News and Publications from 2021
The Disabled Contract
Severe Intellectual Disability, Justice and Morality
by Jonas-Sébastien Beaudry
published by Cambridge University Press
Available March 2021
Social contract theories generally predicate the authority of rules that govern society on the idea that these rules are the product of a contractual agreement struck between members of society. These theories embody values, such as equality, reciprocity and rationality, that are highly prized within our culture. Yet a closer inspection reveals that these features exclude other important values, relations and even persons from the realm of contractual morality and justice, especially people with severe intellectual disabilities. Jonas-Sébastien Beaudry explores the moral status of intellectually disabled people in social contract thought and argues that this tradition needs to be revisited to include the most vulnerable. Addressing this problem will have concrete repercussions in law and policy, because many issues that people with disabilities face are connected to deeply rooted assumptions about their status as full citizens or full members of our moral, political and legal communities.
Alissa Koski was interviewed on CTV News on January 23rd, 2021:
McGill professor Alissa Koski & bestselling author Samra Zafra talk to Angie Seth about concerning new data on child marriage in Canada.
Christopher Barrington-Leigh was quoted in the following article in the McGill Newsroom: Institutional Communications
Published January 21st, 2021.
A Postdoctoral Fellow working with Daniel Weinstock published the following article:
Michael Da Silva
The Traces Left Behind: On Appropriate Responses to Right Acts with Wrong Features
Social Theory and Practice. 2021.
Published on January 20th, 2021.
Fulfilling one’s all-things-considered duty sometimes requires violating pro tanto duties. According to W. D. Ross and Robert Nozick, the pro tanto-duty-violating, wrong-making features of acts in these cases can leave ‘traces’ of wrongfulness that require specific responses: feeling compunction for the wrongfulness and/or providing compensation to the negatively affected person. Failure to respond in the appropriate way to lingering wrong-making features can itself be wrongful. Unfortunately, criteria for determining when traces remain are largely lacking. In this piece, I argue for three necessary conditions for the existence of a trace: ‘The Non-Consequentialist Duty Condition,’ ‘The Identity Condition,’ and ‘The Ratio Condition.’
Daniel Weinstock's work on Harm Reduction was mentioned in the following article:
San Jose Spotlight
by Mauricio La Plante
Published January 19th, 2021.
Arijit Nandi co-authored and article in the Canadian Journal of Surgery:
Batomen B, Moore L, Carabali M, et al.
Effectiveness of trauma centre verification: a systematic review and meta-analysis
Canadian Journal of surgery. Journal Canadien de Chirurgie. 2021 Jan;64(1):E25-E38.
DOI: 10.1503/cjs.016219. MID: 33450148.
Published January 14th, 2020
There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification.
We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis.
Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients.
Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification.
Miñarro S, Reyes-García V, Aswani S, Selim S, Barrington-Leigh CP, Galbraith ED
Happy without money: Minimally monetized societies can exhibit high subjective well-being
PLoS ONE. 2021; 16(1): e0244569.
Published January 13th, 2021
Economic growth is often assumed to improve happiness for people in low income countries, although the association between monetary income and subjective well-being has been a subject of debate. We test this assumption by comparing three different measures of subjective well-being in very low-income communities with different levels of monetization. Contrary to expectations, all three measures of subjective well-being were very high in the least-monetized sites and comparable to those found among citizens of wealthy nations. The reported drivers of happiness shifted with increasing monetization: from enjoying experiential activities in contact with nature at the less monetized sites, to social and economic factors at the more monetized sites. Our results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will raise life satisfaction among low income populations.
Koski A and Clark S.
Child Marriage in Canada
Population and Development Review (2021).
Published January 8th, 2021
View article written in McGill Newsroom - Institutional Communications - Child marriage is legal and persists across Canada on January 8th, 2021.
View article written in CTVNews.ca - Child marriage persists across Canada, rural communities, study finds by Brooklyn Neustaeter on January 10th, 2021.
View article written in the Globe and Mail - Thousands of child marriages in Canada lead to questions over global leadership by Matthew Lavietes on January 11th, 2021.
View article in Science Blog - Child marriage is legal and persists across Canada on January 11th, 2021.
View article written in the McGill Reporter - Child marriage is legal and persists across Canada by Shirley Cardenas, Media Relations Officer, Communications and External Relations on January 12th, 2021.
View article written in Tampa Dispatch - Child marriage in Canada: Over 3,600 marriage certificates were issued to children under the age of 18 between 2000 and 2018.
View article written in Canada.com - Canada must amend its marriage laws to end child marriage by Daphne Bramham on January 13th, 2021.
Child marriage, defined as formal or informal marriage before the age of 18, is a globally recognized indicator of gender inequality. Canada has placed itself at the forefront of global efforts to end child marriage as part of its commitment to the United Nations Sustainable Development Goals. Despite these global aspirations, child marriage remains legal throughout Canada. Data from vital statistics agencies and recent censuses indicate that child marriage, although rare, is practiced across the country. In 2016, nearly 2,300 children between 15 and 17 years of age were in union, a prevalence of 0.2 percent. The vast majority (98 percent) of these were informal, common‐law unions. Demographic patterns of child marriage in Canada are similar to those observed in many low‐ and middle‐income countries. Girls were far more likely to be married as children than boys and typically wed much older spouses. There were marked differences in the prevalence of child marriage across the country, with the highest estimates found in Alberta, Manitoba, Saskatchewan, and the territories. These findings draw attention to the discrepancy between Canada's domestic law and its foreign policy. They also highlight thorny challenges inherent in efforts to eradicate this practice in Canada and elsewhere.
Baron M, Riva M, Fletcher C, et al.
Conceptualisation and Operationalisation of a Holistic Indicator of Health for Older Inuit: Results of a Sequential Mixed-Methods Project
Social Indicators Research (2021).
