American population of papers, themes that emerged were the following: physicians’ attitudes toward aging are complex and mixed; mixed associations among attitude, knowledge, and medical care; aging and disease symptom attributions among physicians; attitudes, knowledge, and exposure to older adults; the role of role models; the influence of the health care culture; and the influence of the health care system. These themes were considered separately and in tandem in order to explore avenues for future research that will clarify the influence that these psychosocial factors have on health care provided to older adults. [ABSTRACT FROM PUBLISHER]

Young bisexual women experience worse mental and sexual health outcomes in comparison to their heterosexual and lesbian peers. These disparities are associated with stigma and devaluation of bisexual identities. The current paper addresses a community-based focus group project in which participants discussed bisexual stigma in regard to bisexual erasure and other stereotypes. Specifically, participants detailed experiences of feeling pressured to provide evidence of their bisexual identity, modifying their relationship or sexual behavior to conform to these expectations, as well as feeling excluded from queer community. Further, participants discussed how these experiences were related to decreased mental and sexual health. Future research should further investigate the relationship between bisexual stigma, pressure to provide evidence of bisexual identity, and negative mental and sexual health outcomes. [ABSTRACT FROM PUBLISHER]

In Canada, there has been a rise in criminal HIV non-disclosure cases where public health records have been subpoenaed for use in police investigations and criminal court proceedings. In particular, public health nurses’ written counseling notes, originally collected for the purposes of creating a record of treatment and a plan of care, have been used as evidence against their clients. This article engages sociologically with this issue by analyzing whether and how this criminal law development has affected public health nurses’ reasoning and documentary practices in settings of HIV post-test counseling sessions. The paper argues that variations in nurses’ inscription styles result in part from considerations about the criminal law, which indicates the influence of ‘medico-legal’ relations that connect health care and the criminal justice system. Implications for nursing practice and the broader goals of HIV prevention are discussed. Data are drawn from interviews with thirty nurses working at four public health units in Ontario. [ABSTRACT FROM PUBLISHER]

Child care, conceptualized as one area of social policy, is a good example of a population health intervention (PHI) that operates outside of the health sector. Exploration of child care as a PHI could help to clarify the scope of the PHI field, and contribute to a credible base from which to advocate for PHIs, yet such exploration is not yet prominent in the population health research literature. The purpose of this paper is to consider child care through the lens of PHI, and in particular, to consider whether a strong case can be made for a universal approach to child care in Canada and perhaps other liberal welfare regimes where targeted approaches are more commonly accepted. We first examine the peer-reviewed evidence on the impact of universal and targeted child care for later outcomes. We then interrogate other issues that are pertinent to making a strong case for universal child care in Canada as one example of a liberal regime; namely, (1) limitations and challenges of research on the impact of universal child care; (2) the intuitive appeal of targeting; (3) the fundamental differences between targeted and universal approaches; and (4) the values inherent in judgments about the equity of universal interventions. Notably, some of these issues do not lend themselves to empirical resolution, which raises interesting questions about the acceptable balance of ideology and empiricism in population health. [ABSTRACT FROM AUTHOR]

The disappointing results of many public health interventions have been attributed in part to the lack of meaningful community engagement in the planning, implementation, and evaluation of these initiatives. Community-based participatory research (CBPR) has emerged as an alternative research paradigm that directly involves community members in all aspects of the research process. Their involvement is often said to be an empowering experience that builds capacity. In this paper, we interrogate these assumptions, drawing on interview data from a qualitative study investigating the experiences of 18 peer researchers (PRs) recruited from nine CBPR studies in Toronto, Canada. These individuals brought to their respective projects experience of homelessness, living with HIV, being an immigrant or refugee, identifying as transgender, and of having a mental illness. The reflections of PRs are compared to those of other research team members collected in separate focus groups. Findings from these interviews are discussed with an attention to Foucault’s concept of ‘governmentality’, and compared against popular community-based research principles developed by Israel and colleagues. While PRs spoke about participating in CBPR initiatives to share their experience and improve conditions for their communities, these emancipatory goals were often subsumed within corporatist research environments that limited participation. Overall, this study offers a much-needed theoretical engagement with this popular research approach and raises critical questions about the limits of community engagement in collaborative public health research. [ABSTRACT FROM PUBLISHER]

In 1998, the Supreme Court of Canada ruled that prosecuting people for HIV-status nondisclosure would neither affect people’s willingness to undergo HIV testing, specifically, nor undermine HIV prevention, more generally. Since that time, limited research has explored this topic. This paper reports a survey of a convenience sample of 721 gay, bisexual, and other men who have sex with men. The aim was to examine participants’ sexually transmitted infection (STI) and HIV testing practices, sexual activities, and perceptions about nondisclosure prosecutions. Results suggest that nondisclosure prosecutions appear to have affected the STI testing practices of the participants in this research who were: (a) the most likely to have reported a sexual history involving unprotected receptive anal sex, and (b) least likely to have undergone testing for STIs. [ABSTRACT FROM PUBLISHER]

