On October 21st , 2005 the Supreme Court of Canada ruled that immigration officials “can no longer assess potential immigrants to be ‘medically inadmissible’ to Canada solely on the basis of a person’s disability” and their likelihood to make “excessive demands on Canadian social services” (Chadha 2005, 1). In this thesis I will explore this ruling using a methodological approach that engages practices of: self-reflexivity; tracing historical and political genealogies; and case study analysis. What I am interested in thinking about is how this moment gestures to the necessity of conceptualizing the nation, nationalism, and citizenship as highly medicalized terrains. Through an engagement with transnational and black feminist theorizing, anticolonial studies, and disability studies, I will suggest that “medical inadmissibility” is one of many regulatory mechanisms that work to fashion the Canadian nation-state as white, healthy, fit, and productive.

On October 21st , 2005 the Supreme Court of Canada ruled that immigration officials “can no longer assess potential immigrants to be ‘medically inadmissible’ to Canada solely on the basis of a person’s disability” and their likelihood to make “excessive demands on Canadian social services” (Chadha 2005, 1). In this thesis I will explore this ruling using a methodological approach that engages practices of: self-reflexivity; tracing historical and political genealogies; and case study analysis. What I am interested in thinking about is how this moment gestures to the necessity of conceptualizing the nation, nationalism, and citizenship as highly medicalized terrains. Through an engagement with transnational and black feminist theorizing, anticolonial studies, and disability studies, I will suggest that “medical inadmissibility” is one of many regulatory mechanisms that work to fashion the Canadian nation-state as white, healthy, fit, and productive.

Drawing on ethnographic and visual anthropological data, this dissertation explores the anticipated and unanticipated effects of youth-targeted health and development programmes in rural Malawi. Contemporary development programmes are anticipatory in nature: they are focused on managing health, behaviour, education and social relations today in ways that are believed to open opportunities for some distant and better future. Working with rural youth who “just stay,” an idiom youth use to describe their “failure” to make progress towards desired futures, I show how discourses and ideals espoused in anticipatory programmes including human rights, education, gender and love are slippery concepts. As they percolate through this particular social, political, historical and demographic context and into the imaginaries of young people, these discourses often become something new and unexpected. In particular I show how: i) a discursive elision occurs between the rights discourse and other markers of modernity and youth take up their “right” to wear modern clothing and drink commercial alcohol, ii) selfish behaviours including alcoholism and womanising surface in boys’ self-constructions as innate tendencies rather than part of a socially produced and constantly shifting construction of masculinity, iii) audit cultures, critical to the operation of anticipatory programmes, reduce gender equality to something “countable,” which, in turn, alters programme activities, leads to performances by participants and filters into youth subjectivities, and iv) discourses on modern and “healthy” loves, free from HIV/AIDS, lead to re-arrangements in romantic relations and friendships that provide new and positive opportunities for women not always available in customary marriages. By privileging the future over the present and the past, programmes overlook numerous structural barriers to improving the lives of the youth who “just stay.” I argue that the unanticipated effects of these programmes constitute and give rise to several invisible forms of violence. On the other hand, however, some effects are generative of new and positive subjectivities and relationships that are egregiously overlooked by programmes. This ignorance prevents programmes from building upon positive effects to generate desired change and sometimes even undermines their own stated goals.

This study aims to examine how the migration experience influences newcomer mothers’ young child feeding and care practices and their children’s overall health. The thesis comprises three separate manuscripts, each of which examines one of the three intermediate determinants of the nutritional status of young children (UNICEF 1990): access to healthcare, household food insecurity, and child feeding and care practices. The research was conducted in Toronto’s Jane-Finch neighbourhood, a suburban neighbourhood home to a high density of newcomers. Thirty-two participants (16 Sri Lankan Tamil and 16 Latin American) who had migrated to Canada within the past five years as refugee claimants or family sponsored immigrants participated in the study. Data collection consisted of semi-structured interviews with women from low-income households who had a child between the ages of 1 and 5 years. Spanish and Tamil speaking interviewers interviewed each participant two or three times. Data was analyzed using a mid-level approach in which broad analytical themes are determined prior to analysis and specific themes were then generated based on participants’ perspectives and are grounded in the data. The first manuscript examines newcomer mothers’ experiences accessing physicians for their children and identifies the major gaps between mothers’ expectations and their actual experiences that lead to barriers in communication and overall patient dissatisfaction. The second manuscript demonstrates that mothers’ past experiences with food insecurity affect two aspects of the construct of food insecurity: its managed aspect and its temporal nature. This finding has implications for the measurement of food insecurity in newcomer populations. The third manuscript reveals that newcomer mothers are exposed to several parallel and often conflicting systems of knowledge concerning health and nutrition for their children, and that their utilization of Canada’s Food Guide is impeded by its failure to acknowledge alternate parallel knowledge systems. These findings can be applied to the development of social and health policy aimed at improving cultural competency in healthcare and nutrition education and at ameliorating the income constraints leading to household food insecurity.

