This dissertation pools time-series and cross-section data among Canadian provinces to examine: (1) whether provincial welfare generosity (health, social services, and education expenditures), power resources and political parties (unions and left, centre, and right political parties), and political democracy (voter turnout and women in government) affects population health; (2) whether the effect of leftist politics channels through or combines with provincial welfare generosity to affect population health; and (3) whether provinces cluster into distinct political regimes which are predictive of population health. Data is retrieved from the Canadian Socio-Economic Information Management System (CANSIM) II Tables from 1976 to 2008 and Canadian Parliamentary Guides from various years. Population health is measured using total, male, and female age-standardized mortality rates. Estimation techniques include Prais-Winsten regressions with panel-corrected standard errors (PCSE), a first-order autocorrelation correction model (AR1), and fixed unit effects. Hierarchical cluster analysis is used to identify how provinces cluster into distinct regimes. Primary findings are three-fold. First, provincial welfare generosity has a significant impact in lowering mortality rates, net of other factors, such as demographic and economic variables. Second, the political power of left and centre political parties and women in government have significant negative effects on mortality rates. Whereas left political parties and women in government combine with provincial welfare generosity to improve population health, the effect of centre political parties is channeled through provincial expenditures. Third, provinces cluster into three distinct regimes based on left political party power and women in government: 1) leftist (Saskatchewan, British Columbia, and Manitoba); 2) centre-left (Ontario and Quebec); and 3) conservative (Alberta, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland). Compared to the leftist regime, centre-left and conservative provinces have significantly higher mortality rates; however, provincial welfare generosity accounts for most of the observed inter-provincial differences in population health.

This dissertation pools time-series and cross-section data among Canadian provinces to examine: (1) whether provincial welfare generosity (health, social services, and education expenditures), power resources and political parties (unions and left, centre, and right political parties), and political democracy (voter turnout and women in government) affects population health; (2) whether the effect of leftist politics channels through or combines with provincial welfare generosity to affect population health; and (3) whether provinces cluster into distinct political regimes which are predictive of population health. Data is retrieved from the Canadian Socio-Economic Information Management System (CANSIM) II Tables from 1976 to 2008 and Canadian Parliamentary Guides from various years. Population health is measured using total, male, and female age-standardized mortality rates. Estimation techniques include Prais-Winsten regressions with panel-corrected standard errors (PCSE), a first-order autocorrelation correction model (AR1), and fixed unit effects. Hierarchical cluster analysis is used to identify how provinces cluster into distinct regimes. Primary findings are three-fold. First, provincial welfare generosity has a significant impact in lowering mortality rates, net of other factors, such as demographic and economic variables. Second, the political power of left and centre political parties and women in government have significant negative effects on mortality rates. Whereas left political parties and women in government combine with provincial welfare generosity to improve population health, the effect of centre political parties is channeled through provincial expenditures. Third, provinces cluster into three distinct regimes based on left political party power and women in government: 1) leftist (Saskatchewan, British Columbia, and Manitoba); 2) centre-left (Ontario and Quebec); and 3) conservative (Alberta, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland). Compared to the leftist regime, centre-left and conservative provinces have significantly higher mortality rates; however, provincial welfare generosity accounts for most of the observed inter-provincial differences in population health.

This thesis examined three different research questions to help build a knowledge base for future intervention strategies by better understanding the reasons behind smoking among pregnant women in Nunavut. The first study focused more at the individual level and investigates clinical and socioeconomic factors and their relationship to readiness to quit smoking. The second manuscript moved beyond the individual level to the broader social and structural environment to identify a broader range of barriers and facilitators to smoking and smoking cessation among Inuit women. This second manuscript draws upon in-depth interviews focusing on perceptions of smoking, and perceived barriers and facilitators of smoking behaviours. Finally, the third manuscript investigated the perspectives of health care providers regarding the barriers and facilitators of smoking cessation for pregnant women in the Baffin Region of Nunavut and describes perceptions of smoking cessation resources available to health care providers in the Baffin Region.

This thesis examined three different research questions to help build a knowledge base for future intervention strategies by better understanding the reasons behind smoking among pregnant women in Nunavut. The first study focused more at the individual level and investigates clinical and socioeconomic factors and their relationship to readiness to quit smoking. The second manuscript moved beyond the individual level to the broader social and structural environment to identify a broader range of barriers and facilitators to smoking and smoking cessation among Inuit women. This second manuscript draws upon in-depth interviews focusing on perceptions of smoking, and perceived barriers and facilitators of smoking behaviours. Finally, the third manuscript investigated the perspectives of health care providers regarding the barriers and facilitators of smoking cessation for pregnant women in the Baffin Region of Nunavut and describes perceptions of smoking cessation resources available to health care providers in the Baffin Region.

