Despite widely accepted clinical care guidelines, uninsured pregnant migrants in Canada face health inequalities and there are ethical implications of denying them publicly-funded care. Uninsured migrants face multiple barriers (financial, systemic, and cultural) to their perinatal care access, which can negatively impact their health and psychosocial outcomes, as well as those of their families. Drawing on interviews with 10 uninsured migrant women in Montreal, Canada, we explore the factors that enabled their access to perinatal care. Our findings underline the importance of health professionals' ability to exercise discretion to volunteer their time, reduce their fees, or "go the extra mile" to ensure care. On the part of the pregnant migrants themselves, individual factors such as resourcefulness, patient proficiency, and social location may enable their care access. This individualization of the access to care is both ethically and politically problematic, and we discuss the role of social workers in addressing the needs of this population.

Lessons learned convey information and experiences that were studied when carrying out projects or policies, in order to improve procedures and practices to better cope with future similar problems in other contexts. Although the term lessons learned appears in the titles of thousands of scientific articles, most do not describe how these lessons were produced or the level of rigor involved in their development. As part of a project aimed at deriving lessons from hospitals' resilience during the COVID-19 pandemic in five countries (the HoSPiCOVID project), we sought to systematised the process of producing these lessons. To do so, we conducted a rapid review to identify the best ways of developing quality lessons learned (QLLs). A QLL results from a systematic process of collecting, compiling, and analysing data derived from a research project. The rapid review follows the same key steps as a systematic review, adapted to a more accelerated and pragmatic format. From 1,881 documents initially identified, 18 were retained. Their analysis identified three principles to guide the process of developing QLLs: 1) Creating a supportive climate; 2) Choosing the right leaders or facilitators for the process; and 3) Engaging in a scientific approach. Based on these findings, we developed a guide comprising 11 steps, structured into two main phases: preparatory steps for QLL development, and steps for identifying and formulating QLLs. This guide offers a structured process for teams seeking to enhance the rigor, clarity, and potential transferability of the lessons they formulate.

Caribbean Small Island Developing States (SIDS) are qualified as disproportionately vulnerable to climate change, including climate extremes like hurricanes. Yet, there is a paucity of research regarding climate risks that refer to health and human mobility, and there is a need for vulnerability and adaptation assessment in Caribbean SIDS. Our study discusses risks and vulnerabilities including local adaptive capacity in a Caribbean context to inform future adaptation measures to climate change. Our discussion is based on qualitative data collected in the Caribbean islands of Dominica and Guadeloupe. The data emanates from semi-structured interviews organized between March 2020 and January 2021 with people who were either displaced within Dominica following climate extremes that struck Dominica in 2015 (Tropical storm Erika) and 2017 (Hurricane Maria), and also with people who migrated to Guadeloupe in 2017. Interview guides were based on conceptual frameworks on climate change, migration and health, and vulnerability to climate change. Data was analyzed deductively, based on frameworks and inductively to allow new codes to emerge. Participants demonstrated diverse perspectives on climate change. The study highlighted the significance of social ties and resources in supporting local adaptive capacity and mobility in response to climate extremes. Agriculture’s vulnerability raised concerns for long-term economic implications and food security. Some recommendations for building local adaptive capacity to climate change underscore the need for knowledge and information exchange between actors and institutions, and community inclusion; equity; enhanced coordination between government and local actors and decentralisation; and public health programmes and resources. Institutions such as health, education and media should be strengthened to build adaptive capacities for communities in the face of climate change.

[This corrects the article DOI: 10.1016/j.joclim.2023.100237.].

Background Adaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC. Methods We explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly. Results Findings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability. Conclusion The primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

IntroductionCaribbean Small island developing states (SIDS) are generally qualified as disproportionately vulnerable to climate change, including extreme weather events like hurricanes. While many studies already documented the impacts of climate change on health in the wealthiest countries, there is little knowledge in this field in Caribbean SIDS. Our study aims to discuss health risks and vulnerabilities in a Caribbean context to inform future adaptation measures to climate change.MethodsOur paper is based on a qualitative study that was conducted in Dominica, a Caribbean SIDS. The data come from semi-structured interviews organized between March 2020 and January 2021 with people internally displaced following an extreme climate event, either tropical storm Erika (2015) or Hurricane Maria (2017), and with some people who migrated to Guadeloupe after Hurricane Maria. Interview guides were based on conceptual frameworks on climate change, migration and health, and vulnerability to climate change. Data were analyzed deductively based on frameworks and inductively to allow new codes to emerge.ResultsOur findings suggest that current knowledge of climate change by those who have been displaced by an extreme climate event varied greatly depending on the education level, class, and socioeconomic condition of the participant. Participants experienced various negative consequences from a storm or hurricane such as increased risk of relocation, lack of access to healthcare, and food, job, and water insecurities – all circumstances know to correlate with mental health issues. Participants suggested stronger dwellings, community preparedness committees to act sooner, and climate change sensitization and awareness campaigns to foster community unity and solidarity.ConclusionThese findings contribute to the perspectives and knowledge of climate change, highlighting that existing extreme climate event committees and government officials need to address structural and social barriers that can potentially increase social inequalities and lead to maladaptation to climate change with potential consequences on public health.

