Major Research Papers - Health

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Open Access
Analyzing Health Financing and the Implications on Health Access and Equity in Canada, Nigeria and Ghana
(2017-09-01) Onilude, Yemisi; Schraa, Ellen; Raphael, Dennis
This major research paper examined health financing and the implications for health equity and access to care in North America and Sub-Saharan Africa (SSA) countries with emphasis on Canada, Nigeria and Ghana. Relevant scholarly journal articles and books were reviewed to meet the objectives of this paper. Literature analysis was used to examine the data obtained for this study. Research findings show that health financing is driven by free market economy (neoliberalism) in both SSA and Canada. Moreover, in making comparison of health financing in the developed and developing nations from 2000 to 2014, the study revealed that the total health expenditure as a percentage of GDP for both Nigeria and Ghana is less than half that of Canada. Also, the government of Ghana is stronger than Nigeria in terms of public health care funding, although both countries are making positive progress in health financing. Generally, the public health financing in Canada is larger than in both Ghana and Nigeria. In the perspective of global health financing, this indicates the presence of inequality in government health expenditure in HICs and LMICs. Furthermore, the analysis shows there are many barriers to the attainment of health financing objectives. This study recommends reform of health care financing systems and giving higher priority to health in government budgetary allocations in various countries as a way of addressing these barriers. In conclusion, it is appropriate for governments of every nation to utilize resources efficiently and equitably for healthcare and ensure prudent spending of money for proper policies in health finance and enhanced health care delivery.
Open Access
Applying a Health Justice Framework to Examine Visitation Policies in Canadian Federal Penitentiaries and Psychiatric Facilities During the COVID-19 Pandemic
(2021-11) Bailey, Megan; van Dreumel, Lynda; Shnier, Adrienne
The COVID-19 pandemic has illuminated inequities in policy development and implementation of emergency intervention strategies. This study addresses the equitable access to visitation in COVID-19 emergency intervention strategies between comparable total institutional settings. This multiple-case design encompassed two selected custodial environments and was compared using the implemented emergency policies surrounding visitation. In comparing the institutionalized settings of psychiatric hospitals and federal penitentiaries in Ontario, it draws appraisals for equity and health justice-based analysis. These emergency intervention policies focused on visitation vary based on institutional influence, interests, and ideas that are consequently highlighted within this study. The findings of this study reflect a lack of consistency in emergency responsesurrounding visitation policies across psychiatric facilities and federal penitentiaries located within Ontario and uncover discrepancies in policies within the various Ontario psychiatric facilities. These findings lead to an analysis rooted in the framework of human rights and social justice that propel a unique discussion surrounding health justice in the context of Canadian institutionalized settings. The study concluded by considering health justice as a framework in practical and theoretical policy development and implementation to promote health equity and the approach to social justice from a health and equity perspective.
Open Access
Applying a Health Justice Framework to Examine Visitation Policies in Canadian Federal Penitentiaries and Psychiatric Facilities During the COVID-19 Pandemic
(2021-11) Bailey, Megan; van Dreumel, Lynda; Shnier, Adrienne
The COVID-19 pandemic has illuminated inequities in policy development and implementation of emergency intervention strategies. This study addresses the equitable access to visitation in COVID-19 emergency intervention strategies between comparable total institutional settings. This multiple-case design encompassed two selected custodial environments and was compared using the implemented emergency policies surrounding visitation. In comparing the institutionalized settings of psychiatric hospitals and federal penitentiaries in Ontario, it draws appraisals for equity and health justice-based analysis. These emergency intervention policies focused on visitation vary based on institutional influence, interests, and ideas that are consequently highlighted within this study. The findings of this study reflect a lack of consistency in emergency responsesurrounding visitation policies across psychiatric facilities and federal penitentiaries located within Ontario and uncover discrepancies in policies within the various Ontario psychiatric facilities. These findings lead to an analysis rooted in the framework of human rights and social justice that propel a unique discussion surrounding health justice in the context of Canadian institutionalized settings. The study concluded by considering health justice as a framework in practical and theoretical policy development and implementation to promote health equity and the approach to social justice from a health and equity perspective.
