'It doesn't happen any other way': relationship-building and reflexivity for equity-focused intersectoral practice (EquIP).

Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.

Abandoning the SRO: Public Health Withdrawal from Sanitary Enforcement in Vancouver's Downtown Eastside.

This paper situates a ten-year period of political upheaval in addressing the problem of Single Room Occupancy (SRO) housing in Vancouver, Canada, within an epistemic transformation of public health. Until 1970, the Vancouver Health Department exemplified a colonial history of public health in establishing the city's skid road as a cordon sanitaire. But the 1970s saw a sudden fading of the Department's authority just as a more collaborative approach to housing policy was emerging. The sunsetting of sanitary enforcement was driven in part by the arrival of a "new public health" that became primarily concerned with defining public health problems and solutions through the regulation of racialized bodies and behaviors-a cordon thérapeutique. By the 1980s, this shift constituted an epistemic and regulatory abandonment of SRO housing, leading to the accelerated deterioration of the entire housing stock and costing incalculable human suffering and the loss of lives.

Naloxone urban legends and the opioid crisis: what is the role of public health?

As the overdose crisis in North America continues to deepen, public health leaders find themselves responding to sensational media stories, many of which carry forms and themes that mark them as urban legends.This article analyzes one set of media accounts - stories of misuse of naloxone, an opioid overdose antidote distributed to people who use drugs - through the lens of social science scholarship on urban legends. We suggest that these stories have met a public need to feel a sense of safety in uncertain times, but function to reinforce societal views of people who use drugs as undeserving of support and resources.Our field has a duty to speak out in favour of evidence-based programs that support the health of people who use drugs, but the optimal communication strategies are not always clear. Drawing attention to the functions and consequences of urban legends can help frame public health communication in a way that responds to needs without reinforcing prejudices, with application beyond naloxone to the other urban legends that continue to emerge in response to this crisis.

Asthma Prevention and Management for Aboriginal People: Lessons From Mi'kmaq Communities, Unama'ki, Canada, 2012.

BACKGROUND: Asthma affects at least 10% of Aboriginal children (aged 11 or younger) in Canada, making it the second most common chronic disease suffered by this demographic group; yet asthma support strategies specific to Aboriginal peoples have only begun to be identified. COMMUNITY CONTEXT: This research builds on earlier phases of a recent study focused on identifying the support needs and intervention preferences of Aboriginal children with asthma and their parents or caregivers. Here, we seek to identify the implications of our initial findings for asthma programs, policies, and practices in an Aboriginal context and to determine strategies for implementing prevention programs in Aboriginal communities. METHODS: Five focus groups were conducted with 22 recruited community health care professionals and school personnel in 5 Mi'kmaq communities in Unama'ki (Cape Breton), Nova Scotia, Canada, through a community-based participatory research design. Each focus group was first introduced to findings from a local "social support for asthma" intervention, and then the groups explored issues associated with implementing social support from their respective professional positions. OUTCOME: Thematic analysis revealed 3 key areas of opportunity and challenges for implementing asthma prevention and management initiatives in Mi'kmaq communities in terms of 1) professional awareness, 2) local school issues, and 3) community health centers. INTERPRETATION: Culturally relevant support initiatives are feasible and effective community-driven ways of improving asthma support in Mi'kmaq communities; however, ongoing assistance from the local leadership (ie, chief and council), community health directors, and school administrators, in addition to partnerships with respiratory health service organizations, is needed.

Low-Income Children, Adolescents, and Caregivers Facing Respiratory Problems: Support Needs and Preferences.

UNLABELLED: Burdens of poverty are often compounded by respiratory problems. This study aimed to identify the support needs and intervention preferences for low-income families facing this challenge. DESIGN AND METHODS: Interviews were conducted in two Canadian provinces with low-income children/adolescents (n=32) diagnosed with respiratory health problems and their parents or family caregiver (n=37). RESULTS: These vulnerable children and parents described non-supportive interactions with some health service providers and inadequate information. They reported isolation and support deficits, exacerbated by limited resources and health restrictions. Children/adolescents felt isolated and excluded and wanted to connect with peers. Group or dyadic level support, delivered by peers and health professionals, was desired. The importance of logistics to enhance accessibility and appeal of group or dyadic support interventions was clearly identified. CONCLUSIONS: The findings of this study reveal that low-income children and their families encounter challenges to accessing support and to utilizing support resources. PRACTICE IMPLICATIONS: Partnerships with low-income children/adolescents and family caregivers in provision of education and social support can combat isolation and ignorance. Reducing inequities for this high risk population could be achieved by providing support from experienced peers, in combination with health professional guidance, and knowledge about pulmonary health.

