- www.dspitzer.ca
Denise L Spitzer
University of Alberta, Public Health, Faculty Member
- Denise L. Spitzer, PhD, is a Professor in the School of Public Health at the University of Alberta and an Adjunct Pro... moreDenise L. Spitzer, PhD, is a Professor in the School of Public Health at the University of Alberta and an Adjunct Professor in the Institute of Feminist and Gender Studies at the University of Ottawa where she served as the Canada Research Chair in Gender, Migration and Health and a Principal Scientist in the Institute of Population Health for a decade. In addition to undergraduate studies in Biology, Chinese Language, and Music, she holds a Master’s degree and doctorate in Anthropology from the University of Alberta, Canada. Dr. Spitzer is interested in examining how global processes—intersecting with gender, racialization, migration status and other social identifiers—are implicated in health and wellbeing. Her current program of research focuses on the impact of the global economy on immigrants, migrants and refugees in different parts of the globe and engages with critical perspectives of the body, transnationalism and constructions of identity; the impact of policy on health; community-based research and intersectional analysis. Professor Spitzer has published in journals such as Gender & Society, Medical Anthropology Quarterly, and the Canadian Journal of Public Health. Her edited collection, Engendering Migrant Health: Canadian Perspectives, was published by the University of Toronto Press in 2011 and was recognized by the Women’s and Gender Studies Association in 2013 with a WGSRF Outstanding Scholarship citation.edit
Background: Gender roles affect health worker migration and their migration experiences, but policy responses have rarely considered the gender dimensions of health worker migration. This invisibility and lack of attention can lead to... more
Background: Gender roles affect health worker migration and their migration experiences, but policy responses have rarely considered the gender dimensions of health worker migration. This invisibility and lack of attention can lead to social, health and labour market inequities. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India studied the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholder interviews. Our particular focus was to examine the causes, consequences and policy responses to health worker migration. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the literature, policy documents and empirical data. Results: Our data from nurses, physicians, and other health workers reveal that gender mediates health workers’ access and participati...
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Background: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can... more
Background: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India examined the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholders. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3,580 health workers. Results: The literature on health worker migration from South Africa, India and the Philippine...
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Research Interests: Focus Groups, Behavior, Health Care, Cambodia, Globalization And Health, and 15 moreHealth insurance, Beer, Health Services, Female, Focus Group, Article, Bangkok, Hanoi, Health Care Delivery, Adult, Heatlh services and reproductive health, HEALTH SERVICE, Health Survey, Health Services Accessibility, and Environmental factor
Background: New immigrants to Canada initially report better health than does the Canadian-born population. With time, this "healthy immigrant effect" appears to diminish. Limited ability to speak English or French has been identified as... more
Background: New immigrants to Canada initially report better health than does the Canadian-born population. With time, this "healthy immigrant effect" appears to diminish. Limited ability to speak English or French has been identified as a possible factor in poor health. This analysis explored the relationship between self-reported official language proficiency and transitions to poor self-reported health. Data and methods: Statistics Canada's Longitudinal Survey of Immigrants to Canada tracked a sample of the 2001 immigrant cohort for four years (6, 24 and 48 months after arrival). Data from each of the three survey waves were available for 7,716 respondents. Bivariate and multivariate analysis were used to examine associations between official language proficiency and self-reported health, by sex, controlling for selected pre-migration and post-migration factors. The prevalence of poor health among immigrants was compared with rates among the Canadian-born population, based on data from the Canadian Community Health Survey. Results: Among a representative sample of recent immigrants, the prevalence of poor self-reported health had risen substantially, especially among women, after four years in Canada. Prolonged limited official language proficiency was strongly associated with a transition to poor health among male and female immigrants who had earlier reported good health. Other factors significantly associated with an increase in the prevalence of poor self-reported health differed by sex. Refugee status, self-reported discrimination, and living in Vancouver were significant for men. Age, health care access problems, and limited friendliness of neighbours were significant for women.
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Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income... more
Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).
