2 results
3 - Mitigating Social Inequities in Quebec: Governance Law to the Rescue?
- Edited by Sabrina Germain, City University of London, Adrienne Yong, City University of London
-
- Book:
- Beyond the Virus
- Published by:
- Bristol University Press
- Published online:
- 17 January 2024
- Print publication:
- 16 March 2023, pp 56-76
-
- Chapter
- Export citation
-
Summary
Introduction
The global pandemic of COVID-19 provoked an unprecedented mobilization of governments and stakeholders from different fields of activity around the world. Very quickly, faced with the urgent threat that COVID-19 represented for the health and survival of individuals, a large proportion of public resources was mobilized to try to understand how the virus worked and to limit as far as possible its spread and its deleterious effects on the health of populations. However, the pandemic occurred in a context already marked by significant social inequalities, which are likely key in understanding the virus and its effects on already vulnerable populations. For example, in Canada, mortality from COVID-19 was higher among women due to their overrepresentation among healthcare workers highly exposed to the virus (Bastien et al, 2020). In addition, lower income households were often less likely to be able to work remotely and many lost their jobs due to the pandemic (Chief Public Health Officer of Canada, 2020).
The notion of syndemic (which comes from merging the words synergy and epidemic) allows us to highlight the distributive and differential effects of COVID-19 by recognizing its medical, environmental and social constituents, and the influence of the latter on the aggravation and spread of the virus (Horton, 2020; Singer and Rylko-Bauer, 2021). Indeed, structural factors such as poverty, homelessness and food insecurity are increasingly recognized as important drivers of the negative effects of the pandemic (Singer and Rylko-Bauer, 2021; Ahmed, 2020; Williams and Cooper, 2020). In the context of COVID-19, in addition to these structural factors, the emergency measures themselves also contributed to exacerbating social inequalities (Carde, 2020), including various containment measures. Even before the COVID-19 pandemic, it was recognized that: ‘[s]ocial distancing measures designed to limit the spread of contagious disease are fundamentally at odds with the structures, institutions, and routines necessary to access food, shelter, and support’ (Mosher, 2014: 948).
Faced with an urgency to act and aware of the perverse effects of the emergency measures on certain groups of the population, decision-makers experienced major governance challenges.
Learning from health system reform trajectories in seven Canadian provinces
- Susan Usher, Jean-Louis Denis, Johanne Préval, Ross Baker, Samia Chreim, Sara Kreindler, Mylaine Breton, Élizabeth Côté-Boileau
-
- Journal:
- Health Economics, Policy and Law / Volume 16 / Issue 4 / October 2021
- Published online by Cambridge University Press:
- 06 August 2020, pp. 383-399
-
- Article
- Export citation
-
In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada?, McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian system based on physician independence and assured universal coverage only for medical and hospital services. This paper focuses on reforms since the turn of the millennium to explore the transformative capacities developed in seven provinces within this system architecture. Longitudinal case studies, based on scientific and grey literature, and interviews with key informants, trace the patterns of reform in each province and reveal five objectives that, to varying degrees, preoccupied reformers: (1) address chronic disease, (2) align health system actors with provincial objectives, (3) shift from hospital to community-based care, (4) integrate physicians, and (5) develop improvement capacities. The range of strategies adopted to achieve these objectives in different provinces is compared to identify emerging pathways of reform and extract lessons for future reformers. We find significant cross-learning between provinces, but also note an emergent dimension to reforms, where multiple strategies aggregate through time to create unique patterns, presenting their own set of possibilities and limitations for the future.