Canadian Centre for Policy Alternatives

Poverty reduction strategies (PRSs) have proliferated across Canada in recent years at different levels of government. In this article, we address the question of what may reasonably be expected of such strategies, in particular the city of Toronto’s PRS, drawing on the Poverty Reduction Strategy Paper experience in the Global South. We argue that key limitations related to the tight fiscal environment in which these strategies have been implemented, their very heavy weighting on the social sectors, and the fact that they are often simple compilations of existing public programs and policies with minimal prioritisation make it highly unlikely that large-scale reductions in poverty will result. Their most important contribution is political, and their impacts on poverty are likely to be positive but modest.

Introduction: The purpose of the study was to compare the existing disability policy in Namibia with those of other southern Africancountries to determine whether the former would require revisions. There were two objectives: to apply the occupational justice framework to analyse the National Policy on Disability of Namibia, to conduct an comparative analysis of the National Policy on Disability of Namibia and selected disability policies and policy environments in Botswana, Lesotho, Malawi, South Africa, Zambia, and Zimbabwe taking into consideration the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD).Methods: A qualitative analytical approach was used to conduct a document review of the Namibia disability policy and to provide a comparative analysis of the Namibia disability policy with those of selected southern African countries using the disability policy analysis lens. Critical disability theory provided the overarching theoretical framework. Discourse analysis was applied to identify themes.Findings: Embedded occupational marginalisation and deprivation were evident in the Namibian disability policy. A new type of occupational injustice emerged that can best be described as 'occupational inconsideration' among disability policy makers, whereby occupational rights for persons with disabilities are of secondary focus when disability policies are formulated.Conclusion: Namibia's disability policy was considered inadequate in terms of addressing occupational rights according to the occupational justice framework. Similarly, Namibia and other southern African countries have not significantly progressed with domesticating the UNCRPD. The findings have implications for disability policy formulation and occupational justice practice in Namibia in particular and in southern Africa in general. Key words: Occupational justice; disability policy; policy analysis; occupational participation; African countries.

Background: The national policy on disability in Namibia is overdue for review having been in existence for over 20 years. In 2017 the government of Namibia expressed intentions to review the policy. Concerns that can be framed as occupational injustice were raised by persons with disabilities in Namibia.Aim: To gather evidence from persons with disabilities; disability policy decision makers and occupational therapists for contributing towards disability policy formulation using an occupational justice perspective.Method: In-depth interviews were conducted with 15 persons with disabilities and eight disability policy decision-makers. Two focus groups were conducted with a total of 17 occupational therapists working in Namibia. NVivo 11 Pro version was used for thematic data analysis to generate themes with critical disability theory as the theoretical framework.Findings: Occupational participation barriers identified in the study were: attitudinal, access, physical, expertise, and systemic. These barriers can be framed as occupational marginalization, occupational deprivation and occupational alienation. All participant groups suggested policy reforms to promote occupational participation among persons with disabilities.Conclusion/Significance: There is potential for applying the participatory occupational justice framework in disability policy formulation to promote participation in occupations that are meaningful, and culturally relevant to persons with disabilities in Namibia.

Housing insecurity is a major barrier to leaving domestic violence; it may force abused women to live in inadequate conditions or to return to their abusers. Immigrant women face additional barriers. Longitudinal interviews with 37 abused immigrant women living in three Canadian cities investigated key causes of housing insecurity. Results show a need to target systemic factors, a diversity of issues foregrounded along pathways into and out of homelessness, and complex indicators of risk. Advocacy is key to exiting abuse and obtaining secure housing, and cultural competency in services is needed to adequately support immigrant women experiencing domestic violence.

IntroductionPulmonary function abnormalities have been described in multiple sclerosis including reductions in forced vital capacity (FVC) and cough but the time course of this impairment is unknown. Peak cough flow (PCF) is an important parameter for patients with respiratory muscle weakness and a reduced PCF has a direct impact on airway clearance and may therefore increase the risk of respiratory tract infections. Lung volume recruitment is a technique that improves PCF by inflating the lungs to their maximal insufflation capacity.ObjectivesOur goals were to describe the rate of decline of pulmonary function and PCF in patients with multiple sclerosis and describe the use of lung volume recruitment in this population.MethodsWe reviewed all patients with multiple sclerosis referred to a respiratory neuromuscular rehabilitation clinic from February 1999 until December 2010. Lung volume recruitment was attempted in patients with FVC <80% predicted. Regular twice daily lung volume recruitment was prescribed if it resulted in a significant improvement in the laboratory.ResultsThere were 79 patients included, 35 of whom were seen more than once. A baseline FVC <80% predicted was present in 82% of patients and 80% of patients had a PCF insufficient for airway clearance. There was a significant decline in FVC (122.6 mL/y, 95% CI 54.9–190.3) and PCF (192 mL/s/y, 95% 72–311) over a median follow-up time of 13.4 months. Lung volume recruitment was associated with a slower decline in FVC (p<0.0001) and PCF (p = 0.042).ConclusionPulmonary function and cough decline significantly over time in selected patients with multiple sclerosis and lung volume recruitment is associated with a slower rate of decline in lung function and peak cough flow. Given design limitations, additional studies are needed to assess the role of lung volume recruitment in patients with multiple sclerosis.

Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative. The authors' experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported. The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2 and, predominantly, by end-tidal CO2. While the results suggested improved CO2 levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years). Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.

Under ideal circumstances, sustainability, food security, nutrition, public health and environmental quality would be interlinked, for they are vital for the wellbeing of cities. Yet, over the course of the 20th century, cheap fossil-fuel energy, the forces of globalisation, and broader socio-cultural patterns have delocalised food production. Cities are now where the majority of humanity lives, and if they are to be sustainable, it is important to bring productive planting back into urban and peri-urban areas through citizen participation. In addition to reaping the benefits of local food production and engagement with the everyday natural processes that sustain life, productive growing in cities will help reduce their global ‘ecological footprint’ – made especially large by importing food from faraway places. In the summer of 2007, with the help of volunteers, the authors of this paper created a containerized garden, or the Edible Campus project, on the grounds of McGill University in which sustainability, food security, and environmental quality were linked through innovative urban design to produce food in a challenging urban setting.