Research Interests: Nursing, Poverty, Tobacco, Social Support, Child Care, and 15 moreMedicine, Canada, Self Help Groups, Humans, Smoking Cessation, Female, Psychosocial, Qualitative Study, Aged, Middle Aged, Adult, Public health systems and services research, Guidance and Counseling Intervention Programs, Low Income, and Psychological Stress
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The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support... more
The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.
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Research Interests: Demography, Genre, Health Care, Adolescent, Canada, and 15 moreCanadian, Foreign Language, Female, Health information, Cohort Study, Access to Health Care, Aged, Adult, Cross Section, Curriculum and Pedagogy, Educational Status, Communication barriers, Cross Sectional Studies, Canadian Public Health Policy, and Health Services Accessibility
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The purpose of this ethnographic study was to understand how immigrant women caregivers accessed support from community resources and identify the barriers to this support. The study included 29 Chinese and South Asian women caring for an... more
The purpose of this ethnographic study was to understand how immigrant women caregivers accessed support from community resources and identify the barriers to this support. The study included 29 Chinese and South Asian women caring for an ill or disabled child or adult relative. All experienced barriers to accessing community services. Some possessed personal resources and strategies to overcome them; others remained isolated and unconnected. Family and friends facilitated connections, and a connection with one community service was often linked to several resources. Caregivers who failed to establish essential ties could not initiate access to resources, and community services lacked outreach mechanisms to identify them. These findings contribute new understanding of how immigrant women caregivers connect with community resources and confirm the impact of immigration on social networks and access to support.
Research Interests: Immigration, Pakistan, China, Medicine, India, and 15 moreCanada, Humans, Female, Caregivers, Nursing Home, Aged, Middle Aged, Outreach, Adult, Community Based Mental Health Services, attitude to health, Health Services Accessibility, Psychology and Cognitive Sciences, Community health services, and Medical and Health Sciences
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The recruitment of articulate, expressive participants is an essential part of methodology in qualitative research. This article presents the authors' experience in the recruitment of immigrant women of Chinese and South Asian... more
The recruitment of articulate, expressive participants is an essential part of methodology in qualitative research. This article presents the authors' experience in the recruitment of immigrant women of Chinese and South Asian origin in an ethnographic study. The study included women caring for an adult or child family member who had a chronic health problem. Knowledge of women family caregivers' health is restricted by the failure to include diverse groups of women in research. In this article, the authors discuss issues related to recruitment and participation of immigrant women in research, including establishing access to diverse groups of women, benefits for immigrant women, and placing the researcher and research process on the same level. Practical research strategies to address these issues and engage the women in research that portrays their perspectives are presented. The authors' discussion concludes with reflection on their experience and that of other researchers.
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The increasing complexity of the migration pathways of health and care workers is a critical consideration in the reporting requirements of international agreements designed to address their impacts. There are inherent challenges across... more
The increasing complexity of the migration pathways of health and care workers is a critical consideration in the reporting requirements of international agreements designed to address their impacts. There are inherent challenges across these different agreements including reporting functions that are misaligned across different data collection tools, variable capacity of country respondents, and a lack of transparency or accountability in the reporting process. Moreover, reporting processes often neglect to recognize the broader intersectional gendered and racialized political economy of health and care worker migration. We argue for a more coordinated approach to the various international reporting requirements and processes that involve building capacity within countries to report on their domestic situation in response to these codes and conventions, and internationally to make such reporting result in more than simply the sum of their responses, but to reflect cross-national an...
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Sex and gender play a critical role in distinct experiences of health and illness between women and men. To highlight health differences and reduce health inequities between sexes and genders, researchers make use of sexdisaggregated... more
Sex and gender play a critical role in distinct experiences of health and illness between women and men. To highlight health differences and reduce health inequities between sexes and genders, researchers make use of sexdisaggregated data. However, these data are insufficient to comprehensively explain and address health inequities between sexes and genders. Therefore, the inclusion of gender analysis in health research is essential. In this article we exemplify the need for engendering health research that includes and moves beyond the analysis of sex-disaggregated data on tuberculosis in Canada. We show that these data are insufficient to explain the unequal distribution of tuberculosis among women and men from different Canadian populations. The absence of gender-based data masks important experiences of tuberculosis among some groups of visible minority foreign-born women making them thus invisible in the current policies designed to control TB in Canada. Gender analysis in heal...
