IntroductionThe One Sustainable Health for All (OSH) Forum was launched in 2021 to promote a transdisciplinary “One Health/Planetary Health” approach in line with the 2030 Sustainable Development Goals. The “One Health” approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems. The OSH Forum leads thematic international working groups (IWGs), and the IWG on health equity undertook a scoping review as part of its mandate. This scoping review of reviews focused on actions to achieve health equity in the realm of One Health. The aim was to describe the types of health equity actions, to identify knowledge gaps and to recommend approaches integrating health equity and One Health.MethodsThe literature search only included peer-reviewed action-focused papers. The WHO building blocks were adapted to categorize the lines of action into five key areas.ResultsWe analyzed 62 reviews out of 295 action-focused papers. Predominant actions were in the area of service delivery (26/62 reviews). Health equity was addressed through governance in 13 reviews, information/evidence data in 7, technologies in 11, and human resources in 5. Refugees, immigrants, and racial/ethnic minorities were the main targeted communities. The connection of health equity and One Health was not directly addressed except in two reviews. Nearly all the reviews were from high-income countries. Few studies assessed the impact of the interventions on health equity. Recurrent themes across the reviews were: the importance of addressing the social determinants of health; the need for disaggregated data; the critical role of human resources and community engagement; and the need to analyze power imbalances.ConclusionThe review highlighted a dire need for studies on the impact of interventions on health equity. Given the limited connections made between health equity and One Health, using a health equity lens to assess One Health initiatives, and vice versa, appears warranted.

BACKGROUND:Refugees often face increased risks of poor perinatal health outcomes compared to native-born individuals and non-refugee immigrants. However, limited research has explored how birth outcomes vary across refugee subgroups in Canada, especially compared to economic immigrants and among refugee groups themselves. This study aimed to (1) compare the risk of preterm birth (PTB), small-for-gestational-age (SGA), large-for-gestational-age (LGA), stillbirth, and infant mortality between refugee subgroups and economic immigrants, and (2) examine differences among Government-Assisted Refugees (GARs), Privately Sponsored Refugees (PSRs), and In-Canada Refugees (ICRs). METHODS:This population-based study used data from the Migrant Maternal and Infant Morbidity and Mortality (MIMMM) dataset, including 706,620 singleton births from 2000 to 2017. Generalized estimating equation models calculated adjusted risk ratios (aRRs) for birth outcomes, accounting for maternal and immigration-related factors. RESULTS:All refugee subgroups had higher PTB (6.26-6.41 per 100 births) and LGA rates (8.65-9.17 per 100 births) but lower SGA rates (9.53-10.40 per 100 births) compared to economic immigrants (PTB: 5.95, LGA: 7.36, SGA: 10.96). After adjustment, GARs maintained higher PTB risks, and all refugee subgroups had lower SGA and higher LGA risks than economic immigrants. Within refugee subgroups, ICRs had higher SGA risks (aRR = 1.09; 95% CI: 1.04-1.14) than GARs, and PSRs (aRR = 1.22; 95% CI: 1.04-1.44) and ICRs (aRR = 1.28; 95% CI: 1.07-1.52) had higher stillbirth risks than GARs. CONCLUSION:Refugee women in Canada have higher risks of PTB and LGA births compared to economic immigrants. ICRs had higher risks of SGA births and stillbirths than other refugee subgroups but lower risks of SGA and stillbirths compared to economic immigrants. These disparities are partly explained by maternal and immigration-related factors. Further research is needed to better understand these factors and inform policies aimed at reducing health disparities among immigrant populations in Canada.

Background: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. Methods: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. Results: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. Interpretation: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities.

