JSGS Faculty

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Open Access
Professional Regulation: A Potentially Valuable Tool in Responding to ‘‘Stem Cell Tourism’’
(Elsevier, 2014-09-09) Zarzeczny, Amy; Caulfield, Timothy; Ogbogu, Ubaka; Bell, Peter; Crooks, Valorie A.; Kamenova, Kalina; Master, Zubin; Rachul, Christen; Snyder, Jeremy; Toews, Maeghan; Zoeller, Sonja
The growing international market for unproven stem cell-based interventions advertised on a direct-to-consumer basis over the internet (‘‘stem cell tourism’’) is a source of concern because of the risks it presents to patients as well as their supporters, domestic health care systems, and the stem cell research field. Emerging responses such as public and health provider-focused education and national regulatory efforts are encouraging, but the market continues to grow. Physicians play a number of roles in the stem cell tourism market and, in many jurisdictions, are members of a regulated profession. In this article, we consider the use of professional regulation to address physician involvement in stem cell tourism. Although it is not without its limitations, professional regulation is a potentially valuable tool that can be employed in response to problematic types of physician involvement in the stem cell tourism market.
Open Access
Unproven stem cell-based interventions & physicians’ professional obligations; a qualitative study with medical regulatory authorities in Canada
(BMC Medical Ethics, 2014-10) Zarzeczny, Amy; Clark, Marianne
Background - The pursuit of unproven stem cell-based interventions (“stem cell tourism”) is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct. Methods - We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians’ professional regulatory bodies in Canada. Results - When considering physicians’ professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians’ obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated. Conclusions - Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
Open Access
Uncovering Research Potential of Administrative Data on Charitable Foundations in Canada
(Canadian Journal of Nonprofit and Social Economy Research, 2017)
This is the first study of its kind to assess the untapped research capacity of administrative data on Canadian foundations. More than twenty years of records collected by the Canada Revenue Agency (CRA) for the entire population of foundations is publicly accessible to researchers. Canadian data offers greater opportunity for nuanced analysis of the charitable foundation sector than information from the comparatively small sample available for U.S. foundations. Despite the richness of Canadian data and the potential it has to inform grantmaking and administrative practices of foundations, the academic community has paid little attention to this wealth of statistical information. This article explores some of the questions that this data can potentially answer. Consultations with foundation representatives help illuminate the directions that the foundation sector would like researchers to pursue with this data. Ceci est la première étude de son genre à évaluer comment certaines données administratives pourraient contribuer à la recherche sur les fondations caritatives canadiennes. En effet, plus de vingt ans de données accumulées par l’Agence du revenu du Canada pour la population entière des fondations sont maintenant accessibles aux chercheurs. Ces données canadiennes représentent une occasion exceptionnelle pour effectuer une analyse nuancée du secteur des fondations caritatives, occasion qui est meilleure qu’aux États-Unis, où l’échantillon est relativement petit. Malgré la richesse des données canadiennes et leur potentiel d’améliorer l’octroi de bourses et l’administration des fondations canadiennes, la communauté académique a porté peu d’attention jusqu’à présent à cette manne de statistiques. Cet article-ci en revanche explore quelques-unes des questions auxquelles ces données pourraient porter des réponses. En outre, des consultations faites auprès des représentants de certaines fondations aident à signaler les directions que le secteur pourrait prendre grâce à ces données.
Open Access
Does Foundation Giving Stimulate or Suppress Private Giving? Evidence from a Panel of Canadian Charities
(Public Finance Review, 2017-09-22) Khovrenkov, Iryna
As non-governmental providers of public goods, charities are funded by governments and also by individuals and foundations. How do foundation grants to charities affect private donations to these organizations? The standard economic theory on voluntary contributions to the public good hypothesizes that foundation giving will crowd out private donations. An alternative giving dynamic may arise whereby foundations act as complements to private donations because they can provide a signal of charity quality to individuals and thereby influence their decisions to give. This article offers a rigorous empirical analysis of the relationship between foundation and private donations by utilizing a unique data set on Canadian social welfare and community charities matched with their foundation donors. Empirical findings confirm that an additional dollar of foundation grants to charities crowds in private giving by three dollars on average, suggesting that private donors may look to foundation grants for information on charities to make informed giving decisions.