This thesis examined three different research questions to help build a knowledge base for future intervention strategies by better understanding the reasons behind smoking among pregnant women in Nunavut. The first study focused more at the individual level and investigates clinical and socioeconomic factors and their relationship to readiness to quit smoking. The second manuscript moved beyond the individual level to the broader social and structural environment to identify a broader range of barriers and facilitators to smoking and smoking cessation among Inuit women. This second manuscript draws upon in-depth interviews focusing on perceptions of smoking, and perceived barriers and facilitators of smoking behaviours. Finally, the third manuscript investigated the perspectives of health care providers regarding the barriers and facilitators of smoking cessation for pregnant women in the Baffin Region of Nunavut and describes perceptions of smoking cessation resources available to health care providers in the Baffin Region.

Romano-British towns are conventionally divided into those that possessed administrative powers (the major or ‘public’ towns) and those that did not (the minor or ‘small towns’). Public towns and small towns differed in terms of size and socioeconomic status, with the latter sometimes characterised as semi-rural rather than truly urban. Hitherto, research into the differing nature of the communities at public and small towns has focused primarily on variations in settlement morphology, architecture and material culture. This study provides a new perspective on the issue by examining osteological indicators of lifestyle and health in skeletal samples from these two categories of site. Roman populations from the small town of Ancaster, Lincs (N=271) and the public town of Winchester, Hants (N=330) dating to c. AD 200-410 were analysed using standard osteological methods. Data on age-at-death, growth and stature, and skeletal and dental pathology were recorded and compared using a range of statistical tests to identify potential differences. Additionally, published data for contemporaneous populations were collated for comparison. A biocultural approach was used to contextualise the data with reference to archaeological and historical evidence. Some differences in demography were observed, but were probably the result of sample biases. No marked differences in growth or stature were observed. Pathology prevalence rates were comparable for many conditions. However, higher rates of joint disease at Ancaster, and differences in the pattern of long bone trauma may point to the Ancaster population having experienced a more agrarian lifestyle, engaging in more frequent and/or extended periods of heavy labour. In contrast, there was more evidence for violent trauma at Winchester, and the frequencies of three non-specific indicators of ill health (cribra orbitalia, porotic hyperostosis and dental enamel hypoplasia) and scurvy were higher. This suggests that people at Winchester experienced greater levels of social, dietary and environmental stress, perhaps reflecting a larger, more heterogeneous population. Dental health status was generally poorer at Ancaster, which may be due to differences in diet, oral hygiene and/or other non-dietary factors. Published data for other populations broadly support the study conclusions, although comparisons were limited by incompatibilities in methodology and data presentation. Overall, the findings corroborate existing perspectives on the socio-economic characters of public and small towns, but differences were not pronounced. The significance of the findings is discussed in relation to the nature of settlement and society in Roman Britain.

Organizational change is undeniably difficult, and change efforts often fail to overcome the status quo processes and routines. By threatening these structures, change becomes an existential danger to organizations, who often respond with significant resistance. Organizations will look to their experiences with past change efforts to inform future changes, limiting the ability of change actors who seek to implement change beyond this narrow scope. The “Heart Failure Lite” model was a change effort that exceeded the scope of previous changes at an organization with deeply embedded routines and processes. This model threatened the traditional revenue streams that had benefited the organization for years. The resistance exhibited by the organization when presented with the change was consistent with the underlying theory. Although change failure is common, proactive efforts on the part of change actors can help break down the organizational barriers. Conceptual models like PARiHS can be utilized to identify the evidence supporting the change, the contextual environment in which the change will be introduced, and the facilitation efforts needed to guide the project to a successful conclusion. The “Heart Failure Lite” team failed to survey the organizational landscape and tailor the project accordingly. Therefore, the change effort failed. Shifting clinical practices toward a population health model presents a unique opportunity for healthcare organizations. A concerted effort from all stakeholders to find common ground will allow change agents to overcome the traditional barriers, and will help organizations to truly transform the delivery of healthcare services.

