Minding the gaps

Jacqueline Gahagan is the director of the Gender and Health Promotion Studies Unit. (Danny Abriel Photo)

Jacqueline Gahagan wants to figure out how public policy can capture the imagination of young people and improve their health in the process.

That’s no mean feat when it comes to HIV or Hepatitis C (HCV). Many youth can’t imagine themselves contracting either of these blood-borne viruses. A 2009 study (CDC Report) by the Centre for Disease Control and Prevention (CDC) indicated that nearly half the cases of young people living with HIV — 47.8 per cent — go undiagnosed.

But Dr. Gahagan, director of the Gender and Health Promotion Studies Unit in Dalhousie’s School of Health and Human Performance, is a firm believer in imaginative policy as a problem solver. To this end, the Nova Scotia Health Research Foundation (NSHRF) has recently funded her three-year $147,883 study entitled, "Our Youth, Our Response."

The goal of the study is to tighten up HIV and HCV prevention policies across Atlantic Canada and to identify existing gaps between policies and programs where youth, aged 16-25, fall through the cracks.

Distinct societies

It continues to be a significant challenge in Atlantic Canada to get people to identify HIV or HCV as a real problem in their lives.

“I would argue we have differences — economic differences, social, political, and so on — that make us unique to many other places in Canada,” Dr. Gahagan says.

In Toronto or Vancouver, for instance, public funding allows for a variety of non-governmental organizations with missions to reach directly out to specific at-risk communities. By comparison, we do not have the same opportunities.

“We need to do better with what we’ve got,” Dr. Gahagan continues. “That means making sure that where those services or programs are available, people who may be in need of those services and programs actually know where they are and how to access them.”

Solutions lie in finding the right balance of messaging, access, targeted resources and importantly — an awareness of the culture of secrecy due to stigma that surrounds risk behavior like intravenous drug use or unprotected sex in the Atlantic region.

“We need to ratchet up the conversation,” in remote rural communities, says Dr. Gahagan, “so it’s not this exceptional, ‘oh my god, are you suggesting that I’m doing that or I’m at risk? It doesn’t apply to me.’”

Teachable moments

Before we get to that conversation, we have to talk at the policy level. Policymakers, researchers, frontline workers in non-governmental organizations and public health practitioners from across the Atlantic provinces will be active participants and advisors in the study.

“You can’t just do research and then dump the final report on a policymaker’s desk,” she says. “You have to have those conversations about what are the nuances in making those policies.”

It’s the first time a large-scale comparative analysis like this has been done in this region. “For me, it’s how do we do better across, rather than within silos, or within provinces. The term is horizontality. So more of (this horizontal action), as opposed to digging deep in your own little silo and issue, in your own province, in your own backyard. Instead, I think we need to do better cutting across disciplines, cutting across sectors.”

“For example, does New Brunswick have a really great approach to youth and Hepatitis C prevention,” says Dr Gahagan. “If so what does it look like? Is there a teachable moment for the other provinces?”

The project begins with a critical review of policy documents across health, education and justice sectors in Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland and Labrador. Year two involves interviews and focus groups. In year three, an advisory committee will analyze the data to look for gaps and report the key findings for action.

"Our Youth, Our Response" final report will be released by the GAHPS Unit team in 2013.

LINKS: CDC Report | Dalhousie’s Gender and Health Promotion Studies Unit