I am a public health professional who has worked in many sectors over the course of my career including: mental health, primary care, settlement, gender-based violence, 2SLGBTQ, homelessness and housing insecurity, Indigenous health and global health. I provide support to non-profit agencies and academics in the areas of: proposal writing, implementation science, strategic planning, knowledge exchange, literature reviews, needs assessments and evaluation.
Abstract: Language barriers, specifically among refugees, pose significant challenges to deliveri... more Abstract: Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada’s healthcare system.
It is widely recognized that structural and social determinants of health (SDoH) account for a la... more It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada.
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the... more Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) "(It's) kinda like a real home" (WISH is unlike other shelters); (2) "It's like a buddy system" (A sense of community was fostered); (3) "It's the same size as a jail cell" (Problems with infrastructure); (4) "To keep us on focus" (Un/supportive staff/volunteers); (5) "I'm not sure what I'm going to do after" (The dearth of permanent housing creates trauma); and (6) "Too much bloody money in too little hands" (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
There is growing evidence that the risk and burden of COVID-19 infections are not equally distrib... more There is growing evidence that the risk and burden of COVID-19 infections are not equally distributed across population subgroups and that racialized communities are experiencing disproportionately higher morbidity and mortality rates. However, due to the absence of large-scale race-based data, it is impossible to measure the extent to which immigrant and racialized communities are experiencing the pandemic and the impact of measures taken (or not) to mitigate these impacts, especially at a local level. To address this issue, the Ottawa Local Immigration Partnership partnered with the Collaborative Critical Research for Equity and Transformation in Health lab at the University of Ottawa and the Canadians of African Descent Health Organization to implement a project to build local organizational capacities to understand, monitor, and mitigate the impact of the COVID-19 pandemic on immigrant and racialized populations. This research note describes the working framework used for this project, proposed indicators for measuring the determinants of health among immigrant and racialized populations, and the data gaps we encountered. Recommendations are made to policymakers, and community and health stakeholders at all levels on how to collect and use data to address COVID-19 health inequities, including data collection strategies aimed at community engagement in the collection of disaggregated data, improving methods for collecting and analyzing data on immigrants and racialized groups and policies to enable and enhance data disaggregation. Résumé Des plus en plus d'études montrent que le risque et le fardeau des infections à la COVID-19 ne sont pas également répartis dans la population et que les communautés racialisées connaissent des taux de morbidité et de mortalité disproportionnellement plus élevés. Cependant, en raison de l'absence de données ventilés selon le statut ethnique, il est impossible de mesurer comment les communautés immigrantes et racialisées vivent la pandémie et quel est l'impact des mesures prises (ou non) pour atténuer ces effets, surtout à un niveau local. Pour résoudre ce problème, le Partenariat local pour l'immigration d'Ottawa (PLIO) s'est associé au Laboratoire de recherche critique collaborative pour l'équité et la transformation en santé (CO-CREATH) de l'Université d'Ottawa et l'Organisation de la santé des Canadiens
The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems ac... more The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems across the world. To date, there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race, beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of these population groups as these race-based data become available.
Canada-EU Migration Platform on the Integration of Migrant Women, 2020
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular. Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes. This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although much of the focus is on the Canadian experience, data from EU Member States is included where available, and most of these findings are relevant to the experiences of migrant women in other Western host countries.
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular. Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes. This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although much of the focus is on the Canadian experience, data from EU Member States is included where available, and most of these findings are relevant to the experiences of migrant women in other Western host countries.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender-questioning community members. It is led by METRAC: Action on Violence in partnership with Centre de Francophone. It is funded by the Public Health Agency of Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender-questioning community members. It is led by METRAC: Action on Violence in partnership with Centre de Francophone. It is funded by the Public Health Agency of Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
This paper reports the prevalence of everyday discrimination experienced by Canadians and uses mu... more This paper reports the prevalence of everyday discrimination experienced by Canadians and uses multivariate regression analysis to explore its socio-demographic and health related predictors. The implications of these findings for social policy are discussed.
Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn abo... more Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn about ongoing concerns and challenges faced by trans and non-binary children and youth; their parents and caregivers; and their service providers. In this report, we review the current literature on trans and non-binary children and youth and share their perspectives, along with those of their caregivers, on their health and social needs. We also offer evidence for policy and service development in support of these populations, and provide cross-sectoral recommendations for public and community sector agencies to better address the needs of these youth and their families.
The findings in this
report are based on data
collected from a sample
of people who had
applied t... more The findings in this report are based on data collected from a sample of people who had applied to WES between 2013 and 2015 for an Educational Credential Assessment (ECA—see below) and who were subsequently admitted to Canada as permanent residents. The data reflect the responses of 6,402 participants who resided in Canada at the time of the survey, all of whom had been admitted through one of the economic immigration categories now included under the Express Entry system.