Open Access
Understanding the mechanisms of administrative burden through a within-case study of Medicaid expansion implementation
(American Political Science Association, 2021-02-01) Camillo, Cheryl, A.
The importance of the administrative burden problem in public programs has been apparent during the COVID-19 crisis in the United States as millions of newly unemployed people have had to wait for unemployment checks and public health insurance benefits due to paperwork requirements, agency staff shortages, and outdated information technology systems. The resulting burdens have extended financial hardship, caused the coronavirus to spread, and eroded citizen and agency morale. Administrative burdens have long been known to be costly, yet remain fixtures of public benefit programs across the world. To reduce them, we need to understand their mechanisms. Formal policy solutions per se will not reduce administrative burdens because they do not exist solely by design. This article contributes to behavioral public administration by providing a comprehensive, empirical-driven theoretical framework for understanding the complex processes through which supply-side administrative burdens are instituted, modified, and eliminated. Using a retrospective within-case study method that utilizes participant observation, documentation, and archival records, the article traces the process by which a state eliminated administrative burdens in the process of implementing an initially straightforward expansion of Medicaid eligibility, thereby creating a model for simplifying and streamlining enrollment that was incorporated into the Affordable Care Act.
Open Access
COVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis
(JMIR Publications Inc., 2022-05-31) Daniel A Adeyinka; Cory Neudorf; Cheryl A Camillo; Wendie N Marks; Nazeem Muhajarine
Background There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. Objective Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. Methods We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. Results We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. Conclusions This “up to the point” analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines.
Open Access
Wellbeing in Saskatchewan Communities
(2022-12-13) Khovrenkov, Iryna; Mann, Tracey; Wreakes, Joanna; Ortynsky, Stephanie; Camacho, Gabriela
Open Access
Comparison of COVID-19 vaccination rollout approaches across Canada: Case studies of four diverse provinces
(McMaster University Library Press, 2023-02-01) Fitzpatrick, Tiffany; Camillo, Cheryl, A.; Hillis, Shelby; Habbick, Marin; Mauer-Vakil, Dane; Roerig, Monika; Muhajarine, Nazeem; Allin, Sara
Across Canada, there were notable differences in the rollout of provincial/territorial COVID-19 vaccination programs, reflecting diverse sociodemographic profiles, geopolitical landscapes, health system designs, and pandemic experiences. We collected information regarding underlying principles and goals, governance and authority, transparency and diversity of communications, activities to strengthen infrastructure and workforce capacity, and entitlement and access in four diverse provinces (British Columbia, Saskatchewan, Ontario, Nova Scotia). Through cross-case analysis, we observed significant differences in provincial rollouts of the primary two-dose vaccination series in adults between December 2020 and December 2021. Nova Scotia was the only province to state explicit coverage goals and adhere to plans tying coverage to the relaxation of public health measures. Both Nova Scotia and British Columbia implemented fully centralized vaccination booking systems. In contrast, Saskatchewan's initial highly centralized approach enabled the rapid delivery of first doses; however, rollout of second doses was slower and more decentralized, occurring primarily through community pharmacies. In alignment with its decentralized health system, Ontario pursued a regionalized approach, primarily led by its existing public health unit network. Our research suggests explicit goals, centralized booking, and flexible delivery strategies improved uptake; however, ongoing learning will be crucial for informing the success of future vaccination efforts.
