Lissa Donner
Introduction
Why include gender in health planning? Because when
it comes to health, sex and gender matter. By deliberately exploring
the possible different needs, concerns and consequences of health plans
for men and women, we can make health services more relevant and appropriate
to both women and men in Manitoba.
This guide has been developed jointly by the Prairie Women’s Health
Centre of Excellence and Manitoba Health as part of the Women’s
Health Strategy endorsed by the Minister of Health and Minister Responsible
for the Status of Women in 2000. Its primary purpose is to assist the
Regional Health Authorities (RHAs) to incorporate gender in their upcoming
Community Health Assessments and subsequent Health Plans. As well, the
guide is a useful tool to Manitoba Health and others involved in gender
& health planning.
When gender-based analysis is done successfully, gender becomes part
of the entire regional health planning process including the Strategic
Plan (vision, mission and values; environmental scan and strategic priorities)
and the annual Operational Plan.
Regional Health Authorities are already taking action to include gender
in health services. For example, South Eastman (RHA) has conducted a
regional study to talk with women about their health. Assinniboine (RHA)
runs a Women’s Health Program to increase knowledge and understanding
of women’s health and needs in the region, support the provision
of effective services to women, and promote good health through preventative
measures. Interlake RHA has conducted focus groups on informal caregiving,
a topic of great relevance to women. As well, in 2002, the Interlake
region was recognized at a national conference for the successful work
done by a multi-sectoral group (health, recreation, education, Aboriginal
peoples) regarding health promotion initiatives to get girls and women
active in the region.
This guide provides some background and history on gender-based analysis.
Two case studies show the value of understanding the health of a population
considering both females and males. Finally we provide brief checklists
to assist you in considering men’s and women’s shared and
differing needs. We hope you find this guide useful.
Gender-based analysis acts like a camera lens, filtering distortions
and inaccuracies that are not immediately obvious.2
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What is Gender-based Analysis
Gender-based Analysis (GBA) is a tool to help understand
how the experiences of women and men are different, and how they are
the same. In the case of health, GBA illuminates the differences in
health status, health care utilization and health needs of men and women.
Health Canada defines Gender-based Analysis as:
“...an analytical tool applied to research, policies,
program design, and evaluations to ensure that appropriate questions
about both men and women yield sensitive and accurate analyses and programs.”1.
“Gender-based analysis helps to ensure that the differential
economic, political, social and biological circumstances of both girls
and boys, and women and men are taken into account. Gender-based analysis
will render transparent issues such as the under-representation of women
in decision-making or the absence of women in research. It may similarly
highlight imbalances in addressing men’s health issues.”3
Gender-based analysis (GBA) flows from a population
health perspective. Manitoba Health's Women's Health
Strategy recognizes gender as one of the important determinants
of population health. The other determinants of health accepted
by Health Canada are:
. income and social status
. social support networks
. education
. employment and working conditions
. social environments
. physical environments
. biology and genetic endowment
. personal health practices and coping skills
. healthy child development
. health services
. culture |
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Why Gender-Based Analysis?
When it comes to health, sex and gender matter. Research
is increasingly alerting us to the ways that sex and gender interact
to “create health conditions, situations and problems that are
unique, more prevalent, more serious, or have different risk factors
or interventions,” for women and men (Greaves et al., 1999:3)...Tailoring
the health care system to meet the particular needs of women (and men)
should lead to better use of resources.4
GBA allows us to consider the ways in which gender interacts with the
other determinants of health to influence the health of women and men,
boys and girls.
This is important because women and men are not all the same. We differ
because of age, education, socio-economic status, culture, physical environments,
etc.
Including GBA can be part of on-going programming and planning for health
care delivery. Using GBA provides an idea of the wider breadth of the
health issues that affect a regional population.
Gender can act in two ways to influence health.
Firstly, gender acts on its own. The most obvious example of this is reproductive
health. But gender acts in other ways, that may not always be considered.
For example the same drug can cause different reactions and different
side effects in women and men.5
Secondly, gender works along with other determinants of health. For example,
income is linked to health. Those with lowest incomes are at the greatest
risk of ill health. The “gender gap” in incomes means that
Manitoba women are more likely to be poor than are Manitoba men - almost
20% of adult women are poor compared with 13.5% of adult men.
GBA also includes an analysis of the diversity among people, recognizing
that all women and all men are not the same. For example, senior women,
especially senior women living on their own, women with disabilities and
Aboriginal women of all ages are at even greater risk of poverty than
their male counterparts.6
In Manitoba the health needs of Aboriginal women and men require particular
attention. GBA shows how the situations of Aboriginal women and men are
the same, and how they are different. It also shows how the situations
of Aboriginal women and men compare to non-Aboriginal women and men.