Open Access
Comparative Critical Policy Analysis of SARS and COVID-19 Policy Responses to PSW Mental Health
(2021-11) Glockmann-Musto, Santina; Chaufan, Claudia; Syed, Iffath
This Major Research Project (MRP)assesses policy responses to the impact of COVID-19 on the mental health of Personal Support Workers (PSWs), a segment of frontline workers, in Canada. Specifically, Iassess how the experience of the 2003 Severe Acute Respiratory Syndrome (SARS)epidemicis informing policy responses to the mental health challenges experienced by PSWs under COVID-19. Despite the magnitude of the COVID-19 pandemic, with Canada reporting over half a million cases and over 15,000 deaths due to COVID-19 as of December 31st, 2020, this is not the first emergency of its kind in Canada. In 2003, the outbreak of SARS led to close to 500 cases and 44 deaths, resulting in the establishment of the Public Health Agency of Canada. It was then reported that PSWs who provided care to SARS patients experienced poor mental health outcomes -anxiety, occupational burnout, depression, and Post-Traumatic Stress Disorder (PTSD), which persisted twoyears after the epidemic. COVID-19, substantially more impactful, poses a much greater challenge to the mental health of PSWs. Drawing from a Marxist Feminist perspective –most PSW are low-income and female -thiscritical comparative policy analysis appraises publicly available documents (e.g., Learning from SARS –Renewal of Public Health in Canada) that represent SARS and COVID-19 policy responses. Preliminary findings suggest that policy responses so far have almost entirely missed key lessons learned from the SARS experience. Myanalysis elaborates on these findings and their implications for practice, policy, and equity.
Open Access
Comparative Critical Policy Analysis of SARS and COVID-19 Policy Responses to PSW Mental Health
(2021-11) Glockmann-Musto, Santina; Chaufan, Claudia; Syed, Iffath
This Major Research Project (MRP)assesses policy responses to the impact of COVID-19 on the mental health of Personal Support Workers (PSWs), a segment of frontline workers, in Canada. Specifically, Iassess how the experience of the 2003 Severe Acute Respiratory Syndrome (SARS)epidemicis informing policy responses to the mental health challenges experienced by PSWs under COVID-19. Despite the magnitude of the COVID-19 pandemic, with Canada reporting over half a million cases and over 15,000 deaths due to COVID-19 as of December 31st, 2020, this is not the first emergency of its kind in Canada. In 2003, the outbreak of SARS led to close to 500 cases and 44 deaths, resulting in the establishment of the Public Health Agency of Canada. It was then reported that PSWs who provided care to SARS patients experienced poor mental health outcomes -anxiety, occupational burnout, depression, and Post-Traumatic Stress Disorder (PTSD), which persisted twoyears after the epidemic. COVID-19, substantially more impactful, poses a much greater challenge to the mental health of PSWs. Drawing from a Marxist Feminist perspective –most PSW are low-income and female -thiscritical comparative policy analysis appraises publicly available documents (e.g., Learning from SARS –Renewal of Public Health in Canada) that represent SARS and COVID-19 policy responses. Preliminary findings suggest that policy responses so far have almost entirely missed key lessons learned from the SARS experience. Myanalysis elaborates on these findings and their implications for practice, policy, and equity.
Open Access
Competing Approaches to Household Food Insecurity in Canada
(2017-10-11) Mendly-Zambo, Zsofia; Raphael, Dennis; Daly, Tamara
Household food insecurity (HFI) impacts over 1.1 million households, adversely impact the health and well-being of individuals and families. Despite the recognition of the right to food by several international covenants, indicating that Canadian governments are obliged to reduce HFI, little has been done by the Canadian government to defend this right. The Canadian Government’s failure to address HFI has resulted in the creation of a number of non-governmental means of managing the problem, which have not been successful in redressing HFI. Furthermore, non-governmental responses may have served to depoliticize the issue of HFI, allowing governments to obfuscate their responsibility in addressing HFI. Four competing approaches of HFI in Canada, nutrition and dietetics, community traditionalism, social determinants of health and political economy complicate solutions by differently conceptualizing and framing the causes and appropriate responses to HFI. I argue that the political economy framework–which views the rise in HFI as precipitating from the skewed distribution of economic and social resources as a result of imbalances in power and influence–best explains the causes of food insecurity and presents the most effective means of responding to its presence in Canada by acknowledging the larger political and economic structures that shape and precipitate HFI.