In Canada, there have been recent increases in HIV infections among men who have sex with men (MSM), making HIV transmission among MSM a continuing public health concern. In this paper, we explore the rationales of MSM for the practice of unprotected sex in casual or anonymous encounters. We found that the men in our sample acknowledged their 'transgressive' behaviour, engaged in numerous harm-reduction strategies, and offered varied yet connected rationales for unprotected sex related to pleasure, knowledge, and social and physical locations. Based on these data, we offer a critical perspective on the traditional, psychological approaches to the design of HIV prevention, and contend that HIV prevention needs to become more inclusive and innovative by recognizing, addressing and engaging men's diverse rationales for unprotected sex. [ABSTRACT FROM AUTHOR]

Despite Canada's leadership in the field of population health, there have been few successes in reducing the country's health inequities. There is an increasing recognition that regardless of the progress made to date, significant gaps remain in comprehending fully the root causes of inequities, including the complex ways in which the determinants of health relate, intersect and mutually reinforce one another. Calls are being made to draw on the theoretical insights of critical social science perspectives to rethink the current framing of health determinants. The aim of this paper is to contribute to the theoretical project of population health by exploring the innovative paradigm of intersectionality to better understand and respond to the 'foundational' causes of illness and disease, which the health determinants perspective seeks to identify and address. While intersectionality has taken hold among health researchers in the United States, the United Kingdom and Canada, the transformative potential of this approach in the context of health determinants is largely unexamined. [ABSTRACT FROM AUTHOR]

A common aim of health and human service programmes is to improve the health status of marginalized groups. One such group is new migrants. This paper summarizes the results of a three-year study of a health and empowerment initiative undertaken with a low-income migrant community in Aotearoa/New Zealand (A/NZ), with subsequent interviews with community workers engaged with such communities in A/NZ and Canada, a country known for its open migration policies and programmes aimed at assisting new migrant communities. Subtle dynamics of identity, culture and power are demonstrated to play key roles in shaping new women migrant's empowerment experiences. The paradoxical nature of these dynamics has implications for those workers and agencies engaged in programs seeking to improve the capacities of such groups to act in empowered ways on conditions that influence their health. [ABSTRACT FROM AUTHOR]

Significant public health attention has been focused on the problems of youth sexual behaviour. Empirical public health research in this area has attempted to account for mostly negative sexual health outcomes (e.g. sexually transmitted infections and teenage pregnancies) by examining individual characteristics and risk-taking behaviour. Public health practice has followed suit, focusing primarily on modifying sexual risk behaviour and lifestyle ‘choices’. In doing so, we may be unwittingly committed to an unarticulated and unrealistic set of assumptions about the level of agency and control that is afforded to many young people. The purpose of this paper is to begin to ‘unpack’ the underpinnings to conventional approaches to public health research and service provision related to youth sexual health in Canada. Drawing on the works of Foucault to show how discourses concerning risky groups, risky behaviour and risky persons have been advanced as sanctioned discourses in Canada (particularly related to HIV/AIDS risk), the authors investigate how themes of safety and goodness have been privileged as healthy , while other, unauthorized forms of youth sexual behaviour have been marginalized. The issue of teen parenthood is examined to demonstrate how these specific discourses have helped to relegate those youth who do not or cannot implant themselves in an ‘approved reality’ to live separately from the norm in a climate of sex-based shame. Drawing on their previous work and that of others, the authors suggest an alternative approach to understanding youth sexual health, one that favours critical, reflexive public health practices and attends to sociological theory. [ABSTRACT FROM AUTHOR]

For decades critics have identified Walmart Canada's employment practices – characterized by inadequate wages with few benefits – as contributing to household food insecurity (HFI). Walmart Canada also opposes unionization drives which would result in higher wages and benefits through the collective bargaining process. In a remarkable example of image management, Walmart Canada now brands itself as an important ally in reducing the HFI its employment and anti-union practices create by entering a partnership with the major food bank association in Canada, Food Banks Canada (FBC). We carry out a critical case study of this partnership that examines the contradictions between Walmart's operating culture and FBC's goal of reducing HFI. We conclude that by entering into a partnership with Walmart Canada and ignoring its own policy documents describing how low-paid work and inadequate benefits create HFI, FBC has become complicit in maintaining the structures and processes that create and perpetuate the HFI that threatens Canadians' health. We then specify the implications these developments have for addressing HFI and the inequitable distribution of other social determinants of health. [ABSTRACT FROM AUTHOR]