Discrimination impacts many areas of life including health, social and economic participation. To... more Discrimination impacts many areas of life including health, social and economic participation. To date, national research on discrimination in Canada is slim. The goal of this paper is to present data on everyday discrimination in Canada and explore its socio-demographic and health related predictors. The main source of data was the Canadian Community Health Survey, which in 2013 included a special module on everyday discrimination (EDS). The study variables included: geographic region, gender, age group, education, income, racialized/Indigenous status, immigration status, language spoken, sexual orientation, weight, and physical / mental disability status. Descriptive statistics were used to describe the characteristics of the sample and frequency of discrimination by EDS items and attributions. Bivariate analysis were used to examine associations between specific types of discrimination (for example, discrimination due on race) and study variables. Logistic regression analyses were conducted to examine the unadjusted and adjusted relationships between everyday discrimination and study variables. Results showed that the proportion of the Canadian population experiencing everyday discrimination was quite high (46.2%). The frequency of everyday discrimination was higher among population sub-groups on the grounds of their human rights classification. The significant predictors of experiencing everyday discrimination were: geography, gender, age group, racialized status, Indigenous status, non-immigrant status, education and income. The largest odds ratios of experiencing everyday discrimination was among youth and young adults (12-29 years) who experienced 4.49 times the odds of experiencing discrimination compared to seniors 70+ years. Understanding the prevalence and predictors of discrimination can help inform the development of health and social policies aimed at reducing population inequities.
Collaboration between child welfare and adult mental health service providers is important to add... more Collaboration between child welfare and adult mental health service providers is important to address parental risk factors that may affect child wellbeing. The aim of this paper is to describe findings from a survey which identified barriers and facilitators to collaboration between these two sectors. A semi-structured instrument, adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.
Abstract: Language barriers, specifically among refugees, pose significant challenges to deliveri... more Abstract: Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada’s healthcare system.
It is widely recognized that structural and social determinants of health (SDoH) account for a la... more It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada.
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the... more Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) "(It's) kinda like a real home" (WISH is unlike other shelters); (2) "It's like a buddy system" (A sense of community was fostered); (3) "It's the same size as a jail cell" (Problems with infrastructure); (4) "To keep us on focus" (Un/supportive staff/volunteers); (5) "I'm not sure what I'm going to do after" (The dearth of permanent housing creates trauma); and (6) "Too much bloody money in too little hands" (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
There is growing evidence that the risk and burden of COVID-19 infections are not equally distrib... more There is growing evidence that the risk and burden of COVID-19 infections are not equally distributed across population subgroups and that racialized communities are experiencing disproportionately higher morbidity and mortality rates. However, due to the absence of large-scale race-based data, it is impossible to measure the extent to which immigrant and racialized communities are experiencing the pandemic and the impact of measures taken (or not) to mitigate these impacts, especially at a local level. To address this issue, the Ottawa Local Immigration Partnership partnered with the Collaborative Critical Research for Equity and Transformation in Health lab at the University of Ottawa and the Canadians of African Descent Health Organization to implement a project to build local organizational capacities to understand, monitor, and mitigate the impact of the COVID-19 pandemic on immigrant and racialized populations. This research note describes the working framework used for this project, proposed indicators for measuring the determinants of health among immigrant and racialized populations, and the data gaps we encountered. Recommendations are made to policymakers, and community and health stakeholders at all levels on how to collect and use data to address COVID-19 health inequities, including data collection strategies aimed at community engagement in the collection of disaggregated data, improving methods for collecting and analyzing data on immigrants and racialized groups and policies to enable and enhance data disaggregation. Résumé Des plus en plus d'études montrent que le risque et le fardeau des infections à la COVID-19 ne sont pas également répartis dans la population et que les communautés racialisées connaissent des taux de morbidité et de mortalité disproportionnellement plus élevés. Cependant, en raison de l'absence de données ventilés selon le statut ethnique, il est impossible de mesurer comment les communautés immigrantes et racialisées vivent la pandémie et quel est l'impact des mesures prises (ou non) pour atténuer ces effets, surtout à un niveau local. Pour résoudre ce problème, le Partenariat local pour l'immigration d'Ottawa (PLIO) s'est associé au Laboratoire de recherche critique collaborative pour l'équité et la transformation en santé (CO-CREATH) de l'Université d'Ottawa et l'Organisation de la santé des Canadiens
The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems ac... more The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems across the world. To date, there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race, beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of these population groups as these race-based data become available.
Canada-EU Migration Platform on the Integration of Migrant Women, 2020
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular. Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes. This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although much of the focus is on the Canadian experience, data from EU Member States is included where available, and most of these findings are relevant to the experiences of migrant women in other Western host countries.
