Health Canada Science Forum Ottawa, October 8-9, 2008

1. Health Canada Science Forum Ottawa, October 8-9, 2008 Sex and Gender Differences in Extreme Heat Events: Building a Collaborative Knowledge Base for Adaptation to Climate Change

2. OVERVIEW • Introduction • Research Methodology & Conceptual Framework: Gender-based Analysis Of Risk Factors • Gender And Extreme Heat Events: Preliminary Findings • Lessons Learned: Research And Interventions • Moving Forward: Next Steps

3. Research Background & Methodology • Computer-assisted English-language search • Academic and grey literature • International and Canadian sources • Morbidity and mortality data • Close review of case studies reporting sex and gender data • Guiding gender-based review questions • How were sex-specific data used? • Who conducts gender-based analysis? • What differences, if any, have been found? • What factors best account for these? • How do sex and gender interact with known risk factors?

4. Analytic Framework: Gender-based Analysis For women and men in extreme heat events, how do sex & gender affect: • Exposure? • Susceptibility? • Coping & adaptation? • Intervention?

5. Identified Risk Factors for Extreme Heat Events • Demographic, e.g. age, marital status, income, ethnicity • Health conditions/behaviours, e.g. dementia, alcohol, CVD obesity, medications • Sociocultural, e.g. social isolation, dependency, housebound, lack of knowledge and resources • Occupational and leisure activities, e.g. heat-exposed stressful labour and sport • Seasonality, e.g. early in heat season • Spatial location, e.g. urban, heat-exposed residences and neighbourhoods • Institutional capacity, e.g. lack of alerts, emergency planning or interventions

6. Some Sex/Gender Dimensions Of Known Risk Factors • Activity: Female-dominated workplaces such as bakeries and cleaners; male-dominated workplaces such as military, farm, construction. Sports such as wrestling and military exercises increase men’s risk. • Demographic: Longevity especially increases the effects of health conditions and extreme heat for women. Lower incomes limit resources and options (housing, transport), especially for senior women. • Health conditions and behaviours: Conditions related to old age such as dementia increase risk for women especially. Obesity and alcohol abuse increase risk for men especially • Socio-cultural: Men’s weaker ties to family increase risk in old age. Women’s longevity increases late-life dependency; women immigrants’ lower rates of literacy is isolating. Men’s greater risk tolerance and lower risk perception increase their risk.

7. Extreme Heat Events And Gender: Preliminary Findings • Gender-based analysis {GBA} is very rare - Only 4 of 70+ publications reviewed addressed gender issues - Sex analyzed as a variable but without gender analysis - Age-based samples may mask large gender patterns 2. Little analysis of morbidity using GBA - Most analysis based on excess mortality vs. effects on overall health conditions, access to hospital care, etc. 3. Little Canadian research with sex-specific data or GBA

8. Preliminary findings (cont’d) 4. Both women and men are at risk in extreme heat • In 46 discrete data sets, over half (54%) reported excess mortality higher for women (vs. 46% reporting more excess deaths among men) • Methodology makes a difference • US researchers study all heat-related deaths & find men at most risk • International researchers study heat waves & find women at most risk • Context and cultural differences in society and in gender relations also matter, e.g. care giving patterns, emergency preparedness, population diversity, gender norms

9. Preliminary findings (cont’d) • Sex/gender interact in complex ways with other risk factors: Age

10. Source: Missouri Department of Health and Senior Services, accessed September 19, 2008 from: http://www.dhss.mo.gov/Hyperthermia/hyper3.pdf Hyperthermia Mortality by Race and Sex Missouri, 2000-2007 Preliminary findings (cont’d) Sex/gender interact in complex ways with other risk factors: Ethnicity/race

11. Preliminary findings (cont’d) • Extreme heat morbidity is gendered, too • Provisional analysis of Manitobans hospitalized with hyperthermia, 1992-2007 • More men (133) than women ( 87) were hospitalized with hyperthermia over 15 years (N= 220) • What put these men at increased risk? • What factors protected women? Source: Manitoba Health, 2008. Note: Age and sex are tracked for cross-tabulation.

12. Lessons Learned • Many methodological issues remain, e.g. • Lack of consistency in data collection for heat related mortality and morbidity • Lack of consistency by jurisdiction • Sex/gender not systematically defined & addressed in biomedical research on heat health • Lack of qualitative, contextual analysis

13. Research needed to inform policy & emergency management, e.g. • How do sex & gender relate to heat risk factors other than age-related health conditions? • How do sex & gender affect exposures, susceptibilities, coping and adaptive capacities for women and men through the life course? • What specific factors are protective for women and for men in extreme heat? In what geographic and social-cultural contexts? • How will national and regional trends in Canada affect women and men, boys and girls in a warming environment? • How do sex/gender differences in the impacts of extreme heat events interact with the practical considerations of developing heat messaging and other protective measures? • In the Canadian context especially, what are the primary practicalopportunities for action to protect women and men from the effects of extreme heat?

14. Moving Forward:Key Messages And Recommendations • Context matters. Extreme heat mortality is not a simple function of any single risk factor. • Sex and gender considerations provide important contextual information that can help to more effectively assess risks, plan interventions and direct resources. • More multidisciplinary research (both qualitative and quantitative) is needed to identify and target high- risk populations of women and men. • Sex- and gender-sensitive research findings can enhance heat alert and other preparedness strategies to ensure appropriate interventions.

15. Thanks to the team of authors and reviewers Authors: Bureau of Women’s Health and Gender Analysis/RAPB/Health Canada: Mireille Kantiebo, Sari Tudiver, Jennifer Payne, and Cindy Moriarty Elaine Enarson - Consulting Margaret Haworth-Brockman, Prairie Women’s Health Centre of Excellence Madeline Boscoe, Canadian Women’s Health Network Reviewers: Climate Change and Health Office/ /HECSB/Health Canada: Anna Yusa, Stephen Dolan, and Ugis Bickis David Dougherty, Health Policy Research Division/SPB/Health Canada

16. If you have any further questions or comments, please contact: Mireille Kantiebo (mireille_kantiebo@hc-sc.gc.ca) Elaine Enarson (eenarson@earthlink.net) We gratefully acknowledge the support of our partners in this work, including the Climate Change and Health Office of Health Canada, Health Policy Research Division, Prairie Women’s Health Centre of Excellence, Canadian Women’s Health Network, and the US Centers for Disease Control Additional resources: Climate Change and Health Office at Health Canada www.healthcanada.gc.ca/cc Gender and Disaster Network http://gdnonline.org Gender and Climate Change http://www.gencc.interconnection.org/