Canadian Health Research Articles

ABSTRACT The proportion of older adults (aged 65+) in Canada is growing rapidly. While many of these older adults will expect or desire to age in place, many will either move to “downsize” their living space, move to be closer to family for support, or move into care facilities such as long‐term care homes. However, despite significant attention to migration flows within the labor force, there has been much less attention given to migration within Canada's older adult population, especially with respect to the role of health as a determinant of migration. The addition of information on Activities of Daily Living (ADL), such as difficulty with hearing, seeing, communicating, walking, climbing stairs, bending, and learning, to the Canadian census may provide additional insights into the role of health in the migration decisions of older adults. Drawing on data from the Canadian census, this paper therefore explores the potential motivations for return migration among older adults, with specific reference to the role of Activities of Daily Living as a determinant of migration.

Socioeconomic status and visual impairment and ocular disease in Canada.

IntroductionNicotine vaping is common among children and youth, and even more so among those with mental health concerns. Identifying and managing nicotine vaping in child and youth mental health treatment settings is key to addressing this modifiable risk factor for poorer physical and mental health in young people. Recommendations exist for screening, assessment and treatment of youth vaping; however, it remains unclear whether current practices in child and youth mental health programmes align with recommended standards.Methods and analysisAn explanatory sequential mixed methods design with three stages will be employed. In the first stage, a cross-sectional survey will be distributed to all eligible Canadian hospitals to identify practices in assessment and treatment of nicotine vaping within their child and youth mental health and addictions programmes. This survey will also assess barriers and facilitators for the uptake of the 2021 Canadian Paediatric Society recommendations on management of youth vaping. Semi-structured focus groups and interviews will be conducted in stage two, with clinicians, managers, youth and caregivers. Qualitative data will be analysed using a reflexive thematic approach. In stage three, findings and proposed behaviour change interventions will be reviewed at a knowledge mobilisation meeting with the goal of developing a national knowledge mobilisation plan to improve assessment and treatment of youth vaping in hospital-based mental health and addictions programmes.Ethics and disseminationThis study has received ethics approval from the Research Ethics Board at the Children’s Hospital of Eastern Ontario (Protocol #25/19X). Participants will provide informed consent prior to participating. Results will be published in peer-reviewed journals and presented at scientific conferences. Summaries will be provided to the funders of the study and to participating hospitals.

Canada’s federal structure is the institutional reality informing our system of public health. While there are advantages to this decentralization, it can also lead to fragmentation and inefficiencies. Calls for stronger federal leadership or better collaboration between jurisdictions are common, but they do not directly address the question of why there has been so little progress in moving in either of these directions. Through the lens of six key public health functions, this article describes contextual realities and disparate interests of the jurisdictions. These underpin a dynamic for public health decision-making in which rational decisions can lead to suboptimal outcomes collectively. Understanding the dynamics of federalism underlying public health in Canada can help us to identify and address barriers to a more effective public health system.

ABSTRACT As radical genres of self-care are co-opted under neoliberal logics, I track an emerging “bubble-bathification” of self-care, which foregrounds rest as a therapeutic avenue toward mental health. Fieldwork at Canadian universities demonstrates that the promotion of restful self-care is often juxtaposed against environments of systemic exhaustion, resulting in a cycle of fatigue for students perpetrated by the sources promoting restorative breaks. There is a simultaneous desire among students to divest themselves from inactivity in favor of pursuing justice-oriented change in their communities. I conclude that social, mental, and bodily unrest are mutually constitutive in understanding how exhaustion threatens people’s selfhood.

