Julia Smith

• PhD
• Assistant Professor at Simon Fraser University

Why has the response to HIV/AIDS been unique? How did civil society organizations gain access to global decision-making forums to demand exceptional attention and resources for HIV/AIDS? This book seeks to answer these questions, among others, through a critical international relations approach that enquires into the role of civil society in global...

Gender norms, roles and relations differentially affect women, men, and non-binary individuals’ vulnerability to disease. Outbreak response measures also have immediate and long-term gendered effects. However, gender-based analysis of outbreaks and responses is limited by lack of data and little integration of feminist analysis within global health...

The COVID-19 pandemic has highlighted the importance of childcare to national economies in general and women's economic participation in particular, spurring renewed interest in childcare policy in many countries that have implemented lockdowns. This paper adopts a circle of care framework to analyzes how COVID-19 has affected paid childcare, unpai...

Pandemics disproportionately affect women due to their dominant roles in healthcare, caregiving, and industries vulnerable to public health policies. Women face higher infection risks, greater unpaid care burdens, and job losses during crises. Violence against women and disrupted access to healthcare, including sexual and reproductive services, als...

Livestock are vital to the health and economic stability of communities worldwide. However, infectious diseases threaten both animal and human health due to losses in livestock, decreased production, and transmission of zoonotic diseases. To manage and mitigate these risks, access to livestock vaccines is critical. This is often gendered, with soci...

This study explores the health-related quality of life (HRQoL) experienced by patients with Long COVD-19 using data from British Columbia’s post-COVID-19 Recovery Clinics. A retrospective cohort of 3463 patients was analyzed to assess HRQoL through the EQ-5D-5L questionnaire which includes five dimensions (mobility, self-care, usual activities, phy...

Objectives: In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed moral distress, of 1678 respondents, using a modified Moral Distress Scale, and an equi...

Background While there is now extensive research on how COVID-19 lockdowns negatively affected unpaid care burdens and intimate partner violence (IPV), the structural determinants shaping both experiences are less well understood. Objectives The review seeks to answer: how did structural determinants of gender inequality shape both the experiences...

While there is growing literature on experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the relationships between paid and unpaid care burdens and contributions. We administered a moral distress survey to healthcare workers in Canada, in 2022, collecting data on both paid and unpaid care. Th...

Background This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. Methods Our cross-sectional observational study utilized a s...

Background Throughout history, vaccines have proven effective in addressing and preventing widespread outbreaks, leading to a decrease in the spread and fatality rates of infectious diseases. In a time where vaccine hesitancy poses a significant challenge to public health, it is important to identify the intricate interplay of factors exemplified a...

Background This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. Methods Our cross-sectional observational study utilized a st...

Background: A growing literature has documented how the secondary effects of the COVID-19 pandemic have compounded socioeconomic vulnerabilities already present in society, particularly across social categories such as gender, race, class, and socioeconomic status. Such effects demonstrate how pandemic response policies act as structural determinan...

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-ex...

Aim To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research. Design Scoping review. Methods The PRISMA (Preferred Reporting Items for Systematic and Meta‐Analysis) Extension for Scoping Reviews was adopted. Data Sources Syst...

Objectives:Moral distress has been identified as both a contributor to healthcare worker attrition as well as an outcome of it. To this aim, our study applies intersectional analysis to explore moral distress levels among doctors, nurses, and in-home- or community-care-providers in British Columbia, Canada with a specific focus on the intersection...

Long-Term Care (LTC) workers have reported declining emotional well-being over the past few years. In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in LTC in British Columbia, Canada. This was an observational, cross-sectional, and retrospective study administered through a...

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-ex...

In Canada, community and policy leaders have issued urgent calls to collect, analyze, and mobilize disaggregated data to inform equity-oriented initiatives aimed at addressing systemic racism and gender inequity, as well as other social inequities. This essay presents critical reflections from a national Roundtable discussion regarding how meaningf...

