Canadian Health Research Articles

Healing through tradition: the role of Indigenous Elder support in child and youth mental health in Canada

The current mental health care system in Canada, with its focus on western biomedical and individualistic approaches, does not support Indigenous holistic views of wellness and silences Indigenous knowledges through colonial ideologies. This research identifies the vital support that mental health services must include to create culturally relevant and safe services: Elders. Elders provide holistic approaches to mental wellness that consider cultural, individual, family, and community needs to promote healing. To explore the roles of Elders in mental health services, a comprehensive narrative review was conducted. All 22 included studies were conducted by Indigenous scholars or with Indigenous communities. Findings were organized into three themes: (a) Elders are knowledge keepers: sharing wisdom; (b) need for cultural-based teachings, ceremonies, and land-based healing led by Elders; and (c) Importance of relationships for increasing youth’s mental wellness. Barriers were identified that prevent Elder involvement, and recommendations for mental health programmes are provided.

Mathematical modelling for pandemic preparedness in Canada: Learning from COVID-19.

The COVID-19 pandemic underlined the need for pandemic planning but also brought into focus the use of mathematical modelling to support public health decisions. The types of models needed (compartment, agent-based, importation) are described. Best practices regarding biological realism (including the need for multidisciplinary expert advisors to modellers), model complexity, consideration of uncertainty and communications to decision-makers and the public are outlined. A narrative review was developed from the experiences of COVID-19 by members of the Public Health Agency of Canada External Modelling Network for Infectious Diseases (PHAC EMN-ID), a national community of practice on mathematical modelling of infectious diseases for public health. Modelling can best support pandemic preparedness in two ways: 1) by modelling to support decisions on resource needs for likely future pandemics by estimating numbers of infections, hospitalized cases and cases needing intensive care, associated with epidemics of "hypothetical-yet-plausible" pandemic pathogens in Canada; and 2) by having ready-to-go modelling methods that can be readily adapted to the features of an emerging pandemic pathogen and used for long-range forecasting of the epidemic in Canada, as well as to explore scenarios to support public health decisions on the use of interventions. There is a need for modelling expertise within public health organizations in Canada, linked to modellers in academia in a community of practice, within which relationships built outside of times of crisis can be applied to enhance modelling during public health emergencies. Key challenges to modelling for pandemic preparedness include the availability of linked public health, hospital and genomic data in Canada.

Rising out-of-hospital mortality in Canada during 2020‒2022: A striking impact observed among young adults.

Out-of-hospital mortality rates surged during the early COVID-19 pandemic. While expecting a return to pre-pandemic levels, the evolving patterns of out-of-hospital mortality in Canada remain uncertain. We investigated whether these rates returned to pre-pandemic levels. This retrospective study, employing linked administrative data, analyzed out-of-hospital mortality trends among adult residents in Ontario, Alberta, and Nova Scotia. Interrupted time series analysis assessed trends in age- and sex-standardized rates/100,000/quarter during pre-pandemic (April 2014-March 2020) and pandemic periods (April 2020-March 2022), while considering April to June 2020 as the pandemic onset period. Crude mortality rates were also examined, stratified by sex and age groups. Pre-pandemic, Ontario's standardized out-of-hospital mortality rates were rising, while Alberta's and Nova Scotia's remained stable. At the pandemic onset, all provinces experienced significant increases in standardized out-of-hospital mortality rates/100,000 (Ontario: β 14.6, 95% CI [3.97, 25.22]; Alberta: 21.3, 95% CI [9.26, 33.34]; Nova Scotia: 10.5, 95% CI [1.06, 19.88]). During the pandemic, standardized out-of-hospital mortality rates/100,000/quarter remained above pre-pandemic levels, with no significant departure from the increased pandemic onset levels (Ontario: - 1.6, 95% CI [- 3.63, 0.52]; Alberta: 0.45, 95% CI [- 1.47, 2.36]; Nova Scotia: - 0.06, 95% CI [- 2.18, 2.06]). Crude out-of-hospital mortality rates increased most prominently among individuals aged 18 to 45 in Alberta and Ontario, and among males across all provinces. The sustained increase in out-of-hospital mortality, observed from the pandemic's onset, spanning more than 2years, potentially suggests its persistent direct and indirect effects on population health in Canada.

