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This thesis explores the role and functionality of the Hamilton Urban Core Community Health Centre (HUCCHC) within the context of advocacy and activism to understand how this institution can contribute a pathway for social change in public health. This qualitative case study uses an interpretive lens to analyze primary health care at the HUCCHC, and how it is being used to improve the social determinants of health (SDH). The study investigated participants’ understandings of how the HUCCHC demonstrates that a community health centre can be a catalyst for social change. Moreover, this research project asked what sorts of conditions or circumstances are necessary to foster an environment conducive for community organizing for social change. This study employed field observation and interview techniques to gather data. Findings suggest that building equitable relationships based on dignity and respect, and community engagement were the foundational aspects necessary to provide the conditions conducive for community organizing. However, the outcomes from these relations put the HUCCHC at risk of becoming marginalized. Findings further suggest that equitable relationships and community engagement also provided a foundation for social action. The HUCCHC demonstrated that it is a catalyst for social change by embracing a primary health care model that also fosters a social action approach to health care. / Thesis / Master of Social Work (MSW)

Currently only 5.7% of physicians in the United States (U.S.) are Black/African American. This comprehensive analysis explores the significant underrepresentation of Black/African American physicians in the United States, a problem that has persisted for over 100 years. This investigation traces this disparity back to the Flexner report, a document that revolutionized medical education for the benefit of the white population but to the detriment of Black and other vulnerable populations. There is a critical examination of the ethical implications of the Flexner report, arguing that it has contributed to health disparities resulting in shortened lives for Black men, women, and children. Moreover, the roles played by private institutions such as the Carnegie Foundation, the Rockefeller Foundation, the Accreditation Council for Graduate Medical Education and the American Medical Association and the U.S. federal government in initiating, funding or upholding the changes resulting from Flexner’s report are delineated. Most importantly, the efforts, as a result of the formation of the National Medical Association to overcome the obstacles placed in front of Black healthcare providers in caring for people of color is revealed. In exposing the damage done to physicians and patients of color there are also proposals of solutions to reverse the ethical harm done because of the Flexner report's implementation, including reparations for Black healthcare providers and patients adversely affected by the Flexner report. In conclusion there is an in-depth analysis of the history and impact of the Flexner report, the ethical and moral imperatives of reparations, and the feasibility and potential impact of these reparations. / Urban Bioethics

Prenatal care (PNC) is an essential health service that can reduce adverse health and social outcomes through prevention, detection and treatment of abnormalities of pregnancy. It offers an opportunity to mitigate the impact of the Social Determinants of Health (SDoH) on individual patients through advocacy and referral to social services. Despite a publicly funded health care system in Canada, disparities in access to PNC persist. Much is known about the barriers to PNC and client experiences of inadequate PNC (IPNC). Very little is known about care provider perspectives of IPNC, what should be done about it and are the barriers to doing it. The goal of this project was to address this gap in knowledge to inform the development of novel care delivery models that could reduce disparities in access to PNC in Hamilton. Using a Critical Theory lens, I conducted an interpretive descriptive study using individual interviews and focus groups with health and social service providers in Hamilton to explore their understandings of IPNC. Participants viewed IPNC as a small but important phenomenon disproportionately impacting people who are marginalized. The experience of IPNC is chaotic, worrisome and joyful for providers. An interdisciplinary, midwifery-led outreach PNC model would better meet the needs of the client population and providers alike. A Community Centred Care model of PNC embodies and enhances participant suggestions for addressing IPNC. Access to abortion, postpartum care and newborn apprehension require special attention. Peer participation and the impacts of patriarchy and racism must be addressed in the development of future PNC models. The ways in which participants described and proposed intervening in IPNC revealed an individualized understanding of the SDoH that is paralleled in existing research on IPNC. This conceptualization of the problem obscures the root causes of disparities in access and warrants future consideration. / Thesis / Master of Science (MSc) / Prenatal care (PNC) can help to reduce complications of pregnancy and birth and connect expecting families with other support services. Even though health care is free in Canada, people who are marginalized struggle to access enough PNC. We know the complexities of people’s lives and their negative experiences with the health care system prevent them from getting PNC. We know little about what PNC for people who don’t access it is like for the providers or why they can’t make their care easier to access. Mindful of systems of power, the goal of this research is to explore how health and social service providers understand inadequate PNC (IPNC), to inform accessible PNC models. Participants proposed an interdisciplinary outreach PNC model responsive to needs of the community. The Social Determinants of Health were an important part of how participants understood IPNC which shaped the way that they proposed to address it.

