Aging in place (AIP) has emerged as a critical priority in policy to support older adults living in their homes and communities. However, achieving equitable support for older adults demands a multi-faceted approach that...Aging in place (AIP) has emerged as a critical priority in policy to support older adults living in their homes and communities. However, achieving equitable support for older adults demands a multi-faceted approach that embraces their choices, capabilities and lived experiences while considering that is a dynamic concept. This commentary explores the challenges older adults may encounter while AIP and identifies technological and policy areas to explore. Drawing insights from the UK, policy makers in Canada are urged to adopt inclusive definitions of AIP, prioritize technological solutions for recognized challenges and actively involve older adults in policy development.
"The use of technology to support AIRP [aging in the right place] holds great promise," (Kokorelias et al. 2024: 16) and ethical and human rights considerations must be considered in the design, development and deploymen..."The use of technology to support AIRP [aging in the right place] holds great promise," (Kokorelias et al. 2024: 16) and ethical and human rights considerations must be considered in the design, development and deployment of AgeTech solutions. This may be realized through interprofessional and intersectoral collaboration, as well as meaningful inclusion and engagement of lived expertise and experience from older adults and their caregivers. Theoretical frameworks and evidence-based design/research models can structure the consultation processes. They can guide the agile and iterative development of AgeTech based on input and feedback from end-users and community stakeholders. Funders and accelerator programs also play an important role in ensuring that AgeTech solutions that they endorse or sponsor would be ethical, accessible and feasible to older adult populations that are ethnically, culturally and linguistically diverse at various levels of digital literacy.
As the Canadian population ages, the imperative to support aging in the community grows increasingly urgent. In this commentary, we build on Kokorelias et al.'s (2024) article to address the ethically appropriate role of...As the Canadian population ages, the imperative to support aging in the community grows increasingly urgent. In this commentary, we build on Kokorelias et al.'s (2024) article to address the ethically appropriate role of digital technologies in supporting aging at home. We argue that a nuanced perspective on this topic is crucial. Focusing on the pivotal role of personal support workers in home and community care, we highlight the multiple challenges they face, from precarious employment to safety concerns. While digital innovations offer promise, we suggest that a holistic approach blending policy initiatives with technological advancements is imperative.
This paper explores the rapidly growing integration of technology in the delivery of health and social care specifically focused on enabling "Ageing in the Place" (AIRP) (Iciaszczyk et al. 2022: 1). While exploring emer...This paper explores the rapidly growing integration of technology in the delivery of health and social care specifically focused on enabling "Ageing in the Place" (AIRP) (Iciaszczyk et al. 2022: 1). While exploring emerging opportunities and challenges, it specifically highlights growing disparities that are creating , as well as ethical concerns that will need to be addressed and supported by comprehensive evaluation frameworks and policies. Ultimately, the development of inclusive and ethical technologies for enabling AIRP in collaboration with all relevant stakeholders - including policy makers, researchers, caregivers and older adults - is needed to ensure that new technologies can both empower and ultimately improve the lives of older adults.
Health system leaders, researchers and the public alike recognize the multiple and often tragic ways in which our health systems continue to fail older adults. We have long been aware of the demographic shifts in our pop...Health system leaders, researchers and the public alike recognize the multiple and often tragic ways in which our health systems continue to fail older adults. We have long been aware of the demographic shifts in our population that are seeing an increasing percentage of the population over the age of 65 years; in fact, up to 30% of the Canadian population is projected to be over 65 years of age by the year 2068 (Statistics Canada 2022). However, we have not yet seen the system-wide adaptations and reforms to health systems to support people to maintain their health as they age.
While the need for research, policy and practice addressing the health equity issues of Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations is increasingly...While the need for research, policy and practice addressing the health equity issues of Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations is increasingly recognized, we acknowledge that significant gaps remain in this area. As authors in this themed issue have consistently pointed out, interventions that grapple with the intersectionally varied structural drivers of 2S/LGBTQ+ health remain lacking and, in particular, warrant urgent consideration. This is especially the case during a time when structural threats to the well-being of 2S/LGBTQ+ populations are on the rise, both in Canada and in other geopolitical contexts.
