Public Health in Global Contexts HLTB16 Summer 2024

Public Health in Global Contexts HLTB16: Introduction to Public Health Health & Society, UTSC Summer 2024 © Tola Mbulaheni  Agenda 01 Course Recap 02 Globalization and Glob...

Public Health in Global Contexts HLTB16: Introduction to Public Health Health & Society, UTSC Summer 2024 © Tola Mbulaheni  Agenda 01 Course Recap 02 Globalization and Global Health 03 Globalized Responses to Health 04 (Im)migration as a Social Determinant of Health 05 Case Study Seasonal Agricultural Workers Program (SAWP) © Tola Mbulaheni  Course Recap © Tola Mbulaheni  Course Recap Section 1: Concepts & systems of public health historical context of public health in Canada conceptual foundations (e.g. SoDH, SEMs) health systems in Canada Section 2: Health data & evidence-based interventions subfields of public health (i.e. health promotion & epidemiology) the role of health data: collection, analysis and interpretation evidence-based public health decision-making and intervention planning Section 3: Epidemics, Pandemics & global health situate previous content within context of globalization and health © Tola Mbulaheni Situate forthcoming topics (e.g. [non-]communicable diseases, health equity)  Globalization and Global Health © Tola Mbulaheni  Globalization “a constellation of processes by which nations, businesses, and people are becoming more connected and interdependent via increased economic integration and communication exchange, cultural diffusion (especially of Western culture) and travel.” – Labonté & Torgerson, 2008, p.163 “[a] world shrinkage, of distances getting shorter, things moving closer.” – Larsson, 2001, p.9 © Tola Mbulaheni  Globalization Two aspects to the processes of globalization: Factors that bring people and societies closer together (e.g. trade, technology, communication) Policies and institutions that support the integration of economies and countries (e.g. international standards of labour, state immigration departments) © Tola Mbulaheni Kawachi & Wamala, 2006  Globalization Multiple ‘waves’ Contemporary globalization Economic conditions increasingly shaped by global conditions Global marketplace Engine influencing economic and non-economic aspects of globalization and resulting pathways to population health transnational goods, services, capital, technology, and labor linked to global marketplace. E.g. Coca-Cola® branding © Tola Mbulaheni Mohindra, 2021  Types of Global ‘Flows’ Finances Information Trade Pathogen People Deregulation of Increased Accelerated flow Wide distribution Economic- and financial markets interconnectivity of traded goods of environment- Speedy via and services vaccines/treatme driven migration movement of digital/internet Vulnerability to nts (Forced) labour money in/out of ‘super highway’ employment wider, faster migrations for national Increased access precarity and spread of viruses economic economies to health insufficient health and bacteria opportunity Remittance flows knowledge, and safety Facilitated by ‘drain’ of health Devaluation of technologies and protections modern workers from currencies and strategies Energy transportation, Global South markets Inequitable requirements for increased access & global migration, misinformation production urbanization and chains contribute climate change © Tola Mbulaheni to climate change  Impacts – Population Health Communicable diseases Rising demand of goods and services; increased trade Global flows of people; oscillations Changing environments Lifestyle behaviours Increased spread of non-communicable diseases (e.g. Type 2 diabetes, obesity) Primary causes include cigarette smoking, diet, sedentarism Environmental threats Climate change E.g. greenhouse gas emissions, deforestation © Tola Mbulaheni Interlinked with industrialization and urbanization  7 4 3 5 6 9 Globalization as a ‘determinant of determinants of health’ 8 Conceptual framework for globalization and SDoH 2 1 Labonté et al., 2019 © Tola Mbulaheni  Impacts – Health systems Globalized health systems contribute to health inequality Health worker migration Canada relies on foreign- trained health human resources Limits universal health protection and coverage Number and percent of internationally educated nurses (IEN) and domestically educated nurses (DEN) by employment sector, 2022 (UHC) due to health worker deficit Crea-Arsenio et al., 2023 © Tola Mbulaheni  Impacts – Health systems In 2014, estimated UHC deficits: 10.3 million health workers globally, Asia (7.1 million health workers) Africa (2.8 million health workers) 97 countries are understaffed and large shares of their population have no access to health care Scheil-Adlung et al., 2015 © Tola Mbulaheni  Health Inequalities Globalization benefits certain populations, disadvantages others and entrenches the disparity between both groups Globalization, as a ‘determinant of determinants of health’, fundamentally contributes to health inequalities and differential access to healthcare © Tola Mbulaheni  Globalized Response to Health © Tola Mbulaheni  IMF & World Bank International Monetary Fund (IMF) major financial agency of the United Nations international financial institution comprises 190 countries “promotes global macroeconomic and financial stability and provides policy advice and capacity development support to help countries build and maintain strong economies” - IMF, 2022 World Bank Comprises: International Bank for Reconstruction and Development (IBRD) International Development Association (IDA) 1970s: provided loans and grants to governments of low- and middle-income countries © Tola Mbulaheni Claim: help reduce poverty  Structural Adjustment Programs (1970s-2002) administered by IMF and World Bank series of loans provided to countries experiencing economic crises adjust country's economic structure, improve international competitiveness, and reduce fiscal imbalances aim to strengthen long-term economic growth iterated into other forms of structural adjustment policies © Tola Mbulaheni  Sustainable development goals (SDGs) © Tola Mbulaheni  Sustainable