Getting Sensitive to Gender Sensitive Health Planning

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In both Saskatchewan and Manitoba, one of the major changes to the health care system under health reform has been "regionalization"-- the transfer of responsibility for health services to regional bodies, known as health districts in Saskatchewan and Regional Health Authorities (RHAs) in Manitoba. These bodies are governed by boards made up of community members.

Critics of regionalization in Manitoba expressed concerns that the province was shifting accountability, but not responsibility for health services to RHAs. RHA Boards would have to make decisions about how to meet the health needs of a community without having the resources to adequately meet those needs. One of the reasons for regionalization was that by moving the decision-making closer to the local community, health care services would be more reflective of a community's needs and concerns.

Women in particular raised concerns about the ability of RHAs to adequately address women's health concerns. Women in many communities had been involved in fighting anti-choice takeovers of local Hospital Boards. With no commitment to gender balance on RHA Boards or the inclusion of advisory committees on women's health, many women's health advocates were concerned that RHA Boards would refuse to make controversial decisions, such as providing access to abortions.

In an effort to make regional health bodies more responsive to community health needs and concerns, they began a process of Community Health Needs Assessments. Using surveys and community meetings, the goals were to gather information about the factors, or determinants, affecting health in a community such as the types of work people did; as well as the health needs of a community, such as the level of certain diseases, like diabetes and asthma; and access to programs that promote health, like recreation. All of this information about the community would inform the Health Plan, which was submitted to the province for funding. If a community identified a high level of smoking among adolescents, the health plan could include specific programs aimed at helping young people quit smoking, and the province would decide whether or not to fund the program.

Recently the Prairie Women's Health Centre of Excellence (PWHCE) released a report titled Invisible Women: Gender and Health Planning in Manitoba and Saskatchewan and Models for Progress by Tammy Horne, Lissa Donner and Wilfreda Thurston. In this study, the authors examined health plans and community health needs assessments of participating Manitoba RHAs and Saskatchewan Health Districts, and talked to key individuals in these regions in order to discover how well women's health issues and concerns were reflected in community health planning documents.

Invisible Women concludes that, with few exceptions, the health needs and concerns of women are not reflected in the community health needs assessments and resulting health plans. Even though both provincial governments have indicated that women's health is a priority, regional health bodies spend little or no time examining how gender affects health. They are not hostile to gender analysis. They simply do not place a priority on it. The question to be answered is: "So what?" Why does it matter if gender isn't included in health planning? Why is it in the best interest of health planners, policymakers and decision-makers to use gender analysis? Why should anyone care if women's needs and interests are met?

Often women's health advocates will respond to these questions with moral reasons. Women's health is important because women are important. It is an injustice to ignore the needs and concerns of over half of the population simply because of gender. All of these arguments are true. However a more persuasive argument might be that without gender analysis, policies designed to improve the health status of women, as well as men, are destined to fail.

Gender Analysis is cost effective. In the early nineties, health policymakers in Manitoba and Saskatchewan were faced with decreasing federal funding for health care, increasing health care costs, and pressure to deliver "balanced" provincial budgets. Many of these policymakers correctly concluded that preventing diseases was cheaper than treating them. Keeping people healthy without spending more on health care would have to mean changing the things that were making people unhealthy.

Health care reform has been influenced by a growing awareness that the health of a population is determined by social, economic, and environmental conditions, not simply by the delivery of health care services. Your health is affected by your income, education, the amount of support you get from family and friends, the kind of work you do, the amount of control you have over your life and many other factors beyond how often you see the doctor. This approach to health is often called "population health" or "determinants of health".

Promoting wellness has to include an examination of the determinants of health. This approach points to inequality as one of the major barriers to health for most people. Inequality in income, education levels and social status is often based on factors such as gender, race and (dis)ability. Improving health status means a more equal distribution of power in society and giving people control over their lives.

The amount of political, economic and social power an individual has in society can also affect their health. In our society, factors like gender, race, age, (dis)ability, sexual orientation and economic class have a lot to do with how much power an individual has. For example, we know that the amount of income has some impact on an individual's health. We also know that women generally have less income than men, because the type of work women do is less valued, is more often part-time and more likely to be interrupted by family responsibilities such as child and elder care. We also know that, as a result of institutionalized prejudices, Aboriginal people and people with disabilities are more likely to experience unemployment, which affects their income. When we think about "income" as a determinant of health, we have to think about all the factors that affect a person's income. When we design policies and programs to address income, they have to be analysed for the different effects they will have on women, Aboriginal people and people with disabilities. If it does not benefit from this kind of analysis, it is unlikely that the program or policy will effectively address income and the goal of improving health status will be missed.

The women's movement has done a very good job of convincing people of the need for equality. However most people only understand "equality" in terms of access to service and opportunities. Questions of power and privilege are much more uncomfortable to examine than questions of access, therefore they are rarely addressed. Often, a "gender analysis" of an existing policy or service only goes as far as determining if something is "gender neutral". As long as women are allowed access to the same services as men, they are considered equal. Gender neutral policy-making and planning only asks the question "Can women get in?", not "Do women get in?".

True gender analysis has to consider the social roles and power that we all live with as women and men, by virtue of our gender, as well as the impact these gendered roles and behaviours have on our health. For most people, gender is as invisible, and as important, as the air we breathe. Unless an analysis that compares how and why women and men are affected differently by policy is applied to programs designed to improve health, these initiatives will likely fail for both women and men. For example, suicide prevention programs that do not examine the reasons why men commit suicide at a higher rate than women, may not be successful in preventing deaths from suicide among men.

Women have to be involved in health planning at all levels if women's health needs are to be met. Women should be involved in asking the questions, answering the questions and making decisions based on those answers.

Jennifer Howard is a Program Coordinator with the Prairie Women's Health Centre of Excellence. The report Invisible Women is available from the Centre through our web site at www.pwhce.ca or by calling (204) 786-9048.