Public health is tasked with addressing the urgent global priority of promoting the health and human rights of adults engaged in sex work and research is critical to support this endeavor. 'What' is studied, 'how' research is done, and 'who' is centered in this research is reflected in how research funding is allocated. In this article, we interrogate funding allocation for sex work-related health research in Canada. Drawing on critical perspectives aimed at illustrating how stigma operates in society, we examine operating grants (N = 64) awarded by the federal health research funding agency between 2003 and 2020. We find that sex workers' health is problematized disproportionately in a street marketplace context that centers on HIV and sexually transmitted infections. Limited work attends to the socio-structural context of sex work and instead perpetuates stigmatizing narratives about sex work. Public health intervention studies are rare, presenting a barrier for implementing and evaluating evidence-based health promotion strategies. Notably, the research projects were conducted by a small number of highly networked, geographically clustered researchers, illustrating gaps in research that considers the complexity of sex work. We propose that it is essential to consider funding as a process that may be limiting the range of health issues being addressed and privileging a small community of researchers, which can inadvertently serve to worsen health inequities among some sex work communities. Researchers and funding bodies may draw on this analysis to inform a research agenda that meaningfully supports the health, safety, and well-being of sex workers in Canada and globally. [ABSTRACT FROM AUTHOR]

Researchers, policy-makers, and political leaders in Canada and the US are championing the ‘Housing First’ (HF) intervention as a solution to homelessness. HF supplies people experiencing both homelessness and challenges around mental health with housing and a range of supports that can include case-coordination, psychiatry, and primary care. While HF’s impact on the housing status of individual participants has received considerable scientific and public consideration, less attention has been paid to its effects on societal conversations related to housing, public services, and social justice. We explore some of the impacts, not of HF the intervention, but of HF the conversation – the way public documents related to HF interact with broader discourses. Specifically, we examine the potential for this conversation to undermine the ultimate goal of ending homelessness in Canada. We conclude that positioning program interventions – no matter how important in the current context – as singular solutions to issues like homelessness or preventable chronic disease risks obscuring distal causes and marginalizing systemic responses. [ABSTRACT FROM PUBLISHER]

Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside – one of Canada's overdose epicenters – this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations. [ABSTRACT FROM AUTHOR]

Within a neoliberal environment that prioritizes the individual over the community, understanding challenges associated with advancing population-level or universal interventions is important if public health is to remain a relevant collective institution. As a case example, we considered a controversial public health intervention – community water fluoridation – and undertook focus groups with dental hygienists in Calgary, Alberta, Canada, to explore ways that fluoridation (a population-level intervention) is understood and discussed in their day-to-day clinical interactions as frontline cavity prevention experts. The overarching theme in our data centered around a key public health conundrum – that is, the difficulties reconciling individual and community- or population-level responsibility for health. Dental hygienists wrestled with the transdisciplinary nature of population-level public health interventions; acknowledged changing roles and relationships between themselves and their patients; and revealed dissonance in their own beliefs about individualism and collectivism in health. Our findings shed light on communication challenges where public health information delivery intersects with clinical encounters, in the context of empowered and knowledgeable health consumers. A challenge for the public health community is to reflect on how to better address a contemporary public's reasonable information requests and negotiate the clash between individualism and collectivism more effectively. [ABSTRACT FROM AUTHOR]

Data concerning increasing economic inequality and its effects are increasingly becoming available in Canada. Warnings concerning the consequences of increasing economic inequality are primarily being raised within the social development sectors. The primary message is that economic inequality is creating poverty, a situation that should, on principle, be unacceptable to Canadians. The health effects of economic inequality and poverty are known to many public health professionals, but with few exceptions, public health responses are usually limited to the delivery of ameliorative programmes to those living in poverty. While federal, some provincial, and public health association documents include economic inequality as a determinant of health, discussions of the role that economic inequality plays in creating poverty, its impact upon community structures that support health, and the causes of increasing inequality are for the most part, isolated from public health discourse. Evidence of, and reasons for, resistance to such analyses and potential courses of action for addressing economic inequality and its health effects are presented. [ABSTRACT FROM AUTHOR]

Unlike many other countries, Canada does not have a publicly funded school lunch program. Instead, parents are responsible for feeding their children during school hours, and charitable organizations attempt to fill gaps for children living in poverty. Canadian activists have mounted a campaign for a federally funded school meal program to address numerous issues affecting children's health, including an 'obesity crisis.' Our examination of the historical record suggests contemporary school meal advocates are in a position similar to the early 1940s, when there was great public concern about a 'crisis of malnutrition' that was undermining the strength of the nation. There was widespread support for a federally funded school meal program as part of a social democratic vision for a 'social minimum' to support Canadians' well-being. However, the federal government adopted only one of many recommendations for a social minimum, the Family Allowance, which provided monthly cash payments to families. The 1940s campaign for federally funded school meals fizzled because the federal government saw the Family Allowance as an adequate solution to the problem of child malnutrition and, in keeping with its liberal welfare state ideology, preferred to keep responsibility for children's well-being with the family, not the state. In addition, the scientific consensus about the constitution of malnutrition shifted, an important pilot test studying school meals' nutritional benefits provided inconclusive results, and a key advocate died. The historical record supports Crenshaw's contention that demands for change that are outside the dominant ideology are rarely adopted. [ABSTRACT FROM AUTHOR]