The Bangladesh government issued a lockdown throughout the country from March–May 2020 in response to the COVID-19. The sudden lockdown caused economic ruptures across the country due to job loss. We conducted a comprehensive analysis of the outbreak through 40 in-depth interviews with men and women living in three Dhaka informal settlements from J...

The health burden due to mental health has historically been underestimated with focus on communicable diseases and deaths and little consideration of disability and comorbidity effects of poor mental health. Recent data show increasing trends of mental health disorders as a share of global health burdens and vulnerability of adolescents. This pape...

This paper examines the anti-mask and anti-lockdown online movement in connection to the COVID-19 pandemic. To combat the spread of the coronavirus, health officials around the world urged and/or mandated citizens to wear facemasks and adopt physical distancing measures. These health policies and guidelines have become highly politicized in some pa...

Pandemic preparedness and COVID-19 response indicators focus on public health outcomes (such as infections, case fatalities, and vaccination rates), health system capacity, and/or the effects of the pandemic on the economy, yet this avoids more political questions regarding how responses were mobilized. Pandemic preparedness country rankings have b...

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political...

The COVID-19 pandemic and subsequent policy responses continue to have widespread social and economic effects across the globe. These effects are not experienced equally. Taking Lagos as a case study, we explored gendered and differential effects of COVID-19 and subsequent policy responses on paid and unpaid work. Using an intersectionality framewo...

Recognition of the differential effects of COVID-19 on women has led to calls for greater application of gender-based analysis within policy responses. Beyond pointing out where such policies are implemented, there is little analysis of the effects of efforts to integrate gender-based analysis into the COVID-19 response. Drawing on interviews infor...

Objective To explore midwives’ experiences working on the frontlines of the COVID-19 pandemic in British Columbia, Canada. Design Qualitative study involving three semi-structured focus groups and four in-depth interviews with midwives. Setting The COVID-19 pandemic in British Columbia, Canada from 2020-2021. Participants 13 midwives working dur...

As with previous global public health emergencies, the COVID-19 pandemic has had distinct and disproportionate impacts on women and their health and livelihoods. As the leader in global public health, it is incumbent upon the World Health Organization (WHO) to ensure gender is prioritized in pandemic response. We conducted a policy analysis of 338...

Social media can be both a source of information and misinformation during health emergencies. During the COVID-19 pandemic, social media became a ubiquitous tool for people to communicate and represents a rich source of data researchers can use to analyse users’ experiences, knowledge and sentiments. Research on social media posts during COVID-19...

Background Throughout the COVID-19 pandemic, as measures have been taken to both prevent the spread of COVID-19 and provide care to those who fall ill, healthcare workers have faced added risks to their health and wellbeing. These risks are disproportionately felt by women healthcare workers, yet health policies do not always take a gendered approa...

Objectives This paper analyzes results from focus groups held with women physicians in British Columbia which explored questions around how gender norms and roles influenced their experiences during COVID-19. Methods Four virtual focus groups were organized between July and September 2020. Participants ( n = 27) were voluntarily recruited. Data we...

Evidence shows that infectious disease outbreaks are not gender-neutral, meaning that women, men, and gender minorities are differentially affected. This evidence affirms the need to better incorporate a gender lens into infectious disease outbreaks. Despite this evidence, there has been a historic neglect of gender-based analysis in health, includ...

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific com...

The global COVID-19 pandemic has brought unprecedented attention to the relationship between gender inequality and global health security. Within this context, Canada is well placed, due to its foreign and domestic policy commitments to advancing gender equity, to take a leadership role in addressing the disproportionate impact of COVID-19 on women...

We collected over 50 million tweets referencing COVID-19 to understand the public’s gendered discourses and concerns during the pandemic. We filtered the tweets based on English language and among three gender categories: men, women, and sexual and gender minorities. We used a mixed-method approach that included topic modelling, sentiment analysis,...

