Five themes

1. Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - AtlantiqueWomen’s Health in Nova ScotiaPrepared for Atlantic Centre of Excellence for Women’s HealthIWK, Halifax, 27 November, 2003

2. Five themes • Practical utility of gender-based analysis • Interactive nature of health determinants • Additional women’s health indicators needed beyond usual population health indictors • Data improvements and gaps - especially for diversity analysis • Purpose = policy link = point to key social interventions to improve women’s health

3. 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......

4. 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)

5. 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

6. 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

7. 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

8. 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.”

9. 1) Income: What does it have to do with women’s health? • 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%

10. …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)

11. 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.

12. Prevalence of low income-women and men-1997 & 2000

13. Prevalence of low income-women and men, Canada1991-2000

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

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

16. Trend:Low income rates ofchildren: Single mother families ---1994-2000

17. Employment of Female Lone Parents 1976-2001

18. Low Incomes : 1991-2000Single mothers without paying jobs

19. 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 food rises faster than wages • Robin Douthitt: “time poverty”. Full-time single mothers = 75 hour week

20. 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

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

22. GINI coefficient 1991-2000

23. Despite growing educational parity....

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

25. Wage inequality in Nova Scotia has remained the same- Ratio of Female to Male Hourly wages: 1998-2001

26. 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.”(Drolet, 2001)

27. Differences among Cdn women: Nova Scotia cf Canada: • 1990 = $0.82 disp.income for $1 in Ontario. 1998 = $0.73 Financial Security Nova Scotia • 1984: 2.1% of national wealth. • 1999: 1.8% “ “ (3.1% of Canadian Pop.)

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

29. 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

30. Within Atlantic Canada: • Richest 10% own 49% of wealth • Richest 20% = 2/3 • Richest 40% = 86% • Poorest 60% have 14% of wealth • Poorest 10% = “negative” wealth

31. 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.

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

33. In Atlantic Can. -higher % of employed are women

34. 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%

35. Employed women with children

36. 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

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

38. 75% of Halifax pop.25-29 graduated high school BUT

39. 60% of Halifax pop. 25-54 post-secondary grads BUT

40. Unemployment rate in Halifax = 7%

41. BUT.... Unemployment + underemployment

42. Youth unemployment 15-24 explains entire gender gap

43. Job security -and work options

44. Job security - temp work

45. Job security – union coverage (helps explain PEI equity)

46. High decision latitude at work - related to lower stress

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

48. Atlantic Canada: f/t employed women also work almost as many hours as men

49. Women still do bulk of unpaid housework

50. 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