The war after the war: How violence is passed down through generations

Source: The Conversation – Canada – By Myriam Denov, Professor and Canada Research Chair in Children, Families and Armed Conflict, McGill University

Editor’s note: This story is the first in a series of articles from Canada’s top social sciences and humanities academics. Click here to register for In Conversation with Myriam Denov, Feb. 25 at 1 p.m. ET. This is a virtual event co-hosted by The Conversation Canada and the Social Sciences and Humanities Research Council of Canada.

From Gaza to Ukraine and from Sudan to Myanmar, war rages across the globe, exacting its gravest toll on those least implicated in the violence: children. Today, an estimated 520 million children worldwide — or one in six — live in conflict zones. Yet even when fighting subsides and peace agreements are signed, violence doesn’t always end. War’s impact endures.

Northern Uganda provides a case in point. During the decades-long conflict from 1987 to 2006, the Lord’s Resistance Army (LRA), led by Joseph Kony, was formed to overthrow the Ugandan government and became well-known for the atrocities and war crimes it committed against civilians. The LRA abducted an estimated 80,000 children into armed conflict — a tactic meant to terrorize communities and swell the LRA’s ranks.

“Rose,” for example, was just 14 years old when the LRA abducted her from school in the mid-1990s. For eight years, she was held captive, forced to fight, coerced into a so-called “marriage” with an LRA commander and subjected to relentless abuse, including sexual violence. Her daughter, Grace, was born of that violence. Grace spent her early childhood in LRA captivity amid brutality, hunger, bombardment and displacement.

When Rose courageously escaped the LRA with Grace after eight years in captivity, they returned not to support but to rejection. Their community viewed them with fear and suspicion. Grace was stigmatized at school, within her extended family and in the wider community, branded “Kony’s child” after the rebel leader. Without stable housing and repeatedly displaced, Grace was forced to leave school and sell goods in the marketplace to support her family.

One day on her long rural walk to the market, the unimaginable happened. Grace was raped, later learning that she was pregnant as the result of the rape. In 2018, and still a teenager, Grace gave birth to Alice, a third-generation child whose life has already been shaped by a war that officially ended years earlier.

War does not end with ceasefires, but is transmitted across generations through stigma, violence, poverty and social exclusion. And despite their inherent connection to conflict, children born of war remain largely invisible in post-conflict discussion and justice efforts.

The war after the war

Sexual violence has long been used as a weapon of war. In recent years, the world has begun to acknowledge its devastating consequences for survivors, including physical injury, psychological trauma, economic marginalization and social exclusion. What remains far less visible are the intergenerational legacies of these crimes, particularly for children born of wartime sexual violence.

My ongoing research with children and youth like Grace shows they often face challenges strikingly similar to those of their mothers.

Many struggle to feel they belong, either within their families or their communities. They are frequently subjected to stigma and rejection. This stigma takes the form of being labelled “violent,” “dangerous” or “rebel children,” who are said to be cursed with “bad spirits” within their families, communities, schools and peer groups. This makes it difficult to develop a secure belonging and identity.

These children are also more likely to experience family and community violence and to encounter barriers to education, health care, land, inheritance, employment and legal rights.

Grace described the hostility she continues to face — and how the violence does not necessarily stop with the second generation — in stark terms:

“Life is hard here because people stigmatize us … they have turned their hate against us. In my family, they hate those of us who were born in captivity. My uncle beats us and said he would kill us. He doesn’t want rebel children, Kony children, at home … I know my child will face stigma. As long as my family is not willing to accept me, I believe they will reject my child as well.”

Rose also fears that Alice will one day inherit the same stigma, echoing Grace’s concerns:

“I feel it is possible my grandchild may be stigmatized because of my daughter’s past. They will say, ‘You see this beautiful child? Her mother was born in the bush.’”

For these families, war has not ended, it has simply changed shape. As one young man in my research who was born of sexual violence during wartime put it: “The war that we are now faced with is stigma.”

How resilience is passed down

And yet violence and devastation are not the whole story. Recognizing intergenerational harm does not mean reducing these families and their lineage to trauma alone.

Across generations and alongside profound loss, there is also resilience, resolve and an unyielding determination to build a different life.

Children born of war in northern Uganda are acutely aware of the sacrifices their mothers made to keep them alive. One young man recalled his mother’s escape from the LRA, carrying him through the bush while evading armed fighters, surviving on stolen cassava and refusing to leave his side even when confronted by death. “She held my hand,” he said. “She never left me.”

These memories of protection and survival are not just recollections of pain, they are sources of strength. Many children draw on them to imagine a future not defined solely by violence. Despite poverty, ostracism and ongoing marginalization, Grace spoke with clarity about what she wants for Alice:

“I want my child to be a doctor. I will support my child in every way possible to achieve this dream.”

This capacity to endure, adapt and hope is not accidental. It reflects what I have described as intergenerational resilience — the ways families transmit strength, meaning and survival strategies across generations, even in the aftermath of extreme violence.

Like a family heirloom, this resilience is forged through collective experience and memory. It equips young people with tools to confront adversity and reframes resilience not as an individual trait, but as a relational and intergenerational process rooted in family bonds and care.

What recognition makes possible

Too often, children born of war are reduced to dehumanizing labels in the countries where the war/genocide has occurred, often referring to them as “children of hate” or “bastards.” Such portrayals obscure both the violence that produced their marginalization and the extraordinary capacities they demonstrate to survive it.

If we continue to treat war as something that ends when peace agreements are signed, we will fail generations of children like Grace and Alice. Post-conflict recovery efforts, transitional justice processes and humanitarian responses must reckon with the fact that war’s harms are cumulative and intergenerational. This requires the meaningful inclusion of children born of war in reconciliation processes, reparations, community sensitization efforts and formal recognition in inheritance and citizenship law.




Read more:
Why Canada must step up to protect children in a period of global turmoil


This also means addressing stigma as a form of ongoing violence, ensuring access to education, employment and legal rights for children born of war and recognizing them not as symbols of past atrocities, but as rights-bearing individuals with futures worth investing in.

As one young participant who is part of my ongoing research in northern Uganda declared, reclaiming a narrative so often denied to them: “We are the light that came out of darkness.”

Intergenerational harms are not unique to northern Uganda, they are unfolding wherever war engulfs children today. And if we are serious about ending war’s toll on children, we must listen — and act accordingly.

The Conversation

Myriam Denov receives funding from the Social Science and Humanities Research Council of Canada, and the Canada Research Chair Program.

ref. The war after the war: How violence is passed down through generations – https://theconversation.com/the-war-after-the-war-how-violence-is-passed-down-through-generations-273669

What dating apps are really optimizing. Hint: it isn’t love

Source: The Conversation – Canada – By Mathieu Lajante, Associate Professor in Marketing, Toronto Metropolitan University

In the weeks leading up to Valentine’s Day, dating apps typically see a spike in new users and activity. More profiles are created, more messages sent, more swipes logged.

