Extreme heat events present significant health risks, particularly for populations facing systemic marginalization. Through interviews and FGs with 63 ( n = 60 residents; n = 3 service providers (SP)) participants, this paper explores the barriers and opportunities related to access and use of cooling centres from both user and provider perspectives, as well as broader implications for addressing vulnerability to extreme heat in the metro Vancouver region of British Columbia, Canada. Initially focused on cooling centres, our research expanded to include the complexities of individual and systemic responses to heat, highlighting the complex interplay between personal preferences and structural barriers. Key barriers to cooling centre usage reported by participants included concerns over safety, hygiene, stigma, lack of information, and infrastructural challenges such as transportation. SPs faced constraints with staffing, limited hours, and underutilization of additional services. Tensions emerged between individual, do-it-yourself (DIY) approaches and collective solutions, with participants seeking agency in their choices while acknowledging the need for improved, community-based interventions. The study also uncovered the unintended effects of inclusivity, as the presence of individuals who use substances or are unhoused in cooling spaces deterred some potential users, underscoring the challenges of designing universally accessible services. Broader systemic issues, such as housing security and the quality of indoor environments, further intersected with vulnerability to extreme heat, exacerbating risks for those opting to stay at home. The paper recommends leveraging existing public spaces, enhancing social networks, improving tenant protections, and fostering ‘right to cool’ initiatives to balance immediate relief with long-term systemic reform, particularly around the rental housing crisis and tenant insecurity. By addressing both individual and collective needs, this approach can mitigate the health impacts of extreme heat while promoting greater equity and resilience.

Public schools play a pivotal role in successful community development. Yet, with school closures on the rise across North America, there is limited knowledge on the outcomes of closed school properties. This study documents the afterlife of closed school properties in Ontario, Canada, identifying their potential beneficiaries, and assessing the prevalence of property vacancies. Using a dataset of over 400 schools closed between 2011 and 2021, we determined that the prevalence of certain school property reuses varied by degree of urbanicity. Fewer than one-fifth of reused properties were designed to benefit highly deprived populations, despite over half of the school closures occurring in neighborhoods with higher levels of deprivation. Furthermore, one-third of school properties remained vacant at the time of study, 36% of which closed over a decade ago. The findings reflect the need for additional consideration of the future uses of school properties prior to their closures.

Preventing people from experiencing homelessness is a complex task requiring the coordination of multiple actors. There are various frameworks for homelessness prevention; however, there is no published example of an Indigenous-led model. We present the Giiwe model for systems homelessness prevention led by M’Wikwedong Indigenous Friendship Centre in Owen Sound, Canada. Giiwe hosts regular in-person meetings that use ceremony, Indigenous Knowledges, discussion, and follow-up actions to increase service access among a network of over 20 organizations. Building on Giiwe’s experience, we discuss how Western and Indigenous worldviews impact inter-organizational collaboration. Giiwe’s success suggests funding and policy contexts mandating partnerships between Indigenous and non-Indigenous organizations could benefit from ceding space for initiatives affirming Indigenous collaboration approaches.

Prenatal exposures to environmental toxicants can adversely affect fetal and child development and lead to increased risk of chronic disease. While regulatory action is essential to reduce sources of environmental toxicants, prenatal care presents an opportunity to educate, mobilize, and support prospective parents to reduce exposures to such hazards. As the first phase of an interdisciplinary research collaboration to inform the development of prenatal environmental health education strategy in Canada, we surveyed reproductive-aged female individuals. The online survey (July–September 2021) yielded a nationally representative sample of 1914 reproductive-aged females living in Canada. The questionnaire topics addressed the respondents’ knowledge and perceptions of environmental health risks, preventive actions and related facilitators and barriers, information sources and preferences, reproductive history, and demographics. The analysis included bivariate and multivariate techniques. Our results suggest broad awareness among reproductive-aged females that exposure to toxicants can be harmful, and that reducing prenatal exposures can benefit child health. However, fewer than half of respondents felt that they had enough knowledge to take protective measures. Despite high levels of preference for prenatal care as an ideal context for learning about environmental health risks and protective measures, fewer than one in four respondents had ever discussed environmental health concerns with a healthcare provider. Our findings reveal a knowledge–action gap and a corresponding opportunity to improve environmental health education and advocacy in prenatal care in the Canadian context.

