Hospital Care for Patients Uninsured due to Immigration Status during the COVID-19 Pandemic in Toronto: Lessons from Front-Line Knowledge Translation.

Before the COVID-19 pandemic, patients in Ontario who were uninsured due to immigration status faced barriers to hospital care that resulted in preventable illness and death. In March 2020, the Ontario Ministry of Health issued a memo indicating that it would pay for medically necessary hospital services for uninsured patients (Ontario Ministry of Health 2020). Front-line providers and research workers associated with the Health Network for Uninsured Clients (HNUC) set out to ensure that hospitals in Toronto implemented the ministry's memo. In this paper, we demonstrate a model of front-line worker-led knowledge translation informed by real-time data and anchored in clearly articulated values and goals. On April 1, 2023, the Ontario Ministry of Health cancelled this uninsured coverage (Ontario Ministry of Health 2023). Healthcare provider associations, grassroots groups and coalitions - including the HNUC - are mobilizing to see this uninsured coverage reinstated.

Who Deserves Health Care in a Global Pandemic?

The COVID-19 pandemic provides an opportunity for reflection on universal health coverage. We look at the case of the province of Ontario, Canada, which expanded health care entitlement during the pandemic to people not normally eligible for coverage, regardless of their citizenship or immigration status. We use the concept of health-related deservingness to examine why certain groups of people are deemed undeserving and are excluded in ordinary times but included in extraordinary times. We argue that tying health-related deservingness to citizenship or immigration status creates problematic inequities in health care access and outcomes and that entitlement to health care should be based instead on a person's right to health. A right to health approach could make health care systems truly universal and comprehensive. We recommend that expanded entitlement to care should be sustained, both in Ontario and elsewhere, beyond the COVID-19 crisis.

Using decision methods to examine the potential impact of intersectoral action programs.

OBJECTIVES: In public health today, there is a widespread call for intersectoral action (ISA) programs, in which two or more sectors cooperate to address a problem. This trend raises a question of how to appropriately assess the effectiveness and cost-effectiveness of ISA programs. To assess the impact of ISA, evaluation methods should provide a framework for simultaneously considering the impact of two or more interventions when selecting from a portfolio of programs. There is a gap in literature on such methods. In this research note, from a narrative review, we report and describe methods that could be useful for evaluating ISA programs. Subsequently, we present a hypothetical case study to demonstrate the use of these methods. RESULTS: We identified four methods that have potential to assess the joint impact of multiple interventions: economic evaluation, portfolio analysis, multiple-criteria decision analysis, and programme budgeting and marginal analysis. To keep pace with the desire to use strong evidence to inform the selection and design of ISA programs, methods must evolve to support these initiatives. This research note seeks to begin a dialogue on existing decision methods which may be used to assist decision makers with funding and resource allocation decisions of ISA programs.

Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes.

INTRODUCTION: Conflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend and fund these programmes. Traditional evaluations and systematic reviews tend to focus predominantly on whether the programmes 'worked' (eg, reduced recidivism) often at the exclusion of understanding for whom they may or may not have worked, under what circumstances, and why. METHODS AND ANALYSIS: We are undertaking a realist review of the batterer treatment programme literature with the aim of addressing this gap. Keeping with the goals of realist review, our primary aims are to identify the theory that underlies these programmes, highlight the mechanisms that trigger changes in participant behaviour and finally explain why these programmes help some individuals reduce their use of violence and under what conditions they are effective or not effective. We begin by describing the process of perpetrator treatment, and by proposing an initial theoretical model of behaviour change that will be tested by our review. We then describe the criteria for inclusion of an evaluation into the review, the search strategy we will use to identify the studies, and the plan for data extraction and analysis. ETHICS AND DISSEMINATION: The results of this review will be written up using the RAMESES Guidelines for Realist Synthesis, and disseminated through peer-reviewed publications aimed at the practitioner community as well as presented at community forums, and at violence against women conferences. Ethics approval was not needed.

Bringing stakeholders together for urban health equity: hallmarks of a compromised process.

There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. We explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. We conclude that participation processes often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice.

Sexual health: the role of sexual health services among homeless young women living in Toronto, Canada.

Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider's perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.