Drawing on ethnographic and visual anthropological data, this dissertation explores the anticipated and unanticipated effects of youth-targeted health and development programmes in rural Malawi. Contemporary development programmes are anticipatory in nature: they are focused on managing health, behaviour, education and social relations today in ways that are believed to open opportunities for some distant and better future. Working with rural youth who “just stay,” an idiom youth use to describe their “failure” to make progress towards desired futures, I show how discourses and ideals espoused in anticipatory programmes including human rights, education, gender and love are slippery concepts. As they percolate through this particular social, political, historical and demographic context and into the imaginaries of young people, these discourses often become something new and unexpected. In particular I show how: i) a discursive elision occurs between the rights discourse and other markers of modernity and youth take up their “right” to wear modern clothing and drink commercial alcohol, ii) selfish behaviours including alcoholism and womanising surface in boys’ self-constructions as innate tendencies rather than part of a socially produced and constantly shifting construction of masculinity, iii) audit cultures, critical to the operation of anticipatory programmes, reduce gender equality to something “countable,” which, in turn, alters programme activities, leads to performances by participants and filters into youth subjectivities, and iv) discourses on modern and “healthy” loves, free from HIV/AIDS, lead to re-arrangements in romantic relations and friendships that provide new and positive opportunities for women not always available in customary marriages. By privileging the future over the present and the past, programmes overlook numerous structural barriers to improving the lives of the youth who “just stay.” I argue that the unanticipated effects of these programmes constitute and give rise to several invisible forms of violence. On the other hand, however, some effects are generative of new and positive subjectivities and relationships that are egregiously overlooked by programmes. This ignorance prevents programmes from building upon positive effects to generate desired change and sometimes even undermines their own stated goals.

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

Si le nombre de nouveaux cas de tuberculose au Québec a considérablement baissé au cours des dernières décennies, l’épidémiologie mondiale rappelle toutefois que cette maladie est responsable de plus de deux millions de morts par an. Au Canada, certains groupes seraient plus vulnérables, notamment les immigrants provenant de pays où la tuberculose est endémique. La Clinique de tuberculose du Centre hospitalier universitaire Sainte-Justine est un outil de lutte active contre cette maladie, entre autres grâce à son programme de dépistage scolaire auprès des enfants immigrants. Ce dépistage vise à identifier les porteurs de la tuberculose latente, c’est-à-dire la forme non contagieuse de la maladie. Un traitement préventif de neuf mois est offert aux enfants qui présentent un résultat positif afin de prévenir le développement de la tuberculose maladie (forme active). Dans 28 % des cas, ce traitement n’est pas adéquatement complété et dans 11 % des cas, il est refusé. La présente étude porte à la fois sur la question de l’observance thérapeutique et sur les conditions de vie post-migratoires. L’observation de consultations à la Clinique de tuberculose et les entrevues auprès des soignants et des familles ont engendré une réflexion sur la prévention de la tuberculose en contexte migratoire de même que sur le caractère multifactoriel de la non-observance thérapeutique. L’analyse des données fait ressortir l’impact du vécu migratoire et des conditions de vie (le logement, l’emploi, la maîtrise de la langue, etc.) sur la prise irrégulière du médicament, permettant une meilleure compréhension de ce comportement (chapitre 4). Il a également été possible de documenter une distinction entre les conduites (l’observance) et les attitudes (l’adhésion) nuançant la compréhension des diverses trajectoires thérapeutiques à l’aide de rationalités plurielles et diversifiées (chapitres 5 et 6). Il s’en dégage une réflexion sur le caractère normatif de la catégorisation de « groupe » et de « comportement » à risque laissant place aux différents univers référentiels et, plus globalement, aux conditions de vie des familles (chapitre 7). / While the number of new tuberculosis cases in Quebec has dropped considerably in recent decades, global epidemiology nonetheless shows that this disease is responsible for more than two million deaths every year. In Canada, some groups are more vulnerable than others; for example, immigrants from countries where tuberculosis is endemic. The Clinique de tuberculose du Centre hospitalier universitaire Sainte-Justine constitutes an active tool in the fight against this disease, notably through its school screening program for immigrant children. This screening identifies carriers of latent tuberculosis, i.e. non-contagious form of the disease. A nine-month preventive course of treatment is provided to children with a positive result so as to forestall the development of tuberculosis disease (active form). In 28 % of cases, this treatment is not completed properly and in 11 % of cases, it is declined. This study focuses on both the issue of medical compliance and post-migration life conditions. Observations of consultations at the Tuberculosis Clinic and interviews with caregivers and families have led to a reflection on the prevention of tuberculosis in the context of migration, as well as the multifactorial nature of non-compliance. Data analysis reveals the impact of migration and living conditions (e.g. housing, employment and language proficiency, etc.) on the irregular intake of medication, allowing for a better understanding of this behaviour (Chapter 4). It was also possible to document a distinction between behaviour (compliance) and attitudes (adherence), nuancing the understanding of various therapeutic trajectories using multiple and diverse rationalities (Chapters 5 and 6). All this allows for reflection on the normative nature of categories such as "risk groups" and "risk behaviour", while leaving room for different referential universes and the impact of the overall living conditions of families (Chapter 7).