Preventing people from experiencing homelessness is a complex task requiring the coordination of multiple actors. There are various frameworks for homelessness prevention; however, there is no published example of an Indigenous-led model. We present the Giiwe model for systems homelessness prevention led by M'Wikwedong Indigenous Friendship Centre in Owen Sound, Canada. Giiwe hosted regular in-person meetings that use ceremony, Indigenous Knowledges, discussion, and follow-up actions to increase service access among a network of over 20 organizations. Building on Giiwe's experience, we discuss how Western and Indigenous worldviews impact inter-organizational collaboration. Giiwe's success suggests funding and policy contexts mandating partnerships between Indigenous and nonIndigenous organizations could benefit from ceding space for initiatives affirming Indigenous collaboration approaches.

In addition to their educational purposes, public schools and their surrounding properties are essential to community liveability, as they enrich the daily lives of children, parents, and nearby residents. Yet, decisions are being made to close schools in Ontario, Canada based on declining enrolments, without due consideration of these benefits. Since 2011, over 400 public schools have been closed in Ontario, causing communities across the province to lose essential hubs. In a province where significant socio-spatial inequities persist, public school closures could worsen the conditions of daily living for residents in neighbourhoods that have already been deprived of resources and opportunities through failed public policy. The objectives of this study were to document the spatial scope of public school closures in Ontario, to understand the population change profiles in communities where closures happened, and to elucidate how these closures temporally relate to structural vulnerabilities of the communities in which these closures took place. Using Census-derived deprivation index scores geo-coded dataset to both currently open and recently closed public schools in Ontario, our analysis revealed three key findings. First, school closures have occurred disproportionately in small to mid-sized cities and rural communities. Second, there is no evidence of significantly declining child populations prior to school closures, in communities where schools closed. And third, closures were more common in higher deprivation communities in small to mid-sized cities. Taken together, these findings offer critical insights on the challenges that many communities face due to insufficient and inequitable policies that govern school closure decisions in Ontario. The study signals an urgent need for a more collaborative, forward-thinking, and equity-oriented school closure decision-making model that supports residents and protects communities from losing a vital public asset.

This paper situates a ten-year period of political upheaval in addressing the problem of Single Room Occupancy (SRO) housing in Vancouver, Canada, within an epistemic transformation of public health. Until 1970, the Vancouver Health Department exemplified a colonial history of public health in establishing the city’s skid road as a cordon sanitaire. But the 1970s saw a sudden fading of the Department’s authority just as a more collaborative approach to housing policy was emerging. The sunsetting of sanitary enforcement was driven in part by the arrival of a “new public health” that became primarily concerned with defining public health problems and solutions through the regulation of racialized bodies and behaviors—a cordon thérapeutique. By the 1980s, this shift constituted an epistemic and regulatory abandonment of SRO housing, leading to the accelerated deterioration of the entire housing stock and costing incalculable human suffering and the loss of lives.