Black-White disparities in maternal and neonatal morbidity and mortality highlight health inequities in several settings, yet such racial disparities in Canada are not well defined. Our objective was to conduct a scoping review to identify the extent of epidemiologic evidence assessing Black-White disparities in maternal and neonatal health in Canada. We included peer-reviewed epidemiologic studies which measured maternal or neonatal outcomes in Black versus White individuals in Canada. We searched OVID platforms (MEDLINE, Embase, Emcare) from inception to May 9, 2024, using keywords and controlled vocabulary terms related to race and maternal and neonatal morbidity and mortality. Results synthesis was carried out using descriptive analysis. After exclusions, six retrospective cohort studies were included in the scoping review. The majority of the included studies used data obtained from provincial datasets (n = 5), defined maternal race using self-reported race (n = 5), and were set in Ontario (n = 4). All studies reported one or more significant associations between race and adverse maternal or neonatal outcomes, with Black individuals experiencing higher rates of spontaneous fetal loss (n = 1), perinatal mortality (n = 1), preterm birth (n = 3), small for gestational age infants (n = 1), low Apgar scores (n = 2), congenital heart disease (n = 1), neonatal intensive care unit admission (n = 1), preeclampsia (n = 2), gestational diabetes (n = 1), and inadequate gestational weight gain (n = 1). Although literature on the topic is sparse, Black-White disparities in maternal and neonatal health in Canada are apparent. National, population-based data are needed to provide a comprehensive understanding of racial disparities in maternal and neonatal health and the factors driving these differences.

The health of Canadians in correctional facilities is poor when compared with the general population. Pharmacists effectively manage chronic illness and minor ailments; pharmacist-led prescriber clinics are being introduced in the community to improve access to care. However, there are no data on this model in correctional facilities. This article aims to evaluate the role of a pharmacist-led prescriber clinic in a provincial remand facility in Alberta, Canada, via a retrospective chart review of a weekly pharmacist-led clinic in a remand center from January to May of 2023. Data were collected for number of patients, drug therapy problems addressed, types and acceptance of interventions, and follow-up plans. Pharmacists saw an average of 8.8 patients per clinic with 1.9 interventions per patient. Most patients (83%) presented with untreated symptoms or indication. For many, pharmacists' interventions resulted in care that fully resolved concerns in a manner acceptable to patients, and 13% of cases were referred to alternative prescribers. This review adds to current literature on pharmacist intervention capacity; however, it does not include clinical outcomes. Pharmacists with prescribing authority in a clinic setting provide patients effective medication support, opening possibilities of expanding pharmacist practice models for quality patient care and increasing access to timely care.

Building evidence-based knowledge, and access to the right information at the right time, are critical factors in enhancing health and wellbeing within communities, particularly during a health crisis such as a pandemic. The COVID-19 pandemic required trusted information resources and effective communication tools to support public understanding and awareness of COVID-19 information. The COVID-19 Printables project was a collaborative initiative which aimed to design and develop a rapidly deployable and inclusive communication tool to inform diverse communities and populations about COVID-19 precautions and response. The Printables were initiated to fill a public health communication gap in understandable and accessible communication tools for lower literacy levels, and minority and marginalized groups, such as immigrant and refugee communities. A community based participatory approach supported the engagement of community members and frontline physicians in the design process, guided by health information behaviour and social inclusion frameworks. The project resulted in the development of a series of open access, easy to use, adaptable, and multilingual (40+ languages) printables that have been used widely from emergency departments to refugee services and community health centres, in Canada and worldwide. They have been used by over 40,000 people in Canada alone.

BackgroundSpinal muscular atrophy (SMA) is a neuromuscular disorder caused by the loss of the SMN1 gene, with an estimated birth prevalence of about 1 in 10,000. Early intervention with disease-modifying therapies (DMTs) significantly improves outcomes. This study evaluates the economic implications and health benefits of newborn screening (NBS) for SMA in Canada from the societal perspective.MethodsA decision analytic model was developed, which combined a decision tree for the screening algorithm and a Markov model for long-term health outcomes. The Markov model included health states based on WHO motor milestones. The population cohort of 357,903 live newborns reflects the 2022–2023 births in Canada. Screening is performed on dried blood spot testing which evaluates for biallelic deletions in SMN1. Cost inputs encompassed treatment and health state costs, while utility values reflected quality of life in each health state.ResultsNBS for SMA is expected to identify 37.1 (95% CI: 15.0, 70.7) newborns annually in Canada. Our analysis over a lifetime horizon and a discount rate of 1.5% shows NBS and early treatment has an incremental cost of -$146,187,000 (95% CI: -249,773,777 to − 17,890,034) and incremental benefit of 872 (95% CI: -193, 2329) quality-adjusted life years (QALYs) compared to no NBS and late treatment. This resulted in a mean ICER value of -$173,572/QALY.ConclusionThe decision analytic model indicated that overall NBS is cost-saving and more effective than no NBS and late treatment in the Canadian health system.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13023-025-03927-6.

