Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique

Social Determinants of Women’s Health

in Canada

Health Canada Policy Forum, Ottawa, 9 October,

2003

Pop. health context: Romanow and the 3 burning health policy

issues1) How to treat the sick - supply side

2) How to improve the health of Canadians

3) How to check spiralling health care costs - demand side

The next Royal Commission......

Practical: High portion of illness burden is

preventableExcess Risk Factors Account for:• 40% chronic disease incidence

• 50% chronic disease premature mortality

• 25% direct medical care costs

• 38% total burden of disease (includes direct and indirect costs)

1) Descriptive: Women have distinct health needs. Causes / outcomes differ by gender

2) Normative: Ensure equal treatment, overcome biases that impede wellbeing

3) Practical: Blunt, across-board solutions often miss mark, waste money. Gender analysis allows policy makers to target health dollars

Why a Gender Perspective

Practical: Women’s use of health services

• Canadian women have higher rates of:– chronic illness, physician visits– disability days, activity limitations– lower functional health status

• In every age group to 75, women more likely see physicians than men. Overall - 33% more likely; age 18-54 - 2-3x

• Teen girls higher rates than boys

• Young women have 2x stress cf young men

• Surveys: young women say stress relief and weight loss = primary reasons for smoking

• Therefore programs, brochures, counselling targeted to girls more effective than blanket one-size-fits-all health warnings

E.g….. Teenage smoking

1998 Federal Health Minister

• “I have undertaken to fully integrate gender-based analysis in all of my Department’s program and policy development work...”

• “...to enhance the sensitivity of the health system to women’s health issues...”

• “...more research...on the links between women’s health and their social and economic circumstances.”

1) Income: What does it have to do with women’shealth?

• Poverty most reliable predictor of poor health, premature death, disability: 4x more likely report fair or poor health

• Low income- higher risk smoking, obesity, physical inactivity, heart risk

• Costly: increased hospitalization: Women 15-39 = +62%; 40-64 = +92%

……health of single mothers• Worse health status than married

(NPHS); higher rates chronic illness, disability days, activity restrictions

• 3x health care practitioner use for mental, emotional reasons = costly

• Longer-term single mothers have particularly bad health (Statcan)

Low income children- at risk - 31 indicators

• More likely to have low birth weights, poor health, less nutritious foods

• Higher rates of hyperactivity, delayed vocabulary development, poorer employment prospects.

• Less organized sports, but higher injury rates, and 2x risk of death due to injury than children who are not poor.

A/c Roy Romanow……:• “If you’re at the bottom of the

income ladder, odds are you’re going to find yourself at the bottom of the health ladder.”

• “So, if we’re serious about making Canadians the healthiest people in the world, then we have to be serious about closing the gap between rich and poor.”

Prevalence of low income-women and men: 1991-2000

Low-income children under 18, 1991-2000

Income: Female lone-parent families - 1997 & 2000

Trend:Low income rates of children: Single mother families

---1991-2000

Employment of Female Lone Parents 1976-2001

Low Incomes : 1991-2000Single mothers w/out paying jobs

The Economics of Single-Parenting

• Single mothers with pre-school children spend 12% income on child care cf 4% in 2-parent families. In one pocket .........

• CPI for child care, restaurant good rises faster than wages

• Robin Douthitt: “time poverty”. Full-time single mothers = 75 hour week

2) Equity and health“What matters in determining mortality

and health in a society is less the overall wealth of the society and more how evenly wealth is distributed.

The more equally wealth is distributed, the better the health of that society.”

----- British Medical Journal 312, 1998

If Equality->Health, What are Trends?

Average Disposable H’hold Income Ratios, 1980-98

GINI coefficient 1991-2000

Despite growing educational parity

Gender wage gap remains unchanged

- Ratio of Female to Male Hourly wages: 1997-2001

Explaining the gender wage gap

• Convergence of women’s hourly wages stalled…. despite clear educational gains.

