3.2.1 Ann Pederson
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3.2.1 AWHN Conference 6 2015 Chancellor 1: Layering the Lenses? Advancing Women’s Health through the Health Inequity Mechanism
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3.2.1 Ann Pederson
- 1. Layering the Lenses? Advancing Women’s Health through the Health Inequity Mechanism Steve Chasey, Manager, Policy and Surveillance Ann Pederson, Director
- 3. Emergence of Equity Canadian Women’s Health Indicators: An Introduction, Environmental Scan and Framework Examination
- 4. Health Inequities in British Columbia
- 5. SGBA of Health Inequity in BC • First bullet point
- 6. Life Expectancy - Health Inequity in BC
- 7. Life Expectancy Range: 70.2-85.4 years Gradient exists from higher LI in urban areas to lower in more rural areas Life Expectancy - Health Inequity in BC
- 8. Life Expectancy – Applying SGBA • Women live longer than men (85.2 vs 79.2 years) • The gap is shrinking • Though women live longer, men spend a greater portion of their lives in good health
- 9. Poverty – Health Inequities in BC
- 10. Worth a Second Look • SGBA-informed policy options in the following areas: • Income • Housing
- 11. An Example: Income Assistance • 11.9% of Canadian women below low-income cut-off, compared to 9.9% of Canadian men • single-parent mothers under 65 • unattached women under 65 • unattached women 65 and older • Women’s relationship to the job market • Policy recommendation: Social assistance programs that address the specific needs of women living in poverty can more effectively reach those in need
- 12. Our Broad Population of Interest Canadian Population
- 13. Sex- and Gender-based Analysis Canadian Population Equity SES Geography Immigrant Income Ethnicity Age Men Women
- 15. Acknowledgements Steve Chasey schasey@cw.bc.ca Putu Duff Lorraine Greaves lgreaves@cw.bc.ca The analysis and reports were supported by the Provincial Health Services Authority (PHSA); the views expressed therein are those of the authors and not necessarily those of PHSA. The BCCEWH is supported by a financial contribution from Health Canada; the opinions expressed herein are not necessarily those of Health Canada.
Editor's Notes
- Just over a year ago, my colleague Margaret Haworth-Brockman and I were speaking with Lorraine Greaves about what we saw happening with regard to the development of women’s health indicators and gender-sensitive health indicators in Canada. We wondered if discussions among national population and public health experts about indicators of health equity were going to supplant and overtake the efforts we had been making for several years to justify and sort out a possible system for gender-sensitive health indicators for Canada. So we set out to determine what was happening by tracing the development of women’s health indicators in the country and then looked at what the latest documents on indicators of health equity were saying about women’s health, gender and/or gender equity. Along the way, however, as these things have a way of doing, the project changed, and we found ourselves approaching the problem from a different perspective. In this presentation, I will try to share with you the insights my colleague Steve Chasey and I have developed regarding how to link health equity analyses to sex- and gender based analysis.
- So we scanned the Canadian and international arenas for health equity analysis reports. Sure enough, when we looked at most of these materials, we find what Pat Kaufert calls the vanishing woman – she’s there but she keeps disappearing from view. She’s implicit in the frameworks, models and analyses but seldom appears outright. Colleagues in British Columbia have since written about this and tried to specifically discuss the position of gender within frameworks of the determinants of health,arguing that sex and gender are foundational determinants that structure social life and help construct individual experiences.
- Here is the product of the environmental and historical scan on the developments of women’s health indicators in Canada. What we essentially learned is that what started off as an exercise to produce a set of women’s health indicators morphed into efforts to generate gender-sensitive indicators and then took a right turn as the conversation became about indicators of health equity.
- While we were busy trying to sort out the history of the discourse and practice of women’s health indicators, we had the chance to review a report on Health Inequities in BC released by the Health Officers Council in 2008. As it turned out, this document did not incorporate a gender analysis, despite identifying gender as a determinant of health. So we went back over the material to illustrate the value of conducting a sex- and gender-based analysis of the underlying data and then did a second piece of work to examine what the potential changes might be to recommendations in policy as a result of that SGBA.