BackgroundPoor oral health (caries and periodontal disease) in seniors is a health risk with minimal preventive care approaches evaluated. The objectives of this study were to: (1) document the oral health status of a sample of Canadian seniors; and then (2) evaluate feasibility, acceptability and efficacy of non-invasive application of chlorhexidine for preventive oral health in the community.MethodsDental examinations of 105 Ottawa seniors were followed by a randomized controlled study of 55 seniors with ≥ 16 natural teeth and ≥ 12 sites of bleeding on probing (BOP). Four treatments of either a chlorhexidine 10% w/v (active) or purified water (placebo) were applied over a 9-week period. Study sites included a hospital, seniors’ community centre, medical practice and long-term care facility. Treatments were applied by a hygienist or a nurse in 10–15 minutes, without dental cleaning or scaling. The primary endpoint was change in oral inflammation (BOP).ResultsThe sample had more decayed, missing or filled teeth (DMFT) and more periodontal disease than reported in the 2007–2009 Canada Health Measures Survey. BOP was reduced almost 2-fold more in the active group compared to placebo although significant in both groups (active: 7.91%, p < 0.001; placebo: 4.1%, p = 0.018). The difference between groups in reducton of BOP failed to reach significance (p = 0.06) likely due to early stoppage of recruitment.ConclusionA four-dose application of chlorhexidine significantly decreased oral inflammation as measured by BOP. The program of non-invasive preventive care in community settings is feasible, clinically impactful, and well received.

It has been fifty years since the publication of A New Perspective on the Health of Canadians, a Green Paper circulated under the name of then Canadian federal Minister of Health and Welfare, the HonourableMarc Lalonde. Since its publication in 1974, the Lalonde Report, as it is commonly known, has been credited with launching a new era of health promotion, with a sustained focus on the social determinants of illness, disease, and disability. It was also surprisingly influential, breaking new ground for other international accords. At the same time, it has garnered a certain amount of criticism for its emphasis on individual responsibility for health outcomes, with some researchers sensing a neo-liberal agenda that occluded structural and environmental contributions to health inequities. At a time when Canadians are again debating the future of a health care system, this Introduction and the historical articles that follow aim to place the Lalonde Report in its political, social, and epidemiological context. It will provide a much-needed reflection on one of the most important public policy documents in contemporary Canadian history.

The Lalonde Report, A New Perspective on the Health of Canadians, is rightly celebrated as an important Canadian contribution to the development of health promotion. It introduced the "Health Field Concept"-the idea that health was the result of human biology, health care systems, the environment, and lifestyle. Although the health field concept was new, the report drew on a long tradition within public health of blaming individuals for their own health problems. With less evidence, some scholars have also made the case for the Lalonde Report contributing to the social determinants of health. But A New Perspective paid little attention to the systemic barriers that prevented people from eating well, exercising, drinking less, or quitting smoking. While it occasionally acknowledged the constraints of poverty, the focus was much more on people's individual responsibility to improve their health. This paper contextualizes the Lalonde Report in the longer history of public health campaigns in Canada and shows the extent to which the Lalonde Report was a product of its time, age, and authors. At the end, the paper will address the intellectual origins of the social determinants of health and argue that the Lalonde Report made only a marginal contribution to the social determinants of health.

The development and afterlife of the Lalonde Report in Canada is re-examined along with the majority and minority narratives of its policy context and ultimate impact. The main purpose of this inquiry is to produce a deeper understanding of the Lalonde Report. This historical analysis relies on primary sources, many of which have never been accessed before. These sources include summaries of cabinet discussions at the time prepared by the Privy Council Office, memorandums and reports generated by officials within the Department of Health and Welfare during the development of the Lalonde Report, and federal-provincial discussions of the Lalonde Report in the months following its release. Three factors came together to produce the Lalonde Report, only one of which directly addressed the policy of public health in Canada; the other two have largely been ignored in the secondary literature. This lacuna has resulted in a misleading understanding of the policy context of the day, which was heavily focused on meeting Quebec's demands for greater autonomy in social policy, including health, as well as reducing federal fiscal exposure by replacing shared-cost Medicare transfer regime with a permanent tax transfer to the provinces. This history explains why the Lalonde Report had such limited impact in Canada. The extensive time and energy absorbed by this shift in Medicare financing meant that both federal and provincial governments paid little attention to developing pan-Canadian strategies, interventions, and programs, based on the insights provided in the Lalonde Report.

