Canadian Jurisdictions Research Articles

Characteristics and determinants of seasonal influenza vaccination in Manitoba, Canada: A population-wide record-linkage study

BackgroundSeasonal influenza vaccine (SIV) uptake (receipt of vaccine) in Manitoba, Canada is consistently low notwithstanding vaccine availability and free-of-charge vaccination. Despite, there is a lack of published evidence on the determinants of uptake of the vaccine. We sought to assess the association between SIV uptake and certain population and primary care physician (PCP) characteristics in Manitoba. MethodsWe conducted a longitudinal study utilizing Manitoba administrative health databases. We summarized SIV uptake from 2000/01–2019/20 influenza seasons across subpopulations defined by socioeconomic, health-related and PCP characteristics. Utilizing multivariable generalized estimating equation logistic regression models, we assessed the association between SIV uptake and the socioeconomic, health-related and PCP characteristics, stratified by age group (<5-, 5–17-, 18–44-, 45–64-, ≥65-year-olds) and sex. Results are adjusted odds ratios with associated 95 % confidence intervals. ResultsSIV uptake percentage increased over time with 4.4 %, 13.1 %, 17.5 % and 21.7 % of < 5-year-olds, 2 %, 4.9 %, 9.7 % and 13.1 % of 5–17-year-olds, 5.4 %, 8.8 %, 10.7 % and 13.5 % of 18–44-year-olds, 16.8 %, 21.3 %, 23.6 % and 24.6 % of 45–64-year-olds receiving the SIV in 2000–2004, 2005–2009, 2010–2014 and 2015–2019, respectively. There was a decline among ≥ 65-year-olds from 58.5 % to 53.5 %. We observed a similar pattern across subpopulations. There were significantly increased odds of SIV uptake among females within the age groups ≥ 18 years, in higher income quintiles, mostly with increased contact with a PCP/hospitalization within age groups ≥ 18 years, among those who had older or female PCPs (the opposite observation among ≥ 65-year-olds) and whose PCP administered at least one SIV in prior influenza season. These observations were largely consistent irrespective of sex. ConclusionSIV uptake in Manitoba appears to increase with age, and many socioeconomic, health-related and PCP characteristics appear to be associated with it. These findings may inform targeted vaccination programs to optimize influenza vaccination in Manitoba and similar Canadian jurisdictions.

Pore Space as a Resource: A Discussion of the Policy and Regulatory Framework for Carbon Capture, Utilization, and Storage

Reinforced by the International Energy Agency (IEA), carbon capture, utilization, and storage (CCUS) is currently the only available group of technologies that reduce emissions in key hard to abate sectors and capture CO2 emissions that enable low carbon value chains such as hydrogen. Further, CCUS and carbon management play a critical role in achieving future global climate and energy goals. In fact, the Intergovernmental Panel on Climate Change and the IEA state that there is no viable path to net zero emissions without CCUS and other carbon management technologies. Due to concerns regarding energy security and an increase in energy demand, generation of energy from conventional hydrocarbon resources continues to be vital. In Alberta, CCUS is a necessary tool to align provincial climate change goals with the responsible and competitive market of energy production. Canada’s oil and gas sector has been an early innovator and adopter of CCUS. Given the petroleum and natural gas resources available in the Western Canadian Sedimentary Basin, and the decades-long energy industry expertise established in connection therewith, there is significant potential to further utilize CCUS to create a CCUS-based value chain. This article provides an overview of the current Canadian regulatory frameworks enabling CCUS, with a focus on the regulatory framework and development in Alberta. Specific topics include: (1) an overview of the regulatory frameworks governing CCUS in key jurisdictions in Canada, including Alberta; (2) an overview of the frameworks for the generation of offset credits from environmental attributes associated with a given project or activity, including both federal and provincial carbon credits and clean fuel credits; (3) a discussion of gaps in policy and legislation; (4) options for regulating “open access” CCUS hubs and CO2 pipelines; and (5) an overview of the various governmental incentives for CCUS projects, including federal and provincial tax credits.

Distribution and Migration of Recent Healthcare Graduates in Canada.

