Gender and place influences on health risk perspectives in northern Canadian Aboriginal communities

Developing a better understanding of the factors underlying health and environmental risk perspectives has been the focus of significant research in recent years. Although many previous studies have shown that perspectives of risk are often associated with gender, sociocultural variables and place, our understanding of the relationship between these factors and risk remains equivocal. A research study was undertaken to develop better insights into the understanding and perspectives of various types of health risks in two sets of northern Canadian Aboriginal communities – the Yellowknives Dene First Nation communities of N'Dilo and Dettah in the Northwest Territories and the Inuit communities of Nain and Hopedale in Nunatsiavut. Gender was found to have a limited overall effect on risk perspectives, consistent with other studies that found no gender differences in communities stressed by multiple and concurrent risks. Nonetheless, subtle gender differences were seen in the qualitative responses, with women focusing more on community impacts and mitigating actions. Threats to ‘place-identity’ associated with changes in traditional lifestyle and connection to the land were strongly associated with risk perspectives. These results reinforce the need to be cautious in making assumptions about the complex effects of community and personal attributes, such as gender and gender relations, in assessing the factors underlying risk views and concerns. They also suggest the importance of gathering multiple types of data (both quantitative and qualitative) in order to fully assess the effects of both gender and place. Ultimately, understanding risk in a northern context requires recognizing the unique circumstances and identities of northern Aboriginal peoples.     

Gendered networks and migration decision-making in Northern Vietnam

This paper examines the gender aspect of migrant networks, particularly the different ways networks are expected to assist men's or women's migration during migration decision-making processes. Through the case study of a farming community in Northern Vietnam, it shows that migrant networks are not gender neutral and, more importantly, men and women capitalise on different functions of networks to facilitate their migratory endeavours. Whilst men tend to be connected to relatively more extended networks primarily for practical support, women are more likely to be tied to family networks, which provide them with not just information and practical support but also social protection. These gender-specific expectations and uses of migrant networks have important implications for men's and women's mobility. The paper provides new insights into the way migration choices are made by men and women and at the same time underscores the importance of understanding migrant networks in researching migration.     

Blurred lines: the home front,the battlefront,and the wartime relationship between citizens and government in the Republic of Vietnam

In the Republic of Vietnam, the blending of the home and battle fronts shaped the relationship between citizens and their government. Civilians viewed the national government as the institution responsible for various forms of social welfare related to the war and the resulting militarisation of non-combatants’ lives. An examination of citizens’ letters to its ministries shifts the focus from questions of political legitimacy to citizens’ expectations of their government. The role of gender in family and social structures also shaped how Vietnamese civilians perceived their war experiences and their relationships to the government.     

Rubber plantations and their implications on gender roles and relations in northern uplands Vietnam

Abstract

In recent years, rubber plantations have been strongly promoted in the northern uplands of Vietnam–especially in the northwest, where it is an ill agro-ecological fit–with an aim to improve ethnic minority livelihoods and to modernize peasants by transforming them into rubber workers. A large area of land has been taken away from farmers to make way for rubber plantations. This land acquisition and agrarian transformation have impacted local people and their livelihoods in various ways. Drawing on ethnographic research, in combination with interviews with authorities and studying related documents, this article focuses on the gendered consequences of rubber plantation in northern uplands Vietnam. It argues that the process of becoming a rubber worker and adapting to the new way of living has indeed added new roles and responsibilities for women. At the same time, it has undermined men’s values and reshaped gender relations both within and outside the home.     

Examining social isolation by gender and geography: conceptual and operational challenges using population health data in Canada

In 2003, the Canadian Federal/Provincial/Territorial Task Force on Seniors identified social isolation as an important issue for further study and policy development given that socially isolated persons are considered to be more vulnerable to both inappropriate use of the health care system and poorer health outcomes. In order to provide adequate support to this vulnerable population, it is critical to untangle the complex web of relationships that influence the need for care, and the health status and service utilization patterns of socially isolated older adults. Using data from the 2000–01 Canadian Community Health Survey (CCHS), this article explores social isolation as a multidimensional social construct examining in particular the axes of gender and geography to try to tease out some of this complexity and its relationship to health status and service utilization. When individual characteristics like gender are considered together with broader contextual variables like place of residence, a more comprehensive and layered portrait of vulnerability among socially isolated persons begins to emerge with insights into their unique patterns of health and service use. For example, home care may be an extremely critical resource for keeping older women in their homes and out of hospital. On the other hand, among socially isolated older men, those living in rural communities may be particularly ‘invisible’, neither benefiting from home care nor having strong social supports. It seems plausible then that both men and women may be in need of special interventions or targeted programmes to help them to remain, or to become, more socially integrated in their communities as they age in place. In addition, this article addresses some of the limitations of using both a quantitative analytic approach and the CCHS dataset itself in grappling with such complexity.     

