Moving Beyond the Policy Debate: How Process
Improvements can Dramatically Impact Service
Delivery in the Health Care System
Canadian Federation of University Women
Laura Zilney, Chair
Health Committee
October 2005
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Background: Canadian Federation of
University Women
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Founded in 1919, CFUW is a voluntary, not for profit, self-funded
organization of over 10,000 women university graduates
members belong to 122 clubs active in every province in Canada
CFUW is one of 78 member affiliates of the International Federation of
University Women and its 140,000 members
CFUW is a non government organization with special consultative status at the
United Nations (Economic and Social Council) Commission on the Status of
Women
CFUW is committed to:
 The pursuit of knowledge;
 The promotion of education;
 The improvement of the status of women and human rights; and,
 Active participation in public affairs in a spirit of cooperation and friendship
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Presentation Outline
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Issues & Challenges - specific studies/research
Guiding Principles - following through
Recommendations - standards and policing
Critical Success Factors
Closing Remarks - fair and gender specific
treatment
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Issues & Challenges (Page 1 of 2)
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Women are underrepresented in health research - leads to improper diagnoses/treatment,
over-medicalization of women’s health
• only in September 1996 did Health Canada revise its guidelines to require drug companies
to include women in clinical trials “in the same proportion as are expected to use the
drug”
• only 5% of Canadian health research funding is spent specifically on women’s issues
(Status of Women Canada)
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Women are often the first to suffer the effects of downsizing on the system (e.g.
caregivers for those released from hospital earlier) - leads to increased economic burden,
increased stress/anxiety
• women less likely than men to have private insurance and therefore bear the brunt of
increased drug costs - cost of prescription drugs increased twice as fast as overall health
expenditures between 1989-1998 (Cyrus & Curtis 2004)
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Women tend to prioritize their health lower than competing social, economic,
environmental, and political concerns - even when changing cultural and social norms
have increased women’s level of risk (e.g. serial monogamy)
• women live 6.3 years longer than men, but only enjoy 1.5 more disability-free years of
life (Health Canada 1999) – does not necessarily translate into quality years of life
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Issues & Challenges (Page 2 of 2)
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Women treated as homogeneous group - policies/procedures do not recognize differences based on
ethnicity, immigrant status, education, class
• domestic violence/violence against women: Health Canada recognizes this is a mostly
“female” problem, but there is no consistency in terms of how this is dealt with in the
health care system across Canada
• difference between women only noted in relation to specific problems e.g. Native women
more prone to cervical cancer; South-Asian and Black women at greater risk of heart
attack/stroke - no explanations/analysis provided (Health Canada 1999)
Women’s health not directly dealt with in health system or in policy - women treated for reproduction
issues (pre and post natal)
• Health Canada (2003) concluded this may lead to women’s exclusion from policy-making,
research, medical research and therefore power within the system
Political, economic, social, and environmental factors not analyzed when developing/modifying health
policy
No consistent experience/access to service across the country - leads to disparities between
rural/urban, lower/middle or upper classes, young/old, women/men
• e.g. poor women often have reduced access to educational opportunities and decreased
exposure to health-related information - results in lower income, poor nutrition, increased
susceptibility to infection, chronic stress - all of which compound to impact women’s
health (Kitts & Hatcher Roberts 2003)
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Guiding Principles
• Accountability
– financial
– service quality
– corporate and individual
• Consistency
– nationally
– between ethnic/cultural groups, geographic, gender
• Performance-based
– service outcomes
• Prevention-based
• Needs-based
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Recommendations
• Re-introduction of national health care standards
• provinces/territories required to provide Mandatory Programs in set program
areas (e.g. Family Health, Chronic Disease Prevention)
• provinces/territories required to offer minimum number of Elective Programs
in program areas that serve the needs of the community in which the health
facility is located
• provinces/territories required to report back annually on set performance
measures - if they fail to report/do not meet measures, federal monies cease or
are reduced, as appropriate
• Provinces/territories provide health services through Combined
Treatment Teams (CTT) to ensure consistency of experiences
• CTTs consist of physicians, nurse practitioners, nurses, social workers,
nutritionists, physiotherapists, orthopedists
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Recommendations: Service
Delivery Breakdown
Federal Government
Provincial/Territorial Governments
Municipal/Local Governments
•Establish performance measures
•Provide monies via Canada Health Transfer
•Ensure implementation of CTTs, Mandatory/Elective Programs
•Coordinate report-back to federal government
•Implement Mandatory and Elective Programs
•Report-back to Provincial/Territorial Government
•Operate CTTs
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Critical Success Factors
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Mandatory Programs offered by provinces/territories must be enforceable and
enforced - requires significant amount of work (e.g. Ontario)
Clear roles between feds, provinces/territories, municipalities established
Clear funding formula developed - should municipalities have taxation ability
to supplement Mandatory and/or Elective Programs?
Municipalities must be engaged in the process despite not necessarily having a
controllership role (examples from across Canada indicate decreased
engagement without controllership) - should this engagement be mandated?
(e.g. Children’s Aid Societies)
Clear process for determining how monies from feds is divided between each
Mandatory Program (e.g. flexibility given to provinces/territories to determine
breakdown, based on social need, based on cost to provide, etc.)
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Closing Remarks
• Need to move beyond “gender-based analysis” to
substantive movement on process/procedural
implementation
• Need to enforce what is already legislated in the Canada
Health Act
• Federal Government needs to assume leadership role so
health care is delivered strategically and equitably
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