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Chronic pain is one of the most common health conditions, affecting nearly six million Canadian adults. Despite abundant research on chronic pain in general, there is limited knowledge on how racialized immigrant women experience living with chronic pain and how this relates to their broader social circumstances. The purpose of this qualitative, exploratory study is to understand living with chronic disabling pain as situated in and contextualized by the lived experiences of immigrant women residing in Ottawa, Ontario, and to explore the perspectives of the women's care partners as well as physicians providing care for chronic pain. Semi-structured interviews were conducted with 24 participants. The dissertation is guided by the social determinants of health framework and an intersectional lens. Four interconnected themes from the data analysis have been generated: (1) The trajectory and meaning of pain; (2) Reasons for pain and triggering factors; (3) Pain consequences; and (4) Coping and control. Findings indicate that chronic pain is a subjective, complex, biopsychosocial, and multidimensional phenomenon. Pain is a deeply personal experience linked with meaning. Results also highlight an association between the distribution of the social determinants of health during the life course and pain. Furthermore, the pain has profound, multidimensional impacts on the women and their families, and its treatment is a challenging task for health care professionals. In addition, the findings show that pain is often poorly recognized, underestimated, and inadequately managed. Finally, the results illustrate the perseverance and incredible resilience of the women and their carers. The findings provide several implications for policy, research, and practice.

<p>Refugee women experience important physical and mental health disparities which are often unmet during resettlement to host countries. These health disparities have been attributed to the gendering of the refugee process, such that women are more vulnerable to gender-specific violence and abuse during flight from war and conflict. Despite having unmet health needs, they face multiple barriers to leading healthy lives and healing during resettlement to a new host country. This paper seeks to respond to the need for research in understanding the health of refugee women in western nations within feminist geographical scholarship by exploring the ‘lived experiences’ of refugee and refugee claimant women during resettlement to Hamilton, Ontario. Data was collected through in-depth interviews and focus groups with key informants (n=9) and refugee women and refugee claimant women (n=37) from various source countries. Results from this study provide in-depth understandings on the experiences of resettlement including the particular challenges refugee and refugee claimant women face in attempting to rebuild their lives in Canada. Perceptions of good health are closely related to various dimensions of gender (roles and identities) and citizenship (status). This paper explores important health determinants as expressed by the participants: pre-migration experiences, citizenship (status), employment and housing experiences and health care during resettlement. Accounts from this study reflect the need to address ongoing immigration reform and refugee policy in a manner that will honour Canada’s commitment to international humanitarian agreements such as the 1951 Geneva Convention.</p> / Master of Arts (MA)

In the current healthcare landscape, parents generally make decisions regarding whether or not their children are allowed to take part in clinical research, with the general assumption being that parents know what is best for children. Investigations have been conducted regarding what is likely to lead parents to consent or not consent to their child’s participation in a trial, but research plans seldom incorporate the consideration that not all parents come into the consent process with equal social, academic, and economic footing. Since the burden of the ultimate decision lies primarily on the parents, it is supremely important that they are capable of making a well-informed and thoughtful choice. Bioethical understanding of the influence of parental decisions in clinical research must consider demographic variables and how they may affect parents’ decisions to allow or disallow their child to participate in a clinical trial. Those differences could affect the consent process and have ramifications for the research findings, as research results are affected in numerous ways by which children do, and do not, participate in studies. This paper looks specifically at parents in the process of informed consent for pediatric research, taking into account several social determinants of health and how they affect who participates in research and how that affects research as a whole. / Urban Bioethics

Personalized medicine is the idea that every patient can be treated in a unique manner, tailored specifically to his or her individual needs. Traditionally the field of personalized medicine has focused on using genetic information to determine medical treatment. However, humans are not only the sum of their genetic parts. All people exist within the context of their environment, their experiences, and their relationships. While the connection between this greater context and medical treatment may not be immediately obvious, it exists. If we are to truly tailor medical care, it must occur in a holistic manner, combining both genetics and social context. A thorough understanding of the way that they interact, as well as the individual limitations of both, is the best way to offer individualized care to all patients. / Urban Bioethics

In hospitals situated in the center of underserved communities, such as North Philadelphia, health care workers are often faced with challenges to patient health that stem from their socioeconomic status. This is an obvious problem in stroke prevention, which requires patients to eat healthy, maintain adherence to medications, and exercise, among other things. As social determinants of health limit a patient’s ability to act on these recommendations, health care workers are forced to grapple with the question of how to best care for a patient with limited resources. Though some may label this patient as difficult due to what may be viewed superficially as non-adherence to medications and lack of motivation to change their lifestyle’, a more compassionate and accurate observation is one that acknowledges the fact that these patients are unable to act on any recommendations given to them due to limitations on their autonomy by several social barriers, such as lack of access to follow-up, transportation, income, food, etc. As physicians have a duty to respect a patient’s autonomy, what this also requires is ensuring a patient understands how best to navigate within their limited autonomy, i.e. how to exercise their agency. Instead of waiting for policymakers to incite change, at the micro level, health care workers can take additional measures by providing resources within their limitations that will then improve a patient’s agency and, as a result, improve their health. / Urban Bioethics

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)