Australian and Canadian financial wellbeing policy landscape during COVID-19: An equity-informed policy scan.

Background: This targeted and comprehensive policy scan examined how different levels of governments in Australia and Canada responded to the financial crisis brought on by the COVID-19 pandemic. We mapped the types of early policy responses addressing financial strain and promoting financial wellbeing. We also examined their equity considerations. Methods: Through a systematic search, snowballing, and manual search, we identified Canadian and Australian policies at all government levels related to financial strain or financial wellbeing enacted or amended in 2019-2020. Using a deductive-inductive approach, policies were categorized by jurisdiction level, focal areas, and target population groups. Results: In total, 213 and 97 policies in Canada and Australia, respectively, were included. Comparisons between Canadian and Australian policies indicated a more diversified and equity-targeted policy landscape in Canada. In both countries, most policies focused on individual and family finances, followed by housing and employment areas. Conclusions: The policy scan identified gaps and missed opportunities in the early policies related to financial strain and financial wellbeing. While fast, temporary actions addressed individuals' immediate needs, we recommend governments develop a longer-term action plan to tackle the root causes of financial strain and poor financial wellbeing for better health and non-health crisis preparedness. Statement on Ethics and Informed Consent: This research reported in this paper did not require ethical clearance or patient informed consent as the data sources were published policy documents. This study did not involve data collection with humans (or animals), nor any secondary datasets involving data provided by humans (or from animal studies).

The Generative Mechanisms of Financial Strain and Financial Well-Being: A Critical Realist Analysis of Ideology and Difference.

BACKGROUND: Rapid, strategic action is required to mitigate the negative and unequal impact of the coronavirus disease 2019 (COVID-19) pandemic on the financial well-being (FWB) of global populations. Personal financial strain (FS) worsened most significantly among systematically excluded groups. Targeted government- and community-led initiatives are needed to address these inequities. The purpose of this applied research was to identify what works for whom, under what conditions, and why in relation to community and government initiatives that promote personal and household FWB and/or address FS in high income economies. METHODS: We employed a critical realist analysis to literature that reported on FWB/FS initiatives in high income countries. This included initiatives introduced in response to the pandemic as well as those that began prior to the pandemic. We included sources based on a rapid review. We coded academic, published literature (n=39) and practice-based (n=36) reports abductively to uncover generative mechanisms - ie, underlying, foundational factors related to community or government initiatives that either constrained and/or enabled FWB and FS. RESULTS: We identified two generative mechanisms: (1) neoliberal ideology; and (2) social equity ideology. A third mechanism, social location (eg, characteristics of identity, location of residence), cut across the two ideologies and demonstrated for whom the initiatives worked (or did not) in what circumstances. Neoliberal ideology (ie, individual responsibility) dominated initiative designs, which limited the positive impact on FS. This was particularly true for people who occupied systematically excluded social locations (eg, low-income young mothers). Social equity-based initiatives were less common within the literature, yet mostly had a positive impact on FWB and produced equitable outcomes. CONCLUSION: Equity-centric initiatives are required to improve FWB and reduce FS among systemically excluded and marginalized groups. These findings are of relevance now as nations strive for financial recovery in the face of the ongoing global pandemic.

A rapid review of initiatives to address financial strain and wellbeing in high-income contexts.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated financial strain among populations worldwide. This is concerning, given the link between financial strain and health. There is little evidence to guide action in this area, particularly from a public health perspective. To address this gap, we examined initiatives to address financial wellbeing and financial strain in high-income contexts. METHODS: We used rapid review methodology and applied an equity-focused lens in our analysis. We searched six databases (MEDLINE, PsycINFO, Web of Science, ProQuest, Informit, and Google Advanced) for peer-reviewed, academic and practice-based literature evaluating initiatives to address financial strain and wellbeing in high-income contexts published between 2015-2020. We conducted a relevancy and quality appraisal of included academic sources. We used EPPI-reviewer software to extract equity-related, descriptive data, and author-reported outcomes. RESULTS: We conducted primary screening on a total of 4779 titles/abstracts (academic n = 4385, practice-based n = 394); of these, we reviewed 182 full text articles (academic n = 87, practice-based n = 95) to assess their relevancy and fit with our research question. A total of 107 sources were excluded based on our selection criteria and relevance to the research question (Figure 1), leaving 75 sources that were extracted for this review (academic n = 39, practice-based n = 36). These sources focused on initiatives predominantly based in Australia, the US, and Canada, with a smaller number from the UK and Europe. Most sources primarily targeted financial literacy and personal/family finances, followed by employment, housing, and education. CONCLUSIONS: We found that holistic initiatives (i.e., complex, wrap-around) that ensured people's basic needs were met (for example, before building financial skills) were aligned with positive and equitable financial wellbeing and financial strain outcomes, as reported in the reviewed studies. We noted significant gaps in the literature related to equity, such as the impact of initiatives on socially excluded populations (e.g., Indigenous peoples, racialised peoples, and rural dwellers). More research using a public health lens is required to guide equitable and sustainable action in this area.