Published January 4th, 2021
Elder Inuit define health as holistic and multifaceted, which contrasts with health-related research where single factor indicators are usually used to measure health in an Inuit context. As the number of Inuit elders is growing, indicators derived from an Inuit definition of health are important if health systems are to be inclusive of the realities of Indigenous Peoples and culture. This study explored and operationalised a model of Inuit health in aging that draws from physical, emotional, spiritual, and interpersonal components identified as salient by participants in this research. Qualitative data gathered through two workshops with 21 participants were analysed to identify key dimensions of health from an Inuit perspective. Quantitative data were retrieved from Statistics Canada Aboriginal Peoples Survey (APS; 2006) with a weighted sample of 4450 Inuit aged ≥ 50 years residing across Inuit Nunangat. Using measures corresponding to the dimensions identified previously, Latent Class Analyses were applied to group survey participants into health profiles to create a holistic indicator of health. Multinomial regressions were conducted with related health and social measures to assess the concurrent validity of the indicator. Health was conceptualised along eight themes: general health balance, mental health, spirituality, not experiencing many activity limitations, being loved and having positive relationships, speaking Inuktitut, and being free of addiction. The holistic indicator grouped participants into three health profiles: (1) good health for most variables; (2) very good perceived and physical health, but poor mental health; and (3) poor health for most variables. Using mixed methods to bridge the concept of health defined in qualitative workshops with quantitative health indicators can contribute to the definition and description of a culturally relevant and sociologically complex understanding of healthy aging in an Inuit context.
News and Publications from 2020
Jill Baumgartner co-authored an article in Environment International:
Lee M, Carter E, Yan L, et al.
Determinants of personal exposure to PM2.5 and black carbon in Chinese adults: A repeated-measures study in villages using solid fuel energy
Environment International. 2021 (Jan):146. 106297
Available online December 8th, 2020
Exposure to air pollution is a leading health risk factor. The variance components and contributions of indoor versus outdoor source determinants of personal exposure to air pollution are poorly understood, especially in settings of household solid fuel use. We conducted a panel study with up to 4 days of repeated measures of integrated gravimetric personal exposure to PM2.5 and black carbon in 787 men and women (ages 40–79) living in peri-urban villages in northern (Beijing and Shanxi) and southern (Guangxi) China. We simultaneously measured outdoor PM2.5 and collected questionnaire data on sociodemographic characteristics and indoor pollution sources including tobacco smoking and solid fuel stove use. We obtained over 2000 days of personal exposure monitoring which showed higher exposures in the heating season (geometric mean (GM): 108 versus 65 μg/m3 in the non-heating season for PM2.5) and among northern participants (GM: 90 versus 59 μg/m3 in southern China in the non-heating season for PM2.5). We used mixed-effects models to estimate within- and between-participant variance components and to assess the determinants of exposures. Within-participant variance in exposure dominated the total variability (68–95%). Outdoor PM2.5 was the dominant variable for explaining within-participant variance in exposure to PM2.5 (16%). Household fuel use (PM2.5: 8%; black carbon: 10%) and smoking status (PM2.5: 27%; black carbon: 5%) explained the most between-participant variance. Indoor sources (solid fuel stoves, tobacco smoking) were associated with 13–30% higher exposures to air pollution and each 10 μg/m3 increase in outdoor PM2.5 was associated with 6–8% higher exposure. Our findings indicate that repeated measurements of daily exposure are likely needed to capture longer-term exposures in settings of household solid fuel use, even within a single season, and that reducing air pollution from both outdoor and indoor sources is likely needed to achieve measurable reductions in exposures to air pollution.
Mah M M, Sanmartin C, Riva M, Dasgupta K, Ross N.
Association Between Active Living Environments and Hospitalization for All-Causes and Cardiometabolic Disease
International Journal of Population Data Science. 2020: 5(5).
Conference Proceedings for International Population Data Linkage Conference 2020.
Published December 7th, 2020
Neighbourhoods have the potential to influence population-wide modifiable risk factors such as physical inactivity and obesity. Built environments that encourage active living hold promise as a policy lever for reducing health care burden, particularly that related to cardiometabolic disease.
Objectives and Approach
We examined the role of active living environments on hospitalization risk, frequency, and cumulative length of stay for all-causes and cardiometabolic diseases. The linked dataset is a combination of survey data from Canadian respondents aged 45+, records from a national census of acute hospitalizations, and the Canadian Active Living Environment (Can-ALE) - a 5-class measure of how conducive one’s neighbourhood is to active living based on street connectivity, points of interest, and population density. We modelled the risk of all-cause and cardiometabolic hospitalizations for respondents living in more and less favourable environments using logistic regression. Frequency and cumulative length of stay were modelled using truncated negative binomial regression. Models were adjusted for individual-level factors and proximity to a hospital. An offset variable was included to account for different follow-up times.
232,000 respondents were included with a mean follow-up time of 5.37 years. Those living in progressively more favourable active living environments (classes 2, 3, 4, and 5) exhibited incrementally lower risk of hospitalization compared to those living in the least favourable (class 1). Relative to respondents living in the least favourable environments (class 1), odds ratios were 0.84 (95% CI 0.76-0.93) for all-cause hospitalization and 0.80 (95% CI 0.68-0.93) for cardiometabolic hospitalization for respondents living in the most favourable environments (class 5). There was little evidence of similar associations for hospitalization frequency and cumulative length of stay.
Conclusion / Implications
Living in neighbourhoods that are more conducive to active living are associated with lower risk of all-cause and cardiometabolic hospitalization.
Batomen B, Moore L, Strumpf E, Nandi A
Addressing competing risks when assessing the impact of health services interventions on hospital length of stay
Epidemiology (Cambridge, Mass.)
November 23, 2020 - Volume Published Ahead of Print
DOI: 10.1097/ede.0000000000001307. PMID: 33284168.
Background: Although hospital length of stay is generally modeled continuously, it is increasingly recommended that length of stay should be considered a time-to-event outcome (i.e., time to discharge). Additionally, in-hospital mortality is a competing risk that makes it impossible for a patient to be discharged alive. We estimated the effect of trauma center accreditation on risk of being discharged alive while considering in-hospital mortality as a competing risk. We also compared these results with those from the "naïve" approach, with length of stay modeled continuously.
