The ‘POWER’ to Improve Women’s Health

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We know that men and women have different health needs and encounter different barriers to accessing care. When they do access health care, men and women are often treated differently. Women with cardiovascular disease, for example, may experience longer delays in accessing appropriate care and may be less likely than men to receive indicated treatments. In addition, women have different social contexts than men that shape their health, including higher rates of poverty and more caregiving responsibilities. It is not possible to reduce health inequities, improve population health, or improve health-care delivery without addressing gender issues.

The POWER Study in Ontario is producing an evidence-based tool to help policy-makers, health-care providers, and consumers improve health and reduce health inequities among the women and men of Ontario. By measuring health inequities, we can help guide interventions to improve health for all women. And by monitoring inequities in health and health care over time, we can help in assessing whether or not progress is being made.

A multidisciplinary team of over 60 researchers is collaborating on this multi-year project which is a partnership between St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES), both based in Toronto, Ontario, and is funded by the Ontario Ministry of Health and Long-Term Care and Echo, the province’s new women’s health agency.

The study is examining differences between men and women as well as differences among women associated with age, income, education, ethnicity, and where they live. Where possible, data are analyzed at the level of Ontario’s recently created Local Health Integration Networks (LHINs), which are responsible for planning, coordinating and funding the delivery of health-care services within their respective communities. Where data do not exist to support analysis at this level, findings are reported at the provincial level.

Health indicators for the study were chosen by a panel of technical experts with input from a wide range of key community-based stakeholders, including women’s health advocates. To assess the indicators, researchers analyze data from administrative health-care databases (e.g., hospitalizations), surveys done by Statistics Canada and other agencies, vital statistics, and disease registries. The indicators capture the most common causes of illness, disability and death among women, and may then be used to improve health. For example, knowledge of the differences in cervical cancer screening rates among different groups of women can guide care providers to increase screening for groups that are currently least likely to receive screening. 

The POWER Study’s findings will be released in two volumes. The first volume includes chapters on the burden of illness (overall health and well-being, prevalence of chronic conditions, risk factors for chronic disease, and mortality); access to health services (access to primary care, specialist care and home care; rates of hospitalization for diabetes, asthma and heart failure); depression (how Ontario’s health-care system meets the needs of women and men with depression); cancer (breast, reproductive system, lung and colorectal cancers; cancer incidence; survival rates; and end-of-life care) and cardiovascular disease (ischemic heart disease, heart failure and stroke; wait times for cardiovascular procedures). These chapters will be sequentially released online beginning in early 2009.

The second volume includes chapters on musculoskeletal disorders, diabetes, HIV infection and women’s gynecological/reproductive health as well as chapters on the social determinants of health and low-income, immigrant, and older women. The data for these chapters are currently being analyzed with anticipated release beginning in Fall 2009 when individual chapters will be available for download from the project website (www.powerstudy.ca).
Study findings will also be available in the ICES inTool (www.ices.on.ca) where health data are presented in an interactive web-based format, and which will contain additional demographic information not included in the POWER Study’s published reports. This will allow policy-makers and planners, public health personnel, providers, health advocates, the public, and researchers to examine the data and make comparisons across subgroups and regions according to their specific needs.

From its inception, a diverse group of community-based organizations, health advocates, providers, consumers and policy-makers have been integral to shaping the report. Their perspectives helped identify priorities, and indicators, and they contributed invaluable suggestions for how to make the report most useful. Community input was also central to developing the POWER Study Gender and Equity Framework, which recognizes non-medical determinants of health, such as living and working conditions.

The aim is for the findings to serve as a catalyst for action. The POWER Study paints a picture of gender, socioeconomic, and ethnic inequities in health in Ontario and in doing so identifies many opportunities for improvement. It provides objective evidence for priority setting and provides a baseline from which to measure progress and to assess the effectiveness of interventions aimed at achieving gender and socioeconomic equity in health.

For more information and to download individual chapters as they become available, visit the POWER Study website at www.powerstudy.ca

Jean Kammermayer BScN, MPA, a senior policy analyst, is Director of Knowledge Translation for the POWER Study. Arlene S. Bierman MD, MS, FRCPC, a general internist, geriatrician, and health services researcher is the Principal Investigator for the POWER Study.