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Abstract The global refugee crisis and the increased number of refugees seeking asylum in Canada has led the federal government to enact a series of policy reforms related to refugee healthcare coverage and spending. This paper provides a critical review of the Interim Federal Health Program (IFHP), drawing on concepts from social justice, migration, and market-oriented theories while examining policy rhetoric, legal ramifications, and media portrayals. The recommendations in this article aim to reduce health inequities and healthcare access barriers for the refugee population in Canada. Findings suggest Canadian federal policies have contributed to refugee health disparities. [ABSTRACT FROM AUTHOR]

Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal. [ABSTRACT FROM AUTHOR]

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes. Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses. Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants. Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth. [ABSTRACT FROM AUTHOR]

Aim: This paper explores the potential for incorporating big data in nursing regulators' decision‐making and policy development. Big data, commonly described as the extensive volume of information that individuals and agencies generate daily, is a concept familiar to the business community but is only beginning to be explored by the public sector. Background: Using insights gained from a recent research project, the College and Association of Registered Nurses of Alberta, in Canada is creating an organizational culture of data‐driven decision‐making throughout its regulatory and professional functions. The goal is to enable the organization to respond quickly and profoundly to nursing issues in a rapidly changing healthcare environment. Sources of evidence: The evidence includes a review of the Learning from Experience: Improving the Process of Internationally Educated Nurses' Applications for Registration (LFE) research project (2011–2016), combined with a literature review on data‐driven decision‐making within nursing and healthcare settings, and the incorporation of big data in the private and public sectors, primarily in North America. Discussion: This paper discusses experience and, more broadly, how data can enhance the rigour and integrity of nursing and health policy. Conclusion: Nursing regulatory bodies have access to extensive data, and the opportunity to use these data to inform decision‐making and policy development by investing in how it is captured, analysed and incorporated into decision‐making processes. Implications for Nursing and Health Policy: Understanding and using big data is a critical part of developing relevant, sound and credible policy. Rigorous collection and analysis of big data supports the integrity of the evidence used by nurse regulators in developing nursing and health policy. [ABSTRACT FROM AUTHOR]

Abstract Local public health authorities often lack the capacity to adapt to climate change, despite being on the 'front lines' of climate impacts. Upper-level governments are well positioned to create an enabling environment for adaptation and build local public health authorities' capacity, yet adaptation literature has not specified how upper-level governments can build local-level adaptive capacity. In this paper we examine how federal and regional governments can contribute to enabling and supporting public health adaptation to climate change at the local level in federal systems. We outline the local level's self-assessed adaptive capacity for public health adaptation in Canadian and German comparative case studies, in terms of funding, knowledge and skills, organizations, and prioritization, drawing upon 30 semi-structured interviews. Based on interviewees' recommendations and complemented by scientific literature, we develop a set of practical measures that could enable or support local-level public health adaptation. We find that adaptive capacity varies widely between local public health authorities, but most report having insufficient funding and staff for adaptation activities. We propose 10 specific measures upper-level governments can take to build local public health authorities' capacity for adaptation, under the interrelated target areas of: building financial capital; developing and disseminating usable knowledge; collaborating and coordinating for shared knowledge; and claiming leadership. Federal and regional governments have an important role to play in enabling local-level public health adaptation, and have many instruments available to them to fulfill that role. Selecting and implementing measures to enable local public health authorities' adaptive capacity will require tailoring to, and consideration, of the local context and needs. Highlights • Local public health authorities often lack capacity to adapt to climate change. • National and regional governments can play supportive or enabling role. • We propose 10 concrete measures to enable local public health adaptation. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Alcohol pricing is an effective prevention policy. This paper compares the 10 Canadian provinces on three research-based alcohol pricing policies-minimum pricing, pricing by alcohol content and maintaining prices relative to inflation.Design and Methods: The selection of these three policies was based on systematic reviews and seminal research papers. Provincial data for 2012 were obtained from Statistics Canada and relevant provincial ministries, subsequently sent to provincial authorities for verification, and then scored by team members.Results: All provinces, except for Alberta, have minimum prices for at least one beverage type sold in off-premise outlets. All provinces, except for British Columbia and Quebec, have separate (and higher) minimum pricing for on-premise establishments. Regarding pricing on alcohol content, western and central provinces typically scored higher than provinces in Eastern Canada. Generally, minimum prices were lower than the recommended $1.50 per standard drink for off-premise outlets and $3.00 per standard drink in on-premise venues. Seven of 10 provinces scored 60% or higher compared to the ideal on indexing prices to inflation. Prices for a representative basket of alcohol products in Ontario and Quebec have lagged significantly behind inflation since 2006.Discussion and Conclusions: While examples of evidence-based alcohol pricing policies can be found in every jurisdiction in Canada, significant inter-provincial variation leaves substantial unrealised potential for further reducing alcohol-related harm and costs. This comparative assessment of alcohol price policies provides clear indications of how individual provinces could adjust their pricing policies and practices to improve public health and safety. [Giesbrecht N, Wettlaufer A, Thomas G, Stockwell T, Thompson K, April N, Asbridge M, Cukier S, Mann R, McAllister J, Murie A, Pauley C, Plamondon L, Vallance K. Pricing of alcohol in Canada: A comparison of provincial policies and harm-reduction opportunities. Drug Alcohol Rev 2016;35:289-297]. [ABSTRACT FROM AUTHOR]