Open Access
Implementation of a Pharmacy Clinical Instructor Model to Facilitate Experiential Learning within Saskatchewan’s Entry-to-Practice Doctor of Pharmacy Program
(Health Reform Observer - Observatoire des Reformes de Sante, 2023-06-02) Kary, Steven; Camillo, Cheryl, A.; Gerwing, Shauna; Dumont, Zack
In response to nationally endorsed changes in pharmacy curricula, the University of Saskatchewan College of Pharmacy and Nutrition (CoPN) sought to expand experiential learning for its pharmacy program. In 2010, Canada’s faculties and deans of pharmacy committed to implementing entry-to-practice Doctor of Pharmacy (PharmD) programs in all schools by 2020. The expansion and change in credentialing of Canada’s pharmacy training from baccalaureate programs was intended to ensure graduates possess the competencies required within the modern scope of pharmacy practice. To further this transition, the Canadian Council for Accreditation of Pharmacy Programs increased the required hours of students’ experiential learning. In Saskatchewan, pre-existing operational and financial pressures on the CoPN, coinciding with the provincial health system’s amalgamation from twelve regional health authorities to a single health authority, prompted a collaborative approach. To address the growing need for practical experience within the Saskatchewan Health Authority, the CoPN implemented clinical instructor positions within tertiary care centres in Saskatoon and Regina. This unique approach among PharmD programs provided financial stability and accountability to student learning, although early student feedback identified several challenges with this model. These findings about the clinical instructor model can guide the ongoing implementation of experiential learning within PharmD and other health care professional programs.
Open Access
Addressing the ethical problem of underdiagnosis in the post-pandemic Canadian healthcare system
(SAGE Publications, 2023-09-15) Cheryl A. Camillo
Proper diagnosis is essential for effective treatment, yet in Canada health conditions are commonly underdiagnosed at all levels of the health system, meaning that they go undiagnosed or are diagnosed only after a delay. Underdiagnosis leads to inadequate treatment and potentially insufficient recovery and rehabilitation, as well as costly inefficiencies, such as repeat medical visits. Moreover, disparities in underdiagnosis in which vulnerable groups, such as women and Indigenous persons, are properly diagnosed at lower rates worsen existing inequities, which threatens the overall health of the general population. As health leaders and policy-makers seek to strengthen Canada’s strained healthcare system, it will be important to address underdiagnosis and its causes, including systematic bias. Providing timely and accurate diagnoses for all patients is an essential component of delivering high quality, efficient, ethical, and cost-effective healthcare. The Canadian College of Health Leaders’ Code of Ethics offers a framework for addressing underdiagnosis equitably. Utilizing the framework, suggestions are made for actions that can be taken at all levels of the health system to reduce underdiagnosis.
Open Access
The Impact Of Provincial Proof- Of-Vaccination Policies On Age-Specific First-Dose Uptake Of COVID-19 Vaccines In Canada
(Health Affairs (Project Hope), 2023-11-01) Tiffany Fitzpatrick; Cheryl A. Camillo; Shelby Hillis; Marin Habbick; Monika Roerig; Nazeem Muhajarine; Sara Allin
Requirements of proof of COVID-19 vaccination were mandated for nonessential businesses and venues by Canada’s ten provinces throughout the fall of 2021. Leveraging variations in the timing of these measures across the provinces, we applied event study regression to estimate the impact the announcement of these measures had nationally on age-specific first-dose uptake in the subsequent seven-week period. Proof-of-vaccination mandate announcements were associated with a rapid, significant increase in first-dose uptake, particularly in people younger than age fifty. However, these behavioral changes were short- lived, with uptake returning to preannouncement levels—or lower—in all age groups within six weeks, despite mandates remaining in place for at least four months; this decline occurred earlier and was more apparent among adolescents ages 12–17. We estimated that nationally, 290,168 additional people received their first dose in the seven weeks after provinces announced proof-of-vaccination policies, for a 17.5 percent increase over the number of vaccinations estimated in the absence of these policies. This study provides novel age-specific evidence showing that proof-of-vaccination mandates led to an immediate, significant increase in national first-dose uptake and were particularly effective for increasing vaccination uptake in younger to middle-aged adults. Proof-of- vaccination mandates may be effective short-term policy measures for increasing population vaccination uptake, but their impact may differ across age groups.
