Dr. Iffath Unissa Syed

The medical device and pharmaceutical industries include a range of drugs, machines, instruments, and apparatuses used to prevent, diagnose, treat disease and illness, or aid in rehabilitation for patients, and are expected to grow substantially in the coming years.  However, they are often targets of criminal organizations who manufacture and profit from fraudulent products, infiltrating the market with counterfeit medical supply chains (CMSCs).  In this paper, we discuss and analyze the extent and nature of this problem and make suggestions for mitigation and prevention of this worldwide challenge. Ultimately, we argue that a holistic approach is essential to addressing this problem, including: the creation and dissemination of reliable and good quality data, developing healthcare systems to be more robust, establishing/enhancing intra- and inter-national cooperation around this issue, and employing effective technological solutions, such as digital tracing.

Gun violence is a unique, preventable problem that contributes to a significant burden of healthcare and social costs, disability, and death in the United States. To address gun violence, several surveillance technologies have been implemented in municipalities across the US which are facilitating the collection of large amounts of data with the aim of reducing the occurrence of gun violence and responding to such incidences more quickly. One tool is ShotSpotter®, a popular acoustic gunshot detection system deployed by police departments. There are, however, research gaps about the concerns of using this technology, and to our knowledge, very little discussion about the implications and its effect on vulnerable groups exists. Accordingly, in this paper, we argue against the use of technologies such as ShotSpotter as current data show inconsistent results in reducing violence. We also suggest the potential for harm from such surveillance technology should be cautiously weighed, as it could exceed the benefits of using such technology, thereby warranting further examination and research.

Evidence continues to emerge that the social determinants of health play a role in adverse outcomes related to COVID-19, including increased morbidity and mortality, increased risk of long COVID, and vaccine adverse effects. Therefore, a more nuanced understanding of the biochemical
and cellular pathways of illnesses commonly associated with adverse social determinants of health is urgently needed. We contend that a commitment to understanding adverse outcomes in historically marginalized communities will increase community-level confidence in public health measures. Here, we synthesize emerging literature on mast cell disease, and the role of mast cells in chronic illness, alongside emerging research on mechanisms of COVID illness and vaccines. We propose that a focus on aberrant and/or hyperactive mast cell behavior associated with chronic underlying health conditions can elucidate adverse COVID-related outcomes and contribute to the pandemic recovery.
Standards of care for mast cell activation syndrome (MCAS), as well as clinical reviews, experimental research, and case reports, suggest that effective and cost-efficient remedies are available, including antihistamines, vitamin C, and quercetin, among others. Primary care physicians, specialists, and public health workers should consider new and emerging evidence from the biomedical literature in tackling COVID-19. Specialists and researchers note that MCAS is likely grossly under-diagnosed; therefore, public health agencies and policy makers should urgently attend to community-based experiences of adverse COVID outcomes. It is essential that we extract and examine experiential evidence of marginalized communities from the broader political–ideological discourse.

We are delighted by the spirited, scholarly and well-argued commentaries; we concur with much of what the commentators have said and have incorporated some of their thoughts and ideas into our response. Along with the commentaries, our response incorporates some ideas generated by others and the evolution of our own thinking to reiterate and support the principles we articulated in the lead paper (Frank et al. 2022). We argue that public health expert advice should be informed by population health thinking and recognize the inherent uncertainty in any guidance. We conclude that effective public health practice for the 21st century should recognize the importance of the broader determinants of health and health inequity, acknowledge the inherent complexity in attributing health outcomes and be mindful of both the unintended consequences and the potential benefits of upstream action to address threats to global health.

Previous research indicates that Canadian healthcare workers, particularly long-term care (LTC) workers, are frequently composed of immigrant and racialized/visible minorities (VM) who are often precariously employed, underpaid, and face significant work-related stress, violence, injuries, illness, and health inequities. Few studies, however, have analyzed the contributions and impact of their labor in international contexts and on global communities. For instance, it is estimated that over CAD 5 billion-worth of remittances originate from Canada, yet no studies to date have examined the contributions of these remittances from Canadian workers, especially from urbanized regions consisting of VM and immigrants who live and/or work in diverse and multicultural places like Toronto. The present study is the first to investigate health and LTC workers’ roles and behaviors as related to remittances. The rationale for this study is to fill important knowledge gaps. Accordingly, this study asked: Do health/LTC workers in the site of study send remittances? If so, which workers send remittances, and who are the recipients of these remittances? What is the range of monetary value of annual remittances that each worker is able to send? What is the purpose of these remittances?
What motivates the decision to send remittances? This mixed-methods study used a single-case design and relied on interviews and a survey. The results indicate that many LTC workers provided significant financial support to transnational families, up to CAD 15,000 annually, for a variety of reasons, including support for education and healthcare costs, or as gifts during cultural festivals.
However, the inability to send remittances was also a source of distress for those who wanted to assist their families but were unable to do so. These findings raise important questions that could be directed for future research. For example, are there circumstances under which financial remittances are funded through loans or debt? What are the implications for the sustainability and impact of remittances, given the current COVID-19 pandemic and its economic effect of dampening incomes and wages, worsening migrants’ health, wellbeing, and quality of life, as well as adversely affecting recipient economies and the quality of life of global communities?

