The 21st century experienced several health crises, especially in the form of infectious disease outbreaks such as the SARS outbreak in 2003, the H1N1 in 2009, and Ebola outbreaks in 2013. However, none has produced a worldwide socio-economic and health impact compared to the recent pandemic, known as COVID-19. As of October 4, 2022, more than 614 million cases with 6 million deaths have been reported worldwide. The United States is currently in the leading position with more than 98 million cases and 1 million deaths. The pandemic, however, did not impact the entire region similarly, and the infections and intensity varied with geographical and socio-economic characteristics. In this project, I used a multi-method approach to analyze the relationship between health disparities and COVID-19-related health outcomes in the USA and examine the influence of health disparities reporting on newspaper coverage of COVID-19. This assessment was performed in three ways. First, I have explored the relationship between Mississippi’s county-level COVID-19-related cases and deaths with the Center for Disease Control and Preventions’s Social Vulnerability Index (CDC SVI). Second, I have investigated the spatial pattern of COVID-19 in the USA and its associations with Social Determinants of Health (SDoH) by utilizing the County Health Rankings & Roadmaps (CHRR) dataset.Finally, I analyzed how news media reporting of key health determinants (i.e., age, race, income and gender) is framed, including the role of different stakeholders in the context of COVID-19. Findings revealed a statistical relationship between CDC’s Social Vulnerability Index (SVI) and Mississippi’s county-level COVID-19 cases and deaths. I also found that COVID-19 infections showed considerable spatial heterogeneity as the distribution of COVID-19 cases and deaths varies across the US counties and among the three largest waves. The multiple regression results also exhibited a temporal association between social determinants of health (SDH) indicators and COVID-19-related health outcomes across the USA. Finally, I found that the NYT coverage of COVID-19 dealt more with human interest, responsibility, and conflict than economic and morality frames. The findings revealed the vital role social determinants of health play during a health crisis, such as the COVID-19 pandemic.

En mars 2020, l’Organisation mondiale de la santé déclare une pandémie mondiale de SARS-CoV-2. Rapidement, le gouvernement du Québec décrète l’état d’urgence sanitaire alors que la métropole de la province, Montréal, se voit affligée de la plus forte prévalence du virus lors de la première vague. La vulnérabilité et les iniquités antérieurement documentées sont potentialisées parmi les populations migrantes et plus spécifiquement pour celles vivant sans assurance médicale. Selon les données les plus récentes, 50 000 à 70 000 personnes vivent sans couverture médicale au Québec. Déjà, avant la pandémie, les personnes migrantes sans assurance médicale (MSAM) étaient confrontées à des barrières culturelles, linguistiques, économiques lorsqu’elles se présentaient dans le réseau public de santé. Ce mémoire de maîtrise vise à documenter les enjeux sociaux, de santé et d’accès aux soins au Québec, plus spécifiquement à Montréal pour la population MSAM dans le contexte de la COVID-19. Une analyse thématique des entretiens semi-dirigés menés auprès de personnes MSAM (n=19) est supportée par le cadre des déterminants sociaux de santé (Gautier et al.,2020). Quatre thèmes émergents de l’analyse seront présentés: Perceptions et attentes par rapport aux politiques (1), Précarité des conditions de vie et de travail : la position sociale déterminante avant et durant la pandémie (2), Stratégies d’adaptation (et leurs limites) pour prévenir les menaces à la santé (3) intraitables institutions de santé en pandémie de COVID-19 (Ou comment les institutions accentuent-elles les barrières d’accès aux soins?) (4). Les résultats de ce projet de recherche mettent en lumière des difficultés et des défis, potentiellement productrices d’ISS, auxquelles ont dit faire face les personnes MSAM durant les premières vagues de la pandémie. Des recommandations sont adressées aux décideurs et aux institutions de santé afin de favoriser l’inclusion des personnes MSAM dans la société québécoise. Celles-ci touchent notamment des politiques et des programmes pour améliorer leur accessibilité aux soins de santé et aux programmes sociaux en temps de pandémie et même au-delà. / In March 2020, WHO declares a global SARS-CoV-2 pandemic. Quickly, the Quebec government declared a state of health emergency while the metropolis of the province, Montreal, was afflicted with the highest prevalence of the virus during the first wave. Vulnerability and previously documented inequities are growing among migrant populations and more specifically for those living without medical insurance. According to the most recent data, 50,000 to 70,000 people live without medical coverage in Quebec. Already before the pandemic, uninsured migrants faced cultural, linguistic and economic barriers when they entered the public health network. This master's thesis aims to document the health and social challenges that they are facing in the context of COVID-19, in Quebec Province, specifically in Montreal. A thematic analysis of the semi-structured interviews conducted with uninsured migrants (n = 19) is supported by the social determinants of health framework (Gautier et al., 2020). Three emerging themes of the analysis will be presented: Precarious living and working conditions: Four emerging themes of the analysis will be presented: Perceptions and expectations in relation to policies (1), precarious living and working conditions: the decisive social position before and during the pandemic (2), adaptation strategies (and its limits) to prevent threats to health (3) Intractable health structures in the COVID-19 pandemic (or how to accentuate the barriers to access to care?) (4). The results of this research project shed light on the difficulties and challenges, potentially producing ISS, that uninsured migrants said they faced during the first waves of the pandemic. Recommendations are addressed to decision-makers and health institutions in order to promote the inclusion of uninsured migrants in Quebec. These relate to policies and programs to improve their accessibility to health care and social programs in times of pandemic and even beyond.

