The present study investigates the self-care and health maintenance strategies undertaken by individuals from Halton Region, Ontario living with type 2 diabetes and receiving assistance from food acquisition services such as community food re-distribution centres and food banks. This qualitative research project pulls narrative and thematic interview data from 18 semi-structured one-on-one interviews analyzed with syndemic theory and social determinants of health frameworks to demonstrate how clustering non-communicable diseases and social conditions disproportionately affect those in the lowest income category, and interact with each other to exacerbate the negative health effects of each condition alone. The contributions of this study are theoretical and applied. Theoretical contributions augment existing evidence for the study of non-communicable diseases using a syndemic model. The study participants demonstrated syndemic clustering of five conditions: type 2 diabetes, food insecurity, low income, poor mental health, and activity limitation. Further, this study suggests an applied element to the syndemic model through an approach to health and diabetes care that incorporates the whole person as opposed to a single disease as a unit of care. As suggested through the findings of research participant testimony, a diabetes health care centre, in addition to traditional diabetes care, would ideally screen and offer care for the other common clustered conditions listed in the syndemic elements above. Thus, the centre would provide nutrition, physical activity, mental health, and social supports to patients. As well, it is recommended that future research contributes to prevention and treatment of non-communicable diseases through social, political, and economic in form of increasing government and healthcare supports for people living with low-income and food insecurity. / Thesis / Master of Arts (MA) / This study looks at how individuals from Halton Region, Ontario maintain their health while living with type 2 diabetes and reduced access to healthy, fresh food. The project uses interview data from 18 one-on-one interviews to demonstrate how people with low income suffer from poorer overall health. Specifically, five conditions affected the study participants’ health: type 2 diabetes, reduced access to healthy food, low income, poor mental health, and reduced financial or physical access to exercise or activities of daily living (activity limitation). To combat these conditions, this study suggests an approach to health and diabetes care that looks at the whole person. Evidence and participant suggestions indicate a diabetes health care centre that screens and offers care for other common conditions that occur such as the elements listed above, and also provides nutrition care, physical activity, and social support to patients.

In early twentieth century Canada, the tuberculosis (TB) epidemic struck far and wide (Herring, 2007) and its effect was greater on indigenous populations, particularly the Inuit (Public Health Agency of Canada, 2013). In 1906, the Mountain Sanatorium was founded by the Hamilton Health Association (HHA) in an effort to curb the disease (Wilson, 2006) and was designated as a treatment centre for Inuit from the Eastern Arctic. Controlling TB became a movement extensively documented by The Hamilton Spectator – a prime news provider. This research concerns the way in which social problems emerge and the responses they generate. Drawing on the literature on social problems, this thesis examines the HHA’s claims-making activities regarding tuberculosis in 1953-1963 along with The Spectator’s role in helping to define TB as a problem. It examines 1) how the HHA constructed TB as a problem 2) how the HHA understood the problems and solutions of tuberculosis; 3) it ascertains whether the HHA and The Spectator drew from a biomedical model or considered social determinants of health (SDOH) in their control and reportage of the disease; 4) the portrayal and treatment of Inuit patients; 5) the role of legitimacy; and 6) the importance of Pfeffer and Salancik’s resource dependency theory in the Sanatorium’s efforts to survive as an institution. This was executed through a content analysis of the HHA’s annual reports and newspaper articles by The Spectator. The examination of this case through the theory of social problems and resource dependency provides a lens to understand how TB became a problem and why hospitals are more than treatment facilities. / Thesis / Master of Arts (MA)

Social determinants of health are associated with a variety of negative health outcomes, including COVID-19 morbidity and mortality. However, most research evaluating this relationship have been case studies, retrospective cohort studies, and case series studies and/or have used use analytic techniques, such as linear regression, that can struggle to adequately model the social determinants' complex nature. This study used United States county-level social determinants of health data and March 2020-December 2020 COVID-19 morbidity and mortality data. Structural equation modeling was used to develop a latent measurement model for the social determinants of health. Substantial cross-loadings among the social determinants of health precluded the estimation of the originally proposed measurement model. However, a more parsimonious model was estimated, with adequate factor loadings and model fit statistics. A multi-level, two-part structural equation model further validated the relationship between social determinants of health and COVID-19 morbidity and mortality. The model's predictive performance was moderate to strong, which validates and extends previous research using structural equation modeling to evaluate the relationship between social determinants of health and COVID-19 morbidity. The study adds to the theoretical and empirical foundation supporting the use of structural equation modeling to study the social determinants of health.

yes / Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.

Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system. My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis. I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments. / Ph. D.