Feminist political economy of health is a term that has emerged as a result of research that has combined and connected a feminist political economy lens with a focus on health disparities of women. This paper provides an overview of the literature from the work of feminist medical sociologists and feminist health scholars that have shaped the concept of feminist political economy of health. The analysis indicates that while women have experienced health inequities inside the healthcare system, there are also significant health disparities that are experienced outside the healthcare system due to women’s social, economic, political, and cultural conditions. Given that there are dual crises with respect to the COVID-19 pandemic as well as social movements pushing for change, further work that uses intersectional approaches is advocated.

Recently there has been a rise in state surveillance of racialized persons, immigrants, and religious minorities.  While there is abundant literature that discusses the discourses of security and concerns over international terrorism, as well as acculturation and accommodation, little is known about how some of these public policies and practices intersect with human rights, health, and wellbeing.  This paper seeks to illuminate the health and human rights consequences of policies about the hijab and niqab, including bans on religious symbols in public workplaces. This work is guided by interdisciplinary health, social justice, and anti-racism frameworks, and it explores the human rights concerns of policies that may be used to justify surveillance and control over racialized people, migrants, and their cultural practices. Various countries have increasingly expanded their surveillance of immigrant people from South Asia and the Middle East, especially Arabs, Central and South Asians, Africans, and Muslims.  These groups have been experiencing racism at their places of worship, borders, ports of entry, and at airports .  Many governments, including the provincial government of Quebec from within Canada, have introduced policy interventions aimed at persons displaying religious symbols, which I argue have undermined the human rights and well-being of affected groups.

The global COVID-19 pandemic has led to a ‘new normal’ with public health measures of physical distancing and quarantine, as well as disruptions to programs, services, delivery, and dampened workers’ health, safety, and well-being. For example, mandatory self-isolation has been put into place by the federal government for travelers arriving in Canada, as well as those who experience any symptoms related to COVID-19, including many essential front-line workers.  Employees with families and domestic care obligations have also been affected, for instance, public health nutrition programs that were offered in some public schools have been hampered as a result of the implementation of e-learning in order to control the spread of COVID-19.  There was also significant loss of employment, which put pressure on workers as they shifted from multi-earner households and became sole earners.  This added mental stress, and both financial and psychological pressures on workers.  Existing research shows significant mental health issues that can affect the well-being of workers in long term care (LTC) homes, such as stress, depressive symptoms, and trauma (Morgan, Stewart, D’Arcy, et al., 2005; McGilton, McGillis-Hall, Wodchis et al., 2007; Astrakianakis, Chow, Hodgson et al., 2014; Woodhead, Northrop, and Edelstein, 2014; Braedley, Owusu, Przednowek et al., 2018; Syed, 2020a).  Several systemic inequities have also been revealed by the pandemic, including those affecting LTC homes in Canada.

Background: Currently, there is abundant research indicating that smoking and alcohol consumption have significant impacts on morbidity and mortality, though little is known about these behaviors among Canadian health care workers. The objective of this study was to examine health and coping behaviors, such as smoking and alcohol consumption as well as stress management techniques, among health care workers consisting of gendered, racialized, and immigrant employees. Methods: Drawing on a single-case, mixed-methods study in Ontario, Canada, this paper presents under-researched data about smoking practices, alcohol consumption, and stress management techniques among health care workers in labor-intensive, high-stress, high-turnover environments. In particular, it identifies the various mechanisms for maintaining health and well-being. Results: The findings suggest that 7.7% of survey respondents reported smoking while 43.4% reported alcohol consumption, which were reported more frequently among immigrants than among non-immigrants. Participants also reported health-promoting activities in face-to-face interviews, such as mindful breathing techniques and drawing upon social support, while a few respondents reported alcohol consumption to specifically cope with sleep disturbances and job stress. Conclusions: Although smoking and alcohol consumption were both connected with coping strategies and leisure, they were predominant in immigrant groups compared to non-immigrant groups.

