Kathi Wilson

I spent nine years looking for a doctor: exploring access to health care among immigrants in Mississauga, Ontario, Canada.

There is a growing body of research in Canada and from other countries acknowledging that immigrants face barriers in accessing health care services. As immigrants make up an increasing percentage of the population in many developed nations, a better understanding and eliminating these barriers is a major priority. This research contributes to current understandings of access among immigrant populations in Canada by exploring perceptions of access to care through focus groups with a diverse group of immigrants living in a Mississauga, Ontario neighbourhood. The results of eight focus groups reveal that immigrants face geographic, socio-cultural and economic barriers when attempting to access health care services in their community. This paper provides policy recommendations relevant to the federal, provincial and local levels for eliminating these barriers.

‘Education? It is irrelevant to my job now. It makes me very depressed …’: exploring the health impacts of under/unemployment among highly skilled recent immigrants in Canada

Immigrants account for 20% of the population and 60% of total population growth in Canada (Statistics Canada 2001). The majority of immigrants are accepted for entry to Canada under the Skilled Worker Program in order to fill employment shortages in the labour market (CIC 2007). Recent research has revealed that an increasing number of immigrants who gain entry under this programme face significant barriers to employment. As a result, many remain unemployed or accept employment outside of and below their field of education and training. However, the impacts such employment circumstances have on the health of immigrants have not yet been examined. This paper presents the results of a collaborative research project that explores the health impacts of under/unemployment among skilled immigrants in Mississauga, Ontario, Canada. In-depth interviews are used to examine the experiences of employment and perceptions of subsequent health impacts among 22 recent immigrants. The participants most frequently identified mental health impacts due to a lack of income, loss of employment-related skills, loss of social status and family pressures. These health concerns are also extended to family members. In addition to mental health, physical health is perceived to be affected by employment circumstances through high levels of stress and strenuous working conditions. These findings shed light on the nature of the links between employment and health relationship as well as determinants of immigrant health. Additional research is required to examine the long-term effects of under/unemployment.

Linking perceptions of neighbourhood to health in Hamilton, Canada

Study objective: To investigate the association between perceptions of neighbourhood physical and social characteristics and three health outcomes (self assessed health status, chronic conditions, and emotional distress). Design: Cross sectional survey data analysed in small neighbourhoods. Setting: Hamilton, Ontario, Canada, a medium sized industrial city, located at the western end of Lake Ontario (population at the time of the study about 380 000). Participants: Random sample of 1504 adults aged 18 years and older residing in four contrasting neighbourhoods. Main results: Significant differences across the four neighbourhoods are apparent in self assessed health status and emotional distress, but not in chronic conditions. Neighbourhoods with lower SES reported poorer health and more emotional distress. Perceptions of the physical environment dominated social concerns in all neighbourhoods. For all three health outcomes, individual risk factors followed expectations, with measures of poverty, age, and lifestyle all significantly associated with poor health outcomes. Physical environmental problems were positively and significantly associated with poor physical and emotional health. Specifically, people reporting they dislike aspects of their neighbourhood’s physical environment are 1.5 times more likely to report chronic health conditions (OR 1.56, 95% CI 1.19 to 2.05), while those reporting physical likes with their neighbourhood are less likely to report fair/poor health (OR 0.50, 95% CI 0.28 to 0.90) or emotional distress (OR 0.45, 95% CI 0.26 to 0.80). Conclusions: These results demonstrate the importance of neighbourhood perceptions as a determinant of health, as well as conventional factors such as low income, lifestyle, and age. The dominance of physical environmental concerns may have arisen from the industrial nature of Hamilton, but this result merits further investigation.

Accessibility and the Canadian health care system: squaring perceptions and realities

The 1984 Canada Health Act (CHA) is the major piece of Federal legislation that governs health care accessibility in the provinces and territories. According to the CHA, all provinces and territories in Canada must uphold five principles in order to receive federal funding for health care (universality, comprehensiveness, portability, public administration, and accessibility). In Canada, there are competing views among policy makers and consumers about how the CHAs principle of accessibility should be defined, interpreted and used in delivering health care. During the 1990s, the health care perceptions of Canadians and their health care behaviours were measured through both public opinion polls and Statistics Canadas National Population Health Survey (NPHS). The goal of this paper is to examine perceptions of accessibility in public opinion polls and actual accessibility as measured through the NPHS. Public opinion polls demonstrate that while Canadians want to preserve the principles of the CHA, a majority of Canadians are losing confidence in their health care system. In contrast, the results from the NPHS reveal that only 6% of Canadians aged 25 years and older have experienced accessibility problems. Among those who report access problems, the barriers to accessibility are linked to specific socio-economic, socio-demographic and health characteristics of individuals. We discuss these findings in the context of the current debates surrounding accessibility within the CHA and the Canadian health care system.

“You Can Make a Place for it”: Remapping Urban First Nations Spaces of Identity

Contemporary research on migration, particularly those studies drawing upon theories of transnationalism, demonstrates the ways in which social relations are stretched across spaces, allowing individuals to disrupt boundaries and create identities of belonging to more than one place. This research focuses on the disruption of state boundaries through migration and identity construction. In this paper we utilize elements of transnational theory and stories of First Nations migrants to explore the ways that First Nations urbanization also disrupts boundaries. Colonial perspectives and practices that confined First Nations cultural practices and identities within the physical boundaries of reserves and defined all other spaces as settler spaces created a framework for the construction of the contemporary Canadian nation-state. We present the results of eighteen in-depth interviews conducted with urban First Nations migrants. The interviews focused on understanding how migration to cities shapes relationships to the land (an important element of indigenous identity), the challenges cities present to maintaining connections to the land, and the strategies First Nations migrants use to preserve those connections. By resisting the assignment of First Nations cultures and identities to reserves, First Nations migration to cities challenges the identity of the modern state by disrupting its internal borders and boundaries.