Canadian Association of Radiologists Statement on Planetary Health Education in Radiology.

The health of Canadians is already impacted by climate change due to wildfire smoke, heat domes, floods, droughts, and the changing distribution of vector borne disease. The healthcare sector contributes to climate change, accounting for approximately 4.6% of annual greenhouse gas emissions in Canada. Healthcare teams have a responsibility and opportunity to reduce harm by limiting emissions and waste, and engaging the public in understanding the planetary health links between clean air and water, a stable climate, a healthy planet and human health. Transformation of Canadian healthcare to a low carbon, climate resilient system will be enhanced by physician engagement and leadership. Cornerstones to physician participation include knowledge of the anthropogenic etiology of the climate crisis, the human health impacts, and the contribution providing healthcare makes to the climate crisis. Integration of climate change knowledge into the Canadian Radiology educational curricula is essential to position radiologists to lead transformative change in mitigation and adaptation of the healthcare system to the climate crisis. This statement is intended to provide guidelines to optimize education and research for current and future Canadian radiologists, and builds on existing planetary healthcare education publications and the Canadian Association of Radiologists Statement on Environmental Sustainability in Medical Imaging.

Sparks of Light, Sparks of Life

This article examines the critical issue of Indigenous mental health in Canada, focusing on First Nations, Inuit, and Métis. It underscores the urgency in addressing Indigenous mental wellness challenges, particularly the high rates of suicide, amid their rapid population growth. The study centers on the role of frontline responders in managing mental health and suicidal distress in these communities, and their work to promote life and mental wellness. Through a synthesis of psychological, critical, and Indigenous perspectives, the article reviews Canadian literature on Indigenous mental health and suicide prevention. The article then highlights reflexive insights derived from a knowledge-sharing event with 33 Indigenous mental health professionals, focusing on the unique challenges and opportunities in this field and the importance of life-affirming dialogues in suicide prevention. The article aims to integrate these insights into broader discussions on Indigenous mental wellness, health, and life promotion systems, proposing enhanced wellness and suicide prevention strategies and frameworks tailored to the needs and aspirations of Indigenous communities.

Prevalence of Multimorbidity and Chronic Diseases in citizens of the Métis Nation of Ontario

Objective and ApproachPopulation-based analyses of Métis health in Canada are limited. The Métis are a distinct Indigenous people with both First Nation and Euro-Settler ancestry. This study aimed to examine multimorbidity in the Métis Nation of Ontario (MNO) citizens from 2009 to 2019. Registered MNO citizens were linked to Ontario’s administrative health data. An existing data algorithm identified individuals with multimorbidity (2+ chronic conditions) among MNO citizens and the Ontario population aged 18+. Annual prevalence rates of multimorbidity were calculated and rates in the latest year were compared across income quintiles, age, and sex. Results & ConclusionThe prevalence of multimorbidity increased in MNO citizens from 49.2 per 100 (CI: 48.1-50.2) in 2009 to 61.0 per 100 (CI: 59.9-62.1) in 2018. A consistently higher prevalence rate was seen in MNO citizens compared to non-MNO citizens across the entire period. Female MNO citizens had a higher prevalence of multimorbidity compared to males. The prevalence of multimorbidity increased with age in MNO citizens from 40.5 per 100 (CI: 39.1-41.8) in those aged 18 to 44 years up to 91.6 per 100 (CI: 88.4-98.0) in those aged 65 years and older. An income gradient was evident with MNO citizens in the highest income quintile having the lowest prevalence of multimorbidity (57.1 per 100) compared to those in the lowest income quintile (66.3 per 100). ImplicationsUnderstanding the burden of multimorbidity in MNO citizens is essential for the MNO to guide program and policy planning, as well as support decision-making related to resource allocation.