Dating platforms market themselves as modern technological solutions to loneliness, right at your fingertips. And yet, for many people, the day meant to celebrate romantic connection feels lonelier than ever.

This, rather than a personal failure or the reality of modern romance, is the outcome of how dating apps are designed and of the economic logic that governs them.

These digital tools aren’t simply interfaces that facilitate connection. The ease and expansiveness of online dating have commodified social bonds, eroded meaningful interactions and created a type of dating throw-away culture, encouraging a sense of disposability and distorting decision-making.

The business of modern dating

Online dating apps are big business.

Match Group, a technology company that dominates the online dating sector with an extensive portfolio of dating app products — including Tinder, Hinge, Match.com, OkCupid, Plenty of Fish and OurTime — reported fourth-quarter revenue of US$878 million this month.

Its analysis showed fewer people paying for its apps, with paying users down five per cent year over year.

The decline appears to reflect a trend prompting the company to develop new artificial intelligence tools to drive user growth and appeal to younger customers. Part of this means converting free users into paying ones.

Dating apps don’t sell love. They sell the feeling that love is one premium upgrade away. The platforms aren’t primarily designed for users to find love and promptly delete the apps from their phones. They’re designed to keep users swiping.

Why swiping never ends

Prolonged uncertainty is profitable. By creating the sense that a better match is always one swipe away keeps users engaged. Design strategies that gamify choice, offer intermittent variable rewards (like a slot machine) and frequent push notifications produce a fear-of-missing-out mentality and can lead to compulsive and addictive patterns of use.

Maximizing user interaction and time spent on the app and accumulating consumer data turn users into lucrative opportunities for paid features, monthly subscriptions and advertising dollars.

Dating apps market the idea that dating platforms can achieve our social goals more efficiently and more intelligently, meeting a real-world need with a technological solution.

In this system, people are expected to constantly improve and optimize themselves. Paying for added features becomes an investment in oneself, while value is determined by desirability, performance and outcomes.

By creating an interesting profile, crafting witty messages and curating photos and videos of ourselves, we commodify our time and self-worth, reinforcing the idea that we alone are responsible for our success on the apps, even if the playing field is strategically manipulated to keep us on them longer.

So are we being set up to fail? The distinction between failure and success overlooks a key issue: dating apps function as political entities that control access to and distribution of resources.

Changing social reality

Online dating apps sell us hope by exploiting our needs, desires and insecurities. When apps keep hinting that something better is just one more swipe away, they start to reshape our expectations, and even inflate them.

Typically, people employ a decision-making strategy called “satisficer,” which refers to both “satisfy” and “suffice.” This means we generally choose something that’s good enough, rather than searching endlessly for perfection, because of limits on time, information and cognitive energy. In relationship decisions, compatibility used to be enough.

With apps, there’s an endless supply of options — endless potential partners, endless possibilities. The issue is that the options feel infinite and, as a result, we’re being trained not to be satisfied anymore. Rather, we’re encouraged to keep swiping.

This process creates a stream of potential matches that commodifies social interactions by using user engagement to refine algorithms. The platforms serve as central planners of resource access, production and distribution, offering the information technologies and databases that guide decisions in a global market of potential partners. As a result, human actions are treated as market-based transactions.

Users adopt a consumption mindset in which choosing partners is no different from shopping, constantly comparing others and discarding some in search of the highest-value partner.

Rather than being defined by connection or mutual care, interactions become a question of optimizing our choices among endless options. The illusion of oversupply creates the sense that people are replaceable and forces them to compete on superficial standards of beauty or status. Success and desirability on these platforms tend to reinforce existing hierarchies such as class, race and religion.

These tools can also promote a rejection mindset, with users more likely to reject potential partners as the number of options increases, becoming more closed off to romantic opportunities.

Loneliness is a feature, not a flaw

Reducing romantic connection to a commodity weakens social bonds and prioritizes individual success over community, leading to increased isolation and loneliness.

Dating apps are active platforms that prioritize personal preferences and individual strategies rather than addressing structural inequalities or the underlying causes of loneliness.

By fostering a competitive digital environment, these apps encourage disposability and change how people assess and select one another, often resulting in burnout and cynicism.

Users are prompted to view themselves as products to be optimized and others as options to evaluate. Dependence on dating apps to address loneliness ultimately weakens our social bonds and alters how we engage with one another.

The Conversation

Mathieu Lajante is the founder and principal at BomaliQ Inc.

Sameh Al Natour is affiliated with Liberal Party of Canada.

ref. What dating apps are really optimizing. Hint: it isn’t love – https://theconversation.com/what-dating-apps-are-really-optimizing-hint-it-isnt-love-274931

Cuba is facing an economic and social catastrophe, and not entirely because of Donald Trump

Source: The Conversation – Canada – By Robert Huish, Associate Professor in International Development Studies, Dalhousie University

If you’re planning on a winter break to Cuba, get ready for an adventure rather than a vacation. If you’re wondering if United States President Donald Trump’s oil embargo will shatter Cuba’s Communist government, dig in for a drawn-out slog. And if you’re Cuban, brace for a nightmare.

Cuba is on the brink of one of the worst social and economic catastrophes since the 1959 revolution. Energy sources are sparse. The electrical grid is in tatters.

Inflation is over 15 per cent, with the peso tumbling in value. Tropical diseases like dengue, chikunguny and Oropuche virus are surging, largely because the municipal waste system in Havana ground to a halt in 2025.

As many as two million Cubans have left the country since 2021. Infant mortality spiked from five per 1,000 live births in 2021 to 14 per 1,000 in late 2025.

And now, revenue streams from tourism, international medical co-operation and pharmaceutical production are all but dried up. Some 5,000 Cubans volunteered as mercenaries to fight alongside Russia against Ukraine since 2022. Cuba is hurting.

The U.S. versus Cuba

Cuba’s current pain may not be enough to topple its Communist government, despite the desires of many Cuban exiles. Nor is the current crisis all Trump’s work. Cuba is a victim of the breakdown of the old international rules-based order.




Read more:
Venezuela attack, Greenland threats and Gaza assault mark the collapse of international legal order


The U.S. has long targeted Cuba through various economic weapons dating from the early 1960s. One of the most vicious was the Helms-Burton Act that not only prohibited U.S. companies from doing business with Cuba, but also punished companies in other countries for dealing with both Cuba and the U.S.

In his second term, U.S. President Barack Obama eased travel restrictions for Americans visiting Cuba along with some trade policies, but this was short-lived. Trump restored these measures in his first administration.

Cuban doctors

For decades, Cuba relied on an elaborate network of international solidarity and co-operation with rich and poor countries alike. More than 100,000 Cuban doctors served abroad, often providing medical care in rural and remote locations.

