title: Globalization and the health of Canadians: 'Having a job is the most important thing'.
abstract: BACKGROUND
  Globalization describes processes of greater integration of the world economy through increased flows of goods, services, capital and people. Globalization has undergone significant transformation since the 1970s, entrenching neoliberal economics as the dominant model of global market integration. Although this transformation has generated some health gains, since the 1990s it has also increased health disparities.
  
  
  METHODS
  As part of a larger project examining how contemporary globalization was affecting the health of Canadians, we undertook semi-structured interviews with 147 families living in low-income neighbourhoods in Canada's three largest cities (Montreal, Toronto and Vancouver). Many of the families were recent immigrants, which was another focus of the study. Drawing on research syntheses undertaken by the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health, we examined respondents' experiences of three globalization-related pathways known to influence health: labour markets (and the rise of precarious employment), housing markets (speculative investments and affordability) and social protection measures (changes in scope and redistributive aspects of social spending and taxation). Interviews took place between April 2009 and November 2011.
  
  
  RESULTS
  Families experienced an erosion of labour markets (employment) attributed to outsourcing, discrimination in employment experienced by new immigrants, increased precarious employment, and high levels of stress and poor mental health; costly and poor quality housing, especially for new immigrants; and, despite evidence of declining social protection spending, appreciation for state-provided benefits, notably for new immigrants arriving as refugees. Job insecurity was the greatest worry for respondents and their families. Questions concerning the impact of these experiences on health and living standards produced mixed results, with a majority expressing greater difficulty 'making ends meet,' some experiencing deterioration in health and yet many also reporting improved living standards. We speculate on reasons for these counter-intuitive results.
  
  
  CONCLUSIONS
  Current trends in the three globalization-related pathways in Canada are likely to worsen the health of families similar to those who participated in our study.
authors.affiliation: Globalization/Health Equity, Professor Faculty of Medicine, Institute of Population Health, University of Ottawa, 1 Stewart Street, ON K1N 6N5, Ottawa, Canada. rlabonte@uottawa.ca.
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonté
authors.affiliation: Politics, Philosophy, Language and Communication Studies, University of East Anglia,, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom. E.Cobbett@uea.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cobbett
authors.affiliation: School of Political Studies, University of Ottawa, 120 University Avenue, Ottawa, ON, K1N 6N5, Canada. morsini@uottawa.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Orsini
authors.affiliation: Institute of Women's Studies, University of Ottawa, 120 University Avenue, Ottawa, ON, K1N 6N5, Canada. denise.spitzer@uottawa.ca.
authors.forename: Denise
authors.initials: D
authors.lastname: Spitzer
authors.affiliation: Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton on Tees, TS17 6BH, United Kingdom. theodore.schrecker@durham.ac.uk.
authors.forename: Ted
authors.initials: T
authors.lastname: Schrecker
authors.affiliation: Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON, K1N 6N5, Canada. aruckert@uottawa.ca.
authors.forename: Arne
authors.initials: A
authors.lastname: Ruckert
mesh_terms: D002170:Canada; D003132:Commerce; D004651:Employment / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D014943:Global Health; D006801:Humans; D038622:Internationality; D007407:Interviews as Topic; D008297:Male; D011203:Poverty; D036301:Qualitative Research