Research Papers by Ilene Hyman
Abstract: Language barriers, specifically among refugees, pose significant challenges to deliveri... more Abstract: Language barriers, specifically among refugees, pose significant challenges to delivering
quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development
of innovative alternatives such as telephone-based and video-conferencing medical interpreting
services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights
the absence of a cohesive national strategy, reflected in diverse funding models employed across
provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating
for medical interpreting, both as a moral imperative and a prudent investment, this article
draws from human rights principles and ethical considerations, justified in national and international
guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes
that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally,
this article illuminates decision-making processes for utilizing interpreting services; recognizing the
pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating
intersectional considerations such as gender, culture and age, underscoring the importance of a
collaborative approach. Finally, it provides recommendations at provider, organizational and system
levels to ensure equitable access to this right and to promote the health and well-being of refugees
and other individuals facing language barriers within Canada’s healthcare system.
It is widely recognized that structural and social determinants of health (SDoH) account for a la... more It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada.
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the... more Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) "(It's) kinda like a real home" (WISH is unlike other shelters); (2) "It's like a buddy system" (A sense of community was fostered); (3) "It's the same size as a jail cell" (Problems with infrastructure); (4) "To keep us on focus" (Un/supportive staff/volunteers); (5) "I'm not sure what I'm going to do after" (The dearth of permanent housing creates trauma); and (6) "Too much bloody money in too little hands" (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
There is growing evidence that the risk and burden of COVID-19 infections are not equally distrib... more There is growing evidence that the risk and burden of COVID-19 infections are not equally distributed across population subgroups and that racialized communities are experiencing disproportionately higher morbidity and mortality rates. However, due to the absence of large-scale race-based data, it is impossible to measure the extent to which immigrant and racialized communities are experiencing the pandemic and the impact of measures taken (or not) to mitigate these impacts, especially at a local level. To address this issue, the Ottawa Local Immigration Partnership partnered with the Collaborative Critical Research for Equity and Transformation in Health lab at the University of Ottawa and the Canadians of African Descent Health Organization to implement a project to build local organizational capacities to understand, monitor, and mitigate the impact of the COVID-19 pandemic on immigrant and racialized populations. This research note describes the working framework used for this project, proposed indicators for measuring the determinants of health among immigrant and racialized populations, and the data gaps we encountered. Recommendations are made to policymakers, and community and health stakeholders at all levels on how to collect and use data to address COVID-19 health inequities, including data collection strategies aimed at community engagement in the collection of disaggregated data, improving methods for collecting and analyzing data on immigrants and racialized groups and policies to enable and enhance data disaggregation. Résumé Des plus en plus d'études montrent que le risque et le fardeau des infections à la COVID-19 ne sont pas également répartis dans la population et que les communautés racialisées connaissent des taux de morbidité et de mortalité disproportionnellement plus élevés. Cependant, en raison de l'absence de données ventilés selon le statut ethnique, il est impossible de mesurer comment les communautés immigrantes et racialisées vivent la pandémie et quel est l'impact des mesures prises (ou non) pour atténuer ces effets, surtout à un niveau local. Pour résoudre ce problème, le Partenariat local pour l'immigration d'Ottawa (PLIO) s'est associé au Laboratoire de recherche critique collaborative pour l'équité et la transformation en santé (CO-CREATH) de l'Université d'Ottawa et l'Organisation de la santé des Canadiens
Canadian Journal of Public Health, 2020
The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems ac... more The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems across the world. To date,
there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of
COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this
pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens
taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations
most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race,
beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand
the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in
Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of
these population groups as these race-based data become available.
Canada-EU Migration Platform on the Integration of Migrant Women, 2020
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and so... more OECD countries are increasingly relying on immigrants to sustain their economic, cultural, and social vitality. It is thus in the best interests of receiving countries to develop policies and practices to maintain the good health of immigrants and address factors that contribute to adverse changes in health. For example in Canada, the government commitment to humanitarian values, and the need to sustain social and economic bases in light of declining rates of natural population growth, ensure that immigration will continue to play a major role in the creation of a healthy, inclusive and productive society. Yet, available research demonstrates that barriers to integration, such as limited access to health services and failed social or economic integration, can adversely influence health outcomes of immigrants and immigrant women in particular.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
TransFormed is a research and action project to better understand and respond to
intimate partner... more TransFormed is a research and action project to better understand and respond to
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit,
Nonbinary, Trans, gender non-conforming, and gender questioning community
members in the Greater Toronto Area.