Background:
Current research advocates lifestyle factors to manage workers’ health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees’ lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector.

Methods:
Drawing on a qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker’s mechanisms for maintaining physical, emotional, and social wellbeing.

Results:
The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important.

Conclusions:
Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers’ health and wellbeing.

Abstract: Currently there is a plethora of research literature which constructs obesity as an alarming new global pandemic associated with a multitude of acute and chronic diseases rooted in lifestyle factors. Although most of these claims related to obesity are well accepted in the research community, some challenges remain. For instance, lifestyle factors only partially explain the risks of developing obesity. In this paper, I advocated for greater caution in interpreting some of the medical claims of obesity due to the epistemological and methodological assumptions that inform certain groups of obesity researchers. While most of the literature has reported lifestyle factors and behavior modification as the major mechanisms to achieving health and wellbeing, a few scholars have raised issues about structural factors.

Global migration has recently garnered intense interest from a public health standpoint. Topics concerning migration, such as push-pull theories, resettlement stress, the healthy immigrant effect, cultural assimilation, and occupational health issues, are increasingly being studied. The occupational health of migrant workers—
particularly female workers—is an especially important area for research. Migrant women have an increased vulnerability to occupational musculoskeletal disorders (MSDs) in low-paid and gendered occupations such as those in the textile, hairdressing, cleaning and garment-work industries, accompanied by mental stress due to production demands.1  One of the fastest growing communities in Canada is that of female migrants from South Asian (SA) countries, comprised of Pakistan, Bangladesh, Sri Lanka, India and Nepal.
The purpose of this paper is to examine the literature concerning work-related musculoskeletal disorders among South Asian immigrant women in Canada. We have focused on SAs because they make up the largest visible minority group since 2006, with a population of 3.2 to 4.1 million people within Canada. This group is expected to remain the largest set of visible minorities until 2031.4 This study defines Canadian
visible minorities as persons who are non-Aboriginal, non-Caucasian or non-white in color. This includes such ethnicities as South Asian, Chinese, Black, Arab, West Asian, Filipino, Southeast Asian, Latin American, Japanese and Korean.5  As the SA population continues to expand, more SA individuals are expected to enter the
workforce and may experience occupational health disparities. If these individuals are at a high risk for MSDs, introducing appropriate interventions could minimize health problems, and reduce the burden of health and disability in this largest visible minority group. A literature review could help assess whether or not a large scale
study is necessary on this topic.
Guided by Arksey and O’Malley’s framework,6 a scoping review of peer-reviewed literature was carried out using the following databases: Medline (Ovid), CINAHL (Ebsco) and Scholars Portal. Search years ranged from 2000 to 2014. Articles were screened for relevance by topic. Following this strategy, manual search of gray
literature was employed, such as searching reference lists from scholarly papers, and textbooks on women’s occupational health. Results were limited to articles in the English language, excluded dissertations, conferences and studies involving undocumented migrants, the latter being excluded because they are not permanent
economic migrants. Including them would be outside of the scope of this study.
Thirteen sources were retrieved and analyzed for this paper. After assessing the sources for relevancy to the topic, issues and gaps in knowledge, pertaining to non-reporting of MSDs, socioeconomic class effects, high-risk occupations and cultural factors as modulators and determinants of the occupational health of immigrant women—including SA immigrant women—were identified. Although most studies of immigrant workers incorporate SA populations, they are not comprehensive in their focus on this group. There is a lack of significant literature that explicitly examines the prevalence of MSDs among SA immigrant women in Canada. This knowledge gap can be explored and filled in future studies.

Previous discourses have recognized institutionalized forms of racism and pointed to structural violence embedded in Canadian policies, institutions, and labor markets. However, there is limited connection of these experiences to health. This paper theorizes a novel connection of health inequities experienced by racialized and immigrant peoples in Canada as a result of globalization and market liberalism. Beginning with a brief historical overview of the slave trade and indentured workers’ experiences, it is suggested that today there is a new variant of slave labor and indentured work. Employing a political economy perspective, this paper suggests the exploitation of “Market Migrants” in Canada. Racialized and migrant workers in Canada experience high levels of precarious work, denizenship, social exclusion, social inequality, and eventually health inequities, which is a result of discrimination experienced by these groups. It reveals that the government has failed to address these issues because of control and lobby through powerful economic and political structures that benefit from the situation as it stands. However, given that there are economic losses to migrant skill underutilization and the growing frustrations manifest in uprisings against these systems of dominance, the current situation is unsustainable and transformation is expected.

