Engaging ideas, transforming minds
Engaging ideas, transforming minds

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420 pages
6.75 x 9.75 inches
September 2018
Print ISBN: 9781773380582


Under-Served brings together the perspectives of academics, front-line health care providers, and policy-makers to examine the historical, political, and social factors that influence the health and health care of under-served populations in Canada, focusing particularly on Indigenous, inner-city, and migrant populations. This vital text broadens the traditional determinants of health—the social, economic, environmental, and behavioural elements—to include factors like family and community, government policies, mental health and addiction, homelessness and housing, racism, youth, and LGBTQ identity.

With a foreword by former Chief Public Health Officer of Canada David Butler-Jones and contributions from leading scholars, this edited collection comprises 28 chapters divided into 6 sections including those on research for under-served groups and ways to promote change through education, advocacy, and system changes. Featuring section introductions, learning objectives, critical thinking questions, and additional resources, this edited collection will engage students in health studies, nursing, and social work in crucial topics such as health promotion, social inequality, and community health.


Table of Contents


Foreword by David Butler Jones

Introduction 1 Akshaya Neil Arya and Thomas Piggott


Section Introduction by Thomas Piggott and Neil Arya

Chapter 1 || Deconstructing the Concept of Special Populations for Health Care, Research, and Policy 12

Thomas Piggott and Aaron Orkin

Chapter 2 || The Social Determinants of Health of Under-Served Populations in Canada 23

Dennis Raphael


Section Introduction by Karen Hill

Timeline || Policies and Practices Influencing Indigenous Health 43

Bonnie M. Freeman

Chapter 3 || The Impact of Intergenerational Trauma to Health: Policies, Relocation, Reserves, and Residential Schools 45

Bonnie M. Freeman

Chapter 4 || Intergenerational Trauma and Indigenous Health in Canada: How Racism Affects the Health of the Indigenous Patient 57

Paul Tomascik, Thomas Dignan, and Barry Lavallée

Chapter 5 || Health and Health Service Needs in Urban Indigenous Communities 67

Martin Cooke and Piotr Wilk

Chapter 6 || Health for Canadian Indigenous Children 82

Anna Banerji

Chapter 7 || Exploring the Development of a Health Care Model Based on Inuit Wellness Concepts as Part of Self-Determination and Improving Wellness in Northern Communities 92

Gwen K. Healey

Chapter 8 || Fostering Resilience with Indigenous Youth 105

Bonnie M. Freeman


Section Introduction by S. Luckett-Gatopoulos

Timeline || Minimal Supports for the Bottom of the Labour Market 120

Joe Mancini

Chapter 9 || Historical Roots—Why in a Time of Unprecedented Wealth and Health Do We Have Homelessness and Ill Health? 121

Joe Mancini

Chapter 10 || Poverty, Homelessness, and Ill Health 129

Abe Oudshoorn

Chapter 11 || The Forgotten Victims: Impact of Parental Incarceration on the Psychological Health of the Innocent Children Left Behind 141

Jessica Reid

Chapter 12 || Approaching the Health and Marginalization of People Who Use Opioids 153

Sharon Koivu and Thomas Piggott

Chapter 13 || Pathways to Health Equity for LGBTQ Populations 165

Nathan Lachowsky, Jacqueline Gahagan, and Kelly Anderson

Chapter 14 || “Prescribing Income”: A Multi-level Approach to Treating Social Determinants for Health Providers 178

Ritika Goel and Gary Bloch

Chapter 15 || Models of Primary Care Delivery for Under-Served Populations in Inner-City Settings 183

Dale Guenter, Abe Oudshoorn, and Joe Mancini


Section Introduction by Shpresa Aliu-Berisha

Timeline || A Brief History of Migration and Marginalization 201

Neil Arya

Chapter 16 || Social Determinants of Refugee Health 202

Michaela Hynie

Chapter 17 || Health Issues in Refugee Populations 224

Meb Rashid, Vanessa Redditt, Andrea Hunter, and Kevin Pottie

Chapter 18 || Mental Health Impact of Canadian Immigration Detention 244

Hanna Gros

Chapter 19 || Migrant Farm Worker Health Care: Unique Strategies for a Unique Population 251

Janet McLaughlin and Michelle Tew


Section Introduction by Thomas Piggott and Neil Arya

Chapter 20 || Indigenous Health Research: Lessons from Life in the Arctic 265

Gwen K. Healey

Chapter 21 || Overcoming Challenges of Conducting Longitudinal Research in Stigmatized Urban Neighbourhoods 275

Biljana Vasilevska, Angela Di Nello, Erin Bryce, and James R. Dunn

Chapter 22 || Practical and Ethical Considerations for Health Research with Refugees 286

Patricia Gabriel

Chapter 23 || Engaging Communities to Identify Needs and Develop Solutions: Participatory Research Incorporates Community Voice in All Aspects of Health Research Decision-Making 304

Jon Salsberg, Soultana Macridis, Treena Delormier, Richard Hovey, Neil Andersson, Alex M. McComber, and Ann C. Macaulay


Section Introduction by Neil Arya and Thomas Piggott

Chapter 24 || Educating Health Professionals to Care for Vulnerable and Marginal Populations 321

Lesley Cooper, Neil Arya, Mona Negoita, and Ngan Pham

Chapter 25 ||Thinking Upstream: A Vision for a Healthy Society 339

Ryan Meili and Thomas Piggott

Chapter 26 || Reforming Health Systems to Promote Equity and Improve the Health of Under-Served Populations 350

Anne Andermann

Chapter 27 || From the Clinics to the Streets: The Fight against Refugee Health Cuts in Canada 362

Philip Berger, Meb Rashid, Alexander Caudarella, Andrea Evans, and Christopher Holcroft

Chapter 28 || The W's of Successful Advocacy for the Under-Served: Lessons from Days of Action for Refugee Health 369

Neil Arya

Conclusion 377
Thomas Piggott and Neil Arya

Glossary 381

Contributors 387

Akshaya Neil Arya

Akshaya Neil Arya is an Assistant Clinical Professor in Family Medicine at McMaster University and Adjunct Professor in Environment and Resource Studies at the University of Waterloo.

Thomas Piggott

Thomas Piggott is a family doctor and is finishing his training in public health and preventive medicine at McMaster University. He completed his Masters in Public Health Economics at London School of Hygiene and Tropical Medicine and is focused on health evidence, equity, and economics in primary care and public health. He is the founder of Global Health Sim, a Canadian non-profit focused on innovative education through simulation.


“This book is an essential textbook for health professionals who want to make a difference for under-served individuals and communities, a ‘how-to’ manual for community engagement. Authors present clear learning objectives and real-world examples of action and advocacy. Readers who engage with the critical thinking questions and attend to the gripping stories that enrich the evidence-based text will be changed: impelled and enabled to act—as care providers, policy-makers, educators, and researchers—to reduce systemic inequity and improve the health of individuals and communities.”
—Carol P. Herbert, MD, Professor Emerita and Former Dean, Schulich School of Medicine & Dentistry, Western University

“This book presents a comprehensive and broad range of topics on health issues related to many different under-served populations in Canada. Students, clinicians, researchers, policy makers, advocates, and community members will find themselves reflected and supported in this text. Regardless of your background in the area of health, you will gain new knowledge while reading this book.”
—Tara Turner, Associate Professor, School of Indigenous Social Work, First Nations University of Canada

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