While Cuban doctors working abroad received a salary bump, the government received handsome cash deposits and preferred trade agreements for select products. Venezuela received tens of thousands of Cuban doctors and, later, security personnel in exchange for heavy petroleum.




Read more:
Big Pharma vs. Little Cuba: Why Cubans trust vaccines and how they’re helping vaccinate the world


Cuban doctors served in 103 countries, and as of 2021, they were active in 69 nations. Agreements were also made for other personnel to work abroad, including athletic coaches, teachers and engineers.

The U.S. targeted Cuba’s international solidarity work in 2006 by creating the Cuban Medical Professional Parole program, which essentially regarded Cuban workers as “trafficked.”

The State Department approved an annual US$10 million budget until 2017 to locate and recruit Cuban and Cuban-trained doctors working in poor areas of Latin America and Africa. Diplomats offered them expedited immigration to the U.S. But upon arrival, many had their medical credentials ignored and wound up unemployed or underemployed.

Global support

Against one of the longest economic blockades in history, Cuba has nonetheless positioned itself as an active global player. It’s a diplomatic heavyweight with 139 active embassies and consulates worldwide and well over 100 foreign embassies in Havana.

The United Nations General Assembly routinely denounces the American embargo on Cuba. In 2025, amid shifting political alliances, the assembly voted 165-7 in favour of demanding an end to the embargo.

Many international partnerships have kept Cuba going through hard times in the past. Canada, Italy and Mexico, in particular, have kept business with Cuba going despite the U.S. embargo. In the 1990s, tourism expanded, notably from these countries, helping to stimulate the Cuban economy.

Canadian mining company Sherritt invested heavily in Cuba to extract nickel. When COVID-19 overwhelmed health systems worldwide in 2020, Cuba was the first to volunteer medical services to 19 countries, including affluent states like Italy and Qatar. They even took in a quarantined British cruise ship to offer care.




Read more:
The scene from Cuba: How it’s getting so much right on COVID-19


But in 2026, countries are sending in aircraft to evacuate their vacationing nationals, and companies like Sherritt are grinding to a halt, not because of the U.S. embargo, but because so many professionally trained Cubans have emigrated.

Unlike the 1960s and the 1990s, no brave partners are coming forward to do business with Cuba, which only shows how weak international solidarity is today.

Here are three possible outcomes for Cuba in the coming months in descending order of likelihood:

1. Deals behind the scenes

A backroom deal could be struck between Trump’s White House and Miguel Díaz-Canal’s government in Cuba in much the same way that the Obama administration struck deals with Raúl Castro’s government, working through the Vatican and Canadian diplomats. For example, the Trump administration could permit fuel to be purchased in cash from the U.S., or more tourist real estate may be opened to foreign ownership.

If any deal is in the works, the sticking point will be elections. Unlike Venezuela, with a legitimate opposition in the wings, Cuba has none. Political opponents to the revolution have long been jailed or exiled, and Cuba’s electoral system itself isn’t structured for a multi-party race. Toppling the current government would leave an enormous power vacuum.

2. Martial law

If the fuel embargo remains, Cuba could declare martial law and civil defence to prepare for foreign hostility and to better ration resources.

Díaz-Canal recently hinted at this in what he calls a “war of the people,” which may help explain why Canadian and Russian airlines are now hastily sending in rescue flights for tourists.

Martial law would mean ultra-tight rationing, political volatility and the government acquiring goods through murky channels, which, combined, pose a heightened security risk to the U.S. just 140 kilometres off its shores. Since Dwight D. Eisenhower, most American presidents quickly figured out it was better to have a stable and secure, even though ideologically opposed, neighbour than a politically unstable and vulnerable basketcase.

The situation will grow dire since the well-educated professional class has already left, along with many doctors and nurses. In past crises, the educated, youthful professional class was on hand; this time, they’re already gone.

3. The international community steps in

Third, the world could stand by its sentiment at the United Nations General Assembly and sends much-needed resources and trade to Cuba despite the U.S. bellicosity.

It could be a rallying point for the new era of international order, where bullied countries in the Americas and in Europe defy American pressure and bring lifelines to Cuba.




Read more:
Mark Carney’s Davos speech marks a major departure from Canada’s usual approach to the U.S.


International solidarity could reverse some of the harm and take the pressure off Cubans, including those so desperate they’d choose to fight as mercenaries with Russia.

As the world has seen before, when nations stand up to Trump, he usually backs down. Assistance need not come through foreign aid, but simply by keeping the channels open for business.

But if the international community ignores Cuba today, a humanitarian nightmare will unfold soon.

The Conversation

Robert Huish receives funding from the Social Sciences and Humanities Research Council of Canada

ref. Cuba is facing an economic and social catastrophe, and not entirely because of Donald Trump – https://theconversation.com/cuba-is-facing-an-economic-and-social-catastrophe-and-not-entirely-because-of-donald-trump-275410

Understanding the difference between apathy and depression can be lifesaving for people with brain disorders

Source: The Conversation – Canada – By Aderonke Agboji, Assistant Professor, University of Northern British Columbia

People with brain disorders, including Parkinson’s disease and dementia, are often misdiagnosed as having depression, when in fact what they’re experiencing is apathy. This can delay an accurate diagnosis, which has negative outcomes for patients as well as for their families and caregivers.

Apathy and depression may look alike from the outside, but they arise from different neurobiological pathways and have different implications for treatment, functioning and quality of life for those affected.

Understanding and identifying the differences is crucial. My recent research focused on developing a simple assessment tool to differentiate apathy from depression.

We will see more cases as people age

Brain disorders, particularly Alzheimer’s disease and other dementias, as well as Parkinson’s disease, are common in Canada.

According to a 2017 Public Health Agency of Canada (PHAC) report, an estimated 3.6 million Canadians have been diagnosed with brain disorders. More recently, the Canadian Brain Research Strategy estimates that one in five Canadians is affected by these conditions, with a total estimate of more than 7.5 million people currently living with brain conditions.

As the Canadian population ages due to demographic shifts and improved survival rates from once-fatal illnesses, the number of people living with these disorders will increase significantly.

As of January 2025, dementia alone affected 771,939 Canadians aged 65 and older. The prevalence of dementia increases with age. The likelihood of a diagnosis more than doubles every five years after age 65. We can therefore expect more than 1.7 million Canadians to be living with dementia by 2050.

Similarly, Parkinson’s disease currently affects more than 100,000 Canadians aged 40 and older, with about 38 new diagnoses each day. Current projections predict that by 2050, the rate may rise by nearly 70 per cent.