In the past three years, Canadian public health systems have been tested and strained to an extent that we have not seen before in our lifetimes. This has exposed weaknesses that many public health leaders have beenwarning about for years, prompted by the failure to learn from previous global and national public health emergencies. The causes vary across the country but include inadequate or decreased funding, the erosion of the role and independence of Medical Health Officers, the dismantling or downgrading of public health departments, and a narrowing of public health’s roles in domains such as health promotion and healthy public policy (Guyon et al., 2017). Although there were some gains in the wake of the 2003 SARS outbreaks and the various public health system reviews that ensued, most jurisdictions only partially implemented the recommendations made, and in a short time put off other improvements or even rolled back some of them, leaving Canadians vulnerable once again. At the end of 2021, the Chief Public Health Officer released a report entitled “A Vision to Transform Canada’s Public Health System” with detailed recommendations and actionable ideas aimed at strengthening public health systems at all levels in Canada (PHAC, 2021). Shortly thereafter, both the Canadian Public Health Association (CPHA, 2022) and the Canadian Institutes of Health Research, Institute of Population and Public Health (CIHR, 2022), produced reports which—although incomplete (Hancock & McLaren, 2021)— provided some options for strengthening public health systems in Canada based on scientific evidence and discussions with experts and stakeholders. An important foundational element in these recommendations is the need to develop robust public health systems and services research (PHSSR) and evaluation capacity across the country. PHSSR has been defined as “a field of study that examines the organization, financing and delivery of public health services within communities and the impact of those services” (Scutchfield et al., 2009). In Canada, we lack basic standardized information about levels of funding, staffing, programs, and outcomes for the public health system to even set a baseline let alone evaluate impacts of investments (or cuts) and changes to public health programs, governance, and leadership. Moreover, it has long been established that Canadian public health knowledge (including systems knowledge) is, or ought to be, premised on a wider epistemological basis than what is typically seen in governmental practice, a problem that was laid bare in the COVID-19 pandemic (Lohse & Bschir, 2020). All of the above-mentioned reports call for the building of this infrastructure through systematic collection of standardized information about public health systems and the necessary interdisciplinary research and evaluation capacity in both the academic and practice sectors. As this capacity is built, the Canadian Journal of Public Health (CJPH) will need to determine its role vis-à-vis this emerging field of research. The CJPH is “a recognized vehicle for timely, high-quality, relevant research and commentary for the community of researchers, policy-makers, and practitioners to support knowledge transfer, contribute to * Cordell Neudorf cory.neudorf@usask.ca

Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.

From October 31 to November 12, 2021, Glasgow, Scotland, hosted the 26th United Nations Climate Change conference, known as Conference of the Parties (COP) 26. Expectations were at an all-time high as this negotiation was widely seen to be the last best chance for governments to come to an agreement that would hold global temperature increases to 1.5° Celsius in accordance with the 2015 Paris Agreement. In an effort to ensure that the Paris Agreement’s commitment for a “right to health” would be meaningfully implemented in the pact, the World Health Organization-hosted Pavilion saw 10 days of presentations and discussions dedicated to placing health and equity “at the centre of climate negotiations” (World Health Organization [WHO], 2021; p.VIII). Yet, to the dismay of many in the public health community, the final outcome of COP26 was largely devoid of substantive content with regard to the public health dimensions of climate change. In fact, “health” only appears once in the final COP26 pact, and only then in reference to healthcare institutions committing to reduce emissions by half by 2030. Such a paucity of recognition was particularly ironic given that COP26 had already been postponed by a year due to the COVID-19 pandemic, which itself has been inextricably linked with ecological change (Poland & Ziolo, 2021; Wu, 2021; Canadian Public Health Association, 2015). While the ecological crisis of the COVID-19 pandemic ought to bolster the relevance of public health within global climate discussions, it seems that in the present moment, the tendency is to have only one eye open. Rather than expanding our remit, COVID-19 has narrowed the government’s agenda and dominated public health system capacity even while population-level health impacts of a changing climate are unfolding before our eyes. We need both eyes to see the full picture. Furthermore, we need a global perspective more than ever. While climate events like atmospheric rivers washing out highways and flooding farms in BC are having tremendous significance locally, such climate events pale in comparison to droughts and flooding across the Global South that are devastating large populations of people in the form of famines, forcedmigration, and political conflict (Leal Filho et al., 2021; Kelley et al., 2015; Chowdhury et al., 2020). Barbados Prime Minister Mia Mottley (2021) posed the question most succinctly at COP26, “Can there be peace and prosperity in one third of the world if two thirds are under siege and facing calamitous threats to their well-being?” What should we make of this double lacuna toward the public health dimensions of the climate crisis and toward the ecological basis of the COVID-19 crisis? We offer three propositions that may move the conversation forward. The first speaks to our principles. It seems clear that we need to do a better job of walking the talk when it comes to a core principle of a socioecological approach to public health. Unfortunately, both the proximal discussions of incremental, industry-centred focused solutions that dominate climate change discourse and the equally incremental, pharmaceutically centred solutions that dominate COVID-19 discourse suggest we have a long way to go. What is missing is a structural critique of the underlying systems that produce crisis in the first place, that is, the antecedent causes of the causes (Commission * Jeffrey Masuda jeffmasuda@uvic.ca

Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity-remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community.

