Genuine Progress Index for Atlantic Canada Indice de progr

1
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueGender-Based
Analysis and Indicators of Womens Health in
CanadaHealth Canada Policy Forum Ottawa, 9
October, 2003
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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

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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)

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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
womenshealth?

• 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
1991-2000
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Low-income children under 18, 1991-2000
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Income Female lone-parent families - 1997
2000
15
TrendLow income rates of children Single
mother families ---1991-2000
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Employment of Female Lone Parents 1976-2001
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Low Incomes 1991-2000Single mothers w/out
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
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GINI coefficient 1991-2000
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Despite growing educational parity....
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Gender wage gap remains unchanged- Ratio of
Female to Male Hourly wages 1997-2001
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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 e.g. Regional wealth
gap grows

• Atlantic region cf Ontario, Canada
• 1990 0.82 disp.income NS for 1 in Ontario.
  1998 0.73
• Financial Security Atlantic Canada
• 1984 5.4 of national wealth.
• 1999 4.4
• (7.8 of Canadian population)

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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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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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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
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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
33
Job security - temporary work
34
Job security union coverage (helps explain PEI
equity)
35
High decision latitude at work - related to lower
stress
36
Official unemployment rate
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BUT.... Unemployment underemployment
38
Youth unemployment 15-24 explains entire gender
gap
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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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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
42
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 pop. 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.
• Volunteerism declining 1997-2000 Canada lost
  960,000 volunteers. 1997 29 men, 33 women
  vold 2000 25 men, 28 women
• Remaining volunteers work 9 more hours

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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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E.g.2Regional 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

• 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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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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More women physically inactive
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Health behaviours vary regionally e.g.
Overweight, pop, 20-64, 2001
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Mammogram Women, 50-69, routine screening within
last two years, 2001
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Cape Breton, W. Nfld low mammogram screening,
high breast cancer death rate
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Pap smear test of women 18-59 years, 2001
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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.

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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...