A growing body of evidence suggests Canada is not prepared for this reality. Expert reviews and health-system assessments highlight persistent barriers to care including limited specialist access, long diagnostic wait times, insufficient standardized care pathways and infrastructure gaps (for example, limited neuroimaging capacity) that constrain early and equitable diagnosis and treatment.

Why we must do better

The lack of Canada’s preparedness for the rapidly growing number of people with brain disorders is harmful in many ways. These include delayed diagnosis and missed opportunities for early intervention, as well as an unsustainable reliance on emergency departments when crises occur.

Fewer than half of Canadians currently living with dementia receive a formal diagnosis. In many regions, wait times for specialist assessments exceed one to two years, further delaying care planning and symptom management. These delays cause significant stress and strain on patients and their family members, many of whom are left to provide a high level of unpaid caregiving without sufficient supports or resources.

As a result, family caregivers often experience both mental and physical health issues that can profoundly reduce their quality of life and place further strain on existing health-care systems. One of the biggest sources of stress is a lack of diagnosis or misdiagnosis.

The key to diagnosis

One of the biggest barriers in accessing timely and accurate diagnoses is the fact that symptoms of brain disorders, particularly apathy, can present very similarly to symptoms of depression. While depression may accompany brain disorders, focusing too narrowly on the symptoms can lead to inappropriate care plans and unsuitable medications, as depression becomes the primary diagnosis while underlying brain disorders remain undetected and undiagnosed.

Understanding apathy is central in addressing current gaps treatment and prognosis. Research shows that symptoms traditionally associated with depression, such as reduced activity and social withdrawal, commonly manifest in people who have brain disorders but it does not always involve sadness or hopelessness, which are core features of depression.

Large international studies show that apathy on its own is linked to a higher risk of cognitive decline and dementia, even when depression is not present, meaning it’s an important warning sign that can be missed if symptoms are mislabelled. When apathy is mistaken for depression, people may receive treatments that worsen their apathy, leading to decreased daily functioning, higher caregiver stress, increased safety risks and poorer health over time.

What we can do to improve?

To improve differentiation between apathy and depression in people with brain disorders, we need targeted assessment tools that detect motivational decline separately from mood symptoms. Research shows that standard depression scales alone often fail to identify apathy because they focus on emotional distress rather than motivation and initiative.

One solution is to adopt a brief apathy-specific tool that is quick to administer in both care settings and at home. This tool consists of three questions:

  1. Have you dropped many of your activities and interests?
  2. Do you prefer to stay in your room/home rather than going out and doing new things? and
  3. Do you feel full of energy?

If the answers are “Yes” to question one or question two (or both) and “No” to question three, apathy — not depression — should be suspected.

Another important solution is to put training and awareness at the centre of clinical practice, education and caregiver support to improve care and quality of life for people with brain disorders.

Research shows that many clinicians, caregivers and health professionals lack specific training on how to recognize and differentiate apathy from depression, which contributes to misdiagnosis and suboptimal care.

Increasing education about apathy including how it presents, why it differs from mood disorders and how to use appropriate assessment tools helps clinicians make more accurate diagnoses and develop tailored care plans.
Training should also extend to multidisciplinary teams and family caregivers, because apathy often goes unrecognized in routine interactions and can be misinterpreted as laziness, resistance or depression.

In brain disorders where cognitive changes complicate the overlap of symptoms, differentiating between apathy and depression is essential to optimal living. Using appropriate screening tools to distinguish these symptoms can lead to better, more personalized care, improved use of health-care resources and, most importantly, can be lifesaving for people navigating complex brain disorders.

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

ref. Understanding the difference between apathy and depression can be lifesaving for people with brain disorders – https://theconversation.com/understanding-the-difference-between-apathy-and-depression-can-be-lifesaving-for-people-with-brain-disorders-273750

Below freezing but still moving: How salamanders stay active in winter

Source: The Conversation – Canada – By Danilo Giacometti, São Paulo Research Foundation Postdoctoral Fellow, NUPENS (USP)

A blue-spotted salamander on the forest floor surrounding Bat Lake, Algonquin Provincial Park, Ontario. (Danilo Giacometti), CC BY-NC-ND

It’s a cold night in a Canadian forest. Temperatures are below freezing, snow is on the ground and most animals remain hidden to avoid the harsh conditions. But one creature is braving the cold weather.

Blue-spotted salamanders (Ambystoma laterale) are on the move. These small amphibians have left their underground winter refuges and started migrating toward breeding pools, often risking freezing.

For animals whose body temperature closely follows the environment, like salamanders, freezing can be deadly, as the formation of ice inside the body can damage cells and disrupt vital functions. However, blue-spotted salamanders remain active and apparently unharmed under the freezing conditions.

As a group of biologists who study how temperature shapes animal behaviour and physiology, our team has been long fascinated by animals that keep active at low temperatures.

In a recent study, colleagues and I documented salamanders migrating with body temperatures below 0 C in the wild. Our findings highlight field-based evidence that these amphibians can function at sub-zero temperatures without freezing. In doing so, salamanders are possibly extending their breeding season.

Survival strategies

A blue-spotted salamander on top some moss
Many amphibians rely on different strategies to cope with winter.
(Danilo Giacometti)

Amphibians have a thin skin that is supported by many blood vessels. This allows them to breathe through their skin; however, it also means they lose a lot of water through evaporation, especially under warm conditions. That means both exposure to extremely cold (risk of freezing) and warm temperatures (risk of desiccation) can be harmful. Consequently, amphibians are often described as extremely vulnerable to environmental change.

At the same time, amphibians are not passive victims of their environment. Many species rely on different strategies to cope with winter, a season that can last several months in parts of Canada. As winters become more unpredictable, with frequent freeze–thaw cycles and reduced snow cover, understanding these strategies is key.

Amphibians generally survive winter through freeze tolerance or freeze avoidance. Freeze-tolerant species can survive even if parts of their bodies are frozen solid. The wood frog (Lithobates sylvatica) is a well-known example: during winter, the frogs allow ice to form in their tissues while their cells are shielded by large amounts of natural antifreeze, like glucose. As temperatures rise in spring, the frogs thaw and resume their normal activity.

Instead of tolerating ice formation, freeze-avoidant animals avoid freezing altogether by keeping their body fluids in a liquid state. This can be achieved by moving to underground refuges, or, as in the case of blue-spotted salamanders, through a physiological process called super-cooling.

An explainer on how the wood frog uses antifreeze to stay alive in the winter. (Smithsonian Channel)

Supercooling: staying liquid below zero

To understand how blue-spotted salamanders cope with early spring cold, we studied migrating individuals in Ontario’s Algonquin Provincial Park. We used infrared thermal cameras to measure salamanders’ skin temperatures (an approximation of body temperature) as they moved naturally across the forest floor to make their way to Bat Lake.

This approach allowed us to record body and forest floor temperatures without the need to handle the animals, which is relevant because direct contact can quickly alter their body temperature.