Impacts of online peer support for children with asthma and allergies: It just helps you every time you can't breathe well".

Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Support was delivered by peer mentors with asthma and allergies and a professional. Weekly support groups were conducted over 8 weeks using Go to Meeting and Club Penguin. Quantitative measures and a qualitative interview were administered. Significant increases in perceived support and support-seeking coping and trends in decreased loneliness emerged at post-test. Participants also reported increased self-confidence and satisfaction with the intervention.

Health inequities experienced by Aboriginal children with respiratory conditions and their parents.

Asthma and allergies are common conditions among Aboriginal children and adolescents. The purpose of this study was to assess the health and health-care inequities experienced by affected children and by their parents. Aboriginal research assistants conducted individual interviews with 46 Aboriginal children and adolescents who had asthma and/or allergies (26 First Nations, 19 Métis, 1 Inuit) and 51 parents or guardians of these children and adolescents. Followup group interviews were conducted with 16 adolescents and 25 parents/ guardians. Participants reported inadequate educational resources, environmental vulnerability, social and cultural pressures, exclusion, isolation, stigma, blame, and major support deficits. They also described barriers to health-service access, inadequate health care, disrespectful treatment and discrimination by health-care providers, and deficient health insurance. These children, adolescents, and parents recommended the establishment of culturally appropriate support and education programs delivered by Aboriginal peers and health professionals.

Reconciling preferences and constraints in online peer support for youth with asthma and allergies.

In this article, we examine the opportunities and constraints of professionally mediated social networking in health promotion practice. Our analysis is based on the findings of a 12-week participatory study of a peer-led support intervention for youth with asthma and life-threatening allergies. The article begins with an overview of the preferences of youth, their parents, and young adults recruited as peer mentors for online features in the design of a customized support program. We then briefly explain the rationale behind our decision to design and host our intervention using a publicly available website called Ability Online in an effort to balance participants' preferences with important research obligations and safety requirements. Finally, we report on participants' level of satisfaction with the intervention as well as recommendations for health practitioners who wish to use social networking to enhance supports for youth with chronic health conditions.

Online support for children with asthma and allergies.

Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Children (n = 27) aged 7 to 11 from across Canada participated. GoToMeeting was employed for the support group sessions and Club Penguin for social connections during and between support group meetings. Content included: strategies for coping with asthma and allergies, role playing and games to help children deal with difficult situations, fun and enjoyment, and presentations by positive role models. Participation in the online peer support intervention was high, 86.3% on average over the 8-week intervention. By sharing their experiences, listening to peers' experiences, and role playing, children were introduced to practical skills: problem solving, communicating, seeking support, and self-advocacy.

Identifying gaps in asthma education, health promotion, and social support for Mi'kmaq families in Unama'ki (Cape Breton), Nova Scotia, Canada.

INTRODUCTION: Asthma is the most common chronic condition affecting Aboriginal youth aged 8 to 12 years in Canada. Research investigating psychosocial challenges associated with asthma is limited. This study examines support resources, support-seeking strategies, support and education needs, and intervention preferences of Aboriginal youth with asthma and their caregivers in an effort to encourage community-wide, health-promoting behaviors. METHODS: We employed a community-based participatory research design to conduct interviews with 21 youths aged 8 to 12 years and 17 caregivers from 5 Mi'kmaq communities in Unama'ki (Cape Breton) Nova Scotia, Canada. After conducting interviews that explored existing and desired social, educational, and health support in participating communities, we held a 2-day asthma camp to engage participants in asthma education, social support networking, and cultural activities. At the camp, we collected data through participant observation, sharing circles, focus groups, and youth drawings of their experiences living with asthma. RESULTS: Our study yielded 4 key findings: 1) asthma triggers included household mold, indoor smoking, pets, season change, strenuous exercise, extreme cold, and humidity; 2) social and educational support is lacking in Mi'kmaq communities despite a strong desire for these services; 3) cultural, linguistic, and geographic barriers to accessing support exist; and 4) family members are primary support resources. CONCLUSION: Improved support and educational resources are needed to foster effective Mi'kmaq asthma support networks. Future asthma interventions for marginalized populations must be culturally meaningful and linguistically accessible to those using and providing asthma support.

