Jerry Spiegel


Relevant Degree Programs

Affiliations to Research Centres, Institutes & Clusters


Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - Nov 2019)
The influence of upstream forces on health : a multi-method investigation of tuberculosis among healthcare workers in South Africa (2019)

Empirical evidence is lacking on the degree to which structural or upstream forces contribute to tuberculosis (TB) incidence in the general population, and in healthcare workers, a group known to be at high-risk for this disease, let alone on how these forces are addressed in policy. This dissertation used a multi-method design to examine the link between upstream forces and TB. First, it utilized a linear mixed-effects regression to investigate the association between globalizing processes and TB incidence in the 22 high burden countries. Secondly, semi-structured in-depth interviews were conducted in South Africa to explore how macro-level determinants of TB incidence in the general population and among healthcare workers are perceived by key stakeholders, identifying barriers and facilitators to the implementation of effective prevention and control measures. South Africa’s current National Strategic Plan was then examined to ascertain how these factors were being addressed. The World Health Organization (WHO) Health Systems Building Blocks framework was also applied to assess interventions for protecting healthcare workers.Globalization was found to be associated with higher TB incidence in high burden countries. In the South African context, a history of colonization, the migrant labour system, economic inequality, poor shelter, health system challenges, the HIV epidemic, and pertinent socio-cultural factors were all perceived to be the major drivers of the epidemic. Although South Africa’s current National Strategic Plan makes a firm discursive commitment to addressing the structural drivers of TB, analysis from this dissertation revealed that this commitment was not clearly reflected in projected budgetary allocations.As many low and middle-income countries continue to integrate their economies into the global market, there is a need to consider ways to address unintended inequities that accompany this integration. In South Africa, while funding allocation to improve diagnostic procedures and investment in more efficacious drugs are laudable, attention to structural drivers of TB is deficient. Although a national TB policy for healthcare workers will soon be launched, it is perceived that implementation and adherence to such policies may well remain problematic unless the policy explicitly addresses the drivers of this scourge.

View record

Discursive and practical challenges in global health : pesticide-related health impacts in Ecuadorian banana production (2014)

This dissertation aims to inform more equitable and effective practice in the emerging field of global health. To address this overriding question of how principles of equity and effectiveness can best be implemented, I critically analyze discursive and practical challenges facing Northern researchers as they approach health problems in the global South, and explore solutions to these challenges. This exploration employs a case study on the articulation of a specific problem in a specific, nominally ‘Southern’, setting: pesticide-related health effects in Ecuador's banana-producing El Oro province. I employ three methodological approaches, in three substantive chapters. Chapter 2 uses discourse analysis to understand how Latin American research sites are framed in peer-reviewed pesticide epidemiology articles. These articles often employ geographic representations of Latin America as inexplicably underdeveloped to demonstrate the need for pesticide research and health sector interventions, typically exhibiting ‘mainstream’ (Northern) public health institutional dynamics. I also show how some epidemiologists are pursuing more politically engaged approaches, in an uneasy negotiation with epidemiology's disciplinary norms. Chapter 3 reports on ethnographic pesticide risk perception work in El Oro, drawing on theories from anthropology and human geography. I document how pesticide risk perception narratives reflect El Oro's position in unstable global commodity chains. Scalar elements of these narratives combine individual and structural explanations for health problems in complex ways. In Chapter 4, I describe a political ecology of health explanation of pesticide exposure in El Oro. I employ a modified meta-narrative methodology, complemented by ethnographic fieldwork, to synthesize literature relevant to the pathways – biological, political economic, environmental and cultural – leading to pesticide-related impacts in El Oro. This analysis complements Chapters 2 and 3 in making the case for empowerment-based participatory approaches to pesticide exposure problems (and, by extension, to global health more generally), with special attention to international linkages, environmental complexity and political economy. The introduction, conclusion and 'linking' material between chapters serve to enhance the coherence of the dissertation by providing additional material not appropriate for inclusion in the three chapters, including elements of reflexivity.

