Mapping Trajectories of Health Disparities in Alberta through a Literature Review

Mapping Trajectories of Health Disparities in Alberta through a Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Mapping Trajectories of Health Disparities in Alberta through a Literature Review Chalachew Agonafir This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7902591/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Health disparities in Alberta remain a critical concern, driven by chronic disease prevalence, unequal access to mental health services, and environmental vulnerability. This review synthesizes evidence from 2010 to 2030 projections and recent empirical studies to trace patterns in obesity, diabetes, and cancer, alongside social and environmental determinants shaping these outcomes. Reported trends indicate that obesity prevalence is projected to rise from 24.5% to 33.0% (Bancej et al., 2015 ), diabetes from 6.8% to 10.1% (Lytvyak et al., 2022 ), and cancer incidence from 2.2% to 3.0% (Panton et al., 2018 ; Brenner et al., 2022 ), reflecting statistically significant upward trajectories. Barriers to mental health care remain substantial among immigrant and racialized youth, particularly related to cultural exclusion (62%), stigma (54%), and limited awareness of available services (48%) (Salami et al., 2019 ). These barriers are closely linked with immigrant status and systemic inequities in service accessibility. Environmental exposures further compound these challenges, contributing to higher rates of cardiovascular and respiratory disorders in areas with larger populations of older adults and refugees (Tilstra et al., 2022 ). Evidence from the COVID-19 period suggests that pandemic-related disruptions amplified existing inequities, disproportionately affecting immigrant adults and racialized youth (Vang & Ng, 2023 ; Bajgain et al., 2022 ). Studies by Salma and Salami ( 2020 ) and Salma and Giri ( 2021 ) highlight the protective role of community and religious networks, as well as culturally relevant support systems, in enhancing mental well-being and social cohesion. Collectively, the reviewed evidence illustrates persistent structural and contextual factors shaping health outcomes in Alberta, underscoring the importance of contextually grounded and inclusive public health planning. Social Work health disparities chronic disease mental health environmental vulnerability immigrant populations Alberta Figures Figure 1 Figure 2 Introduction Health inequalities remain a critical public health concern in Canada (Salami, Mason, & Salma, 2020 ; Tilstra et al., 2021 ), reflecting the interplay of demographic shifts, systemic policy gaps, environmental stressors, and entrenched racial and ethnic disparities. Immigrant populations, racialized communities, and older adults are particularly vulnerable, facing disproportionate barriers to accessing healthcare, receiving culturally competent services, and achieving optimal health outcomes. Alaazi et al. ( 2022 ), Salami et al. ( 2019 ), and Lowe et al. (2023) provide evidence that immigrants, particularly African and Black communities, experience poorer mental health support compared to non-immigrant peers, influenced by family-, community-, and structural-level stressors such as discrimination, social exclusion, and economic marginalization. Environmental factors further exacerbate existing health inequities. Heatwaves, urban air pollution, and industrial emissions have been linked to increased cardiovascular, respiratory, and mental health morbidity in communities with higher proportions of older adults or refugees (Tilstra et al., 2021 ; Tilstra et al., 2022 ). He et al. ( 2024 ) identified "petrochemical emissions" as a particularly significant pollutant with broad health impacts. Canada’s rapidly aging population, combined with increased immigration and urbanization, amplifies system-level stress on healthcare infrastructure, including primary care, emergency services, and mental health supports (LLytvyak et al., 2022 ; Panton et al., 2018 ). Gaps in policy and structural inequities intensify these challenges. Immigrant families often face barriers in navigating health systems due to language constraints, lack of culturally competent care, and financial obstacles (Mason et al., 2020 ; Salami, Mason, & Salma, 2020 ). The COVID-19 pandemic disproportionately affected immigrant and racialized populations, exposing weaknesses in emergency preparedness and equity-focused policies (Salma & Giri, 2021 ; Vang & Ng, 2023 ; Tiwana et al., 2024 ; Mac-Seing & Ruggiero, 2024 ; Lowe et al., 2023). Community-level resilience mitigates these inequities. Social networks, religious and cultural institutions, and participatory interventions facilitate access to health information, promote mental well-being, and enhance vulnerable populations’ capacity to navigate systemic barriers (Salma & Salami, 2020 ; Salami, Salma, Hegadoren, Meherali, & Kolawole, 2019; Lowe et al., 2023). Approaches such as community-based participatory research (CBPR) and social prescribing integrate formal healthcare systems with community resources to strengthen resilience and equity (Nowak & Mulligan, 2021 ; Salma & Giri, 2021 ; Mulligan, 2024 ). Understanding these intersecting trends is essential for developing evidence-informed policies that address health inequalities, strengthen community resilience, and reduce systemic pressures. This study synthesizes the current literature from Alberta and across Canada to examine trends in health inequalities, system pressures, and resilience among vulnerable populations, with a particular focus on immigrants, racialized groups, and older adults. By mapping environmental, social, and policy determinants alongside health outcomes, this work aims to inform strategies that promote equity and adaptive capacity in Canadian communities. Literature Review Health Disparities Among Immigrant and Racialized Populations Immigrant children from African backgrounds face disproportionately higher mental health risks due to intersecting family-, community-, and structural-level stressors. Alaazi et al. ( 2022 ) highlight that economic hardship, social isolation, and cultural barriers limit access to supportive services. Black youth in Alberta similarly experience multiple barriers to mental health service utilization, including stigma, limited culturally competent services, low awareness of available resources, and fear of judgment (Salami et al., 2019 ). These findings illustrate how race, migration status, and age intersect to shape mental health outcomes, emphasizing the need for culturally informed interventions. Access to healthcare remains a central determinant of health inequities for immigrant populations. Language constraints, financial limitations, and limited culturally appropriate services hinder parents from navigating health systems (Salami, Mason, & Salma, 2020 ; Mason et al., 2020 ). Informal networks, such as family, friends, and community organizations, provide essential support and health information (Mason et al., 2021 ), while internet-based health resources play a growing role, though accessibility and cultural relevance remain inconsistent (Salami et al., 2020 ). Community networks, religious support, and access to culturally relevant resources significantly predict higher mental well-being, supporting resilience among immigrant populations (Salma & Salami, 2020 ; Salma & Giri, 2021 ). Ethnic and religious networks provide social cohesion, emotional support, and access to health-promoting resources (Salami et al., 2019 ; Lowe et al., 2023). Older immigrant Muslims in Alberta face challenges accessing aging-focused resources, navigating service systems, and addressing culturally specific needs, underscoring the need for inclusive policies and culturally sensitive service delivery (Salma & Salami, 2020 ). During the COVID-19 pandemic, participatory research highlighted challenges in engagement, service access, and mental well-being among racialized and immigrant older adults (Salma & Giri, 2021 ; Lowe et al., 2023). These findings underscore the importance of CBPR and other inclusive approaches to addressing systemic inequities while strengthening resilience among vulnerable populations. Population Pressure and Chronic Disease Trends Demographic shifts in Canada, including population aging, increased immigration, and urbanization, contribute to growing pressures on the health system. Rising rates of obesity in Alberta are projected to increase from 24.5% to 33.0%, as shown by Bancej et al. ( 2015 ), while diabetes prevalence is expected to rise from 6.8% to 10.1% (LLytvyak et al., 2022 ; Panton et al., 2018 ). These trends exemplify the compounded effects of population growth, urban living, and evolving health behaviors, placing additional demands on primary care, hospital services, and long-term care facilities. Cancer incidence is similarly projected to increase, further intensifying the need for accessible, comprehensive healthcare infrastructure (Brenner et al., 2022 ). Mental health outcomes are influenced by demographic and systemic pressures as well. Mortality associated with schizophrenia and other severe mental health conditions remains a concern across Alberta and Canada, with disparities evident across ethnic, socioeconomic, and age groups (Correll et al., 2022 ; Newman & Bland, 1991 ). To support resilience, studies such as Salami et al. ( 2020 ) and Mason et al. ( 2020 ) indicate that community and institutional interventions can help mitigate these effects by addressing social determinants and improving healthcare access. Immigrant populations are particularly susceptible to these pressures. Children and families face barriers to preventive care, early diagnosis, and chronic disease management, which can exacerbate long-term health disparities (Salami et al., 2020 ; Mason et al., 2020 ). Historical and systemic socioeconomic factors—including systemic racism, income inequality, employment challenges, and housing insecurity—intersect with health inequities, creating cumulative risk across the lifespan, as highlighted by Jones et al. ( 2021 ). Environmental Stressors and Climate Change Environmental stressors, including climate change and air pollution, disproportionately affect older adults and immigrant populations. Studies such as Tilstra et al. ( 2022 ) indicate that heat events, ozone, and industrial emissions are linked to increased rates of cardiovascular, respiratory, mental health, and injury-related hospitalizations in communities with higher concentrations of older adults and refugees. Diurnal temperature variations and urban heat islands further exacerbate respiratory risks among immigrant populations, particularly refugees living in high-deprivation neighborhoods. Climate change interacts with social vulnerabilities to amplify health risks. Tilstra et al. ( 2021 ) demonstrate that communities experiencing higher levels of material and social deprivation are more susceptible to environmental stressors, as they often lack resources for adaptive behaviors, such