Background: Globalization describes processes of greater integration of the world economy through increased flows of goods, services, capital and people. Globalization has undergone significant transformation since the 1970s, entrenching neoliberal economics as the dominant model of global market integration. Although this transformation has generated some health gains, since the 1990s it has also increased health disparities. Methods: As part of a larger project examining how contemporary globalization was affecting the health of Canadians, we undertook semi-structured interviews with 147 families living in low-income neighbourhoods in Canada's three largest cities (Montreal, Toronto and Vancouver). Many of the families were recent immigrants, which was another focus of the study. Drawing on research syntheses undertaken by the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health, we examined respondents' experiences of three globalization-related pathways known to influence health: labour markets (and the rise of precarious employment), housing markets (speculative investments and affordability) and social protection measures (changes in scope and redistributive aspects of social spending and taxation). Interviews took place between April 2009 and November 2011. Results: Families experienced an erosion of labour markets (employment) attributed to outsourcing, discrimination in employment experienced by new immigrants, increased precarious employment, and high levels of stress and poor mental health; costly and poor quality housing, especially for new immigrants; and, despite evidence of declining social protection spending, appreciation for state-provided benefits, notably for new immigrants arriving as refugees. Job insecurity was the greatest worry for respondents and their families. Questions concerning the impact of these experiences on health and living standards produced mixed results, with a majority expressing greater difficulty 'making ends meet,' some experiencing deterioration in health and yet many also reporting improved living standards. We speculate on reasons for these counter-intuitive results. Conclusions: Current trends in the three globalization-related pathways in Canada are likely to worsen the health of families similar to those who participated in our study. © 2015 Labonté et al.

Housing Globalization and health Immigrant health Social protection Labour markets Canada

immigrant Toronto refugee lowest income group economics poverty globalization mental health human job security Internationality housing market social aspect social determinants of health mental stress priority journal housing international cooperation family size financial management qualitative research Family Characteristics Commerce interview health living standard family study investment Vancouver [British Columbia] Humans health impact Interviews as Topic Canada male female employment discrimination general condition deterioration tax semi structured interview Canadian commercial phenomena Article employment status adult global health normal human labor market employment health care disparity British Columbia Ontario [Canada] Quebec [Canada] public health Montreal