Prairie Women's Health Centre of Excellence

  Including Gender in Health Planning
A Guide For Regional Health Authorities


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The research and publication of this study were funded by the Prairie Women's Health Centre of Excellence (PWHCE). The PWHCE is financially supported by the Centre of Excellence for Women's Health Program, Bureau of Women's Health and Gender Analysis, Health Canada. The views expressed herein do not necessarily represent the views of the PWHCE or the official policy of Health Canada.

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Lissa Donner


Why include gender in health planning? Because when it comes to health, sex and gender matter. By deliberately exploring the possible different needs, concerns and consequences of health plans for men and women, we can make health services more relevant and appropriate to both women and men in Manitoba.

This guide has been developed jointly by the Prairie Women’s Health Centre of Excellence and Manitoba Health as part of the Women’s Health Strategy endorsed by the Minister of Health and Minister Responsible for the Status of Women in 2000. Its primary purpose is to assist the Regional Health Authorities (RHAs) to incorporate gender in their upcoming Community Health Assessments and subsequent Health Plans. As well, the guide is a useful tool to Manitoba Health and others involved in gender & health planning.

When gender-based analysis is done successfully, gender becomes part of the entire regional health planning process including the Strategic Plan (vision, mission and values; environmental scan and strategic priorities) and the annual Operational Plan.

Regional Health Authorities are already taking action to include gender in health services. For example, South Eastman (RHA) has conducted a regional study to talk with women about their health. Assinniboine (RHA) runs a Women’s Health Program to increase knowledge and understanding of women’s health and needs in the region, support the provision of effective services to women, and promote good health through preventative measures. Interlake RHA has conducted focus groups on informal caregiving, a topic of great relevance to women. As well, in 2002, the Interlake region was recognized at a national conference for the successful work done by a multi-sectoral group (health, recreation, education, Aboriginal peoples) regarding health promotion initiatives to get girls and women active in the region.

This guide provides some background and history on gender-based analysis. Two case studies show the value of understanding the health of a population considering both females and males. Finally we provide brief checklists to assist you in considering men’s and women’s shared and differing needs. We hope you find this guide useful.

Gender-based analysis acts like a camera lens, filtering distortions and inaccuracies that are not immediately obvious.2

What is Gender-based Analysis

Gender-based Analysis (GBA) is a tool to help understand how the experiences of women and men are different, and how they are the same. In the case of health, GBA illuminates the differences in health status, health care utilization and health needs of men and women.

Health Canada defines Gender-based Analysis as: analytical tool applied to research, policies, program design, and evaluations to ensure that appropriate questions about both men and women yield sensitive and accurate analyses and programs.1.

Gender-based analysis helps to ensure that the differential economic, political, social and biological circumstances of both girls and boys, and women and men are taken into account. Gender-based analysis will render transparent issues such as the under-representation of women in decision-making or the absence of women in research. It may similarly highlight imbalances in addressing men’s health issues.3
Gender-based analysis (GBA) flows from a population health perspective. Manitoba Health's Women's Health Strategy recognizes gender as one of the important determinants of population health. The other determinants of health accepted by Health Canada are:
. income and social status
. social support networks
. education
. employment and working   conditions
. social environments
. physical environments
. biology and genetic   endowment
. personal health practices   and coping skills
. healthy child development
. health services
. culture
Why Gender-Based Analysis?
When it comes to health, sex and gender matter. Research is increasingly alerting us to the ways that sex and gender interact to “create health conditions, situations and problems that are unique, more prevalent, more serious, or have different risk factors or interventions,” for women and men (Greaves et al., 1999:3)...Tailoring the health care system to meet the particular needs of women (and men) should lead to better use of resources.4
GBA allows us to consider the ways in which gender interacts with the other determinants of health to influence the health of women and men, boys and girls.

This is important because women and men are not all the same. We differ because of age, education, socio-economic status, culture, physical environments, etc.

Including GBA can be part of on-going programming and planning for health care delivery. Using GBA provides an idea of the wider breadth of the health issues that affect a regional population.

Gender can act in two ways to influence health.
Firstly, gender acts on its own. The most obvious example of this is reproductive health. But gender acts in other ways, that may not always be considered. For example the same drug can cause different reactions and different side effects in women and men.5

Secondly, gender works along with other determinants of health. For example, income is linked to health. Those with lowest incomes are at the greatest risk of ill health. The “gender gap” in incomes means that Manitoba women are more likely to be poor than are Manitoba men - almost 20% of adult women are poor compared with 13.5% of adult men.

