This thesis extends prior research on LGBT caregivers and carer-employees by employing a mixed-methods approach to investigate the intersecting factors of identity, employment type, and geographical location on the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) caregivers in Canada. These caregivers are broadly absent from both the carer-employee and LGBT caregiving literature, and this dissertation offers an initial attempt to correct this. It begins with a quantitative study involving 2SLGBTQ+ carer-employees, assessing how their identity and experiences of discrimination influence their quality of life, work life, and willingness to seek workplace accommodations for caregiving responsibilities. Subsequently, a qualitative component delves into how employment type shapes these experiences, with a particular focus on how insecure customer service workers and those employed in unionized pink-collar work navigate work-care conflicts. This section also examines the impact of non-traditional caregiving dynamics on the ability of these caregivers to navigate such conflicts. Lastly, it explores how past and current experiences of discrimination, non-conventional relationships, and geographical location affect the capacity of 2SLGBTQ+ carer-employees to interact with healthcare providers and advocate for their care recipients. This research offers a substantial contribution by bringing to the forefront a hitherto unaddressed population. The existing body of literature on carer-employees has overlooked the specific challenges faced by 2SLGBTQ+ carer-employees, and the LGBT caregiving literature has similarly overlooked the role of employment in shaping the experiences of these caregivers. Furthermore, it underscores the significance of geographical location for 2SLGBTQ+ caregivers in rural and remote areas and highlights the experiences of midlife and younger caregivers, particularly those providing care for individuals experiencing severe mental illness. It concludes with discussions of the policy implications of this research. / Dissertation / Doctor of Philosophy (PhD) / This thesis examines and explores the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) carer-employees in Canada. These caregivers balance their unpaid care work with their paid employment, and face barriers when navigating care and work that are related to their 2SLGBTQ+ identity. Building on research that has identified that LGBT caregivers have unique needs and characteristics, and on research that highlights that individuals attempting to balance unpaid care work with paid employment face significant challenges when attempting to do so, this research brings these two fields together to examine how 2SLGBTQ+ identity impacts these experiences. In particular, it highlights that these caregivers experience poorer quality of life and worklife, that type of work and non-traditional caregiving dynamics may leave these caregivers more vulnerable to negative consequences associated with work-care conflicts, and that experiences of discrimination and concerns regarding confidentiality and anonymity for rural and northern 2SLGBTQ+ caregivers shape their ability to successfully navigate healthcare systems.

<p>Obesity is a major public health issue across all age groups. The obesity-related health outcomes of children and adolescents are unique and varied, and therefore need to be studied separately. In response, obesogenic environments have been the focus of attention in recent research. Important contributions have been made to focus on social (e.g., economic) and physical (e.g., geographical) environments based on their role in either hindering or facilitating opportunities for healthy eating. However, research on the policy environment is noticeably absent. Schools have been the setting for focused interventions, particularly in the area of obesity and nutrition. However, there is a paucity of research in this area in Ontario, and virtually no Canadian research has examined the secondary school setting. Therefore, this research focuses on local level factors shaping school nutrition policy implementation in Ontario, Canada.</p> <p>The Analysis Grid for Environments Linked to Obesity (ANGELO) Framework was adopted to organize and conceptualize the local level policy environment. In the first phase of the study, a documentary analysis was undertaken to investigate the relationship between regional and upper level policies and technical reports. Results reveal distinct differences across federal, provincial and regional levels, including: 1) the availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels; 2) federal and provincial priorities are guided by a health promotion framework, and a partnership approach to policy implementation; and, 3) gaps in regional level policy include incorporating nutrition education in the curriculum, and making the link between nutrition and obesity.</p> <p>The second phase of study includes qualitative key informant interviews with community-and school-level school nutrition policy and program stakeholders (n=22) in nine schools three Ontario school boards, in order to understand local level factors shaping school nutrition policy implementation. The cost of healthy food for sale, revenue loss (economic), proximity of schools to off site food outlets (physical), the restrictive nature of policy, and the role of key stakeholders (political), the role of stigma and school culture (sociocultural), act as local level barriers to policy implementation. Findings suggest the need for consultation and communication between stakeholders, and strategies to reduce stigma and improve the school nutrition culture.</p> <p>In the third and final phase of study three focus group interviews were conducted with secondary students (n=20) in two Ontario school boards in fall 2012. School boards were selected to represent both high-and low-income neighbourhoods. Results reveal high priced policy-compliant food for sale, lower revenue generation capacity, and more students purchasing food off-campus at nearby outlets. Limited designated eating spaces, and time constraints act as local level barriers to healthy eating. Student input on cafeteria menus and school community gardens, can facilitate healthy school nutrition environments. Community partnerships with key external stakeholders are needed to leverage financial and human resources to support school nutrition. Future policies need to consider the social context and conditions surrounding school nutrition. This research makes a number of theoretical, methodological and substantive contributions to the public health, adolescent health, and school health policy literature. Policy implications and future research directions are provided.</p> / Doctor of Philosophy (PhD)