Kia et al.'s (2024) article, "Beyond the Rainbow: Advancing 2S/LGBTQ+ Health Equity at a Time of Political Volatility," illustrates the health discrepancies that the Two-Spirit, lesbian, gay, bisexual, transgender, queer...Kia et al.'s (2024) article, "Beyond the Rainbow: Advancing 2S/LGBTQ+ Health Equity at a Time of Political Volatility," illustrates the health discrepancies that the Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (2SLGBTQIA+) community withstand and the Canadian healthcare system's legacy of heteronormativity. This commentary focuses on the straight-centred approach of the Canadian medical system that neglects, harms and fails the 2SLGBTQIA+ population, resulting in a decline in their mental and physical well-being and increased rates of morbidity for queer individuals. The 2SLGBTQIA+ community must be placed in the front and centre of integral decision making and have the final word in policy changes within Canadian regulatory bodies.
Many young people today embrace gender-diverse identities, with adolescents and young adults comprising the largest and fastest-growing demographic of gender-affirming healthcare seekers. Simultaneously, gender-affirming...Many young people today embrace gender-diverse identities, with adolescents and young adults comprising the largest and fastest-growing demographic of gender-affirming healthcare seekers. Simultaneously, gender-affirming healthcare for this demographic has been debated, and restrictions have been introduced in many jurisdictions. Within this politically charged climate, some journalists, cultural commentators, gender clinicians and politicians have leveraged rhetorical claims that gender-affirming healthcare comprises a new form of "gay conversion therapy." In this commentary, we explore the extent to which empirical evidence supports or contradicts this discourse as a real phenomenon. While we conclude that gender-affirming healthcare is not gay conversion therapy, we also draw attention to opportunities to enrich gender-affirming healthcare by embracing the complexity of sexuality and gender.
Advocates and researchers have made myriad recommendations to guide policy actors in stopping conversion therapy. This commentary extends these recommendations by identifying core challenges that policy actors face with...Advocates and researchers have made myriad recommendations to guide policy actors in stopping conversion therapy. This commentary extends these recommendations by identifying core challenges that policy actors face with interventions that solely focus on conversion therapy. Conversion therapy exists because of pervasive social values and beliefs that devalue, erase and stigmatize Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2SLGBTQ+) people, in turn, creating a supply and demand market. That is, those who espouse oppressive values enable and supply conversion therapy for the demand of 2SLGBTQ+ people struggling against these values and those who influence their lives (e.g., guardians). The discussion underscores why policy actors must disrupt the cisheteronormative bedrock that sustains conversion therapy. It is imperative for policy actors to expand policies and programming beyond conversion therapy using an intersectional framework that considers colonialism, racism and cisheterosexism. Interventions must encompass all systems (e.g., health, legal, social, economic) that shape 2SLGBTQ+ people's lives to disrupt the market of conversion therapy.
There is an urgency to advocate for lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) racialized migrants and Canadian policy reform due to the rise in human rights violations globa...There is an urgency to advocate for lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) racialized migrants and Canadian policy reform due to the rise in human rights violations globally for LGBTQ+ community members as they fight for constitutional change. Canada projects itself as a world leader in the protection of LGBTQ+ rights and is promoted as an ideal destination for those fleeing persecution. Contrary to this image, Canada has received harsh public criticism for its failure to live up to the expectations of a benevolent refugee-receiving country. The arrival of African LGBTQ+ migrants creates a lens for us to examine these cracks in our Canadian system and the resulting health disparities experienced by this group.