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Syftet med denna studie var att via intervjuer av nyckelpersoner, varav tre inom vårdsektorn och en antropolog, identifiera en del av de faktorer som påverkar arbetet med att förbättra den orala hälsan och i synnerhet införandet av ett förebyggande tandvårdssystem i Kosovo. Kvalitativa intervjuer med fyra nyckelpersoner genomfördes och analyserades enligt Graneheim och Lundmans kvalitativa innehållsanalys. Resultat av intervjumaterialet mynnade ut i följande kategorier: Förebyggande tandvård saknas, Socioekonomiska hinder, Brist på strategi och fakta och God vilja. Kategorierna visar på följande faktorer som påverkar situationen för den orala hälsan i Kosovo. Det finns en hälsoplan där man bland annat planerar att minska kariesförekomst med 10 procent fram till år 2014, men den verkställs inte. Detta får till följd att kariesprevalensen fortfarande är hög och akuttandvården dominerande. Resultat från intervjuerna visar även att sociala bestämningsfaktorer påverkar oral hälsa och tillgången till tandvård, patienter med låg socioekonomisk status undviker tandvården och söker vård endast vid akut värk. Respondenterna uppgav att epidemiologiskt underlag och forskning skulle underlätta utveckling av olika preventiva aktivitetsprogram. Brist på ett sjukförsäkringssystem och korruption anses förhindra utvecklingen av en fungerande förebyggande tandvård. I intervjumaterialet har faktorer identifierats som på sikt gynnar införandet av den förebyggande tandvården. Man har nyligen startat en kurs i förebyggande tandvård vid odontologiska fakulteten i Pristina. Studien visar att avsaknad av ett förebyggande tandvårdssystem försvårar situationen för den orala hälsan i Kosovo. De sociala bestämningsfaktorerna påverkar idag tillgången till tandvården och även utveckling av hälso- och sjukvårdssystemet. / The aim of the study was that through interviews with key persons, including three in health sector and an anthropologist, identify some of the factors affecting the work to improve the oral health and especially the introduction of a preventive dental care system in Kosovo. Qualitative interviews with four key persons was conducted and analyzed, according to Graneheim and Lundmans qualitative content analysis. Results of the interviews fall into the following categories: Preventive dental care is lacking, Socio-economic barriers, Lack of strategy and facts and Good will. The categories show the following factors affecting the situation of the oral health in Kosovo. There is a health plan that includes plans to reduce tooth decay by 10 percent until 2014, but it is not being executed. This has the effect of caries prevalence is still high, and emergency dental care is dominant. Results from the interviews also show that the social determinants affect oral health and access to dental care, patients with low socioeconomic status avoids dental care and seek treatment only for acute pain. Respondents stated that the epidemiological data and research would facilitate the development of preventive activity program. Lack of a health insurance scheme and corruption are considered being barriers for the development of a workable preventive dental care. The interviews also identified factors which ultimately favor the introduction of preventive dental care. Recently the faculty in Pristina started a course in preventive dentistry. The present study shows that the lack of a preventive dental care system complicates the situation for the oral health of Kosovo. The social determinants are affecting the access to dental care and also development of the health care system.