Open Access
Fostering Synergy: Enhancing Children and Youth Outcomes through Collaboration Across Human Service Organizations- Insights from TRiP (The Regina intersectoral Partnership)
(University of Regina, 2024-02-29) Akram Mahani; Joonsoo Sean Lyeo; Agnes Fung; Erin Thomsen; Mastoora Rizai; Wendy Stone; Lance Dudar; Nathalie Reid; Donna Black; Lisa Frei; Noor Al-Humuzi; Jacob Alhassan; Shanzey Ali; Sara Zahid
Access to services and supports for children and youth in vulnerable contexts remains a key challenge in Canada due to fragmented service delivery systems. Cross-sectoral collaboration has proven to be an effective strategy to overcome existing silos through providing wraparound coordinated services, and a means to promote healthy development and safety of children. Given the challenges associated with establishing and sustaining cross-sector collaborations, including coordination issues and conflicting interests of the sectors involved, our study used TRiP (The Regina intersectoral Partnership) as a case study to explore the dynamics of this collaborative initiative. TRiP is a collaboration across six human service organizations to improve outcomes for children/youth in vulnerable contexts, which has been functioning in Regina, Saskatchewan since 2010. Our research aimed to investigate the emergence, formation, and evolution of this cross-sectoral collaboration; factors influencing collaboration and service coordination across sectors; and the processes and structures involved in establishing and sustaining robust collaborative initiatives. By drawing on interviews with stakeholders from six human service organizations engaged with TRiP (n=25), and persons with lived experience (n=20), observations, and document reviews, the research team identified factors influencing collaboration and service coordination across sectors. We also examined the governance, process of coordinating services across sectors, funding structure, and accountability mecha¬nisms within TRiP. Our research findings are categorized into four key themes: 1) achievements and outcomes, 2) factors contributing to success and sustainability, 3) perceived gaps and areas for improvement, and 4) suggestions for improvement. Many caregivers and children interviewees pointed to the significant achievements and outcomes accomplished by TRiP since its conception, including: the positive outcomes to the safety and well-being of children; and the positive outcomes experienced by the caregivers, including a nurturing support, improved child-caregiver relationships, and better access to support services. Participants identified a host of factors contributing to the success and sustainability of TRiP including: having a shared vision to guide the direction of TRiP; continuous growth and evolution of the initiative; the leading role of champions within the initiative; the sharing of information between sectors and stakeholders; having a dedicated and single point of contact between TRiP and its clients; and TRiP’s ability to act as a conduit for effectively communicating with various human services organizations. Participants also identified several areas for improvement within TRiP, including: chronic resource limitations; administrative hurdles associated with information sharing; ongoing siloing of sectors engaged; TRiP’s limited public presence; and limitations to clients in the form of age-restricted supports and disrupted continuity of care. Finally, participants provided suggestions for improvement to guide the continued refinement and evolution of TRiP, including: adoption of a proactive rather than reactive approach; enhancement of TRiP’s visibility in the public; revitalization of TRiP’s current system of governance; strengthening TRiP’s accountability mechanisms; establishing cohesive and unified definitions and measures of success; enhancing staff retention; and expanding the range of support opportunities for children.
Open Access
Barriers to healthy urban design policies: Perspectives from the City of Regina in Saskatchewan
(Johnson Shoyama Graduate School of Public Policy, 2024-03-06) Akram Mahani; Joonsoo Sean Lyeo; Agnes Fung; Shanzey Ali; Kelly Husack; Nazeem Muhajarine; Tania Diener; Chelsea Brown
The intricate interplay between urban design, health, and equity has emerged as a critical focal point in pursuit of the United Nations Sustainable Development Goal 11, which seeks to make cities inclu¬sive, safe, resilient, and sustainable. It reflects an increasing aware¬ness of the social determinants of health – a term encapsulating the socioeconomic variables that shape an individual’s living and working conditions. In other words, a person’s-built environment (the human-made surroundings within which people live and work) can either support or detract from their health. This relationship is underscored by the impact of urban design on equity. With Canada now 80% urbanized, it is not surprising that cities and urban centers have emerged as a primary arena for addressing current health challenges and safeguarding the wellbeing of residents. Therefore, by recognizing the relationship between urban design and health provides an opportunity to address gaps that contribute to health inequities. However, not all municipal actors and urban design professionals readily acknowledge their pivotal role in improving population health. To understand how key municipal policy- and decision-makers view the relationship between health and urban design, our team used the City of Regina as a case study. We interviewed 30 municipal actors from various roles and educational backgrounds within Regina’s municipal government. These interviews were analyzed using qualitative research methods and the findings were used to inform this policy paper. We identified three key categories of barriers to integrating health and equity into urban design policies: constrained policy-making environment, societal and cultural factors, and competing interests of stakeholders.