Impact of online support for youth with asthma and allergies: pilot study.

Youth with asthma and allergies often feel isolated and different from their peers. The objective of this study was to test the impact of online social support for these youth. Three months of support was provided using weekly synchronous chat sessions. Online sessions were facilitated by trained peer mentors (older youth with asthma and/or allergies) and health professionals. Youth could also e-mail one another between chat sessions and post messages on an electronic community bulletin board. Twenty-eight adolescents across Canada participated. Social isolation and loneliness were significantly reduced. Youth reported gaining confidence and a sense of normality.

Support needs and preferences of young adolescents with asthma and allergies: "just no one really seems to understand".

The objectives of this study were to identify support needs, support resources, and support barriers for young adolescents with asthma and allergies and to describe preferences for an accessible support intervention. Adolescents (N = 57) completed a survey questionnaire. Eight young adolescents, 10 parents, and 5 older adolescents participated in separate group interviews. Young adolescents' challenges included transition to self-care, balancing restrictions with safety, social isolation, and loneliness. Young teens recommended supportive networks facilitated by older adolescent peers and wanted to meet with other young adolescents living with asthma and allergies online and share information, advice, and encouragement with them.

Building capacity for community-based participatory research for health disparities in Canada: the case of "Partnerships in Community Health Research".

Enthusiasm for community-based participatory research (CBPR) is increasing among health researchers and practitioners in addressing health disparities. Although there are many benefits of CBPR, such as its ability to democratize knowledge and link research to community action and social change, there are also perils that researchers can encounter that can threaten the integrity of the research and undermine relationships. Despite the increasing demand for CBPR-qualified individuals, few programs exist that are capable of facilitating in-depth and experiential training for both students and those working in communities. This article reviews the Partnerships in Community Health Research (PCHR), a training program at the University of British Columbia that between 2001 and 2009 has equipped graduate student and community-based learners with knowledge, skills, and experience to engage together more effectively using CBPR. With case studies of PCHR learner projects, this article illustrates some of the important successes and lessons learned in preparing CBPR-qualified researchers and community-based professionals in Canada.

Online solutions to support needs and preferences of parents of children with asthma and allergies.

Many families of children with asthma and allergies experience support deficits and isolation. However, support interventions have not been designed to meet their needs. Consequently, parents' intervention preferences were elicited, and an online peer support group intervention was designed based on these preferences and piloted in the study described. In-depth interviews with 44 parents elicited preferences for support interventions for both children and parents. Many said they felt alone and wanted support from others in similar situations. Based on the parents' preferences for accessible online peer support groups, a pilot online intervention was designed and implemented. Parents received information and reassurance from other parents in peer support sessions. Parents appreciated the accessibility and anonymity of the online support group. This innovative online peer support intervention, informed by parents' preferences, could be adapted and tested in intervention trials and guide programs and practice for families affected by asthma, allergies, and other chronic conditions.

The 'freedom' to pollute? An ecological analysis of neoliberal capitalist ideology, climate culpability, lifestyle factors, and population health risk in 124 countries.

OBJECTIVES: This ecological study examined the relationship between neoliberal capitalist ideology (hereafter, neoliberal ideology) and non-communicable diseases (NCD) mortality in 124 countries, focusing on the degree to which climate culpability and physical inactivity are implicated in explaining that relationship. METHODS: The economic freedom of the world index of the Fraser Institute (representing neoliberal ideology), CO2 emissions (metric tons/capita) from the World Bank (representing climate culpability), and the World Health Organization's age-adjusted physical inactivity and NCD mortality data were used. Covariates included gross domestic product (GDP)/capita, the country-level prevalence of obesity (n = 123), tobacco smoking (n = 111), and alcohol consumption (n = 61). RESULTS: Neoliberal ideology was associated with NCD mortality after controlling for GDP/capita, physical inactivity, and obesity, and this association was most pronounced in less culpable countries. The association between neoliberal ideology and NCD mortality remained statistically significant even after further controlling for tobacco smoking and alcohol consumption. Neoliberal ideology was associated with NCD mortality, after controlling for GDP, climate culpability, and tobacco smoking, regardless of physical inactivity. When alcohol consumption was introduced, physical inactivity moderated the association between neoliberal ideology and NCD mortality. CONCLUSION: Neoliberal ideology was consistently associated with NCD mortality. Also, NCD mortality appears to be most severe in countries that are less culpable for global climate change. Our findings offer preliminary evidence-based support for a shift in thinking toward the fundamental determinants of health and calls for an upstream shift in climate change mitigation interventions to improve population health through the creation of equitable global political and economic systems.