Open Access
Contracting Care: Evaluating the effects of the "Second Generation Health System Strategy' on the contracting environment for community organizations in the Downtown Eastside of Vancouver
(2019-04-11) Wood, Tesia; Daly, Tamara; Armstrong, Pat
This paper examines the impacts of the Downtown Eastside ‘Second Generation Health System Strategy’ (2GHSS) on the contracting environment for community organizations and programs receiving funding from the regional health authority, Vancouver Coastal Health (VCH). The 2GHSS was designed by VCH and implemented in 2015 with the aim of removing siloed services and providing a more integrated and responsive health system in the Downtown Eastside (DTES). The 2GHSS represents a significant reorientation of government priorities in the community and the accompanying funding shuffles and cuts – primarily directed at non-clinical programs and organizations – have shifted the landscape of the DTES third sector. Informed by the theoretical framework of feminist political economy, and through the use of thematic analysis, this paper identifies trends in the DTES contracting environment between 2015 and 2019 that reflect the intensification of medical dominance and indirect neoliberal governance, including: funding cuts to organizations without links to the formal health system; use of market-based competitive tendering; valuing health services for their clinical rather than their social components; and contributing to an environment of fiscal precarity. It is concluded the 2GHSS is an extension of the neoliberal ideological orientation that has long directed the priorities of the BC health sector.
Open Access
Creating Complex Systems: The Implications of the Immigration System Reforms for Refugee Health (2012)
(2019-05-17) Pak, Negeen; Hynie, Michaela; Daly, Tamara
In June 2012, the Canadian federal government introduced a new legislature, which drastically reformed the Canadian immigration system. During this time the Conservative government reformed the Interim Federal Health Program (IFHP), completely transforming health coverage for asylum seekers. This overhaul created a hierarchy, whereby asylum seekers would qualify for different levels of coverage based on their claimant status. This study explores the impacts of this policy change and outlines the inequity consequential to the reforms of 2012. It includes secondary thematic data analysis of interviews conducted with medical health professionals regarding the impacts of the 2012 decision. The study provides a comprehensive look at the implications of patchwork policies through three prominent themes: potential risks to women’s health; barriers to healthcare access (language, fear, cost); significant medical bills and delays lead to additional health problems. Finally, I conclude with policy recommendations for future federal and provincial governments.
