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Research has long-documented how Canada's temporary foreign worker programs (TFWP) foster workers' precarity through their status as non-citizens and living and working conditions, ultimately, impacting their health. While studies point to limited supports and services for workers, their role in reinforcing or alleviating the precarious conditions that migrant agricultural workers experience remains largely unexplored. This paper draws on interviews with 35 service providers in three migrant-intensive regions in southwestern Ontario, to explore how service providers describe and construct support. We explore the barriers workers face in accessing services, challenges providers experience in supporting workers, and strategies employed to surmount these barriers. We argue that this multiregional analysis is important to illuminate how support shapes and is shaped by the larger structural context, namely common features of Canada's TFWP. A more comprehensive understanding of support moreover, provides direction for sustainable interventions that can promote the health and wellbeing of this population. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) across South Africa face significant health disparities rooted in stigmatization due to their sexual orientation, which negatively affects their health. Toward curbing sexually transmitted diseases and ensuring equitable distribution of access to health services for MSM, this study developed a framework capable of providing equal health for MSM in South Africa. The study aims to develop a framework that promote equitable health among MSM in South Africa. This study adopted a qualitative method with in-depth consented interviews targeted at MSM in Umlazi township, South Africa. A total of 25 MSM were interviewed, and their responses were analyzed using Nvivo 11, supported by content analysis. The Equitable Health Access Framework (EHAF) was developed using the study findings, guided by the WHO framework for social health determinants, and underpinned by the systems theory. The framework was structured around three factors: input, processes and output. The key finding depicted that the implementation and collaboration of the input and process will result in an output of equitable health access for MSM. Based on the study findings, the processes and key factors to be considered are sensitization training, community engagement and support, MSM empowerment program, and health promotion. At the same time, the input are finance, human resources, infrastructure, medical equipment and consumables. The "framework" could guide policymakers and health professionals by providing structured processes and key elements to ensure better health space and equal healthcare delivery to MSM in the research setting and similar settings in developing countries. Plain language summary: A detailed plan to ensure fair healthcare services access for men who have sex with other men in South Africa The focus of this study is on South Africa, men who have sex with men who are often seen to suffer with health problems because of their sexual orientation. And in order to help them in dealing with their health issues researcher talked to 25 MSM in Umlazi and learnt about their personal stories. And it was the result of their feedback that help in developing the study framework which is called the Equitable Health Access Framework (EHAF). The framework describes mechanisms that can be used to grant MSM population platform to better access healthcare with the interventions like health education, trainings and community support. It's expected that with this framework different policy makers, health care workers and program implementers will be able to use the mechanism to better support MSM in accessing health services withouth any fear, stigma or discimination. [ABSTRACT FROM AUTHOR]

The objective of this study is to examine access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data on TGD (n = 1,678) and cisgender adults (n = 403,414) from the 2019 to 2020 Behavioral Risk Factor Surveillance System were used. Outcome measures were four barriers to care. We conducted bivariate and multivariable logistic regressions to assess associations between access, rurality, and gender identity. Bivariate results show that TGD adults were significantly more likely to experience three barriers to care. In multivariable models, TGD adults were more likely to delay care due to cost in the full sample (adjusted odds ratio [AOR]: 2.00, p <.001), rural subsample (AOR: 2.14, p <.01), and urban subsample (AOR: 1.97, p <.01). This study revealed greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults. Increased provider awareness and structural policy changes are needed to achieve health equity for rural TGD populations. [ABSTRACT FROM AUTHOR]

Introduction: Following the historic Canadian legislation on medical assistance in dying (MAiD) in 2016, many implementation challenges and ethical quandaries have formed the focus of further scholarly investigation and policy revisions. Of these, conscientious objections held by some healthcare institutions have involved relatively less scrutiny, despite indicating possible hurdles to the universal availability of MAiD services in Canada. Methods: In this paper, we contemplate potential accessibility concerns that pertain specifically to service access, with the hope to trigger further systematic research and policy analysis on this frequently overlooked aspect of MAiD implementation. We organize our discussion using two important health access frameworks: Levesque and colleagues' Conceptual Framework for Access to Health and the Provisional Framework for MAiD System Information Needs (Canadian Institute for Health Information). Results: Our discussion is organized along five framework dimensions through which institutional non-participation may generate or exacerbate inequities in MAiD utilization. Considerable overlaps are revealed across framework domains, indicating the complexity of the problem and the need for further investigation. Conclusion: Conscientious dissensions on the part of healthcare institutions form a likely barrier to ethical, equitable, and patient-oriented MAiD service provision. Comprehensive, systematic evidence is urgently needed to understand the nature and scope of resulting impacts. We urge Canadian healthcare professionals, policymakers, ethicists, and legislators to attend to this crucial issue in future research and in policy discussions. [ABSTRACT FROM AUTHOR]

Objective: Estimate impact of socioeconomic factors and remoteness from tertiary hospital on incidence/duration of Australian mental health admissions. Methods: Retrospective analysis of incidence/duration of public mental health unit admissions (2018–19). Covariates included Indigenous population, potentially preventable hospitalisations (PPH) and socioeconomic disadvantage. Results: Regional distance from hospital was correlated with socioeconomic disadvantage (ρ : p < 0.01). Population identifying as Aboriginal or Torres Strait Islander was associated with distance from hospital, socioeconomic disadvantage and PPH (ρ : p < 0.01). Bed days per capita was explained (R 2adj: 0.48) by distance and socioeconomic disadvantage (p < 0.0001). A 1% increase in distance from hospital was associated with a 0.37% decrease in per capita bed days. Admission rate per capita across Queensland and WA was explained (R 2adj: 0.36) by distance, education/occupation and state (p < 0.05). Across Queensland and WA a 1% increase in distance from hospital was associated with a 0.05% decreased incidence of admission. Conclusions: Rural Australians face high mental illness burden, socioeconomic disadvantage and limited service provision. Overcoming the additional disadvantages of reduced likelihood of admission to and reduced time in hospital with increasing distance from hospital will require increased outreach proportional to remoteness. [ABSTRACT FROM AUTHOR]

