Pregnant and postpartum women often face high levels of psychological stress that increase the risk of common mental disorders (CMDs), such as depression and anxiety. This stress is often not met with timely mental health care and, therefore, may create health inequities. Mobile technology-assisted interventions represent a new opportunity for pregnant and postpartum women that may address health equity, especially during and after the COVID-19 era. We conducted an equity-focused systematic review and included 18 randomized and non-randomized controlled trials for analysis. Our results suggest that mobile interventions can prevent and manage depression across ethnicities and carry the potential to reduce psychological distress. Evidence on anxiety and utilization of care was limited and more research is needed among pregnant adolescents. Our collaborative research approach highlights the potential of mobile technologies and the need for active involvement of patients and other stakeholders in the co-creation and evaluation of mobile interventions.

It has been said that those with the least are often the ones with the most to give. This proved to be true for a Syrian refugee turned cardiologist who provides care in communities that are poor and underserved including refugees, immigrants, minorities, those of low socioeconomic status, and other vulnerable populations. Dr. Heval Kelli is the epitome of a kind-hearted, humble, genuine hero, through his dedication to serving humanity. Between providing health care to those in need, educating future generations of doctors, mentoring high school students, and advocating for the less fortunate, his life is truly his message to the world.

Introduction: Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. Methods: Thus, the current study utilized responses from the Treatment Episodes Data Set–Discharges, 2015–2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. Results: Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. Conclusions: The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.

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Context: Data, primarily from the United States, indicates that Black women experience delays in breast cancer treatment, receive non-standard care, and have a lower survival rate. Canada is not immune to racial disparities, but race-based health data is not routinely collected. Objectives: To understand the lived experiences of Black women in Canada living with breast cancer. Methods: One-on-one semi-structured qualitative interviews were conducted with 20 women living in Toronto, Ontario who identified as Black/African/Caribbean and who were currently undergoing or had previously undergone treatment for breast cancer. Data was analyzed using an inductive, constant comparative method to derive themes. Results: Several themes were identified including 1) the importance of social support and community; 2) importance of faith and spirituality; 3) cultural considerations; 4) mental health and psychosocial support; 5) body image and intimacy challenges; 6) importance of fertility preservation; 7) financial burden; 8) lack of representation; and 9) mistrust of the healthcare system. The overarching theme was a sense of feeling alone, unseen, and unrepresented. Recommendations include the importance of advocacy, the need for race-based cancer and health data and the need for racially concordant care. Conclusion: Invisibility and anti-Black racism in healthcare settings are unique concerns for Black women with breast cancer in Toronto. Understanding their needs can help to dismantle medical racism and colourblind healthcare. Further research is needed to develop tools to address these inequities and work towards culturally appropriate and safe approaches. / Thesis / Master of Public Health (MPH) / Little is known about the breast cancer experiences of Black women in Canada. The purpose of this study is to explore the lived experiences of Black women in Toronto, Ontario with breast cancer, in order to understand their cancer journey. In the United States, Black women are more likely to develop aggressive breast cancer and to die from their disease compared to white women. The information learned from this study will begin to address a gap in the literature about Black women living with breast cancer in Canada.

This study explores the global health diplomacy phenomenon by focusing on how and why health is integrated into foreign policy. Over the last decade or so, precipitated primarily by a growing concern about the need to strengthen global health security and deliver on the Millennium Development Goals, foreign policymakers have been paying more attention to health as a foreign policy concern and several countries have adopted formal global health policy positions and/or strategies. To elucidate a deeper and clearer understanding of how and why health is integrated into foreign policy, this thesis used a case study research design that incorporated literature and document review and interviews with twenty informants to conduct an in-depth analysis of the United Kingdom’s (UK) Health is Global: A UK Government Strategy 2008-13. Health is Global represents the first example of a formal national global health strategy developed using a multi-stakeholder process. Briefer background case reviews of three nations that are leaders in global health diplomacy - Brazil, Norway and Switzerland, were also conducted to inform the analysis of the in-depth case. Policy analysis included categorizing data into five areas: context (why?), content (what?), actors (who?), process (how?) and impact (so what?). The Multiple Streams Model of Policymaking and Fidler’s health and foreign policy conceptualizations - revolution, remediation and regression - were used to analyze the findings. Based on this analysis, the primary reason that the countries examined have decided to focus more on global health is self-interest - to protect national and international security and their economic interests. Investing in global health was also seen as a way to enhance a state’s international reputation. In terms of self-interest, Brazil was an outlier, however. International solidarity and health as a human right have been the driving forces behind its long-term investment in development cooperation to date. Investing in health for normative reasons was also a prevalent through weaker theme in the UK, Swiss and Norwegian cases. The study highlighted the critical role that policy entrepreneurs who cross the domains of international relations and health play in the global health policymaking process. In regards to advancing a conceptual understanding of global health diplomacy, the findings propose that the whole-of-government global health policymaking process is a form of global health diplomacy. The thesis elucidated factors that underpin this process as well as lessons for other nations, in particular, Canada. While ascertaining the impact of national global health strategies was not the main objective of this thesis, the study provided an initial look at the impact of these policy instruments and processes. Such impacts include better collaboration across government actors leading to enhanced policy coherence and a more strategic focus on global health. Finally, some have argued of late that the global health revolution is over due to the current world economic crisis. Considering the level of interest in whole-of-government global health strategies and the ever growing and sophisticated world-wide global health policy community, based on this thesis, the global health revolution is alive and well.