• After controlling for hours worked, educational attainment, work experience, industry, occupation, and socio-demographic factors, StatsCan concluded that: ……..

• ….“roughly one half to three quarters of the gender wage gap cannot be explained.” (2001)–

Regional wealth gap grows:

e.g. Atlantic cf Ontario, Canada:

• 1990 = $0.82 disp.income NS for $1 in Ontario. 1998 = $0.73

Financial Security Atlantic Canada• 1984: 5.4 % of national wealth. • 1999: 4.4 % “ “(7.8% of Canadian population)

Share of national wealth vs. population (1984

& 1999)

Wealth gap in Canada:• Richest 10% own 53% of wealth• Richest 50% own 94.4%, leaving 5.6% for

poorest 50%• Poorest ¼ of Canadians own 0.1% (or one-

thousandth of wealth)• Among poorest 20%, 1/3 fell behind 2+ months

in bill, loan, rent, mortgage

= Importance of diversity approach

3) Employment- a key determinant of women’s

health Issues:• Both overwork and unemployment

are stressful- (Japanese study)• Polarization of work hours -increasing

the level of inequality in family earnings.• Women’s health - function of paid +

unpaid work - gender division of labour in household • Women doubled employment, BUT

still do nearly two-thirds of household work.

% of Women and Men Employed Canada 1976-2001

Women with young children - sharpest increase in

employment, Since 1976:

women without children have increased their employment rate by 26%;

women with youngest child 6-15 by 62%; women with youngest child 3-5 by 83%; women with youngest child 0-2 by 124%

Employed women with children

But distribution is uneven -Employment

and Education• 75.4% of female university graduates have

a job, cf 79.3% of male graduates. • But… women with less than grade 9 are

less than half as likely to be employed as males – 13.6% of women cf 29.4% of men

• Gender analysis not just m/f but diversity - sub-groups of women - esp. vulnerable

Women increased professional status-

I.e. strong educational improvement

Job security - temporary work

Job security – union coverage

High decision latitude at work

Official unemployment rate

Unemployment + underemployment

Youth unemployment 15-24 explains entire gender gap

4) While f-t women work 39 hrs cf 43 - men Women still do most

unpaid housework

Employed mothers (f/t) work average 75-hr week -

pd+unpdStatcan: Women moving to longer work hours:• 4x likely smoke more, 2x likely drink more• 40% more likely decrease physical activity• 80% more likely have unhealthy weight gain• 2.2x more likely experience major depressive

episodes cf women on standard hours

Stress and health behaviours - smoking

Less stressful alternatives

Social supports are important

• Social networks may play as important a role in protecting health, buffering against disease, and aiding recovery from illness as behavioural and lifestyle choices such as quitting smoking, losing weight, and exercising. – See: Mustard, J.F., & Frank, J. (1991).The

Determinants of Health. (CIAR Publ. No. 5).

Social Supports: pop. 12+, 2001

Social Supports-Volunteerism - a saving grace

• Health Canada uses volunteerism as a key indicator of a “supportive social environment” that can enhance health.

• Volunteerism declining: 1997-2000 Canada lost 960,000 volunteers. 1997 = 29% men, 33% women vol’d 2000 = 25% men, 28% women

• Remaining volunteers work 9% more hours

Family violence = key indicator of women’s health

• CIHI, Statcan identify crime as “non-medical determinant of health.” But women’s health analysis requires special indicators - family violence, like unpaid work, is key indicator.

• Family identified as key pillar of social support - determinant of health. But family violence may undermine social support, health

Family=high % of all violence

• Spousal violence = 18% of all violence reported to police.

• Women = 85% of all reported spousal abuse = 6x rate for men

• Nearly 1/3 of all reported female victims of violence in Canada attacked by spouse

• Unreported - much higher = 8% all women with partner attacked past 5 years.

