Daniyal Zuberi

The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: Comparing the United States to Canada

Using a cross-national comparative approach, we examined the influence of health insurance on U.S. immigrant versus non-immigrant disparities in access to primary health care. With data from the 2002/2003 Joint Canada/United States Survey of Health, we gathered evidence using three approaches: 1) we compared health care access among insured and uninsured immigrants and non-immigrants within the U.S.; 2) we contrasted these results with health care access disparities between immigrants and non-immigrants in Canada, a country with universal health care; and 3) we conducted a novel direct comparison of health care access among insured and uninsured U.S. immigrants with Canadian immigrants (all of whom are insured). Outcomes investigated were self-reported unmet medical needs and lack of a regular doctor. Logistic regression models controlled for age, sex, nonwhite status, marital status, education, employment, and self-rated health. In the U.S., odds of unmet medical needs of insured immigrants were similar to those of insured non-immigrants but far greater for uninsured immigrants. The effect of health insurance was even more striking for lack of regular doctor. Within Canada, disparities between immigrants and non-immigrants were similar in magnitude to disparities seen among insured Americans. For both outcomes, direct comparisons of U.S. and Canada revealed significant differences between uninsured American immigrants and Canadian immigrants, but not between insured Americans and Canadians, stratified by nativity. Findings suggest health care insurance is a critical cause of differences between immigrants and non-immigrants in access to primary care, lending robust support for the expansion of health insurance coverage in the U.S. This study also highlights the usefulness of cross-national comparisons for establishing alternative counterfactuals in studies of disparities in health and health care.

The deleterious consequences of privatization and outsourcing for hospital support work: The experiences of contracted-out hospital cleaners and dietary aids in Vancouver, Canada

This article is based on the findings of the Hospital Support Workers Study, which includes in-depth interviews with 70 hospital housekeepers and dietary aids in Vancouver, British Columbia, Canada. As a result of provincial government legislation in 2003, all hospital-based support work in the Vancouver region was privatized and contracted out to three multinational corporations. The outsourcing of hospital support services is part of a larger global trend toward neoliberal policy reform in health care. This article presents the perceptions of hospital support workers about the consequences of contracting out on their work conditions, training, turnover rates and other issues that directly affect their quality of work and have important implications for patient health and well-being. The findings suggest serious negative consequences for the health care system as a result of the privatization and contracting out of hospital support services.

Contracting Out Hospital Support Jobs: The Effects of Poverty Wages, Excessive Workload, and Job Insecurity on Work and Family Life

Based on in-depth interviews with 70 hospital support workers in Vancouver, Canada, this article describes how the contracting out of their jobs to multinational corporations has had deleterious consequences for these workers, their families, and the health care system. Privatization and outsourcing resulted in a steep initial wage reduction for hospital support staff, decreasing by up to 50% from approximately

Local approaches to counter a wider pattern? Urban poverty in Portland, Oregon

18 to

The Cuban paladar: Ideological subversion or substantiation?

20 per hour to between

Certifying voluntary living wage employers

9 and

Globalization and the Service Workplace

12 per hour—with much weaker job benefits. Despite recent wage increases as a result of Hospital Employees’ Union—led contract negotiations, workers still earn lower hourly wages than they did before contracting out and report challenges making ends meet. The concluding discussion presents the implications of these findings for the sociology of work and health and proposes some policy reforms for mitigating the negative consequences of privatization. The article also describes the beginning of a living-wage movement in Vancouver that has emerged in part as a result of this decision to outsource these hospital support jobs.

Reducing the prevalence of obesity in Canada: a call to action

Abstract A model U.S. city, Portland Oregons progressive policies are often credited with making it highly livable, with a vibrant urban core. Yet these policies have not protected Portland from broader trends that have increased urban poverty over the past several decades in the U.S., including social welfare cuts and the shift in the economy to the service sector. In terms of poverty dynamics and social policies, we argue that while regional planning and other progressive policies have helped protect Portland from extremely high concentrated poverty present in many large U.S. cities, it has still experienced growing social dislocations associated with national and macro-level social and economic factors. These trends suggest both the possibilities and limits of local policy, regional planning, and activism for ameliorating the deleterious consequences of social welfare retrenchment and franchise capitalism for vulnerable urban populations, and highlight the importance of the broader social policy context and economic change for understanding urban poverty and the experiences of the urban poor.

Lagging behind in suburbia: Suburban versus urban newcomers’ employment settlement service outcomes in Metro Vancouver, Canada

Abstract The findings of a qualitative, in-depth exploration of Havanas rapidly expanding private sector, reveal that paladares – privately owned Cuban restaurants – are not, as previously suggested, antithetical to Havanas political status quo. Instead the negotiation between the state in, and toleration of, private enterprise in Havana has become the foundation for a host of double standards and informal regulations that manifest themselves in two distinct business models. While at the same time inherently capitalistic, modestly successful paladares help contribute to the socioeconomic endurance of Havanas social doctrine despite their high levels of regulation. On the other hand, elite paladares routinely challenge political and social ideologies, yet remain largely immune to retribution. The findings contribute to the understanding of the context of Havanas informal second economy and the ongoing U.S. embargo.

Meeting Great Expectations: The Experiences of Minority Students at a Canadian University

Purpose – Living wage campaigns are popular responses to counter increasing inequality in advanced industrial countries. The purpose of this paper is to examine how voluntary living wage employer certification engages business in multi-sectoral coalitions to reduce poverty. Design/methodology/approach – The authors utilize qualitative interviews with 30 members of a living wage employer certification program in Vancouver, Canada as a case study to explore campaign participation by the business community and business case outcomes. Findings – Certifying voluntary living wage employers engaged business community members as partners and advocates in a living wage campaign. Certified living wage employers fulfilled business case projections for worker compensation fairness, human resource improvements and corporate branding advantages. Research limitations/implications – The study focussed on the early stages of a living wage employer certification program. As the number of living wage certification programs ...