Yes / The experiences of LGBT asylum seekers in the UK are the focus of this chapter. The relative invisibility of LGBT asylum seekers in social work literature and research is acknowledged. Data from interviews undertaken as part of a small scale research study is used to highlight issues of psychological stress, safety, social isolation and resilience and survival. This material is discussed in relation to models of minority stress, discrimination, social determinants of health, and human rights. A holistic approach to practice in response to an opening vignette, is presented with reference to the importance of advocacy and cross-sector partnership working. / This is a post-peer-review, pre-copy edited version of a chapter published in: Fish J and Karban K (Eds.) Lesbian, Gay, Bisexual and Trans Health Inequalities. Details of the definitive published version and how to purchase it are available online at https://policypress.co.uk/lesbian-gay-bisexual-and-trans-health-inequalities.

Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring mechanisms of violence prevention is increasingly important, especially within the context of multicultural societies. This research does just that by approaching community violence prevention from an interdisciplinary perspective, including aspects of public health, political science, criminology, and sociology. This dissertation explores the interfaith organization InterFaith Leadership Council of Metro Detroit and those in the organization's network. It considers how interfaith leaders, through activism and dialogue, can contribute to community violence prevention. By applying the social ecological model and social disorganization theory, this research considers how to prevent community violence through building social capital, collective efficacy, and community capacity. This inquiry also utilized the social determinants of health to describe how violence and violence prevention is linked to community health. This dissertation uses qualitative data, including interviews, document analysis, and field notes to explore the mechanisms by which interfaith leadership can prevent community violence, specifically gang violence and violent extremism. / Doctor of Philosophy / Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring methods of violence prevention is increasingly important. This dissertation uses qualitative data to explore community violence prevention in Metro Detroit as carried out by the InterFaith Leadership Council and its broader network. Included in this dissertation are insights from interviews, document analysis, and field notes. All this data informs the research and attempts to address how the question of how the interfaith community in Metro Detroit is working to prevent community violence. This research utilizes the social ecological model and social disorganization theory as its overarching framework for analysis. The analysis examines interfaith relationships, collective efficacy, and community capacity. This research also frames violence and violence prevention within the context of the social determinants of health in an attempt to identify the factors that affect violence and violence prevention.

Yes / Non-communicable diseases (NCDs) are currently the leading cause of death worldwide. In this paper, we examine the channels through which economic growth affects NCDs’ epidemiology. Following a production function approach, we develop a basic technique to break up the impact of economic growth on NCDs into three fundamental components: (1) a resource effect; (2) a behaviour effect; and (3) a knowledge effect. We demonstrate that each of these effects can be measured as the product of two elasticities, the output and income elasticity of the three leading factors influencing the frequency of NCDs in any population: health care, healthrelated behaviours and lifestyle, and medical knowledge.

In late 2019, scientists discovered a novel strain of coronavirus originating out of Wuhan, China. By January 2020, the United States (U.S.) saw its first positive case of coronavirus and the public was still unsure how serious of an epidemic this would be. By the time the World Health Organization declared the novel coronavirus disease (COVID-19) epidemic a “global pandemic” on March 11, 2020, world leaders, public health experts, scientists, and public administrators kicked into high gear to start serious pandemic response efforts. The public sector is typically the responsible authority for the preparedness, response, mitigation, and recovery of such a public health crisis. The purpose of this paper is to build on French’s (2011) study on the characterization of pandemic planning preparedness of the 50 most populous U.S. cities to assess the impacts of a real-time pandemic, COVID-19, upon the public health outcomes of these same cities. While certain public health data (e.g., disease-specific mortality data) are typically indicators of the impacts of diseases, this study acknowledges and cautions that taking these indicators into consideration is not a direct reflection of any one government’s performance in the face of disaster. A plethora of factors (e.g., social, economic, geographic, environmental, biological) and choices at the societal, community, and individual levels can impact the health outcomes of those populations. The COVID-19 mortality data show that many of the U.S. cities with large populations were hit hard and fast during the beginning of the pandemic. It was anticipated that as a city’s preparedness level increased, its COVID-19 mortality rate would decrease. However, results indicated that cities with the highest level of preparedness actually experienced higher COVID-19 death rates than their less prepared counterparts. This analysis aims to shed light on the potential impact that local government management and leadership, especially by way of pandemic planning, has upon a real-time pandemic event and provide information relevant to best practices.

Cancer is one of the main causes of death in the US. Lung cancer remains the highest killing form of cancer. Lung screening rates are low amongst the general population and even lower in minority populations. It is not well known what the barriers are for lung cancer screening. In order to investigate barriers, I created questions to add onto an existing questionnaire survey for an ongoing lung cancer screening research project. These questions focused on social determinants of health and the survey was administered to patients who were non-adherent to lung cancer screening. Patients reported cost concerns for screening, potential medical care costs, and ability to attend medical appointments as barriers to lung cancer screening. Both non-white and female patients reported more difficulties attending appointments than their white and male counterparts. Patient physician relationship and perceived racial discrimination were not barriers to lung cancer screening in the patient population surveyed. Further research needs to investigate specific details on these barriers to create interventions to increase lung cancer screening rates. / Urban Bioethics