Evidence-informed health policy making (EIHP) is becoming a necessary means to achieving health system reform. Although Canada has a rich and well documented history in the field of evidence-basedmedicine, a concerted effort to capture Canada's efforts to support EIHP in particular has yet to be realized. This paper reports on the development of EIHP in Canada, including promising approaches being used to support the use of evidence in policy making about complex health systems issues. In light of Canada's contributions, this paper suggests that scholars in Canada will continue engaging in the field of EIHP through further study of interventions underway, as well as by sharing knowledge within and beyond Canada's borders about approaches that support EIHP. [ABSTRACT FROM AUTHOR]

General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community. [ABSTRACT FROM AUTHOR]

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the 'space available' for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the 'barbed-wire fence' that separates funding of medical and 'non-medical' primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to examine the progress of the Mental Health Commission of Canada (MHCC) over the first five years of its existence toward stated goals while existing outside the constitutional framework of health care funding. Design/methodology/approach – The paper is a review of the outputs of the MHCC with emphasis on its first-ever mental health strategy for Canada, knowledge exchange network, anti-stigma initiatives, randomized controlled trial of housing-first initiatives for the homeless mentally ill, as well as other completed projects. Findings – Consultation and collaboration are essential aspects of working successfully with people with lived experience of mental illness, their families, health professionals, and governments. At the same time, when expectations are high, needs are great, and opinions are varied, disappointment and frustration are inevitable. Research limitations/implications – Although the MHCC initiatives include the largest single funded research project in mental health in Canadian history, and evaluation is built into other initiatives, the political dimension of its work does not lend itself to research evaluation. Practical implications – The creation of an organization outside the constitutional framework of health care funding may allow for a catalytic role in precipitating change. Social implications – The emphasis on anti-stigma campaigns targeted at defined populations (youth, health professionals, workforce, journalists) may combat the discrimination people with mental illnesses and their families experience. Originality/value – The paper shows that the Canadian experience is, to date, largely undescribed in the peer-reviewed literature and may influence other jurisdictions. One of its interventions is already being replicated internationally. [ABSTRACT FROM AUTHOR]

For First Nations tuberculosis (TB) patients in the Prairie Provinces, the past matters. In this paper, we draw on the analysis of historical statements made by 20 First Nations interviewees with infectious TB to explore the function of talking about the past in relation to a current diagnosis of TB and the implications of historicity on contemporary TB prevention, programming and care. Despite interviewees not being asked directly about past contexts of TB treatment, they talked about historical topics such as the removal of First Nations TB patients from communities for treatment in distant sanatoria, painful and invasive surgical procedures once used to treat TB, and the attitudes that persist due to the ongoing failure to eliminate TB from First Nations communities. In these narratives, past experiences of TB treatment are intimately connected to present-day experiences and context. What happened 'years ago' profoundly affects the health and well-being of people diagnosed with TB today. Attempts to eliminate TB among First Nations peoples in Canada must also address its historical legacy. Understanding the contemporary effects of past TB treatment and mistreatment among First Nations peoples in the Prairie Provinces can also be seen as part of a larger project of truth and reconciliation in Canada, which involves both Indigenous and non-Indigenous Canadians. [ABSTRACT FROM AUTHOR]