Roughly 35% of employed Canadians are currently informal caregivers — defined as “an individual who provides care and/or support to a family member, friend or neighbour who has a physical or mental disability, is chronically ill or is frail” (Williams, Eby, Crooks, Stajduhar, Giesbrecht, Vuksan, Cohen, Brazil, & Allan, 2011, p. 3). These worker-carers are mostly women and often experience negative impacts on their physical, mental, emotional, social, and economic well-being. The impact on employers is also staggering (Fast, Lero, DeMarco, Ferreira, & Eales, 2014). With the number of seniors requiring such care expected to double by 2031, this is a growing issue for Canadians (Williams, et al, 2011). With the assistance of a Technical Committee of experts, chaired by Dr. Williams from McMaster University, the Canadian Standards Association and McMaster University have developed a Standard for Caregiver Inclusive and Accommodating Workplaces. This has been realized through funding provided by the CIHR/SSHRC Partnership Development Grant addressing Healthy, Productive Workplaces. This research seeks to conduct an Enhanced Public Review of the Caregiver Inclusive and Accommodating Standard through the completion of interviews (n=17) with key stakeholders across Canada. Semi-structured interviews were conducted from May to July 2017. After reading a draft of the Standard, interviewees were asked about: the viability of implementation of the Standard; what they liked about it, and what they would change, as well as; how it met with the mandate of their own organization. Interviewees represented the senior leadership of a wide variety of organizations including: human resources; caregiver support; unions; white-collar industry; healthcare, and; municipal governments. Following transcription and coding of the interviews using thematic analysis, five major themes emerged. First, the Standard is a necessary tool in today’s world. Second, though it is an important tool, it is more likely to be used as an educational tool than to be actually implemented by most organizations. Third, organizations are not likely to implement the Standard for a variety of reasons. For example, small to medium sized organizations do not have the resources or capacity to implement and, given that large organizations already have policies in place, they will view the voluntary Standard as superfluous. Fourth, there is a significant divide in perceptions of sex and gender as relevant to the issue of caregiving and the necessity of supports such as the Standard. Finally, organizations may be motivated to implement the Standard and/or use it as an educational tool in exchange for tax breaks or insurance incentives, awards and recognition, or for grants to assist in developing and implementing policies related to the Standard. We conclude that although there are many barriers to implementation of the Standard, it is a useful and timely tool for organizations to use in order to better support their employees who are engaged in carer roles. Incentivizing implementation may encourage more participation in this program and thus greater support for worker-carers. This is especially important as more than half of carers are women, and women in caregiving roles are more likely to spend much more of their time in that role, meaning that this will keep more women engaged in the labour force, prevent burnout, and support better health outcomes (Sinha, 2012). / Thesis / Master of Arts (MA) / People who are caring for an elderly or sick relative or friend (worker-carers) make up a significant portion of the Canadian workforce. The Canadian Standards Association has developed a voluntary standard for employers to provide accommodations that make working more accessible to employees who are balancing their job with their caring responsibilities. This research assesses the necessity of this Standard and the likelihood that it will be implemented by employer across the country.

This thesis examines the susceptibility of human health to climate-related stresses in the rural municipality of Addington Highlands, Ontario. Human health is sensitive to climatic variations and change, and public health systems play a role in managing climate-related risks. Canada is generally deemed to have considerable capacity to adapt to vulnerabilities associated with climate change, yet there is variability among communities in their exposure and ability to manage health risks. This thesis examines the health-related vulnerability of the community of Addington Highlands. Drawing upon data gained from key informant interviews and newspaper articles, as well as other secondary data sources, the thesis documents climate-related health risks, outlines the programs and services available to deal with those risks, and assesses the capacity of the community to adapt to future climate conditions and risks. Conditions such as storms, heat stress and forest fires currently present health risks in the area, and they are expected to become more prevalent with climate change. The health risks of Lyme disease, West Nile virus and algal blooms are likely to increase in the future as the climate continues to change. Adaptation to these risks is evident in several of Addington Highlands public health and emergency management programs. The community’s adaptive capacity is strengthened by its social networks and institutional flexibility, but it is constrained by its aging population, limits to the availability and access to health care services, and challenges relating to the retention of service providers. An important strategy to assist adaptation to climate change risks to health is the promotion of public awareness, a strategy to which this research contributes. This thesis research serves to identify and better understand vulnerabilities, and help stimulate actions toward preparing Addington Highlands for possible future climate-related risks.

