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

1. Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - AtlantiqueSocial Determinants of Women’s Health in CanadaHealth Canada Policy Forum, Ottawa, 9 October, 2003

2. Pop. health context: Romanow and the 3 burning health policy issues 1) 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......

3. Practical: High portion of illness burden is preventable Excess 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)

4. Why a Gender Perspective 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

5. 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

6. E.g….. Teenage smoking • 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

7. 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.”

8. 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%

9. ……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)

10. 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.

11. 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.”

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

13. Low-income children under 18, 1991-2000

14. Income: Female lone-parent families - 1997 & 2000

15. Trend:Low income rates ofchildren: Single mother families ---1991-2000

16. Employment of Female Lone Parents 1976-2001

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

18. 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

19. 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

20. If Equality->Health, What are Trends?Average Disposable H’hold Income Ratios, 1980-98

21. GINI coefficient 1991-2000

22. Despite growing educational parity

23. Gender wage gap remains unchanged- Ratio of Female to Male Hourly wages: 1997-2001

24. 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)

25. 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)

26. Share of national wealth vs. population (1984 & 1999)

27. 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

28. 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.

29. % of Women and Men Employed Canada 1976-2001

30. 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%

31. Employed women with children

32. 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

33. Women increased professional status- I.e. strong educational improvement

34. Job security - temporary work

35. Job security – union coverage

36. High decision latitude at work

37. Official unemployment rate

38. Unemployment + underemployment

39. Youth unemployment 15-24 explains entire gender gap

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

41. Employed mothers (f/t) work average 75-hr week - pd+unpd Statcan: 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

42. Stress and health behaviours - smoking

43. Less stressful alternatives

44. 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).

45. Social Supports: pop. 12+, 2001

46. 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

47. 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

48. 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.

49. 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%

50. 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