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. Method: The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum). Results: Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. Discussion & conclusions: While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world. [ABSTRACT FROM AUTHOR]

Abstract: Mass media are very influential in shaping discourses about health but few studies have examined the extent to which newspaper coverage of such stories reflect issues embedded in health policy documents. We estimate the relative distribution of health stories using content analysis. Nine meta-topics are used to sort stories across a range of major influences shaping the health status of populations adapted from the document Toward a Healthy Future (Second Report on the Health of Canadians (1999)) (TAHF). A total of 4732 stories were analyzed from 13 Canadian daily newspapers (10 English, 3 French language) using a constructed week per quarter method. Stories were sampled from each chosen newspaper for the years 1993, 1995, 1997 and 2001. 72% (n=3405) of stories in this analysis were from English-language papers, 28% (n=1327) were from French-language papers. Topics related to health care (dealing either with issues of service provision and delivery or management and regulation) dominated newspaper stories, accounting for 65% of all stories. Physical environment topics accounted for about 13% of all stories, the socio-economic environment about 6% of stories, personal health practices about 5% of stories, and scientific advances in health research about 4% of stories. Other influences upon health identified in TAHF were rarely mentioned. The overall prominence of topics in newspapers is not consistent with the relative importance assigned to health influences in TAHF. Canadian newspapers rarely report on socio-economic influences frequently cited in the research literature (and reflected in TAHF) as being most influential in shaping population health outcomes. [Copyright &y& Elsevier]

Abstract: Changes in public policy have led to increasing numbers of children with disabilities and complex medical needs being cared for in the homes of Canadians. Little work, however, has explored the ethical implications of these policies. This paper focuses on some of the shortcomings of current policy and describes a developing method for policy analysis with an explicit focus on ethics that could be adopted in other nations. Three forms of analyses—descriptive, conceptual and normative—conducted on Canadian homecare policy documents describe various dimensions of Canadian homecare policy. The descriptive analysis demonstrated that the jurisdiction of homecare services is dispersed across numerous programs and ministries with no single structure for policy implementation and accountability. The needs of children and youth are rarely mentioned in home healthcare policies, but instead are addressed under broader social policies that are focused upon children and family. The conceptual analysis revealed four over-arching themes that represent the predominant elements of a value-structure that underlie homecare policy. They include: (1) home and community care as ideal; (2) the importance of independence and self-care of citizens; (3) family as primary care provider; and (4) citizenship as entitlement to rights and justice. Overall, these themes tend to reflect a neoliberal ideology that shifts the responsibility of care from the state to the individual and his/her family. A normative framework based on critical healthcare ethics is used in the paper to make recommendations to redress the current imbalance between state and family support. For example, including homecare services within the Canada Health Act (CHA) or the development of separate legislation consistent with the principles of the CHA would make it possible to ensure that the principles of universality, accessibility, portability and public administration, as opposed to principles that reinforce competitive individualism, direct the provision of homecare services in Canada. [Copyright &y& Elsevier]

Unlike the other contributions to this issue, this paper is concerned with the prospects and potential ramifications of implementing interprofessional practice from the legal standpoint. The authors focus on the two forums where the major legal issues are likely to be played out: the laws under which health care professionals are regulated; and the law of professional malpractice as applied by the courts under the tort of negligence. The goal is to examine the regulatory and medico-legal barriers that might prevent or inhibit health care professionals from working together on an interprofessional basis, and to forecast the kinds of changes within legal systems which will be necessary to accommodate the change. The first part of the paper focuses on the legal regimes which govern the Canadian health care system, and argues that the essential integrity of the system of professional self-regulation must be protected in programs of reform that seek to create space for interprofessional practice. The authors also propose a number of specific initiatives of review and legislative change as examples of the role that legal reform can play in the shift to a culture of interprofessional regulation. The second part of the paper focuses on malpractice law and suggests that, while in the long term the superior quality of care brought about by interprofessional practice should produce less liability, in the short term interprofessional practice may fit uneasily within the legal constructs traditionally employed by the courts to evaluate malpractice claims. The authors propose three strategies designed to minimize this risk. [ABSTRACT FROM AUTHOR]