The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.

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.

Introduction: The Caribbean region is repeatedly exposed to extreme climate-related events, such as hurricanes and tropical storms, which are expected to increase in severity with climate change. This study aims to better understand how extreme climate events affect human mobility, social circumstances, and healthrelated issues in the Eastern Caribbean, focusing more specifically on Dominica, a Small Island Developing State (SIDS). Methods: Semi-structured qualitative interviews were conducted with people who were internally displaced following an extreme climate event in Dominica, and with people who migrated from Dominica to Guadeloupe. Results: Mental health was a central issue discussed by participants. Some respondents raised issues regarding loss of livelihoods and poverty that affected their living conditions. For those who decided to migrate to Guadeloupe, the dif ficulties of getting migrant authorized status were very stressful. Other themes related to displacement trajectory, income, occupation, housing, access to food and water, health and psychosocial services, and the role of local and international assistance and social support and ties - that are well known social determinants of mental health, were raised by participants. Discussion and conclusion: Mental health and related determinants should be seen as a public health priority in Caribbean SIDS. Psycho-social interventions that focus on potential sources of vulnerabilities to mental health issues should be integrated in climate preparedness and response efforts. Otherwise, pre-existing social vulnerabilities may be aggravated, limiting the adaptation capacities of Caribbean SIDS to climate change. Public health and the health care system have a role to play in climate change adaptation. (c) 2023 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

In Canada and globally, the COVID-19 pandemic has increased social inequalities in health (SIH), furthering the vulnerability of certain groups and communities. Contact-tracing is a cornerstone intervention with COVID-19 prevention and control programs. The aim of this study was to describe whether and how SIH were considered during the design of the COVID-19 contact-tracing intervention in Montreal. This study is part of the multi-country research program HoSPiCOVID, looking at the resilience of public health systems during the COVID-19 pandemic. A descriptive qualitative study was carried out in Montreal, based on a “bricolage” conceptual framework describing the consideration for SIH in intervention and policy design. Qualitative data were collected using semi-structured interviews with 16 public health practitioners, recruited using both purposive and snowball sampling. Data were analyzed thematically, both inductively and deductively. According to participants, SIH were not initially considered during the design of the contract-tracing intervention in Montreal. The participants were frustrated by the Minister of Health’s initial resistance to integrating SIH into their public health response. However, adaptations were gradually made to better meet the needs of underserved populations. There is a need for a clear and common vision of SIH within the public health system. Decision-makers need to consider SIH prior to designing public health interventions in order for these not to further increase SIH in the future, especially in the face of a health crisis.

Under-Served: Health Determinants of Indigenous, Inner-City, and Migrant Populations in Canada. Akshaya Neil Arya, A. N., & Thomas Piggott (Editors). Canadian Scholars, 2018, 424 pages. An article from journal Canadian Social Work Review / Revue canadienne de service social (Volume 39, Number 1, 2022, pp. 5-185), on Érudit.

Additional file 1. Quantitative tool: quantitative questionnaire for the population. QuantiPop.

BACKGROUND:Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). METHODS:Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. RESULTS:Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. CONCLUSIONS:These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.

Selon les plus récentes estimations, la Loi sur l’assurance maladie laisse 50 000 à 70 000 migrants sans assurance médicale au Québec. L’accès aux soins de santé dans la province canadienne est, entre autres, lié au statut migratoire. Avant la pandémie, diverses barrières à l’accès aux soins (administratives, économiques, linguistiques, culturelles, etc.) avaient été identifiées. En tant que déterminant social de la santé, l’accès discriminatoire aux soins de santé nuit à la santé de ces migrants. Dans le contexte de la crise sanitaire liée à la COVID-19, les inégalités sociales en santé ont semblé s’intensifier pour les personnes issues des diverses communautés migrantes vivant à Montréal et ailleurs dans le monde. Grâce à un projet de recherche qualitatif, nous explorons dans cet article comment la position sociale, en particulier le statut migratoire, se traduit dans l’expérience vécue pendant la pandémie de COVID-19 pour les personnes migrantes sans assurance médicale vivant à Montréal. Pour atteindre cet objectif, nous avons mené des entretiens semi-structurés auprès de 19 personnes lors de la première et de la deuxième vague de pandémie (août 2020 à octobre 2020). Nos résultats suggèrent que le statut migratoire, à l’intersection avec le revenu, les conditions de travail et les rapports de genre, joue un rôle déterminant sur l’expérience vécue des participants avant et pendant la pandémie. Cela met en lumière l’urgence de mettre en place des politiques publiques plus inclusives pour assurer l’accès à l’aide sociale et à l’assurance médicale afin de remédier aux inégalités sociales en santé auxquelles sont confrontées les personnes migrantes sans assurance médicale vivant au Québec.