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular. Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes. This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although much of the focus is on the Canadian experience, data from EU Member States is included where available, and most of these findings are relevant to the experiences of migrant women in other Western host countries.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender-questioning community members. It is led by METRAC: Action on Violence in partnership with Centre de Francophone. It is funded by the Public Health Agency of Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender-questioning community members. It is led by METRAC: Action on Violence in partnership with Centre de Francophone. It is funded by the Public Health Agency of Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
This paper reports the prevalence of everyday discrimination experienced by Canadians and uses mu... more This paper reports the prevalence of everyday discrimination experienced by Canadians and uses multivariate regression analysis to explore its socio-demographic and health related predictors. The implications of these findings for social policy are discussed.
Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn abo... more Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn about ongoing concerns and challenges faced by trans and non-binary children and youth; their parents and caregivers; and their service providers. In this report, we review the current literature on trans and non-binary children and youth and share their perspectives, along with those of their caregivers, on their health and social needs. We also offer evidence for policy and service development in support of these populations, and provide cross-sectoral recommendations for public and community sector agencies to better address the needs of these youth and their families.
The findings in this
report are based on data
collected from a sample
of people who had
applied t... more The findings in this report are based on data collected from a sample of people who had applied to WES between 2013 and 2015 for an Educational Credential Assessment (ECA—see below) and who were subsequently admitted to Canada as permanent residents. The data reflect the responses of 6,402 participants who resided in Canada at the time of the survey, all of whom had been admitted through one of the economic immigration categories now included under the Express Entry system.
Discrimination impacts many areas of life including health, social and economic participation. To... more Discrimination impacts many areas of life including health, social and economic participation. To date, national research on discrimination in Canada is slim. The goal of this paper is to present data on everyday discrimination in Canada and explore its socio-demographic and health related predictors. The main source of data was the Canadian Community Health Survey, which in 2013 included a special module on everyday discrimination (EDS). The study variables included: geographic region, gender, age group, education, income, racialized/Indigenous status, immigration status, language spoken, sexual orientation, weight, and physical / mental disability status. Descriptive statistics were used to describe the characteristics of the sample and frequency of discrimination by EDS items and attributions. Bivariate analysis were used to examine associations between specific types of discrimination (for example, discrimination due on race) and study variables. Logistic regression analyses were conducted to examine the unadjusted and adjusted relationships between everyday discrimination and study variables. Results showed that the proportion of the Canadian population experiencing everyday discrimination was quite high (46.2%). The frequency of everyday discrimination was higher among population sub-groups on the grounds of their human rights classification. The significant predictors of experiencing everyday discrimination were: geography, gender, age group, racialized status, Indigenous status, non-immigrant status, education and income. The largest odds ratios of experiencing everyday discrimination was among youth and young adults (12-29 years) who experienced 4.49 times the odds of experiencing discrimination compared to seniors 70+ years. Understanding the prevalence and predictors of discrimination can help inform the development of health and social policies aimed at reducing population inequities.
Collaboration between child welfare and adult mental health service providers is important to add... more Collaboration between child welfare and adult mental health service providers is important to address parental risk factors that may affect child wellbeing. The aim of this paper is to describe findings from a survey which identified barriers and facilitators to collaboration between these two sectors. A semi-structured instrument, adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.
The U-First! training program has been available to direct health care providers across Ontario s... more The U-First! training program has been available to direct health care providers across Ontario since 2003. The program provides participants with hands-on training, essential skills, and best practices in the care of persons with changes in behaviour due to dementia and other cognitive impairment. In 2019, the U-First! program was adapted for use with informal Care Partners (i.e., family members and friends). The three primary objectives of the U-First! for Care Partners are: To enhance the well-being of both informal Care Partners and those experiencing behaviour changes that they support through problem-solving using the U-First! Framework To increase Care Partner confidence and capability to provide effective care for persons with dementia and other cognitive impairment who are experiencing behaviour changes To improve collaboration between Care Partners and other members of the care team through common knowledge, language, and approach to care Evaluation Methods The evaluation plan was developed building on the U-First! for Care Partner’s logic model and the “Conceptual Framework for Monitoring and Evaluating Health Information Products and Services.” It was designed to measure core program outputs and outcomes, including: Program reach Satisfaction with and effectiveness with the online training format for program facilitators Satisfaction with the U-First! for Care Partners program and materials among Care Partner participants Impact of the program on Care Partner outcomes including, knowledge, confidence, Care Partner stress and well-being, the incidence and severity of behaviours in the person with dementia, interactions with care providers and improved communication and collaboration with the Care Team. A mixed methods approach was adopted that included both surveys and in-depth interviews.
