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Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF–LPF frameworks and suggestions to increase the transformative power of future studies. [ABSTRACT FROM AUTHOR]

This article analyses and compares disability policies for working-age individuals in Canada with a focus on the mode of policy provision and type of measure to determine the degree to which direct funding is used in this country. To consider policy diversity in this federal system, policies are compared using a mixed-methods approach. Using quantitative methods, federal, provincial and territorial policies are first compared using hierarchical cluster analysis. This provides evidence of three distinct clusters in Canada according to policy provision and measure type. In a second, qualitative analysis, the disability strategies of four provinces' (British Columbia, Ontario, Newfoundland and Labrador and Quebec) are compared, to determine over arching policy orientations. Findings indicate that policy provision in Canada largely favours money over services. Furthermore, most provinces emphasize either health or integration measures over substantive measures. Despite these commonalities, significant variation persists across Canada. This extends to poverty and disability reduction strategies with two of the four provinces having a broader orientation while the other two provinces focus specifically on employment as a means of social inclusion. The article concludes with a discussion on the state of employment policies for individuals with a disability in Canada. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which regional variations in poverty and health and social services spending impact the risk of placement, after controlling for individual-level risk factors and regional latent differences in delivery of child protection services. Clinical administrative child protection data were merged with income and health and social services spending data for the province of Quebec; the final data set included all children ( N = 122,466) investigated for maltreatment for the first time between April 1, 2002 and March 31, 2010, of which 22.6% ( N = 27,710) were placed in out-of-home care. Multilevel hazard results indicate that poverty, controlling for health and social services spending, contributes to the increased risk of placement. Specifically, poverty and health and social services spending account for 57.1% of the variation in regional placement for younger children < 5 years of age and 38.1% for children age 5 to 11 years. [ABSTRACT FROM AUTHOR]

• The application of multilevel structural equation modeling was used to examine structural neighborhood factors associated with neglect. • Localized disparities in socioeconomic vulnerabilities are a good predictor of differential child protection involvement for reasons of neglect. • Socioeconomic factors had the greatest association with child protection involvement for neglect in the lowest density small area geographies. This paper explores the use of social geographic data and multilevel latent modeling to make initial predictions on geographic variation in child protection involvement for reasons of neglect, resulting in novel findings regarding the relationship between poverty and neglect in low-density geographies in the province of Quebec, Canada. This study used multilevel structural equation modeling, which combines both structural equation modeling and multilevel modeling, to test how a latent construct of socioeconomic vulnerability – across 10,650 small area geographies and 166 community health and social service regions in Quebec – is connected to child protection intervention for neglect in child population density quintiles across these geographies. Small area geographies and health and social service regions in this study are defined and discretely organized using full six digit postal codes and larger community regions provincially defined according to the public social and health services administered by the province. Full alphanumeric postal codes allow for more granular analysis than studies using only the first three digits. The rate of substantiated neglect cases is calculated per 1000 children aged 0–9 years, for the years 2006 to 2016, inclusively. The socioeconomic data for each of the small area geographies and health and social service regions was drawn from the 2011 Canadian National Household Survey and then matched to provincial administrative child protection data using full alphanumeric postal codes allowing for more granular analysis than studies using only the first three digits. Model fit evaluations (comparative fit index and Tucker-Lewis index) were conducted and results suggested acceptable model fit. Overall results suggest a consistent association between socioeconomic vulnerability and the increased likelihood of child protection involvement for reasons of neglect. However, latent socioeconomic factors were most associated with neglect cases in the lowest density small area geographies, suggesting that increased vulnerability to investigation for neglect is related to a sparse geographic spread of the child population. The association between socioeconomic vulnerability and neglect is not surprising, but the fact that this relationship varies in strength according to child population density is a novel finding. The finding of greatest association between socioeconomic vulnerability and neglect in the lowest density small area geographies suggests that more research should be done to explore the ways that population density may relate to the likelihood of exceptional involvement by child protection authorities for neglect. Implications of this study for policymaking intended to prevent neglect, particularly related to chronic need, include the importance of taking a tailored approach to preventative service provision in small area geographies with lower child population densities, considering the challenges families face in more remote areas in accessing appropriate supports. [ABSTRACT FROM AUTHOR]

Background: Social inequalities in healthcare systems persist worldwide. Physicians' prejudices and negative attitudes towards people living in poverty are one of the determinants of healthcare inequalities. We know very little about general practitioners' (GPs) perceptions of poverty, which shape their attitudes.Objective: To identify the perceptions of poverty of GPs who deal with it in everyday practice.Methods: A qualitative study based on interviews with GPs working in deprived urban neighbourhoods. In-depth semi-structured interviews were conducted with physicians working in disadvantaged neighbourhoods in Montreal, Canada. Interviews were audio-recorded and transcribed verbatim. Analysis consisted of interview debriefing, transcript coding, and thematic analysis using an inductive and iterative approach.Results: Our study revealed two contrasting perceptions of poverty. The global conception of poverty referred to social determinants and was shared by the majority of physicians interviewed, while the moral conception, centring on individual responsibility, was shared by a minority of participants.Conclusion: The moral judgments and misunderstandings evidenced by GPs regarding poverty suggest avenues for improving general medical training. Understanding social determinants of health should be an important component of this training, to improve access to care for people living in poverty. [ABSTRACT FROM AUTHOR]

Primary care practitioners are frequently unprepared to take into account the effects of social determinants on underprivileged patients' health and health management. To address this issue among dental professionals, an original onsite continuing education (CE) course on poverty was co-developed by researchers, dental professionals, and community organizations. Integrating patient narratives and a short film, course material aims to elicit critical reflection and provide coaching for practice improvements. A qualitative case study conducted with a large Montreal Canada dental team reveals CE course participants' newfound understandings and increased sensitivity to the causes of poverty and the nature of life on welfare. Participants also describe revised interpretations of certain patient behaviors, subtle changes in communication with patients and improved equity in appointment-giving policy. Unintended outcomes include reinforced judgment and a tendency to moralize certain patient categories. Implications for health professional educators, researchers, and dental regulatory authorities are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Poverty has been associated with high levels of behavior problems across childhood, yet patterns of associations over time remain understudied. This study aims: (a) to examine whether poverty predicts changes in behavior problems between 1.5 and 8 years of age; (b) to estimate potential selection bias for the observed associations.Methods: We used the 1998-2006 waves of the Quebec Longitudinal Study of Child Development (N = 2120). Main outcomes were maternal ratings of hyperactivity, opposition and physical aggression from 1.5 to 8 years of age. Linear mixed-effects models were used to assess the longitudinal association between poverty and behavior problems. Models were re-estimated adjusting for wave nonresponse and using multiple imputation to account for attrition.Results: Poverty predicted higher levels of behavior problems between 1.5 and 8 years of age. Poverty predicted hyperactivity and opposition in a time dependent manner. Hyperactivity [Bpoverty*age = 0.052; CI 95 % (0.002; 0.101)] and opposition [Bpoverty*age = 0.049; CI 95 % (0.018; 0.079)] increased at a faster rate up to age 5 years, and then decreased at a slower rate for poor than non-poor children. Physical aggression decreased at a steady rate over time for all children [Bpoverty*age = -0.030; p = 0.064). Estimates remained similar when accounting for attrition.Conclusion: Poverty predicted higher levels of behavior problems between 1.5 and 8 years of age. The difference between poor and non-poor children was stable over time for physical aggression, but increased with age for hyperactivity and opposition. Attrition among poor children did not compromise the validity of results. [ABSTRACT FROM AUTHOR]