Global vaccine development is driven by logics that can run counter to local understandings, needs, and contexts. In a global industrial complex, dependent on financial market logics that prioritize private enterprise, highly promising innovative health products developed in public laboratories may be shelved and revealed only when market opportunities attract investment interest. Such an opportunity arrived with the WHO declaration of a Public Health Emergency of International Concern in 2014. The West African Ebola outbreak mobilized a global platform to accelerate development of existing experimental vaccines. This article explores pseudo-authorship by industry of the rVSV-ZEBOV Ebola vaccine that disappeared its actual discovery by public scientists. It shows that vaccine development in a global health pseudoscape disguises the source and means of innovation, deflects resources to the private sector, and can hinder sustainability of health systems. Pseudo-collaborations give little credit to those who have done the risky work, and pseudo-capacity building seldom reaches the people on the ground needing general health systems. Pseudo-standards, however, may offer an opportunity to free evidence-based gold standards to better respond to public health emergencies. [ABSTRACT FROM AUTHOR]

Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities. [ABSTRACT FROM AUTHOR]

Based on a critical review of the obesity and health literature we provide five models of how the hypothesized obesity and health relationship is conceptualized. We then apply these models to make sense of how recent Canadian public health reports and clinical practice guidelines conceptualize the issue of obesity, its causes and health effects, and appropriate responses. We show how conformity to dominant models of the obesity and health relationship by health sciences researchers, public health workers, and the media lead to activities that rather than promoting health, actually threaten it. These dominant models - and the activities derived from them - do so by diverting attention from the far more important issues of the quality and distribution of the social determinants of health. These approaches also stigmatize heavy individuals, doing little to promote their health. For these reasons, we call for an end to seeing obesity as a significant health issue. [ABSTRACT FROM AUTHOR]

Hand hygiene is a long-standing concern in the health sciences literature, but its emergence as a public health issue in the news is a more recent development. Drawing on Alan Hunt’s work on moral regulation and responsibilization, this article analyses 30 years of Canadian newspaper coverage of hand hygiene. Concerns associated with hand hygiene and trends in coverage were identified in a sample of 518 articles, published between 1986 and 2015. Although the Severe Acute Respiratory Syndrome (SARS) and H1N1 influenza epidemics emerged as important triggers, healthcare-associated infection (HAI) was the dominant trigger for hand hygiene coverage. The articles tend to present hand hygiene as a unidimensional approach to infection control. They tend to responsibilize individuals-first members of the general public, then healthcare providers and increasingly patients-for managing the risk of infection, rather than focus upon social, cultural, political and economic factors that would promote a more broad-based and structural response to HAI. [ABSTRACT FROM AUTHOR]

In May of 2011, a decision was made by city council in Calgary, Canada, to cease community water fluoridation and to re-allocate the annual operating costs to targeted dental programming. The purpose of this study was to critically analyze this decision as an example of a shift from a universal approach (fluoridation) to a targeted approach (dental programming delivered to children in low-income communities). We were especially interested in how the concept of equity played out in the deliberations, and we used Hilary Graham’s three conceptualizations of equity as a framework. We examined publicly available municipal council documents pertaining to this policy decision, with a prominent focus on the 26 January 2011 meeting of the Standing Policy Committee on Utilities and Environment at which Calgarians (citizens and professionals) were invited to speak. We extracted and critiqued statements or exchanges pertaining to equity or related concepts (e.g. poverty). We observed different perspectives on the concept of equity, and the notion of community water fluoridation as equitable. In particular, there was a tendency, expressed strongly by some participants in the debate, to conflate equity and poverty (Graham’s ‘disadvantages’ conceptualization of equity), such that a targeted approach was seen as the only viable way of addressing the dental health needs of children living in poverty. This research is timely considering the apparently increasing frequency of cessation of fluoridation in Canada, the consequent search for alternative approaches to preventive dental health, and the apparently strong appeal of a targeted approach. [ABSTRACT FROM PUBLISHER]

