Working Paper Series:
» 2009-10
• 2007-9
• 2006-7
• 2004–5
Sara Allin|Roger Chafe|Antony Chum|Laurie Corna|Lyndsay Hayhurst|Seija Kromm|Meaghan Marian|Krista Maxwell|Tanya Morton|Ubaka Ogbogu|Subha Ramanathan|Kate Rossiter|Sarah Sanford|Eliana Suarez|Marisa Young|
Sara Allin (CPHS & CHSRF Post-Doctoral Fellow)
“Socio-economic Status and Child Health: What Is the Role of Health Care Utilization?"
ABSTRACT: There is a persistent relationship between socio-economic status and health that appears to have its roots in childhood. Not only do children in families with lower incomes and with mothers with lower levels of education have worse health on average than those with greater socio-economic advantages, but also the gradient appears to steepen with age. This study contributes to the literature on socio-economic status and child health by testing the hypothesis that the increasing effect of family income on children’s health with age relates to their use of health care services. Drawing on a nationally representative survey from Canada, the National Longitudinal Survey of Children and Youth, this study provides further evidence of a steepening gradient in child health. It finds that accounting for health care use does not explain the steepening gradient and that the relationship between income and health care use is greater among higher income families.
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Roger Chafe (CPHS & CHSRF-CIHR Post-Doctoral Fellow)
“Examining Variations in Cancer Drug Coverage Across the Country”
ABSTRACT: Coming soon.
Antony Chum (Lupina Junior Doctoral Fellow)
“Policy Implications of Neighbourhood Effects on Health Research: Towards an Alternative to Poverty Deconcentration”
ABSTRACT: While researchers continue to build on the evidence that where one lives has an independent effect on one’s health, the theoretical and empirical work of translating this research into effective social policies is relatively thin as current urban policy discourse often draws on problematic assumptions about urban poverty. In light of a new generation of experimental research on the health effects of neighbourhoods based on housing mobility programs, this paper addresses the politics of poverty deconcentration that implicitly undergirds much of this new research. By raising critiques of poverty dispersal and housing mobility programs rarely considered in the health literature, this paper challenges the central treatment of poverty dispersal in the new experimental literature. This paper argues that efforts of poverty deconcentration, without addressing the structure of municipal competition and fragmentation, simply react to symptoms of urban poverty and ignore the underlying factors that shape the neighbourhood resources that structure health outcomes. These factors include 1) municipal fragmentation, 2) exclusionary land use planning, and 3) municipal competition. Effective and just social policies aimed at improving neighbourhood influence on health must address the competitive and fragmented municipal structure that produces a patchwork of affluence and deprivation in urban America today.
Laurie Corna (Lupina Senior Doctoral Fellow)
“A Lifetime of Experience: Modelling Labour Market and Family Life Course Histories among Older Adults in Britain”
ABSTRACT: From the perspective of the life course, socio-economically based inequalities in health among older adults may be better understood in the context of the life course experiences that precede them. In particular, labour market experiences and family roles during the working years, including the ways in which they are gendered, may offer insight into how inequalities in health emerge in the first place. Yet, assessing the influence of detailed labour market participation and family role histories on inequalities in health among older adults presents particular methodological challenges for life course researchers. In this work, labour market and family experiences from young adulthood to retirement age are modelled using retrospective life course history data from the British Household Panel Survey. A two-stage latent class analysis is applied to identify underlying work-family role configurations at various points across the life course and articulate latent life paths that link these experiences over time. Theoretical considerations, along with indices of model fit, suggest that four latent life paths broadly characterize the experiences of the older adults in this sample. These life paths are distinguished by gender, labour market and family care activities, and by the presence of dependent children in the household. This paper concludes with a discussion of the implications of these latent life paths for research on socio-economic inequalities in health among older adults in Britain.
