Essai de typologie des centres de santé et de services sociaux au Québec

Given the importance of contextual factors—physical, social and institutional environments—for understanding health landscapes, this article examines the situation in the province of Québec and suggests a spatial typology at the scale of the health and social services centres (CSSS). These CSSS provide services for 95 areas which are the finest territorial delineation in terms of health policies since a reform instituted in 2003. While delivery of primary health and social services is defined at this local scale, overall health policy is decided at the provincial scale. The challenge for stakeholders is to supplement their local knowledge with that of the broader context. In this article, we use principal components analysis and hierarchical cluster analysis to identify eight profiles of CSSS. The final results of the cluster analysis demonstrate that two‐thirds of the health and social services centres correspond with two marginally differentiated profiles and the remaining third shows specificities that are highly spatially anchored.     

Indigenous health organizations,Indigenous community resurgence,and the reclamation of place in urban areas

Research around the world has been nearly unanimous about the positive impacts of Indigenous‐led health organizations on Indigenous peoples' qualitative experiences in health care, in the face of often negative experiences in non‐Indigenous‐led health care settings. Urban environments, including health care environments, are areas of increasing attention with regard to Indigenous peoples' health in Canada. In this study, which took place in the northern city of Prince George, British Columbia, 65 Indigenous community members and health services workers participated in interviews and focus groups, describing their experiences with urban Indigenous‐led health organizations—defined in this study as non‐governmental organizations that prioritize the values and practices of local Indigenous communities. Employing perspectives on place and relationships drawn from Indigenous critical theory and Indigenous community resurgence to analyze the findings of this qualitative study leads to a focus on how relationships impact and can even constitute places, enabling new understandings of the roles of Indigenous‐led health organizations in urban Indigenous community resurgence.     

Supporting food security for Indigenous families through the restoration of Indigenous foodways

Indigenous families are overrepresented among those within Canada who experience food insecurity. Studies have largely focused on northern populations, with less attention paid to southern and urban communities, including the social, cultural, and geographic processes that challenge food security. In this study, we present findings from a decade‐long community‐based study with the Southwest Ontario Aboriginal Health Access Centre (London, Ontario) to examine family perspectives related to the social determinants of food security. These topics were explored through qualitative interviews (n = 25) and focus groups (n = 2) with First Nation mothers with young children from the city of London, and a nearby reserve community. Interviewees from both geographies identified a number of socio‐economic challenges including household income and transportation. However, some interviewees also shed light on barriers to healthy eating unique to these Indigenous contexts including access issues such as a lack of grocery stores on‐reserve; loss of knowledge related to the utilization of traditional foods; and the erosion of community, familial, and social supports. Resolving these unique determinants of food security for urban and reserve‐based First Nation families will require a range of economic and culturally specific interventions, particularly those that support development and uptake of Indigenous foodways.     

Environmental health and vulnerable populations in Canada: mapping an integrated equity‐focused research agenda

The uneven distribution of environmental hazards across space and in vulnerable populations reflects underlying societal inequities. Fragmented research has led to gaps in comprehensive understanding of and action on environmental health inequities in Canada and there is a need to gain a better picture of the research landscape in order to integrate future research. This paper provides an initial assessment of the state of the environmental health research field as specifically focused on vulnerable populations in Canada. We present a meta‐narrative literature review to identify under‐integrated areas of knowledge across disciplinary fields. Through systematic searching and categorization, we assess the abstracts of a total of 308 studies focused on the past 30 years of Canadian environmental health inequity research in order to describe temporal, geographical, contextual and epistemological patterns. The results reveal that there has been significant growth in Canadian research documenting the uneven distributions and impacts of environmental hazards across locations and populations since the 1990s, but its focus has been uneven. Notably, there is a lack of research aimed at integrating evidence‐based and policy‐relevant evaluation of environmental health inequities and how they are created and sustained. Areas for future research are recommended including more interdisciplinary, multimethod and preventive approaches to resolve the environmental burden placed on vulnerable populations and to promote environmental health equity.     