GBA also includes an analysis of the diversity among people, recognizing that all women and all men are not the same. For example, senior women, especially senior women living on their own, women with disabilities and Aboriginal women of all ages are at even greater risk of poverty than their male counterparts.6

In Manitoba the health needs of Aboriginal women and men require particular attention. GBA shows how the situations of Aboriginal women and men are the same, and how they are different. It also shows how the situations of Aboriginal women and men compare to non-Aboriginal women and men.

GBA is a powerful tool for health planners and decision-makers who must allocate resources. GBA contributes to “evidence-based” decision making, because it broadens the scope of “evidence” used in the decisions.

Isn’t Gender Just a Polite Way of Saying “Sex”?

In order to undertake GBA, it is important to understand the concepts “sex” and “gender”.
Did You Know...
Women and men do not receive the same (or similar) care, even for the same conditions. American studies show women are less likely to receive high-tech services, and tend to receive less aggressive care for conditions such as heart disease and cancer.8
Sex refers to the biological differences between females and males. The health sector has focussed largely on reproductive differences, particularly maternity care, but physical distinctions between females and males shape a much broader range of health issues.

Gender refers to the array of socially constructed roles and relationships, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis. Gender is relational - gender roles and characteristics do not exist in isolation, but are defined in relation to one another...

Gender roles and responsibilities are rarely evenly balanced in any society. Women and men generally do not have equal access to resources such as money, information, power and influence...

Without GBA, women and men may be treated the same way, when it is inappropriate to do so. Alternatively, they may be treated differently when it is inappropriate to do so, based on traditional, long-standing stereotypes. GBA helps to uncover both of these types of problems.

Consider these examples:

Two Manitoba projects supported by Prairie Women's Health Centre of Excellence give insight into effective women's health planning and programming:
A Rural Women's Health Program: The Experience of the South Westman RHA, by Donner, L., 2002 and; I by Roberts, J., Falk, M.,and South Eastman Health, 2002.
  • It is well-known that young men commit suicide much more frequently than young women. Looking at gender - and understanding the differences in the lives of young women and young men - will help in the development of prevention and intervention strategies to reduce suicides among both young women and young men. The first case study in this guide deals with this issue, as well as the related problem of self-inflicted injuries among women. In this example, treating women and men the same way is not appropriate.

  • Canadian women live, on average, longer than Canadian men do. RHAs will therefore see more elderly women than men in hospital. Considering gender, and its many influences on the lives of senior women, will help to provide services that better meet the needs of these women. For example, their lower incomes mean that they are less able to purchase non-insured treatments such as certain prescription drugs, medical supplies and physiotherapy. Their caregiving roles may mean that senior women are themselves responsible for caring for others who are chronically ill. Again, in this case, treating women and men the same way is not appropriate.

  • Health education messages designed to prevent unwanted pregnancies have primarily focussed on young women. This has reinforced the stereotype that places most of the burden of responsibility for birth control on women. In this case, it would be more appropriate and effective to target both women and men.

What About Men’s Health?
A gender inclusive approach includes men and women. When women’s health is emphasized, it is because much more is already known about men’s health. Most health research in the past has been conducted on men, by men. The results may then be applied to women, leading to inappropriate or ineffective interventions.
Gender-based analysis gives us an opportunity to ask questions based on health data which is already available. It also helps point out information which may be missing from current data.

Why is Gender Important in Health Planning?
GBA is about more than identifying and analyzing issues specific to women (like hysterectomy rates and Caesarean section rates) or men (like prostate cancer) or issues more common to women (like breast cancer). GBA is a tool to apply when analyzing all aspects of health, and all parts of the health care system, because gender affects all aspects of the lives of women and men - everything from income and education to family responsibilities, and social supports to occupational health.
Good health planning is about using the available resources to help obtain the best possible health outcomes for all. However, providing the same programs and treatments for everyone in a region (that is, treating them equally), may not produce results which are equitable. Different programs or treatments may be necessary for women and men, boys and girls, in order to achieve the best possible results. GBA will help to identify and give priority to those areas where gender-sensitive interventions will lead to improved health.

Putting GBA to Work: Two Examples
The two case studies which follow are examples of GBA in action. These examples demonstrate how an understanding of gender can be practically applied to community health assessment and health planning work. They present some basic information and a series of questions for RHAs to consider when analyzing the influence of gender in their own communities.

1 Health Canada, 2002, 1
2 Health Canada, 1999, 35
3 Health Canada, 2002
4 Ministry of Health Services, 2001
5 Health Canada, 2002, 6
6 Donner, 2002, 1 - 3
7 Health Canada, 2000, 14
8 Grant, 2002

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