Development of longitudinal datasets (2000-2020) with high spatiotemporal resolution for air pollution exposure assessment in Canada.

The goal of the Canadian Institute for Health Information (CIHI)'s transformation initiatives is to maximize the value of Canada's health data by ensuring that it is timely, connected, accessible, comprehensive, relevant, contextualized and trusted. This analysis draws on the academic and grey literature to estimate the high-level potential health economic value of health data interoperability, application of artificial intelligence (AI) and other technologies enabled by high-quality data and advancing secondary uses in the public and private sectors. Maximizing the use of health data could create financial value in excess of $9.4 billion annually, with patient health-related quality of life benefits of a similar magnitude.

Loneliness is a growing public health crisis, with profound implications for mental and physical health. Social prescribing offers a proactive solution by connecting individuals to non-clinical supports, such as arts programs, peer networks and physical activities. In Canada, social prescribing is gaining traction, with initiatives addressing loneliness among youth, caregivers and older adults. By integrating social prescribing into healthcare systems, policy makers can enhance well-being, reduce healthcare strain and promote social inclusion. This paper explores social prescribing's role in addressing loneliness, its implementation across different life stages and its potential to transform mental health care in Canada.

Canada's health systems remain vulnerable to supply disruptions due to overreliance on globally sourced health products and limited visibility into domestic manufacturing capacity. This study presents an empirically tested, artificial intelligence-enabled search platform designed to automate the sourcing of health products from Canadian companies. The platform enables supply chain teams to efficiently identify Canadian suppliers for health products, overcoming the lack of awareness of Canadian manufacturers of health products, and builds a "Canada First" supply chain strategy. The platform has the potential to identify Canadian suppliers, reduce the burden of manual searches, support jurisdictions seeking to diversify Canadian sources and prioritize economic growth.

The guiding principle of Canada's health and social systems is recognition of the inherent dignity of every individual. One's dignity is formed by the social fabric and relationships that surround it. As the Ubuntu African philosophy describes, "a person is a person through other people" (Wikipedia 2025). We know that brain development, neural processes and mental health are configured by social structures and connections relevant to our lives, as we experienced first-hand during the COVID-19 pandemic.

BackgroundThe Knee injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific patient-reported outcome that is used to assess knee-related symptoms, function and quality of life across a variety of knee conditions in patient populations. Currently there is no Punjabi version of the tool available. This study aims to cross-culturally adapt the KOOS tool from the source English language to the target Punjabi language for use in the Canadian health context.MethodsWe followed standard guidelines including: 1) creation of a concept definition document 2) forward translation 3) reconciliation 4) back translation 5) expert committee review 6) creation of pilot version for cognitive interviews 7) cognitive interviews 8) final review and proof reading.ResultsThirty people identifying as South Asian with lived experiences of various knee conditions took part in cognitive interviews (70% women, mean age 61 years) to provide insights into equivalence in conceptual, semantic, and content between the source English language and the target Punjabi language KOOS. Cognitive interviews identified comprehension and interpretation, structural, conceptual, cultural, and other issues in the preliminary Punjabi KOOS. These issues were addressed considering the Punjabi audience and culture in Canada, and the purpose of the tool to arrive at a cross-culturally adapted Punjabi KOOS.ConclusionA cross-culturally Punjabi version of the KOOS is available to assess knee related outcomes of SA Punjabi patients in Canada. Future validation of the tool is required with SA Punjabi patients in Canada to ensure that the “target Punjabi instrument” has the same properties as the “original English KOOS instrument”.

HPR6 Market Access Challenges for Innovative Medications in Women's Health in Canada: Overview of the Past 20 Years