Although data on new graduates are available and typically included in the health workforce planning (HWP) model, information on their interprovincial migration pattern is less known. This paper aims to understand the mobility pattern of recent healthcare graduates - family physicians and regulated nurses - across the different Canadian jurisdictions. Health workforce data from the Canadian Institute for Health Information (CIHI) were used to identify recent family physician and regulated nurse graduates. We identified new graduates (between 2015 and 2019) in a particular province and distributed them according to the province/territory in which they registered to practise. The jurisdiction where they are trained is a key factor in determining their migration rates. For both professions, Ontario and British Columbia have the lowest rates of new graduate out-migration and the highest rates of in-migration, leaving them with a positive net interprovincial migration. This analysis can be used to inform better HWP at the jurisdictional level in these professions. Working and community conditions matter to keep and attract new graduates.

How do navigation programs address the needs of those living in the community with advanced, life-limiting Illness? A realist evaluation of programs in Canada

BackgroundWe sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community.MethodsThis realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory.ResultsTwenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients.ConclusionsThe findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations – outside of navigation programs – to work towards more person-centred care.

Opportunistic Salpingectomy Between 2017 and 2020: A Descriptive Analysis

ObjectivesOpportunistic salpingectomy (OS) is the removal of fallopian tubes during another pelvic surgery for the purpose of ovarian cancer prevention. Herein, we describe the rates of OS at the time of hysterectomy and tubal sterilization between 2017 and 2020. MethodsThis study uses the Canadian Institute of Health Information’s Discharge Abstract Database and National Ambulatory Care Reporting System for all Canadian provinces and territories except for Quebec between the fiscal years 2017 and 2020. A descriptive analysis on all people aged 15 years and older who had hysterectomies or tubal sterilizations was conducted to determine the proportion of hysterectomies that included bilateral salpingectomy (OS) and the proportion of tubal sterilizations that were OS compared to tubal ligation. ResultsThere were 174 006 people included in the study. The proportion of hysterectomies that included OS increased from 31.7% in 2017 to 39.9% by 2020. With respect to tubal sterilizations, rates of OS increased from 26.3% of all tubal sterilizations in 2017 to 42.5% in 2020. British Columbia remained the jurisdiction with the highest rates of OS, but rates increased significantly in many jurisdictions, particularly at the time of tubal sterilization. ConclusionThe rates of OS have continued to increase in all Canadian jurisdictions following the official Society of Obstetricians and Gynaecologists of Canada recommendation to consider OS in 2015. Assuming that all tubal ligations could have been OS and 75% of hysterectomies with ovarian conservation could have included OS, our data indicate 76 932 missed opportunities for ovarian cancer prevention.

The Precepting Dilemma: A Reflexive Thematic Analysis Study of Midwifery Preceptors in Undergraduate Education in Canada

&#x0D; &#x0D; &#x0D; Objective: To generate themes on facilitators and barriers for midwifery preceptorship.Methods: Midwifery preceptors in undergraduate education in Canada were invited to participate in&#x0D; one of three focus groups. A constructivist paradigm and reflexive thematic analysis approach was used for responses that were transcribed verbatim.&#x0D; Results: In September and October 2020, three focus groups took place comprising a total of 16 midwifery preceptors. Participants represented multiple Canadian jurisdictions and had a range of education, midwifery, and precepting experiences. Two primary themes, “the altruism of precepting” and “the lack of autonomy in precepting,” were generated from our analysis of participants’ responses. Preceptors also provided suggestions to better enable their role.&#x0D; Discussion/Conclusion: We interpreted a “precepting dilemma” in midwifery clinical teaching such that there are altruistic influences on the role and also an underlying lack of autonomy. Obligations and nurturing elements contributed to midwifery preceptors’ utilitarianism. Exacerbating a lack of sovereignty in precepting were deficits in collaboration and aspects that further marginalized the role. It is imperative for stakeholders of midwifery in Canada to carefully consider how altruism and autonomy of precepting affect the experiential curricula.&#x0D; This article has been peer reviewed.&#x0D; &#x0D; &#x0D;

Canadian Landscape Assessment of Colorectal Cancer Screening during the COVID-19 Pandemic.