Methods: Data include admissions to a level I trauma center in Quebec, Canada between 2008 and 2017. We computed standardized risk of being discharged alive at specific days by combining inverse probability weighting and the Aalen-Johansen estimator of the cumulative incidence function. We estimated effect of accreditation using pre-post, interrupted time series analyses (ITS) and the "naïve" approach.
Results: Among 5,300 admissions, 12% died, and 83% were discharged alive within 60 days. Following accreditation, we observed increases in risk of discharge between the 7, 4.5% (95%CI: 2.3, 6.6) and 30 days since admission 3.8% (95%CI 1.5, 6.2). We also observed a stable decrease in hospital mortality, -1.9% (95%CI -3.6, -0.11) at the 14 day. Although pre-post and ITS produced similar results, we observed contradictory associations with the naïve approach.
Conclusions: Treating length of stay as time to discharge allows for estimation of risk of being discharged alive at specific days after admission while accounting for competing risk of death.
Jill Baumgartner co-authored an article in Chemosphere:
Santa-Rios A, Barst BD, Tejeda L, et al.
Dried blood spots to characterize mercury speciation and exposure in a Colombian artisanal and small-scale gold mining community
Chemosphere 2020, 129001, ISSN 0045-6535
available online November 19, 2020
The artisanal and small-scale gold mining (ASGM) sector uses the most mercury (Hg) worldwide. Despite health concerns associated with high Hg exposures in these communities, ASGM sites are often situated in resource limited and remote regions which challenge traditional human biomonitoring approaches. To help overcome such challenges, here we report on the development of a high-quality method to characterize chemical speciation of Hg in dried blood spots (DBS), and then apply this method to assess Hg exposures in people sampled from an ASGM community (Pueblito Mejia) and a nearby town (Barranco de Loba) in Colombia. We collected DBS and urine samples from 35 individuals in 2018, and used these to assess occupational (DBS inorganic Hg (InHg) and urine total Hg (THg) measures) and environmental (DBS methylmercury (MeHg) measures) exposure of participants to different forms of Hg. The accuracy and precision of the DBS-based measures generally met assay performance guideline. In study participants, the mean concentrations of DBS MeHg, InHg, and THg, and urine THg were 1.9, 4.1, 6.0, and 3.1 μg/L, respectively. For 37% of the participants, DBS THg values exceeded the 5 μg/L ‘alert level’ proposed by the German HBM Commission. About 60% of the blood Hg was in the InHg form thus exemplifying a need to speciate Hg in blood sampled from ASGM sites to better understand the contributions of environmental and occupational exposure sources. This study demonstrates the feasibility of using DBS for Hg speciation exposure assessments in remote and resource-limited areas such as ASGM communities.
Christopher Barrington-Leigh was quoted in the following article from the McGill Newsroom - Institutional Communications, published on November 17, 2020:
Immigrant Doctors and the History of Canadian Medicare
by Sasha Mullally and David Wright
Published by McGill Queen's University Press
When the CBC organized a national contest to identify the greatest Canadian of all time, few were surprised when the father of Medicare, Tommy Douglas, won by a large margin: Medicare is central to Canadian identity. Yet focusing on Douglas and his fight for social justice obscures other important aspects of the construction of Canada's national health insurance - especially its longstanding dependence on immigrant doctors.
Foreign Practices reconsiders the early history of Medicare through the stories of foreign-trained doctors who entered the country in the three decades after the Second World War. By making strategic use of oral history, analyzing contemporary medical debates, and reconstructing doctors' life histories, Sasha Mullally and David Wright demonstrate that foreign doctors arrived by the hundreds at a pivotal moment for health care services. Just as Medicare was launched, Canada began to prioritize "highly skilled manpower" when admitting newcomers, a novel policy that drew thousands of professionals from around the world. Doctors from India and Iran, Haiti and Hong Kong, and Romania and the Republic of South Africa would fundamentally transform the medical landscape of the country.
Charting the fascinating history of physician immigration to Canada, and the ethical debates it provoked, Foreign Practices places the Canadian experience within a wider context of global migration after the Second World War.
Adamou TY, Riva M, Muckle G, et al.
Blood mercury and plasma polychlorinated biphenyls concentrations in pregnant Inuit women from Nunavik: Temporal trends, 1992–2017
Sci Total Environ. 2020 Nov 15;743:140495.
The Inuit of Nunavik (Northern Quebec, Canada) are exposed to polychlorinated biphenyls (PCBs) and mercury (Hg) through their consumption of marine country foods. A temporal trend study was initiated in 1992 to monitor circulating levels of PCBs and Hg in pregnant Inuit women, since the fetus is most at risk of adverse health effects. We set out (1) to describe temporal trends of PCBs and Hg levels in pregnant Nunavik women between 1992 and 2017; (2) to determine the prevalence of participants exceeding the guidance values in 2017; (3) to investigate relations between marine country food intake and contaminant levels over the study period. A total of 559 pregnant women provided a blood sample for contaminant analysis from 1992 to 2017. PCB congeners were quantified in plasma (serum) by gas chromatography (GC) coupled to electron capture detection or mass spectrometry (MS). We determined whole blood mercury concentration by cold vapor atomic absorption or inductively-coupled plasma MS. We performed multilevel modeling to assess temporal trends in contaminant levels and relations with marine country food consumption. Concentrations of total PCBs and Hg decreased by 84% and 65% between 1992 and 2017, respectively. Nevertheless, 10% and 22% of women in 2017 exceeded guidance values for PCBs and Hg, respectively. While the decline in marine country food intake is the only factor associated with decreasing Hg levels, other factors may explain the decline in PCB levels. Despite the significant decline in PCBs and Hg levels from 1992 to 2017, exposure to these contaminants is still quite prevalent among pregnant Nunavik women. Most of the decline in Hg exposure is likely due to a shift away from marine country foods to store-bought foods, which is a concern given the cultural and nutritional importance of country foods and the high food insecurity that prevails in Nunavik.
