Dan Small is a medical anthropologist and lecturer at the University of British Columbia.
Since 2018, British Columbia has been pursuing legal action against pharmaceutical companies for their involvement in the opioid crisis. Within the wider context of North America, there have been over 2600 such lawsuits against the pharmaceutical companies including Purdue, Johnston and Johnson, Teva Pharmaceutical and Endo International. The Purdue pharmaceutical company, the maker of OxyContin, has recently filed for bankruptcy in response to the lawsuits. I believe a suitable strategy for examining the wider variables that have contributed to the opioid crisis: a Royal Commission. This is needed in order to widen public scrutiny beyond the role of pharmaceutical companies to include investigation of the overarching causes of Canada’s overdose epidemic.
Cal Robinson is a PGY2 Pediatrics resident at McMaster University interested in how social determinants of health impact Canadian children.
On November 22nd, 2018, Ontario’s Progressive Conservative government unveiled their planned reforms of provincial social assistance programs, including changing the definition of disability for the Ontario Disability Support Program (ODSP). These announcements have been met with criticism from political and advocacy groups who argue that these represent further cuts to social assistance. Further policy announcements last year included a reduction of the planned 3% increase in social assistance to 1.5% and cancellation of the Ontario Basic Income Pilot, one of the largest minimum income studies ever developed. The Ontario Basic Income Pilot had already enrolled 4,000 low-income individuals across the province. These intended cuts to Ontario’s social assistance programs will have a substantial negative impact on the health of Ontarians, and will particularly threaten the physical, psychological and social wellbeing of Canadian children and their families. ...continue reading →
Noémie La Haye-Caty is a medical student in the Class of 2019 at McGill University
Katy is sleeping on the exam table. She came in looking tired, talking with a weak voice, and walking with small steps. I tried to ask a few questions, but her lack of sleep was evidently preventing her from answering.
She is here today for a follow-up appointment. She was admitted two weeks ago because she wanted to end her life.
I try to gently wake her up. “How are you doing, Katy?”
“Great! What’s better?”
“I was confused, before.”
“Why were you confused?”
Katy is 24 years old and has three young children. She is now a few weeks pregnant. Two of her children were recently taken by the Director of Youth Protection (DYP), while the youngest lives with Katy and Katy’s own mother. Katy tells me that the father of her kids used to be violent with her and has been in prison for the past week. ...continue reading →
Ruth Habte is a medical student in the Class of 2019 at the University of Manitoba
I have been privileged to take part in implementing global health programming while in medical school, both at my own school and across the country. Throughout this time, I have often been prompted to answer the infamous question: “What is global health?” I have also encountered the misconception of global health being synonymous with international health. Based on my learning and experiences, I have come to define global health in my own terms.
While global health is an incredibly broad field, the cornerstone of global health (in my opinion) is attaining health equity for all people. That means that a person with less privilege in life should be afforded greater means to reach the same health outcomes as those with more privilege. ...continue reading →
Yipeng Ge is a medical student in the Class of 2020 at the University of Ottawa
Humbled. I am so truly humbled that I get to work with and learn from so many passionate medical students with such strong and refined values, morals, and dedication to their causes.
I am specifically speaking about the shift in the medical learner community to respond more attentively and compassionately; to acknowledge the importance of health and social inequities as they affect and inform our medical education and profession, and — more importantly — how they ultimately affect our current and future patients. Patients do not experience the health system not as an isolated entity (though for many of us in the healthcare field, it can certainly feel as though our assistance is limited to clinic rooms); instead, they are affected by the many determinants of health and wellbeing beyond the direct control and impact of clinicians in the healthcare setting. ...continue reading →
Ameer Farooq is a General Surgery Resident (R3) at the University of Calgary who completed his Master of Public Health at the Harvard T. H. Chan School of Public Health in the Global Health track. He is interested in global surgery, implementation science, and trying to keep up with his two children.
Alastair Fung is a Pediatrics Resident (R3) at the University of Manitoba who completed his Master of Public Health at the Harvard T. H. Chan School of Public Health in the Global Health track. He is interested in early childhood development and pediatric infectious diseases in low-resource countries, as well as Canadian indigenous child health.
A child is admitted to the PICU for hemiplegia and diagnosed with a brain abscess. The culture of the abscess fluid grows dental flora; clearly, poor education and access to dental hygiene are the root cause. ...continue reading →
Maria Powell is an Internal Medicine Resident (R1) at the University of Calgary who graduated from medical school at Memorial University of Newfoundland in 2017
Admittedly, my social histories used to consist of the same three questions: Do you smoke? Do you drink alcohol? Do you use recreational drugs? I would occasionally ask if the patient worked outside the home, or what they did for income, but the question rarely came up when reviewing consults with resident and staff physicians so I did not routinely ask about it. One thing I am sure of: I never asked whether or not the patient had a home.
During my first two years of medical school, I had lectures on the social determinants of health, and I thought I understood their importance. Yet, it was not until I did a “Health of the Homeless” elective in downtown Toronto that I truly appreciated the impact of the social determinants of health. ...continue reading →
Li (Danny) Liang is a second year medical student at the University of Toronto with a BEng degree and a deep interest in the intersection of urban design and health
Growing up in Toronto's suburbs, I slowly began to realize what was wrong with how much of the city is designed. Most of the neighborhoods outside of the downtown core are clearly designed for cars, instead of pedestrians and cyclists. Most neighborhoods in the suburbs, composed of a sea single detached houses with small oases of high-rises sprinkled in, are not very walkable nor bike-friendly. Getting from point A to point B by walking becomes a huge odyssey: it often took at least half an hour to walk to the nearest library, movie theatre, grocery store or community centre. The way the city is designed is also unfair from a social justice perspective, as most of the people living in the Toronto Community Housing apartments I lived in could not afford to drive. The overall low population density of Toronto's suburbs means that there is not enough ridership to justify building rapid transit to the clusters of high-rises in the suburbs that are drowned by single-family detached houses. ...continue reading →
Bonnie Larson is Family Physician at Calgary Urban Project Society (CUPS) Health Centre
Recently I called the emergency department from my outreach clinic in an urban shelter. Near the end of the day, the nurse mentioned that one of the clients staying there, a young aboriginal woman I will call Ms. Rain, was supposed to follow up on an abnormal lab result from a few days earlier. As I looked the patient up on the ancient clinic laptop, I thought about the promise I had made to my daughter that morning to try to be home by suppertime. I willed the computer to load the results a little faster so I could get home to my family.
Although physicians generally recognize that social determinants influence the health of their patients, many are unsure how they can intervene. Dr. Anne Andermann, Associate Professor in the Department of Family Medicine at McGill University in Montreal and founding director of the CLEAR Collaboration, discusses how physicians and allied health care workers can address social determinants in their day-to-day practice. She wrote a review article (subscription required) published in the CMAJ.