The COVID-19 pandemic caused disruptions in colorectal cancer (CRC) care by interrupting CRC screening across Canada, posing problems for program participants, patients, and physicians and no clear understanding of how provincial healthcare systems would adapt in the face of another pandemic or shock to the system. A nationwide online survey targeted to members of the National Colorectal Cancer Screening Network (NCCSN) using the SurveyMonkey platform was conducted to gain insight into the impact of the pandemic on CRC screening from March 2020 to March 2022 across all thirteen Canadian jurisdictions. The survey included 25 multiple-choice and free-text questions. Both quantitative and qualitative methods were used to analyze the data using Microsoft Excel and NVivo software. Twenty-one provincial and territorial representatives participated in the survey conducted between 13 May 2022 and 27 October 2022. All jurisdictions (100%) reported decreased screenings, including fecal immunochemical testing (FIT) or Fecal Occult Blood testing (FOBT) procedures, and subsequent diagnostic colonoscopies. The average wait time for colonoscopies due to a positive FIT/FOBT was 76 days. To mitigate the backlog and initiate an effective intervention plan, representatives highlighted some key points, including the importance of prioritizing high-risk patients. Survey results concluded that the COVID-19 pandemic impacted CRC screening across Canada. This landscape assessment can help inform intervention measures and policy-related solutions to create greater resilience for CRC screening in provincial and territorial healthcare systems.

Clonal diversity of Streptococcus pneumoniae serotype 19A collected from children < 5 years old in Québec, Canada, 2016–2021

Streptococcus pneumoniae serotype 19A is a highly diverse, often antimicrobial-resistant Gram-positive bacterium which can cause invasive pneumococcal disease (IPD). In 2021, public health authorities in the Canadian province of Québec observed an increase of serotype 19A IPD in children <5 years. The purpose of this study was to determine the clonal composition of serotype 19A isolates collected from this age group in Québec, from 2016 to 2021. Forty-one and 37 IPD isolates from children <5 years from Québec and the remainder of Canada, respectively, were sequenced using the Illumina NextSeq platform. Phylogenetic analysis using SNVPhyl identified three clusters, corresponding to three common clones of serotype 19A: CC199, CC320 and ST695. CC199, predominantly represented by ST416, accounted for similar proportions of serotype 19A isolates collected from children in Québec (19.5 %) and other Canadian jurisdictions (OCJs, 21.6 %), with significant presence of ermB (62.5 % and 60 % of ST416 isolates, respectively). CC320 was more commonly identified from OCJs in comparison to Québec (18.9 % vs. 7.3 %, respectively), but were highly antimicrobial-resistant regardless of region. ST695 was the most common clone of serotype 19A collected in Québec from children <5 years, representing 65.9 % of isolates collected over the study period (40.5 % of isolates collected in OCJs). Phylogenetic analysis identified geographical differences in ST695 across Canada; including a large clade specific to Québec (with both susceptible and macrolide-resistant [ermB] subclades), and a separate macrolide-resistant (mefA) clade associated with OCJs. The Québec-specific ermB-ST695 clone represented 48.1 % of ST695 collected from the province. Continued genomic surveillance of S. pneumoniae serotype 19A is required to: i) track the prevalence and clonal composition of serotype 19A in Québec in future years; ii) characterize the clonal distribution of serotype 19A in adult populations; and iii) monitor whether the currently geographically restricted ermB-ST695 clone observed in Québec expands to OCJs.

2 Excessive Exercise among Youth with a New Diagnosis of Restrictive Eating Disorder before and during the COVID-19 Pandemic

Abstract Background During the COVID-19 pandemic, Canadian youth with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) presented at higher rates with more severe illness. This trend was found to be more pronounced in Canadian jurisdictions where public health measures included full school closures and confinement. Disease severity in AN is multifactorial, however, excessive exercise can be associated with more severe illness. Due to closures, many adolescents turned to unregulated exercise regimes within their homes. The contribution of excessive exercise to the rise of new onset AN during the pandemic remains unknown. Objectives To determine the rate of excessive exercise among newly diagnosed adolescents with AN/AAN during the COVID-19 pandemic compared to the five preceding years. Design/Methods This was a secondary analysis of a prospectively collected intake registry of all new diagnoses of AN and AAN completed between January 1st, 2015, and November 30th, 2020 at two large, urban, tertiary paediatric hospitals in Quebec. Baseline demographic information and clinical assessment variables were collected based on standardized assessment forms. Excessive exercise was self-reported and defined as &amp;gt;10 hours per week of moderate or vigorous physical activity at the time of diagnosis. Medical hospitalization within 1 week of assessment was used as a marker of medical severity. The primary outcome of excessive exercise was compared between the period of pandemic public health preventive measures (March 2020 to November 2020) and the pre-pandemic period (January 2015 to February 2020). Variables were compared before and during the pandemic using Chi square testing. Results Overall, 817 patients with new diagnoses of AN/AAN met inclusion criteria during the study period (pre=647; during=170), with 40 patients (pre=34/647 and during =6/170) excluded due to missing data on exercise frequency. Overall, median patient age was 15.9 (IQR 13.8-16.9) years; 93% female; and 59% diagnosed with AAN. During the pandemic, mean hospitalization rate increased from 2.2 to 7.2 patients per month (p=0.001). Hospitalization within one week of diagnosis increased from 23% to 40% (136/613 vs. 65/16; p=0.001). The rate of excessive exercise did not differ before versus during the pandemic overall (27% vs. 24%; p=0.48) nor in patients requiring admission (40/136 [29%] vs. 23/65[36%]; p=0.39). Conclusion Excessive exercise in isolation does not appear to explain the increased rate and severity of new AN/AAN diagnoses since the pandemic in this cohort. Further studies are needed to better elucidate other drivers which may have contributed to the severity of eating disorders during this period.

