Jerry Spiegel


Relevant Thesis-Based Degree Programs

Affiliations to Research Centres, Institutes & Clusters


Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

Chemical contamination of globalized food systems : applying systems thinking to navigate a multi-level planetary health threat (2023)

Background: Pollution is a major planetary health concern that claims ~9 million lives a year and threatens the integrity of ecosystems that support life on Earth. Chemical contamination has effects at local, regional, and global scales. However, research at some scales may be privileged due to data availability and research practices, leading to persistent gaps. Based on empirical research, this dissertation explored two overarching questions: (1) how can systems thinking expand our understanding of the scale challenges of data to assess pesticides contamination distribution and effects in countries with potentially high levels of exposure?; and (2) how can systems thinking provide a framework to bridge local exposure studies with the critical appraisal of planetary health contamination research at broader scales? Methods: I applied geospatial science to identify areas with the potential to affect human health and the integrity of ecosystems in Ecuador, a country with alarming pesticide use practices. In addition, I used spatial clustering detection and Bayesian multi-level spatial regression to assess the distribution of perinatal health outcomes and their association with application rates. Finally, I conducted a systematic scoping literature review of contamination research in Indigenous food systems. I reflected on the results based on our marine toxicology research conducted in solidarity with the Tsleil-Waututh Nation in Canada. Conclusions: The challenges of pollution to planetary health require the integration of knowledge across scales. Conceptual frameworks that foster multi-scalar discussions can fill knowledge gaps, link multi-level evidence and shift the accountability of contamination issues to scales with the agency over pollution drivers. We found widespread use of pesticides in Ecuador threatening human health and strategic ecosystems. Regional assessments and interventions should follow in the areas of concern highlighted in this study. Moreover, a nationwide coordinated strategy to monitor and control the effects of prenatal pesticide exposures is warranted. Although seldom studied, large-scale drivers of pesticide contamination should be integrated into existing knowledge at local scales. This should promote multi-level controls beyond solely relying on local-level behavioural exposure controls. Conversely, meaningful collaborations with Indigenous populations are vital to strengthening the analytic frameworks of multi-scalar integrative approaches to human health.

View record

Engaging with mining impacts on Indigenous community health: allegiance challenges in public health research and practice (2022)

This dissertation critically examines the ways in which public health professionals in Canada carry out their role in a settler colonial setting. I specifically focus on investigating how such practitioners are engaging with disparate narratives about health impacts of mining on Indigenous communities in Canada. I apply two methodological approaches (a scoping review and in-depth interviews) to produce insights that inform a pedagogical tool-creating approach (social cartography).Through a scoping review of 89 government related documents that guide regulatory and approval processes of mining developments and policy, I identify key framings, definitions and narratives used discursively through these state processes. These documents convey strong messages naturalizing the state’s authority over Indigenous people and normalizing the dominance of Settler Canadian standards. Settler Canada is depicted as exceptional and exemplary, in contrast to Indigenous people who the documents repeatedly characterize as essentially infantile. Analysis also reveals calculated sidestepping of consent, and problematic use of ‘balance’ as a metaphor in ways that discount Indigenous resistance to Canadian authority over land, cast market-driven resource extraction as inevitable, and dismiss Indigenous refusals of consent to access land. Exploring the degree to which public health professionals align with or contest state narratives, I carried out 41 in-depth key informant interviews. The qualitative analysis, using thematic review assisted by NVivo, shows a repeated national narrative of caring for Indigenous Peoples - characterized as ‘in need’ yet as healthy if adapting to Settler Canadian paradigms. This suggests that educational-behavioural interventions addressing problematic practices may be of limited effectiveness without first grappling with structural dimensions of complicities, personal and professional investments, cherished narratives, and entitlements. Consideration of structural influences on roles of public health professionals illustrates that available orientations to professional practice may be circumscribed by imperatives of a settler colonial national narrative. In assessing study findings from an anti-colonial lens, I reflect on the study’s contributions to the literature, and implications for practice, training, research and action. I conclude that, through grappling with difficult knowledges to inform accountable and anti-colonial engagement, public health professionals could broaden imaginations toward a professional orientation centred on responsible relationship.

View record

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 : patent system harmonization and medicines in Mexico (2012)