Women of many cultures and religions find a means of coping with stress and ill health in faith-based practices, such as meditation and prayer. It is customary for Muslim women to participate in such activities, usually with a special dress code, which often includes a hijab. The headscarf ban in French and formerly in Quebec public schools not only forces Muslim female students to shed their essential religious dress code, but also fails to address the resulting health consequences and to acknowledge the cultural aspects of head-covering. This paper argues that the ban on head coverings in public schools is not only an infringement on religious and cultural freedoms, and violation of human rights, but that it is also an unhealthy policy intervention, as it undermines health by restricting prayers, mindfulness and spirituality. Furthermore, the ban has taken away Muslim women's choice to wear a hijab, thus restricting a sense of self-autonomy and in turn causing additional negative health implications. By synthesizing these ideas, this paper holds a novel and critical perspective that the headscarf ban policy in France should be re-examined not only because of its infringement of human rights, but also to assess the negative health impacts on affected groups. For these reasons the paper advocates a reversal of the ban, as has happened in Quebec, Canada.

According to the International Organization for Migration (IOM) (2008), 214 million people, or 3.1% of the world’s population currently live outside their countries of origin.  While a majority of this migration is based on the need to find work, it raises some important issues and concerns such as:  social exclusion, downward social mobility, work in manual occupations, and participation in precarious work. Objective: The research questions are as follows: is there historical evidence of health inequities among workers? What is the evidence for neoliberalization of policies? What are the trends for unionization in Canada, which is a marker of worker protection?  Methods:  A comprehensive literature review was carried out to gather an understanding of the political economy and neoliberalization of labor.  The Statistics Canada database CANSIM was reviewed to measure social cohesion and unionization trends in Canada.  Results:  Evidence of health inequities can be traced back to the labour diaspora experiences.  Furthermore, current knowledge suggests that structural problems such as consistent government policy inaction, neoliberalism, and conservative corporatism create precarious work and working conditions and inadequate wages.  Finally, evidence indicates that the number of individuals without unionization is increasing in Canada. Often, these social circumstances lead to adverse health outcomes such as mental, psycho-social and physiological.  Conclusion: This presentation offers: a new historical perspective to current knowledge, evidence of neoliberalization of labor, and a new model and conceptualization of the new visible minority labor diaspora experiences.  Several policy interventions are suggested to respond to these issues

The last century has been marked by an ever increasing trend of globalization, which is the mass movement and flow of people, information, technology, and capital.  According to the World Health Organization (“WHO”) (2003), migration has resulted in the displacement of approximately 175 million people, or 2.9% of the world’s population, who currently live temporarily or permanently outside their countries of origin.  A majority of this migration is based on the need to find work, including movement from rural to urban areas.  While the rationale behind such economic migration is that it has many benefits by generating productivity growth and development (Schwarz, 1966; Fielding and Evans, 2001), it raises some important issues and concerns, such as social exclusion, and precarious work and working conditions.  Often, these social circumstances lead to adverse health outcomes such as mental, psycho-social and physiological.  This presentation will use elements from political economy, social determinants of health and social justice lenses to examine the concept of the new visible minority labor diaspora in the Canadian context, the problem of work-related illnesses and injuries acquired in the workplace among these vulnerable groups, and how such illness and disease intersects culture, employment background, and gender with an emphasis on immigrant workers from urban areas such as Montreal, Toronto and the Greater Toronto Area (GTA).  The focus on these locations is reflected because they have been popular destinations for migrant settlement and migrant labor market trends in the last two decades (Schellenberg, 2004; Kosny et al., 2011).

Women of many cultures and religions find a means of coping with stress and ill health in faith-based practices, such as meditation and prayer. It is customary for Muslim women to participate in such activities, usually with a special dress code, which often includes a hijab.  The headscarf ban in French public schools not only forces Muslim female students to shed their essential religious dress code, but also fails to address resulting health consequences, nor acknowledges the cultural aspects of head-covering.  This paper argues that the ban on head coverings in public schools is not only an infringement on religious and cultural freedoms, and violation of human rights, but that it is also an unhealthy policy intervention, as it undermines health by restricting prayers, mindfulness, and spirituality.  Furthermore, the ban has taken away Muslim women’s choice to wear a hijab, thus restricting a sense of self-autonomy and in turn causing additional negative health implications.  By synthesizing these ideas, this paper holds a novel and critical perspective that the headscarf ban policy in France should be re-examined not only due to its infringement on human rights, but also to assess the negative health impacts on affected groups.