Police seizure of drugs without arrest among people who use drugs in Vancouver, Canada, before provincial ‘decriminalization’ of simple possession: a cohort study

BackgroundSeveral jurisdictions in Canada have recently considered decriminalizing possession of illicit drugs for personal use (henceforth, simple possession) as part of their responses to the ongoing drug toxicity/overdose crisis. In this context, we sought to examine an early implementation case of a de facto depenalization policy of simple possession offences in Vancouver, Canada, that was enacted in 2006. Specifically, we characterized experiences of people who use drugs (PWUD) whose drugs were discretionally seized by police without arrest.MethodsData were derived from three prospective cohorts of community-recruited PWUD in Vancouver over 16 months in 2019–2021. We conducted multivariable generalized estimating equations analyses to determine the prevalence of and factors associated with drug seizure. Sub-analyses used data collected in 2009–2012 and examined the trends over time.ResultsAmong 995 participants who were interviewed in 2019–2021, 63 (6.3%) had their drugs seized by police at least once in the past 6 months. In multivariable analyses, factors significantly associated with drug seizure included: homelessness (adjusted odds ratio [AOR]: 1.98; 95% confidence interval [CI] 1.09–3.61), working in the unregulated drug market (AOR: 4.93; 95% CI 2.87–8.49), and naloxone administration (AOR: 2.15; 95% CI 1.23–3.76). In 2009–2012, 67.8% reported having obtained new drugs immediately after having their drugs seized by police. Odds of drug seizure were not significantly different between the two time periods (2019–2021 vs. 2009–2012) (AOR: 0.93; 95% CI: 0.64–1.35).ConclusionsDespite the depenalization policy, the Vancouver Police Department has continued to seize illicit drugs from PWUD, even in cases where no arrest occurred. This policing practice may create health and safety risks for PWUD as it forces PWUD to increase the engagement with the unregulated illicit drug market. Our findings support calls for abolishing this often-undocumented discretionary policing practice that may exacerbate ongoing health inequities and interfere with peer-based overdose prevention efforts.

Assessing the ‘forgotten fundamental’ in policy advisory systems research: Policy shops and the role(s) of core policy professionals

AbstractDuring the past 30 years, research on policy analytical capacity's multidimensional nature and the evolution of policy advisory systems (PASs) has both increased knowledge of these processes and structures and opened new avenues of inquiry. While it is clear that changes in PASs in many countries have occurred ‐ featuring processes such as the increased externalisation and politicisation of policy advice ‐ studies of changes among the roles played by core policy professionals in advice provision have lagged. One aspect of this question concerns the nature and extent of changes in this ‘forgotten fundamental’ of advice systems related to how these professionals are arrayed within ‘policy shops’—that is organisational units identified in the 1960s and 1970s as the main organisational home of policy professionals in government. Whether or not such shops have changed from the central‐integrated model identified in early studies and, if so, how, remain outstanding and foundational questions. Recent research in Canada has mapped the distribution of policy professionals at the central and provincial level and found more types of analysts and venues than in earlier eras— which range from the ‘classical’ integrated policy shops of the 1960s and 1970s which remain in central agencies and single‐purpose line departments to the much more 'distributed' patterns found in many departments dealing with multiple or complex controversial issues. Using Canadian data, this study outlines the development of these organisational types and their distribution in government and discusses the implications of these changes for better understanding the work, and needs, of core professionals in policy advice systems. .Points for practitioners ‘Policy professionals’ or public employees specifically tasked with policy analysis in government are key players in policy advisory systems despite the addition of more external and internal actors in policy advice systems in recent years. How these advisors and analysts are organised in government, whether they work in clusters or small groups, and how they interact with other civil servants and policy‐makers are a key determinant of their activities and influence in policy‐making. In the policy sciences, work in the 1960s and 1970s established ‘the policy shop’, that is relatively small centrally located organisational units employing mainly policy analysts, as the main home of policy professionals in government. These units often enjoyed a monopoly in analysis and played a key role in policy‐making. However, research on these organisations has not kept up with changes in advisory relations within and outside of governments and the impact such changes have had on the influence and activities of core professionals. Recent work by the authors looking at the large Canadian province of Ontario has identified more than a single type of arrangement of analysts in the current era. This paper expands this analysis to both small and large jurisdictions in Canada, including the federal government, and develops two detailed case studies of the current organisation of policy professionals in smaller central agencies like Ministries of Justice as well as in larger omnibus Ministries of the Environment. The study finds a ‘distributed’ model of policy shops—in which multiple policy units exist throughout the agency—to be dominant in both cases and in all the governments examined and suggests this is now the new normal, replacing the dominance of the older more integrated central shop model. The predominance of the distributed model contributes to the fragmentation of policy advice already underway in government due to the growth in the number of external advisors such as consultants and think tanks, and internal ones such as political staffers.