Aboriginal women’s health• Life expectancy = 76.2 cf 81 (non-Abor.)• Higher rates hypertension, cervical cancer,

circulatory & respiratory diseases• Diabetes = 3x non-Abor. Fem = 2x male• HIV/AIDS = 2x non-Abor. 50% female Abor

AIDS cases = IV drug use cf 17%• 9% Aboriginal mothers under 18 cf 1%

Aboriginal women’s health• 3x mortality due to violence. 25-44 =

5x

• Alcohol-related accidents = 3x

• Fetal alcohol syndrome. Over 50% view alcohol abuse as problem in community

• 3x suicide rate cf non-Aborig. women

Regional disparities require special attention /

intervention E.g Cape Breton….

• High unemployment and low-income rates, • Much higher incidence of chronic illness,

disability, and premature death than Halifax • Highest age-standardized mortality rate in

Maritimes• Highest death rate from circulatory disease,

heart disease in Maritimes – 30% above nat.av.

Of 21 Atlantic health districts, Cape Breton has highest rates

of:• Cancer death (231.8 per 100,000) – 25%

higher than the national average, lung cancer

• Deaths due to bronchitis, emphysema, and asthma (9.2 per 100,000) –50%+ higher than the national average

• High blood pressure– 21.7%, (24.3% women 19% men = 72% higher than the Canadian rate. The next highest rates are in south-southwest Nova Scotia

Cape Breton = highest:• Arthritis and rheumatism: 31% of

women, 23% of men• Activity limitation (34%), followed by

Colchester, Cumberland, and East Hants counties (30.1%)

• Life expectancy: 72.8 years for men, and 79.4 for women. (Canada: 75.4 years - men and 81.2 years -women

Disability-free life expectancy• Cape Bretoners have an average

disability-free life expectancy of only 61.8 years, seven fewer than the national average, and the lowest of all the 139 health regions in Canada.

• This means that Cape Bretoners can expect to live considerably more years with a disability than other Canadians.

Potential years of life lost

• highest number of potential years of life lost due to both cancer and circulatory diseases.

• Cape Bretoners lose 2,261.9 potential years of life per 100,000 population due to cancer – 41% higher than the national average of 1,603.7,

• and they lose 1,684 potential years of life per 100,000 population due to circulatory diseases – 65% higher than the national average of 1,020.7.

Women have generally healthier behaviours

• Women healthier diets. 5+ servings fruit/veg/day: F = 43%; M = 32%

• Daily smokers: F = 19%; M = 24%• Overweight (BMI = 27+): F = 28%, M =

36% Obesity (BMI = 30+): F = 14%, M = 16%

• Heavy drinking: F = 11%, M = 28% BUT...

But female smoking rates declined later

and slower

Teen Smoking rates by Gender age 15-19, 1996 vs. 2001

40%

21%24% 24%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1996 2001

Male Female

More women physically inactive

Health behaviours vary regionally:

e.g.: % Overweight, pop, 20-64, 2001

Mammogram: Women, 50-69, routine screening within last two

years, 2001

Cape Breton, W. Nfld = low mammogram screening, high breast cancer death

rate

Pap smear test% of women 18-59 years, 2001

The physical environment is an important determinant of health- Health Canada

“At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments.

Factors relating to housing, indoor air quality, and the design of communities and transportation systems can significantly influence our physical and psychological well-being.”

Access to Health care• Women use more health care services than

men, thus are disproportionately affected by barriers.

• Atlantic Canadians have greater difficulties accessing care than most other Canadians.

• The barriers result from less availability of key health care services in rural areas, rather than from longer waiting times.

In Sum:• Women have distinct health issues.... that have social

and economic roots• Diversity approach –special needs of Aboriginals,

disabled, minorities, recent immigrants, disadvantaged regions, etc.

• 3 interventions that can improve women’s health, save health costs:

1) reduce time-overwork stress2) eliminate gender wage gap3) reduce poverty of single parents

Can it be done?...1900s/1980s...

Improving women’s health today will benefit

future generations of Canadians

Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique

www.gpiatlantic.org