In the context of 2S/Indigiqueer challenges to health and wellness, a focus that expands how we conceptualize negative colonial impacts to include cultural approaches to health, we potentially open space more helpful for...In the context of 2S/Indigiqueer challenges to health and wellness, a focus that expands how we conceptualize negative colonial impacts to include cultural approaches to health, we potentially open space more helpful for addressing disparities. Four possible pathways are discussed, and include: (1) Expanding social determinants of health to include 2S/Indigiqueer practices that promote health; (2) Cultural resurgence helps address health disparities as it works to strengthen both individuals and communities; (3) To do these well, it is important to understand the cultural diversity that exists across 2S/Indigiqueer communities; and (4) Responses that privilege 2S/Indigiqueer community led-responses are needed to better ground health and wellness programs in culture. Finally, we add to these pathways by advocating for a series of policy responses that are supported on the ground by community.
This commentary examines the impact of poverty on health and healthcare access for Indigenous, Black, racialized and migrant Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S...This commentary examines the impact of poverty on health and healthcare access for Indigenous, Black, racialized and migrant Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) individuals. It highlights the necessity of inclusive policies and strategies to tackle their unique challenges, including high poverty rates, unemployment, homelessness and intersecting oppressions in the housing and healthcare sectors. Emphasizing the need for comprehensive research to guide policy and practice, this paper calls for structural changes in healthcare and advocates for intersectional training across healthcare, education and public policy domains. It urges healthcare leaders to prioritize and meet the specific needs of these communities, aiming to improve their socio-economic conditions.
Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations continue to experience profound health disparities. In this article, we prioritize five issues in 2S/LGB...Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations continue to experience profound health disparities. In this article, we prioritize five issues in 2S/LGBTQ+ health equity and discuss policy interventions to address disparities in each area: (1) poverty in 2S/LGBTQ+ communities; (2) Two-Spirit mental health; (3) health equity issues in migrant and racialized LGBTQ+ populations; (4) challenges in implementing bans on conversion therapy; and (5) the evolving context of gender-affirming care. Multi-level policy interventions, including those in healthcare-adjacent contexts such as housing and immigration, will be critical to address the structural undercurrents driving health inequities for 2S/LGBTQ+ populations. Recognizing growing complexity and political volatility in the lives of 2S/LGBTQ+ people across Canada, we challenge healthcare policy actors to recognize the breadth of structural barriers to 2S/LGBTQ+ health equity issues and act with urgency in this area.
The social, mental, physical and sexual health of diverse Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations across Canada and globally is under threat. In...The social, mental, physical and sexual health of diverse Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations across Canada and globally is under threat. In Canada, we are not immune to the rise in divisive and regressive policies and rhetoric that is negatively impacting the lives of 2S/LGBTQ+ people in the US and across the world (HRC Staff 2023; United Nations 2022). Make no mistake, the threats to the human rights and health of 2S/LGBTQ+ communities are growing in Canada as well (Benchetrit 2023). Health systems leaders and scholars can play a critical role in learning about, addressing and advocating for health equity for 2S/LGBTQ+ communities. This themed issue focuses on the urgency of addressing the social and structural determinants of health inequity for 2S/LGBTQ+ communities in a context of political volatility.
How can we effectively partner during crises? How can partnership with communities, patients, caregivers, providers and leaders be sustained and even evolve during difficult times? The opening paper of this special issue...How can we effectively partner during crises? How can partnership with communities, patients, caregivers, providers and leaders be sustained and even evolve during difficult times? The opening paper of this special issue (Kuluski et al. 2024) probed these questions. The six response papers in this issue emphasized engagement that moves from partnership with individuals and communities to efforts that are led by communities; trauma-informed approaches at an individual and organizational level; and shed light on the interdependency of culture and leadership. By broadening our engagement efforts with communities, we are more apt to co-produce improvements in care that also address the social determinants of health.