Participatory video drama research in transitional Vietnam: post-production narratives on marriage,parenting and social evils

Based on two years of participatory video drama (PVD) research with men and women in the city of Hu?, this article explores perspectives on, and experiences of, socio-economic transition and its influence on domestic life in Vietnam. Through a combination of output analysis, group screening sessions and individual interviews, it concentrates on the themes of marriage, parenting and ‘social evils’ which emerged in the PVD. It demonstrates how familial tensions collectively identified in the workshop and told in a single video-narrative are complicated by the more nuanced discourses that emerge from co-produced analysis in the post-production period. These illuminate a greater plurality of voices towards the liberalisation of the Vietnamese economy and the new life choices that this brings.     

The Intersection of Gender,Caste and Class Inequalities in Child Nutrition in Rural India

While studies have investigated inequalities in child nutrition along single axes of social power such as, gender, caste and class, there has not been any study that has examined the intersection of the different axes in determining nutritional outcomes of children. This paper examines the intersection of gender, class and caste in determining children's nutritional outcomes for rural north, rural south and rural India as a whole. The paper investigates the intersectionality of the three axes in rural India and focuses on regional differences. The results show that children with particular disadvantageous group affiliations often find significant compensatory benefits from other beneficial identities. Class inequality dominates caste inequality and caste inequality dominates gender inequality in rural North India for all levels of stunting. In contrast, caste inequality dominates class inequality which in turn dominates gender inequality for severe stunting in rural South India.     

Measuring potential spatial access to primary health care physicians using a modified gravity model

Ensuring equity of access to primary health care (PHC) across Canada is a continuing challenge, especially in rural and remote regions. Despite considerable attention recently by the World Health Organization, Health Canada and other health policy bodies, there has been no nation-wide study of potential (versus realized) spatial access to PHC. This knowledge gap is partly attributable to the difficulty of conducting the analysis required to accurately measure and represent spatial access to PHC. The traditional epidemiological method uses a simple ratio of PHC physicians to the denominator population to measure geographical access. We argue, however, that this measure fails to capture relative access. For instance, a person who lives 90 minutes from the nearest PHC physician is unlikely to be as well cared for as the individual who lives more proximate and potentially has a range of choice with respect to PHC providers. In this article, we discuss spatial analytical techniques to measure potential spatial access. We consider the relative merits of kernel density estimation and a gravity model. Ultimately, a modified version of the gravity model is developed for this article and used to calculate potential spatial access to PHC physicians in the Canadian province of Nova Scotia. This model incorporates a distance decay function that better represents relative spatial access to PHC. The results of the modified gravity model demonstrate greater nuance with respect to potential access scores. While variability in access to PHC physicians across the test province of Nova Scotia is evident, the gravity model better accounts for real access by assuming that people can travel across artificial census boundaries. We argue that this is an important innovation in measuring potential spatial access to PHC physicians in Canada. It contributes more broadly to assessing the success of policy mandates to enhance the equitability of PHC provisioning in Canadian provinces.     

Gender,households and reintegration: everyday lives of returned migrant women in rural northern Ghana

Since the late 1990s, migration of single women from the rural north to the urban south in Ghana has been making up a growing share of migrant streams. While the livelihood strategies of these migrant women in their southern destinations have been recently examined, the experience of reintegration for those who return to their place of origin has rarely been studied. Drawing on qualitative research with migrant women, returned migrant women (RMW) and their family members, this study examines everyday reintegration experiences of RMW within their households in a rural Dagomba community in Northern Region, Ghana. We conceptualise the household as an arena of everyday life wherein RMW exercise agency to learn to generate livelihoods that support their own as well as household members’ joint well-being. We combine this conceptualisation of household with feminist scholars’ recognition of gender as situated process. Our conceptualisation makes it possible to illuminate gender dynamics around the everyday repetitive decision-making acts that constitute livelihood generation as performed by RMW within specific intra-household dynamics in the context of reintegration in the situated community. Through the examination of the diverse and contradictory ways in which RMW exercise agency in making decisions about livelihood strategies within their households in the studied community, we show how the everyday repetitive acts of RMW contribute to micro-transformations of a situated gender ideology.     