The paper examines levels and determinants of trust in a health care system and in key actors in the health policy community. Talcott Parsons theorizes that the sharing of common values is a necessary condition for interpersonal trust to exist; this paper tests that notion at the level of systemic (institutional) trust. The paper reports findings of a 1999 survey of 493 randomly selected residents of Calgary, Alberta, Canada. It uses multiple regression analysis to identify the determinants of three different types of trust—generalized systemic trust, fiduciary trust, and generalized trust in particular actors’ input to health system changes. Among the numerous independent variables, special attention is devoted to the degree of congruence or incongruence between the importance which respondents attach to one of the values enunciated in the Canada Health Act—namely, ‘accessibility’ (equal access to quality health care)—and the importance which respondents believe is attached to that value by the Regional Health Authority and by the Premier of the province. Both value importance and value congruence on equal accessibility are found to be important factors explaining variation in all three types of trust. In explaining levels of trust in the Premier on the issue of health care system reform, congruence on equal accessibility proved to be even more important than such factors as political partisanship, political cynicism, and personal experience as a patient in the health care system. Findings also suggest that there is an emotional component to systemic trust. [Copyright &y& Elsevier]

Drawing from a qualitative case study in rural British Columbia, Canada, this paper examines the discourse of kidney scarcity and its impact on renal care policies and practices. Our findings suggest that at different levels of care, there are different discourses and treatment foci. We have identified three distinct scarcity discourses at work. At the macro policy level, the scarcity of transplantable kidneys is the dominant discourse. At the meso health care institution level, we witnessed a discourse regarding the scarcity of health care and human resources . At the micro community level, there was a discourse of the scarcity of health and life-sustaining resources . For each form of scarcity, particular responses are encouraged. At the macro level, renal care and transplant organizations emphasize the benefits of kidney transplantation and procuring more donors. At the meso level, participants from the regional health care system increasingly encourage home hemodialysis and patient-led care. At the micro level, community health care professionals push for rural renal patients to attend dialysis and maintain their care plans. This work contributes to critical, interdisciplinary organ transfer discourse by contextualizing kidney scarcity. It reveals the tension between these discourses and the implications of pursuing kidney donations without addressing the conditions in which individuals experience kidney failure. [ABSTRACT FROM AUTHOR]

Background: By the year 2000, Canada faced high levels of illicit drug use and related harms. Simultaneously, a fundamental tension had raisen between continuing a mainly repression-based versus shifting to a more health-oriented drug policy approach. Despite a wealth of new data and numerous individual studies that have emerged since then, no comprehensive review of key indicators and developments of illicit drug use/harm epidemiology, interventions and law/policy exist; this paper seeks to fill this gap.Methods: We searched and reviewed journal publications, as well as key reports, government publications, surveys, etc. reporting on data and information since 2000. Relevant data were selected and extracted for review inclusion, and subsequently grouped and narratively summarized in major topical sub-theme categories.Results: Cannabis use has remained the principal form of illicit drug use; prescription opioid misuse has arisen as a new and extensive phenomenon. While new drug-related blood-borne-virus transmissions declined, overdose deaths increased in recent years. Acceptance and proliferation of - mainly local/community-based - health measures (e.g., needle exchange, crack paraphernalia or naloxone distribution) aiming at high-risk drug users has evolved, though reach and access limitations have persisted; Vancouver's 'supervised injection site' has attracted continued attention yet remains un-replicated elsewhere in Canada. While opioid maintenance treatment utilization increased, access to treatment for key (e.g., infectious disease, psychiatric) co-morbidities among drug users remained limited. Law enforcement continued to principally focus on cannabis and specifically cannabis users. 'Drug treatment courts' were introduced but have shown limited effectiveness; several attempts cannabis control law reform have failed, except for the recent establishment of 'medical cannabis' access provisions.Conclusions: While recent federal governments introduced several law and policy measures reinforcing a repression approach to illicit drug use, lower-level jurisdictions (e.g., provincial/municipal levels) and non-governmental organizations increasingly promoted social- and health-oriented intervention frameworks and interventions, therefore creating an increasingly bifurcated - and inherently contradictory - drug policy landscape and reality in Canada. [ABSTRACT FROM AUTHOR]

Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care. • Developmental milestones accelerate or decelerate achievement of integrated care. • 5 categories of milestones are identified. • A comprehensive framework for milestones of integrated care is proposed. • Implementation strategies should be based on past milestones achieved. [ABSTRACT FROM AUTHOR]

Different categories of services present different policy issues for financing health care. This conceptual paper suggests four categories: (1) public health services for the entire population; (2) basic health care to individuals, where anticipated costs are small and relatively homogeneous; (3) potentially catastrophically expensive services to individuals, where costs are skewed but not predictable; and (4) potentially catastrophically expensive services to individuals, where anticipated costs are both skewed and predictable. Using Canadian and Manitoba data to illustrate some implications of the distribution of health expenditures, we suggest policies suitable for one category of services may not necessarily work for others. The small proportion responsible for incurring high health expenditures are not attractive candidates for voluntary risk pools, particularly in competitive markets. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the current state of TB in Canada by referencing information presented at the workshop, "Tuberculosis: Detection, Prevention, and Compliance." The workshop took place on November 14 and 15, 2012 in Ottawa. The workshop was organized by the Centre for Disease Modeling and the Public Health Agency of Canada as a two-day knowledge translation event that was comprised of scientific and policy focused presentations designed to address four key objectives: (1) Evaluate the success of current tuberculosis (TB) health policies and control strategies in Canada and for specific Canadian sub-populations; (2) Determine the impact of detection, intervention, compliance, and education strategies in terms of TB incidence and prevalence; (3) Develop targets for future interventions by identifying key characteristics of TB epidemics that impact the success of TB health policies and control strategies; (4) Leverage our existing ties with public health decision makers, aboriginal health organizations, and organizations serving the homeless to develop a research community that is based on close collaboration, and will foster national TB control efforts. The workshop elicited robust discussions between experts from a variety of academic disciplines and government officials. A summary of the information presented, comments shared, and questions posed, will provide a comprehensive understanding of the status of TB in Canada and future directions to be taken for improved control of the disease. [ABSTRACT FROM AUTHOR]

Abstract: International policies regulating clinical ethics committees'' (CEC) roles are non-existent. Nonetheless, CECs have established themselves in several countries and there exist striking differences in the way these work. This international practice variation stems from the ways CECs developed, within particular legal, political, social and professional contexts. National guidelines and normative documents have been published in many countries regarding CECs. To better understand CECs'' evolution and differences in various countries, we reviewed guidelines, position statements and normative papers which describe and frame the development of CECs in the United States, the United Kingdom, Canada and France. Systematic content analysis addressed guideline development, CECs'' roles, consultation methods and CEC members'' education requirements. Differing contexts informed the ways in which guidelines were developed. American CECs, established within a strongly litigious context are perceived to play strong decision-making roles, whereas British CECs, encouraged by clinicians, endorse a more supportive model. Canadian guidelines focus on the role of the ethicist, while the French model is interested in a theoretical interdisciplinary approach. This analysis shows important challenges facing the implementation of accountable CECs in different contexts and can help inform future policy development. [Copyright &y& Elsevier]

A wide array of biomedical and genetic technologies is becoming available in both developed and developing nations. This situation is the cause of growing concern for health policy makers who must evaluate the utility of these technologies for their inclusion in public health insurance programs. Ideally, policy makers would have the information necessary to rationally allocate scarce resources, prioritise technologies, and ensure fair access to necessary health care services. The reality, however, is that policy makers often do not have such information. In this paper, we argue that the field of Health Technology Assessment (HTA), through the integration of ethical analyses (i.e., an "ethical HTA"), can enable Argentinean and other Latin American policy makers to better understand the soco-ethical concerns raised by new biotechnologies. [ABSTRACT FROM AUTHOR]

