Toward intersectional and culturally relevant sex and gender analysis in health research.

Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity-remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community.

From controlling to connecting: M'Wikwedong as a place of urban Indigenous health promotion in Canada.

In recent years, health promotion has come under critique for being framed according to the contexts and priorities of Western communities, with the notion of 'control' underpinning much of its theoretical and practical development. Ceding space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field. This paper reports on insights gained from a participatory digital storytelling project focused on Indigenous health promotion that took place at M'Wikwedong Indigenous Friendship Centre in the city of Owen Sound, Canada. The research team was formed by M'Wikwedong's Executive Director, five Indigenous youth and two university researchers. We co-created data through an 8-month digital storytelling process that involved 13 weekly research meetings, the creation of 4 digital stories and video screenings. We analysed data from seven group interview transcriptions, field notes and video transcripts through qualitative coding and theme building. The four themes we identified speak to the ways M'Wikwedong reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. From our findings, we theorize that egalitarianism of knowledge, restoring balance in relationships and Indigenous leadership are core components of an 'ethos of connection' that underlies Indigenous health promotion. The 'ethos of connection' challenges Western notions of 'control' and brings attention to the unique expertise and practices of urban Indigenous communities and organizations as a primary basis for health promotion.

Stop ringing the alarm; it is time to get out of the building!

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, "Moving on IPCC 1.5°C", which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.

RéSUMé: Le volume des appels aux gouvernements et aux autorités de santé publique à agir de concert face aux changements climatiques devient assourdissant. Au-delà de ce que nous savons des effets des changements climatiques sur la santé, les chercheurs et les praticiens en santé publique doivent examiner ce que nous faisons pour maintenir la hausse de la température mondiale en deçà de 1,5 °C. Dans ce commentaire, nous réfléchissons à la trame commune des articles d'une rubrique spéciale dans ce numéro de la Revue canadienne de santé publique, « Réaction au cri d'alarme du GIEC ¼, qui sollicitait des exemples d'études et de mesures audacieuses pour faire progresser l'atténuation des changements climatiques et l'adaptation à ces changements. Dans les articles de la rubrique, il y a des signes que la communauté de la santé publique se mobilise pour faire face à la crise climatique. Trois leçons essentielles s'en dégagent : la nécessité d'un changement institutionnel au sommet de la santé publique, le pouvoir essentiel de la communauté dans l'action intersectorielle de préparation aux changements climatiques, et l'importance de miser sur la sagesse autochtone pour décoloniser les systèmes hérités du colonialisme. Nous encourageons nos lecteurs à faire passer la recherche et la pratique en santé publique d'une relation instrumentale avec la nature à une relation de révérence et de réciprocité sacrée.

Low-income Canadians' experiences with health-related services: implications for health care reform.

This study investigated the use of health-related services by low-income Canadians living in two large cities, Edmonton and Toronto. Interview data collected from low-income people, service providers and managers, advocacy group representatives, and senior-level public servants were analyzed using thematic content analysis. Findings indicate that, in addition to health care policies and programs, a broad range of policies, programs, and services relating to income security, recreation, and housing influence the ability of low-income Canadians to attain, maintain, and enhance their health. Furthermore, the manner in which health-related services are delivered plays a key role in low-income people's service-use decisions. We conclude the paper with a discussion of the health and social policy implications of the findings, which are particularly relevant within the context of recent health care reform discussions in Canada.

Determinants of health-service use by low-income people.

Poverty influences health status, life expectancy, health behaviours, and use of health services. This study examined factors influencing the use of health-related services by people living in poverty. In the first phase, 199 impoverished users of health-related services in 2 large Canadian cities were interviewed by their peers. In the second phase, group interviews with people living in poverty (n = 52) were conducted. Data were analyzed using thematic content analysis. Diverse health-related services were used to meet basic and health needs, to maintain human contact, and to cope with life's challenges. Use of services depended on proximity, affordability, convenience, information, and providers' attitudes and behaviours. Use was impeded by inequities based on income status. To promote the health of people living in poverty, nurses and other health professionals can enhance the accessibility and quality of services, improve their interactions with people living in poverty, provide information about available programs, offer coordinated community-based services, collaborate with other sectors, and advocate for more equitable services and policies.