Barriers to Healthcare Access for Black Communities in Kingston and London, Ontario

Healthcare access is recognized as a fundamental human right by the World Health Organization. In Canada, the Canada Health Act mandates equitable and accessible healthcare for all. However, many communities, particularly the Black community, continue to face significant barriers due to socioeconomic factors. These challenges are deeply rooted in systemic racism, socio-economic barriers, and cultural biases, which disproportionately impact the health outcomes of Black individuals. This study explores the specific barriers to healthcare access within the Black community using pre-existing qualitative data. We analyzed semi-structured interviews with 15 Black community members in Kingston and 10 in London, Ontario, using NVivo software to systematically code the data and identify key themes. Additionally, a literature review was conducted, which revealed recurring themes such as lack of culturally competent care, distrust of healthcare institutions, and economic barriers. The analysis of the interview data confirmed these themes and highlighted additional issues related to service type, time and availability, and experiences of racism and discrimination. Despite individual differences, these findings consistently emphasize the pressing need for targeted interventions and policy reforms to address these disparities. However, our study was constrained by the limited availability of race-based data in Canada, underscoring the urgent need for increased research and data collection to advocate for equitable healthcare access and monitor the effectiveness of health services for marginalized communities.

Confidence and barriers: Analysis of factors associated with timely routine childhood vaccination in Canada during the COVID-19 pandemic

Routine childhood vaccination is a crucial component of public health in Canada and worldwide. To facilitate catch-up from the global decline in routine vaccination caused by the COVID-19 pandemic, and toward the ongoing pursuit of coverage goals, vaccination programs must understand barriers to vaccine access imposed or exacerbated by the pandemic. We conducted a regionally representative online survey in January 2023 including 2036 Canadian parents with children under the age of 18. We used the COM-B model of behaviour to examine factors influencing vaccination timeliness during the pandemic. We assessed Capability with measures of vaccine understanding and decision difficulty, and Motivation with a measure of vaccine confidence. Opportunity was assessed through parents' self-reported experience with barriers to vaccination. Twenty-four percent of surveyed parents reported having missed or delayed one of their children's scheduled routine vaccinations since the beginning of the pandemic, though most parents reported having either caught up or the intention to catch up soon. In the absence of opportunity barriers, motivation was associated with timely vaccination for children aged 0–4 years (aOR = 1.81, 95 % CI: 1.14–2.84). However, experience with one or more opportunity barriers, particularly clinic closures and difficulties getting an appointment, eliminated this relationship, suggesting perennial and new pandemic-associated barriers are a critical challenge to vaccine coverage goals in Canada.

Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study

RationaleFollowing marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea...

Federal opioid agonist therapy policy: interrupted time series analysis of the impact of the methadone exemption removal across eight provinces in Canada

BackgroundFederal deregulation of opioid agonist therapies are an attractive policy option to improve access to opioid use disorder care and achieve widespread beneficial impacts on growing opioid-related harms. There have been few evaluations of such policy interventions and understanding effects can help policy planning across jurisdictions.MethodsUsing health administrative data from eight of ten Canadian provinces, this study evaluated the impacts of Health Canada’s decision in May 2018 to rescind the requirement for Canadian health professionals to obtain an exemption from the Canadian Drugs and Substance Act to prescribe methadone for opioid use disorder. Over the study period of June 2017 to May 2019, we used descriptive statistics to capture overall trends in the number of agonist therapy prescribers across provinces and we used interrupted time series analysis to determine the effect of this decision on the trajectories of the agonist therapy prescribing workforces.ResultsThere were important baseline differences in the numbers of agonist therapy prescribers. The province with the highest concentration of prescribers had 7.5 more prescribers per 100,000 residents compared to the province with the lowest. All provinces showed encouraging growth in the number of prescribers through the study period, though the fastest growing province grew 4.5 times more than the slowest. Interrupted time series analyses demonstrated a range of effects of the federal policy intervention on the provinces, from clearly positive changes to possibly negative effects.ConclusionsFederal drug regulation policy change interacted in complex ways with provincial health professional regulation and healthcare delivery, kaleidoscoping the effects of federal policy intervention. For Canada and other health systems such as the US, federal policy must account for significant subnational variation in OUD epidemiology and drug regulation to maximize intended beneficial effects and mitigate the risks of negative effects.

