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Why Canada Is in Court to Protect Healthcare for All: Global Implications for Universal Health Coverage

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-11-16
Abstract: 

Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hospital and physician services based on need, not ability to pay. A constitutional challenge to this legislation is underway in British Columbia (BC), led by a corporate plaintiff, Cambie Surgeries Corporation (CSC). This constitutional challenge threatens to undermine the high bar for UHC protection that Canada has set for the world, with potential adverse implications for equitable international development. CSC claims that BC's healthcare law—the Medicare Protection Act (MPA)—infringes patients' rights under Canada's constitution, by essentially preventing physicians who are enrolled in BC's publicly-funded Medicare plan from providing expedited care to patients for a private fee. In September 2020, after a trial that ran for 3.5 years and included testimony by more than 100 witnesses from around the world, the court dismissed the plaintiffs' claim. Having lost their case in the Supreme Court of BC, the plaintiffs' appealed in June 2021. The appellate court's ruling and reasons for judgment are expected sometime in 2021. We consider the evidence before the court from the perspective of social epidemiology and health inequalities, demonstrating that structural features of a modern society that exacerbate inequalities, including inequitable access to healthcare, can be expected to lead to worse overall societal outcomes.

Document type: 
Article
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What Makes Artificial Intelligence Exceptional in Health Technology Assessment?

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-11-02
Abstract: 

The application of artificial intelligence (AI) may revolutionize the healthcare system, leading to enhance efficiency by automatizing routine tasks and decreasing health-related costs, broadening access to healthcare delivery, targeting more precisely patient needs, and assisting clinicians in their decision-making. For these benefits to materialize, governments and health authorities must regulate AI, and conduct appropriate health technology assessment (HTA). Many authors have highlighted that AI health technologies (AIHT) challenge traditional evaluation and regulatory processes. To inform and support HTA organizations and regulators in adapting their processes to AIHTs, we conducted a systematic review of the literature on the challenges posed by AIHTs in HTA and health regulation. Our research question was: What makes artificial intelligence exceptional in HTA? The current body of literature appears to portray AIHTs as being exceptional to HTA. This exceptionalism is expressed along 5 dimensions: 1) AIHT’s distinctive features; 2) their systemic impacts on health care and the health sector; 3) the increased expectations towards AI in health; 4) the new ethical, social and legal challenges that arise from deploying AI in the health sector; and 5) the new evaluative constraints that AI poses to HTA. Thus, AIHTs are perceived as exceptional because of their technological characteristics and potential impacts on society at large. As AI implementation by governments and health organizations carries risks of generating new, and amplifying existing, challenges, there are strong arguments for taking into consideration the exceptional aspects of AIHTs, especially as their impacts on the healthcare system will be far greater than that of drugs and medical devices. As AIHTs begin to be increasingly introduced into the health care sector, there is a window of opportunity for HTA agencies and scholars to consider AIHTs’ exceptionalism and to work towards only deploying clinically, economically, socially acceptable AIHTs in the health care system.

Document type: 
Article
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Childhood bullying: Time to stop

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Childhood bullying can lead to serious consequences, including subsequent mental health problems such as anxiety, depression and suicidality. We therefore set out to identify if there were any effective antibullying programs.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating antibullying programs for children. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating six school-based programs and two clinic-based interventions.

Results: Four school-based programs – Youth Matters, Roots of Empathy, Bullies and Dolls, and Media Heroes – were successful at reducing at least one form of bullying. Integrative Family Therapy, a clinical intervention, was also effective at reducing bullying by teenage boys.

Conclusions: There are effective antibullying interventions that can be delivered in elementary, middle and secondary schools. So programs can start early, reaching more children to prevent the harms that come with bullying. Additionally, some young people may benefit from the help of a mental health practitioner to address bullying and other aggressive behaviours.

Psychedelic Use Is Associated With Reduced Daily Opioid Use Among People Who Use Illicit Drugs in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-02-01
Abstract: 

Background

Research into the therapeutic and naturalistic uses of psychedelics for improving outcomes related to mental health disorders has generated increasing interest in recent years. While controlled clinical trials of psychedelics have signaled benefits for treating substance use disorders, this area has not been well studied in the context of naturalistic psychedelic use. This study sought to investigate the possible relationship between recent naturalistic psychedelic use and subsequent daily illicit opioid use among people who use drugs (PWUD).

 

Methods

Data (2006–2018) were drawn from three harmonized prospective cohorts of community-recruited PWUD in Vancouver, Canada. We used multivariable generalized linear mixed-effects modeling (GLMM) to estimate the independent association between psychedelic use and subsequent daily illicit opioid use.