Key Evaluation Objectives:
The key evaluation objectives were:
To collect data on who participa... more Key Evaluation Objectives: The key evaluation objectives were: To collect data on who participated in HCT services, the range of services received and clients’ experiences with the services received. To determine the acceptability and feasibility of HCT clients using an online Market Place portal to search for needed services To identify the range and location (proximity) of services and supports wanted by HCT clients To obtain feedback from HCT service providers on the one-stop shop and virtual week events To obtain feedback from site leads on the one-stop shop and virtual week events
KEY EVALUATION QUESTIONS INCLUDING:
• How successful is N4 in its stakeholder reach (e.g.,
partne... more KEY EVALUATION QUESTIONS INCLUDING: • How successful is N4 in its stakeholder reach (e.g., partnerships, membership, Newsletter subscribers)? • How effective has N4 been in engaging its stakeholders (e.g., advisory committee, COPs)? • Does N4 provide the types of information users want to access? • How easy is it for users to access the information they need through N4? • Do users find the information they access through N4 useful? • Has membership in N4 resulted in improved connections between members and sectors? • Do N4 members share knowledge with others? • What proportion of users promote N4 to others? What are the perceived main benefits of N4 membership to individuals and organizations? • What is working well, what needs improvement? • What are some of the main lessons learned from the development of N4?
This interim evaluation report was commissioned in the spring of 2018 to document the impact the ... more This interim evaluation report was commissioned in the spring of 2018 to document the impact the THEx has had over the first two fiscal years and to update the Ontario Ministry of health and Long-Term Care on the progress made and remaining challenges. The THEx project implementation team recommended the evaluation focus on three of the project components and their specific objectives.
This report is based on a pan-Canadian research effort involving sixteen academic researchers and... more This report is based on a pan-Canadian research effort involving sixteen academic researchers and five community partners. Six separate but related programs of research, or research pods investigated one or more aspects of this complex multi-level system. Each provides valuable information that assists in our understanding of the complex social system of partnerships and policies that services immigrant integration.
Through the development and pilot project trial of a socio-demographic questionnaire, a set of ei... more Through the development and pilot project trial of a socio-demographic questionnaire, a set of eight questions and three optional questions have been recommended for wide-scale implementation. Research on the equity of health and health care compels action on the collection of socio-demographic data. The results of the Tri-Hospital + TPH Health Equity Data Collection Research Project provide evidence that it is ”doable”.
An evaluation framework and plan for the Trans Health Expansion, an initiative of partners and co... more An evaluation framework and plan for the Trans Health Expansion, an initiative of partners and community members working together to improve the accessibility, quality, appropriateness, and sustainability of health services to support trans individuals and communities across the province.
Evaluation of the effectiveness of the women’s 24-hour and cold weather drop-in service models an... more Evaluation of the effectiveness of the women’s 24-hour and cold weather drop-in service models and identification of evidence based best practices and systemic changes to improve the 24-hour service model.
This scoping review assesses the current state of knowledge in peri to postmenopausal health in O... more This scoping review assesses the current state of knowledge in peri to postmenopausal health in Ontario. It consists of a literature review, qualitative interviews with key informants, and a research synthesis. The Literature Review identified critical issues related to how midlife transition and menopause are defined, the main hormonal and age-related changes experienced by midlife women, and current treatment options for peri to postmenopausal symptoms. The Qualitative Interviews provided additional information on symptoms, treatment approaches, practice issues and issues related to access and regulation from the perspectives of health providers and women’s health advocates. The research synthesis identified major issues concerning peri to postmenopausal health in Ontario.
Canada has yet to develop a unified and interprovincial/territorial social exclusion/inclusion (S... more Canada has yet to develop a unified and interprovincial/territorial social exclusion/inclusion (SE/I) policy framework. The development of such a framework requires a sound grasp of how these terms are understood in the literature and existing frameworks. This paper provides a critical review of how these concepts and indicators have been used in academic and policy discourses. We found that confusion arises in existing definitions of SE/I because of the failure to distinguish SE/I in terms of processes and outcomes. A framework is introduced that posits that SI be conceptualized as ‘processes’ that differentially impact on SE ‘outcomes’ in various domains relative to individual’s or groups’ social status or geographic location. A series of SI and SE indicators across levels and domains in the Canadian context are proposed. This report concludes by discussing many of the political, informational and research gaps that will need to be addressed to adopt and implement this framework in Canada.
The purpose of this evidence review is to explore the independent effect of racialized status on ... more The purpose of this evidence review is to explore the independent effect of racialized status on health and access to health care. The task is difficult because other factors such as immigration and SES can affect or confound its independent effect (Laveist et al., 2009). Toronto Public Health has already explored the relationship between income inequality and health in a 2008 report The Unequal City: Income and Health Inequalities in Toronto and immigrant health in a more recent report in 2011, The Global City: Newcomer Health in Toronto, conducted in partnership with Access Alliance Multicultural Health and Community Services. Both reports called for further investigation of the impact of racialization on health. Thus, this report endeavours to disentangle the effects of immigration and SES to complement previous and future work, while contributing to the wider evidence-based discourse on health inequalities among racialized groups.