Patients and professionals face important crises through their "normal" experiences of illness and care, which can either prepare them or make them more vulnerable to global crises. What can we learn from these experienc...Patients and professionals face important crises through their "normal" experiences of illness and care, which can either prepare them or make them more vulnerable to global crises. What can we learn from these experiences to nurture more resilient health ecosystems? In this commentary, we reflect on resilience in times of crisis, based on our lived experience as patient and physician. We learned that identifying "who is strong" and "who is vulnerable" can be surprising and unexpected, that patients and professionals can lean on one another at different stages of crises and that resilient health ecosystems require reciprocal, caring relationships at the individual and collective levels.
The COVID-19 pandemic magnified the cracks in healthcare performance. Dysfunctionalities and exhaustion appeared, but so did resilience and innovation. Examination of these cracks offers opportunities for learning and po...The COVID-19 pandemic magnified the cracks in healthcare performance. Dysfunctionalities and exhaustion appeared, but so did resilience and innovation. Examination of these cracks offers opportunities for learning and potential for new developments just as in the Japanese art of kintsugi, which is about building new objects from pieces of broken ceramic and mending the cracks. Engagement and partnership activities came under strain in Canada, as well - a pioneer in the field. Some were put on hold; others proved resilient and contributed to surmounting the challenges of the pandemic. Applying their Engagement-Capable Environments Framework, Kuluski and colleagues (2024) studied kintsugi in partnership activities in Canada during the pandemic. The resulting case studies exemplify the factors facilitating engagement and partnership during crisis. Through a lens of co-production that we see as a precondition for understanding and improving healthcare during a crisis and beyond, we challenge the results of the study, hoping to open new perspectives and advance engagement and partnership.
The COVID-19 pandemic has significantly disrupted patient engagement and exposed long-standing inequities within Canada's healthcare system. As a patient partner and caregiver, the author reflects on the exacerbated chal...The COVID-19 pandemic has significantly disrupted patient engagement and exposed long-standing inequities within Canada's healthcare system. As a patient partner and caregiver, the author reflects on the exacerbated challenges during the pandemic, particularly for hardly reached communities and those managing chronic conditions. The crisis highlighted the absence of opportunities for patient partnership, with healthcare organizations halting engagement activities despite an increased need for communication and community involvement. The pandemic underlined the necessity of trauma-informed care and engagement-capable environments (ECE). To address these challenges, the author advocates for integrating trauma-informed practices with ECEs, thereby promoting a healthcare model that is both structurally supportive and responsive to individual trauma and resilience. By focusing on compassion, recognizing trauma and fostering engagement, such an approach could enhance patient outcomes and create a more adaptive, inclusive healthcare environment.
Members of the Indigenous mental wellness and trauma-informed specialist workforce - including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), the Indian Residential Schools Resolution Health Support Program w...Members of the Indigenous mental wellness and trauma-informed specialist workforce - including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), the Indian Residential Schools Resolution Health Support Program workforce, and other community-based cultural support workers - are often the primary and urgent care providers for individuals and families in need of culturally safe supports. While fulfilling a critical role, these teams contend with distinct challenges stemming from colonial impacts and health systems that continue to undermine Indigenous mental wellness and cultural traditions of healing. During the COVID-19 pandemic, increasing rates of mental illness and substance use among Indigenous populations strained the already overworked and under-resourced mental wellness workforce. First Peoples Wellness Circle sought out and embraced new approaches for meaningful virtual engagement to sustain and enhance workforce wellness and capacity by facilitating culturally relevant and culturally led connections from coast to coast to coast.
This commentary focuses on the social determinants of health and how they may be more fully integrated into engagement-capable environments. In this commentary, the authors provide excerpts from their in-depth discussion...This commentary focuses on the social determinants of health and how they may be more fully integrated into engagement-capable environments. In this commentary, the authors provide excerpts from their in-depth discussion that explored how the foundational principles of the Gattuso Centre for Social Medicine emphasize the importance of prioritizing care for populations that are marginalized and engaging communities to improve health outcomes. The article delves into some of the historic and current issues facing communities and individuals that are marginalized and describes how a large academic centre has leveraged its structures and resources to build partnerships with communities and community organizations to address these challenges.