Moving on income as a social determinant of health: free transit for social assistance recipients in Kingston, Ontario.

SETTING: The public health intervention setting is the City of Kingston, Ontario, Canada. The authors were involved in various stages of development of the intervention, including advocacy, design, implementation, and evaluation. INTERVENTION: In early 2017, the City of Kingston launched a pilot program to offer all recipients of social assistance a pass that would provide unlimited access to transit. The 1-year pilot program showed promise in terms of the objectives of the two departments involved, Housing and Social Services and Kingston Transit, as it reduced barriers to transportation and increased ridership in the city. The pilot was adopted as an ongoing program, The Ontario Works Universal Transit Pass, upon completion of the pilot. The program was funded by redirecting provincial means-tested and discretionary employment benefits from the Housing and Social Services budget to the Kingston Transit budget in order to purchase transit in bulk for Ontario Works (OW) recipients. OUTCOMES: The program provided greater access to essential services, increased household budgets, reduced stigma, and increased ridership. The improved social and economic opportunities that the program facilitated demonstrate the potential of addressing social determinants of health through transportation. IMPLICATIONS: The program illustrates an effective model for addressing income as a social determinant of health through transportation policy. Moreover, it demonstrates the potential for creative, cooperative approaches to inter/intra-government operations-like the transfer of funds from Housing and Social Services to Kingston Transit-which simultaneously promotes both greater efficacy of public services and health equity.

RéSUMé: CADRE: Le cadre de l'intervention en santé publique est la ville de Kingston, Ontario, Canada. Les auteurs étaient impliqués pendant les étapes variées d'intervention, y compris faire la promotion, la conception, la mise en œuvre, et l'évaluation. L'INTERVENTION: Au début de 2017, la ville de Kingston a lancé un projet pilote pour offrir à tous les bénéficiaires de l'aide sociale un laissez-passer qui fournirait l'accès illimité aux transports en commun. Le projet pilote dura un an et se montrait prometteur en termes des objectifs des deux services impliqués­Housing and Social Services (logement et services sociaux) et Kingston Transit (transports Kingston)­parce qu'il réduisait les barrières au transport et augmentait le nombre d'usagers de transports en commun en ville. Le projet a été adopté comme un projet continu, appelé le laissez-passer universel de transport en commun de L'Ontario au travail, dès l'achèvement du projet pilote. Le programme était financé en redirigeant les bénéfices d'emploi provincial disponibles avec l'évaluation des revenus, qui font parties du budget pour le service logement et services sociaux, vers le budget du service de transports au Kingston. Les finances étaient utilisées pour acheter les laissez-passer de transport en gros pour les bénéficiaires de L'Ontario au travail. RéSULTATS: Le programme fournissait un meilleur accès au services essentiels, augmentait les budgets famille, réduisait la stigmatisation, et augmentait le nombre d'usagers de transports en commun. Les opportunités économiques et sociales améliorées que le programme avait facilitées illustre le potentiel de s'occuper des facteurs déterminants sociaux de la santé à travers les transports en commun. CONSéQUENCES: Le programme démontre un modèle efficace pour s'occuper de revenu comme un facteur déterminant social de la santé à travers la politique des transports. En outre, il illustre le potentiel pour les approches créatives et coopératives aux opérations entre les niveaux gouvernementaux­comme le transfert des finances du service de logement et services sociaux vers le budget du service de transport au Kingston­qui provoque simultanément une efficacité plus grande des services publics ainsi que l'équité de la santé.

More than chores: The invisible health work of family caregivers in rural New Brunswick, Canada.

Most home care for people living with chronic illness or disability is provided by informal, or unpaid, family members. Family caregivers in rural New Brunswick engage in essential work to maintain the home as a site of care. Renovations, property maintenance, and the administrative work involved in accessing medical equipment and managing staff are examples of the types of invisible labour involved in interacting with a complex care environment. Conversations with 13 family caregivers across a small rural Canadian province suggest that even when resources are 'available', place-based factors involved in caring at home in a rural setting make it difficult for carers to use these resources and accessing them becomes another form of work itself. Similar to Wiles et al.'s (2018) findings in their study of end-of-life family care in Aotearoa, New Zealand, carers in rural New Brunswick spoke of their activities as part of an ongoing process of interaction with the care recipient and care environment. Carers with fewer financial and material resources experienced higher burdens of invisible work. The paper sheds light on the types of labour involved in 'knowing, doing, and negotiating' care at home and re-categorizes these activities as 'health work' as a means of informing home care policy. The paper finds that family caregivers are aware of their invisible work, characterize it as essential health work, and seek recognition for their complex contribution to the formal health system.