Regional disparities in infant mortality in Canada: a reversal of egalitarian trends

<p>Abstract</p> <p>Background</p> <p>Although national health insurance plans and social programs introduced in the 1960s led to reductions in regional disparities in infant mortality in Canada, it is unclear if such patterns prevailed in the 1990s when the health care and related systems were under fiscal duress. This study examined regional patterns of change in infant mortality in Canada in recent decades.</p> <p>Methods</p> <p>We analysed regional changes in crude infant mortality rates and in infant mortality rates among live births with a birth weight ≥ 500 g and ≥ 1,000 g in Canada from 1945 to 2002. Associations between baseline infant mortality rates in the provinces and territories (e.g., in 1985–89) and the change observed in infant mortality rates over the subsequent period (e.g., between 1985–89 and 1995–99) were assessed using Spearman's rank correlation coefficient. Trends in regional disparities were also assessed by calculating period-specific rate ratios between provinces/territories with the highest versus the lowest infant mortality.</p> <p>Results</p> <p>Provincial/territorial infant mortality rates in 1945–49 were not correlated with changes in infant mortality over the next 10 years (rho = 0.01, P = 0.99). However, there was a strong negative correlation between infant mortality rates in 1965–69 and the subsequent decline in infant mortality (rho = - 0.85, P = 0.002). Provinces/territories with higher infant mortality rates in 1965–69 (Northwest Territories 64.7 vs British Columbia 20.7 per 1,000 live births) experienced relatively larger reductions in infant mortality between 1965–69 and 1975–79 (53.7% decline in the Northwest Territories vs a 36.6% decline in British Columbia). This pattern was reversed in the more recent decades. Provinces/territories with higher infant mortality rates ≥ 500 g in 1985–89 experience relatively smaller reductions in infant mortality between 1985–89 and 2000–02 (rho = 0.82, P = 0.004). The infant mortality ≥ 500 g rate ratio (contrasting the province/territory with the highest versus lowest infant mortality) was 3.2 in 1965–69, 2.4 in 1975–79, 2.2 in 1985–89, 3.1 in 1995–99 and 4.1 in 2000–02.</p> <p>Conclusion</p> <p>Fiscal constraints in the 1990s led to a reversal of provincial/territorial patterns of change in infant mortality in Canada and to an increase in regional health disparities.</p

A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011

Background International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere. Methods Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed. Results Evidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence. Conclusions The English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset

Federalism and Entrepreneurship: Explaining American and Canadian Innovation in Pollution Prevention and Regulatory Integration

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72611/1/j.1541-0072.1999.tb01969.x.pd

Youth, terrorism and education: Britain’s Prevent programme

Since the 7/7 bombings of July 2005, Britain has experienced a domestic terror threat posed by a small minority of young Muslims. In response, Britain has initiated ‘Prevent’, a preventative counter-terrorism programme. Building on previous, general critiques of Prevent, this article outlines and critically discusses the ways in which Prevent has approached young Muslims and their educational institutions. The article argues that, rather than trust in broader and non-stigmatising processes of anti-extremist education, the police-led Prevent has ‘engaged’ with and surveilled young Muslims. Within Prevent there is little evidence of educational processes that explicitly build youth resilience against extremism. Instead, Muslim youth are viewed as both ‘risky and at risk’ (Heath-Kelly, 2013), ‘at risk’ of catching the terrorist disease, with the contested model of ‘radicalisation’ and child protection concepts utilised to portray risks of exploitation by Islamist extremists that necessitate a deepening process of education-based surveillance. The article identifies non-stigmatising alternatives to the approach of Prevent, approaches of anti-extremism education that learn from previously problematic anti-racist educational efforts with white young people. This enables the article to advocate for enhanced human rights-based approaches of citizenship education (admittedly, in themselves contested) with all young people as the most effective way of building individual and collective youth resilience against terrorist ideologies

Human cloning laws, human dignity and the poverty of the policy making dialogue

BACKGROUND: The regulation of human cloning continues to be a significant national and international policy issue. Despite years of intense academic and public debate, there is little clarity as to the philosophical foundations for many of the emerging policy choices. The notion of "human dignity" is commonly used to justify cloning laws. The basis for this justification is that reproductive human cloning necessarily infringes notions of human dignity. DISCUSSION: The author critiques one of the most commonly used ethical justifications for cloning laws – the idea that reproductive cloning necessarily infringes notions of human dignity. He points out that there is, in fact, little consensus on point and that the counter arguments are rarely reflected in formal policy. Rarely do domestic or international instruments provide an operational definition of human dignity and there is rarely an explanation of how, exactly, dignity is infringed in the context reproductive cloning. SUMMARY: It is the author's position that the lack of thoughtful analysis of the role of human dignity hurts the broader public debate about reproductive cloning, trivializes the value of human dignity as a normative principle and makes it nearly impossible to critique the actual justifications behind many of the proposed policies

House of Commons debates : official report, first session, 28th Parliament, volume 1, 1968; excerpts, September 12, 1968

Part of the collection of government and miscellaneous documents relating to the history of IDRC