Sara Allin

Background: This paper contrasts and examines the perceptions of policy communities on the dynamics and factors shaping intersectoral collaboration in governance of health emergencies, drawing on the example of public space regulation during COVID-19 in four Canadian provinces, with the goal of exploring variation and perceived quality of policy responses. Methods: We compared public space regulation in four Canadian provinces—British Columbia (BC), Nova Scotia (NS), Ontario (ON) and Québec (QC)—during COVID-19 from 2020 to 2022. The study was designed as a comparative, qualitative, and explanatory case study, utilizing in-depth interviews and documents. We conducted 103 interviews with a diverse range of stakeholders, including senior government and non-government leaders, reviewed selected policy documents, and media reports. We utilized multisite qualitative analysis to analyze our data and develop within- and cross-case themes. Results: Respondents reported vastly different provincial approaches to intersectoral collaboration within government and with non-governmental stakeholders in the management of public spaces, ranging from higher (BC, NS) to lower (ON, QC) levels of collaboration in governance, as reflected in the access of government and non-government stakeholders to key decision-makers and decision-making forums and processes, the transparency of those processes, and responsiveness to their input. Institutional frameworks, political factors and organizational culture and capacity were the major distinguishing factors between these provincial approaches to collaboration. Disparities in access to decision-makers were reported, with business interests and certain civil society organizations experiencing easier access compared to other public interest groups. Conclusion: Public health challenges are increasingly complex and intersectoral. Research on intersectoral collaboration must examine collaboration dynamics within and outside government holistically, rather than exploring these dynamics in siloes. Stakeholder engagement which combines institutional structures and inclusive stakeholder engagement within and outside government is crucial to managing complex policy processes during crisis and beyond.

Background: Digital health technologies (DHTs) have the potential to improve care delivery and outcomes for patients with noncommunicable diseases. Yet their implementation in rural settings remains uneven, and the factors influencing uptake are not well understood. Objective: This mixed methods systematic review aimed to identify barriers and facilitators influencing the implementation and use of DHTs for remote management of noncommunicable diseases in rural areas. Methods: We searched Medline, Embase, and CINAHL from inception to February 12, 2026, using terms related to digital health, noncommunicable diseases, and rural settings. Following the Joanna Briggs Institute methodology for mixed-method systematic review, we synthesized quantitative and qualitative studies. Barriers and facilitators were categorized using the Consolidated Framework for Implementation Research, and study quality was appraised using the Mixed Methods Appraisal Tool. Results: From the initial 1491 records, 14 studies met the inclusion criteria, with most conducted in high-income countries (n=11). Key barriers included technical challenges (software instability and hardware issues), poor internet connectivity, financial constraints, and workforce constraints, such as staff shortages and heavy workloads. Key facilitators included user-friendly technology design, strong leadership, effective teamwork, and ongoing communication. Evidence was predominantly qualitative, with only limited quantitative data available. Conclusions: DHTs show promise for improving access and continuity of care for cardiovascular disease, hypertension, and diabetes in rural settings; however, their impact is constrained by structural inequities, including limited broadband access, workforce shortages, and financial fragility. These findings highlight important implications for research, policy, and practice, including the need for rigorous mixed methods evaluations sensitive to rural contexts, long-term equity-oriented financing mechanisms, and strengthened organizational readiness to support effective DHT uptake.

Objectives: To examine how public health activities addressing extreme heat align with Canada’s Essential Public Health Functions; the roles taken by public health authorities in collaborative responses; and the extent of heat response evaluations to date in three Canadian provinces. Methods: Following Arksey and O’Malley’s Framework, we conducted a scoping review of academic and grey literature on public health heat strategies in British Columbia, Ontario, and Quebec, Canada between 2005 and 2026. We searched ten academic databases, and scanned government and non-government websites. Academic sources were double-screened using Covidence software. Results: We identified 26 peer-reviewed articles (British Columbia: 7, Ontario: 8, and Quebec: 16) and 429 grey literature sources. Nine sources evaluated heat responses across the three provinces. Public health authorities across the provinces fulfilled similar Essential Public Health Functions, focused on downstream response including establishing heat alert systems and communicating preventative health information. Public health actors primarily play advisory roles in intersectoral heat responses, though some co-lead responses. Conclusion: Our findings suggest ongoing gaps in upstream public health heat strategies, and meaningful collaborations with at-risk communities.