development goals (SDGs) 2030 Agenda for Sustainable Development “shared blueprint for peace and prosperity for people and the planet” - United Nations, 2015 17 Sustainable Development Goals (SDGs) Urgent call to action via global partnership of countries across Global North and South Intersectional approach to ending poverty and other social ills “resolve between 2015 and 2030, to end poverty and hunger everywhere; to combat inequalities within and among countries; to build peaceful, just and inclusive societies; to protect human rights and promote gender equality and the empowerment of women and girls; and to ensure the lasting protection of the planet and its natural resources.” - United Nations, 2015 Builds on decades of development work from UN member countries © Tola Mbulaheni  (Im)migration as a SDoH © Tola Mbulaheni  Types of migrants Voluntary (economic) migrants Forced migrants Migrate mainly for employment, No choice in decision to leave home opportunity and family Migrate to secure survival Regulated through procedures determined by national Refugees: persons outside of home governments country who demonstrate vulnerability Based on: to lack of protected human rights by governments skilled workforce priorities population policy for Incl. asylum seekers/refugee demographic targets claimants, trafficked individuals, distribution of national undocumented migrants population Incl. temporary workers, undocumented migrants © Tola Mbulaheni  Global Migration 3.6% 65% of world’s of international population were migrants are international workers seeking migrants (281m employment people) in 2020 48% 6.7% of global of international migrants are migrants hosted in women North America Title: Total temporary foreign workers, 2019-22 in OECD member WHO, 2024 countries © Tola Mbulaheni  Immigration in Canada 23% 56.3% of Canada’s Admitted under population are economic category immigrants 15.9% 31.5% of immigrants of Canadians living in Canada are ‘second- admitted generation’ between 2016- Title: Nearly 1 in 4 people in Canada are immigrants, the highest 2021 Statistics Canada, 2021 proportion of the population in more than 150 years © Tola Mbulaheni  Immigration as a Social Determinant of Health "Work can negatively affect our health, an impact that goes well beyond the usual counts of injuries, accidents, and illnesses from exposure to toxic chemicals. The ways in which work is organized—particularly its pace, intensity and the space it allows or does not allow for control over one’s work process and for realizing a sense of self-efficacy, justice, and employment security—can be as toxic or benign to the health of workers over time as the chemicals they breathe in the workplace air. Certain ways in which work is organized have been found to be detrimental to mental and physical health and overall wellbeing, causing depression and burnout, as well as contributing to a range of serious and chronic physical health conditions, such as musculoskeletal disorders, hypertension, chronic back pain, heart disease, stroke, Type II diabetes, and even death.” – Schnall, Dobson & Rosskam, 2009, p.1 © Tola Mbulaheni  Immigration as a Social Determinant of Health ‘Healthy immigrant’ effect Immigrants arriving to Canada healthier than Canadian-born counterparts Effect disappears over time (~10 years) Impacts of settlement and acculturation food and housing insecurity limited social/familial supports Limited access to healthcare services along immigration pathway ‘medical inadmissibility’ medically uninsured © Tola Mbulaheni  Immigration as a Social Determinant of Health Precarious employment and barriers to decent work ‘Canadian experience’ language skills non-recognition of foreign credentials racial, ethnic and religious-based discrimination Employment conditions and health Workplace injury/death Stress injuries ‘piecemeal’ work effects (e.g. skipping/avoiding breaks) Cleaning work Chronic pain Unpredictable schedules Conflict with family/household Discrimination and mental health © Tola Mbulaheni  Case Study: Seasonal Agricultural Workers Program © Tola Mbulaheni  Case study: Seasonal Agricultural Workers Program (SAWP) History of SAPs; national debt Destabilized political and economic infrastructure “accumulation by dispossession” – Harvey, 2003 limited decent work in home countries © Tola Mbulaheni  Case study: Seasonal Agricultural Workers Program (SAWP) Former Ontario seasonal farmworker speaks out about exploitation, files class action © Tola Mbulaheni CP24, 2024  Case study: Seasonal Agricultural Workers Program (SAWP) Background Most commonly used stream of the Temporary Foreign Workers Program Citizens of Mexico and 11 participating Caribbean countries Duration of employment (8 months?) Systemic abuse Tied to single employer Economic exploitation Low wages & wage theft High deductions Housing Substandard housing conditions; overcrowding © Tola Mbulaheni  7 4 3 5 6 9 Globalization as a ‘determinant of determinants of health’ 8 Conceptual framework for globalization and SDoH 2 1 Labonté et al., 2019 © Tola Mbulaheni  Case study: Seasonal Agricultural Workers Program (SAWP) 1. Grant permanent residency to temporary foreign workers on arrival 2. End closed work permits and guarantee the right to labour mobility 3. Proactively inspect employer-provided residences for seasonal agricultural workers. 4. Increase the provincial minimum wage to a living wage and enforce employer compliance on minimum wage rates 5. Revise the bilateral agreements for the SAWP to stipulate union representation as a necessary condition for the program 6. Conduct regular worksite inspections 7. Provide immediate access to public health care to all temporary foreign workers upon arrival Revise the SAWP transportation guidelines to require employers to pay the full round-trip transportation costs for migrant agricultural workers © Tola Mbulaheni CCPA, 2024  Next Class Communicable & Non-Communicable Diseases Reminders: Office hours: today, 11:30am (sign up!) Tutorial #5: July 5 Coming soon: Health Promotion Evidence Brief – Rubric & Guide © Tola Mbulaheni