The work of Jill Baumgartner was discussed in an article in Old Gold & Black:
The Trump administration did not prioritize climate change, but Biden-Harris promise to
by Sophia Tompkins on November 12, 2020.
Dea S, Weinstock D.
Harm Reduction: A Research Agenda
Health Care Anal. 2020 Nov 3;1-3.
This special issue of Health Care Analysis is part of a larger effort to engage philosophers and political theorists in the study of Harm Reduction (HR) and to encourage scholars and front-line workers who work within the HR tradition to look to philosophy and political theory for conceptual and theoretical resources. The initiative comes surprisingly late. HR has existed under that moniker for 30 years, and has become a globally influential public health approach. However, there has been surprisingly little engagement with HR by philosophers and political theorists, and there exists comparatively little transdisciplinary and transsectoral work on HR involving philosophers and political theorists. We hope to change that.
Arijit Nandi co-authored an article in Environmental Research:
Richardson RA, Harper S, Weichenthal S, et al.
Extremes in water availability and suicide: Evidence from a nationally representative sample of rural Indian adults
Environmental Research. 2020 Nov;190:109969.
Background: Extremes in water availability, either exceptionally wet or dry conditions, can damage crops and may detrimentally affect the livelihood and well-being of people engaged in agriculture. We estimated the effect of water availability on suicide in rural India, a context where the majority of households are dependent upon agriculture.
Methods: We used data from a nationally representative sample of 8.5 million people who were monitored for causes of death from 2001 to 2013. Water availability was measured with high-resolution precipitation and temperature data (i.e., the Standardized Precipitation Evapotranspiration Index). We used a fixed effects approach that modeled changes in water availability within districts (n = 569) over time (n = 13 years) to estimate the impact on suicide deaths. We restricted our analysis to rural areas and to deaths occurring during the growing season (June–March) among adults aged 15 or older, and controlled for sex, age, region, and year. We used Poisson regression with standard errors clustered at the district level and total deaths as the offset.
Results: There were 9456 suicides and 249,786 total deaths in our study population between 2001 and 2013. Compared to normal growing seasons, the percent of deaths due to suicide increased by 18.7% during extremely wet growing seasons (95% CI: 6.2, 31.2) and by 3.6% during extremely dry growing seasons (95% CI: −17.9, 25.0). We found that effects varied by age.
Conclusions: We found extremes is water availability associated with an increase in suicide. Abnormally wet growing conditions may play an important, yet overlooked, role in suicide among rural Indian adults.
Batomen B, Moore L, Strumpf E, Champion H, Nandi A
Impact of trauma centre accreditation on mortality and complications in a Canadian trauma system: an interrupted time series analysis
BMJ Quality & Safety Published Online First: 30 October 2020.
Background - Periodic external accreditation visits aiming to determine whether trauma centres are fulfilling the criteria for optimal care are part of most trauma systems. However, despite the growing trend towards accreditation of trauma centres, its impact on patient outcomes remains unclear. In addition, a recent systematic review found inconsistent results on the association between accreditation and patient outcomes, mostly due to the lack of robust controls. We aim to address these gaps by assessing the impact of trauma centre accreditation on patient outcomes, specifically in-hospital mortality and complications, using an interrupted time series (ITS) design.
Methods - We included all major trauma admissions to five level I and four level II trauma centres in Quebec, Canada between 2008 and 2017. In order to perform ITS, we first obtained monthly and quarterly estimates of the proportions of in-hospital mortality and complications, respectively, for level I and level II centres. Prognostic scores were used to standardise these proportions to account for changes in patient case mix and segmented regressions with autocorrelated errors were used to estimate changes in levels and trends in both outcomes following accreditation.
Results - There were 51 035 admissions, including 20 165 for major trauma during the study period. After accounting for changes in patient case mix and secular trend in studied outcomes, we globally did not observe an association between accreditation and patient outcomes. However, associations were heterogeneous across centres. For example, in a level II centre with worsening preaccreditation outcomes, accreditation led to −9.08 (95% CI −13.29 to −4.87) and −9.60 (95% CI −15.77 to −3.43) percentage point reductions in mortality and complications, respectively.
Conclusion - Accreditation seemed to be beneficial for centres that were experiencing a decrease in performance preceding accreditation.
October 30th, 2020
IHSP Learning from COVID: Perspectives on Health and Social Policy - COVID and Beyond
An ethical analysis of COVID-19 impacts from a global child lens: It’s time to prioritize children’s rights!
Sydney Campbell, Carlo Cicero Oneto, Manav Preet Singh Saini, Nona Attaran, Nora Makasani, Raissa Passos Dos Santos, Shilni Pukuma, Franco A Carnevale
The analysis presented in this blog post relies on a global child lens to assess the ways in which young people in several resource-limited nations have been impacted by the COVID-19 pandemic. The authors draw from children’s rights and justice-based literatures to construct an ethical analysis of these impacts and to provide evidence-informed recommendations for ways forward.
Natalie Stoljar contributed to the book:
Procedural Justice and Relational Theory
Empirical, Philosophical, and Legal Perspectives
Edited by Denise Meyerson, Catriona Mackenzie, Therese MacDermott
Published October 29th, 2020
Copyright Year 2021 (Routledge - Taylor & Francis Group)
Part IV Implications and applications: legal institutions and the exercise of legal authority.
10. Racial profiling as pejorative discrimination
Arijit Nandi co-authored an article in the International Journal for Quality in Health Care
Batomen B, Moore L, Strumpf E, et al.
Trauma system accreditation and patient outcomes in British Columbia: An interrupted time series analysis
International Journal for Quality in Health Care, mzaa133
Published October 26, 2020
Disagreement, Unenforceability, and Harm Reduction.
Health Care Anal. 2020 Oct 24.