Lyndsay Hayhurst (Lupina Junior Doctoral Fellow)
“The Corporatization of Sport, Gender and Development: Postcolonial IR Feminisms, Transnational Private Governance and Global Corporate Social Engagement”
ABSTRACT: Across the globe, the “Girl Effect” is a growing but understudied initiative that assumes that girls are catalysts capable of bringing social and economic change to their families, communities and countries. In an attempt to build on the “promise” of women as agents of development, there has been escalating interest in sport, gender, and development (SGD) interventions that aim to “empower” women and girls in the Two- Thirds World2 through sport and play. Increasingly, SGD interventions are funded and implemented by multinational corporations (MNCs). Drawing on postcolonial feminist international relations theory and recent literature on transnational private governance, the purpose of this study was to consider how MNCs headquartered in the One-Third World that fund, execute and implement corporate-sponsored SGD programs in the Two-Thirds World are implicated in some of the complicated effects observed in the postcolonial contexts in which they operate. Qualitative research methods were used, including interviews with seven key staff members from a sporting goods MNC that funds SGD programs in the Two-Thirds World. The findings revealed three themes that speak to the colonial residue within corporate-funded SGD interventions, including 1) the power of brand authority, 2) the importance of “authentic” subaltern stories, and 3) the politics of the “global sisterhood” enmeshed in saving “distant” others. The implications of these findings for SGD will be discussed in terms of postcolonial feminist approaches to studying sport for development and peace more generally.
Seija Kromm (Lupina Junior Doctoral Fellow)
“Accountability in Health Care and the Use of Performance Measures”
ABSTRACT: Accountability is being stressed in the Canadian health care environment. This paper uses a framework that considers both the production characteristics of services provided and the type of accountability sought, and how they may impact a policy tools’ ability to achieve accountability. The production characteristic focused on is “measurability,” or more specifically, the performance measures currently being used in the province of Ontario to achieve accountability. These measures are considered alongside the criteria of a highperforming health system and policy tools, and are compiled into an inventory. Whether these accountability or performance measures align with the criteria of a high-performing health system may influence the likelihood that accountability for these criteria is achieved using the available policy tools. The inventory of available measures helps identify criteria, such as patient satisfaction and health promotion/population health, which are challenging to assess. In the case of patient satisfaction, a large number of measures were used to deal with the challenge of assessing performance. Conversely, health promotion/population health has only one corresponding measure. Health system efforts to achieve accountability are commendable, even if imperfect. These results indicate the opportunity for further research around accountability and the creation of measures.
Meaghan Marian (Lupina Senior Doctoral Fellow)
“Colonial Medicine, the Body Politic, and Pickering’s Mangle in the Case of Hong Kong’s Plague Crisis of 1894”
ABSTRACT: The eruption of bubonic plague in Hong Kong in 1894 was the flashpoint of the Third Pandemic, marking a critical juncture in the story of plague and plague fighters, and was also a galvanizing moment in the history of the port colony. The spread and containment of plague was accomplished through the agency of human actors, among them a rapidly growing Chinese population in the basin of Victoria Peak, a colonial regime governing from atop the Peak, an emerging class of Chinese elites, and teams of foreign scientists arriving in Hong Kong in hot pursuit of the pathogen. The arc of the plague was also potentiated by nonhuman agents: Hong Kong’s subtropical, monsoonic environment, the mountainous geography of the territory that supported various configurations of power, as well as migratory and commercial flows between China, the British empire and Hong Kong’s harbour, the ghosts of Chinese socio-religious tradition, heterogenous schemas of the body and disease in Chinese and Western medicine, and, of course, the fleas that bite rats, vectors of infection. I suggest that the writing of a history of plague in Hong Kong hinges on weaving together these streams of human and non-human agency. In particular, looking at Hong Kong in this moment of iatric crisis through the lens of the mangle, Andrew Pickering’s contribution to the evolving field of science studies, reveals how human and non-human agents constitute the experience of embodiment, the practice of medical science, the logics of imperialism, and not merely the writing of the histories of such.