- Those two analyses are reported in these two related documents, Taking a Second Look and Worth a Second Look. The first re-examined life expectancy and poverty data in BC through a gender lens and the second looked at potential policy options to respond to those issues using sex and gender-based analysis.
- In the original analysis, life expectancy was reported as ranging from 70.2-85.4 years and the report identified major variations in life expectancy based on geographic location.
- In fact, life expectancy in BC varies by 10-14 years based solely on geographic location alone.
- Then we did a standard sex disaggregation of the life expectancy data and found that though women do live longer than men, the gap between the sexes is shrinking. Men in BC have the highest live expectancy of men across the world, however women have fallen to sixth place and are expected to keep falling as the effects of higher female rates of cardiovascular disease, lung cancer, and diabetes take their toll.
- Health Inequities in British Columbia also described a “BC paradox”: although British Columbians as a whole enjoy high standards of living and rank among the healthiest people in the world, the province also has the highest rate of poverty in the Canada, in particular “child poverty.” However, “child poverty” does not exist on its own, but is determined by parental poverty, and more specifically, women’s poverty. Our report examined a number of the structural factors that make women more vulnerable to low-income status and poverty such as: unpaid housework and care giving; low wages for “women’s work”; women’s lower pensions; and lack of financial autonomy. These factors are interconnected and often cluster together to put women, particularly single mothers, at higher risk for poverty. Correspondingly, women generally experience poverty for different reasons than men. While poverty for men can be directly linked to changes in the labour market, women’s poverty is also strongly influenced by factors such as divorce and separation as well as women’s roles in the household. Thus our conclusion argued for a reframing of child poverty as women’s poverty, a proposal that would not surprise most of us here but which was unsettling when we presented it to our colleagues in the health authority.
- The original Health Inequities in BC document proposed policy options to address health inequities in five areas, Income and Food Security, Education and Literacy, Early Childhood Development, Housing and Healthy Built Environments, and Health Care. We looked specifically at income supports and housing policy. I don’t have time to go over these in detail but it is worth saying that the analyses suggested that some of the existing policies might be exacerbating income inequities rather than solving them.
- For example, poverty rates for Canadian women are higher than for Canadian men. In 2000, 11.9% of Canadian women lived below Statistics Canada’s low-income cut-off, compared to 9.9% of Canadian men. Much of the sex-based difference in poverty rates can be attributed to higher rates for three subgroups of women: single-parent mothers under 65, unattached women under 65 and unattached women 65 and older. A significant gender wage gap exists between men and women performing the same work. Additionally, due to gendered stereotypes of men’s and women’s roles, women often end up assuming the majority of child-raising and household tasks. These forces contribute to a situation in which women on average earn less over the course of their lifetime, have smaller retirement savings, and take part-time or temporary positions to manage the responsibilities of the household. Women are also more likely to forego advance schooling or job opportunities than men. Policy Suggestion: The original report suggested increasing welfare rates and indexing them to the cost of living, however social assistance programs that address the specific needs of women living in poverty can more effectively reach those in need. An example of such a program could be improved access to high-quality job training programs and post-secondary education without facing the high levels of debt necessary to access these programs. Through these two reports, BCCEWH was able to locate BC health inequities within a social context and illustrate how applying a sex- and gender-based analysis could help create more effective and efficient policy responses.
- For example, we start with the same population of interest – in our case, the Canadian population.
- Then we divide that population into men and women and potentially then subgroups within men and women so we can analyze differences or similarities between women and men, among women, or among men. To do that we often focus on groups that have been marginalized in some way that impacts their health. Often these marginalizing forces include Age, SES, geography, immigrant status, income, or ethnicity. Interestingly, our Environmental Scan showed up that the same indicators, and health surveillance techniques that are used for studying women’s health are conceptually similar to those used in the equity approach.
- The point is that SGBA and equity analysis provide complementary lenses for examining the same subpopulation of interest . Equity analysis and SGBA are both critical tools to help identify unfair health situations but they do start from different premises and have different histories. It is our hope that by showing our colleagues who do not usually identify as women’s health researchers that SGBA can open up the black box of the study of health inequities that we can gain further traction for gender-sensitive health research and policy making. Thank you.