1.1.5 Lorraine Greaves
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Transcript of 1.1.5 Lorraine Greaves
Women’s health across time and space6th Australian Women’s Health ConferenceHobart, Australia
Lorraine Greaves, PhD, DUBritish Columbia Centre of Excellence for Women’s HealthCanada
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 making4. To recommend strategies going forward to
improve women’s health policy and practice
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
2nd wave women’s movement
Emerging politics of women’s liberation
Consciousness-raising
Control over body Labour force
participation and pay equity
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
Feminist Women's Health Center, Oregon
Self-examination kits to avoid doctors and be self sufficient
Women’s health movement identified values to underpin care
Inclusive Sensitive Respectful Empowering Accessible Comprehensive
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
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
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
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
The concepts, the issues
Sex Gender Diversity
Language clarity Measurement issues Capacity (Re) training Institutionalization Knowledge transfer
Sedimentary layers of terminology and analytic frames over 30 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
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
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
Sex and gender interact
Sex: biological and physiologically related factors Metabolism, hormones, size, anatomy etc
Gender: social and cultural factors Roles Identity Relations Institutionalized gender
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).
Cardiovascular disease
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)
Cardiovascular Disease (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).
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.
Our locations 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
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
Do these stereotypes persist?
Community
Powerless Persistent
Providers
In Silos Essential
Researchers
Theoretical Opportunistic
Policy makers
Powerful Sold out
All our different commitments need nurturingDifferent “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
Our collective 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
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
But politics matter the 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 p ro c e s s is the lasting
contribution
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
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
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
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
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
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
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
Contribute to better data 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
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