This paper reports the prevalence of everyday discrimination experienced by Canadians and uses mu... more This paper reports the prevalence of everyday discrimination experienced by Canadians and uses multivariate regression analysis to explore its socio-demographic and health related predictors. The implications of these findings for social policy are discussed.
Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn abo... more Rainbow Health Ontario (RHO), a program of Sherbourne Health, led a needs assessment to learn about ongoing concerns and challenges faced by trans and non-binary children and youth; their parents and caregivers; and their service providers. In this report, we review the current literature on trans and non-binary children and youth and share their perspectives, along with those of their caregivers, on their health and social needs. We also offer evidence for policy and service development in support of these populations, and provide cross-sectoral recommendations for public and community sector agencies to better address the needs of these youth and their families.
The findings in this
report are based on data
collected from a sample
of people who had
applied t... more The findings in this
report are based on data
collected from a sample
of people who had
applied to WES between
2013 and 2015 for an
Educational Credential
Assessment (ECA—see
below) and who were
subsequently admitted
to Canada as permanent
residents. The data
reflect the responses of
6,402 participants who
resided in Canada at
the time of the survey,
all of whom had been
admitted through
one of the economic
immigration categories
now included under the
Express Entry system.
Discrimination impacts many areas of life including health, social and economic participation. To... more Discrimination impacts many areas of life including health, social and economic participation. To date, national research on discrimination in Canada is slim. The goal of this paper is to present data on everyday discrimination in Canada and explore its socio-demographic and health related predictors. The main source of data was the Canadian Community Health Survey, which in 2013 included a special module on everyday discrimination (EDS). The study variables included: geographic region, gender, age group, education, income, racialized/Indigenous status, immigration status, language spoken, sexual orientation, weight, and physical / mental disability status. Descriptive statistics were used to describe the characteristics of the sample and frequency of discrimination by EDS items and attributions. Bivariate analysis were used to examine associations between specific types of discrimination (for example, discrimination due on race) and study variables. Logistic regression analyses were conducted to examine the unadjusted and adjusted relationships between everyday discrimination and study variables. Results showed that the proportion of the Canadian population experiencing everyday discrimination was quite high (46.2%). The frequency of everyday discrimination was higher among population sub-groups on the grounds of their human rights classification. The significant predictors of experiencing everyday discrimination were: geography, gender, age group, racialized status, Indigenous status, non-immigrant status, education and income. The largest odds ratios of experiencing everyday discrimination was among youth and young adults (12-29 years) who experienced 4.49 times the odds of experiencing discrimination compared to seniors 70+ years. Understanding the prevalence and predictors of discrimination can help inform the development of health and social policies aimed at reducing population inequities.
Children and Youth Services Review, 2018
Collaboration between child welfare and adult mental health service providers is important to add... more Collaboration between child welfare and adult mental health service providers is important to address parental risk factors that may affect child wellbeing. The aim of this paper is to describe findings from a survey which identified barriers and facilitators to collaboration between these two sectors. A semi-structured instrument,
adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.
Canadian journal of public health. Revue …, 2002
Background: There has been little empirical research on the best ways to influence women's health... more Background: There has been little empirical research on the best ways to influence women's health behaviour, particularly among women who are recent immigrants to Canada.
Canadian Journal of Public Health, 2004
The paper reviews current knowledge on the health of Canadian immigrants, examines evidence, and ... more The paper reviews current knowledge on the health of Canadian immigrants, examines evidence, and identifies research gaps. The information presented is derived from two recent literature reviews. Most literature suggests that Canadian immigrants, particularly recent arrivals, enjoy health advantages over long-term immigrants and the Canadian-born population in terms of overall health status and the prevalence of certain chronic diseases. Immigrants with infectious diseases may experience improvements in health over time. Patterns of immigrant mental health are less clear. More research is needed on specific health problems, how to address determinants of health, and the types of programs and services necessary to maintain immigrants in good health over time. Steps must be taken to strengthen existing databases and develop new ones.