Abstract: Interest in health information exchange (HIE), defined as the use of information technology to support the electronic transfer of clinical information across health care organizations, continues to grow among those pursuing greater patient safety and health care accessibility and efficiency. In this paper, we present the results of a longitudinal multiple-case study of two large-scale HIE implementation projects carried out in real time over 3-year and 2-year periods in Québec, Canada. Data were primarily collected through semi-structured interviews (n =52) with key informants, namely implementation team members and targeted users. These were supplemented with non-participants observation of team meetings and by the analysis of organizational documents. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes: while one project failed, the other was a success. A risk management analysis was performed taking a process view in order to capture the complexity of project implementations as evolving phenomena that are affected by interdependent pre-existing and emergent risks that tend to change over time. The longitudinal case analysis clearly demonstrates that the risk factors were closely intertwined. Systematic ripple effects from one risk factor to another were observed. This risk interdependence evolved dynamically over time, with a snowball effect that rendered a change of path progressively more difficult as time passed. The results of the cross-case analysis demonstrate a direct relationship between the quality of an implementation strategy and project outcomes. [Copyright &y& Elsevier]

Abstract: Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States'' obligations under international human rights law and the disparate local implementations in diverse countries. Studies that are both multidisciplinary and incorporate micro and macro level indicators are needed to reveal discrepancies between entitlements and access. It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions. [Copyright &y& Elsevier]

Abstract: The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a “managed competition” model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario''s managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms. [Copyright &y& Elsevier]

Background: The recent legalisation of cannabis in Canada by the Federal Government, along with the accompanying laws and regulations of provincial and territorial governments provides an opportunity to assess the expected benefits and harms of legalisation. While the legislative changes have been initiated by the federal government, much of the responsibility for the implementation falls onto the provinces and territories. These jurisdictions are responsible for regulating the wholesale distribution, retail structures, cannabis consumption, as well as a host of other regulations.Methods: Key characteristics of policies outlined are categorised according to a framework previously developed by the authors (2018). The categories are: (1) government regulation or control, (2) social costs that accompany its use, and (3) legal sanctions that accompany its production and use. Towards that end, we develop a framework for a cost benefit analysis (CBA) outlining in some detail the data that is needed to undertake a credible economic evaluation of cannabis policies.Results: Key data issues discussed include consumer surplus, government receipts including legal and regulatory costs, impact on substitutes, change in profits to firms (growers, wholesalers, and retailers), incomes earned in the industry, health and other costs incurred by cannabis users.Discussion: This paper presents a summary of the expected categories of costs and benefits given the various provincial cannabis policies. Additionally, it provides a framework for subsequent cost benefit analyses which can quantify said harms and benefits. [ABSTRACT FROM AUTHOR]

Background: Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians. Methods: A narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic. Main findings: Regarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix. Conclusion: Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests. [ABSTRACT FROM AUTHOR]

Indigenous Canadians have a life expectancy 12 years lower than the national average and experience higher rates of preventable chronic diseases compared with non-Indigenous Canadians. Transgenerational trauma from past assimilation policies have affected the health of Indigenous populations. The purpose of this paper is to comprehensively examine the social determinants of health (SDH), in order to identify priorities for health promotion policies and actions. We undertook a series of systematic reviews focusing on four major SDH (i.e. income, education, employment, and housing) among Indigenous peoples in Alberta, following the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Equity. We found that the four SDH disproportionately affect the health of Indigenous peoples. Our systematic review highlighted 1) limited information regarding relationships and interactions among income, personal and social circumstances, and health outcomes; 2) limited knowledge of factors contributing to current housing status and its impacts on health outcomes; and 3) the limited number of studies involving the barriers to, and opportunities for, education. These findings may help to inform efforts to promote health equity and improve health outcomes of Indigenous Canadians. However, there is still a great need for in-depth subgroup studies to understand SDH (e.g. age, Indigenous ethnicity, dwelling area, etc.) and intersectoral collaborations (e.g. community and various government departments) to reduce health disparities faced by Indigenous Canadians. [ABSTRACT FROM AUTHOR]