RéSUMé: OBJECTIFS: Notre étude écologique porte sur le lien entre l'idéologie capitaliste néolibérale (ci-après dénommée « idéologie néolibérale ¼) et la mortalité due aux maladies non transmissibles (MNT) dans 124 pays, et en particulier sur la mesure dans laquelle la culpabilité climatique et la sédentarité peuvent expliquer ce lien. MéTHODE: Nous avons utilisé l'indice de liberté économique dans le monde de l'Institut Fraser (pour représenter l'idéologie néolibérale), les émissions de CO2 (en tonnes métriques par habitant) selon la Banque mondiale (pour représenter la culpabilité climatique) et les données sur la sédentarité et la mortalité due aux MNT de l'Organisation mondiale de la santé, rajustées selon l'âge. Nos covariables ont été le produit intérieur brut (PIB) par habitant et, par pays, la prévalence de l'obésité (n = 123), du tabagisme (n = 111) et de la consommation d'alcool (n = 61). RéSULTATS: L'idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB par habitant, de la sédentarité et de l'obésité, et cette association était la plus prononcée dans les pays les moins coupables. L'association entre l'idéologie néolibérale et la mortalité due aux MNT est demeurée significative même après l'apport d'ajustements pour tenir compte des effets de tabagisme et de la consommation d'alcool. L'idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB, de la culpabilité climatique et du tabagisme, quels que soient les niveaux de sédentarité. Quand la consommation d'alcool était introduite, la sédentarité réduisait l'association entre l'idéologie néolibérale et la mortalité due aux MNT. CONCLUSION: L'idéologie néolibérale était uniformément associée à la mortalité due aux MNT. Par ailleurs, la mortalité due aux MNT semble être la plus grave dans les pays les moins coupables à l'égard du changement climatique mondial. Nos constatations présentent des preuves préliminaires à l'appui d'une évolution de la pensée sur les déterminants fondamentaux de la santé et appellent à intervenir en amont pour atténuer le changement climatique, en vue d'améliorer la santé des populations par la création de systèmes politiques et économiques mondiaux équitables.

Lessons from a rural housing crisis: grounded insights for intersectoral action on health inequities.

Local communities are struggling with persistent health inequities driven by income disparity, housing inadequacy, and other intersecting factors that constrain individual and community well-being. Increasingly, intersectoral approaches are recognized as essential to tackle such challenges, given their intersecting nature. This paper describes Equity-focused Intersectoral Practice (EquIP), a novel methodology that merges participatory research principles with the purposeful positioning of grounded expertise (lived experience) to shift the gaze of intersectoral actors towards the contextual factors that contribute to health inequities. The EquIP methodology creates uncommon spaces for intersectoral encounter that support critical reflexivity and relationship-building among institutional and community-based intersectoral actors. A case example of the EquIP methodology, implemented in a small, rural Canadian city in the context of a regional housing crisis, illustrates how investment in reflexivity and relational praxis among diverse intersectoral actors supports the identification of existing structures, beliefs, and practices within institutional settings that constrain effective intersectoral response to health inequities.

Implementing Indigenous Gender-Based Analysis in Research: Principles, Practices and Lessons Learned.

Numerous tools for addressing gender inequality in governmental policies, programs, and research have emerged across the globe. Unfortunately, such tools have largely failed to account for the impacts of colonialism on Indigenous Peoples' lives and lands. In Canada, Indigenous organizations have advanced gender-based analysis frameworks that are culturally-grounded and situate the understanding of gender identities, roles, and responsibilities within and across diverse Indigenous contexts. However, there is limited guidance on how to integrate Indigenous gender-based frameworks in the context of research. The authors of this paper are participants of a multi-site research program investigating intersectoral spaces of Indigenous-led renewable energy development within Canada. Through introspective methods, we reflected on the implementation of gender considerations into our research team's governance and research activities. We found three critical lessons: (1) embracing Two-Eyed Seeing or Etuaptmumk while making space for Indigenous leadership; (2) trusting the expertise that stems from the lived experiences and relationships of researchers and team members; and (3) shifting the emphasis from 'gender-based analysis' to 'gender-based relationality' in the implementation of gender-related research considerations. Our research findings provide a novel empirical example of the day-to-day principles and practices that may arise when implementing Indigenous gender-based analysis frameworks in the context of research.