Understanding ‘trafficking vulnerabilities’ among children: the responses linking to child protection issues in Nepal

ABSTRACT

The purpose of this paper is to discuss child trafficking in Nepal within the broader framework of child protection. It examines both individual (gender, ethnicity and caste) and structural (their experiences in relation to work, migration, education and lack of birth registration) vulnerabilities and their links with child trafficking as a child protection concern. The paper provides suggestions for why there is a need for a more nuanced understanding of trafficking vulnerabilities as part of a continuum, rather than a distinct event, to improve outcomes for children. We use the evidence presented here to call for a holistic approach. Policies and programmes must be integrated within the broader concerns of child protection, thus strengthening the system from local to national level, while recognising the importance of children’s rights to participate in any decision-making.     

The geographies of crisis: exploring accessibility to health care in Canada

There is increasing concern in Canada that the health care system is in a state of crisis. It is argued that reductions in federal government transfers to the provinces have resulted in a health care system characterized by under‐funding in key areas and policy decisions based more on provincial fiscal concerns than the health needs of their constituents. Provincial governments have responded to reduced levels in federal funding by undertaking aggressive restructuring tactics such as the closure of hospitals and the deinsuring of medical services from provincial health plans. The end result of this restructuring, as argued by the media, consumer groups and indeed some health researchers, is a state of crisis' (i.e., lower levels of accessibility, long waiting lists, overcrowding in hospitals and increasing costs of medication). One crisis theme often mentioned is that fiscal decisions of various kinds are reducing economic and geographic accessibility, one of the five principles of the Canada Health Act (CHA) that defines the very essence of the Canadian health care system. Using data from the 1998‐99 National Population Health Survey (NPHS), this paper explores the extent to which an accessibility crisis exists within the Canadian health care system by examining access to health care services and the barriers encountered in trying to access services in each of the ten provinces. The results show that approximately 6.0 percent of Canadians report access problems, with values ranging from 4.5 percent in Newfoundland to 8.3 percent in Manitoba. Regional variations in barriers to accessing care were also observed. In particular, geographic accessibility appears to be a main barrier to care in Atlantic Canada while economic accessibility emerges as a main barrier to care in Western Canada. We discuss these findings in the context of the current debates on the Canadian health care system ‘crisis’. De plus en plus de Canadiens s'inquiétent que leur systéme de soins de santé soit en état de crise. On défend l'idée selon laquelle la réduction des paiements de transfert aux provinces par le gouvernement fédéral serait responsable de l'état d'un systeme de santé caractérisé par un sous‐financement dans les domaines‐clés et des décisions politiques de santé basées, non pas sur les besoins des membres de la société canadienne, mais sur la fiscalité provinciale. Les gouvernements provinciaux ont réagi à la réduction du financement fédéral par une tactique de restructuration agressive (fermeture d'hôpitaux et retrait de services médicaux des programmes d'assurance de santé provinciaux). Selon les médias, les groupes de consommateurs et même les chercheurs en soins de santé, cette restructuration a eu pour effet un système en état de ‘crise’ (diminution de l'aecès aux services, longues fetes d'attente, hôpitaux surchargés, augmentation des coûts des médicaments etc). Un des thèmes récurrent est celui des décisions flscales de toutes sortes qui entraînent une baisse de l'accessibilité financière et géographique. Cette accessibilité est pourtant un des cinq principes de la Loi canadienne sur la santé définissant l'essence même du système de santé au Canada. Utilisant les données tirèes de l'Enquête nationale sur la santé de la population, 1998‐99 et examinant l'accès aux services de santé et les obstacles rencontrés dans les 10 provinces canadiennes, cet article évalue dans quelle mesure une crise d'accessibilité existe au sein du système de santé canadien. Les résultats démontrent qu'environ 6.0 pour cent des Canadiens ont rencontré des problèmes d'accessibilité, avec des variantes allant de 4.5 pour cent à Terre‐Neuve jusqu'à 8.3 pour cent au Manitoba. On observe aussi des variantes régionales dans les obstacles rencontrés. L'accessibilité géographique en particulier semble un obstacle mqjeur dans les régions de l'Atlantique, alors que l'accessibilite financière semble être un obstacle majeur dans l'Ouest du Canada. Ces résultats sont présentés dans le contexte des débats actuels sur l'existence dune, ‘crise’ dans le système de santé au Canada.     