As freeze-avoiders, blue-spotted salamanders would likely die if their body fluids were to freeze. This makes their early spring movement particularly risky, but this is where super-cooling comes in. Super-cooling occurs when liquids inside the animal’s body remain unfrozen below their normal freezing point.

This strategy occurs through a combination of processes. The animal removes surfaces in its body where water molecules can collect and start crystallizing through gut evacuation and partial dehydration. Producing antifreeze (typically sugars) and accumulating them in certain body parts (like the liver) also help in the process, although this occurs in smaller proportions than in freeze-tolerant species.

Previous lab-based research had shown that blue-spotted salamanders could super-cool down to about -1.5 C. Our field measurements not only validated the importance of super-cooling under natural conditions, but also demonstrated that salamanders can remain active at temperatures far below their known minimum super-cooling point, with values as low as –3.6 C.

Since we recorded individuals actively moving over ice, our observations confirm that the animals were not frozen. These results show that salamanders can push their limits further in nature than expected from lab tests alone.

Why do salamanders take the risk?

A blue-spotted salamander on top some moss
Blue-spotted salamanders use a process of super-cooling to keep liquids in their bodies from freezing in winter.
(Peter Paplanus/flickr), CC BY

Super-cooling is unstable. Contact with ice or sudden temperature changes can trigger rapid freezing. That means salamanders moving over ice are operating close to their physiological limit. Why take the risk, then?

The answer lies in timing. Blue-spotted salamanders breed in temporary ponds formed by snowmelt and spring rain, and their breeding season lasts only a few weeks. Arriving at the ponds early increases access to suitable egg-laying sites and reduces competition. Although waiting for consistently warm nights would be safer, it could also mean missing the breeding window altogether.

Early migration appears to be a trade-off: higher short-term risk of freezing in exchange for long-term reproductive success. This behaviour also shows that salamanders respond to small changes in environmental conditions, not just average temperatures.

Winter brings with it various challenges, and opportunities, for animals. Whether they hibernate, develop antifreeze or stay super-cooled, various species have developed fascinating ways of surviving the freezing temperatures.

The Conversation

Danilo Giacometti receives funding from the São Paulo Research Foundation (Brazil).

ref. Below freezing but still moving: How salamanders stay active in winter – https://theconversation.com/below-freezing-but-still-moving-how-salamanders-stay-active-in-winter-274100

Tumbler Ridge shootings highlight the need for mental health support for survivors and their community

Source: The Conversation – Canada – By Margaret McKinnon, Professor and Homewood Research Chair in Mental Health and Trauma, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Although mass shootings and gun violence have long plagued American communities, events like yesterday’s mass shooting at a high school in northern British Columbia are rare in Canada.

Following this tragedy, our communities may feel less safe and we may worry about family and loved ones.

The mental health and well-being of many Canadians will be impacted by this mass victimization event, including students and teachers present during the attack and their families, friends and peers. Supporters, including first responders and victim support providers, may also experience mental-health difficulties in the aftermath of the shooting.

Many survivors of mass shootings will experience symptoms of post-traumatic stress, anxiety and depression following the incident, with symptoms persisting one year or longer in a smaller group of survivors.




Read more:
I research mass shootings, but I never believed one would happen in my own condo in Vaughan, Ont.


Reactions to traumatic events

Reactions to traumatic events may manifest as emotional, cognitive, interpersonal and physical symptoms.

Emotionally, individuals may become more irritable, experience trauma-related nightmares or struggle with feelings of guilt for not having done more to prevent or mitigate the event.

Cognitive reactions can involve difficulties with concentration, memory or making decisions.

Interpersonally, trauma survivors may find it harder to trust others who were not involved in the incident, or they may notice increased tension and conflict within family relationships.

Physical reactions can include gastrointestinal issues, headaches and difficulty sleeping.

Women, younger Canadians, and people belonging to racial and ethnic minorities are more likely to experience mental-health difficulties following exposure to gun violence.

The mental health and well-being of these groups, along with that of all survivors, should be carefully monitored, and early access to mental-health and well-being supports provided.

Community impacts

Communities are also impacted by mass shootings, including via mental distress associated with fear and anxiety and through school and business closures.

These impacts can persist past the immediate aftermath of the incident, pointing to the need for not only individual mental-health supports for survivors and supporters, but also public health interventions that can support the needs of the community.

Following mass victimization events like school shootings, promoting a sense of physical and emotional safety and providing opportunities for social support from family, friends and the community can assist in healing.

This may include providing for physical needs, such as blankets, and nourishing food, as well as promoting community connection through groups and organizations. Metaphorically speaking, it’s important for survivors and their supporters to remember to put their oxygen mask on first to best assist others.

Family support also contributes to recovery. Parents are encouraged to provide warmth and support, spend time and encourage talking to one another, and maintain routines and social connections as much as possible.

Support network resource

For a directory of mental health services across Canada, a mental health self-assessment tool and individual and community mental health tool kits, see
The Canadian Emergency Response Psychosocial Support Network (CanEMERG), which can can connect you with mental-health resources from coast to coast to coast.

CanEMERG was developed at McMaster University and is supported by financial contributions from the Public Health Agency of Canada.

The Conversation

Margaret McKinnon receives funding from the Public Health Agency of Canada, the Canadian Institutes of Health Research, National Defence, Veterans Affairs Canada, the Canadian Institute of Military and Veteran Health Research, the Worker’s Safety Insurance Board, Homewood Health and Homewood Research Institute, the AllOne Foundation, the FDC Foundation, the True Patriot Love, the Military Casualty Support Foundation, the Cowan Foundation and St. Joseph’s Healthcare Hamilton.

ref. Tumbler Ridge shootings highlight the need for mental health support for survivors and their community – https://theconversation.com/tumbler-ridge-shootings-highlight-the-need-for-mental-health-support-for-survivors-and-their-community-275766

Burned out by smartphones, young people are choosing flip phones, cameras and MP3 players instead

Source: The Conversation – Canada – By Emma G Duerden, Canada Research Chair, Neuroscience & Learning Disorders, Associate Professor, Western University

Alarm clocks, maps, books, flashlights, watches, radios, MP3 players, Palm Pilots, remote controls, cameras, handheld recorders and other devices have all been gradually absorbed into a single one: the smartphone.

This convergence has brought unparalleled convenience into our fast-paced lives. Free internet-based calls and messaging, navigation, documentation, entertainment and even authenticator apps required to access work email have become essential daily functions and tasks.

For most of us, smartphones are no longer optional; they’re constant companions that have restructured how we work, communicate and move through the world.

Yet, as smartphones have become increasingly central to everyday life, a counter-trend has begun to take shape. In an effort to combat the attentional drain of smartphones, teens and young adults are deliberately reintroducing single-purpose technologies into their lives.