Urban Aboriginal health: Examining inequalities between Aboriginal and non‐Aboriginal populations in Canada

Cet article a pour but de contribuer à la littérature en émergence portant sur la santé des Autochtones en milieu urbain, en comparant l’état de santé et les déterminants de la santé de la population autochtone et non‐autochtone en milieu urbain au Canada. L’étude s’appuie sur des données tirées de l’Enquête auprès des peuples autochtones (EPA) de 2001 et de l’Enquête sur la santé dans les communautés canadiennes (ESCC), cycle 1.1. Préconisant une approche axée sur la santé de la population, nous explorons les différences de l’état de santé et des déterminants de la santé entre les populations autochtones et non‐autochtones en milieu urbain. Trois variables sont utilisées pour décrire l’état de santé : l’auto‐évaluation de l’état de santé, les maladies chroniques et la limitation d’activités. Si l’existence de disparités en matière de santé entre la population autochtone et non‐autochtone en milieu urbain est démontrée, celles‐ci ne sont pas aussi importantes que les disparités qui caractérisent la population non‐autochtone et autochtone vivant dans une réserve. Les déterminants sociaux de la santé sont comparables pour les deux populations, mais les résultats illustrent à quel point des facteurs culturels peuvent également intervenir en faveur ou au détriment de la santé parmi la population autochtone en milieu urbain. Cette étude exploratoire fait ressortir la nécessité de tenir compte des facteurs culturels propres aux déterminants de la santé dans les recherches ultérieures afin d’identifier des pistes d’explication des disparités en matière de santé entre les individus autochtones et non‐autochtones en milieu urbain.     

Linking land displacement and environmental dispossession to Mi'kmaw health and well‐being: Culturally relevant place‐based interpretive frameworks matter

For over five decades, Pictou Landing First Nation, a small Mi'kmaw community on the northern shore of Nova Scotia, has been told that the health of its community is not impacted by a pulp and paper mill pouring 85 million litres of effluent per day into a lagoon that was once a culturally significant place known as “A'se'k,” and which borders the community. Based on lived experience, the community knows otherwise. Despite countless government‐ and industry‐sponsored studies indicating the mill's pollutants are merely “nuisance” impacts and harmless, the community's concerns have not gone away. Using a “Piktukowaq” (Mi'kmaw) environmental health research framework to guide the interpretation of oral histories coming from the Knowledge Holders in Pictou Landing First Nation, we convey the deep, health‐enhancing relationship with A'se'k that the Piktukowaq enjoyed before it was destroyed, and the health suppression that has occurred since then. Conducting the research using a culturally relevant place‐based interpretive framework has demonstrated the absolute necessity of this kind of approach where Indigenous communities are concerned, particularly those facing health impacts vis‐à‐vis land displacement and environmental dispossession.     

Going unscripted: A call to critically engage storytelling methods and methodologies in geography and the medical‐health sciences

Geography and the medical‐health sciences have long histories of engaging the humanities. The last decade has seen for both disciplines a significant growth in theoretical frameworks, pedagogic strategies, and research methods that draw upon visual and literary arts, critical self‐reflection, creative tools and expressions, and even direct engagement or partnership with artists, curators, authors, theatre‐practitioners, and other professionals in the arts. Both geographers and medical‐health professionals, then, are increasingly (re)making and understanding various worlds through the humanities. In this paper we explore the histories of humanities in both geography and the medical‐health sciences, especially medicine: we argue the two disciplines have much to learn from each other's engagement and work with the humanities. Focusing on the increasing use of narrative and storytelling in both disciplines, we argue that deployment of humanities‐based frameworks and impulses must not be taken up without careful and critical analytical reflection. Finally, we ground our theoretical explorations with empirical examples from recent community‐based work about the risks and benefits of storytelling and visual arts when looking at the health geographies of Indigenous and settler peoples in Northern British Columbia.

De manière impromptue : vers une démarche critique sur les méthodes de mise en récit et les méthodologies en géographie et en sciences médicales et de la santé

