Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

Objective: Our study investigates the efforts of local medical health officers during COVID-19 in Canada, with a focus on explicating enabling factors and barriers to effectively respond through local public health efforts.

Methods: We conducted 26 semi-structured interviews with local-level public health leadership from across Canada and analyzed the transcripts for salient facilitators and barriers to effective local public health practice using the Consolidated Framework for Implementation Research.

Results: Effective local-level public health practice was facilitated by efforts that potentiated synergistic efforts inside and outside of the public health sector, including trust, buy-in, and ample resources. Barriers to effective practice involved uncertainty associated with governance, human resources, and the complexity of the pandemic itself.

Conclusion: Sustained coordinated efforts across organizations together with clear governance mandates are required for robust local emergency management.

Public health systems undergo recurrent "boom and bust" cycles, also described as panic and neglect. Given such turbulence, we argue that Canadian public health workers, institutions, and systems would benefit from more spaces for sensemaking and policy capacity. This commentary shares observations on these public health cycles. It builds on specific concepts and frameworks from the disciplines of organizational development, health policy, public health sociology, political science, and public administration. It contends that holding organizational spaces for sensemaking is possible and useful for at least five reasons: (1) it may help public health workers contend with the complex dynamics underlying their daily work, (2) fortifying policy capacity (particularly analytical competences) can be a stepping stone in the process of becoming better learning organizations, (3) discerning common patterns or helpful strategies to better cope with change likely paves the way for more efficient and better-adapted solutions, (4) creating spaces for sensemaking may lead to innovations in public health decision-making, such as more meaningful citizen participation and greater staff involvement, (5) securing sensemaking spaces while maintaining day-to-day operations is feasible, even in the midst of major reforms.

Recent legislative changes have allowed the rapid expansion of online and sports gambling in Ontario. These changes include the privatization of the online and sports gambling market and the legalization of marketing practices for private operators, leading to an unprecedented growth in opportunities and inducements to gamble. While the stated objectives of these reforms centre on economic growth, consumer choice, and consumer protections, the potential public health implications of this policy shift demand urgent attention. This commentary argues for the necessity of applying a public health lens to understand the wide range of potential harms associated with Ontario's gambling policy changes, particularly as other jurisdictions in Canada and across the Americas consider adopting similar approaches. It advocates for targeted research that reframes policy debates around gambling, moving away from a narrow focus on individual responsibility and towards a broader understanding informed by environmental, social, and commercial determinants of health. The public health community must step up to provide the public and decision-makers with the evidence needed to mitigate harm, protect vulnerable populations, and advance equitable health outcomes.

Setting: Setting. Health system leaders in Canada recognise that quality improvement alone cannot address health inequities. Intersectoral action, which involves coordination and collaboration across public, private, and third-sector organisations, can improve the distribution of social determinants of health (SDOH) and thereby, health equity. While Health in All Policies (HiAP) promotes this approach, critiques and empirical data highlight implementation gaps over whether health equity is actually being improved. The potential for HiAP initiatives to reduce health inequities can be strengthened by paying greater attention to how these interventions are designed, implemented, and evaluated.

Intervention: We developed and pilot tested a self-study tool that helps organisations learn and reflect on how health equity can be targeted in intersectoral initiatives, including HiAP. This is not the only tool that can be used to consider ways to integrate health equity into intersectoral action; however, it is the first one designed for HiAP initiatives specifically.

Outcomes: The self-study tool asks the user to reflect on a series of health equity concepts to raise awareness about opportunities to better integrate health equity into the design, implementation, and evaluation of intersectoral initiatives.

Implications: The survey and appendix can fill in the gaps of other tools meant to support intersectoral action for health by focusing on ways to strengthen the health equity potential of initiatives. Users can apply the tool prospectively and retrospectively to explicitly target specific criteria to improve how their interventions focus on and potentially address health equity.

Objectives: The COVID-19 pandemic fueled a surge in anti-Asian sentiment in Canada, which negatively impacted the health and well-being of Asian Canadians. This study examines whether anti-Asian racism has decreased since the end of the COVID-19 pandemic.

Methods: We conducted a trend analysis of anti-Asian racism in Canada by synthesizing and analyzing two key sources of data that capture changes in both objective and subjective dimensions of anti-Asian racism before, during, and after the pandemic. First, we used a census of all racially motivated hate crimes known to police services in Canada (2014-2023). Second, we used a series of anti-Asian racism surveys conducted at different time points by various research teams in collaboration with the Angus Reid Institute, including most recently, the Asian Canadians' Experiences Survey conducted by our team in June 2023.