An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts. METHODS: We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice. RESULTS: The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators. CONCLUSION: The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

Experiences of Size Inclusive Physical Activity Settings Among Women With Larger Bodies.

Purpose: Size inclusive physical activity settings may help mitigate the impact of physical activity-related weight stigma. In this interpretive description study, we aimed to understand how women with larger bodies experienced size inclusive physical activity settings. The study was informed by a settings-based approach to health promotion. Method: We interviewed nine women with larger bodies who participated in size inclusive physical activity and used an inductive approach to analyze the data. Findings: At the individual level, size inclusion was experienced as an enhancement of well-being, self-worth, and belonging. This was closely tied to the interpersonal level, whereby weight-neutral practices used by fitness instructors and lack of judgment from other exercisers contributed to experiences of size inclusion. At the organizational level, the organization's culture, marketing, programs, and physical spaces could enhance or limit inclusion and participation. However, weight stigma was prevalent in women's experiences outside the physical activity setting. Conclusion: We provide recommendations to improve size inclusion in physical activity settings.

In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world.

In-situ methodologies, including go-along and photo-elicited interviews, are ideal for harnessing people's lived experiences of place and their meanings for health and health equity. Their immersive nature means that the COVID-19 pandemic has impacted their use. Physical distancing measures combined to anxiety over the sharing of physical space have created ethical and practical challenges to the conduct of in-person in-situ methodologies. However, in-situ methodologies are precisely needed to gain deeper understandings of people's changing relationships to place post-COVID-19. In this commentary we discuss emerging challenges, highlight questions researchers should ask before engaging in these methods in the future, and explore adaptations and alternatives to traditional in-person in-situ methodologies.

Understanding urban accessibility: A community-engaged pilot study of entrance features.

The accessibility of the built environment is an equity issue. Accessibility standards for buildings exist, but often apply to new buildings or major renovations. This renders historic neighborhoods inaccessible. Accessibility standards and related assessments rarely consider the experiences and priorities of people who experience disability. Partnered with local government and an accessibility advisory committee, we conducted a pilot study of urban accessibility in Edmonton Edmon, Alberta, Canada. We measured four indicators of entranceway accessibility along a popular, central commercial corridor and mapped the data with building age using QGIS. We found significant accessibility barriers.

Community intervention strategies to reduce the impact of financial strain and promote financial well-being: a comprehensive rapid review.

Financial well-being describes when people feel able to meet their financial obligations, feel financially secure and are able to make choices that benefit their quality of life. Financial strain occurs when people are unable to pay their bills, feel stressed about money and experience negative impacts on their quality of life and health. In the face of the global economic repercussions of the COVID-19 pandemic, community-led approaches are required to address the setting-specific needs of residents and reduce the adverse impacts of widespread financial strain. To encourage evidence-informed best practices, a provincial health authority and community-engaged research centre collaborated to conduct a rapid review. We augmented the rapid review with an environmental scan and interviews. Our data focused on Western Canada and was collected prior to the pandemic (May-September 2019). We identified eight categories of community-led strategies to promote financial well-being: systems navigation and access; financial literacy and skills; emergency financial assistance; asset building; events and attractions; employment and educational support; transportation; and housing. We noted significant gaps in the evidence, including methodological limitations of the included studies (e.g. generalisability, small sample size), a lack of reporting on the mechanisms leading to the outcomes and evaluation of long-term impacts, sparse practice-based data on evaluation methods and outcomes, and limited intervention details in the published literature. Critically, few of the included interventions specifically targeted financial strain and/or well-being. We discuss the implications of these gaps in addition to possibilities and priorities for future research and practice. We also consider the results in relation to the COVID-19 pandemic and its economic consequences.

Do you mind if I smoke here? Exploring the insights that public benches bring to public health research.

In this commentary, we illustrate how exploring the meanings and uses of everyday, seemingly mundane, public objects can advance our understanding of health-related practices and the social norms that shape them. We use the example of the public bench and smoking for this purpose. By observing the design of public benches, the places where they are found, the meanings people attribute to them, and the way people use them, we can learn what health-related practices (e.g., smoking) and who (e.g., people who smoke or who do not smoke) are included and excluded as part of local community life. We thus consider the idea that public benches can be instructive in helping us understand how our health-related practices may be shaped by what can be seen enacted on or from public benches. We ultimately demonstrate how this type of object-based experiential exploration, largely absent from public health research, can provide a novel and insightful perspective to public health research.