This systematic integrative review provides a unique pioneering perspective on community support practices in social, community, and cooperative housing, improving our understanding of the practice and its outcomes. Two research questions guided this work: 1) What are the community support practices in social and community housing serving individuals in the context of socioeconomic deprivation in permanent housing structures? And 2) What are the outcomes of the community support practices in social and community housing. Studies describing and/or reporting on outcomes of community support practices in social and community housing (psychosocial, economic, and health/mental health) were included from the journals’ inception to September 2022. A total of 42 studies were included in the systematic review, of which 20 were qualitative, 14 quantitative, and eight mixed-method studies. Of them all, 34 studies reported on public housing, four on community housing, and four on cooperative housing. Results inform practitioners and decision makers on issues related to community practices in permanent supportive housing and their outcomes in relation to tenure orientations and potential impact. Community practice workers are pillars in housing settings who provide bridging, bonding, and linking that builds social capital in adverse conditions. This review provides insight into innovative research avenues in this domain, while bringing to the forefront the fundamental challenges of individual support pathways to collective empowerment, increased health needs, and unequalled peer-tenant support engagement, as well as their precarious conditions.

Cette réflexion critique porte sur l’expression « compétence culturelle » utilisée dans le secteur de la santé et des services sociaux. Nous discutons des éventuelles conséquences dans un contexte clinique culturellement diversifié, induisant potentiellement des enjeux éthiques. La juxtaposition des termes « compétence » et « culture » produit une expression qui ne tient que peu compte, et ce, de façon inclusive de particularités des personnes/groupes. Ce rapprochement de deux concepts très spécifiques limite l’application effective de la personnalisation des soins et des services, le respect de la déontologie professionnelle d’accès à des soins de qualité et à un traitement équitable. Ces deux termes adjacents ont un potentiel de créer de l’insatisfaction par le personnel de santé et des services sociaux, liée à des attentes et doublée d’un sentiment d’impuissance à répondre aux diverses responsabilités de soins et de services de qualité.

Gender equality has been a crosscutting issue in Horizon 2020 with three objectives: gender balance in decision-making, gender balance and equal opportunities in project teams at all levels, and inclusion of the gender dimension in research and innovation content. Between 2017 and 2022, the EU funded, in collaboration with national agencies, 13 transnational projects under "GENDER-NET Plus" that explored how to best integrate both sex and gender into studies ranging from social sciences, humanities, and health research. As the projects neared completion, forty researchers from these interdisciplinary teams met in November 2022 to share experiences, discuss challenges, and consider the best ways forward to incorporate sex and gender in research. Here, we summarize the reflections from this workshop and provide some recommendations for i) how to plan the studies (e.g., how to define sex and/or gender and their dimensions, rationale for the hypotheses, identification of data that can best answer the research question), ii) how to conduct them (e.g., adjust definitions and dimensions, perform pilot studies to ensure proper use of terminology and revise until consensus is achieved), and iii) how to analyze and report the findings being mindful of any real-world impact.

The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.

Objectives Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. Design Retrospective cohort study. Participants This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. Outcome Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). Results Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). Conclusions Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.

AbstractFemawle Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e. performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedures are usually carried out in infancy or childhood and, most often before the age of 15. Although some pictorial and training tools are available, existing literature focuses primarily on adults. The signs of FGM/C particularly in prepubertal girls, can be subtle and depend on the type as well as on the experience of the examiner. The health care provider (HCP) should be trained to be familiar with, and able to identify a wide range of both modified and unmodified genitalia, as well as findings that may superficially look like FGM/C but actually reflect the normal range of genital anatomy. Knowledge of FGM/C types and subtypes, as well as complications and differential diagnoses of physical findings, are critical. We present a reference guide and atlas containing iconographic material of both the pre- and post-pubertal external female genital area with and without genital cutting/alteration. Our purpose is to facilitate training of health care professionals in making accurate diagnoses, providing appropriate clinical management, ensuring culturally informed/sensitive patient–provider communication, and accurate recording and reporting to child welfare/law enforcement agencies, where required.

AbstractLabial and Clitoral adhesion. Examples of convergence of inner labia under the glans and intersection with clitoral hood.