Patent system harmonization obligations found within international trade agreements have been subject to intense scrutiny over the past two decades due to the potential negative implications for public health in developing countries. In 1994, NAFTA became the first trade agreement to include patent system harmonization obligations. Mexico as a signatory to NAFTA was the first developing country to adopt the patent system of developed countries via patent system harmonization. This makes Mexico a particularly relevant case study on the subject. The central research question addressed in this dissertation is: Does NAFTA patent system harmonization promote access to medicines in Mexico, while incentivizing pharmaceutical R&D? This dissertation undertakes a comparative legal analysis, a scoping study, and qualitative stakeholder analysis to address the central research question. Evidence is provided that compulsory licensing as a safeguard is inadequate as a downstream measure in the promotion of access. A key finding is that international trade agreements should be drafted with optimal pharmaceutical patent protection standards in mind. Further, patent system harmonization results in a net health benefit that can be maximized through the provision of feedback evidence to decision-makers in order to develop responsive laws and policy. This dissertation proposes that: if we reform the granting of patent terms from a fixed twenty year life period to a flexible and adjustable term determined through an assessment of health and economic conditions that exist during any given time period, we will improve both global equity in access to medicines and reduce economic inefficiencies in our current model for pharmaceutical R&D, while maintaining adequate incentives to conduct pharmaceutical R&D. The proposed reform is akin to the use of interest rates as an economic growth and stabilization tool in monetary policy. It would require government patent offices to analyze global conditions in pharmaceutical access and R&D, and accordingly adjust the number of years of patent protection awarded. This novel contribution to the academic literature informs Canadian, Mexican, and developing country decision makers on how to design appropriate policy for the benefit of public health.

View record

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

Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.

Multi-criteria decision analysis comparing agricultural production methods: protocol for analyzing British Columbia blueberries (2020)

INTRODUCTION: Methods such as Multi-criteria decision analysis (MCDA) are often applied to assess how preferences to make rational choices are applied. This thesis aims to examine how farmers balance environmental and social factors of sustainability and health with economic factors (e.g. costs) by assessing their preference for applying alternative agricultural approaches (e.g. conventional, agro-ecological/organic, and integrated farming/mixed-methods).METHODS: First, a systematic bibliometric review of studies that used MCDA techniques for agricultural purposes was conducted to consider the ways that the analytical approach was being applied in this area. The review was restricted to all English language studies of farm-based agricultural studies that considered cost in their analysis. Studies from the Web of Science, CAB Direct, and Agriculture & Environmental Science databases were reviewed to identify publication trends that helped situate the objectives the thesis’ own MCDA feasibility study. Second, a small group (9) of BC Blueberry farmers were interviewed using an Analytic Hierarchy Process (AHP) MCDA technique to elicit their preferred production system while considering potential constraints. The costs of agricultural production systems were divided by the aggregate value scores of the AHP, and systems ranked on their cost-benefit ratio.RESULTS: MCDAs in agriculture have become increasingly popular over time, particularly AHPs in Europe and Asia, and in fruit, vegetable, and nuts farming sectors. Most studies considered costs as one of the criteria in the analysis, most often as a production/operating cost. Health was not mentioned extensively in these studies. The MCDA study showed that organic farming is the most preferred method without the consideration of costs, but conventional farming was the most preferred in the cost-benefit ratio.CONCLUSION: Farmers prefer to be more mixed-methods or ecological (without the consideration of costs), constraints (specifically costs) prevent them from practicing their preferences. As a novel approach in agriculture, the MCDA-CBA is a feasible tool to understand farmer preferences and how they can be advocated for to achieve more sustainable and healthy processes in policy. MCDA-CBA has potential for understanding health and sustainability as connected with similar, if not the same, goals and criteria.

View record

Household Food Insecurity and Obesity in First Nations Communities in Canada (2017)

Background: Food insecurity for Indigenous households across Canada is an ongoing challenge and the associated impacts on health and wellness represent an important public health issue. For Indigenous populations living both on and off-reserve, the diet-related health concerns of food insecurity include obesity, poor dietary quality and chronic disease.Objective: To better understand the factors and processes underlying food insecurity and obesity in First Nations living on-reserve in order to contribute to an evidence-based discussion of strategies for protecting traditional food practices and addressing inequities in health and nutrition.Methods: Secondary data analysis was conducted from the First Nations Food, Nutrition and Environment Study (FNFNES), which applied a cross-sectional study design intended to be representative of First Nations living on-reserve in Canada (south of 60°). Data were analysed from the social, health and lifestyle questionnaire and food security questionnaire components of the FNFNES. Multivariate logistic regression, approached within a holistic framework of First Nations health and wellness, was used to examine the determinants of food insecurity and associations with obesity among individuals living in food insecure households. Analyses were conducted of First Nations communities in British Columbia, Manitoba, Ontario and Alberta.Results: Forty-six percent of First Nations households were food insecure, with 9.5% of households classified as marginally food insecure, 27.9% moderately food insecure and 8.9% severely food insecure. Socio-demographic characteristics significantly associated with food insecurity included age, gender, region, main source of income, years of education, presence or absence of children in the household, road access and household traditional food activity. Rates of obesity were highest among marginally food insecure households (56%). Compared with food secure households, marginally food insecure households had significantly higher odds of obesity (OR 1.5, 95% confidence interval 1.19, 1.97), after adjustments for socio-demographic variables.Conclusions: The relationship between food insecurity and obesity highlight the need for multifaceted approaches that focus on income and the provision of affordable and accessible healthy foods, with particular consideration for quality and cultural appropriateness. Indigenous food sovereignty provides a promising framework for developing culturally appropriate strategies that enable community capacity to address food insecurity and diet-related health conditions.

View record

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.


Planning to do a research degree? Use our expert search to find a potential supervisor!