Talk of harm reduction has expanded horizontally, to apply to an ever-widening range of policy domains, and vertically, becoming part of official legal and political discourse. This expansion calls for philosophical theorization. What is the best way in which to characterize harm reduction? Does it represent a distinctive ethical position? How is it best morally justified, and what are its moral limits? I distinguish two varieties of harm reduction. One of them, technocratic harm reduction, is premised on the fact of non-enforceability of prohibitionist policies. The second, deliberative harm reduction, is premised on the fact of reasonable disagreement, grounded in the fact that reasonable persons disagree about a range of controversial behaviours. I argue that deliberative harm reduction better accounts for some of harm reduction’s most attractive features, and provides a plausible way of accounting for harm reductions’s justificatory grounds and limits.
Disgust or Dignity? The Moral Basis of Harm Reduction.
Health Care Anal. 2020 Oct 24.
Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by ‘deontological’ considerations: it is claimed that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples—the provision of supervised injection sites and the Housing First policy to address homelessness—to illustrate the argument.
Shoari N, Ezzati M, Baumgartner J, Malacarne D, Fecht D (2020, Oct 23)
Accessibility and allocation of public parks and gardens in England and Wales: A COVID-19 social distancing perspective.
PLoS ONE 15(10): e0241102.
Visiting parks and gardens supports physical and mental health. We quantified access to public parks and gardens in urban areas of England and Wales, and the potential for park crowdedness during periods of high use. We combined data from the Office for National Statistics and Ordnance Survey to quantify (i) the number of parks within 500 and 1,000 metres of urban postcodes (i.e., availability), (ii) the distance of postcodes to the nearest park (i.e., accessibility), and (iii) per-capita space in each park for people living within 1,000m. We examined variability by city and share of flats. Around 25.4 million people (~87%) can access public parks or gardens within a ten-minute walk, while 3.8 million residents (~13%) live farther away; of these 21% are children and 13% are elderly. Areas with a higher share of flats on average are closer to a park but people living in these areas visit parks that are potentially overcrowded during periods of high use. Such disparity in urban areas of England and Wales becomes particularly evident during COVID-19 pandemic and lockdown when local parks, the only available out-of-home space option, hinder social distancing requirements. Cities aiming to facilitate social distancing while keeping public green spaces safe might require implementing measures such as dedicated park times for different age groups or entry allocation systems that, combined with smartphone apps or drones, can monitor and manage the total number of people using the park.
Rosenthal J, Arku RE, Baumgartner J, et al. October 9, 2020
Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs
Environmental Health Perspectives 128:10 CID: 105001
Background: Two of the most important causes of global disease fall in the realm of environmental health: household air pollution (HAP) and poor water, sanitation, and hygiene (WASH) conditions. Interventions, such as clean cookstoves, household water treatment, and improved sanitation facilities, have great potential to yield reductions in disease burden. However, in recent trials and implementation efforts, interventions to improve HAP and WASH conditions have shown few of the desired health gains, raising fundamental questions about current approaches.
Objectives: We describe how the failure to consider the complex systems that characterize diverse real-world conditions may doom promising new approaches prematurely. We provide examples of the application of systems approaches, including system dynamics, network analysis, and agent-based modeling, to the global environmental health priorities of HAP and WASH research and programs. Finally, we offer suggestions on how to approach systems science.
Methods: Systems science applied to environmental health can address major challenges by a) enhancing understanding of existing system structures and behaviors that accelerate or impede aims; b) developing understanding and agreement on a problem among stakeholders; and c) guiding intervention and policy formulation. When employed in participatory processes that engage study populations, policy makers, and implementers, systems science helps ensure that research is responsive to local priorities and reflect real-world conditions. Systems approaches also help interpret unexpected outcomes by revealing emergent properties of the system due to interactions among variables, yielding complex behaviors and sometimes counterintuitive results.
Discussion: Systems science offers powerful and underused tools to accelerate our ability to identify barriers and facilitators to success in environmental health interventions. This approach is especially useful in the context of implementation research because it explicitly accounts for the interaction of processes occurring at multiple scales, across social and environmental dimensions, with a particular emphasis on linkages and feedback among these processes. https://doi.org/10.1289/EHP7010
Jill Baumgartner co-authored an article in Scientific Reports on October 7, 2020
Biel, R., Danieli, C., Shekarrizfard, M. et al.
Acute cardiovascular health effects in a panel study of personal exposure to traffic-related air pollutants and noise in Toronto, Canada
Sci Rep 10, 16703 (2020).
Urban populations are often simultaneously exposed to air pollution and environmental noise, which are independently associated with cardiovascular disease. Few studies have examined acute physiologic responses to both air and noise pollution using personal exposure measures. We conducted a repeated measures panel study of air pollution and noise in 46 non-smoking adults in Toronto, Canada. Data were analyzed using linear mixed-effects models and weighted cumulative exposure modeling of recent exposure. We examined acute changes in cardiovascular health effects of personal (ultrafine particles, black carbon) and regional (PM2.5, NO2, O3, Ox) measurements of air pollution and the role of personal noise exposure as a confounder of these associations. We observed adverse changes in subclinical cardiovascular outcomes in response to both air pollution and noise, including changes in endothelial function and heart rate variability (HRV). Our findings show that personal noise exposures can confound associations for air pollutants, particularly with HRV, and that impacts of air pollution and noise on HRV occur soon after exposure. Thus, both noise and air pollution have a measurable impact on cardiovascular physiology. Noise should be considered alongside air pollution in future studies to elucidate the combined impacts of these exposures in urban environments.