Impact of Gender Equality Policies on Women’s Career Mental Health and Well-Being

This paper examines the impact of gender equality policies on women’s career mental health and well-being in Canada. Over the past few decades, Canada has implemented a variety of legislative measures aimed at promoting gender equality, including pay equity, parental leave, and anti-discrimination laws. These policies have been instrumental in creating more inclusive and supportive workplace environments, improving job satisfaction, and enhancing overall mental health for women. However, despite significant progress, challenges such as persistent wage gaps, underrepresentation in leadership roles, and workplace harassment continue to hinder the full realization of gender equality. Using a qualitative research approach, this study explores the experiences of women across different industries and backgrounds to understand how these policies impact their mental health and career progression. The findings highlight the importance of strengthening policy implementation, promoting cultural change within organizations, and addressing intersectional inequalities to further improve the mental health and well-being of women in the workforce. Recommendations for policymakers and organizations are provided to enhance the effectiveness of gender equality policies and create more equitable workplaces.

Data-Driven Insights and Solutions for the Health and Human Resource Crisis in Canada.

Canada's healthcare system is experiencing a health and human resource (HHR) crisis. The available evidence of the scope of the problem and potential solutions, however, is not commensurate with the scale and urgency of the crisis. The use of linked health administrative data to study the health, well-being and work patterns of the health workforce offers critical insights into how the workforce is functioning at a population level. Efforts to rapidly expand the use of these data are needed to understand the scope of the HHR crisis, find opportunities for improvement and drive change.

Impact of Alternative Income Assistance Payment Schedules on Health and Social Service Access in Canada: Evidence from an Experimental Study

Despite mitigating the severe impacts of poverty, synchronized, monthly government income assistance payments can negatively impact people who use drugs, including disrupting service utilization. This study evaluates whether changing payment timing and frequency impacts health and social service access. This secondary analysis of an exploratory, parallel, unblinded, randomized controlled trial assessed data collected between 2015–2019 from income assistance recipients who use drugs in British Columbia, Canada (n = 194). Participants were randomly assigned for six monthly payment cycles to: (a) synchronized government schedules (control); (b) desynchronized “staggered” single monthly payments; or (c) desynchronized “split & staggered” twice-monthly payments. Generalized linear mixed models assessed utilization of, and barriers to, acute/emergency healthcare, community healthcare, psychosocial services and material/legal services. Mixed results showed increases in access to psychosocial services and material/legal services, but also increases in the barriers to community healthcare and material/legal services. Changing payment schedules may alter access to services in complex ways implicating practice, organizational and interagency adaptations for marginalized populations. Results support the importance of social service agency involvement in income assistance policy reform discussions to ensure effective service delivery. Further research should include perspectives from service providers and utilize agency administration data to better understand payment schedules and service provision dynamics.

The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada.

Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.

Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study

BackgroundSevere exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of...

The response of Canada's clinical health research ecosystem to the COVID-19 pandemic.