L'intérêt pour les sciences humaines par la géographie et les sciences médicales et de la santé s'inscrit dans une longue tradition. Au cours de la dernière décennie, les deux disciplines ont connu une importante croissance de cadres théoriques, de stratégies pédagogiques et de méthodes de recherche qui font appel aux arts visuels et à la littérature, à l'autoréflexion critique, à des outils et modes d'expression novateurs, voire même à une participation directe ou à des partenariats avec des artistes, conservateurs, auteurs, praticiens de l'art dramatique et d'autres professionnels du domaine des arts. Autant les géographes que les professionnels de la médecine et de la santé contribuent de plus en plus à (re)constituer et comprendre divers mondes à travers les sciences humaines. Cet article brosse un tableau historique des sciences humaines tant en géographie qu'en sciences médicales et de la santé, en particulier la médecine : nous soutenons que les deux disciplines ont beaucoup à apprendre l'une de l'autre sur l'intérêt que chacune porte aux sciences humaines. En mettant l'accent sur le recours grandissant par les deux disciplines à la narration et à la mise en récit, nous faisons valoir l'idée que le déploiement des cadres et des impulsions fondés sur les sciences humaines ne peut pas être envisagé sans mener au préalable une réflexion analytique minutieuse et critique. Enfin, nous fondons cette étude du champ théorique sur des exemples empiriques tirés de travaux réalisés à l'échelle communautaire sur les risques et les avantages de la mise en récit et des arts visuels quand on se penche sur les aspects géographiques de la santé des peuples autochtones et colonisateurs dans le nord de la Colombie‐Britannique.     

Mining sick: Creatively unsettling normative narratives about industry,environment, extraction,and the health geographies of rural,remote, northern,and Indigenous communities in British Columbia

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely—as Cree Elder Willie Ermine says—pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as “sick”? Constructions of “sick” geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively “mined” for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro‐white‐settler imaginations. Drawing from multi‐year, relationship‐based, cross‐disciplinary qualitative community‐informed experiences, and anchored in feminist, anti‐colonial, and anti‐racist methodologies that guided creative and humanities‐informed stories, this paper concludes with different stories. It unsettles settler‐colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well‐being and the environment.     

The social dynamics of attracting talent in Halifax

The paper reports a case study of factors attracting and retaining talented and creative workers in Halifax, Nova Scotia. All categories of workers interviewed mentioned quality of place and amenities in discussing their location preferences, but that could not fully explain their choices. For some occupations (like health research), talented people followed jobs; in other sectors (like music), talented workers migrated to a sympathetic locale with the right conditions for creative engagement; creative workers in some occupations (like those in architectural, engineering or planning consulting) were more rooted in place. The social dynamics—that is, positive and collaborative social networks within key sectors and a wider community perceived as welcoming and interesting—make this mid‐sized city attractive to talented workers. Local universities and a vibrant music scene generate a mutually reinforcing context that attracted mobile talented and creative workers to the city. Respondents noted Halifax's limited cultural diversity but did not report a perceived lack of tolerance as affecting their choices. In smaller cities, the social dynamics of place and workplace and the quality of life available may play more significant roles than tolerance in attracting and retaining talented workers, challenging a basic assumption of creative cities discourse.     

Examining Indigenous perspectives on the health implications of large‐scale agriculture in Jalisco,Mexico

In Mexico, as in many other parts of the world, industrial agriculture is dramatically changing rural landscapes and altering relationships with the land. This paper draws on community‐based research from a collaborative international research project that examined the perceived health implications of the agricultural industry for Indigenous peoples in the state of Jalisco, Mexico. Thirty interviews were conducted in a Nahuas community experiencing expanding agribusiness industries. The results of this study show that the implications of export‐oriented agricultural industry for this Nahuas community are complex and, at times, contradictory: employment in the agricultural industry provides community members with much‐needed sources of income, but it is precarious work. At the same time, community members are concerned about the long‐term health and environmental implications, such as increased exposure to chemicals, depletion of the soil and water, and loss of traditional food and lifeways. These results suggest that to better understand the costs and benefits of large‐scale agriculture for Indigenous health, a broad lens of health that is situated in the context of colonial legacies and the particularities of relationships with the land is required.     

Geography's secret powers to save the world

The purpose of this paper, prepared to present at the 2018 joint Canadian Association of Geographers (CAG) and International Geographical Union (IGU) regional conference, is to suggest three strategies, framed as proposals, that geography and geography education can deploy to “save the world.” The first proposal is to expand explicit instruction in spatial thinking to close gender‐based achievement gaps. The second proposal is to apply research from the learning sciences to develop persuasive geography curricula and instructional materials. The third proposal focuses on ways social media and geospatial technologies can be employed in civic education, an idea termed “spatial citizenship.” The paper suggests a re‐envisioning of geography education with an enhanced focus on teaching for, in, and about a world that fully appreciates difference and acts on that appreciation.