Objectives This ecological study examined the relationship between neoliberal capitalist ideology (hereafter, neoliberal ideology) and non-communicable diseases (NCD) mortality in 124 countries, focusing on the degree to which climate culpability and physical inactivity are implicated in explaining that relationship. Methods The economic freedom of the world index of the Fraser Institute (representing neoliberal ideology), CO2 emissions (metric tons/capita) from the World Bank (representing climate culpability), and the World Health Organization's age-adjusted physical inactivity and NCD mortality data were used. Covariates included gross domestic product (GDP)/capita, the country-level prevalence of obesity (n = 123), tobacco smoking (n = 111), and alcohol consumption (n = 61). Results Neoliberal ideology was associated with NCD mortality after controlling for GDP/capita, physical inactivity, and obesity, and this association was most pronounced in less culpable countries. The association between neoliberal ideology and NCD mortality remained statistically significant even after further controlling for tobacco smoking and alcohol consumption. Neoliberal ideology was associated with NCD mortality, after controlling for GDP, climate culpability, and tobacco smoking, regardless of physical inactivity. When alcohol consumption was introduced, physical inactivity moderated the association between neoliberal ideology and NCD mortality. Conclusion Neoliberal ideology was consistently associated with NCD mortality. Also, NCD mortality appears to be most severe in countries that are less culpable for global climate change. Our findings offer preliminary evidence-based support for a shift in thinking toward the fundamental determinants of health and calls for an upstream shift in climate change mitigation interventions to improve population health through the creation of equitable global political and economic systems.

In light of the rapidly unfolding consequences of the COVID-19 pandemic among the precariously housed community of the Downtown Eastside in Vancouver, we offer some reflections drawn from an ongoing activist research project the Right to Remain that has supported the life-saving frontline organizing response for tenants living under adverse housing circumstances in single room occupancy (SRO) buildings. With the public health system predictably overwhelmed at the onset of the pandemic, the gap was quickly filled by grassroots tenant organizers, whose capacity and credibility grew quickly as a result of their intimate knowledge of SROs and level of trust with tenants. From our experiences in chronicling their efforts between March and December, we describe how activist participatory research has important roles to play 'beyond' the project. With a vaccine just arriving, we are only half way through the crisis, and the ability to sustain basic supports, let alone continue on a pathway of transformative critical research, is in peril as burnout grows and tenants' lives, including among our own collective, continue to be placed in jeopardy.

Numerous tools for addressing gender inequality in governmental policies, programs, and research have emerged across the globe. Unfortunately, such tools have largely failed to account for the impacts of colonialism on Indigenous Peoples' lives and lands. In Canada, Indigenous organizations have advanced gender-based analysis frameworks that are culturally-grounded and situate the understanding of gender identities, roles, and responsibilities within and across diverse Indigenous contexts. However, there is limited guidance on how to integrate Indigenous gender-based frameworks in the context of research. The authors of this paper are participants of a multi-site research program investigating intersectoral spaces of Indigenous-led renewable energy development within Canada. Through introspective methods, we reflected on the implementation of gender considerations into our research team's governance and research activities. We found three critical lessons: (1) embracing Two-Eyed Seeing or Etuaptmumk while making space for Indigenous leadership; (2) trusting the expertise that stems from the lived experiences and relationships of researchers and team members; and (3) shifting the emphasis from 'gender-based analysis' to 'gender-based relationality' in the implementation of gender-related research considerations. Our research findings provide a novel empirical example of the day-to-day principles and practices that may arise when implementing Indigenous gender-based analysis frameworks in the context of research.