As leishmanioses são doenças consideradas antropozoonoses, ou seja, doenças primárias de animais que podem ser transmitidas ao homem. São causadas por microorganismos do gênero Leishmania e transmitidas através da picada de flebotomíneos, que são insetos alados da ordem Diptera (mesmo grupo das moscas, mosquitos e borrachudos). Apresentam-se sob duas formas clínicas: Leishmaniose Visceral ou Calazar (LV) e Leishmaniose Tegumentar Americana (LTA). As leishmanioses apresentam distribuição geográfica vasta pelo Velho e Novo Mundo, sendo estimado dessa maneira que aproximadamente 350 milhões de pessoas estejam sob iminente risco de contrair algum tipo de leishmaniose. No Brasil, as leishmanioses são encontradas em todas as unidades federadas, e o estado do Rio de Janeiro vem apresentando franca expansão dessas doenças em áreas urbanas, devido principalmente ao desmatamento ocasionado pela expansão não planejada da malha urbana. Nesse contexto, faz-se necessário desenvolver estudos sobre o espaço e o processo saúde-doença, relação estabelecida pela Geografia da Saúde, a fim de que se compreenda a correlação entre o homem e o ambiente vivido. / The leishmaniasis are diseases considered as zoonosis, primary diseases of animals which can be transmitted to humans. They are caused by microorganisms of the Leishmania genus and transmitted by the phlebotominaes pitch: these are winged insects from the Diptera group (Psycodidae;Plebotominae;Lutzomyia). They are presented in two clinical forms: Visceral Leishmaniasis or Kala-azar - VL and Cutaneous Leishmaniasis - CL. The leishmaniasis have wide geographic distribution throughout the Old and New World and it has been estimated that about 350 million people are under imminent risk of contagious of some type of leishmaniasis. In Brazil, the leishmaniasis are found in all the federated units, and the state of Rio de Janeiro has been presenting an increasing number of these diseases in urban areas, mainly due to deforestation caused by unplanned expansion of urban zones. In this context, it is necessary to carry out studies on space and the health-disease relationship established by the Health Geography, in order to explain the relationship between man and the environment, to determinate the spatial elements and social determinants that compose this relationship. Therefore, the main objective of this research is to discuss the health-disease process in the ambit of Geographic science in the actuality, looking up to demonstrate the distribution of the leishmaniasis in Rio de Janeiros state on the 2000-2010 period. It was verified at the end of the study that the VL-kind presents a regular standard of distribution in the state and the CL-kind are more likely an irregular default of distribution. Although, for the analyzed period, it has been pointed the presence of the CL-kind in areas like Rio de Janeiros Metropolitan and Costa Verde (Green Coast) Regions, a fact that deserves attention because of the high/expressive tourist vocation and activity of those.

This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children.

This thesis examines the susceptibility of human health to climate-related stresses in the rural municipality of Addington Highlands, Ontario. Human health is sensitive to climatic variations and change, and public health systems play a role in managing climate-related risks. Canada is generally deemed to have considerable capacity to adapt to vulnerabilities associated with climate change, yet there is variability among communities in their exposure and ability to manage health risks. This thesis examines the health-related vulnerability of the community of Addington Highlands. Drawing upon data gained from key informant interviews and newspaper articles, as well as other secondary data sources, the thesis documents climate-related health risks, outlines the programs and services available to deal with those risks, and assesses the capacity of the community to adapt to future climate conditions and risks. Conditions such as storms, heat stress and forest fires currently present health risks in the area, and they are expected to become more prevalent with climate change. The health risks of Lyme disease, West Nile virus and algal blooms are likely to increase in the future as the climate continues to change. Adaptation to these risks is evident in several of Addington Highlands public health and emergency management programs. The community’s adaptive capacity is strengthened by its social networks and institutional flexibility, but it is constrained by its aging population, limits to the availability and access to health care services, and challenges relating to the retention of service providers. An important strategy to assist adaptation to climate change risks to health is the promotion of public awareness, a strategy to which this research contributes. This thesis research serves to identify and better understand vulnerabilities, and help stimulate actions toward preparing Addington Highlands for possible future climate-related risks.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