Overview Examining the issues and challenges facing immigrants as they attempt to integrate succe... more Overview Examining the issues and challenges facing immigrants as they attempt to integrate successfully into Canadian society, Immigrant Integration is a multidisciplinary compendium of research papers, most of which were presented at the 14th National Metropolis Conference, held in Toronto in 2012. This book addresses the growing economic and educational inequality among immigrants and racialized populations in Canada and seeks to guard against further inequities. The authors address policy issues, newcomers’ health and well-being, cultural challenges, and resilience in immigrant communities. Each chapter concludes with a clear set of policy recommendations indicating how those in government and the broader public, private, and non-profit sectors can help newcomers integrate, as well as welcome them as significantly contributing members of Canadian society. Thorough and relevant, this book includes the research of academics, policy-makers, and experts from a wide range of discipli...
The internationalization of education fuels the ties crucial to long-term success in an increasin... more The internationalization of education fuels the ties crucial to long-term success in an increasingly interconnected global economy. With its low rates of study abroad, internationalization in Canada largely consists of international students coming to our shores. Encouraged by federal and provincial governments as well as leadership within the postsecondary education sector, the number of international students in Canada is surpassing targets set even just a few years ago. Approximately one-fourth of Canada’s international students study in Toronto, and their presence adds to existing diversity on campuses and in communities. To document international student trends and to better understand their impact on Toronto’s economic, social and post-secondary educational infrastructure, this report was commissioned by the Intergovernmental Committee for Economic and Labour Force Development in Toronto (ICE Committee).
The objectives of this report were to define and conceptualize Time Use, examine its associations... more The objectives of this report were to define and conceptualize Time Use, examine its associations with wellbeing and to propose a series of indicators to monitor Time Use in Canada. We conceptualized a gendered, life stage approach for understanding the relationship between time use and wellbeing, because each life stage group and gender has unique time use patterns and challenges. An extensive literature search was conducted to determine aspects of time use that had consistently strong associations with wellbeing. Then, these aspects of time use were evaluated as potential indicators based on their validity, relevance and feasibility. Ten indicators met all criteria. For working age adults, they are: working non-standard hours, working long hours, experiencing time pressure and providing care to seniors. For retired seniors they are: time spent in active leisure and formal volunteering. For children/adolescents they are: screen time, time in organized activities, parental reading to preschoolers and family meals. Among the positive trends observed are declining rates of adults working long hours and high rates of retired seniors engaged in active leisure or volunteering. Among the negative trends are the increasing proportions of adults working non-standard hours, providing care to seniors and experiencing high levels of time pressure. Of particular concern for children/adolescents are increases in average screen time and declines in the proportion of teenagers eating family meals at home. Findings suggest the need for policies and programs to address social level factors (e.g. workplace, community and school) that promote time spent in health enhancing activities.
The objectives of this report are: To conduct an environmental scan of existing newcomer servic... more The objectives of this report are: To conduct an environmental scan of existing newcomer services and networks in Ontario, along with a situational analysis of key organizational players working in newcomer health in Ontario including: o Identifying and synthesizing information on key strategy documents, policies and guidelines o Identifying and synthesizing information on key networks and organizations who have a mandate to build capacity of front-line service providers working in newcomer health, including relevant knowledge exchange networks in Ontario and across the country o The identification and summary information on key organizational players and networks, particularly with a newcomer health focus To make recommendations for CATIE’s future action plan for work with newcomer health organizations, with a focus on South Asian and Chinese service providers To strengthen the local and provincial response to Hepatitis C prevention, testing and engagement in treatment for newcomers
This paper begins with definitions of racism, recognizing that terminologies and concepts in disc... more This paper begins with definitions of racism, recognizing that terminologies and concepts in discourses on race and racism have changed and evolved over time. We next present evidence of the major health and health access inequities that exist for racialized people in Canada and elsewhere, and, for racism as a determinant of health. Finally, policy and research actions that address racism and reduce health inequities are presented.
Ensuring the continued good health of first and second generation immigrants and their families i... more Ensuring the continued good health of first and second generation immigrants and their families is an important goal. The first half of this paper reviews literature on the determinants of immigrant health in an attempt to explain „why‟ health status and health risks change over time. The second half uses a Population Health Approach to identify promising strategies and solutions that the Region of Peel can advocate for, collaborate on and/or implement to address the determinants of immigrant health identified in this review.
When immigrants first arrive in Canada, their health status is often superior to the Canadian-bor... more When immigrants first arrive in Canada, their health status is often superior to the Canadian-born population—a phenomenon known as the “healthy immigrant effect.” However,there is growing evidence that immigrants lose this health advantage over time. Based on a review of the literature commissioned by the Public Health Agency of Canada, this article presents evidence of the healthy immigrant effect and its subsequent decline; it also explores the implications of these changes for research and policy.
Men’s health is increasingly becoming a topic of attention in the world of health research and co... more Men’s health is increasingly becoming a topic of attention in the world of health research and community action. One of the key drivers of men’s health has been the Movember Foundation. The Movember Foundation commissioned this landscape review in the thematic areas of men’s physical activity, social connectedness and positive masculinity to inform investment opportunities for men’s health promotion activities in Canada. The landscape review consists of three primary steps: 1) an inventory review to identify existing organizations, services, as well as identify key players including all levels of government; 2) engagement with key informants from across Canada in the areas of research, government and community stakeholders to generate feedback on current challenges and future ideas and opportunities; and, 3) identification of gaps and future funding opportunities.