GBA is a powerful tool for health planners and decision-makers who must
allocate resources. GBA contributes to “evidence-based” decision
making, because it broadens the scope of “evidence” used in
the decisions.
Isn’t Gender Just a Polite Way of Saying “Sex”?
In order to undertake GBA, it is important to understand the concepts
“sex” and “gender”.
Did You Know...
Women and men do not receive the same (or similar) care, even
for the same conditions. American studies show women are less
likely to receive high-tech services, and tend to receive
less aggressive care for conditions such as heart disease
and cancer.8 |
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Sex refers to the biological differences
between females and males. The health sector has focussed largely on
reproductive differences, particularly maternity care, but physical
distinctions between females and males shape a much broader range of
health issues.
Gender refers to the array of socially constructed
roles and relationships, personality traits, attitudes, behaviours,
values, relative power and influence that society ascribes to the two
sexes on a differential basis. Gender is relational - gender roles and
characteristics do not exist in isolation, but are defined in relation
to one another...
Gender roles and responsibilities are rarely evenly balanced in any
society. Women and men generally do not have equal access to resources
such as money, information, power and influence...7
Without GBA, women and men may be treated the same way, when it is inappropriate
to do so. Alternatively, they may be treated differently when it is inappropriate
to do so, based on traditional, long-standing stereotypes. GBA helps to
uncover both of these types of problems.
Consider these examples:
Two Manitoba projects supported by Prairie Women's Health
Centre of Excellence give insight into effective women's health
planning and programming:
A Rural Women's Health Program: The Experience of the
South Westman RHA, by Donner, L., 2002 and; I by Roberts,
J., Falk, M.,and South Eastman Health, 2002. |
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- It is well-known that young men commit suicide much more frequently
than young women. Looking at gender - and understanding the differences
in the lives of young women and young men - will help in the development
of prevention and intervention strategies to reduce suicides among
both young women and young men. The first case study in this guide
deals with this issue, as well as the related problem of self-inflicted
injuries among women. In this example, treating women and men the
same way is not appropriate.
- Canadian women live, on average, longer than Canadian men do. RHAs
will therefore see more elderly women than men in hospital. Considering
gender, and its many influences on the lives of senior women, will
help to provide services that better meet the needs of these women.
For example, their lower incomes mean that they are less able to purchase
non-insured treatments such as certain prescription drugs, medical
supplies and physiotherapy. Their caregiving roles may mean that senior
women are themselves responsible for caring for others who are chronically
ill. Again, in this case, treating women and men the same way is not
appropriate.
- Health education messages designed to prevent unwanted pregnancies
have primarily focussed on young women. This has reinforced the stereotype
that places most of the burden of responsibility for birth control
on women. In this case, it would be more appropriate and effective
to target both women and men.
What About Men’s Health?
A gender inclusive approach includes men and women. When women’s
health is emphasized, it is because much more is already known about
men’s health. Most health research in the past has been conducted
on men, by men. The results may then be applied to women, leading to
inappropriate or ineffective interventions.
Gender-based analysis gives us an opportunity to ask questions based
on health data which is already available. It also helps point out information
which may be missing from current data.
Why is Gender Important in Health Planning?
GBA is about more than identifying and analyzing issues specific to
women (like hysterectomy rates and Caesarean section rates) or men (like
prostate cancer) or issues more common to women (like breast cancer).
GBA is a tool to apply when analyzing all aspects of health, and all
parts of the health care system, because gender affects all aspects
of the lives of women and men - everything from income and education
to family responsibilities, and social supports to occupational health.
Good health planning is about using the available resources to help
obtain the best possible health outcomes for all. However, providing
the same programs and treatments for everyone in a region (that is,
treating them equally), may not produce results which are equitable.
Different programs or treatments may be necessary for women and men,
boys and girls, in order to achieve the best possible results. GBA will
help to identify and give priority to those areas where gender-sensitive
interventions will lead to improved health.
Putting GBA to Work: Two Examples
The two case studies which follow are examples of GBA in action. These
examples demonstrate how an understanding of gender can be practically
applied to community health assessment and health planning work. They
present some basic information and a series of questions for RHAs to
consider when analyzing the influence of gender in their own communities.
Endnotes:
1 Health Canada, 2002, 1
2 Health Canada, 1999, 35
3 Health Canada, 2002
4 Ministry of Health Services, 2001
5 Health Canada, 2002, 6
6 Donner, 2002, 1 - 3
7 Health Canada, 2000, 14
8 Grant, 2002
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