Vancomycin Therapeutic Drug Monitoring: A Cross-Sectional Survey of Canadian Hospitals.

Little is known about the current landscape of vancomycin therapeutic drug monitoring (TDM) in Canadian hospitals, which operate within publicly funded health care systems. To determine current TDM practices for vancomycin and associated challenges and to gather perceptions about TDM based on area under the concentration-time curve (AUC) in Canadian hospitals. An electronic survey was distributed to hospital pharmacists in spring 2021 through multiple national and provincial antimicrobial stewardship, public health, and pharmacy organizations. The survey gathered data about hospital characteristics, TDM methods, inclusion criteria for patient selection, pharmacokinetic and pharmacodynamic targets, vancomycin susceptibility testing and reporting, and perceived barriers and challenges. In total, 120 pharmacists from 10 of the 13 provincial and territorial jurisdictions in Canada, representing 12.5% of Canadian acute care hospitals (n = 962), completed at least 90% of survey questions. The predominant TDM method was trough-based (107/119, 89.9%); another 10.1% of respondents (12/119) reported performing AUC-based TDM (with or without trough-based TDM), and 17.9% (19/106) of those not already using AUC-based TDM were considering implementing it within 1 to 2 years. Among hospitals performing trough-based TDM, 60.5% (66/109) targeted trough levels between 15 and 20 mg/L for serious infections with methicillin-resistant Staphylococcus aureus. One-quarter of the respondents using this method (27/109, 24.8%) agreed that trough-based TDM was of uncertain benefit, and about one-third (33/109, 30.3%) were neutral on this question. Multiple challenges were identified for trough-based TDM, including sub- or supra-therapeutic concentrations and collection of specimens at inappropriate times. Overall, 40.5% (47/116) of respondents agreed that AUC-based TDM was likely safer than trough-based TDM, whereas 23.3% (27/116) agreed that AUC-based TDM was likely more effective. This survey represents a first step in developing evidence-based, standardized best practices for vancomycin TDM that are uniquely suited to the Canadian health care system.

Considerations for collecting data on race and Indigenous identity during health card renewal across Canadian jurisdictions.

Considerations for collecting data on race and Indigenous identity during health card renewal across Canadian jurisdictions.

Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review

IntroductionInterprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the...

The efficacy of statutory public hearings for planning: A comparison of four Canadian jurisdictions

ABSTRACT Statutory public hearings for urban development proposals are among the oldest venues for public participation in urban planning in the U.S., Canada, and many other jurisdictions, and the most common venues for resident participation in planning. A number of scholars discuss public hearings in their work. However, such depictions are often contradictory and do not test nor examine whether public hearings allow residents to influence planning decisions. This paper tests the efficacy of statutory public hearings and examines whether institutional difference (at-large vs. ward-based councils) and contextual difference (suburban municipalities vs. their urban cores) affect residents’ ability to influence municipal councilors via public hearings. The paper finds that resident opposition to development at public hearings does not result in substantial changes to development proposals. However, contextual and institutional differences do alter how councilors respond to resident opposition.

