“Your DNA Doesn’t Need to Be Your Destiny”: Colonialism, Public Health and the Financialization of Medicine

Blacker, Sarah

doi:10.3138/topia.30-31.123

Cited by 4 publications

(5 citation statements)

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“…These findings extend other authors’ conclusions that poor service access and long wait times for an assessment in Canada are distressing [ 27 , 28 , 49 ], that informed consent procedures in gender care are often insufficient [ 33 , 38 ], and that assessments are unlikely to reliably predict whose gender/sexual identity will change over time [ 37 , 50 ]. Healthcare delivered within neoliberal environments is under tremendous pressure to cost-contain, which translates into care delivered to meet the system’s needs—to the detriment of quality patient care [ 51 , 52 ]. We recommend that healthcare policy decision-makers strive to reduce wait times, while also developing publicly-funded social and mental health support programs that individuals can access while waiting for, and accessing, care services.…”

Section: Discussionmentioning

confidence: 99%

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Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

MacKinnon,

Gould,

Enxuga

et al. 2023

PLoS ONE

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Background Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. Aims To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). Methods Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants’ social networks. Interviews ranged between 50–90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants’ experiences of, and recommendations for, gender care. Results Participants were between the ages of 20–53 (71% were between 20–29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers’ “informed consent” procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. Conclusions To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.

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Section: Discussionmentioning

confidence: 99%

“…needs-to the detriment of quality patient care [51,52]. We recommend that healthcare policy decision-makers strive to reduce wait times, while also developing publicly-funded social and mental health support programs that individuals can access while waiting for, and accessing, care services.…”

Section: Plos Onementioning

confidence: 99%

Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

MacKinnon,

Gould,

Enxuga

et al. 2023

PLoS ONE

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“…In following the microbiome and test users' discussions, I have learned that DTC gut microbiome tests are fundamentally part of the political economies of North American biotechnology and biomedicine (Lorimer 2017) and the financialisation of health in Canada (Blacker 2014). DTC microbiome testing works using similar techniques and principles to other sub-sectors of the biotechnology industry so as to harness the reproductive powers of biological materials in order to render them available for profit making (Helmreich 2008).…”

Section: Microbiome Microbiopoliticsmentioning

confidence: 99%

Positioning Human Microbiome DTC Tests On the Search for Health, Data and Alternatives Amid the Financialisation of Life

Widmer¹

2021

MAT

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Early during my fieldwork on the social life of the microbiome in Toronto, I was asked ‘Do you believe in microbiome testing?’ This question invited me to evaluate the science of the direct-to-consumer (DTC) test. In this Position Piece, I consider this question in a more expansive manner so as to position the test in its social and economic context. The distribution and public uptake of such a DTC test require scientific expertise but also marketing, capital investments, and clinical labour. This test requires consumers to do the work of stool collection and the reproductive labour of diet changes in their domestic spaces. I have learned that the microbiome is part of the quest for alternative ways of living and being healthy. Broadening the question to consider more than just the science expands the frame from one of scientific efficacy and individual consumption to one that considers the financialisation of health and the politics and environments of post-Pasteurian and post-industrial contexts.

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“…Through Calls 18 and 19, the field of public health has both an explicit and implicit role in recognizing and addressing the colonial roots of health inequities. Systemic forces are acknowledged within the Social Determinants of Health (SDOH) framework; however, some (e.g., Blacker, 2014;McPhail-Bell et al 2013) have pointed out that the neoliberal and neocolonial tendencies of public health and health promotion focus on individual behaviour change, thus constructing and blaming the victim. This process absolves settler responsibility, and therefore, it is imperative for CGPHPs to educate their students on the manifestations of political forces (i.e., settler colonialism, structural, systemic, and individual anti-Indigenous racism) and social processes before entering the field (see Gaudry & Lorenz, 2018;Ninomiya et al 2021;Sylvestre et al 2019;Tuck & Yang, 2012;Yassi et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Public health moves to innocence and evasion? Graduate training programs’ engagement in truth and reconciliation for Indigenous health

Castleden

Darrach

Lin

2021

Can J Public Health

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Objectives Indigenous peoples are the first peoples of what is now called Canada. Canadians have benefitted from their largesse and contributions in a myriad of ways that remain unacknowledged. Indeed, ongoing colonization and systemic anti-Indigenous racism in all quarters of our society have had heinous impacts on their health and well-being. Despite this reality and multiple calls for redress, Indigenous health is still missing from the Core Competencies for Public Health in Canada, having obvious implications for public health training programs and subsequent practice. Our objective in this paper is to critically explore the reasons behind institutional apathy for reconciliation in Indigenous health. Methods Interviews were conducted with 19 leaders in Canadian Graduate Public Health Programs (CGPHPs) at 15 universities to explore the extent to which CGPHPs engage with Canada's 2015 Truth and Reconciliation Commission's Calls to Action to address Indigenous health. We used thematic discourse analysis to illuminate the landscape and make recommendations. Results Participants agree that Indigenous health is important, but our data reveal an uneven landscape for addressing the Calls to Action. Curriculum was limited though we noted modest positive change. On the whole, the non-Indigenous (white) professoriate still needs to educate themselves while not all see the need to do so. Many deflected responsibility. Yet anecdotally, there is desire among CGPHP students who are already unsettling themselves to see such competency in their training. Conclusion It is a settler evasion to claim lack of expertise, to express a desire to limit the burden on Indigenous academics, and to stand on the sidelines of institutional inertia. Our findings are a call to CGPHPs to do better. RésuméObjectifs Les peuples autochtones sont les premiers peuples de ce qu'on appelle maintenant le Canada. Les Canadiens ont profité de leurs largesses et de leurs contributions d'une multitude de façons qui restent méconnues. Cependant, la colonisation en cours et le racisme systémique anti-autochtone dans tous les quartiers de notre société ont eu des effets odieux sur leur santé et leur bien-être. Malgré cette réalité et les multiples demandes de réparation, la santé des Autochtones est toujours absente dans les Compétences essentielles en santé publique au Canada, ce qui a des implications évidentes pour la formation en santé publique et la pratique subséquente. Notre objectif dans cet article est d'explorer de manière critique les raisons pour l'apathie institutionnelle pour la réconciliation en santé autochtone. Méthodes Des entrevues ont été menées auprès de 19 dirigeants des Programmes de Santé Publique Tertiaire Canadiens (PSPTC) dans 15 universités afin d'explorer dans quelle mesure les PSPTC s'engagent dans les appels à l'action de la Commission de vérité et réconciliation du Canada de 2015 pour améliorer la santé des Autochtones. Nous avons utilisé l'analyse thématique du discours pour éclairer la situation actuelle et faire des recomm...

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“Your DNA Doesn’t Need to Be Your Destiny”: Colonialism, Public Health and the Financialization of Medicine

Abstract: health sciences, history THE CANADIAN HISTORICAL REVIEW utpjournals.press/chr Offering a comprehensive analysis on the events that have shaped Canada, CHR publishes articles that examine Canadian history from both a multicultural and multidisciplinary perspective.

Cited by 4 publications

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Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

Positioning Human Microbiome DTC Tests On the Search for Health, Data and Alternatives Amid the Financialisation of Life

Public health moves to innocence and evasion? Graduate training programs’ engagement in truth and reconciliation for Indigenous health

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