Genuine Progress Index for Atlantic Canada Indice de progr

1
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueWomens Health
in Nova ScotiaPrepared for Atlantic Centre of
Excellence for Womens HealthIWK, Halifax, 27
November, 2003
2
Five themes

• Practical utility of gender-based analysis
• Interactive nature of health determinants
• Additional womens health indicators needed
  beyond usual population health indictors
• Data improvements and gaps - especially for
  diversity analysis
• Purpose policy link point to key social
  interventions to improve womens health

3
Pop. health context Romanow and the 3 burning
health policy issues

• 1) How to treat the sick - supply side
• 2) How to improve the health of Canadians
• 3) How to check spiralling health care costs -
  demand side
• The next Royal Commission......

4
Practical High portion of illness burden is
preventable

• Excess Risk Factors Account for
• 40 chronic disease incidence
• 50 chronic disease premature mortality
• 25 direct medical care costs
• 38 total burden of disease (includes direct and
  indirect costs)

5
Why a Gender Perspective
1) Descriptive Women have distinct health needs.
Causes / outcomes differ by gender 2) Normative
Ensure equal treatment, overcome biases that
impede wellbeing 3) Practical Blunt,
across-board solutions often miss mark, waste
money. Gender analysis allows policy makers to
target health dollars
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Practical Womens use of health services

• Canadian women have higher rates of
• chronic illness, physician visits
• disability days, activity limitations
• lower functional health status
• In every age group to 75, women more likely see
  physicians than men. Overall - 33 more likely
  age 18-54 - 2-3x

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E.g., Teenage smoking

• Teen girls higher rates than boys
• Young women have 2x stress cf young men
• Surveys young women say stress relief and weight
  loss primary reasons for smoking
• Therefore programs, brochures, counselling
  targeted to girls more effective than blanket
  one-size-fits-all health warnings

8
1998 Federal Health Minister

• I have undertaken to fully integrate
  gender-based analysis in all of my Departments
  program and policy development work...
• ...to enhance the sensitivity of the health
  system to womens health issues...
• ...more research...on the links between womens
  health and their social and economic
  circumstances.

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1) Income What does it have to do with womens
health?

• Poverty most reliable predictor of poor health,
  premature death, disability 4x more likely
  report fair or poor health
• Low income- higher risk smoking, obesity,
  physical inactivity, heart risk
• Costly increased hospitalization
  Women 15-39 62 40-64 92

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health of single mothers

• Worse health status than married (NPHS) higher
  rates chronic illness, disability days, activity
  restrictions
• 3x health care practitioner use for mental,
  emotional reasons costly
• Longer-term single mothers have particularly bad
  health (Statcan)

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Low income children- at risk - 31 indicators

• More likely to have low birth weights, poor
  health, less nutritious foods
• Higher rates of hyperactivity, delayed vocabulary
  development, poorer employment prospects.
• Less organized sports, but higher injury rates,
  and 2x risk of death due to injury than children
  who are not poor.

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Prevalence of low income-women and men -1997
2000
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Prevalence of low income-women and men, Canada
1991-2000
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Low-income children under 18, 1991-2000
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Income Female lone-parent families - 1997
2000
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TrendLow income rates of children Single
mother families ---1994-2000
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Employment of Female Lone Parents 1976-2001
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Low Incomes 1991-2000Single mothers
without paying jobs
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The Economics of Single-Parenting

• Single mothers with pre-school children spend 12
  income on child care cf 4 in 2-parent families.
  In one pocket .........
• CPI for child care, restaurant food rises faster
  than wages
• Robin Douthitt time poverty. Full-time single
  mothers 75 hour week

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2) Equity and health

• What matters in determining mortality and health
  in a society is less the overall wealth of the
  society and more how evenly wealth is
  distributed.
• The more equally wealth is distributed, the
  better the health of that society.
• ----- British Medical Journal 312, 1998

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If Equality-gtHealth, What are Trends?Average
Disposable Hhold Income Ratios, 1980-98
22
GINI coefficient 1991-2000
23
Despite growing educational parity....
24
Gender wage gap remains unchanged in Canada-
Ratio of Female to Male Hourly wages 1997-2001
25
Wage inequality in Nova Scotia has remained the
same- Ratio of Female to Male Hourly wages
1998-2001
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Explaining the gender wage gap