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Musculoskeletal trauma including fractures, represents a significant burden of disease for Low- and Middle-Income Countries (LMICs). Within LMICs, women possess reduced agency to make health care decisions and represent a vulnerable population. In this thesis, I aimed to characterize priority fractures among women within LMICs, and investigated whether women were delayed in hospital admission following an orthopaedic trauma. In Chapter 1, I introduce and review the existing literature on injury burden, health care deficiencies, and gender inequities within LMICs. In Chapter 2, we analyzed regional distributions of fracture burdens across 9,934 female orthopaedic trauma patients across 17 LMICs. Half of our study patients were ≥ 60 years old. We determined that the major burden of orthopaedic trauma among women within LMICs were fractures among the elderly. Fracture burden in Africa was notably different. A majority of patients were between the ages 18-59, and common fractures included tibia/fibula and femur fractures. In Chapter 3, we analyzed 26,910 orthopaedic trauma patients across 17 LMICs to determine whether women were delayed in hospital admission by >24 hours. After controlling for confounds, sex was not a significant predictor of delay. We found that instead, the severity and type of fracture influenced the delay of patient’s hospital admission. Closed fractures, falling-related injuries, pelvic, spine and hip fractures were associated with increasing delay. Irrespective of sex and region, inter-hospital referrals accounted for nearly half of the reasons patients were delayed. These two chapters highlight regional trends in orthopaedic burden sustained by women, pointing to the high frequency of fragility fractures. In addition, this thesis identifies critical gaps within LMICs’ health care systems infrastructure, demonstrating the need for improved hospital referral systems and ambulatory services. This analysis will enable policymakers, and future researchers to target interventions to address the rising global burden of injuries especially among women. / Thesis / Master of Science (MSc) / Fractures represent life-threatening injuries within Low- and Middle-Income Countries (LMICs), and globally are a top-ten leading cause of death and disability. Within LMICs, due to gender inequalities, women may be restricted from receiving hospital care following an injury. We investigated the most common types of fractures in women within LMICs and determined that women most frequently experienced fractures due to old age. We further examined whether women were delayed in reaching a hospital after sustaining a fracture, and found that sex did not significantly play a role in determining delay. Instead, injury associated factors, such as the type and severity of the fracture influenced whether a patient was delayed. In addition, transferring patients between hospitals was the most common reason for delay. As a result, policymakers in LMICs should explore strategies to treat the high burden of fractures in the elderly and improve communication between hospitals to reduce delays.

This study showed that health equity must be achieved through education, awareness, and advocacy. A structured program must be put in place to provide accountability towards achieving health equity within organizations, communities, cites, and states. In Virginia, the Health Equity Campaign was a program put in place to provide such accountability to the citizens of Virginia. This study attempted to evaluate the Health Equity Campaign implemented by the Virginia Department of Health Office of Minority Health and Public Health Policy Division of Health Equity in order to get all Virginians to become advocates for health equity in their organizations, communities, neighborhoods. Organizational/group leaders were interviewed in addition to surveying various staff members. This study provides a detailed description of the strength of the Health Equity Campaign's ability to promote education and awareness about health equity and why many participants found it difficult to transition from motivation to advocacy. / Ph. D.

<p dir="ltr">Families experiencing homelessness and housing instability (FEH/HI) face myriad challenges, placing their children at risk for adverse outcomes. Research typically adopts a deficit-based approach to meet immediate needs, but this may limit understanding of the children’s experiences. Recognizing children’s strengths is important for improving their health, development, and support. Resilience and family resilience are concepts that draw on a strengths-based approach. However, there is a need for more research to identify the strengths, such as resilience, among families and their children who are not stably housed. The present research seeks to address the gaps in the literature by examining the resilience perceptions and experiences of adolescents in FEH/HI, as much of the existing research focuses on the adult perspectives, within a family resilience framework through multiple studies. Study 1 (Chapter 2) systematically reviewed existing research on resilience and family resilience within FEH/HI. An analysis of 27 studies identified resilience-related factors across individual, interpersonal, and community domains. Study 2 (Chapter 3) integrated a strengths- and deficit-based approach to explore the challenges and strengths of children in FEH/HI from the perspectives of parents/caregivers and service providers. Semi-structured interviews with 17 parents/caregivers and 15 service providers identified challenges and strengths at the individual, interpersonal, and system levels. Study 3 (Chapter 4) investigated how adolescents within FEH/HI experience and make meaning of family resilience in their day-to-day lives using photo-elicitation (PE) and Froma Walsh’s family resilience framework. Four adolescents participated and took photographs depicting family resilience within their families. Together, findings from these studies provide insights into the strengths and resilience within FEH/HI. Moreover, they emphasize the need for strengths-based approaches in research and practice to support the health, development, and wellbeing of children and adolescents in FEH/HI.</p>