How do health workers understand population health as a concept and as it relates to their practice? How does an accreditation of a health region lead to an understanding of a population health approach? <p>The purpose of this study was to explore the extent to which health region staff understands population health and to determine how the Canadian Council on Health Services Accreditation (CCHSA) accreditation process addresses population health perspectives. The goal was to ascertain the knowledge, practices, and attitudes of the staff with respect to population health in general and with respect to an accreditation process in order to see how a health region integrates a population health component into its services. A case study of the Saskatoon Health Region (SHR) was used to determine how a health region can integrate a population health component into the design and delivery of its services. The case study was comprised of a literature review, secondary data review from the 2001 Accreditation Survey Report, and primary data collection from people involved in the 2004 accreditation self-assessment which took place in the health region from March through June, 2004, which was facilitated by the Canadian Council on Health Services Accreditation (CCHSA). Primary data was captured through the use of key informant interviews of twenty employees in the health region. The participants were selected from the sponsors and leads of the accreditation teams that are most connected to a population health perspective; other participants were invited from those teams. These teams were selected by the author after reviewing the results of the CCHSA 2001 Accreditation Report that highlighted areas for improvement. This variety of input from across the teams triangulated the responses. In addition, key informants representing senior management, (i.e. the medical health officer(s) and the Chief Executive Officer for SHR), were also interviewed. These people were included in order to capture the knowledge practices and attitudes of the visionaries and leaders of the region and their ideas with respect to the direction for population health. <p>The thesis closes with a discussion on implications for the policy arena and opportunities for the CCHSA to improve the population health content in their accreditation documents.

The increase in the academic literature concerning the potential impacts that urban park systems can have over the life course of urban residents is beginning to be recognized by professionals in the fields of community quality of life studies, population health and in health geography. Typically urban spaces within Canada are designed to include a component of open space which can facilitate the recreation needs of residents. Within the City of Saskatoon neighbourhoods have such spaces in the form of neighbourhood parks, which are meant to facilitate passive or active recreation. Parks also provide open spaces of vegetation cover as opposed to the concrete and structural components of the city. Parks are meant to positively contribute to the residents lives and to the neighbourhood in which they are located. <p>In community quality of life studies, open spaces, such as parks along with other neighbourhood attributes, are often used to gauge residents perceptions of their immediate surroundings. The Saskatoon Quality of Life Project conducted by the Quality of Life Module at the Community-University Institute for Social Research (CUISR) conducted such a study in 2004 in which park spaces were related alongside other neighbourhood features such as transportation and social activities in order to capture residents perceptions of their community quality of life. <p>The purpose of this study is to look at how residents of differing socio-economic status (SES) neighbourhoods (one high SES and one low SES) perceive their neighbourhood park spaces and if their perceptions affect their perceived quality of life. In order to capture residents perceptions of their neighbourhood parks, face-to-face interviews were conducted with residents. In addition to the resident interviews, interviews were conducted with key informants as well as statistical analysis of secondary data from the 2004 Saskatoon Quality of Life Project was carried out. Results showed residents of different neighbourhood SES status shared common perceptions of their park spaces as well as how neighbourhood parks contributed to their quality of life.

How do health workers understand population health as a concept and as it relates to their practice? How does an accreditation of a health region lead to an understanding of a population health approach? <p>The purpose of this study was to explore the extent to which health region staff understands population health and to determine how the Canadian Council on Health Services Accreditation (CCHSA) accreditation process addresses population health perspectives. The goal was to ascertain the knowledge, practices, and attitudes of the staff with respect to population health in general and with respect to an accreditation process in order to see how a health region integrates a population health component into its services. A case study of the Saskatoon Health Region (SHR) was used to determine how a health region can integrate a population health component into the design and delivery of its services. The case study was comprised of a literature review, secondary data review from the 2001 Accreditation Survey Report, and primary data collection from people involved in the 2004 accreditation self-assessment which took place in the health region from March through June, 2004, which was facilitated by the Canadian Council on Health Services Accreditation (CCHSA). Primary data was captured through the use of key informant interviews of twenty employees in the health region. The participants were selected from the sponsors and leads of the accreditation teams that are most connected to a population health perspective; other participants were invited from those teams. These teams were selected by the author after reviewing the results of the CCHSA 2001 Accreditation Report that highlighted areas for improvement. This variety of input from across the teams triangulated the responses. In addition, key informants representing senior management, (i.e. the medical health officer(s) and the Chief Executive Officer for SHR), were also interviewed. These people were included in order to capture the knowledge practices and attitudes of the visionaries and leaders of the region and their ideas with respect to the direction for population health. <p>The thesis closes with a discussion on implications for the policy arena and opportunities for the CCHSA to improve the population health content in their accreditation documents.