The Intersection of Gender, Race/Ethnicity
and Poverty:
Implications for Research & Policy
Arlene S. Bierman, M.D., M.S
Ontario Women’s Health Council Chair, Women’s Health
St. Michael’s Hospital, University of Toronto
Academy Health Annual Meeting June 29, 2009
June 22nd, 2009
Measuring and Monitoring Gender Differences
in Health and Health Care
Women and men have very different:
 Patterns of illness, morbidity, and mortality
 Social contexts
 Experiences with health care
Health inequities among women often larger than
those between women and men associated
with:
 Socioeconomic position
 Ethnicity
 Geography
Developing a Framework for
Gender, Migration, and Health
• Four bodies of literature
– Gender Disparities in Health
– Racial and Ethnic Health Disparities
– Socioeconomic Inequities in Health and
Social Determinants of Health
– Gender and Migration
Gender, Migration and Health:
A Conceptual Framework
Central concentric circles adapted from Hertzman (2001)
Bierman: 2006
A Tool for Monitoring and Improvement
The Project for an Ontario Women’s Health
Evidence-Based Report (POWER) will
serve as a tool to help policymakers and
providers to improve the health of and
reduce inequities among the women of
Ontario.
Determinants of Health
Canadian Institute for Healthcare Information
• income and social
status
• social support networks
• education
• employment/working
conditions
• social environments
• physical environments
(CIHI)
• personal health
practices
• healthy child
development
• biology and genetics
• health services
• gender
• culture
POWER
Study Gender
and Equity
Health
Indicator
Framework
Assessing Equity
Overall
Population
Men
Women
Income
Education
Geography
Ethnicity
Income
Education
Geography
Ethnicity
Stakeholder Consultations
Community Engaged Research
 Power Study Roundtables
 Consumers: representatives of community
based groups and associations
 Providers: clinicians, government, health
data agencies, LHINs, CHCs, CCACs
 Wide range of interests and areas of
expertise
• Priorities for measurement and
interpretation of findings.
Age-standardized percentage of adults aged 25 and older who reported their
health as fair or poor, by sex and annual household income, in Ontario 2005
Percentage (%)
40
30
26
25
18
20
21
13
13
8
10
7
0
Low
Low er middle
Middle
Annual household income
Women
Data source: Canadian Community Health Survey cycle, 3.1
Men
Higher
Age-standardized percentage of adults aged 25 years
and older who reported their health as fair or poor,
by sex and ethnicity, in Ontario, 2005
Percentage (%)
40
30
Women
Men
29
24
19*
20
16* 16*
15*
14
9*
10
12*
12 13
Other***
White
8*
0
Aboriginal**
Black
South and
West Asian,
Arab
East and
Southeast
Asian
Ethnicity
Data source: Canadian Community Health Survey 3.1
*Interpret with caution due to high sampling variability (coefficient of variation
16.6–33.3)
**Only includes off-reserve Aboriginals (North American Indian, Metis, Inuit)
***Includes Latin American, other racial and multiple racial origins.
Age-standardized percentage of women aged 25 and older who reported health
behaviours that increase the risk of chronic diseases, by education level, in Ontario,
2005
Data source: Canadian Community Health Survey cycle, 3.1
*Physical activity index was less than 1.5 kcal/kg/day
** Less than five servings per day
***Body Mass Index (BMI) >greater than or equal to 25 (calculated from self-reported height and
weight)
Age-standardized percentage of adults aged 25 years and older who reported
being current smokers, by sex and ethnicity, in Ontario, 2005
Percentage (%)
100
80
60
40
39
43
20
10*
19*
18
18
5*
4*
25
13
22
25
0
Aboriginal**
Black
South and West
Asian, Arab
East and
Southeast
Asian
Ethnicity
Women
Data source: Canadian Community Health Survey cycle, 3.1
Men
Other***
White
Agestandardized
percentage of
adults aged 25
and older who
reported being a
daily or
occasional
smoker, by sex,
education level
and Local Health
Integration
Network, in
Ontario, 2005
Age-specific percentage of adults aged 25 years and older who reported that their activities
were prevented due to pain or discomfort, by sex and annual household income, in Ontario,
2000/01
Percentage (%)
40
30
35
27
26
23
20
18*
16 15
27 26
25
16
13
11
10
11*
7
10
0
Women 25–64
Women 65+
Men 25–64
Men 65+
Sex and age group (years)
Low income
Low er middle income
Data source: Canadian Community Health Survey cycle, 1.1
Middle income
Higher income
Age-specific percentage of adults aged 25 years and older who reported
having two or more chronic conditions, by sex and annual household
income, in Ontario, 2005
Aged 25–64 years
Aged 65 and older
100
100
80
Percentage (%)
Percentage (%)
80
60
40
34
28
30
23
25
20
20
70
69
61
60
65
62
57
60
50
40
21
16
0
20
0
Low
Lower
middle
Middle
Higher
Annual household income
Data source: Canadian Community Health Survey cycle, 3.1
Low
Lower
middle
Middle
Annual household income
Higher
Age-standardized percentage of adults aged 25 years and older who reported
having two or more chronic conditions, by sex and ethnicity, in Ontario, 2005
60
50
48
Percentage (%)
41
40
34
29
30
29
25*
27
23
26
19
20
16
16
10
0
Aboriginal**
Black
South and West
Asian, Arab
East and Southeast
Asian
Ethnicity
Women
Men
Data source: Canadian Community Health Survey cycle, 3.1
*Interpret with caution due to high sampling variability
** INCludes self-identified off-reserve Aborigianl adults (North American Indian, Metis, Inuit
*** Includes Latin American, other racial and multiple racial origins
Other***
White
Canadians reporting arthritis, diabetes, or heart
disease who also report food insecurity
70
59
57
60
60
56
54
51
50
Percent
43
43
40
33
33
31
30
25
20
15
12
12
10
6
3
x
10
*
5
0
Canada
Arthritis
Lowest
Lower Middle
Diabetes
Middle
Upper Middle
*Interpret with caution due to high sampling variability (CV 16.6-33.3)
Data source: CCHS 3.1
Age-standardized
Heart Disease
Highest
Source: CCHS 1.1
Premature mortality (percentage of the population who died before age 75
years), by sex and neighbourhood income quintile, in Ontario^, 2001
50
41
Percentage (%)
40
33
30
31
29
28
26
21
20
19
20
19
10
0
Q1
Lowest
income
Q2
Q3
Q4
Neighbourhood income quintile
Women
Men
Data sources: Statistics Canada’s Canadian Mortality Database and 2001
Census
Q5
Highest
income
Driving Improvement and Equity
• Prioritize Chronic Disease Prevention and
Management
• Coordinate Population Health, Community,
and Clinical Responses
• Address the Broader Determinants of
Health
• Routinely Include Gender and Equity
Analysis in Health Indicator Monitoring
Addressing Intersectionality
• Stratified reporting capturing heterogeneity of
women’s experiences
• Include indicators that capture SDOH
• Provide context-qualitative literature
• Highlight what we can’t measure
• Engage broad community including
policymakers, providers, non-governmental
organizations, community based organizations,
advocates
Download report at powerstudy.ca
The POWER Study is funded by Echo: Improving Women's Health in Ontario,
an agency of the Ministry of Health and Long-Term Care. This presentation
does not necessarily reflect the views of Echo or the Ministry.