Essays on the Work of Charles Taylor
Edited by Daniel M. Weinstock, Jacob T. Levy and Jocelyn Maclure
Published by McGill University Press
There are few philosophical questions to which Charles Taylor has not devoted his attention. His work has made powerful contributions to our understanding of action, language, and mind. He has had a lasting impact on our understanding of the way in which the social sciences should be practised, taking an interpretive stance in opposition to dominant positivist methodologies. Taylor's powerful critiques of atomist versions of liberalism have redefined the agenda of political philosophers. He has produced prodigious intellectual histories aiming to excavate the origins of the way in which we have construed the modern self, and of the complex intellectual and spiritual trajectories that have culminated in modern secularism. Despite the apparent diversity of Taylor's work, it is driven by a unified vision. Throughout his writings, Taylor opposes reductive conceptions of the human and of human societies that empiricist and positivist thinkers from David Hume to B.F. Skinner believed would lend rigour to the human sciences. In their place, Taylor has articulated a vision of humans as interpretive beings who can be understood neither individually nor collectively without reference to the fundamental goods and values through which they make sense of their lives. The contributors to this volume, all distinguished philosophers and social theorists in their own right, offer critical assessments of Taylor's writings. Taken together, they provide the reader with an unrivalled perspective on the full extent of Charles Taylor's contribution to modern philosophy.
Frank J. Elgar, Anna Stefaniak, Michael J.A. Wohl
The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries
Can social contextual factors explain international differences in the spread of COVID-19? It is widely assumed that social cohesion, public confidence in government sources of health information and general concern for the welfare of others support health advisories during a pandemic and save lives. We tested this assumption through a time-series analysis of cross-national differences in COVID-19 mortality during an early phase of the pandemic. Country data on income inequality and four dimensions of social capital (trust, group affiliations, civic responsibility and confidence in public institutions) were linked to data on COVID-19 deaths in 84 countries. Associations with deaths were examined using Poisson regression with population-averaged estimators. During a 30-day period after recording their tenth death, mortality was positively related to income inequality, trust and group affiliations and negatively related to social capital from civic engagement and confidence in state institutions. These associations held in bivariate and mutually controlled regression models with controls for population size, age and wealth. The results indicate that societies that are more economically unequal and lack capacity in some dimensions of social capital experienced more COVID-19 deaths. Social trust and belonging to groups were associated with more deaths, possibly due to behavioural contagion and incongruence with physical distancing policy. Some countries require a more robust public health response to contain the spread and impact of COVID-19 due to economic and social divisions within them.
Arijit Nandi and Erin Bresnahan were interviewed by Gonzalo Moreno of the Montreal Gazette in the article:
As a result of Canada’s patchwork system, fewer than half of Canadian workers currently have access to paid sick days. That should change.
Published on September 25th, 2020.
Mylène Riva co-authored an article in the Canadian Journal of Public Health:
Schiff, R., Buccieri, K., Schiff, J.W. et al.
COVID-19 and pandemic planning in the context of rural and remote homelessness
Can J Public Health. 2020 Sep 24;1-4.
Johri M, Chandra D, Kone KG, Sylvestre MP, Mathur AK, Harper S, Nandi A
Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study
JMIR Mhealth Uhealth 2020;8(9):e20356
DOI: 10.2196/20356 PMID: 32955455 PMCID: 7546625
Published September 21, 2020
Arijit Nandi co-authored an article in the Journal of Social Policy:
Jahagirdar D, Dimitris M, Strumpf E, et al.
Balancing Work and Care: the Effect of Paid Adult Medical Leave Policies on Employment in Europe.
Journal of Social Policy, 2020, pp. 1–17.
Published September 20, 2020
Ma, R.; Fu, Y.; Deng, M.; Ding, X.; Baumgartner, J.; Shan, M.; Yang, X.
Measurement of Personal Experienced Temperature Variations in Rural Households Using Wearable Monitors: A Pilot Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6761;
Published September 16, 2020
Congratulations to the IHSP's faculty member, David Wright, who is one of ten McGill researchers honoured by the Royal Society of Canada. Read More!
Congratulations to Gilla Shapiro, a former IHSP GAP intern, who has been awarded the Alice Wilson Award (CIHR)! Read more HERE!
If you missed Wellbeing, sustainability, and progress: what's needed to help governments be accountable to human experience with Chris Barrington-Leigh, you can view it HERE!
Bilsback, K.R., Baumgartner, J., Cheeseman, M., Ford, B., Kodros, J.K., Li, X., Ramnarine, E., Tao, S., Zhang, Y., Carter, E. and Pierce, J.R.
Estimated Aerosol Health and Radiative Effects of the Residential Coal Ban in the Beijing-Tianjin-Hebei Region of China
Aerosol Air Qual. Res. 2020; 20 (11): 2332–2346.
Published September 4, 2020
Maduro, A., Elgar, F., Demchenko, I. et al.
Methodological restrictions within a birth cohort study examining maternal mood symptoms and postpartum depression
Soc Psychiatry Psychiatr Epidemiol. 2020; 55(11), 1547–1548.
Epub September 1, 2020
A Harm Reduction Approach to the Ethical Management of the COVID-19 Pandemic
Public Health Ethics, phaa026,
Published: 30 August 2020
Jill Baumgartner co-authored an article in BMJ Open
Clark SN, Alli AS, Brauer M, et al.
High-resolution spatiotemporal measurement of air and environmental noise pollution in Sub-Saharan African cities: Pathways to Equitable Health Cities Study protocol for Accra, Ghana
BMJ Open. 2020;10(8):e035798.
Published 2020 Aug 20.
Nandi A, Agarwal P, Chandrashekar A, Harper S
Access to affordable daycare and women’s economic opportunities: evidence from a cluster-randomised intervention in India
Journal of Development Effectiveness. 2020; 12(9):1-21
Published August 13, 2020
Edited by Yael Peled and Daniel M. Weinstock
Published by McGill University Press
Nazif-Munoz JI, Puello A, Williams A, Nandi A.
Can a new emergency response system reduce traffic fatalities? The case of the 911-emergency response system in the Dominican Republic
Accident; Analysis and Prevention. 2020 Aug;143:105513.
Smith‐Greenaway, E., Koski, A. and Clark, S.
Women's Marital Experiences Following Premarital Fertility in Sub‐Saharan Africa
J. Marriage Fam. First Published 27 July 2020
Ravitsky V, Weinstock D.
Are Immunity Licenses Just?
Am J Bioeth. 2020 Jul;20(7):172-174.
doi: 10.1080/15265161.2020.1779408. PMID: 32716785.