Open Access
Critical Analysis of National Nutrition Policy and Strategies of India
(2021-04-30) Sayeed, Shurovi; Chaufan, Claudia; Sridharan, Sanjeev
Abstract Global malnutrition and food insecurity are rising. The root cause of both malnutrition and food insecurity is poverty. Despite a remarkable increase in food production, developing countries show alarming rates of child malnutrition. India is a good example of this dichotomy. The country that harbours one-third of the world’s malnourished children is also one of the world's largest food grain exporters. Moreover, India has had the world’s most extensive government funded nutrition intervention programs.A National Nutrition Policy (NNP) was enacted in 1993, one of the earliest submitted in response to the World Health Organization’s call for countries to develop a NNP. India’s poverty reduction strategy and food policy are also aligned with NNP. Nevertheless, despite these massive initiatives, India’s nutrition problem remains a major public health concern. India’s nutrition problems and national nutrition programmes are generalizable to other agro based South East Asian developing countries.This study’s objective was to explain why nutrition policy and strategies failed to address malnutrition in India. A critical discourse analysis approach was used to show textual and contextual dimensions of government policy documents in relation to the neoliberal policy and practice. A political economy lens was employed to illustrate the global food politics context perpetuating persistent hunger and child malnutrition. The study revealed that India’s recent National Nutrition Strategy and National Nutrition Mission does not adequately address the lack of quality protein, fruits and vegetables and that the heavy reliance on grain is due to the government's sole support of rice and wheat production. The study also revealed that transnational agro-industries, international banking and donor organizations heavily influence India’s food and agriculture policy. Finally, it identified a shift in the policy, from challenging neoliberal
Open Access
A Critical Literature Review of the Impact of Precarious Work on the Mental Health of Immigrant Women in Canada
(2017-09-29) Umaigba, Karina; Raphael, Dennis; Tompa, Emile
This critical review draws on existing literature on the discourse of precarious work within the Canadian nation-state. The goal of this research work is to critically examine the impact of precarious work on the lives, well-being and mental health of immigrants with a specific focus on immigrant women. Given that most research works have been mainly focused on the way in which precarious work creates health inequalities, this paper aims to throw light on the way in which precarious work can affect mental health. Also, the paper will examine the Canadian public policy response to this issue. The paper argues that Canada’s policy response is a reflection of the dominant political ideology within this nation-state. The dominant political ideology of neoliberalism seeks to justify minimal state intervention in policies that directly affect health and more broadly citizen’s life. The following principal questions will guide this critical review. 1) Why are immigrants, particularly immigrant women of color disproportionately situated in precarious forms of labour within the Canadian nation-state? 2) How does precarious work affect the mental health of immigrant women? 3) How and to what extent has capitalism and neoliberalism within the Canadian nation-state helped to perpetuate precarious working conditions for racialized immigrant women? By interrogating Canada’s neoliberal policy agenda as it affects immigrants through entrenched legislations of immigrant classes, the primary goal of this paper is to advance the construction that immigrants/migrants exist for economic exploitation and gain. The main theoretical framework that will guide this analysis is based on a post-colonial feminist scholarship that analyzes how inequities grounded on gender, race, class, and migratory status intersect to create complex and diverse labour market results for racialized immigrant women in Canada. A common theme that emerged throughout the critical review of several scholarly and grey literatures is that more women than men are situated in precarious work, and of those women in precarious forms of employment, women who identified as members of a visible minority group were even more disproportionately situated in precarious forms of work. Also, it was observed that the Canadian nation-state has to date failed to respond appropriately to this social and economic situation. Since employment and working conditions, unemployment and employment security -- described as some of the most crucial social determinants of health -- are significantly correlated to income and its security, allowing precarious work has only served to reinforce high-levels of income inequality, income insecurity and poverty within Canada.
Open Access
Examining Mental Health Apps Potential in Providing Equitable Access to Care in the Global North and Global South: A Scoping Review
(2019-08-09) Rasendran, Raneeshan; Ahmad, Farah; Morrow, Marina
Promising, ongoing research on online mental health interventions or mental health applications (MHAPPs) has presented the global mental health care community with a potential solution to fill in the gaps in access to mental health care. Many of the MHAPPs have focused on conditions of depression and anxiety. Yet, it remains unclear whether such interventions can address the access to care gap in an equitable manner by reaching the diverse communities both in the global North and global South. The countries of Canada and United States were chosen as exemplars for the global North and China and India as exemplars for the global South. Using Arksey and O’Malley’s methodical framework, a scoping review was conducted on academic and grey literature published since 2015. Under critical social paradigm, the synthesis of review studies employed the social determinants of health lens along with role of macro forces like neoliberalism and collectivism-individualism. The results reveal that MHAPPs for depression and anxiety have been shown to be efficacious in studies both in the global North and global South, though few of the efficacious apps have been made freely available. Further, the guided-online interventions in the global North and global South are also found to facilitate program adherence, especially in rural settings. However, the review reveals that several barriers exist in the global South to make online interventions widely available and accessible. The identified barriers include mental health stigma and discrimination, financial and social challenges, difficulties in using the technology-based applications, and cultural barriers to ‘self-management’. In conclusion, this review has identified the potential of MHAPPs in broad settings; however, there is a need to design these programs by incorporating the social determinants of health framework to better address the structural barriers to access care. Policy makers should be cautious in steadily implementing MHAPPs in disadvantaged communities, as broader policies are needed to address the logistical capabilities of accessing online mental care. Further studies on MHAPPS are also needed with a bottom-up approach to adapt to various cultural context and reach marginalized communities. Given the specific focus of the presented review on Canada and United States as global North and China and India as global South, the findings need to be interpreted carefully. Further work by including additional geographic regions is needed to advance the scholarly understanding.
