2018 Oral Defences

Syeda Farahnaaz Kabir

Dissertation Title: Psycho-Social Contributions to Higher Type 2 Diabetes Mellitus Prevalence among South Asian Immigrants Living in Canada

Committee Members: (Chair) R. da Silva Gorman, (Supervisor) D. Raphael, (Internal Member) I. Daiski, (Committee Member) F. Ahmad, (Committee Member) M. Rioux, (External Examiner) K. Shankardass
Date of Defence: August 16, 2018
University, Degree and Year: York University, PhD, 2018
Current Email:

Abstract: This thesis studies psycho-social aspects of the experiences of South Asian immigrants (SAI) in Canada and how these may be related to the elevated presence of type 2 diabetes mellitus (T2DM) in this group. It does so by examining the way in which variables such as education and income levels, the gap between education and income levels, and psycho-social variables related to stress, predict the presence of T2DM in this group as compared to two other social groups: Chinese Immigrants (CI) and Canadian born whites (CBW). The results of this research support the hypotheses laid out for this dissertation that exposure to an education/income gap increases risk for T2DM, and that SAI have higher risk for T2DM compared to CI and CBW.

Akwatu Khenti

Dissertation Title: Three Decades of Epidemic Black Gun Homicide Victimization in Toronto: Analyzing Causes and Consequences of a Criminological Approach

Committee Members: (Chair) L. Ginsburg, (Supervisor) D. Raphael, (Internal Member) P. Idahosa, (Committee Member) M. Morrow, (Committee Member) C. Williams, (External Examiner) C. Chalin
Date of Defence: March 27, 2018
University, Degree and Year: York
University, PhD, 2018

Abstract: This dissertation analyzes Black gun violence and homicide victimization in Toronto from a health equity and critical race perspective rather than prevailing criminological theories. Young Black men in Toronto are estimated to be five times more likely to become victims of homicidal violence (Gartner & Thompson, 2004). Utilizing a publication-based dissertation format, the first manuscript (Chapter 2) highlights a declining public safety of young Black men over three decades and questions why this phenomenon is not regarded as a public health crisis. It identifies some key public health considerationsrelated to violence prevention, early intervention, and treatment. The theoretical framework (Chapter 3) contextualizes core assumptions of criminological theories with striking inequities across key social determinants of health, significant intersectionalities, and persistent patterns of systemic racism. The second manuscript (Chapter 4) applies a Critical Race Theoretical (CRT) framework to the available literature. CRT highlights the ongoing relevance of systemic racism to the current framing of Black gun-violence by the media, education, and criminal justice system. The third manuscript (Chapter 5) explores potential pathways from experiencing structural violence to the increased risk of homicide victimization. The implementation of the politically motivated War on Drugs compounds risks and vulnerabilities associated with the key determinants of socioeconomic status -- especially because of over-policing and excessive incarceration. The fourth manuscript (Chapter 6) argues that the War on Drugs (WOD) approach has strengthened systemic anti-Black racism across key sectors of society. The fifth manuscript (Chapter 7) analyzes an 11-year period (2004-2014) and finds Black homicide rates to be highest in neighbourhoods with intersecting socioeconomic disadvantage and a high proportion of Black residents. However, neighbourhoods of less socioeconomic disadvantage with smaller proportions of Black residents also have some of the highest Black homicide rates -- probably due to racial stigmatization. The sixth and final manuscript (Chapter 8) describes dominant public stigmatizations, as well as health promotion potential in Afrocentric resiliency building. The chapter elucidates how public racial stigmatization drives and sustains Black homicide victimization (BHV) through self-stigmatization. Afrocentrism provides an alternative narrative with which to counter dominant deficit narratives and engender agency in individuals and communities.

Juha Mikkonen

Dissertation Title: Intersectoral Action for Health: Challenges, Opportunities, and Future Directions in the WHO European Region

Committee Members: (Chair) M. Morrow, (Supervisor) D. Raphael, (Internal Member) L. Gilbert, (Committee Member) V. Tyyska, (Committee Member) J. Lexchin, (External Examiner) C. Quinomer
Date of Defence: May 7, 2018
University, Degree and Year: York
University, PhD, 2018

Abstract: Human health is shaped by public policy decisions made not only by the health sector, but numerous other sectors and actors that influence peoples social, economic, and cultural conditions. Therefore, national health ministries cannot solve the root causes of many health problems without also engaging non-health sectors to implement health-promoting public policies. For over three decades, the World Health Organization (WHO) has actively endorsed the concept of intersectoral action for health as a key approach to address the most pressing health challenges at the national and international levels. At the international level, the need to engage non-health sectors in health promotion activities has been repeated in nine outcome documents of the global health promotion conferences organized by WHO between 1986 and 2016. However, calls to promote health through greater intersectoral action have not led to wide-scale and systematic implementation by national governments and jurisdictions.

