Canadian Federation of University Women Laura Zilney, Chair Health Committee October 2005

1. Moving Beyond the Policy Debate: How Process Improvements can Dramatically Impact Service Delivery in the Health Care System Canadian Federation of University Women Laura Zilney, Chair Health Committee October 2005

2. Background: Canadian Federation of University Women • Founded in 1919, CFUW is a voluntary, not for profit, self-funded organization of over 10,000 women university graduates • members belong to 122 clubs active in every province in Canada • CFUW is one of 78 member affiliates of the International Federation of University Women and its 140,000 members • CFUW is a non government organization with special consultative status at the United Nations (Economic and Social Council) Commission on the Status of Women • CFUW is committed to: • The pursuit of knowledge; • The promotion of education; • The improvement of the status of women and human rights; and, • Active participation in public affairs in a spirit of cooperation and friendship

3. Presentation Outline • Issues & Challenges - specific studies/research • Guiding Principles - following through • Recommendations - standards and policing • Critical Success Factors • Closing Remarks - fair and gender specific treatment

4. Issues & Challenges(Page 1 of 2) • Women are underrepresented in health research - leads to improper diagnoses/treatment, over-medicalization of women’s health • only in September 1996 did Health Canada revise its guidelines to require drug companies to include women in clinical trials “in the same proportion as are expected to use the drug” • only 5% of Canadian health research funding is spent specifically on women’s issues (Status of Women Canada) • Women are often the first to suffer the effects of downsizing on the system (e.g. caregivers for those released from hospital earlier) - leads to increased economic burden, increased stress/anxiety • women less likely than men to have private insurance and therefore bear the brunt of increased drug costs - cost of prescription drugs increased twice as fast as overall health expenditures between 1989-1998 (Cyrus & Curtis 2004) • Women tend to prioritize their health lower than competing social, economic, environmental, and political concerns - even when changing cultural and social norms have increased women’s level of risk (e.g. serial monogamy) • women live 6.3 years longer than men, but only enjoy 1.5 more disability-free years of life (Health Canada 1999) – does not necessarily translate into quality years of life

5. Issues & Challenges (Page 2 of 2) • Women treated as homogeneous group - policies/procedures do not recognize differences based on ethnicity, immigrant status, education, class • domestic violence/violence against women: Health Canada recognizes this is a mostly “female” problem, but there is no consistency in terms of how this is dealt with in the health care system across Canada • difference between women only noted in relation to specific problems e.g. Native women more prone to cervical cancer; South-Asian and Black women at greater risk of heart attack/stroke - no explanations/analysis provided (Health Canada 1999) • Women’s health not directly dealt with in health system or in policy - women treated for reproduction issues (pre and post natal) • Health Canada (2003) concluded this may lead to women’s exclusion from policy-making, research, medical research and therefore powerwithin the system • Political, economic, social, and environmental factors not analyzed when developing/modifying health policy • No consistent experience/access to service across the country - leads to disparities between rural/urban, lower/middle or upper classes, young/old, women/men • e.g. poor women often have reduced access to educational opportunities and decreased exposure to health-related information - results in lower income, poor nutrition, increased susceptibility to infection, chronic stress - all of which compound to impact women’s health (Kitts & Hatcher Roberts 2003)

6. Guiding Principles • Accountability • financial • service quality • corporate and individual • Consistency • nationally • between ethnic/cultural groups, geographic, gender • Performance-based • service outcomes • Prevention-based • Needs-based

7. Recommendations • Re-introduction of national health care standards • provinces/territories required to provide Mandatory Programs in set program areas (e.g. Family Health, Chronic Disease Prevention) • provinces/territories required to offer minimum number of Elective Programs in program areas that serve the needs of the community in which the health facility is located • provinces/territories required to report back annually on set performance measures - if they fail to report/do not meet measures, federal monies cease or are reduced, as appropriate • Provinces/territories provide health services through Combined Treatment Teams (CTT) to ensure consistency of experiences • CTTs consist of physicians, nurse practitioners, nurses, social workers, nutritionists, physiotherapists, orthopedists

8. Recommendations: Service Delivery Breakdown Federal Government • Establish performance measures • Provide monies via Canada Health Transfer Provincial/Territorial Governments • Ensure implementation of CTTs, Mandatory/Elective Programs • Coordinate report-back to federal government • Implement Mandatory and Elective Programs • Report-back to Provincial/Territorial Government • Operate CTTs Municipal/Local Governments

9. Critical Success Factors • Mandatory Programs offered by provinces/territories must be enforceable and enforced - requires significant amount of work (e.g. Ontario) • Clear roles between feds, provinces/territories, municipalities established • Clear funding formula developed - should municipalities have taxation ability to supplement Mandatory and/or Elective Programs? • Municipalities must be engaged in the process despite not necessarily having a controllership role (examples from across Canada indicate decreased engagement without controllership) - should this engagement be mandated? (e.g. Children’s Aid Societies) • Clear process for determining how monies from feds is divided between each Mandatory Program (e.g. flexibility given to provinces/territories to determine breakdown, based on social need, based on cost to provide, etc.)

10. Closing Remarks • Need to move beyond “gender-based analysis” to substantive movement on process/procedural implementation • Need to enforce what is already legislated in the Canada Health Act • Federal Government needs to assume leadership role so health care is delivered strategically and equitably