The caste system is social stratification system that has been used over the last 3 millennia. This review aims to investigate caste-based inequity in health care utilization in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR, and ASSIA) were searched for relevant articles published before October 2019, using comprehensive search strategy in accordance with the PRISMA guidelines. In total 15,109 papers were found, and from these, nine selected papers were included in the review. The papers focused on studies in both India (n = 7) and Nepal (n = 2) and utilized a range of methods including qualitative (n = 2), quantitative (n = 3), and mixed methods (n = 4) approaches. The review identified four main themes: stigma, poverty, cultures and beliefs, and health care. Caste-based inequity impacts upon all aspects of an individual's well-being including violence and everyday life risks. Caste also impacts upon individuals' opportunities to access education, employment, and health care. Dalits appear to experience this more significantly due to both poverty and their caste status, which increases their vulnerability to health risks. [ABSTRACT FROM AUTHOR]

The COVID-19 (coronavirus disease–2019) pandemic has exposed long-standing inequalities in U.S. health care. Historically, racial and ethnic minorities have been the most likely to suffer from inadequate health care access and insurance coverage. With the spread of COVID-19, these disparities have dramatically increased. Focusing on native and foreign-born racial/ethnic minorities, this article discusses how entrenched health inequities and structural discrimination have led to COVID-19 morbidities and mortalities. Considering that "essential" frontline workers are disproportionately native and foreign-born racial/ethnic minorities, this work evaluates the impact(s) of social exclusion and the lack of support systems for these workers. Using the framework of intersectionality, this work also examines how race and immigrant status affect COVID-19 spread in prisons and immigration detention centers—facilities that often lack effective health and sanitary conditions and where inmates are also likely to be racial/ethnic minorities. [ABSTRACT FROM AUTHOR]

This article examined the association between social position variables (i.e., Hispanic, health insurance coverage, and poverty rates) on the prevalence of specific learning disabilities (SLD) in students between 3 and 21 years of age. We used the 2012 to 2013 U.S. population data from the U.S. Department of Education, Office of Special Education Program, and the American Community Survey for the 50 states, Puerto Rico, and Washington, D.C. Results indicate that states with higher rates of Hispanics were related to higher rates of SLD, while lower rates of no health insurance coverage were related to lower SLD rates. We conclude that Hispanic students are at a higher risk of being diagnosed with SLD, while having no health insurance coverage might be a detriment to be properly diagnosed. The importance of a national perspective in disabilities and the role of social position variables on special education are discussed. [ABSTRACT FROM AUTHOR]

U.S. Latinos experience constrained access to formal health care resources, contributing to higher incidence of preventable diseases and chronic health conditions than the general population. The authors explore whether a rich set of informal health communication connections—to friends, family, radio, television, Internet, newspapers, magazines, churches, and community organizations—can compensate, even partially, for not having access to doctors. The authors find no evidence of any such compensatory mechanism among respondents to the Pew Hispanic Center/Robert Wood Johnson Latino Health Survey (N = 3,899). Analyses revealed that the informal health communication ecologies of respondents with favorable immigration/nativity status and greater income, education, and language proficiencies were more diversified than those of respondents reporting less favorable social status. Further analyses revealed that diversified informal health communication ecologies related to health care access (regular doctor visits, uninterrupted health insurance, and regular health care location) and favorable health outcomes (self-ratings of general health, health-related efficacy, and knowledge of diabetes symptoms). [ABSTRACT FROM PUBLISHER]

Objectives: In the shared care model, psychiatrists and physicians work in the same office areas, write their notes in the same casebooks, and can more rapidly exchange information about referrals and health conditions of their patients. We evaluated the impact of the introduction of a shared mental health care service, co-located with a primary care site, on wait times for mental health services in a northern Ontario city. Method: Chart reviews were conducted to examine a total of 3589 referrals for 5 mental health outpatient services (1 shared care and 4 existing services) from January 2001 to the end of June 2004. The shared mental health care service site was started in July 2001. Wait time was measured 6 months prior to and up to 3 years after the introduction of the shared care service. Results: The shared care site offered services more than 40 days sooner and also helped to reduce wait time on the nonshared care sites. After shared care began, the pre-existing, nonshared care services had wait times of about 13 days shorter during the 3 subsequent years. Conclusions: The shared care service maintained the lowest overall wait times, compared with the existing nonshared care services. The existing services experienced a decrease in the number of days waiting when the baseline wait time was compared with that of the following year. INSETS: Clinical Implications;Limitations. [ABSTRACT FROM AUTHOR]

Certain racial, ethnic, and economic groups, specifically men of color and men with low incomes, experience disproportionately high rates of chronic illness and of diseases and conditions that are leading causes of death in the United States. The dismal rates of morbidity and premature death among poor men and men of color in the United States underscore societal inequities and exacerbate health disparities among these populations. As the evidence of disparities continues to compound, the need for many-layered responses to address complex and intractable health inequalities becomes more obvious. Detailing the actual utilization of health services in specific populations by gender, race, ethnicity, and income can contribute to a wider understanding of health disparities and the costs of inadequate access to quality health care. Such population-based approaches to data collection and health service delivery within a community context can both ameliorate health disparities and suggest novel interventions to inform policy decisions. Nontraditional collaborations that create broad community coalitions around population-based approaches and join non profits with philanthropy, academe, and local, state, and federal governmental entities hold the greatest potential for leveraging change. [ABSTRACT FROM AUTHOR]

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