In my video, I (James Schlonies) tell the story of how I struggled when I was younger. I went through all mental health services available in my town, but sometimes I just felt worse after. When I was in grade 7, I started going to M’Wikwedong. My family and I received help from M’Wikwedong to cope with what I was going through. Drumming helped me learn to speak up for myself. Now I am a member of the Board of Directors at M’Wikwedong and I am an advocate for other youth in my area. This video was created through a research project entitled: Promoting healthy urban environments for young Indigenous peoples: The case of M'Wikwedong Native Cultural Resource Centre. The research team was formed by the M’Wikwedong Youth Group (Ryerson King, Kaitrina Harrisson, Steven Schlonies, Nikita Jones, and James Schlonies) and the Centre for Environmental Health Equity at Queen’s University (Carlos Sanchez-Pimienta and Jeffrey Masuda). This video displays a previous iteration of the name of this project. M'Wikwedong recently changed its name to "M'Wikwedong Indigenous Friendship Centre."

In recent years, health promotion has come under critique for being framed according to the contexts and priorities of Western communities, with the notion of ‘control’ underpinning much of its theoretical and practical development. Ceding space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field. This paper reports on insights gained from a participatory digital storytelling project focused on Indigenous health promotion that took place at M’Wikwedong Indigenous Friendship Centre in the city of Owen Sound, Canada. The research team was formed by M’Wikwedong’s Executive Director, five Indigenous youth and two university researchers. We co-created data through an 8-month digital storytelling process that involved 13 weekly research meetings, the creation of 4 digital stories and video screenings. We analysed data from seven group interview transcriptions, field notes and video transcripts through qualitative coding and theme building. The four themes we identified speak to the ways M’Wikwedong reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. From our findings, we theorize that egalitarianism of knowledge, restoring balance in relationships and Indigenous leadership are core components of an ‘ethos of connection’ that underlies Indigenous health promotion. The ‘ethos of connection’ challenges Western notions of ‘control’ and brings attention to the unique expertise and practices of urban Indigenous communities and organizations as a primary basis for health promotion.

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, "Moving on IPCC 1.5°C", which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.

BACKGROUND:Since harm reduction's origins as a grassroots, activist movement, cooperation and compromise among people who use drugs, bureaucrats, politicians, and other actors have been critical to its advancement in Canada. Critics have argued, however, that the institutionalization of harm reduction practice within the context of a politically sensitive environment has eroded its radical potential. The overdose crisis in Vancouver's Downtown Eastside (DTES) community has led to innovative harm reduction organizing that has been replicated globally. In this paper, we explore how one such intervention, the Tenant Overdose Response Organizers (TORO) program, has supported a resurgence in tenant-led harm reduction organizing in Single Room Occupancy (SRO) buildings in the DTES.METHODS:We draw on 15 months of ethnographic fieldwork conducted between May 2017 and August 2018, over 100 hours of participant observation of TORO activities, and 15 semi-structured interviews with key stakeholders in the program.RESULTS:TORO's leaders attempted to mobilize harm reduction intervention towards collective action on SRO risk environments underlying drug-related harms, but their efforts were constrained by the necessity of meeting practical expectations of funders regarding health education and supply distribution. Navigating these constraints ultimately shaped the development of the TORO program, helping to secure its longevity but also limiting its ability to organize a coordinated harm reduction and tenants' rights response to the dual housing and overdose crises.CONCLUSION:Our examination of TORO demonstrates how the harm reduction movement continues to be shaped by conflict, cooperation, and compromise between the state and grassroots groups. Even as actors strive to work collaboratively, the unequal distribution of power inherent in this relationship may contribute to the reinscription of a depoliticized harm reduction approach. We discuss the potential role of the risk environment framework in lending political legitimacy to grassroots harm reduction initiatives.

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5 degrees C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, "Moving on IPCC 1.5 degrees C", which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.