After two decades of intersectoral public health action, the literature reports considerable ongoing difficulty in achieving this aim. This article analyses two of the challenges of intersectoral action: (1) ensuring convergence among the interests and resources of sectoral actors, and (2) coordinating the multiplicity of sectoral programmes. A case study employing Actor–Network Theory is used to provide an in-depth understanding of the persistence of these problems. In 2008, the Montreal Directorate of Public Health in the province of Quebec, Canada, implemented a vast consultation and mobilization process to address problems highlighted by theSurvey of the School Readiness of Montreal Children. The process mobilized regional and local multi-sectoral actors in order to propose solutions. At the local community level, the process resulted in increased coordination leading to intersectoral innovation, while at the regional level it brought about the deployment of additional resources, albeit in sectoral programmes. This study analyses how intersectoral issues raised by the survey have been addressed so as to produce these results. It discusses how the balance between sectoral interests and the common good, as well as between sector autonomy and interdependence, is central to dealing with these two critical challenges. [ABSTRACT FROM PUBLISHER]

Comprehensive agri-food policy includes food waste reduction as an important policy goal. Food bank donor indemnification is codified in law in several countries to support the charitable food sector. Other policy instruments to address waste reduction have emerged recently, among them tax measures to incentivize private sector action. These have been increasingly linked to the discourse on hunger in many jurisdictions. We asked 17 Canadian food insecurity policy entrepreneurs to comment on a vignette scenario featuring a hypothetical proposal for food waste diversion as a policy response to household food insecurity; the polarization in responses – ‘Not human garburators,’ vs. ‘everyone wins’ – was remarkable. This case of an unexpected divergence in the response to a policy idea in the food insecurity realm provides an opportunity to understand fundamental differences in societal perspectives that might be relevant to public health more generally. In particular we address the parallel humanist and ecological imperatives at work in contemporary public health practice. It appears that objections to food waste diversion for human consumption could be crystallized in terms of Mary Douglas’s theory of morality within particular worldviews. From a humanist viewpoint, the proposal was an indignity; for those with an ecological worldview, it was sensible and pragmatic. Public health has embraced ecosystem thinking and takes for granted that its ecological approach is sensitive to humanist perspectives but the two worldviews may differ and humanist ideals of dignity may raise moral rancor when considered in the context of ecological good. [ABSTRACT FROM PUBLISHER]

Illicit drug use and homelessness among street-involved young people remain community and public health concerns, in part because of their association with ‘public disorder’, as well as increased encounters between youth, police, the criminal justice system, and the associated health-related harms. In the public imagination, illicit drug use, homelessness, and police encounters (including incarceration) are often understood as problems rooted in individual biographies. In general, there has been a lack of attention to the larger historical, institutional, and social-spatial contexts that converge across time, to increase young people’s risk of coming into contact with police and the criminal justice system. Drawing from a longitudinal ethnography with street-involved young people who use illicit drugs in Vancouver, Canada, we highlight two qualitative case studies that illustrate some of the ‘pathways’ to criminalization among this population. Specifically, these case studies reflect the complex linkages between child apprehension, foster care, homelessness, illicit substance use, and incarceration (juvenile detention and prison) across time. Our findings highlight the role of state interventions in perpetuating the marginalization that occurs across young people’s lives, in ways that increase their vulnerability to police and criminal justice encounters. [ABSTRACT FROM PUBLISHER]

This article reports findings from focus group conversations and in-depth interviews about the things that parents do to take care of their children’s health in Toronto, Canada. Our data demonstrate that within a single urban setting, parents are differently positioned to effectively find and engage existing healthcare resources. Parents’ ‘family health work’ is shaped by systemic expectations for health and institutional literacy and inter-institutional navigation skills that not all parents possess in equal measure. The intensive focus in Ontario paediatric healthcare settings on patient and parent education suggests increased interest in cultivating autonomous health information seeking and use strategies among parents. But the degree to which parents’ health-information seeking and use strategies are deemed effective depends on whether they are able to construct coherence between what they know about their child’s health and how to take care of it, and the knowledge the medical system requires to support diagnosis and treatment. Our research suggests that the healthcare system is only interested in information-seeking autonomy insofar as it supports patients’ engagement with the systems’ existing practices, frames of validity and service pathways. People who are unable to demonstrate health knowledge and work that support existing systemic processes cannot effectively use what they know and do to support their children’s health and wellness. [ABSTRACT FROM PUBLISHER]

Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compareindirectestimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities. [ABSTRACT FROM PUBLISHER]

