HealthcarePapers最新文献

In the context of 2S/Indigiqueer challenges to health and wellness, a focus that expands how we conceptualize negative colonial impacts to include cultural approaches to health, we potentially open space more helpful for addressing disparities. Four possible pathways are discussed, and include: (1) Expanding social determinants of health to include 2S/Indigiqueer practices that promote health; (2) Cultural resurgence helps address health disparities as it works to strengthen both individuals and communities; (3) To do these well, it is important to understand the cultural diversity that exists across 2S/Indigiqueer communities; and (4) Responses that privilege 2S/Indigiqueer community led-responses are needed to better ground health and wellness programs in culture. Finally, we add to these pathways by advocating for a series of policy responses that are supported on the ground by community.

The social, mental, physical and sexual health of diverse Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations across Canada and globally is under threat. In Canada, we are not immune to the rise in divisive and regressive policies and rhetoric that is negatively impacting the lives of 2S/LGBTQ+ people in the US and across the world (HRC Staff 2023; United Nations 2022). Make no mistake, the threats to the human rights and health of 2S/LGBTQ+ communities are growing in Canada as well (Benchetrit 2023). Health systems leaders and scholars can play a critical role in learning about, addressing and advocating for health equity for 2S/LGBTQ+ communities. This themed issue focuses on the urgency of addressing the social and structural determinants of health inequity for 2S/LGBTQ+ communities in a context of political volatility.

Many young people today embrace gender-diverse identities, with adolescents and young adults comprising the largest and fastest-growing demographic of gender-affirming healthcare seekers. Simultaneously, gender-affirming healthcare for this demographic has been debated, and restrictions have been introduced in many jurisdictions. Within this politically charged climate, some journalists, cultural commentators, gender clinicians and politicians have leveraged rhetorical claims that gender-affirming healthcare comprises a new form of "gay conversion therapy." In this commentary, we explore the extent to which empirical evidence supports or contradicts this discourse as a real phenomenon. While we conclude that gender-affirming healthcare is not gay conversion therapy, we also draw attention to opportunities to enrich gender-affirming healthcare by embracing the complexity of sexuality and gender.

Kia et al.'s (2024) article, "Beyond the Rainbow: Advancing 2S/LGBTQ+ Health Equity at a Time of Political Volatility," illustrates the health discrepancies that the Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (2SLGBTQIA+) community withstand and the Canadian healthcare system's legacy of heteronormativity. This commentary focuses on the straight-centred approach of the Canadian medical system that neglects, harms and fails the 2SLGBTQIA+ population, resulting in a decline in their mental and physical well-being and increased rates of morbidity for queer individuals. The 2SLGBTQIA+ community must be placed in the front and centre of integral decision making and have the final word in policy changes within Canadian regulatory bodies.

Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations continue to experience profound health disparities. In this article, we prioritize five issues in 2S/LGBTQ+ health equity and discuss policy interventions to address disparities in each area: (1) poverty in 2S/LGBTQ+ communities; (2) Two-Spirit mental health; (3) health equity issues in migrant and racialized LGBTQ+ populations; (4) challenges in implementing bans on conversion therapy; and (5) the evolving context of gender-affirming care. Multi-level policy interventions, including those in healthcare-adjacent contexts such as housing and immigration, will be critical to address the structural undercurrents driving health inequities for 2S/LGBTQ+ populations. Recognizing growing complexity and political volatility in the lives of 2S/LGBTQ+ people across Canada, we challenge healthcare policy actors to recognize the breadth of structural barriers to 2S/LGBTQ+ health equity issues and act with urgency in this area.

While the need for research, policy and practice addressing the health equity issues of Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations is increasingly recognized, we acknowledge that significant gaps remain in this area. As authors in this themed issue have consistently pointed out, interventions that grapple with the intersectionally varied structural drivers of 2S/LGBTQ+ health remain lacking and, in particular, warrant urgent consideration. This is especially the case during a time when structural threats to the well-being of 2S/LGBTQ+ populations are on the rise, both in Canada and in other geopolitical contexts.

There is an urgency to advocate for lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) racialized migrants and Canadian policy reform due to the rise in human rights violations globally for LGBTQ+ community members as they fight for constitutional change. Canada projects itself as a world leader in the protection of LGBTQ+ rights and is promoted as an ideal destination for those fleeing persecution. Contrary to this image, Canada has received harsh public criticism for its failure to live up to the expectations of a benevolent refugee-receiving country. The arrival of African LGBTQ+ migrants creates a lens for us to examine these cracks in our Canadian system and the resulting health disparities experienced by this group.

This commentary examines the impact of poverty on health and healthcare access for Indigenous, Black, racialized and migrant Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) individuals. It highlights the necessity of inclusive policies and strategies to tackle their unique challenges, including high poverty rates, unemployment, homelessness and intersecting oppressions in the housing and healthcare sectors. Emphasizing the need for comprehensive research to guide policy and practice, this paper calls for structural changes in healthcare and advocates for intersectional training across healthcare, education and public policy domains. It urges healthcare leaders to prioritize and meet the specific needs of these communities, aiming to improve their socio-economic conditions.

This series of papers explores the concept of essential digital health for the underserved. Several cross-cutting themes are highlighted in this paper, for example: (1) harmonizing journeys of different patient groups to understand diverse perspectives; (2) engaging health professionals in interoperability, change management and health human resource capacity building; (3) ensuring harmonization of micro, meso and macro levels of health services delivery; and (4) integrating evaluation iteratively to enable continuous improvement and learning. Adopting a learning health system (LHS) approach facilitates iterative growth and evolution, incorporating concepts from the software industry, as well as participatory processes such as failing forward, developing ecosystems for collaboration and engagement of stakeholders. The example of HealthLink BC's 811 as a digital front door is used to demonstrate how an LHS approach can enable meaningful system change. We welcome further dialogues and discussion on existing and emerging examples of health system implementation approaches that can help our Canadian health systems move continuously and progressively closer toward the ultimate goal of Health for All (WHO 2023).

Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators, and lacks a comprehensive approach to human factor interoperability, defined as system-level relationships that impact the capacity of health sector stakeholders to adopt harmonized health data standards and technology. Without addressing these system-level relationships, the adoption of harmonized health data standards and technology will be obstructed and Canadians will be underserved. The proposed health data interoperability framework articulates the factors that Canada needs to address to optimize health data design to support quality health programs and services.