Results

Among 3813 PWUD at baseline, 1093 (29%) reported daily use of illicit opioids and 229 (6%) reported psychedelic use in the past six months. Over study follow-up after adjusting for a range of potential confounders, psychedelic use remained independently associated with a significantly reduced odds of subsequent daily opioid use (Adjusted Odds Ratio: 0.45; 95% Confidence Interval: 0.29 to 0.70).

Conclusion

While confirmation in other settings is required, these findings align with growing evidence that psychedelic use may be associated with detectable reductions in subsequent substance use including illicit opioid use.

Document type: 
Article

The Role of Tailored Public Health Messaging to Young Adults during COVID-19: “There’s a lot of ambiguity around what it means to be safe”

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-10-01
Abstract: 

The COVID-19 global incidence rate among young adults (age 19–40) drastically increased since summer 2020, and young adults were often portrayed by popular media as the "main spreader" of the pandemic. However, young adults faced unique challenges during the pandemic due to working in high-risk, low-paying essential service occupations, as well as having higher levels of financial insecurity and mental burden. This qualitative study aims to examine the attitudes and perceptions of health orders of young adults to better inform public health messaging to reach this demographic and increase compliance to public health orders. A total of 50 young adults residing in British Columbia, Canada, were recruited to participate in focus group in groups of four to six. Focus group discussions were conducted via teleconferencing. Thematic analysis revealed four major themes: 1) risks of contracting the disease, 2) the perceived impact of COVID-19, 3) responsibility of institutions, 4) and effective public health messaging. Contrary to existing literature, our findings suggest young adults feel highly responsible for protecting themselves and others. They face a higher risk of depression and anxiety compared to other age groups, especially when they take on multiple social roles such as caregivers and parents. Our findings suggest young adults face confusion due to inconsistent messaging and are not reached due to the ineffectiveness of existing strategies. We recommend using evidence-based strategies proven to promote behaviour change to address the barriers identified by young adults through tailoring public health messages, specifically by using positive messaging, messaging that considers the context of the intended audiences, and utilizing digital platforms to facilitate two-way communication.

Document type: 
Article
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Patterns, Trends and Determinants of Medical Opioid Utilization in Canada 2005–2020: Characterizing an Era of Intensive Rise and Fall

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-09-14
Abstract: 

Background

Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020.

Methods

Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing.

Results

All provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control.

Conclusions

We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.

Document type: 
Article
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A Drug-Related Good Samaritan Law and Calling Emergency Medical Services for Drug Overdoses in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-08-26
Abstract: 

Background

People who use drugs (PWUD) are known to fear calling emergency medical services (EMS) for drug overdoses. In response, drug-related Good Samaritan Laws (GSLs) have been widely adopted in the USA and Canada to encourage bystanders to call emergency medical services (EMS) in the event of a drug overdose. However, the effect of GSLs on EMS-calling behaviours has been understudied. We sought to identify factors associated with EMS-calling, including the enactment of the Canadian GSL in May 2017, among PWUD in Vancouver, Canada, a setting with an ongoing overdose crisis.

Methods

Data were derived from three prospective cohort studies of PWUD in Vancouver in 2014–2018. Multivariable logistic regression was used to determine factors associated with EMS-calling among PWUD who witnessed an overdose event. An interrupted time series (ITS) analysis was employed to assess the impact of GSL on monthly prevalence of EMS-calling.

Results

Among 540 eligible participants, 321 (59%) were males and 284 (53%) reported calling EMS. In multivariable analysis, ever having administered naloxone three or more times (adjusted odds ratio [AOR] 2.00; 95% confidence interval [CI] 1.08–3.74) and residence in the Downtown Eastside (DTES) neighbourhood of Vancouver (AOR 1.96; 95% CI 1.23–3.13) were positively associated with EMS-calling, while living in a single occupancy hotel (SRO) was negatively associated with EMS-calling (AOR 0.51; 95% CI 0.30–0.86). The post-GSL enactment period was not associated with EMS-calling (AOR 0.81; 95% CI 0.52–1.25). The ITS found no significant difference in the monthly prevalence of EMS-calling between pre- and post-GSL enactment periods.

Conclusion

We observed EMS being called about half the time and the GSL did not appear to encourage EMS-calling. We also found that individuals living in SROs were less likely to call EMS, which raises concern given that fatal overdose cases are concentrated in SROs in our setting. The link between many naloxone administrations and EMS-calling could indicate that those with prior experience in responding to overdose events were more willing to call EMS. Increased efforts are warranted to ensure effective emergency responses for drug overdoses among PWUD.

Document type: 
Article
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Fighting racism

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Racism has a profound impact on children well-being. In fact, researchers have found links between experiencing racial discrimination and mental health concerns, including depression, anxiety and conduct problems. We therefore set out to identify effective interventions for reducing racism in children.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating interventions to reduce racism. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating 11 interventions.