A geographic assessment of 'total' health care supply in Ontario: complementary and alternative medicine and conventional medicine

Shortages of family physicians, specialists and other personnel working within the realm of conventional medicine (CM) concern citizens in many regions and municipalities in Canada. Complementary and alternative medicine (CAM) approaches (such as chiropractic, holistic, homeopathic, naturopathic, massage and acupuncture) are increasingly used in conjunction with, or in some cases as replacements for, conventional medicine. Thus, to get an idea of 'total' health care supply in a jurisdiction and to draw comparisons between locations, it is useful to understand the spatial tendencies of both CM and CAM offices. With the use of a sample that contains the location, employment and sales of 4,955 CAM and 8,709 CM offices, this study details the spatial patterns of health care supply in the Canadian province of Ontario. The analysis comprises three main parts. First, the geographic tendencies of CAM and CM office activity are revealed in per capita terms and while regional differences are detectable, the main contrast is that CAM displays a much more even distribution across the urban-rural continuum in comparison to CM. Second, through the use of location quotients and a local spatial autocorrelation analysis, it is shown that certain municipalities (especially in Ontario's southwest and south-central regions) specialize in CAM and the most outstanding spatial feature is an '81 municipality CAM cluster' that represents arguably the pinnacle of CAM activity in the province. CM specialization is rarer and is biased towards the more populated municipalities. Third, a Spearman's correlation analysis suggests that CAM and CM health care supply are associated with community well-being indictors and urban density measures.     

Conflicting Traditions,Concurrent Treatment: Medical Pluralism in Remote Aboriginal Australia

ABSTRACT In remote Aboriginal communities in Australia, researchers cast health beliefs and treatments as belonging to either an Aboriginal or biomedical system, which are considered to be irreconcilable and in conflict. Warlpiri people also speak of two distinct traditions that, they claim, are able to heal only specific classes of illness. Nevertheless, both Aboriginal and biomedical systems can be used simultaneously. An examination of two illness episodes will illustrate the complexity of how both Aboriginal and biomedical diagnoses and treatments are employed in a similar manner. I argue that while diagnosis is often stressed in statements regarding illness, it is only one of many factors that influence the treatment choices of individuals.     

Toward a care ethical approach to access to health care in neoliberal times

In December 2017, the Republican-controlled US Congress closed its session by pushing through a comprehensive tax overhaul bill, HR 1. Additional provisions of the ‘must pass’ bill included a last-ditch effort to quash the Affordable Care Act (ACA), otherwise known as Obamacare. In this article, I unpack some of the immediate and long-term net-positive impacts that the ACA has had on access to health care for women, infants, and children in the US while also acknowledging the continued unevenness of health outcomes along race, gender, and income differences. I argue that if we take seriously the potential of a care ethical analysis to respond to neoliberal ethics, then there is a need for a more robust engagement with intersectional analysis in order to address interlocking oppressions that exacerbate ongoing inequalities. By extension, I show how HR 1 clearly highlights the racist, classist, and gendered neoliberal logics that permeate contemporary US political and legislative debates related to health care access, underscoring the uncaring nature of US democracy and making plain a need to ‘care with’ others. I end by posing a set of speculative possibilities, asking what might be possible if we take seriously care and caring relations as fundamental to imagining worlds-otherwise.     

Caregiving as mobility constraint and opportunity: married daughters providing end of life care in northern Ghana

In the global south where care services are sparse and familial care remains practically and socially important, end of life care often occurs within families. Furthermore, in health care related policy development, care is often assumed to be ensured by ‘traditional’ norms of extended family relationships. In this context, the demands of providing care may require care providers to relocate, as well as reorganize their everyday responsibilities. This article contributes to geographies of care by offering an examination of the mobility constraints experienced by married and externally-resident daughters seeking to provide end of life care to a parent in northern Ghana. Drawing on ethnographic research, I examine how particular familial relationships are embedded with socially constructed labour obligations, leading to conflicting responsibilities at a parent’s end of life. I then consider how a woman as a daughter works to overcome these constraints to provide end of life care. I conclude that understanding the mobility of care providers can contribute to avoiding potentially damaging assumptions of ‘traditional’ norms of care and is an important consideration towards understanding the geographies of care in the rural global south.     