There is a lack of representation in the current data on the perceptions, experiences and needs o... more There is a lack of representation in the current data on the perceptions, experiences and needs of Ottawa’s African, Caribbean and Black (ACB) community in accessing mental health services. This study was designed to address gaps in understanding of the barriers to access, which are both structural and systemic in nature. While the ACB participants who have interacted with mental health services and providers are mostly satisfied, there are a number of significant issues and obstacles which prevent others in the community from obtaining appropriate care. Ongoing stigma, rooted in cultural sensitivities as well as racism and discrimination, are a critical risk factors. Participants who are financially stressed face additional obstacles. Study respondents identified employment and financial security, as well as the ability to receive mental health services from a provider who has a similar cultural and racial identity as the two most important factors which would facilitate improved access. Moreover, developing cultural competence within the mental health provider community is vital to building a trusting relationship between the client and the provider, and to addressing known biases which affect proper diagnosis and treatment plans. Related to this, there is a clear need for a more diverse and inclusive mental health workforce, one that better reflects and represents members of the ACB community.
In order to effectively promote and sustain the health and well-being of newcomers in Toronto, pl... more In order to effectively promote and sustain the health and well-being of newcomers in Toronto, planners, policy makers and service providers need timely and relevant information on the health status, health needs and determinants of health for this population. This report brings together new and existing evidence related to newcomer health. Findings presented here draw from recent academic and local community-based studies, insights from focus groups with local service providers and newcomers who use health services, and analyses of existing health and socio-demographic data. This report is intended to be a useful resource for policy makers, health planners, service providers and others interested in making Toronto a healthier and more equitable place to live for newcomers and all residents.
The Face of Poverty: A Jewish Community Study was commissioned to identify and document the multi... more The Face of Poverty: A Jewish Community Study was commissioned to identify and document the multidimensional impacts of poverty in the Jewish community, and to offer recommendations to address these challenges. Through evidence-based research, it seeks to both inform strategic planning among Jewish policy-makers and service providers and to help galvanize the Jewish community to respond to this serious challenge affecting Jewish individuals living among us.
The interpretation of variations in perinatal morbidity by immigration status has been difficult.... more The interpretation of variations in perinatal morbidity by immigration status has been difficult. Of particular concern is the lack of attention to adaptive capacity. This study explores the effect of acculturation on term low birthweight (LBW) in five ethnic groups representing different immigration experiences. Using Quebec birth certificates (1979-1988), two birth cohorts were defined to control for the effects of repeat pregnancies. Bivariate and logistic regression analyses were used to examine the relationship between acculturation and term LBW. In both birth cohorts the more acculturated women experienced significantly higher rates of term LBW. The odds ratio for term LBW (1.6) was also significantly higher for the more acculturated group but this effect was only observed in the second birth cohort. These findings imply that in addition to other conventional factors, the level of acculturation of the mother should be assessed in perinatal risk identification systems.
Chronic diseases and injuries in Canada, Dec 1, 2012
Our objective was to explore self-management practices, health services use and information-seeki... more Our objective was to explore self-management practices, health services use and information-seeking for type 2 diabetes care among adult men and women from four recent immigrant communities in Toronto. A structured questionnaire was adapted for the Canadian context and translated into 4 languages. A total of 184 participants with type 2 diabetes-130 recent immigrants and 54 Canadian-born-were recruited in both community and hospital settings. Recent immigrants were significantly less likely than the Canadian-born group to perform regular blood glucose and foot checks and significantly more likely than the Canadian-born group to be non-smokers, participate in regular physical activity and reduce dietary fat. Recent immigrants were significantly less likely than the Canadian-born group to use a specialist, alternative provider and dietician and less likely to report using dieticians, nurses and diabetes organizations as sources of diabetes-related information. Important differences were observed by sex and country of origin. Findings suggest that diabetes prevention and management strategies for recent immigrants must address linguistic, financial, informational and systemic barriers to information and care.
Objective. We examined the prevalence of intimate partner violence (IPV) among recent (0–9 years)... more Objective. We examined the prevalence of intimate partner violence (IPV) among recent (0–9 years) and nonrecent (≥ 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada.Methods. We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV.Results. The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV.Conclusions. Our findings have important implications for both prevention and detection of IPV among immigrant women.
