This document summarizes Lorraine Greaves' presentation on women's health across time and space at the 6th Australian Women's Health Conference. The presentation reflected on progress over 50 years, identified conceptual developments, and recommended strategies to improve policy and practice. Greaves discussed the evolution of women's health concepts, movements advocating for self-care over medicalization, and key policy achievements promoting inclusion of sex and gender in research. She argued for embracing complexity, fluid concepts, and better data to measure progress and make the case for women's health. The overall goal is to improve care, policies, information, and build bridges across community, provider, researcher, and policymaker sectors.

1. Women’s health across
time and space
6th
Australian Women’s Health Conference
Hobart, Australia
Lorraine Greaves, PhD, DU
British Columbia Centre of Excellence for
Women’s Health
Canada

2. Goals
1. To reflect on progress in women’s health over
the past 50 years
2. To identify conceptual developments in
women’s health
3. To promote understanding of policy making
4. To recommend strategies going forward to
improve women’s health policy and practice

3. Keeping in mind four“locations”
 Providers
 Academic researchers
 Policy makers
 Communities

4. Messages
 There has been progress, lots of it
 Conceptual approaches are in constant
evolution
 Evidence, engagement and economics
matter in policy making
 We need to be more strategic to secure
our achievements

5. Part 1
Progress

6. 2nd
wave women’s movement
 Emerging politics of
women’s liberation
 Consciousness-
raising
 Control over body
 Labour force
participation and
pay equity

7. Including decades of women’s health
advocacy
 Over-medicalization of women
 Sexism & paternalism
 Gender-neutrality and gender-blindness
 Exclusion from trials
 Lack of women in science and medicine

9. Feminist Women's Health Center, Oregon
Self-examination kits to avoid
doctors and be self sufficient

10. Home birth and midwifery- avoiding
hospital and reclaiming birthing

11. Women’s health movement
identified values to underpin care
 Inclusive
 Sensitive
 Respectful
 Empowering
 Accessible
 Comprehensive

12. Since 1970 in Canada
 Royal Commission on the Status of Women
1970
 Women’s Health Bureau, 1993
 Centres of Excellence for Women’s Health
Program, 1996
 Women’s Health Strategy, 1999
 Gender analysis policy, 2000
 Institute of Gender and Health, 2000

13. Some achievements in this time
periodStructural changes
 Rapidly increasing evidence and research on sex,
gender and health
 Introduction of gender analysis into policy
 Creation of women-specific health care services
Parallel processes
 Infiltration of feminists into positions of influence
 Evolution of consciousness raising into communities
of practice and knowledge exchange
 Global advocacy connecting women’s status to
women’s health

14. Key policies were, and are, very
important
 Institute of Medicine report (USA)
 Argues importance of sex (and gender) in all pillars of
health research “Every cell is sexed” (2001)
 Canadian Institutes of Health Research (CIHR)
Institute of Gender and Health (2000)
 Requires sex and gender analysis be included in all
proposals
 Health Canada, requires GBA of policies (audited by the
Auditor General of Canada, 2009)
 National Institutes of Health (USA)
 NIH requires women, children and minorities be included in
all research (1993)
 Audited by the General Accounting Office 1999

15. Led to new knowledge
 Newly identified disease trajectories for
women
 Identification of diagnostic issues
 Requirement for new treatment
approaches
 Shortcomings of rehabilitation identified
 Health system design is gendered
 Health reform is gendered

16. Part 2
Some theoretical and conceptual
transitions

17. The concepts, the issues
 Sex
 Gender
 Diversity
 Language clarity
 Measurement issues
 Capacity
 (Re) training
 Institutionalization
 Knowledge transfer

18. Sedimentary layers of terminology
and analytic frames over30 years
 Sex
 Gender
 Sex and gender
 Sex differences
 Gender differences
 Sex differences and gender
influences
 Sex and gender related
factors
 Gender equity
 Sex stratification
 Sex differentiation
 Gender (based) analysis
 Determinants of health
 Sex and gender (based)
analysis
 Sex, gender and diversity
(based) analysis
 Disparities, inequities of
health
 Intersectional analysis
 Intersectional-type analyses

19. Parameters of the field have
evolved Health
 Women’s health
 Gender and health
 Men’s health
 Gender and women’s health
 Gender and health, (including
women’s health and men’s health)
 Health equity
 Now three fields: (at least)
 gender and health
 women’s health
 men’s health

20. Lessons?
 Keep women in sight
 Being vigilant about diluting the focus on
women
 Broadening the field can generate
support
 Continuous adult education is necessary
 Retain the historical values base
 Embrace increasing complexity of
conceptual development

21. Sex and genderinteract
 Sex: biological and physiologically related
factors
 Metabolism, hormones, size, anatomy etc
 Gender: social and cultural factors
 Roles
 Identity
 Relations
 Institutionalized gender

22. Osteoarthritis &
Osteoporosis
Sex: Female bodies are more likely to
develop osteoarthritis or osteoporosis due
to differences in bone structure, bone
density, and hormones (Cenci et al., 2000;
Riggs, 2000).
Gender: Feminine gender roles do not
encourage women to do weight-bearing
exercises, which put women at risk for
developing osteoarthritis and osteoporosis
(Fausto-Sterling, 2005).

23. Cardiovasculardisease
Sex: Aspirin helps prevent cardiovascular disease
in men but not women due to genetics and
hormones (Levin, 2005). Women may have different
symptoms than men of CVD.
Gender: Women may delay seeking care for
cardiovascular health problems due to cultural
expectations or their multiple roles within families,
which may prevent them from taking time for
themselves (Rosenfeld, Lindauer, and Darney, 2005)

24. CardiovascularDisease (CVD)
and Diversity
 Substantial ethnic differences in CVD exist;
The death rate due to CVD is 69% higher in
black women than white in the USA
(American Heart Association, 1997).
 Gender and class-linked differences
associated with CVD risk factors include:
smoking, hypertension, poor nutrition,
diabetes, obesity (American Heart
Association, 1997), access to health care
and educational attainment (Nietert,
Sutherland, Keil, & Bachman, 2006).