Femininities on transnational journeys and sexual health risk: experiences of Chinese immigrant women in Canada

Negotiations at work in a globalising China in regard to femininity, sexuality, and family relationships have been well documented from the 1990s. Nonetheless less is known about them in a transnational context, and femininities are far less explored than masculinities. Drawing on interview data from a larger research study of transnationalism and gendered HIV vulnerability, this article investigates the intersection of femininity, sexuality and sexual health risk through Chinese immigrant women’s narratives about their experiences in Canada. It examines to what extent these intimate negotiations within China are re-enacted through Chinese immigrant women’s transnational experiences in Canada. These women live ‘in-between’ China and Canada in terms of identity, space and time with their cross-cultural connections unveiling both virtual and actual relations. Gender norms and roles, intimate and sexual experience, and family relations are realigned in the transnational lives of these women and are impacted by both their home and host societies, as well as their past and present experience in China. Used in the article as a concept and an analytical lens, gender is acknowledged as a key organising principle in post-immigration individual and social experience.     

The contested meanings of home for women caring for children with long-term care needs in Ontario,Canada

Home as a place of caring is theorized using the literature from geography, sociology, housing and feminist studies. To support our theorization, grounded theory is used to capture and interpret the experiences of women caring for children with long-term care needs in the home. Eleven semi-structured interviews conducted with women in Ontario, Canada uncovered differences in the way the women perceived their homes and highlighted their multiple and complex experiences. The findings revealed three key issues. First, women do not want their homes to be completely defined by long-term care activities as many other types of activities are situated in their homes. Second, long-term care activities and schedules are not segregated but become deeply embedded and enmeshed within the spatial and temporal practices and processes of family life. Third, the meanings, characteristics and ideal of ‘home’ portrayed in popular culture and the academic literature often clashed with what the women experienced on a daily basis. Analysis revealed the tensions surrounding ‘reconstructing spaces in the home’ and ‘the home as a private and public place’ which are indicative of the women's struggles with the disjuncture between the ideal and lived home. The women's experiences challenge us to consider new ways of theorizing the home, and the home when it is a place where long-term care is provided.     

Medical versus social work-places: constructing and compensating the personal support worker across health care settings in Ontario,Canada

This article explores the role of place in explaining variation in caregiver compensation. Using the labour category of Personal Support Worker (PSW) in Ontario, Canada, it contrasts wage rates across three health care settings: hospitals, long-term care facilities and private homes. An evaluation of current literature from disciplines spanning geography, gender studies, political science and sociology is combined with a critical analysis of policy documents and wage data to reveal that, despite holding similar qualifications and performing comparable job duties, hospital-based workers receive higher wages than home-based workers. I theorize that this wage disparity is partially attributable to the historical privileging of hospital settings in Canada, based on a medical-social continuum of health care valuation. Given that the hospital is constructed as a highly medical place, whereas the home is considered to be a social place, caregiving work enjoys greater financing protection in the former. I argue that these constructions stem from deeply gendered historical roots which view the marketplace as a male-dominated setting for productive waged labour, and the home as a female-dominated setting for unpaid social pursuits. Thus, when personal support services shift from public institutions into private homes, these activities become invisible to the state, and their provision beyond its purview. I conclude that the medical versus social nature of the duties performed by PSWs has become secondary to the medical versus social nature of the setting in which these activities take place. This has translated into lower wages for home-based PSWs, effectively resulting in wage discrimination.     

Voluntarism and long-term care in the countryside: the paradox of a threadbare sector

This article contributes to the burgeoning literature on the geographies of voluntarism by addressing how voluntary sector providers in rural communities respond to the downloading of responsibilities for health and social care associated with public service restructuring. Drawing on a qualitative analysis of long-term care in Ontario, it focuses on the consequent actions of non-profit organizations, community support groups and volunteer caregivers in three different rural settings. Despite evidence of increasingly disproportionate levels of voluntarism amongst rural communities, the results reveal sector- and place-specific opportunities that allow voluntary sector providers to overcome the limitations of the rural service environment. The findings suggest that in the longer run, however, the growing dependence on local solutions will only exacerbate the uneven geographies of health and social care across rural space. Resolving this paradox remains a critical yet neglected challenge for sustainable rural services and communities.