Published online July 27th, 2020
Jill Baumgartner co-authored an article in the Journal of Exposure Science & Environmental Epidemiology
Loo, R.L., Lu, Q., Carter, E.M. et al.
A feasibility study of metabolic phenotyping of dried blood spot specimens in rural Chinese women exposed to household air pollution
J Expo Sci Environ Epidemiol (2020).
Published July 24, 2020
Christopher Barrington-Leigh co-authored an article in People and Nature (July 23, 2020)
Chan K.M.A. et al.
Levers and leverage points for pathways to sustainability
People and Nature. 2020;2:693-717
Jonas-Sébastien Beaudry contributed to the book
The Oxford Handbook of Philosophy and Disability
Edited by Adam Cureton and David T. Wasserman
Published by Oxford University Press
Part One - Concepts, Models, and Perspectives of Disability
Chapter One - Theoretical Strategies to Define Disability
On July 13th, 2020 the IHSP will launch its new blog entitled, Learning from COVID: Perspectives on health & social policy - COVID and beyond. It is a space for weekly commentaries on health, social, ethical, legal and environmental policy responses to the COVID-19 pandemic and beyond. Our first post is CHSLDs in Court: Thoughts on Government’s and Managers’ Liability by Lara Khoury, Associate Professor and Co-Convenor of the McGill Research Group on Health and Law, Faculty of Law, and Associate Member of the IHSP and BMEU (McGill).
Blogs will be posted weekly on Mondays at https://blogs.mcgill.ca/learning-from-covid/.
by Christopher P. Barrington-Leigh
Jan 2020; Revised July 2020
Oxford Research Encyclopedia of Politics
Published online June 30th, 2020
June 16, 2020 - article by Christopher Maskell, Communications Officer, Healthy Brains, Healthy Lives
Young brains on cannabis: Making science accessible
New website offers a layperson's guide to neuroscience studies on cannabis and the developing brain.
Read the McGill Reporter article HERE!
Richardson, R., Nandi, A., Jaswal, S. et al.
The effect of intimate partner violence on women’s mental distress: a prospective cohort study of 3010 rural Indian women
Soc Psychiatry Psychiatr Epidemiol 55, 71–79 (2020).
Published June 8th, 2020
Hansen CB, Larsen CVL, Bjerregaard P, Riva M.
The effect of household crowding and composition on health in an Inuit cohort in Greenland
Scand J Public Health. 2020 Jun 7;1403494820929496.
Frank Elgar co-authored an article in the Journal of Adolescent Health
Dierckens M, Weinberg D, Huang Y, et al.
National-Level Wealth Inequality and Socioeconomic Inequality in Adolescent Mental Well-Being: A Time Series Analysis of 17 Countries
Journal of Adolescent Health. 66(6). S21-S28. June 01, 2020
Frank Elgar co-authored an article in the Journal of Adolescent Health
Gariepy G, Dannna S, Gobina I, et al.
How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries
Journal of Adolescent Health. 66(6). S81-S88. June 01, 2020
Frank Elgar co-authored an article in the Journal of Adolescent Health
Craig W, Boniel-Nissim M, King N, et al.
Social Media Use and Cyber-Bullying: A Cross-National Analysis of Young People in 42 Countries
Journal of Adolescent Health. 66(6). S100-S2108. June 01, 2020
Baron M, Fletcher C, Riva M
Aging, Health and Place from the Perspective of Elders in an Inuit Community
J Cross Cult Gerontol. 2020 Jun;35(2):133-153.
Arsenault C, Harper S, Nandi A
Effect of vaccination on children’s learning achievements: findings from the India Human Development Survey
J Epidemiol Community Health 2020 (June);74:778-784.
McGill University's Law School and the McGill University Faculty of Arts are delighted to announce that Professor Daniel Weinstock has been appointed to the Katharine A. Pearson Chair in civil society and public policy, effective June 1, 2020.
June 1, 2020 - Funded by the Healthy Brains, Healthy Lives initiative, a team of researchers based at the Departments of Psychiatry and Philosophy, Institute for Health & Social Policy and the Montreal Neurological Institute have launched https://www.cannabisbrainhub.org/. Led by Dr. Suparna Choudhury, the Cannabis & Adolescent Brain Development (CABD) website will post summaries of the latest published research on cannabis and the adolescent brain to help policy-makers, journalists, educators and parents engage directly with neuroscience. The website aims to increase neuroscience literacy and translation of neuroscience to policy by presenting critical, accessible research digests which pay attention to methodologies, context, analyses and interpretations.
Please click the link to view the full-sized Launch Announcement!
The work of Christopher-Barrington Leigh was discussed in an article in Wired:
Streets arranged in grids, with few dead-ends, encourage walking and transit. But in developing countries, growing cities are taking the opposite route.
by Flavie Halais on May 31st, 2020.
May 21, 2020 Webinar on Power, people and the pandemic: the legal sides of COVID-19 with speakers: Lara Khoury, Associate Member of the Institute for Health and Social Policy, Associate Professor at the McGill Faculty of Law and the co-convener of the McGill Research Group on Health and Law; Alana Klein, Associate Member of the Institute for Health and Social Policy, Associate Professor at the McGill Faculty of Law and co-convener of the McGill Research Group on Health and Law; and Marie-Eve Couture Ménard, Associate Professor at Faculty of Law of Université de Sherbrooke and affiliated with the Centre de recherche sur la régulation et le droit de la gouvernance (CrRDG).
Arijit Nandi co-authored an article in the Journal of Epidemiology & Community Health:
Nazif-Muñoz JI, Batomen B, Oulhote Y, et al
State or market? How to effectively decrease alcohol-related crash fatalities and injuries
J Epidemiol Community Health. 2020; 74(6):502-509.
Published online on May 10, 2020
Riva M, Perreault K, Dufresne P, et al.
Social housing construction and improvements in housing outcomes for Inuit in Northern Canada
Housing Studies. 2020 May 4.