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Background Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can... more
Background Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. Results The documentary analysis of health work...
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Based on an assessment of low-income women’s support needs and preferences, an intervention was designed consisting of 14 weekly group support sessions encompassing peer and professional facilitators and volunteer buddies. Participants... more
Based on an assessment of low-income women’s support needs and preferences, an intervention was designed consisting of 14 weekly group support sessions encompassing peer and professional facilitators and volunteer buddies. Participants (n=44) completed a 13-item semi-structured qualitative interview following the intervention and an 8-item semi-structured interview three months later. Most women reported that the support group mobilized and reinforced their intentions to quit smoking. Participants enjoyed opportunities to interact with women facing similar challenges and to receive emotional, informational, affirmation and practical support. Women indicated that the program provided useful information about life skills; improved their selfesteem; taught them smoking reduction and cessation strategies; offered an opportunity to share feelings and life experiences; and helped them to relax and enjoy their time together through exercises and crafts. The intervention addressed multiple ...
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Neoliberal globalization contributes to the out-migration of labour from sending countries in the global South. Supported by multilateral organizations including the IMF and World Bank, the migration and development nexus holds that... more
Neoliberal globalization contributes to the out-migration of labour from sending countries in the global South. Supported by multilateral organizations including the IMF and World Bank, the migration and development nexus holds that nations and households in migrant sending countries can migrate their way out of poverty. Two countries that embrace this paradigm, the Philippines and Indonesia, are major suppliers of migrant labour including domestic workers, and Malaysia is a primary destination country.
Theory and Methods
We deployed a multi-scalar and intersectional lens to highlight the impact of global forces and policies, interacting with constructions of gender and national identity, to explore the health and wellbeing of migrant domestic workers in Malaysia. In addition to documentary analysis, we conducted face-to-face interviews with 30 Indonesian and 24 Filipino migrant domestic workers, five representatives from civil society organizations, three government representatives, and four individuals engaged in labour brokerage and the health screening of migrant workers in Kuala Lumpur.
Results
Migrant domestic workers in Malaysia work long hours in private homes and are not protected by labour laws. Workers were generally satisfied with their access to health services; however, their intersectional status, which is both an outcome of, and contextualized by, the lack of opportunities in their own country, prolonged familial separation, low wages, and lack of control in the workplace, contributed to stress and related disorders—which we regard as the embodied manifestation of their migratory experiences. Migrant domestic workers eased these ill effects through self-care, spiritual practices, and the embrace of gendered values of self-sacrifice for the family as a form of solace.
Conclusions
Structural inequities and the mobilization of gendered values of self-abnegation underpin the migration of domestic workers as a development strategy. While individual self-care practices were used to cope with the hardships of their work and family separation, these efforts did not remedy the harms nor redress structural inequities wrought by neoliberal globalization. Improvements in the long-term health and wellbeing of Indonesian and Filipino migrant domestic workers in Malaysia cannot focus solely on the preparation and maintenance of healthy bodies for productive labour, but must attend to workers’ attainment of adequate social determinants of health, which challenges the migration as development paradigm. Neo-liberal policy instruments such as privatization, marketisation and commercialization of migrant labour have led to both host and home countries benefitting, but at the expense of the migrant domestic workers’ well-being.
Theory and Methods
We deployed a multi-scalar and intersectional lens to highlight the impact of global forces and policies, interacting with constructions of gender and national identity, to explore the health and wellbeing of migrant domestic workers in Malaysia. In addition to documentary analysis, we conducted face-to-face interviews with 30 Indonesian and 24 Filipino migrant domestic workers, five representatives from civil society organizations, three government representatives, and four individuals engaged in labour brokerage and the health screening of migrant workers in Kuala Lumpur.