Background Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. Methods The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. Discussion This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.

Access to quality drinking water is a fundamental right. Despite Canada's wealth of fresh water, many First nations, including the Anishinaabeg, regularly face inequitable access to quality drinking water, a situation that has health, spiritual and cultural consequences. These injustices are a direct result of colonization and the unequal relationship between the Canadian government and First Nations, which has greatly contributed to restricting the traditional role of Anishinaabeg women as water protectors, despite their spiritual and identity connection to water. Nevertheless, these women have shown resilience, which is reflected in a number of initiatives to raise awareness, mobilize and advocate for water protection. In this article, we seek to show that an ecological and sanitary issue, such as the availability of quality drinking water for Indigenous peoples in Canada, is part of a power struggle, past and present, with the federal government and the provinces. Our article aims more specifically at : 1) showing the importance of the lack of availability of drinking water for Indigenous nations ; 2) describing the traditional role of Anishinaabeg women as water protectors ; 3) situating the water issue in its colonial context ; and 4) exploring the various mobilizations led by Indigenous women in response to this historical and political problem.

Background Knowledge about the health impacts of the absence of health insurance for migrants with precarious status (MPS) in Canada is scarce. MPS refer to immigrants with authorized but temporary legal status (i.e. temporary foreign workers, visitors, international students) and/or unauthorized status (out of legal status, i.e. undocumented). This is the first large empirical study that examines the social determinants of self-perceived health of MPS who are uninsured and residing in Montreal. Methods and findings Between June 2016 and September 2017, we performed a cross-sectional survey of uninsured migrants in Montreal, Quebec. Migrants without health insurance (18+) were sampled through venue-based recruitment, snowball strategy and media announcements. A questionnaire focusing on sociodemographic, socioeconomic and psychosocial characteristics, social determinants, health needs and access to health care, and health self-perception was administered to 806 individuals: 54.1% were recruited in urban spaces and 45.9% in a health clinic. 53.9% were categorized as having temporary legal status in Canada and 46% were without authorized status. Regions of birth were: Asia (5.2%), Caribbean (13.8%), Europe (7.3%), Latin America (35.8%), Middle East (21%), Sub-Saharan Africa (15.8%) and the United States (1.1%). The median age was 37 years (range:18-87). The proportion of respondents reporting negative (bad/fair) self-perception of health was 44.8%: 36.1% among migrants with authorized legal status and 54.4% among those with unauthorized status (statistically significant difference; p<0.001). Factors associated with negative self-perceived health were assessed using logistic regression. Those who were more likely to perceive their health as negative were those: with no diploma/primary/secondary education (age-adjusted odds ratio [AOR]: 2.49 [95% CI 1.53-4.07, p<0.001] or with a college diploma (AOR: 2.41 [95% CI 1.38-4.20, p = 0.002); whose family income met their needs not at all/a little (AOR: 6.22 [95% CI 1.62-23.85], p = 0.008) or met their needs fairly (AOR: 4.70 [95% CI 1.21-18.27], p = 0.025); with no one whom they could ask for money (AOR: 1.60 [95% CI 1.05-2.46], p = 0.03); with perception of racism (AOR: 1.58 [95% CI 1.01-2.48], p = 0.045); with a feeling of psychological distress (AOR: 2.17 [95% CI 1.36-3.45], p = 0.001); with unmet health care needs (AOR: 3.45 [95% CI 2.05-5.82], p<0.001); or with a health issue in the past 12 months (AOR: 3.44 [95% CI 1.79-6.61], p<0.001). Some variables that are associated with negative self-perceived health varied according to gender: region of birth, lower formal education, having a family income that does not meet needs perfectly/very well, insalubrious housing, not knowing someone who could be asked for money, and having ever received a medical diagnosis. Conclusions In our study, almost half of immigrants without health insurance perceived their health as negative, much higher than reports of negative self-perceived health in previous Canadian studies (8.5% among recent immigrants, 19.8% among long-term immigrants, and 10.6% among Canadian-born). Our study also suggests a high rate of unmet health care needs among migrants with precarious status, a situation that is correlated with poor self-perceived health. There is a need to put social policies in place to secure access to resources, health care and social services for all migrants, with or without authorized status.

This think piece discusses ‘Alzheimer’s disease’ from a critical anthropological perspective. I aim to challenge the taken-for-granted biomedical framing in four steps. First, a brief genealogical account shows that Alzheimer’s disease as a biomedical category has only recently become a public and global health preoccupation. Second, the concept of medicalization is mobilized to illustrate the construction of and the uncertainty around this new medical object. Third, I build a case for analysing this medical category within a sociocultural context. Finally, a brief account of the relevance of social intervention is given.