Reaching for environmental health justice: Canadian experiences for a comprehensive research, policy and advocacy agenda in health promotion.

Spatial disparities in environmental quality and practices are contributing to rising health inequalities worldwide. To date, the field of health promotion has not contributed as significantly as it might to a systematic analysis of the physical environment as a determinant of health nor to a critique of inequitable environmental governance practices responsible for social injustice-particularly in the Canadian context. In this paper, we explore ways in which health promotion and environmental justice perspectives can be combined into an integrated movement for environmental health justice in health promotion. Drawing on Canadian experiences, we describe the historical contributions and limitations of each perspective in research, policy and particularly professional practice. We then demonstrate how recent environmental justice research in Canada is moving toward a deeper and multi-level analysis of environmental health inequalities, a development that we believe can inform a comprehensive research, policy and advocacy agenda in health promotion toward environmental health justice as a fundamental determinant of health. Lastly, we propose four key considerations for health promotion professionals to consider in advancing this movement.

"You need to just provide health services:" navigating the politics of harm reduction in the twin housing and overdose crises in Vancouver, BC.

BACKGROUND: Since harm reduction's origins as a grassroots, activist movement, cooperation and compromise among people who use drugs, bureaucrats, politicians, and other actors have been critical to its advancement in Canada. Critics have argued, however, that the institutionalization of harm reduction practice within the context of a politically sensitive environment has eroded its radical potential. The overdose crisis in Vancouver's Downtown Eastside (DTES) community has led to innovative harm reduction organizing that has been replicated globally. In this paper, we explore how one such intervention, the Tenant Overdose Response Organizers (TORO) program, has supported a resurgence in tenant-led harm reduction organizing in Single Room Occupancy (SRO) buildings in the DTES. METHODS: We draw on 15 months of ethnographic fieldwork conducted between May 2017 and August 2018, over 100 hours of participant observation of TORO activities, and 15 semi-structured interviews with key stakeholders in the program. RESULTS: TORO's leaders attempted to mobilize harm reduction intervention towards collective action on SRO risk environments underlying drug-related harms, but their efforts were constrained by the necessity of meeting practical expectations of funders regarding health education and supply distribution. Navigating these constraints ultimately shaped the development of the TORO program, helping to secure its longevity but also limiting its ability to organize a coordinated harm reduction and tenants' rights response to the dual housing and overdose crises. CONCLUSION: Our examination of TORO demonstrates how the harm reduction movement continues to be shaped by conflict, cooperation, and compromise between the state and grassroots groups. Even as actors strive to work collaboratively, the unequal distribution of power inherent in this relationship may contribute to the reinscription of a depoliticized harm reduction approach. We discuss the potential role of the risk environment framework in lending political legitimacy to grassroots harm reduction initiatives.

"We have a roof over our head, but we have to eat too:" Exploring shifting foodscapes from homelessness into Housing First in Kingston, Ontario.

BACKGROUND: People facing extended periods of homelessness exhibit a remarkable degree of agency and resilience in procuring food. The literature on foodscapes considers the sociospatial contexts of food procurement, finding that what happens within and along the way to sites of food acquisition and consumption are important considerations in fully understanding and realizing food security. PURPOSE: This study explores the shift in foodscapes of people who are transitioning from homelessness into scattered-site independent housing via a municipal Housing First program and considers implications for health and wellbeing. METHODS: Our mixed-method approach included observational research at 11 local food providers and drop-in centres that provided context for semi-structured interviews with 10 Housing First clients in Kingston, Ontario between November 2016 and March 2017. RESULTS: The findings confirm that the provision of stable housing makes it possible for people to store, prepare, and consume food at home. An increased ability to have control over when, where, and what is eaten had a positive impact on people's sense of health and wellbeing. However, other effective markers of wellbeing were enacted along people's everyday routines and activities that had negative impacts. Interviewees remained heavily dependent on charitable food programs, including increased use of foodbanks. Others reported increasing detachment and social isolation from previously established food routines. Finally, the structured transition perpetuated a circuit of dependence and marginalization that fell short of contributing to improved food security as well as health and wellbeing. IMPLICATIONS: Understanding the relational geography of foodscape transitions is critical to the design of effective Housing First programs. Addressing the root causes of homelessness and poverty requires investments in comprehensive housing strategies including adequate social assistance and community supports that take a sociospatially holistic approach to wellbeing.