• Convergence of womens hourly wages stalled.
  despite clear educational gains.
• After controlling for hours worked, educational
  attainment, work experience, industry,
  occupation, and socio-demographic factors,
  StatsCan concluded that
• roughly one half to three quarters of the
  gender wage gap cannot be explained. (Drolet,
  2001)

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Differences among Cdn women Nova Scotia cf
Canada

• 1990 0.82 disp.income for 1 in Ontario.
  1998 0.73
• Financial Security Nova Scotia
• 1984 2.1 of national wealth.
• 1999 1.8
• (3.1 of Canadian Pop.)

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Share of national wealth vs. population
(1984 1999)
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Wealth gap in Canada

• Richest 10 own 53 of wealth
• Richest 50 own 94.4, leaving 5.6 for poorest
  50
• Poorest ¼ of Canadians own 0.1 (or
  one-thousandth of wealth)
• Among poorest 20, 1/3 fell behind 2 months in
  bill, loan, rent, mortgage
• Importance of diversity approach

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Within Atlantic Canada

• Richest 10 own 49 of wealth
• Richest 20 2/3
• Richest 40 86
• Poorest 60 have 14 of wealth
• Poorest 10 negative wealth

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3) Employment- a key determinant of womens
health

• Issues
• Both overwork and unemployment are stressful-
  (Japanese study)
• Polarization of work hours -increasing the level
  of inequality in family earnings.
• Womens health - function of paid unpaid work -
  gender division of labour in household
• Women doubled employment, BUT still do nearly
  two-thirds of household work.

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of Women and Men Employed Canada 1976-2001
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In Atlantic Can. -higher of employed are women
34
Women with young children - sharpest increase in
employment,

• Since 1976
• women without children have increased their
  employment rate by 26
• women with youngest child 6-15 by 62
• women with youngest child 3-5 by 83
• women with youngest child 0-2 by 124

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Employed women with children
36
But distribution is uneven -Employment and
Education

• 75.4 of female university graduates have a job,
  cf 79.3 of male graduates.
• But women with less than grade 9 are less than
  half as likely to be employed as males 13.6 of
  women cf 29.4 of men
• Gender analysis not just m/f but diversity -
  sub-groups of women - esp. vulnerable

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Women increased professional status - I.e. strong
educational improvement
38
75 of Halifax pop.25-29 graduated high school BUT
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60 of Halifax pop. 25-54 post-secondary grads BUT
40
Unemployment rate in Halifax 7
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BUT.... Unemployment underemployment
42
Youth unemployment 15-24 explains entire gender
gap
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Job security -and work options
44
Job security - temp work
45
Job security union coverage (helps explain PEI
equity)
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High decision latitude at work - related to lower
stress
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4) While f-t women work 39 hrs cf 43 - men, women
still do most unpaid housework
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Atlantic Canada f/t employed women also work
almost as many hours as men
49
Women still do bulk of unpaid housework
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Employed mothers (f/t) work average 75-hr week -
pdunpd

• Statcan Women moving to longer work hours
• 4x likely smoke more, 2x likely drink more
• 40 more likely decrease physical activity
• 80 more likely have unhealthy weight gain
• 2.2x more likely experience major depressive
  episodes cf women on standard hours

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Stress and health behaviours - smoking
52
More Nova Scotians report high stress of
pop. 18, reporting quite a lot of life stress,
2001
53
Nova Scotia health regions with quite a lot of
stress, 2001
54
Less stressful alternatives(societal vs
individual solutions)
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Social supports are important

• Social networks may play as important a role in
  protecting health, buffering against disease, and
  aiding recovery from illness as behavioural and
  lifestyle choices such as quitting smoking,
  losing weight, and exercising.
• See Mustard, J.F., Frank, J. (1991).The
  Determinants of Health. (CIAR Publ. No. 5).