The challenges and opportunities to intersectoral action for health are rarely identified in a systematic way in the existing research literature. To address the current gap in knowledge, this dissertation was based on three key research questions: (1) How do the expert informants within the WHO Regional Office for Europe understand the concepts of intersectoral action for health and governance for health?, (2) What do the academic literature and key informants identify as the challenges and barriers to intersectoral action for health?, and (3) Which factors facilitate the implementation of the intersectoral action for health and what are the opportunities to promote health through such action in the future?

The methods of this study included an in-depth review of literature and primary data collection that involved 28 semi-structured interviews with WHO Programme Managers, Unit Leaders, Directors, and Technical Officers working at the WHO Regional Office for Europe in Copenhagen. A thematic analysis of the key informant interviews focused on the challenges and opportunities to intersectoral action for health. The aim of this analysis is to shed light on the factors that are relevant to the policy process and dynamics of intersectoral policymaking. The findings of this study draw on the perspectives that the informants had gained by working with many of the 53 countries that comprise the WHO European region. The analysis involved a computer-assisted coding process with NVivo software and led to ten thematic challenges/barriers and to ten thematic opportunities/facilitators.

Overall, this dissertation increases understanding of the political, technical, institutional, and managerial barriers to intersectoral action for health. In addition, it presents a systematic analysis of the factors that can facilitate intersectoral action for health and considers the future of intersectoral approaches in health promotion. Based on the empirical findings, the concluding section includes eighteen recommendations for strategies to overcome the challenges and barriers to the implementation of intersectoral action for health in the future. These recommendations include various strategies such as ensuring high-level political support and a mandate for intersectoral action, mapping out co-benefits among sectoral partners, establishing permanent intersectoral mechanisms, ensuring adequate resources for implementation and monitoring, and increasing the capacity of the health sector to work with non-health sectors.

Maryam Salaripour

Dissertation Title: The Epidemiology of Community-Acquired Clostridium Difficile in the Niagara Region, Ontario, Canada, Between September 2011 and December 2013

Committee Members: (Chair) D. Raphael, (Supervisor) L. Ginsburg, (Internal Member) B. Pilkington, (Committee Member) J. Johnstone, (Committee Member) C. El Morr, (Committee Member) M. Gardam, (External Examiner) D. Mertz
Date of Defence: June 7, 2018
University, Degree and Year: York University, PhD, 2018
Current Email:

Abstract: Clostridium difficile infections (CDIs) have historically been associated with exposure to healthcare settings. In recent years, however, the incidence of community-acquired Clostridium difficile infections (CA-CDI), along with the number of patients requiring hospitalization for it, has been increasing. This research uses a framework grounded in Complex Adaptive Systems (CAS) to reveal new and different epidemiological findings on CA-CDI to indicate novel health equity leverage points. It explores the epidemiology and established risk factors associated with CA-CDI in the Niagara Region, Ontario, and compares them with those of healthcare-associated CDI (HA-CDI) in the same area.

The first manuscript evaluates the literature on existing evidence of risk factors for CA-CDI by applying The Joanna Briggs Institute (JBI) Reviewers’ Manual 2015, Methodology for JBI Scoping Reviews. The review identifies that CA-CDI is seen more often than HA-CDI in younger and female populations. Exposure to antimicrobials is common but not as common as in HA-CDI cases. The scoping review establishes the need for further epidemiological studies on CA-CDI. The second manuscript provides a nonparametric descriptive analysis, comparing CA-CDI and HA-CDI cases in Niagara Health System (NHS) hospitals, based on a retrospective case series design. Hospitalized CA-CDI patients have a lower median age and less exposure to antimicrobials and other medications. Gender proportions are similarly distributed between the two groups. The emerging recommendation is that CA-CDI must be considered as a potential diagnosis in patients admitted to hospital with diarrhea, even in the absence of conventional CDI risk factors. The third and final manuscript evaluates the spatial and genotype features of CA-CDI and HA-CDI. It finds that geographical clustering, temporal patterns, and genotypic features are unique in each category. These studies point to the need for a better understanding of transmission routes between communities and healthcare settings; further research is required to establish community CA-CDI risk factors.