Background: Leadership competence is important to ensure the provision of safe and high-quality care in hospitals.Purpose: The aim was to demonstrate the feasibility of enhancing the perceived leadership competence of nursing students through an innovative health education strategy, consisting of a student-led dedicated education unit (DEU) informed by a service-learning approach in a community setting.Design: Feasibility study in a three-phase process: I: Design; II: Acceptability and implementation; III: Expansion to a different setting. In phase II the DEU was piloted with 62 students using a pretest/post-test with control group design. In phase III it was piloted with 20 students in the expansion setting.Methods: The DEU was implemented and tested in Barcelona (Spain) between 2014 and 2019. To assess acceptability and implementation, students' perceived leadership competence was measured using the Self-Assessment Leadership Instrument. We also obtained satisfaction ratings using an ad hoc questionnaire.Results: Satisfaction was high among students, as well as among service users who received health education. In phase II, students' post-test self-ratings of their leadership competence were higher in both the intervention and control groups, but the increase was significantly greater among students who participated in the DEU (25.84 % vs. 16.72 %, p = .012). Similar results were obtained in the expansion phase, with students in the intervention group once again showing a significant increase in perceived leadership skills (12.89 %, p = .005).Conclusions: Student-led DEUs appear to be an effective way of enhancing perceived leadership competence among senior nursing students.

AbstractFGM/C type IIIb in a 16-month old girl from Mali (a, b), admitted with acute retention of urine and acute renal failure, Mali.

AbstractInformed consent is essential to ensuring a trauma-informed, survivor-centered, ethical process that respects the (developing) autonomy of a patient.

Background The COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work. Methods Using a qualitative descriptive design, we interviewed 17 management and frontline staff of organizations supporting survivors of intimate partner and sexual violence across Canada. Results: We identified 4 themes that describe the impacts of COVID-19 on intimate partner and sexual violence survivors, from the perspective of service providers: (1) No escape; (2) Isolation; (3) Tough decisions; and (4) Heightened vulnerability. These narrative findings are presented first, followed by an analysis within a social determinants of health framework. Interpreting our findings against such a framework revealed a complex interplay of social determinants, notably social support, access to services, and poverty, that produced several challenges for intimate partner and sexual violence survivors during COVID-19. Conclusion According to service providers, intimate partner and sexual violence survivors in Canada faced several challenges during the pandemic, including reduced ability to escape their situations, increased isolation, increasingly complex decisions, and heightened vulnerability. Our findings demonstrate the critical need to adopt a broader, more holistic approach in tackling intimate partner and sexual violence by also addressing socioeconomic issues such as poverty and marginalization.

AbstractPlease note that when WHO refers to labia minora and majora such terms are now replaced by inner and outer labia.

Femawle Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e. performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedures are usually carried out in infancy or childhood and, most often before the age of 15. Although some pictorial and training tools are available, existing literature focuses primarily on adults. The signs of FGM/C particularly in prepubertal girls, can be subtle and depend on the type as well as on the experience of the examiner. The health care provider (HCP) should be trained to be familiar with, and able to identify a wide range of both modified and unmodified genitalia, as well as findings that may superficially look like FGM/C but actually reflect the normal range of genital anatomy. Knowledge of FGM/C types and subtypes, as well as complications and differential diagnoses of physical findings, are critical. We present a reference guide and atlas containing iconographic material of both the pre- and post-pubertal external female genital area with and without genital cutting/alteration. Our purpose is to facilitate training of health care professionals in making accurate diagnoses, providing appropriate clinical management, ensuring culturally informed/sensitive patient–provider communication, and accurate recording and reporting to child welfare/law enforcement agencies, where required.

OBJECTIVES:Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery.METHODS:We interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens.RESULTS:We identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care.CONCLUSION:A feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.

The combined forces of economic globalization and international migration have resulted in specific challenges to palliative care systems. The COVID-19 pandemic has and is still greatly affecting elder populations as well as those across the age continuum living with long-standing chronic conditions or with pre-existing diverse unmet needs. While health promotion and palliative care may appear to be conceptually opposing fields, we argue that palliative care can and should fit under the umbrella of the health promotion continuum. This commentary seeks to discuss the importance of linguistic literacy and communication imperatives in the context of access to palliative care, given the broad, diversified and sensitive scope of care. While the pandemic has demonstrated that the public health responses of migrant host societies are deeply intertwined with policies as well as local rules and constraints, the promotion and provision of safe, timely and appropriate palliative care can be achieved through a sensitive assessment of differential contexts of diversity. The pandemic has painfully illustrated the need for a strong, respectful and equitable working partnership within the professions as well as with the civic society in order for the palliative needs of those exposed to a sustained risk not to be forgotten.