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Social Supports NS low in Atlantic region -
those reporting high levels, over age 12, 2001
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Key Social Supports-Volunteerism and Family

• Health Canada uses volunteerism as a key
  indicator of a supportive social environment
  that can enhance health.
• All four Atlantic provinces highest rates of
  volunteer work in the country.
• More women than men volunteer

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Volunteerism Atlantic Provinces lead (formal
rate)
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But volunteerism has declined --here and
nationally
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Volunteerism rests on narrower base Fewer
volunteers - longer hours

• NS lost 30,000 volunteers 1997-2000
• Work hours of remaining volunteers up 32
• So volunteer service hours increased 18 despite
  loss of volunteers - burnout danger

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Family violence key indicator of womens health

• CIHI, Statcan identify crime as non-medical
  determinant of health. But womens health
  analysis requires special indicators - family
  violence, like unpaid work, is key indicator.
• Family identified as key pillar of social support
  - determinant of health. But family violence may
  undermine social support, health

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Familyhigh of all violence

• Spousal violence 18 of all violence reported
  to police.
• Women 85 of all reported spousal abuse 6x
  rate for men
• Nearly 1/3 of all reported female victims of
  violence in Canada attacked by spouse
• Unreported - much higher 8 all women with
  partner attacked past 5 years.

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Importance of diversity approach. E.g 1
Aboriginal womens health

• Life expectancy 76.2 cf 81 (non-Abor.)
• Higher rates hypertension, cervical cancer,
  circulatory respiratory diseases
• Diabetes 3x non-Abor. Fem 2x male
• HIV/AIDS 2x non-Abor. 50 female Abor AIDS
  cases IV drug use cf 17
• 9 Aboriginal mothers under 18 cf 1

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Aboriginal womens health

• 3x mortality due to violence. 25-44 5x
• Alcohol-related accidents 3x
• Fetal alcohol syndrome. Over 50 view alcohol
  abuse as problem in community
• 3x suicide rate cf non-Aborig. women

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Eg2 Regional disparities require special
attention / intervention E.g Cape Breton.

• High unemployment and low-income rates,
• Much higher incidence of chronic illness,
  disability, and premature death than Halifax
• Highest age-standardized mortality rate in
  Maritimes
• Highest death rate from circulatory disease,
  heart disease in Maritimes 30 above national
  average

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Of 21 Atlantic health districts, Cape Breton has
highest rates of

• Cancer death (231.8 per 100,000) 25 higher
  than the national average, lung cancer
• Deaths due to bronchitis, emphysema, and asthma
  (9.2 per 100,000) 50 higher than the national
  average
• High blood pressure 21.7, (24.3 women 19 men
  72 higher than the Canadian rate. The next
  highest rates are in south-southwest Nova Scotia

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Cape Breton highest

• Arthritis and rheumatism 31 of women, 23 of
  men
• Activity limitation (34), followed by
  Colchester, Cumberland, and East Hants counties
  (30.1)
• Life expectancy 72.8 years for men, and 79.4 for
  women. (Canada 75.4 years - men and 81.2 years
  -women

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Disability-free life expectancy

• Cape Bretoners have an average disability-free
  life expectancy of only 61.8 years, seven fewer
  than the national average, and the lowest of all
  the 139 health regions in Canada.
• This means that Cape Bretoners can expect to live
  considerably more years with a disability than
  other Canadians.

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Potential years of life lost

• highest number of potential years of life lost
  due to both cancer and circulatory diseases.
• Cape Bretoners lose 2,261.9 potential years of
  life per 100,000 population due to cancer 41
  higher than the national average of 1,603.7,
• and they lose 1,684 potential years of life per
  100,000 population due to circulatory diseases
  65 higher than the national average of 1,020.7.

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Women have generally healthier behaviours NS

• Women healthier diets. 5 servings fruit/veg/day
  F 38.1 M 26.8
• Daily smokers F 21.2 M 25.8
• Physically Active F 23.4 M 18.5
• Overwt (BMI 27) F 33.8, M 44.1 Obesity
  (BMI 30) F 19,3, M 22.7
• Heavy drinking F 15.4, M 36.6
  BUT...

