Marginalization through aggregation

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The Prairie Women’s Health Centre of Excellence (PWHCE) in Manitoba has also recently undertaken a series of projects that strengthen our understanding of both how a female-specific set of health indicators and a gender-sensitive set of health indicators would improve our understanding of women’s health. In 2007, the PWHCE conducted the a field test of a set of women’s health indicators proposed by the World Health Organization using Manitoba data, with the goal of assessing the feasibility of using the core set in a province of Canada. Similar field tests were undertaken in Tanzania and China. PWHCE noted that in order for the core set of indicators to properly capture the experiences of Manitoba women, data would need to be not only sex-disaggregated, but also account for diversity. Their report notes that Manitoba women have different geographical, ethnic, and socioeconomic backgrounds and that therefore indicator analysis must examine the health implications of these differences.

In 2008, building on the feasibility study of the WHO core set of women’s health indicators, PWHCE released their gender-based analysis of over 140 women’s health indicators, using a variety of sources of data for Manitoba (available at www.pwhce.ca). Whereas the feasibility study approached a core set of indicators of women’s health, the Profile of Women’s Health applied a sex- and gender-based analysis to mainstream data sources in Manitoba in order to develop a comprehensive picture of women’s health. The report was one of the first to provide an in-depth, provincial analysis; local-level results contain profound implications for service delivery, policy and research such as concrete recommendations on how to support the development of a health system that is sensitive and responsive to women’s needs.

The British Columbia Centre of Excellence for Women’s Health (BCCEWH) in Vancouver has also been a key organization in advancing the surveillance of women’s health in Canada. Since 2006, BCCEWH has partnered with women’s health organizations from across Canada in order to develop The Source, a pan-Canadian resource for women’s health surveillance. The Source  provides an SGBA, data sources, and reports on over 70 indicators of women’s health broken down into categories of health determinants, health status, and health services. The Source contains descriptions of sex-specific, gender-sensitive, and qualitative indicators, including analysis of each in terms of sex, gender, and diversity.
These initiatives, which have been influenced by and have contributed to similar international efforts, have all provided insight into how to move forward with Canadian women’s health surveillance. While the debate continues between the utility of a sex-specific set of indicators versus making standard indicator sets more gender-sensitive, a different trend has also begun to emerge. A number of organizations, including the World Health Organization, have begun to explore an equity-focused set of indicators that measure not only issues of sex and gender, but also other population characteristics that have historically led to marginalization and/or health inequity. Socio-economic status, geography, language, race, religion, and other factors all fall into this category.

The development of effective indicators to monitor marginalizing social and material forces may assist in the future advancement of women’s health surveillance. Many of the questions equity indicators seek to answer – such as how is health affected for different population groups – are the same types of questions asked in sex- and gender-based analysis. Fundamentally both techniques are concerned that summarizing data across a population can potentially mask important differences for specific subgroups. If the differences for these groups cannot be seen in the data, they will continue to be invisible in research, policy and practice. In order to develop the most effective techniques to avoid marginalizing at-risk groups, future research should explore the overlap between equity, sex, and gender, and create suggestions on how these techniques can complement and support each other.

Steve Chasey is the Manager of  Data and Surveillance at the British Columbia Centre of Excellence for Women`s Health. Ann Pederson is the Director of the British Columbia Centre of Excellence for Women`s Health.