Recently, scholars have called for more robust population and public health ethical frameworks to inform how the health of populations and individuals ought to be improved through various approaches to HIV testing practices. Our objective is to examine the breadth, range and foci of a variety of ethical issues pertaining to HIV testing approaches within the peer-reviewed literature, and how these issues address population and/or individual interests. We identify potential tensions between individual and collective approaches as well as other concerns, including equity, justice and distribution of health and risk – hallmarks of the emergent field of population and public health ethics. Based on our review, we suggest that additional theoretical work and empirical research are required in order to inform more ethically robust debates related to population HIV testing practices. Specifically problematic were consequentialist arguments that deem testing approaches as either morally permissible or impermissible without sufficient robust empirical and/or theoretical underpinnings and about how a particular approach would unfold among individuals and populations. The current review underscores the need to continue to articulate an evidence- and theory- informed population and public health ethics pertaining to HIV testing. [ABSTRACT FROM PUBLISHER]

The objective of this study was to systematically examine predominant themes within mainstream media reporting about marijuana use in Canada. To ascertain the themes present in major Canadian newspaper reports, a sample (N = 1999) of articles published between 1997 and 2007 was analyzed. Drawing from Manning’s theory of the symbolic framing of drug use within media, it is argued that a discourse of ‘privileged normalization’ informs portrayals of marijuana use and descriptions of the drug’s users. Privileged normalization implies that marijuana use can be acceptable for some people at particular times and places, while its use by those without power and status is routinely vilified and linked to deviant behavior. The privileged normalization of marijuana by the media has important health policy implications in light of continued debate regarding the merits of decriminalization or legalization and the need for public health and harm reduction approaches to illicit drug use. [ABSTRACT FROM PUBLISHER]

Dog walking enables physical activity and positive social interactions, but uncontrolled dogs as well as dog feces can foster conflict and deter physical activity, for both dog owners and nonowners. This case study shows that previously reported associations with dogs (both positive and negative) can be linked to the wording and the day-to-day implementation of, or incompliance with, local governments’ bylaws on pets. In this example of posthumanist health promotion, the policy goal is to optimize the overall impact on well-being of pet animals. Analytically, the case study draws together insights from actor–network theory, Foucault’s theory of governmentality, Bourdieu’s theory ofhabitus, and anthrozoology (i.e. the study of human–animal interactions as well as related ideas and norms). Posthumanist health promotion is a theoretically informed approach that can assist in developing policy and implementation strategies, not only on pets but on a range of topics. [ABSTRACT FROM PUBLISHER]

The Multicultural Yard Health and Environment Project (MYHEP) used Toronto's Pesticide Bylaw roll-out process to examine how culturally specific perceptions and practices might influence the relevance of municipal public health information and community engagement strategies and the effectiveness of health protection initiatives. In Canada, and particularly in Toronto, such information is needed for governments to effectively engage with increasingly diverse populations. Focus groups and individual interviews were conducted with Spanish- and Cantonese-speaking participants to document opinions about pesticide use and regulation and views on municipal information and engagement strategies. MYHEP participants reported a need for more accessible environmental health messaging. There was confusion over the safety and legality of pesticide products available for sale in Toronto stores. Most participants indicated they were unwilling to make formal complaints about neighbours who were not complying with the bylaw (an important mechanism for enforcement). Results indicate that environmental health communication and engagement strategies need to be more carefully tailored to address local sociocultural and linguistic contexts in order to provide more equitable environmental health protection and promotion for all residents. These findings led Toronto Public Health to adapt its efforts so as to better engage communities regarding environmental health. [ABSTRACT FROM AUTHOR]

In response to the mental health disparities experienced by Aboriginal peoples, and related inequities regarding the accessibility to appropriate mental health care, there has been a shift in health policy to endorse ‘By Indigenous for Indigenous’ health care delivery models. In Canada, this has resulted in the creation of new mechanisms for Aboriginal participation in health care planning by health authorities with the goal of fostering culturally safe mental health and addictions care. Yet, there is a growing concern about the effects of neo-liberal cost concerns in health policy on the effective implementation of such progressive reform ideas. Drawing on a critical policy review and ethnographic interviews with four community-based Aboriginal organisations and one health authority, this article uses ‘cultural safety’ as a critical lens to discuss emerging tensions within the context of regional Aboriginal mental health care reform in British Columbia. The findings of this study draw attention to the intersecting ways that dominant socio-historical and political ideologies undermine cultural safety in decision-making and funding practices, thereby creating situations of cultural risk for both Aboriginal people working within the area of Aboriginal mental health and by extension for Aboriginal people who are seeking mental health and addictions care. The insights gained from this research contribute to the ongoing dialogue regarding how to foster culturally safe mental health policy and practice, and for action in the political realm. [ABSTRACT FROM PUBLISHER]

