Denise L. Spitzer

Where There Is Smoke, There is Stress: Low-Income Women Identify Support Needs and Preferences for Smoking Reduction

Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income womens support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).

Impacts of a support intervention for low-income women who smoke

The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.

Challenges and barriers to services for immigrant seniors in Canada: "you are among others but you feel alone"

Purpose – This paper seeks to explore varied interrelated challenges and barriers experienced by immigrant seniors.Design/methodology/approach – Senior immigrants representing diverse ethnicities (Chinese, Afro Caribbean, Former Yugoslavian, Spanish) described their challenges, support needs, and barriers to service access. Service providers and policy makers from organizations serving immigrant seniors were interviewed to elicit their views on barriers to access and appropriateness of services for immigrant seniors. Qualitative methods were employed to enhance understanding of meanings, perceptions, beliefs, values, and behaviors of immigrant seniors, and investigate sensitive issues experienced by vulnerable groups. The qualitative data were subjected to thematic content analysis.Findings – Seniors reported financial and language difficulties, health problems, discrimination, family conflicts, and social isolation. Although most immigrant seniors appreciated the standard of living in Canada and the serv...

Retrenched and Returned: Filipino Migrant Workers during Times of Crisis

Situating data from a pilot study conducted in the Philippines within the research literature, we examine the impact of the recent global economic crisis on the experiences of Filipino migrant workers and their families in the context of previous economic upheavals. In so doing, we highlight the gendered effects of shifts in the global economy and detail government response to the premature return of migrant workers to the Philippines primarily due to retrenchment impelled by the global economic crisis. While the current conditions of migration and return are significant, we argue that these are not the result of a new global economic crisis, but are instead the ongoing effects of neoliberal globalization that have resulted in sustained multiple crises with which residents of the Global South have had to contend. Moreover, the reputed solutions offered to returned migrants are rooted in the same faulty paradigm that will be destined to produce only further hardship.

Community health workers in Canada: innovative approaches to health promotion outreach and community development among immigrant and refugee populations.

This article provides results from an empirical case study that showcases a community health worker practice targeting immigrants and refugees in Canada. The study focuses on the Multicultural Health Brokers practice, which offers an innovative approach to health promotion outreach and community development addressing broad social determinants of health. This article offers new evidence of both the role of community health worker interventions in Canada and community health workers as an invisible health and human services workforce. It also discusses the Multicultural Health Brokers contribution both to the “new public health” vision in Canada and to a practice that fosters feminist urban citizenship.

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

BackgroundThe purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011.MethodsFocus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities.ResultsSeveral common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends.The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites.ConclusionsRecommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.

The global financial crisis: whither women's health?

The global integration of trade and financial markets that has been the hallmark of the past 30 years of neoliberal globalization means that local economies can be shaped by economic events seemingly unrelated to the scale or geography where womens empowerment projects unfold. These global–local interactions raise questions so far largely absent in public discussions of the 2008 crisis precipitated by the US sub-prime loan scandal: what are the gendered effects of global financial crises; specifically, how do these crises affect women? And how do these market crises intersect with the non-market activities that are key to understanding gendered health issues in developing countries. This article addresses these questions by reviewing the literature on gendered health impacts of financial crises over the past two decades. We find that the manner in which national governments and the broader international community react to crises can either magnify (as illustrated through the impacts of structural adjustment programmes on womens health) or mitigate (as illustrated through the policies pursued following the loss of support from the collapsed Soviet Union on Cuban womens health) gendered health-negative effects. Lack of attention to gender-specific consequences of past crises or health-positive interventions into such crises has weakened the ability to advance policy advice on protecting womens health during the present crisis. The article concludes with a gender-focused critique of the dominant policy responses to the 2008 financial crisis and a call to undertake real-time investigation of gendered health risks and opportunities arising from the present crisis.

Sexual and reproductive health issues facing Southeast Asian beer promoters: a qualitative pilot study

BackgroundIn Southeast Asia, hundreds of thousands of young rural women migrate from their villages to the larger cities in search of work. Many find employment with beer companies or in the clubs where beer is sold, promoting the sale of beer. Previous research suggests these young migrants are in a highly vulnerable position. This paper will describe the findings of an October 2009 meeting to develop a research agenda on the sexual and reproductive health of beer promoters and a subsequent pilot study of focus groups with beer promoters to review this agenda.MethodsParticipants of the research meeting representing beer promoters, academics, non-governmental organizations (NGOs), government and the beer industry from Cambodia, Thailand, Laos, and Vietnam collaborated in the development of three key research themes. The themes were verified in focus group discussions with beer promoters organized by local research partners in all four countries. The focus group participants were asked what they felt were the key sexual and reproductive health issues facing them in a non-directive and unstructured manner, and then asked to comment more specifically on the research priorities developed at the meeting. The focus groups were recorded digitally, transcribed, and translated into English. The data were analyzed by coding for common themes and then developing matrices to compare themes between groups.ResultsThe participants of the meeting identified three key research themes: occupational health (including harassment and violence, working conditions, and fair pay), gender and social norms (focusing on the impact of power relations between the genders on womens health), and reproductive health (knowledge and access to reproductive health care services). The participants in the focus groups in all four countries agreed that these were key priorities for them, though the emphasis on the most important issues varied between groups of women. Sexual harassment in the workplace and challenges in accessing reproductive health care services because of the barriers of cost, shyness, and stigmatizing attitudes of health care providers were common problems for many of the women.ConclusionsThere is a need for regional research and programming for beer promotion women in Southeast Asia focusing on the three research themes of occupational health, gender norms and reproductive health. Such research and programs could provide important benefits for many beer promotion women who currently face significant risks to their sexual and reproductive health.

An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving—a mixed method study

BackgroundDramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses.MethodsThis mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers’ migration of relevant policy documents and academic literature on health workers’ migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists.ResultsFilipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility.ConclusionsUnless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Globalization and the health of Canadians: ‘Having a job is the most important thing’

BackgroundGlobalization describes processes of greater integration of the world economy through increased flows of goods, services, capital and people. Globalization has undergone significant transformation since the 1970s, entrenching neoliberal economics as the dominant model of global market integration. Although this transformation has generated some health gains, since the 1990s it has also increased health disparities.MethodsAs part of a larger project examining how contemporary globalization was affecting the health of Canadians, we undertook semi-structured interviews with 147 families living in low-income neighbourhoods in Canada’s three largest cities (Montreal, Toronto and Vancouver). Many of the families were recent immigrants, which was another focus of the study. Drawing on research syntheses undertaken by the Globalization Knowledge Network of the World Health Organization’s Commission on Social Determinants of Health, we examined respondents’ experiences of three globalization-related pathways known to influence health: labour markets (and the rise of precarious employment), housing markets (speculative investments and affordability) and social protection measures (changes in scope and redistributive aspects of social spending and taxation). Interviews took place between April 2009 and November 2011.ResultsFamilies experienced an erosion of labour markets (employment) attributed to outsourcing, discrimination in employment experienced by new immigrants, increased precarious employment, and high levels of stress and poor mental health; costly and poor quality housing, especially for new immigrants; and, despite evidence of declining social protection spending, appreciation for state-provided benefits, notably for new immigrants arriving as refugees. Job insecurity was the greatest worry for respondents and their families. Questions concerning the impact of these experiences on health and living standards produced mixed results, with a majority expressing greater difficulty ‘making ends meet,’ some experiencing deterioration in health and yet many also reporting improved living standards. We speculate on reasons for these counter-intuitive results.ConclusionsCurrent trends in the three globalization-related pathways in Canada are likely to worsen the health of families similar to those who participated in our study.