No one’s 20s and 30s look the same. You might be saving for a mortgage or just struggling to pay rent. You could be swiping dating apps, or trying to understand childcare. No matter your current challenges, our Quarter Life series has articles to share in the group chat, or just to remind you that you’re not alone.

Read more from Quarter Life:


Revival of single-use devices

Single-use devices include basic mobile phones with limited functionality (“dumb phones”), standalone digital and film cameras, MP3 players and iPods, e-readers such as Kindles and even paper planners and physical alarm clocks.

Several overlapping factors appear to be fuelling this move to digital minimalism. One is digital burnout and choice overload. Smartphones collapse multiple roles into a single interface, making it difficult to disengage from them. Persistent notifications and algorithmically curated feeds intensify this effect.

Rather than abandoning technology altogether, people are increasingly seeking to use it with greater intention. Instead of accumulating thousands of photos and screenshots on their phones, many young adults are purchasing cameras to capture the important moments, people and places in their lives.

Likewise, there’s a resurgence in iPod and MP3 player sales. These devices allow people to listen to music without advertisements, notifications or algorithmic recommendations.

Patterns of smartphone use help explain why such alternatives are appealing. Not surprisingly, mobile phone use has increased year after year for Canadian adults from 3.2 hours a day in 2019 to 5.65 hours 2023.

A 2022 Statistics Canada report found just over half of Canadians said they checked their smartphone first thing in the morning, and the last thing before bed. Forty-three per cent said they typically check their smartphone at least every 30 minutes.

Canadian adolescents are among the most digitally dependent, with a smartphone penetration rate of 87 per cent in 2021 and about  88 per cent of those aged 15 to 24 reporting that they check their phones at least once every hour.

Mobile phones and screens are deeply embedded in daily life globally. Worldwide, the average person now spends nearly six to seven hours a day looking at screens, with most of that time spent on mobile devices at almost four hours a day on phones alone.. In countries like the Philippines, Brazil and South Africa, daily mobile screen time regularly exceeds five hours.

By comparison, those in the United States and United Kingdom tend to spend slightly less time on their screens, but still a significant proportion of their waking hours engaged with digital devices.

A new trend or old habit?

The turn toward single-purpose devices may appear to be a reaction to smartphones specifically, but efforts to unplug from technology long predate them.

Organized “cellphone free” days were already being promoted as early as the 2000s, already fuelled by unease with “always available” connectivity. What has changed in recent years is not the desire to step back, but who is being most affected and what they are stepping away from.

Today’s single-use movement is being driven largely by people who are deeply embedded in digital work and culture: international workers, those who are self-employed, professionals, those working in creative industries, students and parents.

Research on digital disconnection shows that people are most likely to disengage when they experience persistent time pressure, cognitive overload, blurred work–life boundaries or emotional fatigue from constant exposure to online content.

In that sense, the turn to dumb phones, dedicated cameras or e-readers is less about nostalgia and more about an attempt to use digital tools that help us focus and create, rather than platforms that are designed to constantly capture our attention.

Stepping back from screens

Reducing screen time and social media use can have profound benefits on cognition and well-being. One study found that limiting social media use to around one hour per day reduced symptoms of anxiety, depression and fear of missing out, while improving sleep among young people aged 17 to 25.

Another study blocked internet access on participants’ smartphones for two weeks. A staggering 91 per cent of participants reported improvements in their mental health, life satisfaction and ability to sustain attention, with the effects comparable to reversing 10 years of age-related cognitive decline.

Participants spent more time socializing, exercising and spending time in nature, all of which are associated with improved well-being.

Research on forced digital disconnection also offers insight into the immediate effects of removing internet-enabled devices. In Swedish detention centres, for example, inmates are issued basic mobile phones with no internet access. Ethnographic research shows this eliminated compulsive phone checking and made communication slower and more deliberate.

While the context is extreme, it highlights that once devices designed for endless engagement are removed, patterns of attention and behaviour can change almost immediately.

Thinking of unplugging?

Voluntary forms of disconnection have started gaining traction. Digital detox retreats, for instance, offer a chance to step away from the constant pull of online life. Whether in off-grid cabins or rural retreats, these escapes allow time for reading, board games, cooking and nature walks. They offer a deliberate pause from the looming sense of urgency to be online and the pressure to perform for an audience.

If you’re curious about experimenting with single-purpose devices, a full break from smartphones isn’t necessary. Many people begin by identifying the functions that feel most disruptive, such as social media or constant messaging and relocating others to separate tools.

Simple steps include using an e-reader for reading, a standalone alarm clock to keep phones out of the bedroom or a dedicated music player for commuting.

A more moderate approach includes installing an app that can monitor screen time use, like Brick, or switching smartphone displays to greyscale to mitigate distractions and boost focus by removing colours that grab attention and trigger dopamine loops.

If all the hours spent scrolling were suddenly yours, an entire extra month a year, what would you do with that time? Perhaps it’s time to think about stepping off the feed and reclaiming the moments that are intrinsically meaningful and chosen by you.

The Conversation

Emma G Duerden receives funding from the Canada Research Chairs program.

Rubina Malik does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Burned out by smartphones, young people are choosing flip phones, cameras and MP3 players instead – https://theconversation.com/burned-out-by-smartphones-young-people-are-choosing-flip-phones-cameras-and-mp3-players-instead-273545

Toronto’s Project South charges point to systemic issues beyond police corruption

Source: The Conversation – Canada – By Tandeep Sidhu, Assistant Professor, Department of Sociology and Criminology, University of Manitoba

The Toronto Police Service is embroiled in an unprecedented crisis following a criminal investigation that led to several officers being charged with a list of drug trafficking, theft, conspiracy, fraud and other offences related to an organized crime investigation.

Project South was a seven-month long investigation that disrupted a criminal network that used information supplied to them via police databases.

The details of Project South were disclosed during a news conference that featured senior police officers bizarrely wearing bullet-proof vests. The core of these allegations involve claims of officers leaking information to this network that contributed to a series of violent crimes, including a conspiracy to murder a correctional officer.

Image management strategies activated

Toronto police Chief Myron Demkiw promised that no stone would be left unturned in the investigation and said the actions of a few officers did not define the force. He requested an independent external investigation before announcing the Project South charges.

The head of the Toronto Police Association, Clayton Campbell, similarly said there is “nothing our members hate more than a corrupt cop.”

Ontario’s inspector general of policing announced the province will lead a review of police services to address corruption in policing.

These public statements and requests for a probe are best understood through the lens of police image management, which refers to the array of what are essentially marketing strategies employed by police services to maintain their public image.

The police employ a series of strategic communications in times of crisis, and in their routine corporate communications, to convey a curated image to the public. Like other public relations strategies, this can obscure systemic issues in policing.