Type 2 diabetes (T2DM) is a serious life-threatening chronic disease whose prevalence is especially high among Canadians living in poverty. And these Canadians with T2DM in poverty are especially likely to experience serious consequences of the disease. Of special concern is Statistics Canada reporting an explosive increase in mortality rates from diabetes (of which 90% represent T2DM) in low-income urban neighbourhoods across Canada. We place findings from interviews with 60 Canadians with T2DM who live in poverty within the context of recent shifts in public policy that have affected the distribution of the social determinants of health. Findings of material deprivation among our participants indicate that it is almost impossible for these individuals to acquire the diet necessary to prevent the adverse outcomes associated with T2DM. These findings draw attention to consideration of the important role public policy plays in affecting the situation of people living in poverty who are afflicted with T2DM and other chronic diseases. [ABSTRACT FROM AUTHOR]

The social determinants of health (SDH) concept is common to Canadian policy documents and reports. Yet, little effort is undertaken to strengthen their quality and promote their more equitable distribution through public policy action. Much of this has to do with the SDH concept conflicting with current governmental approaches of welfare state retrenchment and deference to the dominant societal institution in Canada, the marketplace. In addition, many SDH researchers and implementers of SDH-related concepts are reluctant to identify the public policy implications of the SDH concept. The result is a variety of SDH discourses that differ greatly in their explication of the SDH concept and their implications for action. This article identifies these various SDH discourses with the goal of noting their contributions and limitations in the service of advancing the SDH agenda in Canada and elsewhere. [ABSTRACT FROM AUTHOR]

Over the past 25 years, Aboriginal leaders, community advocates, children's and women's health specialists and Canadian government agencies have drawn increasing attention to the perceived need to undertake targeted initiatives to prevent fetal alcohol spectrum disorder (FASD) in indigenous communities. In pursuit of this goal, a range of prevention campaigns have been undertaken - generally with funding from the State - urging pregnant women to abstain from alcohol. Because both risk and protective factors for FASD are intimately connected to the social conditions in which women become pregnant, give birth to and mother their children, FASD prevention campaigns targeting Aboriginal communities suggest possibilities that are both provocative and problematic for advancing movements for social justice, decolonisation and improved maternal and child health. In this essay, I consider how the gendered and racialised legacies of colonisation emerge alongside concerns for improved health and well-being of indigenous children to inform contemporary, state-funded efforts to prevent FASD. In so doing, I examine the ways that neoliberal economic and political trajectories of Canadian state formation intersect with some aspects of decolonisation movements to raise important questions about when, how and under what conditions colonial states support FASD prevention efforts among indigenous peoples. [ABSTRACT FROM AUTHOR]

Historically, Western liberal democracies have defined relevant knowledge for social and economic management as that produced by experts following established professional methods. As we experience a shift from government to governance, state departments and bodies have attempted to impose their own desire for this particular form of knowledge, typically constructed as quantitative performance measures, onto their community partners. This is done in the name of accountability. Health promotion, as practiced in government health agencies, faces these same pressures to demonstrate outcomes and successes from community work. However, this article argues that, rather than blindly following these imperatives characteristic of advanced liberalism, it will be more fruitful for health promotion to explore the potential of incorporating and employing local knowledge(s). This argument is illustrated through two brief examples drawn from population health initiatives in two regional health authorities in western Canada. Persistent pressure from community members and their advocates can open up professional and bureaucratic systems to allow new forms of information to influence judgment. Local knowledge(s) offer a unique contribution to health promotion practice. It is incumbent upon practitioners and government organizations to seek ways to engage and incorporate the insights that are only thus available. [ABSTRACT FROM AUTHOR]

Obesity was once considered a lifestyle issue; recently it has become an 'epidemic'. Media coverage presents an opportunity to explore this phenomenon. A framing analysis was conducted on obesity media coverage in one representative Canadian newspaper in 1996, 2000 and 2005/06. The analysis finds that by 2005, an obesity epidemic is unquestioned. However, it does not support others' findings that obesity is attributed to the decline of western civilization and blamed on lazy individuals who overeat. To relate obesity to such factors flies in the face of capitalistic progress, which demands continued production and consumption. Obesity in Canadian media is presented almost as an opportunity: an obstacle impeding national progress, but one that with a great deal of collective, focused effort, can be overcome. Armstrong's 'surveillance medicine', where responsibility for one's health is internalized, focuses the discussion. In turn, the analysis builds on Armstrong's concept, illustrating that the downloading of responsibility to the citizen is not a one-way transfer. The state may benefit by shifting the responsibility for health to the individual, but there are benefits to reclaiming that responsibility at times. An epidemic provides an opportunity to strengthen national pride and enhance an increasingly significant Canadian health research enterprise, thereby stimulating the economy and positioning the country as a world leader. This does not suggest that calling obesity an epidemic serves no population health goals, but simply highlights that by creating a groundswell of concern that in turn justifies immediate action, it does much more. [ABSTRACT FROM AUTHOR]