Results
Migrant domestic workers in Malaysia work long hours in private homes and are not protected by labour laws. Workers were generally satisfied with their access to health services; however, their intersectional status, which is both an outcome of, and contextualized by, the lack of opportunities in their own country, prolonged familial separation, low wages, and lack of control in the workplace, contributed to stress and related disorders—which we regard as the embodied manifestation of their migratory experiences. Migrant domestic workers eased these ill effects through self-care, spiritual practices, and the embrace of gendered values of self-sacrifice for the family as a form of solace.
Conclusions
Structural inequities and the mobilization of gendered values of self-abnegation underpin the migration of domestic workers as a development strategy. While individual self-care practices were used to cope with the hardships of their work and family separation, these efforts did not remedy the harms nor redress structural inequities wrought by neoliberal globalization. Improvements in the long-term health and wellbeing of Indonesian and Filipino migrant domestic workers in Malaysia cannot focus solely on the preparation and maintenance of healthy bodies for productive labour, but must attend to workers’ attainment of adequate social determinants of health, which challenges the migration as development paradigm. Neo-liberal policy instruments such as privatization, marketisation and commercialization of migrant labour have led to both host and home countries benefitting, but at the expense of the migrant domestic workers’ well-being.
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This article primarily aims to demonstrate how diversity is reflected among urban Aboriginal peoples in Canada. Secondly, it uncovers if and how preventive health services in the province of Ontario, Canada are responsive to this... more
This article primarily aims to demonstrate how diversity is reflected among urban Aboriginal peoples in Canada. Secondly, it uncovers if and how preventive health services in the province of Ontario, Canada are responsive to this diversity. Data for this study were gathered from a review of literature on culturally appropriate health service delivery to Aboriginal peoples in Canada and a qualitative exploratory study conducted with urban First Nation and Métis people, and health service providers and policy makers. The findings from review of literature and the exploratory study indicated that the nature of Aboriginal diversity and its trends are complex. From the document review, we can comprehend that socio-economic disparities among First Nations and Métis, compared to non-Aboriginal people, are reducing slowly; however, evidence from the exploratory study suggested otherwise and indicated that there is also a strong need for First Nation and Métis families to overcome barriers i...
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The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing... more
The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses’ involvement in national policy processes, factors hindering nurses’ engagement in policy processes, and ways to enhance nurses’ involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses’ involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing prof...
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The aim of this paper was to examine, via a scoping review, how the literature focusing on immigrant women‟s health, based on selected criteria, has been able to capture not only sex and gender differences but also the other socially... more
The aim of this paper was to examine, via a scoping review, how the literature focusing on immigrant women‟s health, based on selected criteria, has been able to capture not only sex and gender differences but also the other socially grounded determinants of health. Using selected health databases as well as a diversity of keywords, a final sample of 59 was obtained after a number of steps to increase validity and credibility of the process were taken. Since “women” was one of the main keywords, all of the studies included women either by themselves (n=20/59) or along with men (n=39/59). In 34 (57.6%) of the papers reviewed, gender was defined above and beyond „sex‟ (i.e. some discussion was provided regarding the social context of the study population prior to the presentation of the goal of the study). Ethnicity was merely mentioned without being expanded upon and at times being substituted with race in 26 (44%) of the papers reviewed. Migration was defined in 22 (37.2%) of the pa...
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The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support... more
The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.
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... Focusing attention on the interlinking regimes of care work, gender Int. Migration & Integration DOI 10.1007/s12134-010-0146-4 DL Spitzer (*) University of Ottawa, Ottawa, Canada e-mail: denise.spitzer@uOttawa.ca Page 2. ...
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Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income... more
Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).
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The global integration of trade and financial markets that has been the hallmark of the past 30 years of neoliberal globalization means that local economies can be shaped by economic events seemingly unrelated to the scale or geography... more
The global integration of trade and financial markets that has been the hallmark of the past 30 years of neoliberal globalization means that local economies can be shaped by economic events seemingly unrelated to the scale or geography where women's ...
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In this book chapter in The Handbook on Gender and Health (J. Gideon, ed., Elgar Publishing), I strive to articulate how im/migrant health and well-being is influenced, experienced, structured, and gendered.