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But female smoking rates declined later and slower
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Teen Smoking rates by Gender age 15-19,
1996 vs. 2001
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Health behaviours vary regionally NS high rates
m/f e.g. Overwt (BMI 27), pop. 20-64, 2001
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And within regions eg Obesity (BMIgt30), NS
regions, aged 20-64, 2001
75
Cape Breton, W. Nfld low mammogram screening,
high breast cancer death rate
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The physical environment is an important
determinant of health- Health Canada

• At certain levels of exposure, contaminants in
  our air, water, food and soil can cause a variety
  of adverse health effects, including cancer,
  birth defects, respiratory illness and
  gastrointestinal ailments.
• Factors relating to housing, indoor air quality,
  and the design of communities and transportation
  systems can significantly influence our physical
  and psychological well-being.

77
NS 2nd-hand smoke exposure on most days in the
last month, regions, 2001 2001
78
Access to Health care

• Women use more health care services than men,
  thus are disproportionately affected by barriers.
  
• Atlantic Canadians have greater difficulties
  accessing care than most other Canadians.
• The barriers result from less availability of key
  health care services in rural areas, rather than
  from longer waiting times.

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In Sum

• Women have distinct health issues.... that have
  social and economic roots
• Diversity approach special needs of Aboriginals,
  disabled, minorities, recent immigrants,
  disadvantaged regions, etc.
• 3 interventions that can improve womens health,
  save health costs 1) reduce time-overwork
  stress 2) eliminate gender wage gap 3) reduce
  poverty of single parents

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Can it be done?...1900s/1980s...
81

Improving womens health today will benefit
future generations of Nova Scotians
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SOME ADDITIONAL SLIDES NOT PART OF PRESENTATION

• The slides that follow were not part of the
  presentation and include a few additional
  details on behavioural determinants of health

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Women have generally healthier behaviours

• Women healthier diets. 5 servings fruit/veg/day
  F 43 M 32
• Daily smokers F 19 M 24
• Overweight (BMI 27) F 28, M 36 Obesity
  (BMI 30) F 14, M 16
• Heavy drinking F 11, M 28 BUT...

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Behavioural pathways Atlantic Canadians eat
less fruits and vegetables
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less than 5 servings of fruit and veg. per day,
Nova Scotia, 2001
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Alcohol consumption consuming 5 drinks 12
times/year (2001)
87
Nova Scotia consuming 5 drinks 12 times a
year, (2001)
88
Tobacco of pop. who are current smokers
1985 and 2001
89
But female smoking rates declined later and slower
90
Smoking who are daily smokers (age 12 and
over, 2001)
91
Nova Scotia- of daily smokersby health
district, 2001
92
More women physically inactive
93
Physically active or inactive. of pop. (2000)
94
Nova Scotia Physically active by health
district (2000)
95
Overweight-aged 20-64, 2001
96
Nova Scotia of overweight men and women
(BMIgt27), aged 20-64, 2001
97
Obesity increasing, NS men highestBMI30,
1994/95- 2000
98
Mammogram Women, 50-69, routine screening within
last two years, 2001
99
Mammogram Women, 50-69, routine screening within
last two years, 2001
100
Cape Breton lowest mammogram screening, highest
breast cancer rate
101
Pap smear test of women 18-59 years, 2001
102
Pap smear test of women 18-59 years, 2001
103
The physical environment is an important
determinant of health- Health Canada

• At certain levels of exposure, contaminants in
  our air, water, food and soil can cause a variety
  of adverse health effects, including cancer,
  birth defects, respiratory illness and
  gastrointestinal ailments.
• Factors relating to housing, indoor air quality,
  and the design of communities and transportation
  systems can significantly influence our physical
  and psychological well-being.

104
Second hand smoke exposure on most days in the
last month, 2001
105
Access to Health care

• Women use more health care services than men,
  thus are disproportionately affected by barriers.
  
• Atlantic Canadians have greater difficulties
  accessing care than most other Canadians.
• The barriers result from less availability of key
  health care services in rural areas, rather than
  from longer waiting times.
• Atlantic Canadians are generally highly satisfied
  with the quality of the health care services they
  receive.

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In Sum

• Women have distinct health issues.... that have
  social and economic roots
• 3 interventions that can improve womens health,
  save health costs 1) reduce time-overwork
  stress 2) eliminate gender wage gap 3) reduce
  single parent poverty
• Can it be done?......1900s/1980s.......

107

Improving womens health today will benefit
future generations of Nova Scotians