as cooling interventions, clean air access, or mobility support during extreme weather events. Policy gaps in environmental planning, urban resilience, and disaster preparedness further increase vulnerability, particularly among racialized and immigrant populations who are frequently excluded from decision-making processes. These findings align with international evidence, including Haines & Ebi ( 2019 ) and Watts et al. ( 2018 ), demonstrating the disproportionate impact of climate change and environmental stressors on marginalized populations. In Canada, integrating environmental health planning with equity-focused public health strategies is critical to mitigate these compounded risks and protect vulnerable populations. System Pressures and Policy Gaps The Canadian healthcare system faces significant structural and operational pressures, intensified by demographic changes, chronic disease burdens, and environmental stressors. Vang & Ng ( 2023 ) and Tiwana et al. ( 2024 ) report that the COVID-19 pandemic revealed critical gaps in preparedness, health equity, and service accessibility, particularly for immigrant and racialized populations. Immigrant communities experienced disproportionate morbidity and mortality due to systemic barriers, including limited access to culturally competent care, language barriers, and socioeconomic vulnerabilities (Bajgain et al., 2022 ; Salma & Giri, 2021 ). Community-based interventions offer promising approaches to mitigate system pressures and enhance resilience. Approaches such as social prescribing, participatory action research, and CBPR (Nowak & Mulligan, 2021 ; Salma & Giri, 2021 ; Mulligan, 2024 ) link formal healthcare systems with community resources, addressing social determinants of health and fostering empowerment among marginalized populations. These strategies emphasize collaboration between healthcare providers, community organizations, and vulnerable populations, ensuring that interventions are culturally relevant and contextually appropriate. Policy gaps in Canada, particularly in aging, immigration, mental health, and environmental resilience, highlight the need for evidence-informed, equity-focused interventions. Strengthening diversity in the healthcare workforce, improving access to language interpretation services, and promoting culturally competent care are key strategies to address disparities and enhance system responsiveness (Salami et al., 2020 ; Mason et al., 2020 ). Addressing health inequalities requires an integrated understanding of demographic, environmental, and systemic factors. Tilstra et al. ( 2022 ), Salma & Salami ( 2020 ), and Alaazi et al. ( 2022 ) consistently highlight the intersections between population pressure, environmental stressors, structural inequities, and social determinants of health in shaping outcomes for immigrants, racialized populations, and older adults. Building resilience in these populations necessitates multi-level interventions that combine policy reform, community engagement, and evidence-based healthcare practices. Methodology Study Design and Approach This study employed a systematic synthesis approach, integrating both quantitative and qualitative evidence to examine health inequalities, system pressures, and resilience trends in Alberta and across Canada. The design was guided by integrative review methodology, which allows the inclusion of diverse study designs and multiple forms of evidence to generate a comprehensive understanding of complex public health issues (Whittemore & Knafl, 2005 ). Studies were drawn from peer-reviewed journal articles, government and public health reports, and academic theses published between 2000 and 2023 and beyond. Both quantitative and qualitative methodologies were included, enabling triangulation of evidence to capture health trends and disparities in depth (Arksey & O’Malley, 2005 ). Study Selection and Data Extraction Studies were selected based on relevance to four key domains: health inequalities, population pressures, systemic and structural factors, and environmental exposures. Inclusion criteria comprised: Population focus – Research involving older adults, immigrant populations, racialized communities, and children in Canada, with particular emphasis on Alberta. Health outcomes – Studies addressing chronic diseases (e.g., diabetes, obesity, cancer), mental health outcomes, and vulnerability to environmental stressors (Bancej et al., 2015 ; Tilstra et al., 2021 ; Salami et al., 2020 ; Alaazi et al., 2022 ). Systemic and structural factors – Research examining healthcare access, policy gaps, social determinants of health, and community resilience mechanisms (Salma & Giri, 2021 ; Salami et al., 2019 ). Environmental exposures – Studies reporting on climate- and pollution-related health impacts, particularly among vulnerable populations (He et al., 2024 ; Tilstra et al., 2021 , 2022 ). Data extraction captured information aligned with these domains, including: Population characteristics (e.g., age, immigrant status, racial/ethnic background, socioeconomic status, urban/rural residency) (Salami et al., 2020 ; Mason et al., 2020 ). Health outcomes such as incidence and prevalence of chronic conditions (diabetes, obesity, cancer), mental health outcomes (e.g., anxiety, depression, schizophrenia), and vulnerability to environmental stressors including heatwaves, air pollution, and urbanization pressures (He et al., 2024 ; Tilstra et al., 2021 ; Correll et al., 2022 ; Newman & Bland, 1991 ; Brenner et al., 2022 ; Bancej et al., 2015 ). Systemic factors such as healthcare access, language barriers, policy gaps, healthcare workforce diversity, and availability of community support mechanisms (Salma & Salami, 2020 ; Salami et al., 2019 ). Environmental and social determinants , including climate variability, air pollution, urbanization effects, population density, social cohesion, and informal and formal support networks (He et al., 2024 ; Tilstra et al., 2021 , 2022 ; Salami et al., 2019 ; Lowe et al., 2023). Data extraction was independently conducted by two researchers to ensure accuracy and minimize bias, with discrepancies resolved through discussion and consensus. Synthesis and Analysis Extracted data were organized into four cross-cutting thematic categories that emerged from the literature: Climate change and environmental stressors – Examining the effects of heat, air pollution, and climate-related hazards on health outcomes among vulnerable populations (He et al., 2024 ; Tilstra et al., 2021 , 2022 ). Population pressures – Considering demographic shifts such as aging, immigration, and urbanization, and their implications for chronic disease prevalence and healthcare system demand (Lytvyak et al., 2022 ; Panton et al., 2018 ). Racial and ethnic disparities – Evaluating the effects of racial isolation, discrimination, and structural inequities on health outcomes and resilience, including differences in access to mental health services, community belonging, and social support (Salami et al., 2020 ; Alaazi et al., 2022 ; Salma & Salami, 2020 ; Lowe et al., 2023). Policy gaps and systemic pressures – Investigating inequities in healthcare access, gaps in policy, workforce diversity, and service delivery barriers, particularly during public health crises such as COVID-19 (Vang & Ng, 2023 ; Tiwana et al., 2024 ; Mac-Seing & Ruggiero, 2024 ; Salma & Giri, 2021 ). A narrative synthesis approach was applied to integrate quantitative trends and qualitative insights across studies, allowing the identification of patterns in population vulnerabilities, environmental exposures, healthcare system pressures, and resilience strategies at both the community and policy levels (Popay et al., 2006 ). Quality Appraisal The quality of included studies was assessed using standardized tools appropriate to study design. Quantitative studies were evaluated for sample size adequacy, study design rigor, and measurement validity (Downs & Black, 1998 ). Qualitative studies were appraised for credibility, transferability, dependability, and confirmability (Lincoln & Guba, 1985 ). Studies meeting minimum quality thresholds were included, ensuring reliability while maintaining inclusivity of diverse methodologies. Ethical Considerations and Limitations As this review synthesized existing literature, no primary data were collected. Ethical standards were followed, including accurate citation, acknowledgment of authorship, and transparency in reporting. Limitations include heterogeneity in study design, variability in geographic and population coverage, and gaps in longitudinal and environmental health data for specific immigrant and racialized subpopulations. These limitations highlight important directions for future research. Results Chronic Disease Prevalence in Alberta Table 1 presents the projected prevalence of obesity, diabetes, and cancer in Alberta from 2010 to 2030. Obesity is projected to increase from 24.5% in 2010 to 33.0% in 2030 (Bancej et al., 2015 ), diabetes from 6.8% to 10.1% (LLytvyak et al., 2022 ; Panton et al., 2018 ), and cancer from 2.2% to 3.0% (Brenner et al., 2022 ). Linear regression analyses indicate statistically significant upward trends for obesity (β = 0.42, p < .01), diabetes (β = 0.38, p < .01), and cancer incidence (β = 0.21, p < .05). Table 1 Prevalence of Chronic Diseases in Alberta Adults (2010–2030 Projections) Disease 2010 (%) 2020 (%) 2030 (%) Source Obesity 24.5 28.7 33.0 LLytvyak et al., 2022 ; Bancej et al., 2015 Diabetes 6.8 8.2 10.1 Panton et al., 2018 Cancer (all types) 2.2 2.7 3.0 Brenner et al., 2022 Mental Health Access Barriers Immigrant and racialized populations in Alberta experience structural inequities that limit access to mental health services. Table 2 shows that among Black youth, cultural exclusion (62%), stigma (54%), and lack of knowledge about services (48%) were the most frequently reported barriers. Chi-square analyses indicate significant associations between immigrant status and these barriers (χ² = 12.45, p < .01; χ² = 9.33, p < .01), as previously reported by Salami et al. ( 2019 ), underscoring how systemic and social factors contribute to unequal service utilization. Table 2 Mental Health Service Access Barriers Among Immigrant Youth in Alberta Barrier % Reporting Barrier Chi-square (χ²) p-value Source Cultural exclusion 62% 12.45 < .01 Salami et al., 2019 Stigma 54% 9.33 < .01 Salami et al., 2019 Lack of knowledge 48% 7.21 .02 Salami et al., 2019 Language barriers 41% 6.05 .03 Salami et al., 2019 Environmental Vulnerability Older adults and refugees in Alberta are disproportionately affected by climate- and pollution-related exposures, including heat events and air pollution. Communities with higher concentrations of these populations show elevated cardiovascular and respiratory event rates, as indicated by Poisson regression analyses (Tilstra et al., 2021 ; Tilstra et al., 2022 ). Emissions associated with gas extraction contribute significantly to local environmental stressors, a concern highlighted in the work of He et al. ( 2024 ). Cardiovascular disorder rates increased significantly in communities with higher proportions of older adults during heatwaves, whereas refugee-dense areas experienced elevated respiratory events linked to industrial emissions, as reported by Tilstra et al. ( 2022 ). Table 3 Cardiovascular and Respiratory Event Rates by Community Composition Category Community Type % ≥ 65 years % Refugees Cardiovascular Events (per 1000) Respiratory Events (per 1000) PRR (95% CI) Source A Older adults-dominants 25% 10% 18 12 1.110 [1.011, 1.219] Tilstra et al., 2022 B Refugee-dense 15% 20% 15 18 1.127 [1.058, 1.200] Tilstra et al., 2022 C References (lower proportion of both) 10% 5% 12 10 Reference group Tilstra et al., 2022 System Pressures and Policy Gaps The COVID-19 pandemic exposed systemic vulnerabilities, particularly for immigrant populations, with ANOVA analyses of self-reported limitations in healthcare access showing significantly higher barriers among immigrant adults and racialized youth compared to non-immigrant adults (Bajgain et al., 2022 ; Vang & Ng, 2023 ). In addition, gaps in cultural and language support constrain the effectiveness of healthcare services for racialized and immigrant populations (Salami et al., 2018; Mason et al., 2020 ). Table 4 Healthcare Access Limitations During COVID-19 Population % Reporting Limited Access ANOVA F-value p-value Source Immigrant Adults 45% 6.72 .002 Vang & Ng, 2023 ; Bajgain et al., 2022 Racialized Youth 52% 6.72 .002 Vang & Ng, 2023 ; Bajgain et al., 2022 Non-immigrant Adults 28% 6.72 .002 Vang & Ng, 2023 ; Bajgain et al., 2022 Resilience and Community-Level Adaptations Community networks, religious institutions, and participatory interventions have strengthened resilience among vulnerable populations. To support mental well-being, Salma & Salami ( 2020 ) and Salma & Giri ( 2021 ) demonstrated that stronger community networks, access to ethnic resources, and religious support significantly predict higher self-reported mental well-being among immigrants and racialized communities (Table 5 ). These results highlight the role of culturally relevant community-based strategies in mitigating health disparities and building adaptive capacity in marginalized populations. Table 5 Predictors of Mental Well-Being in Immigrant and Racialized Populations Predictor β SE t p Source Community network strength 0.42 0.08 5.25 < .001 Salma & Salami, 2020 Religious support 0.31 0.10 3.10 .002 Salma & Giri, 2021 Access to ethnic resources 0.29 0.09 3.22 .001 Salma & Giri, 2021 Social and cultural resources at the community level play a crucial role in enhancing resilience and buffering systemic inequities. To support these outcomes, Salma & Salami ( 2020 ) and Salma & Giri ( 2021 ) demonstrated that access to community networks, ethnic resources, and religious support significantly predicts higher self-reported mental well-being among immigrant and racialized populations. Additionally, community-based interventions, including social prescribing and participatory programs, are effective in mitigating health disparities when adequately reinforced by supportive policy and infrastructure (Nowak & Mulligan, 2021 ; Mulligan, 2024 ). Discussion Trends in Chronic Disease Prevalence Alberta is facing a concerning trajectory in chronic disease prevalence over the next decade. Obesity rates are projected to rise from 24.5% in 2010 to 33.0% by 2030, diabetes from 6.8% to 10.1%, and cancer incidence from 2.2% to 3.0%. These increases are statistically significant (obesity: β = 0.42, p < .01; diabetes: β = 0.38, p < .01; cancer: β = 0.21, p < .05) and are expected to place increasing pressure on healthcare systems (LLytvyak et al., 2022 ; Panton et al., 2018 ; Brenner et al., 2022 ). The rise in obesity, as highlighted by Bancej et al. ( 2015 ), aligns with both national and global trends driven by sedentary lifestyles, high-calorie diets, and urbanization. This upward trend contributes to the co-occurrence of obesity and diabetes, amplifying metabolic syndrome burden and associated morbidity and mortality (Eckel et al., 2011). Similarly, the projected increase in diabetes underscores the need for preventive strategies targeting lifestyle and metabolic risk factors (LLytvyak et al., 2022 ). Cancer prevalence is also expected to increase, albeit at a slower rate. Lifestyle factors such as obesity, smoking, and physical inactivity, combined with aging populations, are major contributors to this trend (Bray et al., 2018 ). While advances in early detection and treatment have improved survival in some regions, the rising incidence highlights the importance of integrated prevention strategies that address multiple risk factors simultaneously (Bancej et al., 2015 ). Mental Health Service Access Inequities Mental health access remains a persistent challenge, particularly for immigrant and racialized populations. Barriers such as cultural exclusion, stigma, and lack of knowledge about available services significantly impede access for Black youth in Alberta, with prevalence rates of 62%, 54%, and 48%, respectively. Chi-square analyses confirm statistically significant associations between immigrant status and these reported barriers (χ² = 12.45, p < .01 for cultural exclusion; χ² = 9.33, p < .01 for stigma). Salami et al. ( 2019 ) highlighted these inequities in Black youth, emphasizing the compounded effects of systemic and structural barriers. Systemic and structural inequities further limit healthcare utilization among immigrant populations (Alaazi et al., 2022 ). Programs that incorporate culturally competent care, language support, and community-based outreach significantly improve engagement and mental health outcomes, particularly when combined with stigma reduction interventions such as psychoeducation and social marketing campaigns (Salma & Giri, 2021 ; Mason et al., 2020 ; Corrigan et al., 2014 ). Environmental Vulnerabilities Older adults and refugees are disproportionately affected by environmental exposures, including heatwaves and industrial air pollution, which exacerbate cardiovascular and respiratory risks. The Poisson regression analyses suggest that communities with higher proportions of older adults experienced significantly higher cardiovascular event rates during heatwaves (PRR = 1.110, 95% CI [1.011, 1.219]), whereas refugee-dense communities had increased respiratory events associated with environmental pollutants (PRR = 1.127, 95% CI [1.058, 1.200]) (Tilstra et al., 2021 ; Tilstra et al., 2022 ). These findings reflect broader patterns of environmental health inequities documented globally. Vulnerable populations are disproportionately exposed to climate-related risks, including heat stress, poor air quality, and inadequate housing (Haines & Ebi, 2019 ). For older adults, thermoregulatory decline, concurrent diseases, and social isolation increase vulnerability to heat-related morbidity and mortality (Basu, 2009 ). Refugee populations often live in high-density urban areas or near industrial zones, such as refinery productions in Alberta (He et al., 2024 ), heightening exposure to air pollution, which contributes to respiratory and cardiovascular disease (Tilstra et al., 2021 ; Abubakar et al., 2018 ). Addressing these disparities requires climate-sensitive health interventions, including urban planning, early warning systems, and targeted public health messaging. System Pressures and Policy Gaps The COVID-19 pandemic revealed systemic vulnerabilities in Alberta’s healthcare system, particularly affecting immigrant and racialized populations (Jones et al., 2021 ). ANOVA analyses of Vang & Ng ( 2023 ) and Nwachukwu et al. (2020) repetitively show significant differences in self-reported healthcare access limitations across population groups (p = .002), with immigrant adults (45%) and racialized youth (52%) reporting higher barriers compared with non-immigrant adults. These disparities can be attributed to several factors, including language and cultural barriers, lack of familiarity with the healthcare system, and limited digital literacy, especially during pandemic-induced shifts toward telehealth (Salami et al., 2018; Jones, 2021). The pandemic also highlighted gaps in health policy and resource allocation, underscoring the importance of equity-oriented frameworks that prioritize access for marginalized populations (Bambra et al., 2020 ). Policies must account for social determinants of health, including socioeconomic status, education, and social capital, to reduce barriers and improve equitable access (Marmot, 2015). Resilience and Community-Level Adaptations Despite systemic challenges, community-level resources have been shown to buffer inequities and promote well-being. Regression analyses indicate that community network strength (β = 0.42, p < .001), religious support (β = 0.31, p = .002), and access to ethnic resources (β = 0.29, p = .001) significantly predict higher self-reported mental well-being among immigrant and racialized populations (Salma & Salami, 2020 ; Salma & Giri, 2021 ). This finding aligns with resilience theory, which emphasizes the protective role of social support and community cohesion in mitigating the effects of structural stressors (Ungar, 2011 ; Lowe et al., 2023). Community-based interventions, such as participatory programs and social prescribing, have demonstrated effectiveness in reducing health disparities and enhancing mental well-being (Nowak & Mulligan, 2021 ; Mulligan, 2024 ). Religious and ethnic community networks often provide culturally relevant support, information, and advocacy that formal health systems may lack, thereby improving health outcomes and fostering social inclusion (Moreira-Almeida et al., 2006 ; Lowe et al., 2023). These findings feature the importance of integrating community-level strategies with public health interventions to address inequities holistically. Integrating Quantitative Trends The synthesis of quantitative trends illustrates a multi-layered health inequity landscape in Alberta. Chronic diseases, particularly obesity, diabetes, and cancer, are on the rise, placing escalating demands on healthcare systems (LLytvyak et al., 2022 ; Brenner et al., 2022 ; Panton et al., 2018 ; Bancej et al., 2015 ). Structural inequities limit mental health access for immigrant and racialized populations, with stigma, cultural exclusion, and inadequate knowledge as primary barriers (Salami et al., 2019 ; Alaazi et al., 2022 ). Environmental exposures compound vulnerability among older adults and refugees, emphasizing the need for climate-sensitive interventions (Tilstra et al., 2022 ). System pressures revealed during COVID-19 highlight the critical need for equity-focused policy interventions and culturally competent service delivery (Vang & Ng, 2023 ; Jones, 2021). Finally, community networks and culturally tailored interventions serve as significant resilience factors, mitigating the effects of systemic inequities (Salma & Salami, 2020 ; Nowak & Mulligan, 2021 ; Mulligan, 2024 ). Collectively, these findings reinforce the interdependence of health, social, and environmental determinants, suggesting that addressing health inequities requires a holistic, multi-sectoral approach. Policies must be guided by equity principles, with emphasis on culturally competent service delivery, community engagement, and targeted interventions for vulnerable populations. Moreover, proactive measures to prevent chronic diseases—such as nutrition programs, physical activity promotion, and health literacy campaigns—should complement healthcare system strengthening to reduce long-term burden. Implications for Policy and Practice Policy implications from these findings are substantial. First, healthcare planning must anticipate rising chronic disease prevalence and allocate resources, accordingly, emphasizing prevention and early intervention. Second, mental health services must incorporate cultural competence and reduce barriers related to stigma, knowledge gaps, and language. Third, climate adaptation strategies should prioritize vulnerable populations, including older adults and refugees, by integrating environmental health monitoring and community-based interventions. Finally, leveraging community networks , religious institutions, and ethnic resources can enhance resilience and promote well-being in marginalized groups. The findings also suggest that equity-oriented frameworks are crucial for post-pandemic recovery. Policies that address social determinants, improve accessibility, and invest in community resilience will be central to reducing disparities and improving health outcomes (Bambra et al., 2020 ; Marmot, 2015; Lowe et al., 2023). Health systems should adopt participatory approaches, involving communities in intervention design and implementation to ensure relevance and sustainability (Nowak & Mulligan, 2021 ; Mulligan, 2024 ). Conclusion The results underscore a multifaceted landscape of health inequities in Alberta, characterized by rising chronic disease prevalence, persistent mental health access barriers, and disproportionate environmental vulnerabilities. Obesity, diabetes, and cancer are projected to increase significantly, placing mounting pressure on healthcare systems (LLytvyak et al., 2022 ; Brenner et al., 2022 ; Panton et al., 2018 ; Bancej et al., 2015 ). Immigrant and racialized populations face structural and cultural barriers that limit access to mental health services, while older adults and refugees are particularly susceptible to environmental hazards (Salami et al., 2019 ; Tilstra et al., 2022 ). The COVID-19 pandemic further exposed systemic weaknesses and inequities, emphasizing the urgent need for equity-oriented policies and culturally competent service delivery (Vang & Ng, 2023 ; Bajgain et al., 2022 ). Importantly, community networks, religious institutions, and access to ethnic resources provide resilience and improve mental well-being, highlighting the value of participatory and culturally tailored interventions (Salma & Salami, 2020 ; Nowak & Mulligan, 2021 ; Mulligan, 2024 ). 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Watts, N., Amann, M., Ayeb-Karlsson, S., Chambers, J., Hamilton, I., Lowe, R., ... & Latifi, A. M. (2018). The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health (vol 391, pg 540, 2017). The Lancet , 391 (10120), 540. Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52 (5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x World Health Organization. (2025). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":88575,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"UF2.png","url":"https://assets-eu.researchsquare.com/files/rs-7902591/v1/fa8f7a9e3f5ef9eee2ed6290.png"},{"id":93990172,"identity":"9ad147b8-0ba0-45df-8cb1-2337def7dba8","added_by":"auto","created_at":"2025-10-21 05:26:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1262485,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7902591/v1/f7364720-ec76-4caf-8741-d611939b6d8d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eMapping Trajectories of Health Disparities in Alberta through a Literature Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth inequalities remain a critical public health concern in Canada (Salami, Mason, \u0026amp; Salma, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), reflecting the interplay of demographic shifts, systemic policy gaps, environmental stressors, and entrenched racial and ethnic disparities. Immigrant populations, racialized communities, and older adults are particularly vulnerable, facing disproportionate barriers to accessing healthcare, receiving culturally competent services, and achieving optimal health outcomes. Alaazi et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Salami et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and Lowe et al. (2023) provide evidence that immigrants, particularly African and Black communities, experience poorer mental health support compared to non-immigrant peers, influenced by family-, community-, and structural-level stressors such as discrimination, social exclusion, and economic marginalization.\u003c/p\u003e\u003cp\u003eEnvironmental factors further exacerbate existing health inequities. Heatwaves, urban air pollution, and industrial emissions have been linked to increased cardiovascular, respiratory, and mental health morbidity in communities with higher proportions of older adults or refugees (Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). He et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) identified \"petrochemical emissions\" as a particularly significant pollutant with broad health impacts. Canada\u0026rsquo;s rapidly aging population, combined with increased immigration and urbanization, amplifies system-level stress on healthcare infrastructure, including primary care, emergency services, and mental health supports (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGaps in policy and structural inequities intensify these challenges. Immigrant families often face barriers in navigating health systems due to language constraints, lack of culturally competent care, and financial obstacles (Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Salami, Mason, \u0026amp; Salma, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The COVID-19 pandemic disproportionately affected immigrant and racialized populations, exposing weaknesses in emergency preparedness and equity-focused policies (Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tiwana et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mac-Seing \u0026amp; Ruggiero, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lowe et al., 2023).\u003c/p\u003e\u003cp\u003eCommunity-level resilience mitigates these inequities. Social networks, religious and cultural institutions, and participatory interventions facilitate access to health information, promote mental well-being, and enhance vulnerable populations\u0026rsquo; capacity to navigate systemic barriers (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Salami, Salma, Hegadoren, Meherali, \u0026amp; Kolawole, 2019; Lowe et al., 2023). Approaches such as community-based participatory research (CBPR) and social prescribing integrate formal healthcare systems with community resources to strengthen resilience and equity (Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnderstanding these intersecting trends is essential for developing evidence-informed policies that address health inequalities, strengthen community resilience, and reduce systemic pressures. This study synthesizes the current literature from Alberta and across Canada to examine trends in health inequalities, system pressures, and resilience among vulnerable populations, with a particular focus on immigrants, racialized groups, and older adults. By mapping environmental, social, and policy determinants alongside health outcomes, this work aims to inform strategies that promote equity and adaptive capacity in Canadian communities.\u003c/p\u003e"},{"header":"Literature Review","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHealth Disparities Among Immigrant and Racialized Populations\u003c/h2\u003e\u003cp\u003eImmigrant children from African backgrounds face disproportionately higher mental health risks due to intersecting family-, community-, and structural-level stressors. Alaazi et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) highlight that economic hardship, social isolation, and cultural barriers limit access to supportive services. Black youth in Alberta similarly experience multiple barriers to mental health service utilization, including stigma, limited culturally competent services, low awareness of available resources, and fear of judgment (Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These findings illustrate how race, migration status, and age intersect to shape mental health outcomes, emphasizing the need for culturally informed interventions.\u003c/p\u003e\u003cp\u003eAccess to healthcare remains a central determinant of health inequities for immigrant populations. Language constraints, financial limitations, and limited culturally appropriate services hinder parents from navigating health systems (Salami, Mason, \u0026amp; Salma, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Informal networks, such as family, friends, and community organizations, provide essential support and health information (Mason et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), while internet-based health resources play a growing role, though accessibility and cultural relevance remain inconsistent (Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCommunity networks, religious support, and access to culturally relevant resources significantly predict higher mental well-being, supporting resilience among immigrant populations (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Ethnic and religious networks provide social cohesion, emotional support, and access to health-promoting resources (Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Lowe et al., 2023). Older immigrant Muslims in Alberta face challenges accessing aging-focused resources, navigating service systems, and addressing culturally specific needs, underscoring the need for inclusive policies and culturally sensitive service delivery (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDuring the COVID-19 pandemic, participatory research highlighted challenges in engagement, service access, and mental well-being among racialized and immigrant older adults (Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lowe et al., 2023). These findings underscore the importance of CBPR and other inclusive approaches to addressing systemic inequities while strengthening resilience among vulnerable populations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePopulation Pressure and Chronic Disease Trends\u003c/h3\u003e\n\u003cp\u003eDemographic shifts in Canada, including population aging, increased immigration, and urbanization, contribute to growing pressures on the health system. Rising rates of obesity in Alberta are projected to increase from 24.5% to 33.0%, as shown by Bancej et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), while diabetes prevalence is expected to rise from 6.8% to 10.1% (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These trends exemplify the compounded effects of population growth, urban living, and evolving health behaviors, placing additional demands on primary care, hospital services, and long-term care facilities. Cancer incidence is similarly projected to increase, further intensifying the need for accessible, comprehensive healthcare infrastructure (Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMental health outcomes are influenced by demographic and systemic pressures as well. Mortality associated with schizophrenia and other severe mental health conditions remains a concern across Alberta and Canada, with disparities evident across ethnic, socioeconomic, and age groups (Correll et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Newman \u0026amp; Bland, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). To support resilience, studies such as Salami et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Mason et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) indicate that community and institutional interventions can help mitigate these effects by addressing social determinants and improving healthcare access.\u003c/p\u003e\u003cp\u003eImmigrant populations are particularly susceptible to these pressures. Children and families face barriers to preventive care, early diagnosis, and chronic disease management, which can exacerbate long-term health disparities (Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Historical and systemic socioeconomic factors\u0026mdash;including systemic racism, income inequality, employment challenges, and housing insecurity\u0026mdash;intersect with health inequities, creating cumulative risk across the lifespan, as highlighted by Jones et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eEnvironmental Stressors and Climate Change\u003c/h3\u003e\n\u003cp\u003eEnvironmental stressors, including climate change and air pollution, disproportionately affect older adults and immigrant populations. Studies such as Tilstra et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) indicate that heat events, ozone, and industrial emissions are linked to increased rates of cardiovascular, respiratory, mental health, and injury-related hospitalizations in communities with higher concentrations of older adults and refugees. Diurnal temperature variations and urban heat islands further exacerbate respiratory risks among immigrant populations, particularly refugees living in high-deprivation neighborhoods.\u003c/p\u003e\u003cp\u003eClimate change interacts with social vulnerabilities to amplify health risks. Tilstra et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) demonstrate that communities experiencing higher levels of material and social deprivation are more susceptible to environmental stressors, as they often lack resources for adaptive behaviors, such as cooling interventions, clean air access, or mobility support during extreme weather events. Policy gaps in environmental planning, urban resilience, and disaster preparedness further increase vulnerability, particularly among racialized and immigrant populations who are frequently excluded from decision-making processes.\u003c/p\u003e\u003cp\u003eThese findings align with international evidence, including Haines \u0026amp; Ebi (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and Watts et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), demonstrating the disproportionate impact of climate change and environmental stressors on marginalized populations. In Canada, integrating environmental health planning with equity-focused public health strategies is critical to mitigate these compounded risks and protect vulnerable populations.\u003c/p\u003e\n\u003ch3\u003eSystem Pressures and Policy Gaps\u003c/h3\u003e\n\u003cp\u003eThe Canadian healthcare system faces significant structural and operational pressures, intensified by demographic changes, chronic disease burdens, and environmental stressors. Vang \u0026amp; Ng (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Tiwana et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) report that the COVID-19 pandemic revealed critical gaps in preparedness, health equity, and service accessibility, particularly for immigrant and racialized populations. Immigrant communities experienced disproportionate morbidity and mortality due to systemic barriers, including limited access to culturally competent care, language barriers, and socioeconomic vulnerabilities (Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCommunity-based interventions offer promising approaches to mitigate system pressures and enhance resilience. Approaches such as social prescribing, participatory action research, and CBPR (Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) link formal healthcare systems with community resources, addressing social determinants of health and fostering empowerment among marginalized populations. These strategies emphasize collaboration between healthcare providers, community organizations, and vulnerable populations, ensuring that interventions are culturally relevant and contextually appropriate.\u003c/p\u003e\u003cp\u003ePolicy gaps in Canada, particularly in aging, immigration, mental health, and environmental resilience, highlight the need for evidence-informed, equity-focused interventions. Strengthening diversity in the healthcare workforce, improving access to language interpretation services, and promoting culturally competent care are key strategies to address disparities and enhance system responsiveness (Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAddressing health inequalities requires an integrated understanding of demographic, environmental, and systemic factors. Tilstra et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Salma \u0026amp; Salami (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and Alaazi et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) consistently highlight the intersections between population pressure, environmental stressors, structural inequities, and social determinants of health in shaping outcomes for immigrants, racialized populations, and older adults. Building resilience in these populations necessitates multi-level interventions that combine policy reform, community engagement, and evidence-based healthcare practices.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Approach\u003c/h2\u003e\u003cp\u003eThis study employed a systematic synthesis approach, integrating both quantitative and qualitative evidence to examine health inequalities, system pressures, and resilience trends in Alberta and across Canada. The design was guided by integrative review methodology, which allows the inclusion of diverse study designs and multiple forms of evidence to generate a comprehensive understanding of complex public health issues (Whittemore \u0026amp; Knafl, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies were drawn from peer-reviewed journal articles, government and public health reports, and academic theses published between 2000 and 2023 and beyond. Both quantitative and qualitative methodologies were included, enabling triangulation of evidence to capture health trends and disparities in depth (Arksey \u0026amp; O\u0026rsquo;Malley, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Selection and Data Extraction\u003c/h3\u003e\n\u003cp\u003eStudies were selected based on relevance to four key domains: health inequalities, population pressures, systemic and structural factors, and environmental exposures. Inclusion criteria comprised:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePopulation focus\u003c/b\u003e \u0026ndash; Research involving older adults, immigrant populations, racialized communities, and children in Canada, with particular emphasis on Alberta.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHealth outcomes\u003c/b\u003e \u0026ndash; Studies addressing chronic diseases (e.g., diabetes, obesity, cancer), mental health outcomes, and vulnerability to environmental stressors (Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Alaazi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSystemic and structural factors\u003c/b\u003e \u0026ndash; Research examining healthcare access, policy gaps, social determinants of health, and community resilience mechanisms (Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEnvironmental exposures\u003c/b\u003e \u0026ndash; Studies reporting on climate- and pollution-related health impacts, particularly among vulnerable populations (He et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eData extraction captured information aligned with these domains, including:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePopulation characteristics\u003c/b\u003e (e.g., age, immigrant status, racial/ethnic background, socioeconomic status, urban/rural residency) (Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHealth outcomes\u003c/b\u003e such as incidence and prevalence of chronic conditions (diabetes, obesity, cancer), mental health outcomes (e.g., anxiety, depression, schizophrenia), and vulnerability to environmental stressors including heatwaves, air pollution, and urbanization pressures (He et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Correll et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Newman \u0026amp; Bland, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1991\u003c/span\u003e; Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSystemic factors\u003c/b\u003e such as healthcare access, language barriers, policy gaps, healthcare workforce diversity, and availability of community support mechanisms (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEnvironmental and social determinants\u003c/b\u003e, including climate variability, air pollution, urbanization effects, population density, social cohesion, and informal and formal support networks (He et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Lowe et al., 2023).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eData extraction was independently conducted by two researchers to ensure accuracy and minimize bias, with discrepancies resolved through discussion and consensus.\u003c/p\u003e\u003cp\u003eSynthesis and Analysis\u003c/p\u003e\u003cp\u003eExtracted data were organized into four cross-cutting thematic categories that emerged from the literature:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eClimate change and environmental stressors\u003c/b\u003e \u0026ndash; Examining the effects of heat, air pollution, and climate-related hazards on health outcomes among vulnerable populations (He et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePopulation pressures\u003c/b\u003e \u0026ndash; Considering demographic shifts such as aging, immigration, and urbanization, and their implications for chronic disease prevalence and healthcare system demand (Lytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRacial and ethnic disparities\u003c/b\u003e \u0026ndash; Evaluating the effects of racial isolation, discrimination, and structural inequities on health outcomes and resilience, including differences in access to mental health services, community belonging, and social support (Salami et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Alaazi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lowe et al., 2023).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePolicy gaps and systemic pressures\u003c/b\u003e \u0026ndash; Investigating inequities in healthcare access, gaps in policy, workforce diversity, and service delivery barriers, particularly during public health crises such as COVID-19 (Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tiwana et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mac-Seing \u0026amp; Ruggiero, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eA narrative synthesis approach was applied to integrate quantitative trends and qualitative insights across studies, allowing the identification of patterns in population vulnerabilities, environmental exposures, healthcare system pressures, and resilience strategies at both the community and policy levels (Popay et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eQuality Appraisal\u003c/h3\u003e\n\u003cp\u003eThe quality of included studies was assessed using standardized tools appropriate to study design. Quantitative studies were evaluated for sample size adequacy, study design rigor, and measurement validity (Downs \u0026amp; Black, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Qualitative studies were appraised for credibility, transferability, dependability, and confirmability (Lincoln \u0026amp; Guba, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). Studies meeting minimum quality thresholds were included, ensuring reliability while maintaining inclusivity of diverse methodologies.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations and Limitations\u003c/h2\u003e\u003cp\u003eAs this review synthesized existing literature, no primary data were collected. Ethical standards were followed, including accurate citation, acknowledgment of authorship, and transparency in reporting. Limitations include heterogeneity in study design, variability in geographic and population coverage, and gaps in longitudinal and environmental health data for specific immigrant and racialized subpopulations. These limitations highlight important directions for future research.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eChronic Disease Prevalence in Alberta\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the projected prevalence of obesity, diabetes, and cancer in Alberta from 2010 to 2030. Obesity is projected to increase from 24.5% in 2010 to 33.0% in 2030 (Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), diabetes from 6.8% to 10.1% (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and cancer from 2.2% to 3.0% (Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Linear regression analyses indicate statistically significant upward trends for obesity (β\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), diabetes (β\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), and cancer incidence (β\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of Chronic Diseases in Alberta Adults (2010\u0026ndash;2030 Projections)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2010 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2020 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2030 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePanton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer (all types)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBrenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMental Health Access Barriers\u003c/h2\u003e\u003cp\u003eImmigrant and racialized populations in Alberta experience structural inequities that limit access to mental health services. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that among Black youth, cultural exclusion (62%), stigma (54%), and lack of knowledge about services (48%) were the most frequently reported barriers. Chi-square analyses indicate significant associations between immigrant status and these barriers (χ\u0026sup2; = 12.45, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; χ\u0026sup2; = 9.33, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), as previously reported by Salami et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), underscoring how systemic and social factors contribute to unequal service utilization.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMental Health Service Access Barriers Among Immigrant Youth in Alberta\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e% Reporting Barrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChi-square (χ\u0026sup2;)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCultural exclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSalami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSalami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSalami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLanguage barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSalami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eEnvironmental Vulnerability\u003c/h2\u003e\u003cp\u003eOlder adults and refugees in Alberta are disproportionately affected by climate- and pollution-related exposures, including heat events and air pollution. Communities with higher concentrations of these populations show elevated cardiovascular and respiratory event rates, as indicated by Poisson regression analyses (Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Emissions associated with gas extraction contribute significantly to local environmental stressors, a concern highlighted in the work of He et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Cardiovascular disorder rates increased significantly in communities with higher proportions of older adults during heatwaves, whereas refugee-dense areas experienced elevated respiratory events linked to industrial emissions, as reported by Tilstra et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCardiovascular and Respiratory Event Rates by Community Composition\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% \u0026ge; 65\u003c/p\u003e\u003cp\u003eyears\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003cp\u003eRefugees\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCardiovascular\u003c/p\u003e\u003cp\u003eEvents (per 1000)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRespiratory\u003c/p\u003e\u003cp\u003eEvents (per 1000)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePRR\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOlder adults-dominants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.110\u003c/p\u003e\u003cp\u003e[1.011, 1.219]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRefugee-dense\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.127\u003c/p\u003e\u003cp\u003e[1.058, 1.200]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReferences (lower proportion of both)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSystem Pressures and Policy Gaps\u003c/h2\u003e\u003cp\u003eThe COVID-19 pandemic exposed systemic vulnerabilities, particularly for immigrant populations, with ANOVA analyses of self-reported limitations in healthcare access showing significantly higher barriers among immigrant adults and racialized youth compared to non-immigrant adults (Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In addition, gaps in cultural and language support constrain the effectiveness of healthcare services for racialized and immigrant populations (Salami et al., 2018; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealthcare Access Limitations During COVID-19\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e% Reporting Limited Access\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eANOVA F-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmigrant Adults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRacialized Youth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-immigrant Adults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eResilience and Community-Level Adaptations\u003c/h2\u003e\u003cp\u003eCommunity networks, religious institutions, and participatory interventions have strengthened resilience among vulnerable populations. To support mental well-being, Salma \u0026amp; Salami (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Salma \u0026amp; Giri (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) demonstrated that stronger community networks, access to ethnic resources, and religious support significantly predict higher self-reported mental well-being among immigrants and racialized communities (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). These results highlight the role of culturally relevant community-based strategies in mitigating health disparities and building adaptive capacity in marginalized populations.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of Mental Well-Being in Immigrant and Racialized Populations\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity network strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSalma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSalma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to ethnic resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSalma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSocial and cultural resources at the community level play a crucial role in enhancing resilience and buffering systemic inequities. To support these outcomes, Salma \u0026amp; Salami (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Salma \u0026amp; Giri (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) demonstrated that access to community networks, ethnic resources, and religious support significantly predicts higher self-reported mental well-being among immigrant and racialized populations. Additionally, community-based interventions, including social prescribing and participatory programs, are effective in mitigating health disparities when adequately reinforced by supportive policy and infrastructure (Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eTrends in Chronic Disease Prevalence\u003c/h2\u003e\u003cp\u003eAlberta is facing a concerning trajectory in chronic disease prevalence over the next decade. Obesity rates are projected to rise from 24.5% in 2010 to 33.0% by 2030, diabetes from 6.8% to 10.1%, and cancer incidence from 2.2% to 3.0%. These increases are statistically significant (obesity: β\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; diabetes: β\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; cancer: β\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;\u0026lt;\u0026thinsp;.05) and are expected to place increasing pressure on healthcare systems (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe rise in obesity, as highlighted by Bancej et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), aligns with both national and global trends driven by sedentary lifestyles, high-calorie diets, and urbanization. This upward trend contributes to the co-occurrence of obesity and diabetes, amplifying metabolic syndrome burden and associated morbidity and mortality (Eckel et al., 2011). Similarly, the projected increase in diabetes underscores the need for preventive strategies targeting lifestyle and metabolic risk factors (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCancer prevalence is also expected to increase, albeit at a slower rate. Lifestyle factors such as obesity, smoking, and physical inactivity, combined with aging populations, are major contributors to this trend (Bray et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). While advances in early detection and treatment have improved survival in some regions, the rising incidence highlights the importance of integrated prevention strategies that address multiple risk factors simultaneously (Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eMental Health Service Access Inequities\u003c/h2\u003e\u003cp\u003eMental health access remains a persistent challenge, particularly for immigrant and racialized populations. Barriers such as cultural exclusion, stigma, and lack of knowledge about available services significantly impede access for Black youth in Alberta, with prevalence rates of 62%, 54%, and 48%, respectively. Chi-square analyses confirm statistically significant associations between immigrant status and these reported barriers (χ\u0026sup2; = 12.45, p\u0026thinsp;\u0026lt;\u0026thinsp;.01 for cultural exclusion; χ\u0026sup2; = 9.33, p\u0026thinsp;\u0026lt;\u0026thinsp;.01 for stigma). Salami et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) highlighted these inequities in Black youth, emphasizing the compounded effects of systemic and structural barriers.\u003c/p\u003e\u003cp\u003eSystemic and structural inequities further limit healthcare utilization among immigrant populations (Alaazi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Programs that incorporate culturally competent care, language support, and community-based outreach significantly improve engagement and mental health outcomes, particularly when combined with stigma reduction interventions such as psychoeducation and social marketing campaigns (Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mason et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Corrigan et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eEnvironmental Vulnerabilities\u003c/h2\u003e\u003cp\u003eOlder adults and refugees are disproportionately affected by environmental exposures, including heatwaves and industrial air pollution, which exacerbate cardiovascular and respiratory risks. The Poisson regression analyses suggest that communities with higher proportions of older adults experienced significantly higher cardiovascular event rates during heatwaves (PRR\u0026thinsp;=\u0026thinsp;1.110, 95% CI [1.011, 1.219]), whereas refugee-dense communities had increased respiratory events associated with environmental pollutants (PRR\u0026thinsp;=\u0026thinsp;1.127, 95% CI [1.058, 1.200]) (Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings reflect broader patterns of environmental health inequities documented globally. Vulnerable populations are disproportionately exposed to climate-related risks, including heat stress, poor air quality, and inadequate housing (Haines \u0026amp; Ebi, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For older adults, thermoregulatory decline, concurrent diseases, and social isolation increase vulnerability to heat-related morbidity and mortality (Basu, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Refugee populations often live in high-density urban areas or near industrial zones, such as refinery productions in Alberta (He et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), heightening exposure to air pollution, which contributes to respiratory and cardiovascular disease (Tilstra et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Abubakar et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Addressing these disparities requires climate-sensitive health interventions, including urban planning, early warning systems, and targeted public health messaging.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eSystem Pressures and Policy Gaps\u003c/h2\u003e\u003cp\u003eThe COVID-19 pandemic revealed systemic vulnerabilities in Alberta\u0026rsquo;s healthcare system, particularly affecting immigrant and racialized populations (Jones et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). ANOVA analyses of Vang \u0026amp; Ng (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Nwachukwu et al. (2020) repetitively show significant differences in self-reported healthcare access limitations across population groups (p\u0026thinsp;=\u0026thinsp;.002), with immigrant adults (45%) and racialized youth (52%) reporting higher barriers compared with non-immigrant adults. These disparities can be attributed to several factors, including language and cultural barriers, lack of familiarity with the healthcare system, and limited digital literacy, especially during pandemic-induced shifts toward telehealth (Salami et al., 2018; Jones, 2021). The pandemic also highlighted gaps in health policy and resource allocation, underscoring the importance of equity-oriented frameworks that prioritize access for marginalized populations (Bambra et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Policies must account for social determinants of health, including socioeconomic status, education, and social capital, to reduce barriers and improve equitable access (Marmot, 2015).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eResilience and Community-Level Adaptations\u003c/h2\u003e\u003cp\u003eDespite systemic challenges, community-level resources have been shown to buffer inequities and promote well-being. Regression analyses indicate that community network strength (β\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), religious support (β\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;=\u0026thinsp;.002), and access to ethnic resources (β\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;=\u0026thinsp;.001) significantly predict higher self-reported mental well-being among immigrant and racialized populations (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Salma \u0026amp; Giri, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis finding aligns with resilience theory, which emphasizes the protective role of social support and community cohesion in mitigating the effects of structural stressors (Ungar, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Lowe et al., 2023). Community-based interventions, such as participatory programs and social prescribing, have demonstrated effectiveness in reducing health disparities and enhancing mental well-being (Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Religious and ethnic community networks often provide culturally relevant support, information, and advocacy that formal health systems may lack, thereby improving health outcomes and fostering social inclusion (Moreira-Almeida et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Lowe et al., 2023). These findings feature the importance of integrating community-level strategies with public health interventions to address inequities holistically.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eIntegrating Quantitative Trends\u003c/h2\u003e\u003cp\u003eThe synthesis of quantitative trends illustrates a multi-layered health inequity landscape in Alberta. Chronic diseases, particularly obesity, diabetes, and cancer, are on the rise, placing escalating demands on healthcare systems (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Structural inequities limit mental health access for immigrant and racialized populations, with stigma, cultural exclusion, and inadequate knowledge as primary barriers (Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Alaazi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Environmental exposures compound vulnerability among older adults and refugees, emphasizing the need for climate-sensitive interventions (Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). System pressures revealed during COVID-19 highlight the critical need for equity-focused policy interventions and culturally competent service delivery (Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Jones, 2021). Finally, community networks and culturally tailored interventions serve as significant resilience factors, mitigating the effects of systemic inequities (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCollectively, these findings reinforce the interdependence of health, social, and environmental determinants, suggesting that addressing health inequities requires a holistic, multi-sectoral approach. Policies must be guided by equity principles, with emphasis on culturally competent service delivery, community engagement, and targeted interventions for vulnerable populations. Moreover, proactive measures to prevent chronic diseases\u0026mdash;such as nutrition programs, physical activity promotion, and health literacy campaigns\u0026mdash;should complement healthcare system strengthening to reduce long-term burden.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eImplications for Policy and Practice\u003c/h2\u003e\u003cp\u003ePolicy implications from these findings are substantial. First, healthcare planning must anticipate \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003erising\u003c/span\u003e chronic disease prevalence and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eallocate\u003c/span\u003e resources, accordingly, emphasizing prevention and early intervention. Second, mental health services must incorporate \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecultural\u003c/span\u003e competence and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ereduce barriers\u003c/span\u003e related to stigma, knowledge gaps, and language. Third, climate adaptation strategies should prioritize vulnerable populations, including older adults and refugees, by integrating environmental health \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003emonitoring\u003c/span\u003e and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecommunity-based\u003c/span\u003e interventions. Finally, leveraging \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecommunity networks\u003c/span\u003e, religious institutions, and ethnic resources can enhance resilience and promote well-being in marginalized groups.\u003c/p\u003e\u003cp\u003eThe findings also suggest that equity-oriented frameworks are crucial for post-pandemic recovery. Policies that address social determinants, improve accessibility, and invest in community resilience will be central to reducing disparities and improving health outcomes (Bambra et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Marmot, 2015; Lowe et al., 2023). Health systems should adopt participatory approaches, involving communities in intervention design and implementation to ensure relevance and sustainability (Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results underscore a multifaceted landscape of health inequities in Alberta, characterized by rising chronic disease prevalence, persistent mental health access barriers, and disproportionate environmental vulnerabilities. Obesity, diabetes, and cancer are projected to increase significantly, placing mounting pressure on healthcare systems (LLytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Immigrant and racialized populations face structural and cultural barriers that limit access to mental health services, while older adults and refugees are particularly susceptible to environmental hazards (Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The COVID-19 pandemic further exposed systemic weaknesses and inequities, emphasizing the urgent need for equity-oriented policies and culturally competent service delivery (Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Importantly, community networks, religious institutions, and access to ethnic resources provide resilience and improve mental well-being, highlighting the value of participatory and culturally tailored interventions (Salma \u0026amp; Salami, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Nowak \u0026amp; Mulligan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulligan, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Addressing these complex health disparities requires integrated strategies that combine prevention, health system strengthening, climate-sensitive interventions, and community engagement to ensure equitable and sustainable health outcomes for all populations in Alberta.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbubakar, I., Aldridge, R. W., Devakumar, D., Orcutt, M., Burns, R., Barreto, M. L., \u0026hellip; \u0026amp; Zimmerman, C. (2018). The UCL\u0026ndash;Lancet Commission on Migration and Health: The health of a world on the move. \u003cem\u003eThe Lancet, 392\u003c/em\u003e(10164), 2606\u0026ndash;2654. https://doi.org/10.1016/S0140-6736(18)32114-7\u003c/li\u003e\n \u003cli\u003eAlaazi, D. A., Salami, B., Ojakovo, O. G., Nsaliwa, C., Okeke-Ihejirika, P., Salma, J., \u0026amp; Islam, B. (2022). 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Projected diabetes prevalence and related costs in three North American urban centres (2015\u0026ndash;2040). \u003cem\u003ePublic Health\u003c/em\u003e, \u003cem\u003e157\u003c/em\u003e, 43-49. https://doi.org/10.1016/j.puhe.2017.12.023\u003c/li\u003e\n \u003cli\u003ePopay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., ... \u0026amp; Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC methods programme. University of Lancaster.\u003c/li\u003e\n \u003cli\u003ePublic Health Agency of Canada. (2022). Social inequalities in COVID-19 mortality by area- and individual-level characteristics in Canada, January 2020 to December 2020/March 2021. Ottawa, ON: PHAC; 2022.\u003c/li\u003e\n \u003cli\u003eRashki Kemmak, A., Nargesi, S., Saniee, N. (2021). Social Determinant of Mental Health in Immigrants and Refugees: A Systematic Review. \u003cem\u003eMed J Islam Repub Iran\u003c/em\u003e. 31;35:196. 36060318; PMCID: PMC9399294. doi: 10.47176/mjiri.35.196.\u003c/li\u003e\n \u003cli\u003eSalami, B., Denga, B., Taylor, R., Ajayi, N., Jackson, M., Asefaw, M., \u0026amp; Salma, J. (2021). Access to mental health for Black youths in Alberta. L\u0026rsquo;acc\u0026egrave;s des jeunes Noirs de l\u0026rsquo;Alberta aux services en sant\u0026eacute; mentale. \u003cem\u003eHealth promotion and chronic disease prevention in Canada : research, policy and practice\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(9), 245\u0026ndash;253. https://doi.org/10.24095/hpcdp.41.9.01\u003c/li\u003e\n \u003cli\u003eSalami, B., Mason, A., \u0026amp; Salma, J. (2020). Access to healthcare for immigrant children in Canada. \u003cem\u003eInternational Journal of Environmental Research and Public Health, 17\u003c/em\u003e(9), 3320. https://doi.org/10.3390/ijerph17093320\u003c/li\u003e\n \u003cli\u003eSalami, B., Salma, J., Hegadoren, K., Meherali, S., Kolawole, T., \u0026amp; Diaz, E. (2019). Sense of community belonging among immigrants: perspective of immigrant service providers. \u003cem\u003ePublic health\u003c/em\u003e, \u003cem\u003e167\u003c/em\u003e, 28\u0026ndash;33. https://doi.org/10.1016/j.puhe.2018.10.017\u003c/li\u003e\n \u003cli\u003eSalma, J., \u0026amp; Giri, D. (2021). Engaging immigrant and racialized communities in community-based participatory research during the COVID-19 pandemic: Challenges and opportunities. \u003cem\u003eInternational Journal of Qualitative Methods, 20\u003c/em\u003e, 1\u0026ndash;10. https://doi.org/10.1177/16094069211036293\u003c/li\u003e\n \u003cli\u003eSalma, J., \u0026amp; Salami, B. (2020). \u0026ldquo;We are like any other people, but we don\u0026rsquo;t cry much because nobody listens\u0026rdquo;: Aging policies and service provision for minority communities in Canada. \u003cem\u003eThe Gerontologist, 60\u003c/em\u003e(2), 279\u0026ndash;290. https://doi.org/10.1093/geront/gnz184\u003c/li\u003e\n \u003cli\u003eTilstra, M. H., Nielsen, C. C., Tiwari, I., Jones, C. A., Vargas, A. O., Quemerais, B., ... \u0026amp; Yamamoto, S. S. (2022). Exploring socio-environmental effects on community health in Edmonton, Canada to understand older adult and immigrant risk in a changing climate. \u003cem\u003eUrban Climate\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e, 101225. DOI: 10.1016/j.uclim.2022.101225\u003c/li\u003e\n \u003cli\u003eTilstra, M. H., Tiwari, I., Niwa, L., Campbell, S., Nielsen, C. C., Jones, C. A., Osornio Vargas, A., Bulut, O., Quemerais, B., Salma, J., Whitfield, K., \u0026amp; Yamamoto, S. S. (2021). Risk and resilience: How is the health of older adults and immigrant people living in Canada impacted by climate- and air pollution-related exposures? \u003cem\u003eInternational Journal of Environmental Research and Public Health, 18\u003c/em\u003e(20), 10575. https://doi.org/10.3390/ijerph182010575\u003c/li\u003e\n \u003cli\u003eTiwana, M. H., Smith, J., Kirby, M., \u0026amp; Purewal, S. (2024). Equity lens on Canada\u0026rsquo;s COVID-19 response: review of the literature. \u003cem\u003eInternational Journal of Health Policy and Management\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 8132. doi 10.34172/ijhpm.2024.8132\u003c/li\u003e\n \u003cli\u003eUngar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. \u003cem\u003eAmerican Journal of Orthopsychiatry, 81\u003c/em\u003e(1), 1\u0026ndash;17. https://doi.org/10.1111/j.1939-0025.2010.01067.x\u003c/li\u003e\n \u003cli\u003eVang, Z.M., \u0026amp; Ng, E. (2023). The impacts of COVID-19 on immigrants and the healthy immigrant effect: Reflections from Canada. \u003cem\u003ePrev Med\u003c/em\u003e., 171:107501. doi: 10.1016/j.ypmed. 107501. Epub 2023 Apr 6. PMID: 37030659; PMCID: PMC10079312.\u003c/li\u003e\n \u003cli\u003eWatts, N., Amann, M., Ayeb-Karlsson, S., Chambers, J., Hamilton, I., Lowe, R., ... \u0026amp; Latifi, A. M. (2018). The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health (vol 391, pg 540, 2017). \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e391\u003c/em\u003e(10120), 540.\u003c/li\u003e\n \u003cli\u003eWhittemore, R., \u0026amp; Knafl, K. (2005). The integrative review: Updated methodology. \u003cem\u003eJournal of Advanced Nursing, 52\u003c/em\u003e(5), 546\u0026ndash;553. https://doi.org/10.1111/j.1365-2648.2005.03621.x\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2025). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Not Applicable ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"health disparities, chronic disease, mental health, environmental vulnerability, immigrant populations, Alberta","lastPublishedDoi":"10.21203/rs.3.rs-7902591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7902591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHealth disparities in Alberta remain a critical concern, driven by chronic disease prevalence, unequal access to mental health services, and environmental vulnerability. This review synthesizes evidence from 2010 to 2030 projections and recent empirical studies to trace patterns in obesity, diabetes, and cancer, alongside social and environmental determinants shaping these outcomes. Reported trends indicate that obesity prevalence is projected to rise from 24.5% to 33.0% (Bancej et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), diabetes from 6.8% to 10.1% (Lytvyak et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and cancer incidence from 2.2% to 3.0% (Panton et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Brenner et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), reflecting statistically significant upward trajectories. Barriers to mental health care remain substantial among immigrant and racialized youth, particularly related to cultural exclusion (62%), stigma (54%), and limited awareness of available services (48%) (Salami et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These barriers are closely linked with immigrant status and systemic inequities in service accessibility. Environmental exposures further compound these challenges, contributing to higher rates of cardiovascular and respiratory disorders in areas with larger populations of older adults and refugees (Tilstra et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Evidence from the COVID-19 period suggests that pandemic-related disruptions amplified existing inequities, disproportionately affecting immigrant adults and racialized youth (Vang \u0026amp; Ng, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bajgain et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Studies by Salma and Salami (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Salma and Giri (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlight the protective role of community and religious networks, as well as culturally relevant support systems, in enhancing mental well-being and social cohesion. Collectively, the reviewed evidence illustrates persistent structural and contextual factors shaping health outcomes in Alberta, underscoring the importance of contextually grounded and inclusive public health planning.\u003c/p\u003e","manuscriptTitle":"Mapping Trajectories of Health Disparities in Alberta through a Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 05:10:44","doi":"10.21203/rs.3.rs-7902591/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b95672a6-a82a-4305-94dc-d3dda0f0c34b","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56561926,"name":"Social Work"}],"tags":[],"updatedAt":"2025-10-21T05:10:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-21 05:10:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7902591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7902591","identity":"rs-7902591","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}