"They forgot about us": experiences of the COVID-19 pandemic among people deprived of housing in an urban centre in Ontario, Canada.

OBJECTIVES: People deprived of housing have been disproportionately affected by the COVID-19 pandemic and the public health mitigation measures implemented in response. Emerging evidence has shown the adverse health outcomes experienced by these communities due to SARS-CoV-2 infection; however, the voices of community members themselves have not been widely amplified in the published literature. METHODS: We conducted an interpretive qualitative study. People deprived of housing were involved in study development, recruitment, and data analysis. People deprived of housing or precariously housed were recruited during street outreach from June to July 2020. Participants completed one-on-one semi-structured interviews that were audio-recorded, transcribed, and analyzed thematically. RESULTS: Twenty-one participants were interviewed. Central to participants' experiences of the COVID-19 pandemic were descriptions of access to services, in terms of both changes in service availability and the reality of how accessible existing services were to the community, represented by the theme access. Four other themes were generated from our analysis and include feeling and being unheard, stripped of dignity, I've been broken, and strength and survival (with a subtheme, community care). CONCLUSION: Future emergency response efforts must meaningfully engage people deprived of housing in planning and decision-making in order to minimize adverse impacts of health emergencies and the associated public health responses. There needs to be more careful consideration of the unintended harmful impacts of public health measures implemented in response to pandemics.

RéSUMé: OBJECTIFS: Les personnes sans abri ont été démesurément affectées par la pandémie de COVID-19 et par les mesures sanitaires mises en œuvre en réponse à la pandémie. Des données probantes émergentes montrent les résultats sanitaires indésirables éprouvés par ces communautés en raison de l'infection par le SRAS-CoV-2, mais les voix des membres de ces communautés ne sont généralement pas amplifiées dans les articles publiés. MéTHODE: Nous avons mené une étude qualitative interprétative. Des personnes sans abri ont été mises à contribution dans l'élaboration de l'étude, le recrutement des participants et l'analyse des données. Des personnes sans abri ou au logement précaire ont été recrutées lors d'activités d'approche dans la rue en juin et juillet 2020. Elles se sont prêtées à des entretiens semi-directifs en tête à tête qui ont été enregistrés, transcrits, puis analysés par thèmes. RéSULTATS: Vingt et une personnes ont été interviewées. Leurs expériences de la pandémie de COVID-19 ont été fortement axées sur le thème de l'accès aux services, tant pour ce qui est des changements dans la disponibilité des services que de l'accessibilité réelle des services existants pour les membres de ces communautés. Quatre autres thèmes sont ressortis de notre analyse : le sentiment/le fait de ne pas être entendu, d'être dépouillé de sa dignité, d'avoir été brisé, et la force et la survie (et un thème secondaire : les soins de proximité). CONCLUSION: Les futurs efforts d'intervention d'urgence doivent inclure une véritable collaboration avec les personnes sans abri dans la planification et la prise de décisions afin de réduire les répercussions néfastes des urgences sanitaires et des mesures de santé publique connexes. Il faut examiner plus attentivement les effets pervers des mesures sanitaires mises en œuvre en réponse aux pandémies.

The "problem" of health: An analysis of health care provision in Canada's federal prisons.

The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision of health care is governed in custodial settings. In this article, we examine one important aspect of governance: legislation governing the provision of health care in prisons. We view this issue through a critical lens, building on a body of poststructural scholarship which has illuminated how laws and policies are not merely tools of governance but also key sites for the production of meanings around social "problems," including the "problem of health." Taking Canada's Corrections and Conditional Release Act as a case example and applying Carol Bacchi's "What's the Problem Represented to Be" analytical framework, we examine how the specific representation of "health" in this legislation works to produce effects for persons in federal prison. Three key themes are formed through this analysis. First, what constitutes "essential services" in the context of federal prisons is more limited compared with the broader community. Second, the dichotomy between the rights of persons in prison versus the protection of society that is produced in development of these laws has significant bearing on the treatment of those in prison. Third, this representation has negative effects on the health of persons in prison. In order to meet United Nations standards, greater attention must be paid to the ways in which laws and other governing practices reproduce inequities in health care provision in prisons.

Enhancing health promotion and disease prevention in networked primary care

Health systems are moving away from traditional primary care (e.g., by increasingly shifting to group practice and interprofessional teams rather than solo practice primary-care providers), which is often siloed and results in barriers to timely access to care.(1) The Ministry of Health of British Columbia, which requested this rapid synthesis, is undergoing system transformation to better coordinate and potentially integrate primary care with some and community care and public-health services.(2) The transformation presents an important opportunity to improve primary care and preventive care services through improved management of clinical conditions coupled with health promotion and diseaseprevention services.

Examining compensation models for walk-in clinics

Positioning primary care as the cornerstone of the health system and establishing primary-care providers as the gatekeepers and coordinators of care has been a long-sought aim of health systems around the world. Further, a main aim of this goal in Canada has been to have a primary-care provider that is responsible for the health and well-being for each insured patient. However, ensuring that all citizens in a province are registered with a primary-care provider who is responsible for their care and can provide timely access to care when needed has proven difficult to achieve. This is not surprising given that primary-care providers in Canada are confronted with many challenges in their practices, including one or more of having to serve large geographical areas, providing care to uninsured populations, and managing high workloads as well as a mismatch between provider availability and the need for timely access to services (particularly after-hours and weekend care). When coupled with the policy legacies of how physicians in Canada have traditionally delivered care and been remunerated (e.g., as private business owners with public fee-for-service payment), the result is a patchwork of primary-care models.

Understanding the use of and compensation for virtual-care services in primary care

Provincial and territorial health systems across Canada continue to struggle with delivering timely access to primary-care services. In 2016, 74% of Canadians reported in the Commonwealth International Health Policy Survey that they received excellent or very good care from their regular doctor, which is above the 11-country average of 65%. However, Canadians also reported the longest wait times to see a primary-care provider across the 10 countries, with one in five reporting a wait of over seven days the last time they needed medical attention. To address this challenge, policymakers across the country have been increasingly exploring options to improve the delivery of patient-centred health services through the introduction and evolution of virtual care to enhance accessibility and efficiency.