Research confirms that breastfeeding disparities persist and that lactation consultants play a key role in reducing them. However, there continues to be a limited availability of International Board Certified Lactation Consultants (IBCLCs) in the US with racial minorities in particular facing persistent barriers in the certification process. Through semi-structured interviews with 36 IBCLCs across the US, this study takes a systematic look at breastfeeding disparities through the lens of the IBCLC. Specifically, this study addresses barriers to certification and employment discrimination faced by IBCLCs of color, race-based discrimination against patients, and the ways in which IBCLCs work to both medicalize and demedicalize breastfeeding. Each of these areas can impact breastfeeding equity, and each help to reveal the ways in which race, class, gender and medicine shape views and practices related to lactation and motherhood. Cost and the increasingly university-focused approach of the IBCLC certification process are found to be significant barrier for participants. Race-based discrimination during the certification process and in the workplace is also an ongoing and persistent reality that affects participant’s relationships with patients and coworkers and their ability to secure workplace resources and to advance in their careers. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient’s backs. Finally IBCLCs are found to demedicalize breastfeeding, but they often lack the authority to change breastfeeding policies. They also engage in other work that medicalizes breastfeeding and perpetuate the idea that mothers are anxiety-prone patients in need of professional intervention.

Low-income groups have greater potential to gain from incorporating health promotion into daily living using bike-share to increase physical activity and expand transport options. The potential is unmet because of socioeconomics and access. Disproportionate uptake of bike-share by higher income individuals widens the gaps in health equity and transportation equity as bike-share use over-represents males with more resources, less need, and lower health risk. The Prescribe a Bike (RxBike) program, a key focus of this study, is a partnership between primary care providers (PCPs) at an urban safety net hospital and the city’s existing income-based, subsidized bike-share membership. Three studies using quantitative and qualitative methods were performed to: examine utilization of bike-share by Boston residents among subsidized and non-subsidized members; examine perceived attributes of the RxBike program by Boston Medical Center (BMC) PCPs; and evaluate BMC patient referrals. The overarching conceptual model uses elements of theories from health services and organizational behavior, in a public health framework. Analysis of Boston resident utilization at the trip-level (2012-2015) demonstrated overall ridership was increasingly by males and residents of more advantaged neighborhoods. Subsidized members had significantly higher likelihood of living in neighborhoods with socioeconomic and health disadvantage, and less gender disparity when compared to non-subsidized members. The impact was minimal because subsidized members made only 7.17% of trips. The survey of PCPs revealed mismatch between highly favorable opinion of RxBike appropriateness and lower intent to refer. Female gender and not being an urban biker predicted lower likelihood of intent to refer. Examination of open-ended survey comments mirrored quantitative data and expanded on the range of provider biking safety concerns in Boston. From 2013-2015, 27 BMC providers made only 72 referrals to RxBike. Patients referred had high cardiovascular health risk, resided in neighborhoods with extremely high levels of disadvantage, and in neighborhoods without meaningful access to bike-share kiosks. Overall, the subsidized membership extends reach of bike-share to residents of neighborhoods with more health and socioeconomic risk than the rest of the city; RxBike has strong potential to impact this vulnerable population. The most critical matters for program success are safety and neighborhood access.

Human papilloma virus (HPV) is the most common viral infection of the reproductive tract and a well-established cause of cervical, anal, and oropharyngeal cancers in both women and men worldwide. Despite data that supports HPV vaccine as an effective measure to prevent such cancers, vaccine uptake has not been optimal in many countries. In the United States (US) for example, rates have stagnated over the past few years and only one-third of adolescents are fully immunized, in contrast to other adolescent vaccines such as Tdap and meningococcal that have double the rates of uptake. Current approaches to HPV vaccine education and delivery have not been successful at improving immunization rates. In this article we propose the implementation of a child rights, social justice, and health equity-based approach to HPV vaccine policy. This approach would promote youth’s participation in medical decision-making and advance policies that allow for independent consent to HPV vaccination. We postulate that by empowering youth to be involved in issues pertaining to their health and well-being, they will be more likely to explore and discuss information about HPV with others, and be able to make informed decisions related to HPV vaccine.

Set in 2000, with a completion date of 2015, the deadline for the Millennium Development Goals is approaching, at which time a new global development infrastructure will become operational. Unsurprisingly, the discussions on goals, topics, priorities and monitoring and evaluation are gaining momentum. But this is a critical juncture. Over a decade of development programming offers a unique opportunity to reflect on its structure, function and purpose in a contemporary global context. This article examines the topic from an analytical health perspective and identifies universal health equity as an operational and analytical priority to encourage attention to the root causes of unnecessary and unfair illness and disease from the perspectives of those for whom the issues have most direct relevance.