Strong health system governance requires effective stewardship of private actors operating within health systems and ensuring that their activities align with a government’s strategic health goals. Financialisation, defined as the expanding role of financial actors, instruments, and ideas, has been identified as a potential opportunity, but also challenge to health systems and their governance. There is a need to comprehensively understand how financialisation impacts both health systems and their governance. We initiated a critical interpretative synthesis of literature theorising financialisation of health systems or health system governance. A search was conducted to identify English-language, peer-reviewed and grey articles that (1) contains definitions or conceptual frameworks of financialisation; and (2) relates this concept to health systems or health-system governance. We found that articles defined financialisation as a transformative process characterised by the advent of private investors and financial instruments within health systems. We identified several emergent themes in the literature, such as the role of profits and competition in financialised health systems. Finally, most articles addressed potential challenges that financialisation raises for health system governance, especially accountability and transparency challenges. We conclude by considering how future research might address the remaining gaps within the literature.

Introduction: There is a need to reflect on the COVID-19 vaccine distribution plans across Canada and the extent to which they considered equity-deserving populations, as lessons from the rollout can inform future emergency responses and foster trust in public health. This paper examined and compared strategies implemented by six Canadian provinces to increase access and promote the uptake of COVID-19 vaccines among selected priority populations. We also explored the factors that impacted the implementation of these strategies. Methods: In six provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, and Quebec), we conducted an environmental scan of provincial rollout documents and media sources reporting vaccine distribution among selected priority populations: First Nations, Inuit, and Métis; Black communities; essential workers; people experiencing homelessness; and people with disabilities. We subsequently interviewed 39 key informants to validate the environmental scan results, identify additional strategies to increase COVID-19 vaccine uptake, and uncover perceptions of the facilitators and challenges that influenced the strategies implementation. Results: We identified that provincial health authorities employed several strategies to overcome structural, geographical, and attitudinal barriers to COVID-19 vaccines experienced by the priority populations. Most provinces implemented walk-in, mobile, and pop-up vaccination clinics, mobilized their public and private health workforce, and designed multilingual communication materials. Facilitators in implementing COVID-19 vaccination strategies included harmonizing communication efforts, leveraging existing relationships and networks, and ensuring representation and leadership of community partners. Challenges to implementing COVID-19 vaccination strategies included uncoordinated communication efforts, inadequate distribution of vaccines to areas with the greatest need, mistrust in the government and healthcare system, vaccine hesitancy, and lack of cultural competence by vaccine providers. Conclusions: This study highlights the divide between well-intentioned strategies and interventions and the reality of on-the-ground implementation. The findings offer valuable insights and can inform the implementation of strategies to distribute vaccines equitably in future large-scale vaccination efforts in Canada and globally.

Climate change is an urgent global crisis requiring collaboration across sectors, including public health. In Canada, extreme heat is a leading cause of weather-related mortality, and cities play a central role in mitigating health impacts. This study examined the governance mechanisms shaping intersectoral extreme heat response in Vancouver, Toronto, and Montreal, Canada. Using a comparative case study methodology, we conducted semi-structured interviews (N = 28) and reviewed local heat response documents (N = 30) between November 2023 and December 2024. Thematic analysis informed cross-case comparisons of governance mechanisms shaping collaborative efforts. Across cases, legislative mandates, formal response plans, and coordinating structures for network engagement supported effective intersectoral collaboration. However, collaboration varied in terms of network governance leadership, intersectoral scope (i.e., the type and number of sectors involved), degree of engagement, and the roles of public health authorities. Co-leadership across sectors in Montreal seems to enable greater intersectoral engagement and integration of heat strategies. Areas for improvement include community-engaged heat response planning and enhanced capacity for conducting heat response outcome evaluations. Public health authorities may inform the strategic direction of future heat strategies by supporting the application of a population health lens and facilitating intersectoral collaboration to better address the upstream determinants of heat health inequities.