Le diagnostic de prédisposition génétique du cancer du sein et de l’ovaire est détenu par la firme de biotechnologie Myriad Genetics depuis 1996, sous la forme d’un brevet, qui lui octroie une licence d’exploitation internationale, infirmant le droit d’analyse moléculaire aux autres laboratoires. Ce monopole, lui permet de statuer sur un prix excessivement plus élevé qu’en milieu public et d’astreindre en justice, les laboratoires contrevenants. Depuis 2001, le Québec est la seule province qui se soumet (en partie) au brevet, en faisant appel à la compagnie pour le séquençage complet. À travers cette recherche, j’analyse les politiques de brevetage génétique, dans sa construction juridique de la propriété intellectuelle et dans les significations culturelles des biotechnologies. Je m’appuie sur un cadre analytique des théories de propriété et sur la recherche en biomédical. Je procède également à l’analyse du discours des médecins et conseillers généticiens au Québec, à travers des entrevues conduites dans des centres hospitaliers de la région de Montréal et de Sherbrooke. Cette étude qualitative identifie comment les conseillers et médecins généticiens conçoivent le rôle des brevets dans les dépistages et diagnostics du cancer et comment les brevets génétiques expriment une culture médicale. Je cherche à déterminer comment sont perçus par des professionnels de santé les brevets génétiques en analysant et en comparant les variations entre limites idéologiques et limites pratiques. / The biotechnology company Myriad Genetics owns the diagnosis of genetic predisposition of breast and ovarian cancer since 1996. The patent, which grants an international license, reverses the right of molecular analysis by other laboratories. This monopoly allows the company to apply an excessively higher price than public laboratories and pursue the offenders in justice. However, since 2001, Quebec is the only province to respect (in part) the patent, using the company for the complete sequencing. This research analyzes the gene patent politics in its legal structure of intellectual property and the cultural meanings of biotechnology. I rely on an analytical framework of theories of property and biomedical research. I also proceeded to the discourse analysis of physicians and genetic counsellors in Quebec through interviews conducted in hospitals in the region of Montreal and Sherbrooke. This qualitative study identifies how doctors and genetic counsellors analysis the role of patents in the screening and diagnosis of cancer and how genetic patents express a medical culture. The study aims to explore how gene patents are perceived in analyzing and comparing the variations between ideological limits and practical limits.

Ce mémoire s’inscrit dans un contexte où les inégalités sociales ne cessent d’augmenter. Dans les sociétés occidentales, le fossé entre les riches et les pauvres se creuse de plus en plus et celui-ci influence les inégalités de santé. À Montréal, il existe un écart d’espérance de vie de plus de dix ans entre les résidents des quartiers les plus riches et ceux des plus pauvres. Ce mémoire se penche sur ce phénomène en s’attardant aux liens entre les inégalités de santé et le sentiment d’appartenance des résidentes d’Hochelaga-Maisonneuve. À travers l’analyse d’un corpus de données recueillies par une recension des écrits, par des entretiens semi-dirigés ainsi que par des séances d’observations participantes, des pistes de réflexion à ce sujet s’en dégagent. Après avoir exposé une recension des écrits brossant les principaux concepts utilisés dans ce mémoire, ainsi qu’un cadre méthodologique décrivant la cueillette de données et le contexte de l’étude, la perception qu’ont les répondantes de leur santé, ainsi que les facteurs y contribuant sont adressés. Les inégalités de santé étant comprises au-delà de leur aspect individuel, ce projet met de l’avant l’importance des environnements physique et social ainsi que des dynamiques d’inclusion et d’exclusion sur la création de celles-ci. / This thesis was conducted amidst a context of growing social inequalities. In our western societies the gap between rich and poor is widening which influence health inequalities. In Montreal, there is a ten year gap in life expectancy between rich and poor. This thesis is linking health inequalities with a sense of belonging of women living in Hochelaga-Maisonneuve, an area of Montreal. Through datas, gathered by litterature review, interviews and participant observation, we opened up areas to think about our theme. First of all, we write a literature review which describes the basic concepts as health, sense of belongings and social inclusion or exclusion, of this project. The methodology is explained through data collection and the context of the study. After, health is studied through women’s perception and factors which are contributing to it. The fourth chapter is studying the impact of physical and social environment on health. Finally, social exclusions are linked with health inequalities. Consequently, this project is not only understanding health inequalities by their individual aspects.