Krista Maxwell (Lupina Senior Doctoral Fellow)
“Ojibwe Activism, Harm Reduction and Healing in 1970s Kenora, Ontario: A Micro- History of Canadian Settler Colonialism and Urban Indigenous Resistance”
ABSTRACT: Red Power activism, Ojibwe cultural revival, and Indigenous and biomedical responses to alcohol abuse, provided fertile terrain for the growth of an Indigenous healing movement in Kenora, northwestern Ontario, during the 1970s. This paper explores how different social actors framed the “problem” of Aboriginal alcohol abuse in Kenora at this time, and the different paradigms underlying approaches to its resolution. I argue that to understand colonization as a determinant of health, we need to consider both geographically and historically-specific manifestations of colonial policies and practices, and how Indigenous people have creatively and strategically engaged with dominant institutions and discourses.
Tanya Morton (Lupina/OGS Doctoral Fellow)
“Spheres of Risk: Examining Targeted and Universal Approaches to Childhood Injury Prevention”
ABSTRACT: One identified high-risk group for injury is children of low socio economic status. One of the enduring controversies in the prevention field is whether programs should be offered universally to the whole population or target specific “high-risk” groups. The debate on universal versus targeted programs has been ongoing. This paper discusses the implications of universally offered and targeted injury prevention programs. An analysis of the targeted versus universal conundrum suggests that a comprehensive constellation of universal and targeted programs are conducive to addressing the various levels of injury risk to children. However, universal models of prevention have advantages in terms of promoting safety through wide ranging public policies. Considering the social determinants of health can enhance the identification of injury prevention priorities amongst researchers and health and social service professionals. Given the recent economic context of widening income disparities, injury prevention practitioners and child advocates can learn from existing success stories of universal programs in injury prevention as a way to mute the effects of socio-economic inequality. Future directions for research and practice are discussed.
Ubaka Ogbogu (Lupina Senior Doctoral Fellow)
“The Scope and Limits of Legal Intervention in Controversies Involving Biomedicine: A Legal History of Vaccination and English Law (1813–1853)”
ABSTRACT: This paper examines the historical role of law and politics in the adoption of smallpox vaccination in Britain, focusing primarily on the early Victorian period, when legislation was passed to enforce compulsory infantile vaccination. The primary thesis of the study is that law, and the processes through which it is created and maintained, provide a distinct “envelope of social order” (Jasanoff 2008, 764) within which competing and duelling interests and opinions about scientific innovation find origin, expression, and debate. Consequently, the manner in which law responds to science and its impact on society is neither static nor self-evident, but subject to mutable circumstances that are historically, politically, and socially situated. The paper is divided into two main parts. The first provides a brief history of vaccination and the second focuses on events surrounding the introduction of compulsory vaccination laws in England and Wales.
Subha Ramanathan (Lupina/OGS Doctoral Fellow)
“A Mixed-Method Approach to Examining Physical Activity among Canadian Girls of South Asian Ancestry in High School”
ABSTRACT: Physical activity (PA) participation is a critical issue for health promotion with well-established links to healthy development, disease prevention, and well-being. Population research indicates that youth PA levels are low, especially among older adolescents, girls, and visible minorities in Canada. Researchers have identified persons of South Asian origin to be at risk for inactivity and chronic disease risk factors, e.g., glucose intolerance. Thus, there is a need for PA research with youth of South Asian ancestry, and especially girls who report lower levels of PA than boys. The purpose of this research was to better understand PA participation among girls in high school of South Asian ancestry using a mixed methods design of daily diaries and a survey. This paper reviews the literature on youth PA and focuses on study methodology, methodological challenges, and solutions that were employed. Episodic daily diaries of everyday activities were administered to girls with probes for types, timing, location, and companions. Girls identified their most physically demanding pastimes each day. The survey examined demographics, participation in, and perceptions of support in PA, parental and peer relationships, and cultural and religious identities. Diaries offered a comprehensive strategy for evaluating PA while simultaneously gathering information on pastimes and responsibilities.