ABSTRACT Helping women victimized by intimate partner violence (IPV) is a challenge, particularly... more ABSTRACT Helping women victimized by intimate partner violence (IPV) is a challenge, particularly when the women belong to diverse ethnic groups. The objective of our study was to collect information on perceptions of coping with IPV from the perspective of a specific immigrant group of women. Sixty-three women from the Tamil community in Toronto representing different generations and experiences of IPV were interviewed in focus group settings about their views of coping with IPV. Study findings suggested that their views were deeply embedded in their sociocultural context and influenced by the gender-role expectations from the community. The women showed a marked preference for “passive” modes of coping rather than “active.” Study findings have implications for the development of alternative approaches to helping ethnically diverse women deal with IPV.
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the... more Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) “(It’s) kinda like a real home” (WISH is unlike other shelters); (2) “It’s like a buddy system” (A sense of community was fostered); (3) “It’s the same size as a jail cell” (Problems with infrastructure); (4) “To keep us on focus” (Un/supportive staff/volunteers); (5) “I’m not sure what I’m going to do after” (The dearth of permanent housing creates trauma); and (6) “Too much bloody money in too little hands” (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in ... more We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the... more Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) “(It’s) kinda like a real home” (WISH is unlike other shelters); (2) “It’s like a buddy system” (A sense of community was fostered); (3) “It’s the same size as a jail cell” (Problems with infrastructure); (4) “To keep us on focus” (Un/supportive staff/volunteers); (5) “I’m not sure what I’m going to do after” (The dearth of permanent housing creates trauma); and (6) “Too much bloody money in too little hands” (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
<sec> <title>Introduction</title> <p>Notre objectif était d'explorer ... more <sec> <title>Introduction</title> <p>Notre objectif était d'explorer les pratiques d'auto-traitement, l'utilisation des services de santé et la recherche d'information sur le diabète de type 2 chez les adultes des deux sexes issus de quatre communautés d'immigrants récents de Toronto.</p> </sec> <sec> <title>Méthodologie</title> <p>Un questionnaire structuré a été adapté au contexte canadien et traduit en 4 langues. En tout, 184 participants atteints du diabète de type 2 (130 immigrants récents et 54 sujets nés au Canada) ont été recrutés tant en milieu communautaire qu'en milieu hospitalier.</p> </sec> <sec> <title>Résultats</title> <p>Les immigrants récents étaient significativement moins nombreux que les sujets nés au Canada àvérifier régulièrement leur glycémie et l'état de leurs pieds et significativement plus nombreux que les sujets nés au Canada à être non-fumeurs, à faire régulièrement de l'activité physique et à réduire leur apport alimentaire en graisses. Les immigrants récents avaient significativement moins souvent recours à un spécialiste, à un autre dispensateur de soins et à un diététiste et déclaraient en moins grand nombre consulter des diététistes, des infirmières et des organisations pour diabétiques comme sources d'information sur le diabète. Des différences importantes ont été observées selon le sexe et le pays d'origine.</p> </sec> <sec> <title>Conclusion</title> <p>Les observations semblent indiquer que les stratégies de prévention et de prise en charge du diabète destinées aux immigrants récents doivent tenir compte des barrières linguistiques, financières, informationnelles et systémiques qui nuisent à l'accès à l'information et aux soins.</p> </sec>
Journal of Comparative Family Studies, May 1, 2000
Abstract 1. Examined the stressful experiences of youth in Southeast Asian refugee families reset... more Abstract 1. Examined the stressful experiences of youth in Southeast Asian refugee families resettled in Canada. While many studies have focused on the mental health of adult refugees few have examined the situation of their children. The authors suggest that these ...
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Research Papers by Ilene Hyman
quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development
of innovative alternatives such as telephone-based and video-conferencing medical interpreting
services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights
the absence of a cohesive national strategy, reflected in diverse funding models employed across
provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating
for medical interpreting, both as a moral imperative and a prudent investment, this article
draws from human rights principles and ethical considerations, justified in national and international
guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes
that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally,
this article illuminates decision-making processes for utilizing interpreting services; recognizing the
pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating
intersectional considerations such as gender, culture and age, underscoring the importance of a
collaborative approach. Finally, it provides recommendations at provider, organizational and system
levels to ensure equitable access to this right and to promote the health and well-being of refugees
and other individuals facing language barriers within Canada’s healthcare system.
there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of
COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this
pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens
taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations
most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race,
beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand
the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in
Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of
these population groups as these race-based data become available.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit,
Nonbinary, Trans, gender non-conforming, and gender questioning community
members in the Greater Toronto Area.
report are based on data
collected from a sample
of people who had
applied to WES between
2013 and 2015 for an
Educational Credential
Assessment (ECA—see
below) and who were
subsequently admitted
to Canada as permanent
residents. The data
reflect the responses of
6,402 participants who
resided in Canada at
the time of the survey,
all of whom had been
admitted through
one of the economic
immigration categories
now included under the
Express Entry system.
adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.
quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development
of innovative alternatives such as telephone-based and video-conferencing medical interpreting
services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights
the absence of a cohesive national strategy, reflected in diverse funding models employed across
provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating
for medical interpreting, both as a moral imperative and a prudent investment, this article
draws from human rights principles and ethical considerations, justified in national and international
guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes
that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally,
this article illuminates decision-making processes for utilizing interpreting services; recognizing the
pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating
intersectional considerations such as gender, culture and age, underscoring the importance of a
collaborative approach. Finally, it provides recommendations at provider, organizational and system
levels to ensure equitable access to this right and to promote the health and well-being of refugees
and other individuals facing language barriers within Canada’s healthcare system.
there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of
COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this
pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens
taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations
most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race,
beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand
the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in
Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of
these population groups as these race-based data become available.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit,
Nonbinary, Trans, gender non-conforming, and gender questioning community
members in the Greater Toronto Area.
report are based on data
collected from a sample
of people who had
applied to WES between
2013 and 2015 for an
Educational Credential
Assessment (ECA—see
below) and who were
subsequently admitted
to Canada as permanent
residents. The data
reflect the responses of
6,402 participants who
resided in Canada at
the time of the survey,
all of whom had been
admitted through
one of the economic
immigration categories
now included under the
Express Entry system.
adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.
practices in the care of persons with changes in behaviour due to dementia and other cognitive impairment. In 2019, the U-First! program was adapted for use with informal Care Partners (i.e., family members and friends).
The three primary objectives of the U-First! for Care Partners are:
To enhance the well-being of both informal Care Partners and those experiencing behaviour
changes that they support through problem-solving using the U-First! Framework
To increase Care Partner confidence and capability to provide effective care for persons with
dementia and other cognitive impairment who are experiencing behaviour changes
To improve collaboration between Care Partners and other members of the care team through common knowledge, language, and approach to care
Evaluation Methods
The evaluation plan was developed building on the U-First! for Care Partner’s logic model and the “Conceptual Framework for Monitoring and Evaluating Health Information Products and Services.” It was designed to measure core program outputs and outcomes, including:
Program reach
Satisfaction with and effectiveness with the online training format for program facilitators
Satisfaction with the U-First! for Care Partners program and materials among Care Partner
participants
Impact of the program on Care Partner outcomes including, knowledge, confidence, Care Partner stress and well-being, the incidence and severity of behaviours in the person with dementia, interactions with care providers and improved communication and collaboration
with the Care Team.
A mixed methods approach was adopted that included both surveys and in-depth interviews.
The key evaluation objectives were:
To collect data on who participated in HCT services, the range of services received and
clients’ experiences with the services received.
To determine the acceptability and feasibility of HCT clients using an online Market Place
portal to search for needed services
To identify the range and location (proximity) of services and supports wanted by HCT
clients
To obtain feedback from HCT service providers on the one-stop shop and virtual week
events
To obtain feedback from site leads on the one-stop shop and virtual week events
• How successful is N4 in its stakeholder reach (e.g.,
partnerships, membership, Newsletter subscribers)?
• How effective has N4 been in engaging its
stakeholders (e.g., advisory committee, COPs)?
• Does N4 provide the types of information users want
to access?
• How easy is it for users to access the information
they need through N4?
• Do users find the information they access through
N4 useful?
• Has membership in N4 resulted in improved
connections between members and sectors?
• Do N4 members share knowledge with others?
• What proportion of users promote N4 to others?
What are the perceived main benefits of N4
membership to individuals and organizations?
• What is working well, what needs improvement?
• What are some of the main lessons learned from the
development of N4?
Committee).
between time use and wellbeing, because each life stage group and gender has unique time use patterns and challenges. An extensive literature search was conducted to determine aspects of time use that had consistently strong associations with wellbeing. Then, these aspects of time use were evaluated as potential indicators based on their validity, relevance and feasibility. Ten indicators met all criteria. For working age adults, they are: working non-standard hours, working long hours, experiencing time pressure and providing care to seniors. For retired seniors they are: time spent in active leisure and formal volunteering. For children/adolescents they are: screen time, time in organized activities, parental reading to preschoolers and family
meals. Among the positive trends observed are declining rates of adults working long hours and high rates of retired seniors engaged in active leisure or volunteering. Among the negative trends are the increasing proportions of adults working non-standard hours, providing care to
seniors and experiencing high levels of time pressure. Of particular concern for children/adolescents are increases in average screen time and declines in the proportion of teenagers eating family meals at home. Findings suggest the need for policies and programs to address social level factors (e.g. workplace, community and school) that promote time spent in health enhancing activities.
o The identification and summary information on key organizational players and networks, particularly with a newcomer health focus To make recommendations for CATIE’s future action plan for work with newcomer health organizations, with a focus on South Asian and Chinese service providers To strengthen the local and provincial response to Hepatitis C prevention, testing and engagement in treatment for newcomers
a review of the literature commissioned by the Public Health Agency of Canada, this article presents evidence of the healthy immigrant effect and its subsequent decline; it also explores the implications
of these changes for research and policy.