RéSUMé: Dans ce commentaire, nous illustrons comment l'exploration des utilisations et des significations attribuées aux objets publics quotidiens apparemment anodins peut avancer notre compréhension des pratiques liées à la santé et des normes sociales qui les façonnent. Nous utilisons, à cette fin, l'exemple du banc public en lien avec le tabagisme. Le design des bancs publics, les endroits où ils se trouvent, la façon dont ils sont utilisés et le sens qui leur est attribué peuvent nous renseigner sur les pratiques liées à la santé (p.ex. fumer) et sur les personnes (p.ex. les gens qui fument et ceux qui ne fument pas) qui font partie intégrante ou, à l'inverse, sont exclues de la vie communautaire. Ainsi, nous considérons les apprentissages que les bancs publics nous permettent de faire pour mieux comprendre comment les pratiques liées à la santé sont influencées par ce qui peut être vu en y étant assis ou en observant ceux qui y sont assis. Enfin, nous démontrons comment cette exploration expérientielle basée sur l'objet, largement absente en santé publique, peut offrir une perspective de recherche novatrice dans ce domaine.

The time is now for public health to lead the way on addressing financial strain in Canada.

Financial strain was an issue for many Canadians long before the arrival of the global novel coronavirus pandemic in early 2020. However, it has worsened in recent months in relation to the pandemic and public health measures put in place to prevent the spread of COVID-19. Members of underserved groups and people who experience poverty are particularly vulnerable to financial strain and its negative health impacts. As public health professionals, we should be concerned. In this commentary, we discuss the concept of financial strain and its health consequences and highlight how existing research in the area is falling short and why. We suggest next steps to guide research and practice related to financial strain such that it reflects the core values of public health, including equity, life course approaches, and the social determinants of health. This commentary is a call to action for public health researchers and practitioners in Canada to take a more prominent role in shaping the agenda on financial strain to support financial well-being for all.

RéSUMé: De nombreux Canadiens subissaient une pression financière bien avant l'arrivée de la pandémie mondiale du nouveau coronavirus au début de 2020. Cette pression s'est toutefois aggravée ces derniers mois en raison de la pandémie et des mesures de santé publique mises en place pour prévenir la propagation de la COVID-19. Les membres des groupes mal desservis et les personnes aux prises avec la pauvreté sont particulièrement vulnérables à la pression financière et à ses effets néfastes sur la santé. En tant que professionnels de la santé publique, nous devrions nous en inquiéter. Dans notre commentaire, nous abordons la notion de pression financière et ses conséquences pour la santé et nous soulignons en quoi et pourquoi la recherche actuelle dans ce domaine n'est pas à la hauteur. Nous proposons des mesures pour orienter la recherche et la pratique liées à la pression financière afin qu'elles reflètent les valeurs fondamentales de la santé publique : l'équité, les approches axées sur la vie entière et les déterminants sociaux de la santé. Ce commentaire est un appel à l'action lancé aux chercheurs et aux praticiens en santé publique du Canada pour qu'ils jouent un plus grand rôle dans la définition des mesures à prendre face à la pression financière afin de favoriser le bien-être financier de tous.

"Don't smoke in public, you look like trash": An exploratory study about women's experiences of smoking-related stigmatisation and the connection to neighbourhood-level deprivation.

In this exploratory qualitative study we used Goffman's theory of stigmatisation to examine how women experience smoking-related stigma in relation to neighbourhood-level deprivation. From an existing cohort, we recruited fifteen women who smoked. We found differences in the women's experiences and abilities to negotiate and avoid a stigmatised smoking identity based on neighbourhood-level deprivation. Women in high-deprivation neighbourhoods described limited access to such places and this restricted their abilities to 'pass' as non- or not-quite-smokers and avoid smoking-related stigmatisation. We discuss the implications of the findings in relation to social-spatial inequalities in health and public health policy.

Young adults' experiences of neighbourhood smoking-related norms and practices: A qualitative study exploring place-based social inequalities in smoking.

In this qualitative exploratory study we asked how smoking among young adults relates to the local neighbourhood context to better understand place-based social inequalities in smoking. We used data collected through focus groups with young adults from four economically diverse neighbourhoods in Montreal, Canada. Using the collective lifestyles framework to guide data analysis, we examined within and between neighbourhood social norms, practices, and agency. We found that some smoking-related social norms, practices and agency were particular to neighbourhoods of the same socio-economic status (SES). For example, permissive smoking-related social norms in low-SES neighbourhoods made it difficult to avoid smoking but also reduced local experiences of smoking-related stigma and isolation. In high-SES neighbourhoods, strong anti-smoking norms led to smoking in secret and/or amidst 'acceptable' social settings. Findings may inform future investigations and local-level interventions focused on this age group.