O conjunto de técnicas de Geomática tem sido um poderoso aliado no apoio à tomada de decisões e manipulação de dados espaciais. Nas últimas décadas tornou-se quase indispensável na gestão de recursos humanos e recursos naturais. Na área da Saúde, a Geomática tem viabilizado estudos sobre: análise da distribuição de pacientes; variações na ocorrência de epidemias; monitoramento de vetores; avaliação em tempo real de situações de emergência ou catastróficas, entre outros. A associação da Medicina com a Geografia é antiga. A associação entre a saúde e a espacialização das doenças deve considerar a estruturação física do espaço geográfico a partir da caracterização de cada parte componente do sistema como preconiza a perspectiva sistêmica na Teoria Geral de Sistema, pois a população é parte integrante do espaço geográfico no qual ocorrem determinados agravos à saúde. Nestes pontos recai a relevância da presente pesquisa. O estudo foi desenvolvido na área da Bacia Hidrográfica de Jacarepaguá no município do Rio de Janeiro. Com aproximadamente 295 km2 é composta por 19 bairros e tem uma população aproximada de 682000 habitantes. O estudo pretendeu estruturar uma metodologia para inserção das técnicas de Geomática na prática de análises de dados de saúde, apoiada na Teoria Geral de Sistemas, visando contribuir no processo de vigilância ambiental em saúde permitindo realizar um prognóstico de situações de risco de determinada população. A base cartográfica que apoiou o estudo foi construída através de cartas topográficas da DSG na escala 1:50000. Das cartas foram retiradas informações de planimetria relevantes ao estudo e as informações de altimetria que foram utilizadas na elaboração do modelo digital de terreno (MDT). Com o MDT foi gerado o mapa de declividade por grau que permitiu criar divisões em 5 classes para posterior geração de mapas temáticos com os dados de saúde. Os dados de saúde foram retirados do Sistema de Informações de Notificação de Agravos (SINAN) disponibilizado pelo Ministério da Saúde. A doença analisada foi a leptospirose. Os casos foram localizados pontualmente a partir dos endereços de residência. A hipótese aventada neste estudo era a existência de um alto grau de correlação entre as partes componentes representadas pela estruturação física do espaço e a ocorrência de leptospirose. Com os resultados comprovou-se a hipótese nula, pois somente ocorrem doenças em áreas associadas ao Fundo Chato da Baixada de Jacarepaguá e nos Declives Suaves dos Morros Isolados, também localizados no Subsistema Baixada. Isto demonstra que em termos desta doença existe uma ausência de população nesta componente espacial em áreas de maiores declividades. / The collection of Geomatics techniques has been a powerful allied to support space data decisions and handling. Last decade, it almost became essential to human and natural resources management. For health, Geomatics has made feasible some researches, such as: analyses about patients distribution, epidemics occurrence variation, vector tracking, assessment about emergency or catastrophic situations in real time, among others. The association between Medicine and Geography is old. The association between health and spacialization of diseases may consider the physical structure of geographic space from characterization of each systems component part as the systemic perspective spreads in General System Theory seeing that the population is part of geographic space which occur some health disorders. Therefore, these facts are the importance of this research that was developed in Baixada de Jacarepaguá, Rio de Janeiro. This place has approximately 295 Km2 and it is compounded by 19 neighborhoods which have an estimate of 682000 inhabitants. The research intended to structure a methodology to insert Geomatics techniques into practice of health data analyses, supported by General System Theory, aiming to contribute in the process of environmental monitoring in health which allows a prognosis about situations of risks of certain population. The basic mapping that supported this study was built by topographic charts of DSG on the scale 1:50000. From these charts, planimetry details were taken off and also altimetry information that were used in the development of digital terrain model (DTM). With DTM, the slope mapping by percentage was done and it allowed the creation of compartments in five classes for subsequent generation of thematic maps with health data. The data of this study were found in health information systems released by the Ministry of Health. The analyzed disease was leptospirosis. And its cases were located from addresses of residence. The hypothesis raised here was the existence of high correlation among component parts represented by physical structure of space and the occurrence of leptospirosis. By the results, it was proved the void hypothesis because diseases only happen in areas which are associated with plain area of the coastal bas of Jacarepaguá and the suave hillside of the hillock, both in subsystem coastal bas. It demonstrates that in terms of leptospirosis, an absence of population exists at this space component in areas of major steepness.