Open Access
'Fat' or Fiction: Examining the Role Political and Economic Forces Play in Driving the Concern over Obesity
(2015-08-25) Ali, Ahmednur; Raphael, Dennis; Pilkington, Beryl
This paper attempts to examine the present focus on obesity by government officials, the private sector, and the general public. More specifically, this paper argues that there is a hyper-concern with obesity that stems more from well-established power dynamics and societal structures than a result of medical concern over public health. The role of political and economic forces is argued as being the reason for this hyper-concern. A critical analysis of the literature is presented to identify the underlying relevant factors that drive this hyper-concern with obesity. Finally, this paper considers the implications this hyper-concern with obesity can potentially have on the distribution of wealth, power, and influence within the public and private sector. This paper will also attempt to critically assess the clinical practice guidelines created to address obesity by the Registered Nurses' Association of Ontario, the Canadian Medical Association, the American Medical Association, and the Australian government. The argument that these clinical practice guidelines lack the breadth and depth to adequately and effectively address obesity will be put forth and highlighted in the context of six specific concerns.
Open Access
The Impact of Islamophobia on the Mental Health of Muslim Post-Secondary Students
(2021-08-12) Khan, Khan, Zainab; Raphael, Dennis; Marrow, Marina
Open Access
The Impact of Islamophobia on the Mental Health of Muslim Post-Secondary Students
(2021-08) Khan, Zainab; Raphael, Dennis; Marrow, Marina
Open Access
Indigenous Youth Mental Health in Canada: A WPR Approach to Canada's (In) Action in Response to Suicide Crises
(2020-10-02) Francavilla, Victoria; Hillier, Sean; Morrow, Marina
Across Canada, Indigenous Peoples have been resilient to active colonization for more than 400 years, all the while upholding their traditional values, systems, and ways of being. However, despite this resilience, Indigenous youth experience disproportionate and elevated rates of negative mental health outcomes, including elevated rates of suicides. Canadian mental health policy has not been responsive to the needs of Indigenous youth, often ignoring the specific needs of Indigenous communities in documents that are meant to guide programming and responses. In this Major Research Paper (MRP) I review one such key document - the Mental Health Commission of Canada's (MHCC) 2016 recommendations in its report titled The Mental Health Strategy for Canada: A Youth Perspective. This document is the broadest reaching and most current official document addressing the issue of First Nations, Inuit, and Métis (FNIM) youth mental health at a Federal level. By analysing the narrative used throughout this document one can learn how the solutions proposed may actually be failing to address the root causes of the issue at hand. Using Carol Bacchi’s WPR (What’s the Problem Represented to be?) approach, it will become evident as to why these responses are not wholly conducive to achieving better mental health outcomes for Indigenous youth. Following this discussion, I will highlight the progress that is being made in various Indigenous communities in a variety of culturally relevant, safe, and sensitive ways. Communities who are thriving and who are working towards positive change for youth are the experts in this case, as they have the knowledge and are taking up practices which are created from themselves, not for them. These practices have the potential to influence policy, as they are paving the way for a better response in cases of Indigenous youth suicide. When systems are put in place that truly benefit the community, this has a profound effect by influencing community members, researchers, academics, and policymakers alike, and also highlights the shortcomings of existing governmental action. As a non-Indigenous person, I engaged in reflexivity throughout my research and situate myself as an ally.