Le traitement de la violence conjugale comme un enjeu de SST au Canada : une étude empirique

La violence conjugale (VC) est un enjeu important pour les milieux de travail, et ce, tant du point de vue de la productivité que de la sécurité au travail. Pourtant, au Québec et au Canada, la conception de la VC en tant que dimension de la santé et de la sécurité du travail (SST) est relativement récente. Peu d’études sur la VC et le travail portent sur des interventions, et encore moins sur celles de nature préventive. Cette étude contribue à combler cette lacune. Elle présente les résultats d’une série d’entretiens avec des informatrices-clés dans différentes juridictions canadiennes où la législation en SST vise la VC. L’étude suggère que, pour que la législation puisse atteindre son but, la sensibilisation à la VC dans les milieux de travailreprésente un élément incontournable. De plus, les ressources communautaires spécialisées en VC ont un rôle crucial à jouer dans la mise en œuvre de la législation.

A critical analysis of the standard of consent in rape law in India

This article critically analyses the standard of consent in rape law in India by engaging in a doctrinal analysis of the current jurisprudence. It also analyses various extraneous circumstances influencing the determination of consent in Indian rape law. The article will then assess the status of consent jurisprudence and related issues in the English and Canadian jurisdictions for a comparative assessment. Thereafter, it will critically assess the arguments in favour of an affirmative standard of consent before concluding with possible solutions for better interpretation of the law in determining consent by courts during rape trials in India.

Multi-level climate governance: examining impacts and interactions between national and sub-national emissions mitigation policy mixes in Canada

ABSTRACT Jurisdictions use an assortment of policies to reduce greenhouse gas emissions. Climate policy mixes have often evolved through the ad hoc layering of new policies onto an existing policy mix, rather than deliberate design of a complete policy portfolio. This can lead to unanticipated interactions between policies which can support or undermine policy objectives and is further complicated where climate policy is implemented at multiple jurisdictional levels. In the context of Canada and its four most populous provinces, we examine the development of climate policy mixes across jurisdictional levels between 2000 and 2020 and evaluate policy interactions. We develop an inventory of 184 climate policies, and examine each in terms of instrument type, implementation timing, technological specificity, and expected abatement. We evaluate interactions between overlapping policies both within jurisdictional levels (horizontal) and across jurisdictional levels (vertical) for their impact on emissions abatement using a policy coherence analysis framework. We find that subsidies and R&D funding were the most abundant policies (58%), although pricing and flexible regulation are expected to achieve the most abatement. Sub-national jurisdictions have often acted as policy pilots preceding federal policy implementation. We evaluate 356 policy interactions and find 74% are consistent in adding abatement. Less than 8% have a negative impact by reducing abatement, although vertical interactions between federal and provincial policies were more often negative (11%) than horizontal interactions at the federal (<3%) or provincial (<2%) levels. Although the impact of many interactions is unknown (13%), we generate interaction matrices as a foundational roadmap for future research, and for policy-makers to consider potential interactions when designing and assessing policy effectiveness. Key policy insights Climate policy mixes have expanded and diversified over the period 2000–2020 across jurisdictions in Canada. Sub-national jurisdictions have often acted as policy ‘pilots’ by implementing policy before the adoption of similar national level policy. Climate mitigation policy interactions are predominantly supportive toward achieving additional emissions abatement. Vertical interactions between federal and provincial policy can undermine the additionality of policy effort by sub-national jurisdictions. These findings emphasize the need for better coordination in climate policy mix design between national and sub-national jurisdictions.

Canadian Public Policy: The State of the Discipline

AbstractThis article examines the state of the English-language peer-reviewed literature published over the 2011–2021 period whose objective is to describe and explain processes of development of Canadian public policies and their consequences. It first presents a profile of the surveyed literature's attention to different policy sectors, elements of public policy, and its chosen methodologies to study them. It then examines the empirical and theoretical contributions of the literature to uncovering the constitutive actors and their interactions in policy processes in policy domains of Canadian jurisdictions; the logics of chosen policy instruments and their distributive effects; and the interactions among Canada's structural, institutional and ideational features and policy actors’ motivations and behaviour with processes of policy innovation, continuity and change. A foremost contribution of Canadian policy studies to comparative policy studies is to demonstrate the causal impacts of the interaction of institutional, structural and ideational/cultural factors on processes of policy development.

Fatal and non-fatal firearm-related injuries in Canada, 2016–2020: a population-based study using three administrative databases

BackgroundFirearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes.MethodsWe conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year.ResultsOver the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory.ConclusionsOur results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.