25. Contracting HIV – sex and gender
collide
Sex: The vagina is more susceptible to
contracting sexually transmitted infections
(STIs) than the penis due to physiology
(Darroch and Frost, 1999)
Gender: Women can have less power in
sexual relationships which puts them at a
greater risk of contracting HIV (Amaro and
Raj, 2000). And, women may delay
seeking treatment for HIV/AIDS due to
family and childcare obligations.

26. Ourlocations have evolved as well…
 Community
 Women and girls
 Community
organizations
 Advocates
 Activists
 Providers
 Health care providers
 Social services
 Hospitals
 Health authorities
 Researchers
 Academics
 Community based
researchers
 Polling firms
 Policy makers
 Government
 Decision makers
 Institutional leaders
 Research funding
agencies

27. In reality, many linkages between
sectors
Community
Research
Policy
Care

28. In reality, common goals and
movement
 These sectors are overlapping sets
 Less distinguishable now compared to 50 years
ago
 Roles evolve and change over time
But,
 Stereotypes still dominate, and impede
 More synergy is required
 Some bridges exist, but we need to embody
these

29. Do these stereotypes persist?
Community
 Powerless
 Persistent
Providers
 In Silos
 Essential
Researchers
 Theoretical
 Opportunistic
Policy makers
 Powerful
 Sold out

30. All ourdifferent commitments need
nurturing
Different “projects” and goals for each sector
 Clinical treatment
 Health system improvement
 Program design
 Policy design
 Academic research
 Community based research
 Capacity building
 Advocacy
 Knowledge translation

31. Part 3
Strategies forgoing forward in
policy and
practice

32. Ourcollective aims
 To improve health care practices
 To change policies and policy making
 To deliver health information to women
 To generate support for gender analysis
and reform
 To generate new thinking and language
 To broaden the view of health
 To increase the evidence on women’s
health

33. Things to know about policy
making
 The cycle of government
 Budgets are made same time each year
 Internal processes are fixed
 Information is public
 Too little or too much funding?
 Speed
 Decisions are made quickly
 Policy is made quickly
 Decision making is not public
 Enacting decisions may take a long time

34. But politics matterthe most
 Politicians
 Tensions are normal
 Economics will rule
 Ideology will surface
 Public service
 Civil servants outlast politicians
 Leadership and championship matter
 Changing the policy making pro ce ss is the lasting
contribution

35. Things to know about engagement
 Network
 Who knows who and what position did they have
before?
 Who has a personal interest?
 The power of reacting
 One individual complaint can kill an initiative
 One community can kill a policy
 Write letters, they count and are counted
 Critical incidents and media coverage rule

36. Positioning the argument
 Enter the dialogue
 What is a ‘wicked problem’?
 What is a ‘killer fact’?
 How to exploit a ‘wedge issue’?
 Link to the platform
 Contortion or reality?
 Learning the language
 Being ready for the next ideology

37. Women’s health requires evidence,
engagement and economic overlay
 Has a tenuous position in government
 Corporate memory is short
 Sexism tenacious
 Must be renewed and refreshed continuously
 Personnel, politicians and deputies change
 Requires vigilance
 Take nothing for granted
 Needs economic arguments
 How can improving women’s health contribute?
 Framing women’s health in economic terms

38. Using the structure of government
to advance women’s health
 In Canada, for example
 GBA is required at the federal level, but not provincial
 Women’s health strategy is federal
 Federal government signs international treaties
 Federal government sets rights
 GBA was audited in 2009 by the Auditor General

39. A global view: Women’s health in all
policies Women’s health in all policies
 protect women’s property rights
 policies that support equal access to formal employment
 targeted action to encourage girls to enrol in and stay in
school
 health promotion to increase access of all adolescent
girls to health education
 measures that provide specific economic opportunities
for women
 measures that increase access to water, fuel and time-
saving technologies
 strategies to challenge gender stereotypes and change
discriminatory norms, practices and behaviours
 action to end all forms of violence against women
 building “age-friendly” environments for older women
World Health Organization, 2009

40. How do we need to shift our
approach?

41. Embrace biology, in conjunction
with social models of health
 Social determinants don’t fully explain, or intrigue,
scientists and policy makers
 Science is increasingly identifying more biological
issues that affect health
 Epigenetics is the frontier of explanation - the
interaction of environmental factors and genetic
factors

42. Drop the binaries, and accept,
embrace and teach, the fluidity of
concepts
 Sex, gender, (dis)ability & ‘ethnoracial’ categories are
increasingly diffuse and blurry
 Drop measuring “differences”, on the assumption that
there is a standard
 Adopt more complex views of the various factors
affecting women’s health
 Move into globalized views of women’s health

43. Contribute to betterdata collection
 Without data, we cannot measure progress
 Facilitates evaluation and costing
 Underpins the “business case”
 Can be used for performance management
 Will get noticed, if governments collect them
 Expand the notion of data and evidence

44. Finally, be bridge-builders for
women’s health
 Understand each sector’s role and responsibilities,
measures of success
 Actively assist with other sector’s goals
 Cultivate mutual support across sectors
 Travel across sectors in your own careers
 Engage in 21st
century consciousness-raising

45. Thankyou
The British Columbia Centre of Excellence for Women’s Health
and its activities are supported by a financial contribution from
Health Canada, through the Women’s Health Contribution
Program