Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
Social Determinants of
Women’s Health in Canada
Health Canada Policy Forum,
Ottawa, 9 October, 2003
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......
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)
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
Practical: Women’s 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
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
1998 Federal Health Minister
• “I have undertaken to fully integrate
gender-based analysis in all of my
Department’s program and policy
development work...”
• “...to enhance the sensitivity of the health
system to women’s health issues...”
• “...more research...on the links between
women’s health and their social and
economic circumstances.”
1) Income: What does it have
to do with women’shealth?
• 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%
……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)
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.
A/c Roy Romanow……:
• “If you’re at the bottom of the
income ladder, odds are you’re
going to find yourself at the
bottom of the health ladder.”
• “So, if we’re serious about making
Canadians the healthiest people in
the world, then we have to be
serious about closing the gap
between rich and poor.”
Prevalence of low incomewomen and men: 1991-2000
Low-income children
under 18, 1991-2000
Income: Female lone-parent
families - 1997 & 2000
Trend:Low income rates of children:
Single mother families ---1991-2000
Employment of Female Lone
Parents 1976-2001
Low Incomes :
1991-2000
Single mothers w/out paying jobs
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 good rises
faster than wages
• Robin Douthitt: “time poverty”. Fulltime single mothers = 75 hour week
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
If Equality->Health, What are Trends?
Average Disposable H’hold Income Ratios, 1980-98
Richest 20% : Poorest 20%
1980
1990
1998
Canada
8.2
7.1
8.5
Newfoundland
Prince Edward Is.
Nova Scotia
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
7.6
7.4
7.1
6.7
7.6
7.8
8.8
8.1
9.1
9.3
5.8
6.2
6.2
6.1
6.9
7.1
6.7
7.3
7.4
7.6
7.3
6.7
8.5
7.0
7.9
8.3
7.6
7.4
10.4
8.0
GINI coefficient 1991-2000
Despite growing educational
parity
Gender wage gap remains
unchanged
-
Ratio of Female to Male Hourly wages: 1997-2001
1997 1998
1999 2000
2001
Av. hrly 81.5% 81.3% 80.9% 80.5% 80.7%
Median
78.5% 78.1% 79.1% 77.2% 79.8%
hourly
Av. hrly
82.9% 82.5% 82.3% 81.9% 82%
full-time
Av. wkly
69.1% 69.2% 69.4% 69.3% 69.5%
full-time
Explaining the gender wage
gap
• Convergence of women’s 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.” (2001)
–
Regional wealth gap grows:
e.g. Atlantic 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)
Share of national wealth vs.
population
(1984 & 1999)
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
3) Employment- a key
determinant of women’s
health
Issues:
• Both overwork and unemployment
are stressful- (Japanese study)
• Polarization of work hours -increasing
the level of inequality in family earnings.
• Women’s health - function of paid + unpaid
work - gender division of labour in household
• Women doubled employment, BUT still
do nearly two-thirds of household work.
% of Women and Men
Employed Canada 1976-2001
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%
Employed women with
children
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
Women increased professional
statusI.e. strong educational improvement
Job security - temporary work
Job security – union coverage
High decision latitude at work
Official unemployment rate
Unemployment +
underemployment
Youth unemployment 15-24
explains entire gender gap
4) While f-t women work 39 hrs cf
43 - men Women still do most
unpaid housework
Employed mothers (f/t) work
average 75-hr week - pd+unpd
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
Stress and health behaviours smoking
Less stressful alternatives
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).
Social Supports: pop. 12+, 2001
Social SupportsVolunteerism - a saving grace
• 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 vol’d
2000 = 25% men, 28% women
• Remaining volunteers work 9% more
hours
Family violence = key indicator
of women’s health
• CIHI, Statcan identify crime as “nonmedical determinant of health.” But
women’s 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
Family=high % 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.
Aboriginal women’s 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%
Aboriginal women’s 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
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 nat.av.
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
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
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.
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.
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...
But female smoking rates
declined later and slower
Teen Smoking rates by Gender
age 15-19,
1996 vs. 2001
45%
40%
40%
35%
30%
24%
25%
24%
21%
20%
15%
10%
5%
0%
1996
2001
Male
Female
More women physically
inactive
Health behaviours vary
regionally:
e.g.: % Overweight, pop, 20-64,
2001
Mammogram: Women, 50-69,
routine screening within last two
years, 2001
Cape Breton, W. Nfld = low
mammogram screening, high
breast cancer death rate
Pap smear test
% of women 18-59 years, 2001
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.”
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.
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 women’s health,
save health costs:
1) reduce time-overwork stress
2) eliminate gender wage gap
3) reduce poverty of single parents
Can it be
done?...1900s/1980s...
Improving women’s health
today will benefit future
generations of Canadians
Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
www.gpiatlantic.org