The experience of regaining weight following weight loss surgery: A narrative-phenomenological exploration.

Weight loss surgery (WLS) is gaining ground as the most effective treatment against obesity. In the literature, however, we see a divide among individuals who have undergone WLS based on the amount of weight lost and maintained: successful and unsuccessful patients. In this article, we focus on the notion of unsuccessful patients-exploring the accounts of three women who have regained weight following WLS. In doing so, we endeavor to better understand how weight regain has meaning, and its impact and implications for the lives of individuals who undergo WLS. The findings reveal how weight-regain stories are easily silenced, buried beneath social, cultural, and institutional/medical narratives of successful weight loss and transformation. People who have such experiences may feel reticent to reveal them and in doing so increase their own suffering, therefore leaving the popular narratives unchallenged.

Mandatory weight loss during the wait for bariatric surgery.

Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies.

Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars.

Students training in obesity research, prevention, and management face the challenge of developing expertise in their chosen academic field while at the same time recognizing that obesity is a complex issue that requires a multidisciplinary and multisectoral approach. In appreciation of this challenge, the Canadian Obesity Network (CON) has run an interdisciplinary summer training camp for graduate students, new career researchers, and clinicians for the past 8 years. This paper evaluates the effects of attending this training camp on trainees' early careers. We use social network analysis to examine the professional connections developed among trainee Canadian obesity researchers who attended this camp over its first 5 years of operation (2006-2010). We examine four relationships (knowing, contacting, and meeting each other, and working together) among previous trainees. We assess the presence and diversity of these relationships among trainees across different years and disciplines and find that interdisciplinary contact and working relationships established at the training camp have been maintained over time. In addition, we evaluate the qualitative data on trainees' career trajectories and their assessments of the impact that the camp had on their careers. Many trainees report that camp attendance had a positive impact on their career development, particularly in terms of establishing contacts and professional relationships. Both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in the health sciences.

Exploring media representations of weight-loss surgery.

Scholars have problematized popular culture and media (re)presentations of obesity/overweight. However, few have considered the ways bariatric surgery, a rapidly growing treatment for morbid obesity, fits within the discussion. In this article, we explore news media (re)presentations of bariatric surgery using an eclectic approach to critical discourse analysis. Our findings reveal dominant discourses about bariatric surgery and the surgical population, providing an understanding of media (re)presentations as possible contributors to bias, stigmatization, and discrimination. Novel in our findings was our identification of subject positions in the dominant discourses (which were biomedical and benevolent government). We argue that existing (re)presentations of bariatric surgery are highly problematic because they reinforce oversimplistic and binary understandings of weight-loss surgery and obesity, weaving a highly gendered fairy-tale narrative and ultimately promoting weight-based stigmatization.

Weight-ing: the experience of waiting on weight loss.

Perhaps we want to be perfect, strive for health, beauty, and the admiring gaze of others. Maybe we desire the body of our youth, the "healthy" body, the body that has just the right fit. Regardless of the motivation, we might find ourselves striving, wanting, and waiting on weight loss. What is it to wait on weight loss? I explore the meaning of this experience-as-lived using van Manen's guide to phenomenological reflection and writing. Weight has become an increasing focus of contemporary culture, demonstrated, for example, by a growing weight-loss industry and global obesity "epidemic." Weight has become synonymous with health status, and weight loss with "healthier." I examine the weight wait through experiences of the common and uncommon, considering relations to time, body, space, and the other with the aim of evoking a felt, embodied, emotive understanding of the meaning of waiting on weight loss. I also discuss the implications of the findings.

Effects of pregnancy on maternal work tolerance.

This review summarizes current information on the tolerance of healthy pregnant women and their fetuses to acute strenuous exertion. Maximal aerobic power, expressed in L x min(-1), is not significantly affected in women who maintain an active lifestyle, whereas values expressed in ml x kg(-1) x min(-1) decline with advancing gestational age in relation to maternal/fetal weight gain. Efficiency during standard exercise testing and the ventilatory anaerobic threshold (Tvent) also appear to be unaffected by pregnancy, but the ability to utilize carbohydrate and exercise anaerobically during brief strenuous exercise may be reduced. Fetal responses to short strenuous exercise are usually moderate and revert to baseline values within approximately 30 min postexercise. Future studies should examine alveolar gas exchange kinetics at the start of exercise and during recovery from both moderate and strenuous exertion. Existing studies of the responses of pregnant women to prolonged exercise have focused primarily on substrate utilization and glucose homeostasis. Other maternal responses to prolonged exercise that should be examined include acid-base regulation, temperature regulation, fluid and electrolyte balance, and perception of effort. Fetal reactions should also be examined in relation to maternal responses. Until evidence-based, occupation-specific guidelines become available, it is recommended that pregnant women use the Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period, published by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology (2003).