Together, these evaluations establish that we must develop a systems approach to explore health problems and respond effectively at a population level. The research and policy environment must be strengthened by modifying current practices, setting priorities, and providing funding for empirical studies and equitable health policies.

2016 Oral Defences

Adrienne Shnier

Dissertation Title: Medical Education and Financial Conflict of Interest Relationships with the Pharmaceutical Industry in Canada: An Analysis of Four Areas of Medical Education

Committee Members: (Chair) F. Ahmad, (Supervisor) J. Lexchin, (Member) H.G. Rosenburg, (Member) M.A. Gagnon, (Outside Member) K. Thomson
Date of Defence: July 20, 2016
University, Degree and Year: York University, PhD, 2016
Current Email:

Abstract: Financial conflict of interest (FCOI) relationships in medicine have been found to expose medical education in medical schools, medical journals, and continuing medical education (CME) hosted by professional medical associations (PMAs) to vulnerability to corporate bias. Institutional policy analysis concerning FCOI relationships and industry involvement in medical education in Canada is limited. Therefore, informed by neoliberal corporate bias theory and Mertonian norms of science, this dissertation contributes analyses of conflict of interest policies, disclosures, and opportunities for drug company involvement in the production and dissemination of medical knowledge. In a publication-based dissertation format, the first manuscript provides an evaluation of conflict of interest policies at the 17 medical schools in Canada. The second manuscript provides an analysis of the culture of corporate science, informed by neoliberal ideology, through an examination of the extensive and pervasive roles of the drug promotion industry in clinical trial research, interpretation, writing, and publishing in medical journals. The third manuscript offers an evaluation of policies concerning FCOI relationships and industry involvement in CME development and programming adopted by 60 professional medical associations in Canada. The fourth and final manuscript comprises an quantitative analysis of FCOI relationship disclosures in Canadian clinical practice guidelines. In general, these evaluative efforts found that the policy environment concerning industry involvement in various types of medical education in Canada is permissive and FCOI relationships are common among guideline authors. Positioned within the context of neoliberal corporate bias theory and Mertonian norms of science, these findings of general policy permissiveness indicate an alignment of goals between the pharmaceutical industry and medical education institutions. The necessity for increased transparency in terms of industry’s roles in not only conducting, analyzing, interpreting, and publishing pharmaceutical research, but also data sharing is supported by existing literature on financial conflict of interest relationships with the pharmaceutical industry. Furthermore, the strengthening and enforcement of policies on industry involvement and FCOI relationships in these areas of medical education would help to ensure that medical education in the public’s interest is achieved.

2015 Oral Defences

Julia Brassolotto

Dissertation Title: Querying Everyday Scarcity: A Feminist Political Economy Analysis of Kidney Dialysis and Transplantation in Rural British Columbia

Committee Members:  (Chair) M. Hynie, (Supervisor) T. Daly, (Member) P. Armstrong, (Member) M. MacDonald, (Outside Member) D. Davidson
Date of Defence: October 16, 2014
University, Degree and Year: York University, PhD, 2015
Current Email: julia.brassolotto@uleth.ca

Abstract: This thesis uses a feminist political economy perspective to analyze the findings from a qualitative case study regarding kidney dialysis and transplantation in rural and remote British Columbia. This case study was conducted in order to investigate the concept of "scarcity," which is very common in organ transfer discourse. Critical ethnography and document analysis were used to examine the ways in which scarcity manifests in policy, practice, and everyday life. The main areas of focus include: the systemic context for the practices; the intersection of social location and geographic isolation; the intersection of gender, work and health; the implications of work in the local resource industry for renal health and renal replacement options; the role of unpaid care work provided by family members; and the implications of shifting care from institutions to families and individuals – particularly in a rural and remote context. Broadly, I argue that the scarcity of transplantable organs remains the dominant public discourse, that this discourse informs policies and practices, and that, despite these trends, lived experiences of scarcity at this site of study have more to do with the scarcity of human and health care resources, particular services, and health and life-sustaining resources for patients.