May 4, 2020 Blog post in Psychology Today on Happiness and the CoVid Pandemic by economist Chris Barrington-Leigh, Associate Professor jointly appointed by McGill's Institute for Health and Social Policy and the School of Environment.
Professor Daniel Weinstock was interviewed by Neale McDevitt of the McGill Reporter on April 28th, 2020 about ethics, social distancing and reopening elementary schools. Read the interview.
April 20, 2020 Webinar on High Compliance Policies and their Pitfalls by Daniel Weinstock, IHSP Director and Professor in the McGill Faculty of Law:
April 19, 2020 Philodio interview with Daniel Weinstock, IHSP Director and Professor in the McGill Faculty of Law
Chai Y, Nandi A, Heymann J
Association of increased duration of legislated paid maternity leave with childhood diarrhoea prevalence in low-income and middle-income countries: difference-in-differences analysis
J Epidemiol Community Health 2020;74:437-444.
Published April 15, 2020
Hendriks, A., Bartels, M., Stevens, G., Walsh, S., Torsheim, T., Elgar, F., & Finkenauer, C.
National Child and Adolescent Health Policies as Indicators of Adolescent Mental Health: A Multilevel Analysis of 30 European Countries
The Journal of Early Adolescence, 40 (April 2020), 537 - 565.
DOI:10.1177/0272431619858413 Corpus ID: 198704825
The work of Christopher Barrington-Leigh was discussed in an article in Axios:
by Kim Hart on March 4th, 2020.
Zaman M, Koski A
Child marriage in Canada: A systematic review
PLoS One. 2020; 15(3): e0229676.
Published online 2020 Mar 3.
Roman L. G., del Pieve Govvi R., Beaudry JS, Blackbridge P.
Rippling excesses: A/r/tography becoming dis/a/r/tography
International Journal of Education Through Art, Volume 16, Number 1, 1 March 2020, pp. 63-82(20)
Jill Baumgartner co-authored an article in Indoor Air
Lai, AM, Clark, S, Carter, E, et al.
Impacts of stove/fuel use and outdoor air pollution on chemical composition of household particulate matter
Indoor Air. 2020; 30: 294– 305.
Published online February 26, 2020
The work of Christopher Barrington-Leigh was discussed in an article in Master Geonum:
by Pierre Niogret on February 26, 2020.
The work of Christopher Barrington-Leigh was discussed in an article in IndiaSpend:
by Jameela Ahmed on February 25th, 2020.
Baumgartner, J., Brauer, M. & Ezzati, M.
The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries
BMC Med 18, 39 (2020).
Published February 24, 2020
The work of Christopher Barrington-Leigh was discussed in the following article in Scientific American:
Building more disconnected thoroughfares might lock cities into a dependence on greenhouse-gas emitting cars
by Jen Monnier on February 12, 2020
The work of Christopher Barrington-Leigh was discussed in the following article in Archinect:
by Alexander Walter on February 11, 2020.
The work of Christopher Barrington-Leigh was discussed in the following article in City Lab:
Satellite images dating back to 1975 allow researchers to map how millions of cul-de-sacs and dead-ends have proliferated in street networks worldwide.
by Laura Bliss on February 5, 2020.
The work of Christopher Barrington-Leigh was discussed in the following article in Mercury News:
A global study of urban sprawl shows mixed results in the Bay
by Jerimiah Oetting on February 3rd, 2020.
Elgar FJ, Gariepy G.
42. Early-Life Income Inequality and Adolescent Mental Health and Bullying
MacNeil, Allison & Dirks, Melanie & Elgar, Frank.
45. Food Insecurity and Adolescent Mental Health in 156 Countries
Journal of Adolescent Health. 66(2). S24-S25.
February 01, 2020
Riva M, Fletcher C, Dufresne P, et al.
Relocating to a new or pre-existing social housing unit: significant health improvements for Inuit adults in Nunavik and Nunavut
Can J Public Health. 2020 Feb;111(1):21-30.
Karine Perreault & Mylène Riva & Philippe Dufresne & Christopher Fletcher
Overcrowding and sense of home in the Canadian Arctic
Housing Studies, Taylor & Francis Journals. 2020; 35(2): 353-375, February.
Barrington-Leigh C., Millard-Ball A.
Global trends toward urban street-network sprawl
PNAS. 2020; 117(4):1941-1950
Published January 28th, 2020
The work of Christopher Barrington-Leigh was mentioned in an article in Radio-Canada:
Une tendance qui décourage l'utilisation des transports en commun.
by Alain Labelle on January 27, 2020.
Cooper JE, Benmarhnia T, Koski A, King NB.
Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries.
Soc Sci Med. 2020 Jan 25;247:112806.
Epub ahead of print. PMID: 32086171.
The work of Christopher Barrington-Leigh was discussed on CBCListen - Let's Go with Sabrina Marandola on January 22, 2020.
The work of Christopher Barrington-Leigh was discussed in the following article in La Presse:
L’étalement urbain nuit au transport en commun à très long terme, selon une nouvelle étude montréalaise. Les villes qui poussent comme des champignons en Inde, en Amérique du Sud et en Afrique ont des rues où introduire des lignes d’autobus sera très difficile.
by Mathieu Perreault on January 17th, 2020.
Jill Baumgartner co-authored an article in Energy and Buildings
Ma, Rongjiang et al.
Diverse heating demands of a household based on occupant control behavior of individual heating equipment
Energy and Buildings 207 (2020): 109612. January 15, 2020
Maurice A, Lavoie M, Hamel D, and Riva M
Adoption of municipal bylaw legislating mandatory helmet use for cyclists under the age of 18: impact on cycling and helmet use
Health Promot Chronic Dis Prev Can. 2020 Jan;40(1):11-17.
Jill Baumgartner co-authored an article in Nature Sustainability
Carter, E., Yan, L., Fu, Y. et al.
Household transitions to clean energy in a multiprovincial cohort study in China
Nat Sustain 3, 42–50 (2020).
King NB, Koski A
Defining global health as public health somewhere else
BMJ Global Health 2020;5:e002172.