Characterizing food systems to better understand their vulnerabilities: a case study in Québec and São Paulo

Characterizing food systems, i.e., describing their organizational features, can help to generate a better understanding of the structural vulnerabilities that constrain transitions towards sustainable food security. However, their characterization across different economic contexts remains challenging. In this paper, by linking key concepts from research on food regimes, food system vulnerabilities and responsible innovation, we aim to characterize food systems in a developing and a developed economy to identify their shared vulnerabilities. We applied a case study design to characterize food production, processing and distribution in the province of Québec (Canada) and in the state of São Paulo (Brazil). In both cases, the processing and distribution stages have higher economic predominance when compared to the agricultural production stage. Furthermore, we observed concentration in a few activities in both food systems, with a shared focus on export-oriented supply chains. Vulnerabilities in both food systems include: (1) increased interdependence because some supply chains are export-oriented or depend on foreign labor and are, therefore, exposed to external risks;(2) concentration in a few activities, which threatens present and future local food diversity and (3) unequal power relations, making small and medium players vulnerable to decisions made by big players. The characterization developed in this study shows that the two food systems are mainly pursuing economic goals, following the institutional logics of the neoliberal food regime, which are not necessarily aligned with food security goals. It also exposes the presence of characteristics of ‘responsibility' that may eventually help overcome food systems' vulnerabilities and support transitions toward sustainability.

A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada)

The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information;(2) professional and organizational issues;(3) quality of services and patient satisfaction;(4) cost, remuneration, and funding;(5) technology and infrastructure;(6) the emergence of private telehealth platforms in a public HSSS;(7) digital divide and equity;and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges. © Copyright © 2021 Alami, Lehoux, Attieh, Fortin, Fleet, Niang, Offredo, Rouquet, Ag Ahmed and Ly.