Open Access
Cross-Sectoral Collaboration to Improve Outcomes for Children/Youth in Vulnerable Contexts: Policy Dialogue Report
(University of Regina, 2024-04-08) Akram Mahani; Shanzey Ali; Sara Zahid; Mastoora Rizai; Erin Thomsen; Lisa Petermann; Keagan Townsley; Yasha Afshar Jalili; Adrienne Ratushniak; Jennifer Martin; Raelynn Fohr; Emma McKenna
Executive Summary This report summarizes a one-day policy dialogue event that brought together 55 stakeholders and persons with lived experiences to discuss key lessons from TRiP (The Regina intersectoral Partnership) initiative. TRiP is an example of sustained collaboration across six human service organizations to improve outcomes for children and youth in vulnerable contexts within Regina, Saskatchewan, since 2010. The event aimed to explore how these lessons can be applied in other intersectoral contexts through the engagement of the participants in 1) TRiP translation and 2) consensus-building activities (World Café). During TRiP translation group activity (see details below), participants were asked about the top reason for TRiP's success. Collaboration was the most common response among 28 participants, followed by the knowledge and dedication of frontline staff (4 participants) and shared consent (2 participants). When asked what aspects of TRiP could be translated into other contexts, participants identified six key categories: effective communication, governance and leadership, building relationships and trust, accountability and responsibility, evaluation and measurement, and organization support and resources. During the World Café conversations, the event participants discussed the core themes that emerged from the research study including governance and leadership, accountability, information sharing, defining and measuring success and resources. Below is the summary of key findings in each theme. Governance and Leadership: Participants emphasized the need for buy-in from government and higher-level leadership, suggesting concrete actions beyond written strategies to foster cross-sectoral collaboration. They discussed various leadership models, including single-entity and shared approaches, with considerations for accountability and alternative governance structures. Accountability: Challenges to accountability in collaborative initiatives were identified, including a lack of shared definitions and siloed structures hindering collaboration. Proposed solutions included inclusive engagement strategies, enhanced communication, capacity building, and person-centered care for improved service continuity. Information Sharing: Participants stressed the importance of building trust among partners, understanding sector skill sets, and utilizing shared physical space for efficient collaboration. Purposeful information collection and sharing, with a trauma-informed approach, empower clients and improve service delivery. Defining and Measuring Success: Defining success in collaborative initiatives such as TRiP was seen as complex, tailored to individual needs, and requiring a holistic approach with quantitative and qualitative measures. Success was viewed as collective and reflective of strong partnerships and family connections. Resources: Concerns about potential burnout among dedicated staff and financial challenges, especially in securing government funding, were noted. Suggestions included exploring direct resource allocation options and addressing the high turnover rate among TRiP personnel to enhance service delivery.
Open Access
Barriers to integration of health and equity into urban design policies in Regina, Saskatchewan
(2024-12-06) Mahani, Akram; Lyeo, Joonsoo Sean; Fung, Agnes; Husack, Kelly; Muhajarine, Nazeem; Diener, Tania; Brown, Chelsea
Although there is extensive literature on the impact of urban design on health, little is known about the barriers to integrating health into urban design policies. As cities increasingly lead efforts to improve health equity and population health, understanding the perspectives and experiences of municipal actors on health and equity is essential. To address this gap, we conducted semi-structured interviews with 30 stakeholders engaged with urban design policy- and decision-making at the City of Regina in Saskatchewan, Canada. We analysed our data using a qualitative thematic framework. Our research uncovered a lack of shared understanding of health among municipal actors. Interviewees identified several barriers to integrating health and equity in urban design policies, including inaccessibility of evidence; insufficient resourcing; fragmented governance structure; limited legal power of local governments in Canada; a deeply ingrained culture of individualism and lack of representation. Our findings underscore the importance of adopting an integrated and holistic approach for healthy and equitable urban design. As urbanization continues to bring a greater share of the world’s population into urban areas, it is crucial to understand how municipal governance can foster environments that promote residents’ well-being.

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