<p>Research has demonstrated repeatedly that income and income distribution are powerful determinants of health. While Ontario public health units are mandated to promote health and reduce health inequities, they have done little to help eliminate poverty, instead focusing on individual behaviours such as smoking, diet, and physical activity – an approach likely to worsen health inequities, rather than mend them. Public health nurses (PHNs) across Canada recognize poverty as a powerful determinant of health, yet have expressed challenges in their ability to take meaningful action to address it (Cohen, 2006b; Reutter & Ford, 1996). The study sought insight into how Ontario public health units can strengthen PHNs socio-political efforts to address the causes of poverty. A qualitative descriptive design was used to explore PHNs’ views, while an <em>Appreciative Inquiry</em> approach was used to draw on participants’ successful past experiences in addressing the causes of poverty and their thoughts for the future. Organizational factors thought to empower PHNs’ socio-political efforts to address the causes of poverty were identified using Kanter’s <em>Structural Theory of Power in Organizations</em> as a starting conceptual framework. Fifteen PHNs participated in face-to-face or telephone interviews. Qualitative content analysis was used to describe participants’ affirmative experiences, empowering organizational attributes, and desired actions and supports for the future. Three overall themes emerged with respect to empowering organizational attributes: authorities within the health unit ‘permit and provide’, active associates ‘help each other out’, and external allies ‘contribute and collaborate’. Factors beyond the health unit that would support anti-poverty work were also identified. Findings suggested that action to address the causes of poverty is within the reach of PHNs, and is consistent with their role and the public health mandate, but requires leadership support and political buy-in in order to maximize its effectiveness.</p> / Master of Science (MSc)

<p>This thesis presents the results of a study exploring the health status and health determinants in two farming groups in Waterloo, Ontario, Canada: Old Order Mennonites (OOMs) and non-OOM farmers. Physical health and mental health are examined, and Canada’s 12 health determinants (excluding genetics) are included in the analysis. A survey was distributed to both groups in 2010 to obtain information on health status and determinants. Comparing the two groups reduces the likely impact of contextual features impacting both, such as local economic conditions. The mental component summary (MCS) and physical component summary (PCS) of the SF-12 were used to measure mental and physical health. The study compares health in the two populations, and uses ordinary least squares (multiple) regression to determine the relative importance of the determinants in shaping health. The study found that mental health is better in OOMs, mainly due to OOM women’s strong mental health. Physical health was worse in OOMs, and while true for both genders, OOM women appear to be particularly disadvantaged. There is overlap between the groups in the determinants shaping physical and mental health. In both groups, mental health is shaped by social interaction, stress and coping; and physical health by age, childhood disease history, coping and body mass index. This suggests these factors may be important across many populations facing different life circumstances, thus representing priorities for policy action. Interestingly, the key determinants shaping physical health in both groups do not include social factors such as social capital, although social factors do shape mental health (especially in OOMs). This may be due to the rural or farming status of the two groups, or differences between physical and mental health. Determining which is more likely requires reconciling the results of this study with others, an effort hampered by differences in models, methods and health outcomes employed.</p> / Doctor of Philosophy (PhD)

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Background: People who use illegal drugs are disproportionately affected by HIV and hepatitis C, stigmatization and social exclusion. Health inequities are worsened by drug policy of criminalization, which thwarts health promotion efforts and hinders access to services. To address these inequities, people who use drugs are increasingly included in decisions that affect them by sitting on policy, service delivery and research committees. This study addressed a gap in understanding how power inequities are transformed in committees where people who use drugs are at the table. Methods: In partnership with the Drug Users Advocacy League and the Society of Living Illicit Drugs Users, this participatory critical emancipatory inquiry explored power relations in four committees in Ontario and BC. Data were collected in 2013 through meeting observations, interviews, demographics surveys and document reviews. Data analysis was guided by theoretical frameworks grounded in critical theory and transformative learning theory. Results: Findings confirmed striking socioeconomic inequities between people who use drugs and others at the table. Inconsistent measures were taken by committees to alleviate barriers to inclusion. Despite openness to inclusion, committee members tended to underestimate people who use drugs. The presence of local organizations of people who use drugs ensured a more democratic selection of their representatives to sit on committees. Once at the table, creating a safe space entailed building trust, authentic relationships, relational and reflective dialogue, and skilled facilitation. Democratic practices of negotiated relationships and consensus-based decision-making enhanced meaningful inclusion. A structural environment in which drug policy criminalizes people who use illegal drugs hindered capacity to transform power inequities by feeding stigma, which worsens health and social inequities. Committees were committed to inclusion of people who use drugs though capacity to do so varied due to budgetary and human resources constraints. Study limitations, practice implications and future research directions are offered. / Graduate / 0700 / 0680 / lynnebel@uvic.ca