Results: Two interventions showed promising outcomes. Books that recounted close friendships between non-refugee and refugee children resulted in children having more positive attitudes towards refugees.  As well, history lessons focused on Black American’s contributions to society and their experiences of racism resulted in children having more positive attitudes towards Black people and increased their valuing of racial fairness. 

Conclusions: Two brief interventions had a positive impact on children’s attitudes towards people of colour. They offer a helpful starting point for ongoing efforts to create more equitable experiences for all children. 

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Qualitative Evaluation of a Mandatory Health Insurance ‘Wait Period’ in a Publicly Funded Health System: Understanding Health Inequities for Newcomer Im/Migrant Women

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-08-05
Abstract: 

Objectives To evaluate impacts of a residency-based waiting period for health insurance coverage on lived experiences of health and settlement for im/migrant women in British Columbia, Canada.

Design The IRIS study is a mixed-methods, community-based, qualitative evaluation of recently arrived im/migrant women’s access to sexual and reproductive care. In-depth, semistructured interviews were conducted by trained multilingual and multicultural interviewers with lived migration experience in the participant’s preferred language.

Setting Metro Vancouver, British Columbia, Canada from July 2018 to January 2020.

Participants Data collected from community focus groups (four groups, n=29) of both service providers and im/migrant women was used. Following this, qualitative interviews with service providers (n=10) and im/migrant women (n=47) were conducted. Eligible participants self-identified as women; were aged 18–49 and had arrived in Canada from another country. Eligible providers were employed in the health, social or legal sectors working with im/migrant women.

Results The wait period resulted in mistrust and internalised stigma for racialised im/migrant women, for whom the policy resulted in feeling ‘undeserving’ of care. Resulting administrative burden produced delays and unmet need for care, particularly related to sexual and reproductive healthcare and children’s health. Unexpected costs meant difficult choices between survival and care. Negative health outcomes included the inability to family plan, difficulties during pregnancy, as well as hardships related not being able to seek help for sick children. Community-based organisations provided support in many areas but could not fill all gaps produced by this policy.

Conclusions Findings highlight severe, yet commonly overlooked, health inequities produced by a mandatory health coverage wait period within a purportedly ‘universal’ healthcare system. Health system policies such as mandatory ‘waiting periods’ produce discriminatory and inequitable outcomes for im/migrant women. Policy reforms towards full ‘healthcare for all’ are urgently needed to affirm the health and human rights of all im/migrants.

Document type: 
Article
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COVID-19 and the Impact on Children's Mental Health

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

The COVID-19 public health crisis has created significant challenges for children in British Columbia. These challenges have included most children facing restrictions in their contacts with family members and friends, as well as temporary school closures. Many children are also part of families that have experienced economic hardships. Beyond the social, educational and economic costs, there will also be mental health consequences. This rapid review therefore aimed to determine how the pandemic and its associated challenges may affect the mental health of BC’s children, including those who may be disproportionately harmed. The overarching goal was to inform and assist policymakers to support all children in BC during COVID-19 — and beyond.

Our systematic review identified one relevant original study on the mental health consequences of previous pandemics and five systematic reviews on the mental health consequences of natural disasters for children. The findings showed dramatic increases in rates of anxiety, posttraumatic stress, depression and behavioural challenges compared to rates typically found in the general population of children. Other literature suggests that some groups may also be disproportionately affected, including children from socioeconomically disadvantaged families and those who have faced extreme or cumulative adversities. Racism may contribute to Asian-Canadian children facing added hardships. Indigenous children may also be particularly disadvantaged given the cumulative adversities associated with the legacies of colonialism. As well, children with neuro-diverse special needs such as autism spectrum disorder, fetal alcohol spectrum disorder, developmental delays or other disabilities may have greater mental health needs during the pandemic.

On balance, the available research evidence suggests that BC’s response to the COVID-19 pandemic must make children’s mental health a high priority — ensuring that children do not experience additional avoidable adversities due to either the pandemic or the public health responses. Central to these objectives will be: providing additional necessary prevention and treatment services; ensuring that public investments go towards effective interventions; preventing avoidable childhood adversities including reducing socioeconomic disparities; and tracking child outcomes so that all British Columbians can see the progress. Failing to address children’s mental health now will lead to greater costs in the future, if mental health problems are allowed to persist into adulthood. COVID-19 is an unprecedented public health crisis. Yet it also presents an unprecedented opportunity — to make BC a place where the social and emotional wellbeing of all children is highly valued and where children are the focus of sustained collective efforts to ensure their healthy development.

Document type: 
Report