Objective: Though sufficient and stable funds are critical to effective public health systems, existing literature on public health system financing is limited. This study aimed to address this gap by uncovering the salient factors influencing public health system financial decision-making. Methods: We conducted a qualitative case study of public health system financing in British Columbia, consisting of a jurisdictional review of academic and grey literature, and semi-structured interviews with 14 participants influential in public health budget-setting. Taking an inductive analytical approach, we constructed a conceptual model of the political, structural, and external factors influencing public health funding trends. Building on insight from participants, we identified promising policy considerations for improving the sustainability of public health funding. Results: Participants identified that external factors such as public health crises and major sociopolitical events create windows of opportunity for investments or cuts. They reported that structurally separating public health budgets from other health service budgets seems to protect public health funding. Political priorities of top decision-makers were highlighted as the most influential political factor, though advocacy has been successful in bringing public health issues onto the political agenda. Strong relationships between public health actors and decision-makers such as senior executives are seen as important for promoting investment in public health programs. Conclusion: This study sheds light on some of the possible policy strategies for sustaining public health funding, such as inclusion of public health experts in financial decision-making and developing public health performance indicators, which may inform current public health system strengthening efforts.

Virtual health care has existed for decades, but the COVID-19 pandemic significantly accelerated its adoption. In response to the pandemic, all Canadian provinces swiftly implemented virtual care and adjusted remuneration fee codes to ensure health care access. However, as the pandemic subsided, provinces faced the decision to either retain or reverse these changes. In Ontario, the provincial government introduced barriers that limited access to virtual primary care, while in British Columbia, the government maintained and expanded its virtual care services. This paper presents a comparative analysis of Ontario and British Columbia, applying John Kingdon’s Multiple Streams Framework to uncover the political and policy contexts shaping their post-pandemic approaches. The findings highlight key factors influencing policy divergence, including how virtual care is framed — either as a tool for accessibility or a disruption to patient-provider relationships. Additionally, the study underscores the role of unified advocacy and strong political commitment in sustaining virtual care beyond emergency measures. By comparing these two provinces, this analysis suggests the need for long-term policy strategies that prioritize accessibility and integration rather than short-term cost-cutting measures. Establishing virtual care as a permanent component of the primary health care system requires sustained political will and a policy framework that views virtual care as a means of improving health care access. Les soins de santé virtuels existent depuis des décennies, mais la pandémie de COVID-19 a considérablement accéléré leur adoption. En réponse à la pandémie, toutes les provinces canadiennes ont rapidement mis en place des soins virtuels et ajusté les codes de rémunération afin de garantir l’accès aux soins de santé. Cependant, à mesure que la pandémie s’est atténuée, les provinces ont dû décider de maintenir ou d’annuler ces changements. En Ontario, le gouvernement provincial a mis en place des restrictions à l’accès aux soins primaires virtuels, tandis qu’en Colombie-Britannique, le gouvernement a maintenu et élargi ses services de soins virtuels. Cet article présente une analyse comparative de l’Ontario et de la Colombie-Britannique, en appliquant le cadre des courants multiples de John Kingdon afin de mettre en lumière les contextes politiques et stratégiques qui ont façonné leurs approches post-pandémiques. Les résultats mettent en évidence les principaux facteurs qui influencent la divergence des politiques, notamment la manière dont les soins virtuels sont présentés : soit comme un outil favorisant l’accessibilité, soit comme une perturbation des relations entre les patients et les prestataires. En outre, l’étude souligne le rôle d’un plaidoyer unifié et d’un engagement politique fort dans le maintien des soins virtuels au-delà des mesures d’urgence. En comparant ces deux provinces, cette analyse suggère la nécessité de stratégies politiques à long terme qui privilégient l’accessibilité et l’intégration plutôt que des mesures de réduction des coûts à court terme. Pour faire des soins virtuels une composante permanente du système de soins de santé primaires, il faut une volonté politique soutenue et un cadre politique qui considère les soins virtuels comme un moyen d’améliorer l’accès aux soins de santé.