The statements from Demkiw and Campbell serve several functions, all of which are intended to safeguard the public image of policing. They disavow the charged officers, protect the reputation of the larger policing community and demonstrate a public-facing commitment to change.

Demkiw’s request for an external investigation, outlined during the news conference, is a strategy that allows the Toronto Police Service to be seen as taking the issue seriously and pre-empts public calls for such a response.

Police misconduct in Toronto and beyond

Allegations of misconduct against the Toronto Police Service have persisted for decades and include charges of corruption, theft, evidence management, misleading the court and fraud, among other offences.

A 2020 study investigating the experiences of inner-city Toronto residents subjected to police raids also demonstrated that allegations of theft, violence and intentional property damage are commonplace.

Some researchers have argued that a double standard exists for police services in terms of officers accused of corruption and other forms of misconduct. They argue that police often demand harsh sentences and punishment for members of the public, but face less severe consequences when misconduct is addressed internally.

A lesser-known form of police misconduct surrounds the abuse of police databases. Officers across Canada have used databases to stalk former partners, interfere in investigations for friends and family, form intimate relationships, access the personal information of and monitor lawyers and leak information.

While Campbell noted that searches on police databases leave digital footprints, this does little to prevent their abuse.

Like ticket-fixing, database abuse is difficult to detect. The true scope of database abuse is immeasurable, owing to the vast volume of data and searches officers perform, which makes it difficult to distinguish legitimate policing activity from illegitimate activity. What is known about its prevalence should be regarded as the tip of the iceberg.

Why bother?

So what value does an “independent” probe into Ontario police services offer? Considering the hard-to-detect nature of many forms of police misconduct, the efficacy of such an initiative is debatable.

There is also an inherent contradiction at play. The probe is being directed at all Ontario police services, suggesting that these forms of misconduct are systemic.

But Ontario Premier Doug Ford referred to a “few bad apples” in response to the public uproar following the Project South charges, suggesting there’s no systemic issue in place.

So why launch such an expansive probe that will likely cost taxpayers millions of dollars if these acts of misconduct are limited to a select few officers?

Demkiw’s request for an independent probe is an admission that police misconduct is systemic, but places the onus for repair onto an independent institutional body. As I’ve argued previously, police services cannot be trusted to repair these issues. This strategy not only allows police forces to appear as though they take internal corruption seriously, but insulates them from future criticism when officers engage in misconduct.

Considering there are already calls for Demkiw to resign, inaction would mark the end of his career.

Nonetheless, while the probe promises to investigate the “totality of the landscape” of policing in Ontario, the public should regard these efforts as a form of image management that insulates police forces from serious, genuine scrutiny.

Better ways to prevent corruption

While the police are mitigating the damage stemming from Project South, the question of how to prevent these abuses arises.

The existing mechanisms for detecting database abuse, for example, are inherently reactive. These issues are brought to the attention of the police following the misconduct.

One strategy to address this issue is a more robust system of random audits that function as a general “integrity check” on the police use of databases. This would function in tandem with a requirement that officers provide a detailed explanation of why searches on people are performed, creating a more substantive digital footprint that may be audited.

This strategy will inherently be met with resistance from police unions and researchers who partner with the police who have drawn attention to the occupational stress stemming from police reporting requirements.

But the research drawing attention to report writing and its proposed relationship to occupational stress fails to adequately consider that report writing is not only an expected function of the police — it may also be a critical avenue for accountability.

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

ref. Toronto’s Project South charges point to systemic issues beyond police corruption – https://theconversation.com/torontos-project-south-charges-point-to-systemic-issues-beyond-police-corruption-275408

Flag politics in Canada and New Zealand resulted in drastically different outcomes

Source: The Conversation – Canada – By Paul Hamilton, Associate Professor of Political Science, Brock University

National Flag Day, Feb. 15, marks the 61st anniversary of Canada’s Maple Leaf. Fading in the public consciousness are the debates that accompanied Prime Minister Lester B. Pearson’s proposal to replace the Red Ensign in the 1960s.

Of course, Canada isn’t the only state to have considered changes to its national flag. There are numerous example of flags redesigned to reflect a variety of political agendas.

Flags are treated with reverence in public ceremonies. As we’re witnessing as we take in this year’s Winter Olympic Games, flags brand a nation. They serve as a symbol uniting diverse populations of citizens who share this instant sign of belonging.

Irish political scientist Benedict Anderson referred to these populations as “imagined communities” united by symbols, mass media and myth. Flags are great examples of what British social psychologist Michael Billig refers to as “banal nationalism”. But while flags are often taken for granted, proposals to redesign them can arouse great passion.

Canada versus New Zealand

The Canadian process differed from New Zealand’s, which is interesting since the two cases share so much else in common.

Canada and New Zealand are both British settler states with large Indigenous and immigrant populations. Neither achieved independence by revolution and both retain strong ties to the Commonwealth.

A red flag with a Union Jack in the top left corner.
The Canadian Red Ensign used between 1879 and 1898.
(WikiMedia Commons), CC BY

These ties have been reinforced by the First and Second World Wars, when Canadians and New Zealanders shed blood with Great Britain.

Canada became self-governing in 1867, but relied on Westminster to pass constitutional amendments until 1982. New Zealand became self-governing in 1907, but only ended Britain’s role in some legislative matters in 1986.

Both countries also experienced a post-war reassessment of their ties to their colonial pasts, evident in the Union Jack occupying the upper left quadrant of each flag. But the efforts to redesign the Canadian and New Zealand flags followed different pathways.

In the case of Canada, the process ended with an entirely new flag. In the case of New Zealand, the status quo prevailed.

Canadian debate

The debate in Canada was dominated by political leaders, accompanied by lively coverage in the media. Conservative John G. Diefenbaker defended the status quo, while Pearson championed a new design.

The question was whether the new flag should represent a fresh start or retain symbols of a colonial past. Polls revealed that about half of Canadians wanted a new flag, enough to engage politicians but not enough to establish a clear direction.

Canada’s flag debate, which inspired the longest parliamentary session in history, was the country’s top news story of 1964. Politicians tinkered with designs to appease British imperialists, Québec and those who wanted something new.

After more than 200 Conservative speeches — and on the recommendation of the 15-member all-party committee — Parliament voted 163 to 78 in favour of the new flag in December 1964.

The flag was raised for the first time on Feb. 15, 1965. When Diefenbaker died in 1979, his coffin was draped with both the Maple Leaf and the Red Ensign, the symbol he fought so hard to keep, perhaps signalling a societal transition.

According to a recent poll, the flag is now the national symbol that Canadians are most proud of (79 per cent).

New Zealand votes

Unlike Canada, New Zealand held a public consultation about its proposed flag redesign involving two referendums in 2015-16.