View record

Developing a clinical tool to treat depression in Spanish-speaking Latin American immigrants in Canada : applying a global mental health perspective for improved mental health outcomes (2013)

This dissertation considers the implications of applying of global health perspective to guide the development of culturally appropriate mental health services in Canada. Recognizing that forces of globalization can both affect determinants of health that vulnerable populations face and the kind of mental health services that are available, I focus on the situation of immigrants in the Greater Toronto Area, a population that has been prioritized for increased access to equity-driven health services, drawing on my personal and professional positionality with the issues examined. This study specifically examines Latin American immigrants, a group that has been identified as a high-growth population at-risk for mental health difficulties. An extensive and comprehensive review of social determinants of health as it relates to the mental health of Latin American immigrants in Canada is conducted, and the availability and effectiveness of patient-centred care for Latin American populations is also reviewed, with particular attention to the standard delivery versus the cultural adaptation of cognitive behavioural therapy – currently regarded as the ‘gold standard’ in psychotherapeutic treatment. Clinical, service delivery, and social policy issues that may arise in providing culturally appropriate, patient-centred care are exemplified in the findings of a secondary qualitative analysis of focus groups that were conducted for a feasibility study for a culturally adapted cognitive behavioural therapy (CA-CBT) for Latin American immigrants in Canada. A key contribution of this work is the synthesis of the foregoing evidence to conclude that the provision of culturally adapted mental health services is necessary but not sufficient to promote the health equity of Latin American immigrant population in Canada. Recommendations for policy, future research, and changes to the philosophy of psychiatric practice are discussed, and the findings are related to debates on the concept of “global mental health” that are currently underway.

View record

Interdisciplinary knowledge translation and evaluation strategies for participatory dengue prevention in Machala, Ecuador (2013)

This dissertation explores how knowledge management approaches and socio-political systems affect the accessibility to and application of evidence to improve the health of socially and politically disempowered groups of people. As, dengue provides a particularly vivid example of a human health issue intricately linked to biological, environmental, social and political systems, this study is embedded in a participatory dengue prevention and control program in Machala, Ecuador, that is committed to capacity-building and scaling-up. Guided by a transformative emancipatory approach with a focus on equitable participation, a multi-method approach was pursued including ethnographically-framed stakeholder analyses, social network mapping and analysis, illustrative vignettes and participatory indicator development. Six major stakeholder groups were identified in Machala: community, local government, government functionary, government administrator, researcher and private sector. Varying degrees of collaboration and interaction with one another as well as with the problematic of dengue are shaped by the dynamics of differing health priorities, paternalism/equitable participation, quemeimportismo/social resentment, nepotism/centrism/social justice, marginalization/self-determination and Buen Vivir. Power dynamics and knowledge valuation schemes dictate definitions of success and shape evaluation tools and processes tend to marginalize experiential and tacit knowledge, perpetuating narrow conceptions of health, benefit and dengue transmission risk. Overall, opinions regarding evaluation criteria did not significantly differ by stakeholder group, which suggests that social and cultural dynamics, as well as history and narrative of place, may be far more important factors in determining both stakeholder priorities and the character of intersectoral spaces than previously thought. A participatory evaluation tool is developed to assess both impact and process-related performance of proposed dengue prevention and control strategies. A knowledge translation model is developed with a strong emphasis on equitable participation and health equity. This study observes that there is deep need for change in underlying institutional power structures and research-to-policy processes, without which new evaluation tools will likely not “make sense” or result in improved policy, programs and community well-being. These findings and their implications challenge current macro, mid and local-level knowledge management strategies. This study indicates that opportunity for change exists through participatory evaluation processes situated at the interface of equitable knowledge translation and social determination.

View record

International cancer control congresses : do they make a difference? (2012)

Statement of the Problem This study has taken advantage of a “natural experiment,” the holding of International Cancer Control Congresses (ICCC) to conduct research that assesses the value of such undertakings, and examines ways for effectively pursuing positive change in improving policy and practice related to cancer control. Given the importance of this global challenge, this study investigates the question: Do International Cancer Control Congresses influence reported changes in participant behaviors and activities that enhance the development or implementation of population-based cancer control programs and increased collaborations? Methods of Investigation The population of interest included all the congress registered participants for two International Cancer Control Congresses—362 individuals at the 3rd ICCC for the first pod of surveys; and 310 participants at ICCC4 for the second pod of surveys. The primary data collection instrument was self-report surveys, surveyed in two pods. Each pod included an on-site survey followed by a follow-up survey a few months later on the same census sample of participants. Research instruments for data collection included surveys, interviews, conference documentation, observations as well as secondary data from WHO publications and appropriate web based publications like country plans and others. The study was organized as a mixed methods research using a triangulation design that allowed a mix of both quantitative and qualitative data in a single study.Conclusions The study indicates that most respondents gained professionally in improved understanding of global population based cancer control programs and new insights into cancer control. Through sharing best practices and insights gained at the congress in their jurisdictions, many indicated that the Congress has helped them in their cancer control work, including increased awareness for establishing collaborations and for setting up surveillance systems; also highlighting for them the importance of expediting national cancer/integrated non-communicable disease plans. Increasing their networks, participants continue experiencing a rise in interest and involvement in cancer control. The Latin American Region research reveals that it takes time before initiatives emerge and can be attributed to ICCC. In revealing which finds are inconclusive, this study offers opportunities for cohort longitudinal investigations.