Background Sugar-sweetened beverages (SSBs) are the leading global source of added sugar intake and their consumption is associated with negative health outcomes, such as diabetes, cancers, cardiovascular diseases, and overall mortality. Despite consensus within the public health community about the need to reduce sugar intake, the non-alcoholic be...

Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is a...

The coronavirus disease 2019 (COVID-19) pandemic poses particular challenges for migrant workers around the world. This study explores the unique experiences of foreign domestic workers (FDWs) in Hong Kong, and how COVID-19 impacted their health and economic wellbeing. Interviews with FDWs (n = 15) and key informants (n = 3) were conducted between...

The coronavirus disease 2019 (COVID-19) pandemic poses particular challenges for migrant workers around the world. This study explores the unique experiences of foreign domestic workers (FDWs) in Hong Kong, and how COVID-19 impacted their health and economic wellbeing. Interviews with FDWs (n = 15) and key informants (n = 3) were conducted between...

Background While there is widespread recognition of global health failures when it comes to infectious disease outbreaks, there is little discussion on how policy-makers and global health organizations can learn to better prepare and respond. Serious games provide an underutilized tool to promote learning and innovation around global health crises....

Commercial tobacco products are a leading contributor to health disparities for many Indigenous peoples. Mainstream interventions developed for non-Indigenous peoples have been found less effective at addressing these disparities. Meaningful engagement is needed to develop effective measures but there are limited understandings of what engagement m...

Background The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public’s gendered discourses about the pandemic. Objective T...

There is growing recognition that diversifying away from tobacco farming can contribute to progress towards the Sustainable Development Goals in lower‐ and middle‐income countries. However, diversification projects are often limited in scope and impact. This paper analyses structural barriers to tobacco diversification and opportunities to challeng...

COVID-19 has been declared a public health emergency of international concern and a global pandemic by the World Health Organization. This global threat to health security underscores the urgent need to accelerate progress on achieving Sustainable Development Goal (SDG) 3 and the need to massively scale up international cooperation to deliver on SD...

The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure. The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sh...

BACKGROUND The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public’s gendered discourses about the pandemic. OBJECTIVE T...

Could covid-19 help unravel gender norms?

While debates continue about China’s role in sub-Saharan Africa, there is growing consensus that China is a different kind of development partner. One distinct feature of Chinese partnerships is that they include support for the tobacco industry, a sector other donor states and institutions shun. Not only is tobacco a primary agricultural export in...

Recent research documents the globalization strategy of the Chinese tobacco industry since the early 2000s and risks posed to global health. There are limited analyses to date of how this strategy is playing out in specific countries. This paper analyses the expansion of the China National Tobacco Company (CNTC) in Zimbabwe, the largest producer of...

The recent perspective article "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention, " by Lencucha and Throw, interrogates how the dominant neoliberal paradigm restricts meaningful policy action to prevent non-communicable diseases (NCDs). It contributes an NCD perspective to the existing literatu...

This article contributes to discussions on the gender dimensions of disease outbreaks, and preparedness policies and responses, by providing a multi-level analysis of gender-related gaps, particularly illustrating how the failure to challenge gender assumptions and incorporate gender as a priority at the global level has national and local impacts....

Most of the research on transnational advocacy networks documents progressive, voluntary movements, motivated by values associate with human rights and public goods. There is little critical reflection on the role of corporations within such networks or on the material motivations behind movements. Meanwhile literature on corporate political strate...

Introduction The illicit trade in tobacco products (ITTP) is widely recognised as a substantial and complex problem in Canada. However, the independence of available data and quality of analyses remains unknown. Reliable and accurate data on the scale and causes of the problem are needed to inform effective policy responses. Methods We searched th...

The influence of for-profit businesses in collective action across countries to protect and promote population health dates from the first International Sanitary Conferences of the nineteenth century. The restructuring of the world economy since the late twentieth century and the growth of large transnational corporations have led the business sect...

Tobacco industry public relations campaigns have played a key role in challenges to standardised cigarette packaging. This paper presents a comparative analysis of industry campaigns in Australia and the United Kingdom, which have implemented standardised packaging legislation; Canada, where policy has been adopted but not yet implemented; and the...

Malawi, the world’s most tobacco dependent country, has long defended the tobacco industry as essential to its economy. The impoverished living conditions of tobacco farmers, however, raise questions about the true benefits accruing to the country. While the government and industry often blame public health advocates for declining leaf prices, and...

Civil society organizations (CSOs) are recognized as playing an exceptional role in the global AIDS response. However, there is little detailed research to date on how they contribute to specific governance functions. This article uses Haas' framework on global governance functions to map CSO's participation in the monitoring of global commitments...

The illicit tobacco trade accounts for 10% of the global cigarette market and results in US$31 billion in lost tax revenues annually. Despite legal prosecution of tobacco companies, and the introduction of new policy responses, the trade has reached an all-time high. Previous research documents how transnational tobacco companies have sought to inf...

Background: The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) stands to significantly reduce tobacco-related mortality by accelerating the introduction of evidence-based tobacco control measures. However, the extent to which States Parties have implemented the Convention varies considerably. Article 5.3 of the FCTC,...

This article argues that despite a history of championing HIV/AIDS as a human rights issue, and rhetorical commitment to health as a human right by European states and institutions, since the economic recession of 2008, both have shifted from a rights-based response to a risk management approach to the epidemic. An interdisciplinary perspective is...

• In May 2016, the Canadian government announced a public consultation on plain and standardized packaging for tobacco products, which closes on Aug. 31, 2016. • When the Australian government introduced plain packaging in 2011, tobacco companies tried to use trade law, intellectual property rights and biased research by allied institutions to thwa...

Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. We argue, using illustrative examples, that a robust civil society...

Amid growing academic and policy interest in the influence of think tanks in public policy processes, this article demonstrates the extent of tobacco industry partnerships with think tanks in the USA, and analyzes how collaborating with a network of think tanks facilitated tobacco industry influence in public health policy. Through analysis of docu...

This article analyzes the history of tobacco industry funding for the AIDS response - a largely ignored aspect of private donor involvement. Primary documents from the Legacy Tobacco Documents Library and AIDS organizations are analyzed, alongside existing literature on the tobacco control and AIDS responses. Research on the tactics of transnationa...

Human history has been shaped by shifting patterns of health and disease. Many of the factors influencing those patterns have spanned national borders, such as human and animal migration, armed conflict, colonization, trade and investment, globalization, and environmental change. International studies scholars’ interest in health and disease has sl...

Through a convergence of activism and policy approaches, the HIV/AIDS epidemic in Sub-Saharan Africa has been framed as exceptional, with AIDS exceptionalism referring to arguments that the epidemic requires a response above and beyond that of other health interventions. Civil society organizations (CSOs) used the AIDS exceptionalism frame to justi...

This article provides a critical perspective on global health initiatives (GHIs) in response to HIV/AIDS in post-conflict African countries. Focusing on the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and UN bodies, it argues that many global health initiatives lack consideration of the co...

The idea that HIV and AIDS gets too much attention and funding emerged in 2008 with a call to end 'AIDS exceptionalism.' This article outlines a short history of AIDS exceptionalism — the idea that HIV and AIDS require a response above and beyond 'normal' health interventions and is privileged in terms of attention and resources when compared with...

In the history of public health, HIV/AIDS is unique; it has widespread and long-lasting demographic, social, economic and political impacts. The global response has been unprecedented. AIDS exceptionalism - the idea that the disease requires a response above and beyond "normal" health interventions - began as a Western response to the originally te...

There has been a renewed debate over whether AIDS deserves an exceptional response. We argue that as AIDS is having differentiated impacts depending on the scale of the epidemic, and population groups impacted, and so responses must be tailored accordingly. AIDS is exceptional, but not everywhere. Exceptionalism developed as a Western reaction to a...