This article presents a case study of a community-university physical activity initiative in which the author operated as a change agent responsible for facilitating community intersectoral collaboration, capacity, and autonomy. Change agents in community-institution initiatives typically work with communities or organizations to initiate and maintain a change effort. Using a first-person, insider action research approach, the change agent examined a set of dilemmas and dynamics she faced throughout the course of the initiative, and framed these in terms of tensions occurring along three continuums: (1) process-product, defined by the challenge of finding a balance between building capacity and delivering concrete and timely results; (2) insider-outsider, linked to the duality of roles of the change agent and community partners, and ensuing conflicts of identity, territory, loyalty, and accountability; and (3) bottom-up/top-down, associated with the difficulty of respecting local circumstances and needs while simultaneously operating within set parameters. The author critically reflects on the role of institutions involved as partners in community-institution initiatives, and draws attention to the complexity of the change agent's role in such initiatives. Recommendations for practice are offered, including the need for community-institution initiatives to provide sufficient time and resources for community capacity-building processes to develop, properly support change agents in their multiple roles and core functions, and develop their own capacities to engage in community capacity-building and change. [ABSTRACT FROM AUTHOR]

Community is a key construct in population health research and a major locus of health determinants study. In recent years in Canada, a new emphasis on such research has emerged in the form of community–university partnerships, supported by several of the major research granting agencies. The authors regard such partnerships as a special case of participatory action research (PAR), albeit one where greater emphasis is placed on the institutional nature of the university research partner. Drawing from the first three years’ experience of a local quality of life study, and the extant North American literature on community–university partnerships, this article explores how such partnerships are established and sustained. These processes are illustrated with critical reflections on some of the methods, actions and relational issues that arose during the authors’ quality of life project. The article concludes with a brief reflection on the potential benefits and costs of the growing Canadian trend to require such partnerships as a condition for research grants. [ABSTRACT FROM AUTHOR]

In the 1920s in Canada, the Federal Government's Division of Child Welfare issued the nation's first dietary guidelines aimed at encouraging women to breastfeed and also, somewhat ambivalently, encouraging women to feed cow's milk to babies over nine months of age. The early 1920s was a time of transition in milk processing and distribution. Some cities and provinces had strong sanitary hygiene laws to ensure that milk was free of disease and contamination but others did not so that general national guidelines promoting the use of cow's milk were problematic. These guidelines were promulgated at a time when many public health officials had begun to shift from vilifying milk, because of its potential to harbour dirt and bacteria and because of its well-known links to infant mortality, to extolling its virtues because of its newly discovered rich vitamin and mineral content. The shift in milk's status as an unhealthy liquid to the quintessential protective food for children, both in the public's mind and in the mind of many public health practitioners, particularly those from cities that had managed to clean up their milk supply, was rapid and occurred while much of the nation's milk supply was in fact not safe. The promulgation of dietary guidelines promoting the consumption of cow's milk for babies over nine months at this time was inconsistent and probably quite dangerous, particularly as Canada during the 1920s had the highest infant mortality rates among industrialized nations. The guideline was issued at a time of scientific enthusiasm over the new value of milk in protecting against under-nutrition and promoting optimal health. The dairy industry and the Federal Department of Agriculture unabashedly promoted the protective benefits of milk in large national campaigns overwhelming the ability of the Division of Child Welfare to deliver the best possible dietary guidelines for the times. The relatively weak guidelines developed by the Division in the 1920s... [ABSTRACT FROM AUTHOR]

In the early 1980s, the sawmill sector in British Columbia (BC), Canada experienced economic recession which was followed by industrial restructuring in many mills. This is an investigation of the relationship between unemployment, which occurred in the recession and the new psychosocial and physical work conditions in restructured workplaces using a cohort of approximately 29,000 sawmill workers in 14 BC sawmills. The purpose of this investigation is to describe the changes in the cohort's job structure and labour demography in order to best frame future health studies on the effects of unemployment and restructuring. Downsizing reduced the number of workers by 60% and the number of job titles by 25%. The youngest workers were downsized and job titles with the least control and most demand were eliminated by restructuring. Although psychosocial conditions of work (assessed using 'expert' raters) improved after restructuring, these better work conditions were available to fewer workers. Four main lessons were learned. First, to assess the health impact of the downsizing/restructuring process a population-based approach must be taken with long-term follow up of downsized workers through their period of unemployment and re-employment in similar or new industries. Second, particular attention must be paid to the long-term employment experiences and associated health outcomes for downsized workers under 35 years of age. Third, although all job categories showed increased levels of control in restructured workplaces, the gradient in control across job categories was steeper in 1997 compared to 1965 which may have health implications particularly for unskilled workers in restructured mills. And, fourth, the expert rater method for estimating work conditions should be improved upon and tested by using self-reports in future health studies with this cohort. [ABSTRACT FROM AUTHOR]