Open Access
Indigenous Youth Mental Health in Canada: A WPR Approach to Canada’s (In)Action in Response to Suicide Crises
(2020-10) Victoria, Francavilla; Marrow, Marina; Hillier, Sean
Across Canada, Indigenous Peoples have been resilient to active colonization for more than 400 years, all the while upholding their traditional values, systems, and ways of being. However, despite this resilience, Indigenous youth experience disproportionate and elevated rates of negative mental health outcomes, including elevated rates of suicides. Canadian mental health policy has not been responsive to the needs of Indigenous youth, often ignoring the specific needs of Indigenous communities in documents that are meant to guide programming and responses. In this Major Research Paper (MRP) I review one such key document -the Mental Health Commission of Canada's (MHCC) 2016 recommendations in its report titled The Mental Health Strategy for Canada: A Youth Perspective. This document is the broadest reaching and most current official document addressing the issue of First Nations, Inuit, and Métis (FNIM) youth mental health at a Federal level. By analysing the narrative used throughout this document one can learn how the solutions proposed may actually be failing to address the root causes of the issue at hand. Using Carol Bacchi’s WPR (What’s the Problem Represented to be?) approach, it will become evident as to why these responses are not wholly conducive to achieving better mental health outcomes for Indigenous youth. Following this discussion, I will highlight the progress that is being made in various Indigenous communities in a variety of culturally relevant, safe, and sensitive ways. Communities who are thriving and who are working towards positive change for youth are the experts in this case, as they have the knowledge and are taking up practices which are created from themselves, not for them. These practices have the potential to influence policy, as they are paving the way for a better response in cases of Indigenous youth suicide. When systems are put in place that truly benefit the community, this has a profound effect by influencing community members, researchers, academics, and policymakers alike, and also highlights the shortcomings of existing governmental action. As a non-Indigenous person, I engaged in reflexivity throughout my research and situate myself as an ally.
Open Access
Let's Talk About 'fat': Conceptualization of Obesity in Canada, the Role of Social Determinants of Health & Neoliberal Policies
(2015-08-26) Medvedyuk, Stella; Raphael, Dennis; Daiski, Isolde
In the last twenty years, obesity has become a major concern in the public health and academic literatures. Most of this literature stems from a biomedical and behavioural/lifestyle perspective. However, parallel to this view emerged a different approach which questioned the validity of the obesity ‘epidemic’. This Major Research Paper (MRP) focuses on how obesity is conceptualized in Canada by analyzing two governmental and one non-government report through use of qualitative content analysis. A critical analysis of these reports will use Labonte’s (1993), supplemented by Raphael, framework of biomedical, behavioural/lifestyle, socio-environmental and critical structural approaches. It explores whether social determinants of health play a role in these reports. And lastly, a political economy approach is used to explore how the Canadian political climate with its neoliberal public policy reforms formulates and influences strategies proposed to ‘treat’ obesity.
Open Access
The Liberal Party of Canada’s Proposal for Nationwide Universal Pharmacare: Informing the Path Forward Via International Comparison
(2021-11-12) Wadhawa, Sapna; Raphael, Dennis; Chaufan, Claudia
In 2019, the Liberal Party of Canada (LPC) tabled the most recent proposal (Hoskins Report) for nationwide Pharmacare. It made sixty recommendations on how to achieve universal drug coverage in Canada. Since the 1943 draft proposal for public health insurance, several periodic proposals for nationwide Pharmacare have been put forward at the federal level. A narrative review of these proposals established nationwide Pharmacare is once againon the table federally. To inform the path forward, this study compared the Canadian approach to prescription drug coverage with that of the United Kingdom (UK). Canada and the UK were compared in three clusters: (a) the levels and sources of expenditures on prescription drugs; (b) the levels and distribution of pharmaceutical insurance associated with prescription drug spending; and (c) the health outcomes “produced.” Recommendations were then provided for implementation of nationwide Pharmacare. I argue that a rapidapproach is needed by the federal governmentto implement the service. The steps taken towardsa Pharmacare inclusive Medicare systemmust be fast-tracked. This type of system is observed to be the norm in high income countries. Several findings indicated poor trends in health system performance and production of health inequalities under the current system for prescription drug coverage. The Hoskins Report concretely places Pharmacare on the political agenda, creating a window of opportunity for the federal government to employ a rapidapproach.