The rationale for change was similar to Canada’s but also inspired by mix-ups where the New Zealand flag was mistaken for the Australian one. The referendum was promised by John Key’s National Party after it won the 2014 general election.

A public consultation attracted 10,292 designs, including one featuring a Kiwi firing a laser from its eyes.

Voters were asked to select one of five designs in the first referendum held in November and December 2015. The winner, featuring a silver fern and no Union Jack, was then pitted against the official flag in the second referendum held from March 3-24, 2016. Ultimately, almost 60 per cent of voters chose to keep the official flag that had been adopted in 1902.

In Canada, there was little consultation with Indigenous Peoples about the new flag.

In New Zealand, Maori voters mainly supported the status quo, partly out of a concern with the connection to the British monarchy, the guarantor of the Treaty of Waitangi. A new flag without a Union Jack could have signalled a step toward republicanism and a weakening of Maori political rights and status.

National identity

In both countries, the chance to change the flag represented an opportunity to reflect on their national identity. The New Zealand process took public opinion seriously, but binary referenda may not be the ideal method for choosing a new flag and turnout was low (67 per cent).




Read more:
Next wave: what Australia can learn from New Zealand’s flag referendum


In the Canadian case, it seems highly unlikely that such an important change would be enacted today by a simple vote in the House of Commons. A third option, for any country, would be a citizens’ assembly that could deliberate over a longer period and solicit the views of all community members.

A flag is not just a national garment; it’s the national self-portrait. Debates about designs are debates about who we are and can arouse great passion. Such debates are not trivial — they’re essential parts of the evolving nation-building project.

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

ref. Flag politics in Canada and New Zealand resulted in drastically different outcomes – https://theconversation.com/flag-politics-in-canada-and-new-zealand-resulted-in-drastically-different-outcomes-274905

For women who live on the margins, health care is often out of reach. Here’s how we can build a bridge to access

Source: The Conversation – Canada – By Sonia S Anand, Associate Vice-President Global Health, McMaster University

Most Canadians either know personally or are aware that getting an appointment with a family doctor can be difficult. Across the country, it’s estimated that 6.5 million people do not have a family doctor or nurse practitioner they see regularly.

For women who live on the margins — those experiencing poverty, racism, trauma, care-giving stress or unstable housing — the barriers to care are even greater.

From adolescence through to mid-life, such women often put their own health needs last. Even if they have a family doctor, the structural realities of care — uneven geographical access, long waits, limited appointment slots and rigid scheduling systems — are difficult for most people to navigate. For women with limited resources of income, time and agency, the barriers to access are, too often, insurmountable.

Life satisfaction is lower among women in Canada than men, and serious conditions such as cardiovascular disease, cancer or reproductive health problems are often diagnosed late. For many women, cultural norms may make it difficult to raise issues such as sexual health, contraception or depression within a 15-minute medical visit, especially if they lack language or gender concordance with their family doctor.

The World Health Organization (WHO) estimates that primary care can deliver more than 90 per cent of essential health services, but only if people can access it. For women who live on the margins, gaining this access is difficult.

Real-world needs not met

In 2023, the federal government’s agreement with the provinces committed to expanding access to family health services, especially in rural and remote areas, and to supporting health workers while reducing backlogs.

Under this plan, Ontario was designated receive $2.5 billion between 2023 and 2026 to strengthen family health services, including $90 million specifically to expand inter-professional primary care teams in high-need communities and to help existing teams manage rising costs.

Ontario’s Primary Care Action Plan has committed to incentives and investments to improve rates of attachment to team-based primary care. But it’s not clear if these can overcome the barriers for marginalized women.

There are other forces that impact the availability of access to family physicians. Studies from the United States indicate that if primary care physicians followed every preventive and chronic-care guideline, they would need 27 hours a day — more than half of that devoted to prevention alone.

The system as designed may not be able to meet the real-world needs of patients, especially those with complex social and health circumstances.

A bridge to access: Learning from global innovation

Women on the margins often experience stigma, mistrust and have a scarcity mindset, and are unable to prioritize their own health needs. As a result, they end up in walk-in clinics or emergency departments at a late stage of serious illnesses. Our current system — stretched and time-deficient — is not optimized for preventive, trust-based, community-embedded care.

As physicians and population health researchers, we propose importing and adapting a proven innovation from the Global South — the Community Health Worker model, first endorsed by WHO and UNICEF in the 1978 Alma-Ata Declaration.

A community health worker (CHW) is typically a trusted member of the local community who understands the challenges of those who are sick or socially excluded. With targeted training, CHWs can conduct basic health screenings for conditions such as high blood pressure, diabetes, breast and cervical cancer, and reproductive and mental health problems.

Importantly, CHWs act as bridges to primary care physicians, meaning when a woman’s screening reveals a concern, the CHW can prioritize her for a physician review. This approach builds trust, continuity and access — creating the “first mile” of connection to the health system for women who might otherwise remain invisible.

Unlike nurses, CHWs do not require professional credentials, though many have college or allied-health backgrounds such as a personal support worker or occupational therapy assistant. Their greatest assets are trust, cultural competence and mobility — the ability to meet marginalized women where they are at.

Implementation is key

The CHW model has the potential to deliver community-based, first-contact access — what we call “A Bridge to Access.” These workers can provide the first mile of care, ensuring that prevention, screening and support reach the women who need it most.

While CHWs can be equipped with digital or artificial intelligence (AI) enabled screening tools to optimize the connection with care, technology should complement — not replace — human connection. Digital tools can support communication and record-keeping, but relationships and trust remain the foundation of effective care.

Money alone cannot fix Canada’s patchwork health-care system of today. Funding is necessary, but innovation is essential. The CHW model — an evidence-based success in countries from India to Indonesia — represents an opportunity for reverse innovation: bringing proven global strategies from the Global South to Canada.

If implemented well, CHWs have the potential to strengthen first-contact accessibility, foster trusting relationships and deliver person-centred, integrated care. For women on the margins, this could mean earlier diagnosis, greater continuity and restored faith in a system they currently cannot access easily.

Testing and evaluating the CHW model in Canada offers a path to close the health-equity gap for women and other underserved populations. If successful, it could be scaled across provinces, contributing to a stronger, more inclusive health-care system — one that delivers on prevention, screening and primary care for those most in need.

The Conversation

Sonia Anand receives funding from Public Health Agency of Canada, and the CIHR. She receives speaking honoraria from pharmaceutical companies. She volunteers for the Heart and Stroke Foundation of Canada.

Gina Ogilvie receives funding from Canadian Institutes of Health Research.

Cathy Risdon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. For women who live on the margins, health care is often out of reach. Here’s how we can build a bridge to access – https://theconversation.com/for-women-who-live-on-the-margins-health-care-is-often-out-of-reach-heres-how-we-can-build-a-bridge-to-access-273453