View record

The Impact of International Trade Agreements on Health (2012)

No abstract available.

Harnessing the community capacity of small farmer organizations to reduce pesticide-related environmental health risks : a case study in an indigenous community in the southern ranges of Ecuador, 2007-2008 (2011)

This work aims to better understand the capacity of small farmers, their organizations and other social players in the Ecuadorian indigenous communities of Quilloac and San Rafael to reduce pesticide-related environmental health risks. I used a multi-method approach that included Pierre Bourdieu’s field theory along with a 187-household survey, ethnographic methods, and participative approaches in 2007-2008. This study analyzed community capacity-building as social relationships co-determined by human agency and social structure in local and global contexts. By mapping community stakeholders’ differential access to cultural, social and economic capital, this study reveals connections between the degree of access to resources and health vulnerabilities.Four key findings emerged. First, in a context in which workers were forced to diversify their income through strategies such as emigration and urban employment, families had reduced time for their crops and increased reliance on pesticides. Members of households with fewer people applied pesticides more times. Elders from poor households were left to care for crops and experienced more problems with pesticide handling and symptoms. Children experienced increases in accidental pesticide poisoning cases that coincided with a period of high farmer migration to find work. Second, despite numerous well-intended efforts by community leaders, farmers with the highest participation in agriculture had less contact with community organizations. Third, structural factors such as inequitable land distribution, unfavorable market policies, and limited state support for small farmers represent critical barriers for harnessing the capacity of small farmer organizations. Fourth, community leaders tended to adopt peasantry-focused strategies that were likely to further marginalize some vulnerable families who combined non-agricultural activities with their farming, which was characterized by consumption crops with low workforce and high pesticide use. My findings provide theoretical and practical contributions for understanding the causes of environmental health inequities. Results from this research informed the development of several community-based initiatives (workshops, a radio show). My approach described important contextual barriers that need to be addressed by national and international stakeholders in order to harness the capacity of local organizations. It also identified specific social mechanisms that could increase health inequities despite great efforts by community organizations.

View record

Master's Student Supervision (2010 - 2018)
Assessing equity in access to healthy diets in Ecuador following the addition of food sovereignty to the constitution (2014)

Background: Ecuador shows high and increasing rates of diet-related non-communicable diseases, attributed in part to a nutrition transition toward more animal-based and processed foods. In 2008, Ecuador introduced the right to food sovereignty to its constitution in an effort to improve diets and protect local agricultural production. However, this has not yet translated to evidence of improved nutrition at the community level. Objective: This thesis examines whether the promotion of food sovereignty has contributed to improving access to healthy diets for marginalized populations in Ecuador; if so, it asks how and to what extent, and if not, it explores the barriers to achieving change and opportunities for improvement. This project thus seeks to provide suggestions of entry points for policies and programs to improve access to and consumption of healthy foods.Methods: Complementary qualitative methods were used to examine geographic access, food prices, nutritional knowledge and dietary preferences, and priorities for food policy improvement in three low-income neighbourhoods in the city of Machala, El Oro. Results: Access to affordable healthy foods is still an issue as perceived by the study neighbourhoods. Poor nutritional knowledge, high relative cost of fruits and vegetables, and inequitable geographic access to affordable healthy foods were the main barriers to healthy eating. Price was the primary factor influencing food purchasing and consumption behaviours. Knowledge of the concept of food sovereignty and its inclusion in the constitution was nonexistent, as was the awareness of any new policies or programs implemented to improve access to healthy foods since 2008.Conclusions: As there are no food sovereignty policies in place so far that address price, the affordability of healthy foods could be addressed either by improving the linkages between producers and consumers to reduce intermediaries, or by adopting fiscal policies that subsidize healthy foods and tax unhealthy foods to help make healthy options more affordable and viable. These policy initiatives fall within the potential scope of a commitment to food sovereignty, but greater focus is needed as the government advances in the development of specific policies and programs in order to have an impact on population health.

View record

Current Students & Alumni

This is a small sample of students and/or alumni that have been supervised by this researcher. It is not meant as a comprehensive list.

If this is your researcher profile you can log in to the Faculty & Staff portal to update your details and provide recruitment preferences.


Learn about our faculties, research, and more than 300 programs in our 2021 Graduate Viewbook!