Kate Rossiter (CPHS Research Associate Fellow)
“Abide with Me: A Story of Two Pandemics”
ABSTRACT: Given its perceived ability to engage diverse audiences and capture and interpret qualitative data in a nuanced manner, research-based theatre has become increasingly popular within the field of health care over the last decade. This paper describes a research-based theatre project focused on ethical issues that may arise during pandemic influenza planning and response. To do so, we detail the project’s history and methodology and then present the script that has emerged from this process. Set between two time periods, this script incorporates contemporary qualitative data as well as historical material gathered from archives in Brantford, Ontario. Thus, this project draws from multiple methodological traditions in order to create an engaging piece of research-based theatre.
Sarah Sanford (Lupina/OGS Doctoral Fellow)
“Global Biopolitics and Emerging Infectious Disease”
ABSTRACT: This paper takes as its starting point the idea that emerging infectious disease has become a paradigmatic way of thinking about disease in the West in recent years. These understandings are often directly or indirectly attributed to the phenomenon of globalization. In addition, the last decade has seen a growing interest in the possibility of a future influenza pandemic that could have dire consequences for global health. This heightened concern has been accompanied by an increase in investment in planning that aims at preparedness against this imminent yet uncertain event by global and national authorities, pointing to pandemic as both a health issue and a broader social problem. This paper builds upon existing social science research that explores understandings of infectious disease within broader contexts. The theoretical concepts of biopolitics, securitization, risk and race, and their relation to understandings of emerging infectious disease are discussed and are followed by a discussion of the implications of global biopolitics for understanding the field of global pandemic governance in relation to broader political and economic contexts. This analysis illustrates the importance of exploring understandings and effects of inequality in relation to the regulation of infectious disease within contemporary global contexts.
Eliana Suarez (Lupina Senior Doctoral Fellow)
“Re-visiting Traumatic Stress: Integrating Local Practices and Meanings in Explanatory Frameworks of Trauma”
ABSTRACT: Although Post Traumatic Stress Disorder (PTSD) is only one of the identifiable responses to trauma, it has become the main focus of trauma research, writing, and clinical interventions. The unquestioned use worldwide of PTSD as a diagnostic category, however, presents the risk of pathologizing and/or oversimplifying human responses to traumatic events if local meanings and practices of trauma are marginalized from dominant explanatory frameworks of trauma. This paper goes beyond critiques of the current trauma paradigm and offers new theoretical tenets whereby multiple local contexts could be better incorporated into trauma discourse and practice. In doing so, this paper reviews the historical and theoretical context of leading explanatory frameworks of traumatic stress with an emphasis on cross-cultural settings. If a renewed trauma paradigm aims to have a renewed role in the global health arena, it should be informed locally and globally.
Marisa Young (Lupina Senior Doctoral Fellow)
“Neighbourhood Effects on Family-to-Work Conflict and Distress”
ABSTRACT: My research examines the extent to which individuals’ neighbourhood of residence impacts family stressors and resources, family-to-work conflict (FWC), and resulting distress. Unlike previous literature on FWC and mental heath, I contextualize these processes by considering the direct and mediating effects of social context. I focus on three research questions: 1) How do real and perceived neighbourhood stressors and resources combine to affect FWC and subsequent distress? 2) Are these associations mediated by family stressors and resources? 3) How do these processes vary across social status groups? I draw upon three data sources to answer my research questions, including interview data from residents of Toronto Canada, 2006 Canadian Census data, and 2010 administrative data on Toronto’s neighbourhood resources. The results of my research will contribute to literature on FWC and mental health in several ways: First, I effectively model individual and neighbourhood effects simultaneously. Second, my research considers structural neighbourhood effects on family stressors and resources, FWC and subsequent distress, as well as individuals’ perceptions of neighbourhood stressors and resources. Finally, I document these trends across various social status groups using multiple data sources to more accurately capture neighbourhood and family stressors and resources and their association with FWC and distress.