Health, healing and recovery: Therapeutic landscapes and the everyday lives of breast cancer survivors

Drawing on the theory of therapeutic landscapes, this paper examines the importance of place for shaping health and healing among breast cancer survivors. Semi-structured in-depth interviews were conducted with 14 women in the Greater Toronto Area at various stages of breast cancer recovery to examine where and how they access and create landscapes of healing. The interviews revealed the importance of everyday and extraordinary therapeutic landscapes that are created in bodies and homes, as well as the broader community and nature. Those landscapes with which women interact on an everyday basis appear to be most important for physical and psychological healing. In addition, the research suggests a strong interplay between emotions and place such that emotional geographies, which appear to be embedded within places of healing, play an important role in shaping and maintaining therapeutic landscapes. Further research is needed to understand the place of emotions in creating therapeutic landscapes, particularly for those populations most in need of healing.

Neighbourhoods and potential access to health care: The role of spatial and aspatial factors

The availability of, and access to, primary health care is one neighbourhood characteristic that has the potential to impact health thus representing an important area of focus for neighbourhood-health research. This research examines neighbourhood access to primary health care in the city of Mississauga, Ontario, Canada. A modification of the Two Step Floating Catchment Area method is used to measure multiple spatial and aspatial (social) dimensions of potential access to primary health care in natural neighbourhoods of Mississauga. The analysis reveals that neighbourhood-level potential access to primary care is dependant on spatial and aspatial dimensions of access selected for examination. The results also show that potential accessibility is reduced for linguistic minorities as well as for recent immigrant populations who appear, on the surface, to have better access to walk-in clinics than dedicated physicians. The research results reinforce the importance of focusing on intra-urban variations in access to care and demonstrate the utility of a new approach for studying neighbourhood impacts that better represents spatial variations in health care access and demand.

An overview of Aboriginal health research in the social sciences: current trends and future directions

OBJECTIVES: To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population. STUDY DESIGN: Review. METHODS: We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995–2005 using search terms to reflect different names used to refer to Canada’s Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods. RESULTS: Based on the 96 papers reviewed, the results show an under-representation of Metis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods. CONCLUSIONS: Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples.

Access to Primary Health Care: Does Neighborhood of Residence Matter?

Neighborhood social and physical contexts have the ability to impact health and health behaviors of residents. One neighborhood characteristic that remains underexamined in the research is access to health care resources. This research examines potential (geographical) access to primary health care in the city of Mississauga, Ontario, Canada. A modification of the two-step floating catchment area method that better suits the study of locally relevant natural neighborhood units is presented. Potential access to health care is measured in each of Mississaugas neighborhoods considering several spatial and aspatial (i.e., social) characteristics of the population and of physicians, including the raw abundance of physicians, languages spoken by physicians and patients, and whether physicians are accepting new patients. Neighborhood-level results are compared to census tracts. The results of this analysis reveal that potential access significantly differs between neighborhoods for all spatial and aspatial dimensions of access. Accessibility is considerably reduced for linguistic minorities and for those who might not have a dedicated family physician as compared to the general population. This research contributes to the existing body of literature on neighborhoods and health by demonstrating the utility of an alternative methodology for developing a more comprehensive understanding of access to health care within natural geographical neighborhoods.

My health has improved because I always have everything I need here...: a qualitative exploration of health improvement and decline among immigrants.

Immigrants in Canada constitute approximately 20% of the total population and will continue to account for a significant portion of the countrys population in the future. Accordingly, a growing body of research has focused on examining the disparity in health status between the increasing foreign-born and the Canadian-born populations. The healthy immigrant effect, in particular, acknowledges that immigrants have better health status than their Canadian-born counterparts upon arrival in the country. However, studies have shown that over time the health of immigrants declines to a level on par with the Canadian-born population. There is much speculation as to the reasons for this decline including acculturation (i.e., uptake of unhealthy lifestyles) and a lack of access to health care. Yet, there have been few studies to examine possible reasons for potential declines in health, especially from the perspective of immigrants themselves. This study is one of the first to qualitatively examine perceived changes in health status and reasons for health status change among immigrants. The paper presents the results of 23 in-depth interviews with adults with recent (less than 3 years of residency), mid-term (3-10 years), and long-term (more than 10 years) immigrants living in the Greater Toronto Area. The results reveal that the majority of the participants believed their health had remained stable or even improved over time due to improved living standards and lifestyle behaviours in Canada. Those who perceived their health to have worsened over time attributed the change to the stress associated with migration, and the aging process rather than the adoption of an unhealthy lifestyle. Additionally, while the vast majority of participants reported improved access to resources upon migration, there were mixed reviews in terms of how beneficial these resources were or could be for health. The findings highlight the need for research to incorporate mental health into studies on changing immigrant health status and to focus on those factors contributing to high levels of stress among more recent immigrants.