An Interview with Abby Hoffman

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A former Olympic track and field athlete and a prominent figure on the Canadian sport scene for over 30 years, Abby Hoffman was made an Officer of the Order of Canada in 1982 in recognition of her contributions to sport and public service.

Now Director General of the Women's Health Bureau, Hoffman coordinates Health Canada activities and policies related to women's health. A large part of her job is helping ensure the Canadian health system recognizes and responds to women's health needs. To that end, Hoffman has played a key role in the development of The Centres of Excellence for Women's Health program.

The recent federal government announcement of the selection of five Centres of Excellence for Women's Health represents an important step towards placing women's health issues and concerns on the Canadian political agenda.

Each centre will do policy-based non-clinical research with a goal of promoting positive changes in women's health status and services. The centres will also provide policy advice to government and other organizations. The program will be administered by the Women's Health Bureau of Health Canada and a National Advisory Board.

We asked Hoffman to share her thoughts on the program's potential impact on women's health.

CWHN: What are Centres of Excellence in Women's Health?

Abby Hoffman: The purpose of a centre is to bring people and organizations together that are interested in and have expertise in women's health. The program and the centres individually and collectively will hopefully generate significant new knowledge about women's health which can be applied to improving the health of Canadian women.

CWHN: What do you mean by "expertise"?

A.H.: In this case, "expertise" is not meant strictly in the traditional academic research sense. It extends to those who have experiencthis case, "expertise" is not meant strictly in the traditional academic research sense. It extends to those who have experience through grassroots work or work as service providers in the health system, or who know about women's health issues generally.

CWHN: So it's not just researchers?

A.H.: No. The people associated with a centre may do research but they will also do communications, advocacy and policy advice work as well. What we are aiming for is a concentrated effort with sufficient financial support so that people can spend their time and energy thinking about and working on women's health issues.

CWHN: Why are thinking about and working on these issues important?

A.H.: There is a lack of information about how well the health system responds to women's health concerns and a need to generate new information and understanding about factors which influence women's health.

Over the last five or six years, so-called health reform has been high on the agenda of all governments. However, the amount of policy-based research work that has been done looking at the impace of health reform on women and women's health is almost non-existant

CWHN: Why is that?

A.H.: Two reasons. Historically, the majority of health research has gone toward the study of major diseases, care, and treatment concerns. Considerably less attention has been paid to what makes people healthy and the impact of seases, care, and treatment concerns. Considerably less attention has been paid to what makes people healthy and the impact of the health system. Secondly, relatively few people have recognized that our health system may affect men and women differently and that these differences are worth studying.

CWHN: Who will decide what is researched at the centres?

A.H.: Every centre will be different , but I think that what gets investigated needs to be influenced by people beyond the research community. One of the roles of the Canadian Women's Health Network (CWHN) is to contribute to setting a relevant research agenda through its various contacts and networks.

CWHN: What has the reaction been at the grassroots level?

A.H.: My sense is that the reaction is generally favourable. I think that part of what people like is that underpinning the program is a determinants of health approach. It's not an approach that says that the only things that contribute to women's health are delivered by doctors. It's saying that many factors - political, economic, social, cultural - influence women's health

I also think people in community-based organizations see the opportunity to connect with one of the centres directly or through the work of the CWHN to influence research agendas.

CWHN: What do you say to women who are cynical of this kind of partnership approach?

A.H.: When you try to bring together people and organizations with different perspectives there are going to be difficulties in finding ways of working in partnerships as work in progress: there is no such thing as one right way to do it or an absolute state of satisfaction that all the right players and processes are in place. Just becuase all the parts don't mesh perfectly doesn't mean we should throw up our hands or wait until we have the perect working model. Everyone should feel that they are there to both contribute and learn, and to find some common threads they can weave together to make something coherent and useful.

CWHN: Are there common threads?

A.H.: In all the proposals we received, both the original 25 and the 13 that advanced to stage two of the selection process, there are the makings of some potentially very effective partnerships.

CWHN: What does the program mean to the field of women's health?

A.H.: The centres will provide individuals and teams of researchers with an opportunity to do work that would not otherwise be done. It has not been easy for academics to build careers around women's health - particularily using a determinants framework - because that approach has not been held in high regard. There is a need to create more credibility in the field. Hopefully, the program will contribute to that.

CWHN: Why hasn't women's health received the respect it deserves?

A.H.: Women's health requires a cross-disciplinary perspective and an awareness of how gender inequity affects health, neither of whicomen's health requires a cross-disciplinary perspective and an awareness of how gender inequity affects health, neither of which is the norm in academia. I think women's health requires a new type of perspective and new training. People in the centres are going to try to figure out how these many disciplines and the expertise of individuals can be brought together.

CWHN: Where do you see the centres being in a couple of years?

A.H.: I'm hoping there will be a growing general awareness and an injection of energy into the system with respect to women's heatlh because of the centres. There will be an increase in the amount of work that is being done on women's health in Canada and a better job will be done on the identification of key issues that need further work. I hope people interested in these issues will be more successful in getting money from major health funding bodies. I'd like to think that the centres and their associations across the country will be well respected sources of policy advice as the Canadian health system evolves.