The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought to describe patterns of enrolment across Canadian Institutes of Health Research (CIHR)-funded studies on COVID-19. We identified COVID-19 studies funded by the CIHR and that enrolled participants from Canadian acute care hospitals between January 2020 and April 2023. We collected information on study-and site-level variables from study leads, site investigators, and public domain sources. We described and evaluated factors associated with cumulative enrolment. We obtained information for 23 out of 26 (88%) eligible CIHR-funded studies (16 randomized controlled trials [RCTs] and 7 cohort studies). The 23 studies were managed by 12 Canadian and 3 international coordinating centres. Of 419 Canadian hospitals, 97 (23%) enrolled a total of 28 973 participants - 3876 in RCTs across 78 hospitals (median cumulative enrolment per hospital 30, interquartile range [IQR] 10-61), and 25 097 in cohort studies across 62 hospitals (median cumulative enrolment per hospital 158, IQR 6-348). Of 78 hospitals recruiting participants in RCTs, 13 (17%) enrolled 50% of all RCT participants, whereas 6 of 62 hospitals (9.7%) recruited 54% of participants in cohort studies. A minority of Canadian hospitals enrolled the majority of participants in CIHR-funded studies on COVID-19. This analysis sheds light on the Canadian health research ecosystem and provides information for multiple key partners to consider ways to realize the full research potential of Canada's health systems.

PCR180 Measuring and Valuing Child Health in Canada

PCR180 Measuring and Valuing Child Health in Canada

Edmonton's Race-based Data Table: A municipal approach to addressing systemic racism through the collection and use of disaggregated, race-based data.

Recent events, such as the COVID-19 pandemic, have drawn nationwide attention to systemic racism as a serious threat to public health in Canada. One promising approach to address such racism is through developing and implementing standardized procedures for collecting and using disaggregated, race-based data. In this commentary, we summarize why this approach is necessary to address systemic racism in Canada, and highlight municipal actions being taken in Edmonton, Alberta, to move this approach forward. In 2021, a Race-based Data Table, comprising 24 institutions and organizations affiliated with health, education, and policing systems, was formed in Edmonton. It aimed to engage practitioners, systems representatives, academics, and community members in collective advocacy around accessing race-based data to better understand and address disparate health outcomes associated with COVID-19 for racialized communities. Further, the Table intends to co-create a charter and toolkit outlining best practices for ethical, race-based data collection and use with local stakeholders and knowledge users. In documenting the beginning stages of the Table, and in evaluating its ongoing progress, we contribute to national conversations regarding the need for government institutions and other organizations to consistently collect and use race-based data as a means of increasing transparency and accountability in their actions.

Social prescribing in Canada: health promotion in action, 50 years after the Lalonde report.

The Lalonde report, published in 1974 by the Canadian Minister of National Health and Welfare, broke ground for public health in Canada by acknowledging that the determinants of health are much broader than health care services. Fifty years later, this special issue of Health Promotion and Chronic Disease Prevention in Canada charts a clear path towards addressing upstream determinants of health through an emerging intervention called "social prescribing." Social prescribing connects patients with community resources tailored to their individual priorities, fostering a paradigm shift from a deficitbased to a strengths-based approach in health promotion. Part 1 of this issue covers the rapid growth and diverse applications of social prescribing across Canada, with targeted initiatives for various populations and interventions ranging from nature and arts to physical activity and social connectivity. Contributions from a wide range of partners, including researchers, health professionals and community members, explore the adaptability of social prescribing for different groups, underscore the role of community and lived experiences in research, and call for more studies on social prescribing's effectiveness and outcomes. Highlighted case studies demonstrate tangible benefits in health equity and access to social services. This issue not only reflects the current scope and impact of social prescribing in Canada but also sets the stage for its future development and integration into broader health practices.

Professional education and training of public health and preventive medicine specialists in Canada

Public health and preventive medicine (PHPM) specialist physicians focus on the population rather than individuals as their patients. These specialists assess the health status of a community and subsequently develop, implement and evaluate effective interventions at the population level to improve health. This work brings together their medical expertise, population health approach and management/ leadership skills. The Royal College of Physicians and Surgeons of Canada (RCPSC) states that ‘the Public Health and Preventive Medicine or community medicine (as called previously) specialist uses population health knowledge and skills to play leading and collaborative roles in the maintenance and improvement of the health and well-being of the community’. It is a broad speciality that requires strong generalist skills including in preventive medicine, management, epidemiology, emergency response, health promotion, and health protection.