Results: Our analysis of police-reported data suggests that the number of hate crimes targeting East or Southeast Asians rose sharply from 67 in 2019 to 263 in 2020-a 293% increase. The number peaked at 312 in 2021, then declined to 213 in 2022 and further to 158 in 2023. These figures suggest a decline in anti-Asian racism following the pandemic; however, the levels have not returned to their pre-pandemic baseline. Our analysis of survey data indicates Asian Canadians continue to encounter more subtle forms of racism, including micro-aggressions, racist media representations, reduced respect in social interactions, and derogatory name-calling. We highlight that such experiences, though not always explicitly violent, foster a hostile environment that can profoundly affect the overall well-being of Asian Canadians.

Conclusion: Anti-Asian racism is multifaceted and persistent. Policymakers and public health practitioners need to also pay attention to the negative health impacts of micro-aggressions and other less overt forms of racial discrimination, including subjective experiences of racism.

Canada has faced numerous public health challenges but remains inadequately prepared for future crises. For example, despite extensive reports and plans following the 2003 SARS-CoV-1 outbreaks, the country was unprepared for COVID-19 and lessons learned from the pandemic emphasized the need for immediate action to enhance preparedness. In the current era of poly-crisis, Canada must be ready for diverse challenges, including potential conflicts and their impacts on public health and health systems. The conflict in Ukraine highlights the need for extensive medical resources for returnees, which could strain public health and health systems alongside other concurrent threats. Exercise Trillium Cura (ETC) in 2024 simulated Ontario's health system response to a prolonged conventional war, revealing both successes and challenges. Key issues included leadership and resource needs, with recommendations for specific actions like creating a repatriation hub and a trauma registry. ETC emphasized a "whole of society" approach, engaging civil society in planning and highlighting the importance of integrated preparedness. Tabletop exercises like ETC are crucial for building relationships, shared learning, and innovative solutions. They help prepare for complex crises by fostering collaboration and readiness. Regular exercises are recommended to enhance preparedness and resilience, ensuring effective responses to future health emergencies.

Objectives: Black-White disparities in maternal and neonatal morbidity and mortality highlight health inequities in several settings, yet such racial disparities in Canada are not well defined. Our objective was to conduct a scoping review to identify the extent of epidemiologic evidence assessing Black-White disparities in maternal and neonatal health in Canada.

Methods: We included peer-reviewed epidemiologic studies which measured maternal or neonatal outcomes in Black versus White individuals in Canada. We searched OVID platforms (MEDLINE, Embase, Emcare) from inception to May 9, 2024, using keywords and controlled vocabulary terms related to race and maternal and neonatal morbidity and mortality. Results synthesis was carried out using descriptive analysis.

Synthesis: After exclusions, six retrospective cohort studies were included in the scoping review. The majority of the included studies used data obtained from provincial datasets (n = 5), defined maternal race using self-reported race (n = 5), and were set in Ontario (n = 4). All studies reported one or more significant associations between race and adverse maternal or neonatal outcomes, with Black individuals experiencing higher rates of spontaneous fetal loss (n = 1), perinatal mortality (n = 1), preterm birth (n = 3), small for gestational age infants (n = 1), low Apgar scores (n = 2), congenital heart disease (n = 1), neonatal intensive care unit admission (n = 1), preeclampsia (n = 2), gestational diabetes (n = 1), and inadequate gestational weight gain (n = 1).

Conclusion: Although literature on the topic is sparse, Black-White disparities in maternal and neonatal health in Canada are apparent. National, population-based data are needed to provide a comprehensive understanding of racial disparities in maternal and neonatal health and the factors driving these differences.

Introduction: In September 2024, the province of Ontario expanded alcohol sales into convenience stores. It is important to examine differences in alcohol sales expansion by socioeconomic status (SES) as lower SES groups experience a disproportionately higher burden of alcohol-attributable harms.

Methods: This repeated cross-sectional study examined whether neighbourhood SES was associated with increases in alcohol outlets immediately following the expansion of alcohol sales. A spatial BYM2 Poisson regression model was used to estimate the association between neighbourhood SES and the number of alcohol outlets.

Results: Immediately following expansion, 4200 alcohol outlets were licensed in Ontario. The median increase in alcohol outlets within 1500 m of a neighbourhood was greater in the lowest SES neighbourhoods (400% increase) compared to the highest (183%). In adjusted models, the lowest SES quintile was associated with a greater increase in outlets (relative risk = 2.26, 95% credible interval:1.98-2.58) compared to the highest quintile, with a dose-response relationship by SES quintile.

Discussion: A large increase in alcohol outlets was seen across Ontario neighbourhoods. Lower SES neighbourhoods experienced a greater increase in outlets, which may disproportionately increase harms related to the expansion of alcohol sales. These findings highlight the need for strategies to mitigate potential harm in low SES groups and the widening of existing inequities.