Canadian journal of …, 1995
The Journal of nervous and mental …, 2004
The purpose of this study was to determine the occurrence of and risk factors for depressive diso... more The purpose of this study was to determine the occurrence of and risk factors for depressive disorder in a random sample of 342 Ethiopian immigrants and refugees in Toronto. The Composite International Diagnostic Interview questionnaire was used to measure depression. The results suggested a lifetime prevalence of depression among Ethiopian immigrants and refugees of 9.8%, which was slightly higher than the lifetime prevalence rate in the Ontario population (7.3%). However, the rate among Ethiopian immigrants and refugees was approximately three times higher than the rate estimated for Southern Ethiopia (3.2%). The data confirmed the significance of known risk factors for depression in immigrants, including younger age, experiences of premigration trauma, refugee camp internment, and postmigration stressful events. The implication of the overall finding is that there is a need to develop mental health intervention programs, particularly for people who have experienced premigration trauma, refugee camp internment, and postmigration stresses.
Journal of Comparative Family Studies, 2000
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Research Papers by Ilene Hyman
quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development
of innovative alternatives such as telephone-based and video-conferencing medical interpreting
services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights
the absence of a cohesive national strategy, reflected in diverse funding models employed across
provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating
for medical interpreting, both as a moral imperative and a prudent investment, this article
draws from human rights principles and ethical considerations, justified in national and international
guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes
that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally,
this article illuminates decision-making processes for utilizing interpreting services; recognizing the
pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating
intersectional considerations such as gender, culture and age, underscoring the importance of a
collaborative approach. Finally, it provides recommendations at provider, organizational and system
levels to ensure equitable access to this right and to promote the health and well-being of refugees
and other individuals facing language barriers within Canada’s healthcare system.
there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of
COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this
pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens
taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations
most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race,
beyond “visible minority” status; gender, beyond looking at differences between women and men; and factors to help understand
the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in
Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of
these population groups as these race-based data become available.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
Pre-migration experiences such as violence or trauma, and post-migration experiences, such as family separation, social exclusion and status inconsistency, may impede integration and increase immigrant women’s health risks. Refugee women, immigrant women experiencing language barriers, LGBTIQ immigrant women and senior immigrant women are at high risk of experiencing poor health outcomes.
This chapter starts by defining the “healthy immigrant effect” (HIE) and discussing observed differences in the
HIE of immigrant men and women over time (Section 1). It then presents the determinants of immigrant women’s
health (Section 2), and health issues specific to immigrant women (Section 3). Section 4 identifies best practices in
addressing health issues affecting immigrant women, which could offer inspiration for effective policymaking in this
area. The specific effects of Covid-19 on the health of immigrant women (Section 5) are also discussed. Although
much of the focus is on the Canadian experience, data from EU Member States is included where available, and
most of these findings are relevant to the experiences of migrant women in other Western host countries.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit, Nonbinary, Trans, gender non-conforming, and gender questioning community members in the Greater Toronto Area.
intimate partner violence among Two-Spirit, Nonbinary, Trans, gender non-conforming,
and gender-questioning community members. It is led by METRAC: Action on Violence
in partnership with Centre de Francophone. It is funded by the Public Health Agency of
Canada and the City of Toronto. Between 2018 to 2019, mixed-method research activities were undertaken with a trauma-informed, community-based approach. This report summarizes the findings of an online survey, focus groups, and individual interviews with 154 diverse Two-Spirit,
Nonbinary, Trans, gender non-conforming, and gender questioning community
members in the Greater Toronto Area.
report are based on data
collected from a sample
of people who had
applied to WES between
2013 and 2015 for an
Educational Credential
Assessment (ECA—see
below) and who were
subsequently admitted
to Canada as permanent
residents. The data
reflect the responses of
6,402 participants who
resided in Canada at
the time of the survey,
all of whom had been
admitted through
one of the economic
immigration categories
now included under the
Express Entry system.
adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery.