Rethinking Healthy Living for Women in Canada
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This document summarizes a presentation on healthy living for women in Canada. It discusses how current healthy living discourse focuses too much on individual responsibility and fails to consider social and systemic factors. It also finds limited evidence about the impacts of gender on health behaviors and outcomes. The presentation calls for more gender-responsive approaches to healthy living policies and programs that employ sex- and gender-based analysis. It provides an overview of Canadian data on various healthy living topics for women and examples of promising gender-sensitive interventions. The conclusion advocates for incorporating a gender lens on healthy living to better address the needs and inequities faced by women.
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Rethinking Healthy Living for Women in Canada
- 1. Rethinking Healthy Living for Women in Canada: Reflections on the Discourse, Evidence and Practice Ann Pederson1, Barbara Clow2, Margaret Haworth-Brockman3, Harpa Isfeld3, Anna Liwander1 7th Australian Women’s Health Conference, Sydney, NSW May 8, 2013 1 2 3
- 2. Acknowledgements Co-authors and colleagues who contributed to individual chapters, including Pamela Chalmers for her layout of the final report and Elaine Littman of Working Design for the cover This project was made possible through a financial contribution from Health Canada. The views expressed herein are not necessarily those of Health Canada. My travel to this conference was supported by a grant from the Canadian Institutes of Health Research as a member of Promoting Health in Women, PhiWomen.
- 3. Outline of this Presentation Brief background to the project Healthy living discourse Issues of evidence Reflections on policy and practice Some potential implications
- 4. Collaboration between three Centres of Excellence for Women’s Health Troubling individualistic discourse Limited evidence about women Gender-blind programs and policies Propose gender-responsive approaches
- 5. Employed Sex- and Gender-based Analysis “A sex- and gender-based approach is part of systematically planned interventions … and consistent with population health approaches.” 2012 Chief Public Health Officers’ report Sex: biological and physiological attributes Gender: social norms and roles, structures, relationships, power over resources and opportunities Diversity: recognizing that women are not all the same Equity: fostering fairness, ensuring that we understand where we can remediate
- 6. Who is missing from the analysis/policy/evaluation/discussion? Encourages us to think beyond the mainstream and consider what makes women and men, girls and boys, vulnerable.
- 7. Policy Starting Point: Integrated Pan- Canadian Healthy Living Strategy Goals are to improve overall health outcomes and reduce health disparities. In light of the 2009 Health Portfolio Policy on SGBA, how are sex and gender considered? What are the implications for action?
- 8. Key Features of HL Discourse Individual vs. social responsibility for health Individual vs. collective and systemic solutions for illness, especially chronic diseases Transformation of risk and probability for populations of ill health into “certain danger” for individuals Blame for certain types of illnesses – so-called “lifestyle” conditions Limited attention to context of healthy living and sex, gender, diversity as well as the determinants of health Focus on physical health rather than mental health or social well-being
- 9. Statistical Profile of Women and Healthy Living in Canada: 11 Healthy Living Topics
- 10. National-Level Data Sources Canadian Community Health Survey, including: CCHS-Nutrition Module, Cycle 2.2, 2004; CCHS, Cycle 3.1, 2005; and annuals 2007- 2008 and 2009-2010. Canadian Health Measures Survey, Cycle 1, 2007- 2009 Canadian Tobacco Use Monitoring Survey, Annual 2010 Canadian Alcohol and Drug Use Monitoring Survey, 2010 National Trauma Registry, Comprehensive Dataset (NTR-CDS) General Social Survey-Victimization Cycle 2009 Association of Workers Compensation Boards of Canada, National Work Injury Statistics Program (AWCBC - NWISP) Census of Agriculture, 2001 and 2006 Public Health Agency of Canada, Sexually Transmitted Infections Surveillance Data
- 11. A Snapshot of Women and Healthy Living in Canada Women with higher incomes are more likely to take part in physical activity, but are also more likely to drink heavily. We know very little about sexual behaviour for women over the age of 49 or those not considered “high risk”. All women show excessive sedentary behaviour. Tobacco smoking rates are largely declining, except among young women and women who use smoking as a coping behaviour. Older women find food labels complicated, and they don’t necessarily prefer cooking programs. Occupational injury data may under-represent women’s injuries in certain sectors.
- 12. SGBA of Healthy Living Strategies Review of strategy documents plus telephone consultations with policy makers about how sex and gender was been considered in various healthy living strategies across the country. Detailed examination of strategies in four provinces (Prince Edward Island, Ontario, Manitoba and British Columbia)
- 13. Promising Gender-Sensitive Healthy Living Interventions for Women Emerging discourse on gender-sensitive practice Selected examples of promising practices, policies and programs related to healthy living topics. Recommendations for future directions to advance healthy living in Canada for women.
- 14. Defining Gender-Sensitive Interventions Take sex and gender considerations into account and consider, for example, the different social roles of men and women that lead to women and men having different needs, health behaviours and outcomes. Criteria: • Target girls and/or women explicitly; • Incorporate an understanding of sex and/or gender (including gender norms, gender relations and gendered social institutions); • Engage with the determinants of girls and women’s health not just individual-level health behaviours; and/or • Seek to reduce gender-related social and health inequities. Scoping review results in summer 2013 (poster here at AWHN conference)
- 15. Trauma-informed Physical Activity Yoga Outreach Yoga can help mitigate trauma by increasing experience of control of the body, sensation and emotion but can also trigger Yoga Outreach adapted yoga instruction to enhance safety, choice and ‘action’ for participants - Minimize touch; invitation to participate; limited focus on breath work TI physical activity programs may reduce barriers to participation by reducing anxiety and helping manage physicality www.yogaoutreach.com
- 16. Conclusions A gender lens on healthy living can shift our understanding of, and responses to, the needs of women in Canada. Responses to healthy living for women in Canada might look different if they incorporate sex, gender, diversity and equity. A sex and gender lens can allow the Pan-Canadian Healthy Living Strategy and provincial strategies to address the inequities that constrain women from healthy living.
- 17. Draw Inspiration from HIV/AIDS Prevention “To effectively address the intersection between HIV/AIDS and gender and sexuality requires that interactions should, at the very least, not reinforce damaging Geeta Rao gender Gupta and sexual
Editor's Notes
- Alternative title page
- Taking the position that there are important inequalities between and among women that have implications for their opportunities for health, and that sex and gender are key determinants of health, we have undertaken a sex and gender-based analysis of healthy living in Canada. Our work involved an analysis of the healthy living discourse, the examination of ten areas of healthy living practice and research, namely: body weights, ‘eating well’ (incl. sodium), food insecurity, physical activity, sedentary behaviour, tobacco, alcohol, sexual behaviour, injury, gender-based violence and self-harm, and a review of selected healthy living strategies from 4 provinces – ON, BC, PEI and Manitoba. Ends with promising gender-sensitive healthy living interventions for women
- A way of thinking about policy (from new research to evaluation) in terms of the differences between and among women and men Sex- and gender-based analysis is the mechanism to understand inequities that create disparities
- A fundamental question asked in SGBA is: “Who is not included here?”
- Policy Context: Integrated Pan-Canadian Healthy Living Strategy released in 2005. The Strategy identified reducing health disparities and improving overall health outcomes as its two goals. Notably, the strategy did not include goals specific for women or men and the influences of gender and other determinants of health are not articulated. Only in the discussion of the consultations with First Nations Women’s organizations did issues of gender arise and it should be said that the Native Women’s Association of Canada actually made three important recommendations during the consultation: Domestic, racialized and sexualized violence must be taken into consideration. Realities of Aboriginal women’s lives need to be considered. Must support women-centered activities and sports.
- To contextualize our data analysis and review of interventions, we started by reading and examining the discourse of healthy living that frames and positions the Pan-Canadian Healthy Living Strategy. The discourse of healthy living reflects neoliberal approach to the economy that favours freedom of the market and a minimal role for the state. More specifically, the HL discourse is characterized by a tendency to embrace an individual rather than a social view of health and hence to propose individual rather than collective or structural solutions for health problems, including chronic diseases. This is accompanied by the almost magical transformation of statistical, probabilistic models of risk into virtually certain danger for individuals, a focus on physical rather than mental health, a tendency to blame people when they become ill. The healthy living discourse is also largely blind to the impact of sex, gender and diversity on health and the opportunities for health, despite the emergence of a discourse focusing on equity. A lack of awareness of sex, gender and diversity within the healthy living discourse leads to one-size-fits-all policy recommendations and programs that do not necessarily meet the needs of their participants nor reach out to those most in need of support. More specifically, the HL discourse is characterized by a tendency to embrace an individual rather than a social view of health and hence to propose individual rather than collective or structural solutions for health problems, including chronic diseases. This is accompanied by the transformation of statistical, probabilistic models of risk into virtually certain danger for individuals, a focus on physical rather than mental health, a tendency to blame people when they become ill. The healthy living discourse is also largely blind to the impact of sex, gender and diversity on health and the opportunities for health, despite the emergence of a discourse focusing on equity. A lack of awareness of sex, gender and diversity within the healthy living discourse leads to one-size-fits-all policy recommendations and programs that do not necessarily meet the needs of their participants nor reach out to those most in need of support.
- Add images of gbviolence and injury Body weights, eating well, food insecurity, physical activity, sedentary behaviour, smoking tobacco, drinking alcohol, sexual behaviour, injuries, gender-based violence and self-harm. Each snapshot includes current rates, sex-specific details, gendered influences, risk factors, critique of measures, and policy implications. Women in Canada, 15 years and older – mostly
- Followed a standard analytical process for writing about each topic: Definition of issues & measures Gathering Information - review of data & add gender contexts, meaning, experience including findings from other qualitative and quantitative studies as available Analytical Inquiry - asking challenging questions Implications & Lessons to build gender-sensitive strategies
- These are just some of examples of findings from our analysis.
- In the next few minutes, what I would like to do is to introduce the concept of gender-sensitive healthy living interventions for women. This approach to thinking about interventions is new, particularly in the context of healthy living, but we believe it is a logical extension of the sex- and gender-based analysis we have described so far in this presentation. The examples that I am going to share are largely drawn from the experiences I’ve had working with colleagues on a research group based at the BC Centre of Excellence called PhiWomen – Promoting Health in Women. We are a CIHR-funded team in sex, gender and health promotion and we have been working for the past few years to generate a framework for health promotion that incorporates a critical awareness of gender as a determinant of health. We believe that this approach to thinking about interventions holds promise for advancing healthy living for women in Canada.
- Gender-sensitive promising practices in health have largely emerged in the context of addressing maternal-child health and trying to prevent the transmission of HIV/AIDS have been paramount health concerns and it has become increasingly clear that not all approaches are equally effective. In 2010, the Department of Gender, Women and Health (GWH) at the World Health Organization, in collaboration with UNAIDS, , started developing a Gender and Health Promising Practices Series to document pioneering initiatives that employ gender mainstreaming methods to reduce gender-based health inequities in different health areas.
- Finally, I want to briefly describe some work on developing trauma-informed efforts to increase physical activity that we have been exploring in a project at the BCCEWH. Our thinking is that incorporating a violence and trauma lens in our program development might help us to reduce the ways that physical activity initiatives can be negative experiences for women. We might find that incorporating principles such as those being articulated among practitioners of trauma-informed yoga, in which it is assumed that a focus on the body is a potentially triggering and emotionally challenging experience, as well as an important site for healing and growth. Trauma-informed yoga adopts practices that are intended to ensure that the experience is safe for everyone, including those who have experienced violence and trauma. In this approach, efforts are made to avoid interactions and forms of touch and speech that are potentially retraumatizing. We are currently developing a model of trauma and physical activity approaches that we think will facilitate adapting these principles in other physical activity and recreation options in the hope that this will facilitate more people from being able to comfortably, safely and successfully participate in recreation, sport and fitness.
- Looking at healthy living through a gender lens might: shift our understanding of, and responses to, the needs of women in Canada. Using a sex and gender lens would facilitate the Pan-Canadian Healthy Living Strategy and provincial strategies to address the unequal distribution of risk factors and barriers to healthy living for women. Responses to the issue of healthy living among women in Canada might look different if they incorporated sex, gender, diversity and equity.
- An inspiration for our approach to rethinking health promotion for women comes from the field of HIV/AIDS and the work of Geeta Rao Gupta, former President of the International Center for Research on Women (ICRW). In a speech she gave to the International HIV/AIDS conference in Durban in 2000, she made the provocative statement that [CLICK]: “To effectively address the intersection between HIV/AIDS and gender and sexuality requires that interventions should, at the very least, not reinforce damaging gender and sexual stereotypes. Many of our past and, unfortunately, some of our current efforts, have fostered a predatory, violent, irresponsible image of male sexuality and portrayed women as powerless victims or as repositories of infection. This poster, in which a sex worker is portrayed as a skeleton, bringing the risk of death to potential clients, is an example of the latter which, from experience we can predict, probably succeeded in doing little other than stigmatizing sex workers, thereby increasing their vulnerability to infection and violence. There are many other examples of such damaging educational materials. A particularly common type is one that exploits a macho image of men to sell condoms. No amount of data on the increase in condom sales is going to convince me that such images are not damaging in the long run. Any gains achieved by such efforts in the short-term are unlikely to be sustainable because they erode the very foundation on which AIDS prevention is based—responsible, respectful, consensual, and mutually satisfying sex.”