Open Access
NAFTA - The Politics Behind Drug Production
(2018-02-16) Mohamed, Faisal Ali; Chaufan, Claudia; Raphael, Dennis
In the year 1993, the Canadian federal government ratified the North American Free Trade Agreement (NAFTA), with the ostensible purpose of improving trade relations and economic prosperity for the country. For ratification to proceed, and in response to pressure from the pharmaceutical industry, between 1987 and 1993 significant changes were made to Canada’s Patent Act. Changes included the elimination of a system of compulsory licensing and the strengthening of intellectual property rights (IPRs). Compulsory licensing allows competitors to produce drugs still under patent without the consent of the patent holder, if public interest, such as a public health emergency, warrants it, thus challenges drug monopolies and leads to lower prices, whereas intellectual property rights have the opposite effect – they lengthen patent protections, thus shielding patent holders from competition and leading to higher prices. The pharmaceutical industry strongly opposed compulsory licensing, and lobbied for strong IPRs, arguing that research and development (R&D) required for pharmaceutical innovation involved high risks and costs and that weak IPRs (weak by their standards) undermined job creation by the industry. Since then, R&D risks, in Canada and elsewhere, have all but decreased, the promised jobs are nowhere to be seen, and increasing drug prices have led to medication non compliance on the part of a growing number of Canadians, with significant impact on the public’s health. This paper argues that to ratify NAFTA, laws were changed by the federal government to align with US IPR laws and serve the interests of transnational drug corporations, by creating an environment in which they could easily monopolize the national drug market, thus undermining the interests of the vast majority of Canadians. In so doing, the federal government has done an injustice to taxpayers, who were de facto made to subsidize unreasonable prices for Big Pharma, while the promises of increased Canadian R&D investments or job creation were never fulfilled. I aim to answer three questions: 1) Why is drug development treated as a market good rather than a public good or service? 2) How do provisions within NAFTA, a treaty signed by representatives of the Canadian state, deal with the tension between private corporate interests and public needs? 3) What discursive mechanisms within NAFTA legitimize private intervention and drug development and production? I perform a critical discourse analysis (CDA) on relevant key provisions from Chapter 17 of NAFTA as a means of answering these questions.
Open Access
Pathologizing Abuse: Examining Public Health Approaches to Addressing Intimate Partner Violence in Canada
(2018-10-24) Nandakumar, Manasi; Raphael, Dennis; Ahmad, Farah
This paper aims to examine the medicalization of intimate partner violence (IPV) using critical political economy, feminist political economy and Foucault’s theory of power. A critical discourse analysis of publications released by public health and medical associations reveal explanations of IPV that avoid addressing the socio-political context in which family violence takes place. Additionally, the limiting epistemological frameworks guiding medical and public health disciplines give rise to professional and societal discourses that remain uncritical of larger political and social structures that perpetuate inequalities. Biologically and psychologically rooted theorizations of violence are shown to perpetuate a victimization model that places the locus of change at the individual. Drawing from concepts of decommodification and defamilisation, the MRP will explore the role of the Canadian welfare state in facilitating women’s dependency on the family. I argue that current approaches and initiatives proposed in the Chief Public Health Officer’s (CPHO) Report on the State of Public Health in Canada 2016: A Focus on Family Violence in Canada, A Year in Review: Canada’s Strategy to Prevent and Address Gender-Based Violence, the Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable adults: U.S. Preventive Services Task Force Recommendation Statement and the Intimate Partner Violence Consensus Statement by the Society of Gynecologists and Obstetricians of Canada fails to address the overall poor social standing of women that arises from inequitable macro-social policies. Findings of the analysis elucidate the ways in which abused women are further disenfranchised by policies informed by medical and public health discourses.

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