Women's Health & Public Health Roundtable Report

May 12^th, 2004

In Toronto, the Minister of State met approximately 11 women's health stakeholders.

1. Regarding a Mandate for a Public Health Agency of Canada (PHAC):

The Agency must consider:

• Acknowledging the important roles women play in the home, in the community and in society. This can be done using the PHAC discussion papers, on Web site, etc.
• Praising the historical role women have played in the public health sector and the important role women play in public health efforts in the community, for example the role of women in the advancement of birth control, the Marion Powell story, poverty activists, etc.
• Celebrating Canadian successes around grassroots mobilization of reaching out to, engaging with and drawing on expertise from existing communities.
• Drawing on energy from non-governmental organizations and communities to create a layer of cooperation outside of government in order to achieve common outcomes.
• Taking advantage of the fact that Canada is internationally recognized for espousing the health determinants. Canada has been a leader in health promotion.
• Showing that the determinants of health and the Canadian Constitution use similar language for equity and equality.

2. Regarding Operational Strategies for a Public Health Agency of Canada:

An Agency should consider:

• Applying the federal Gender-Based Analysis tool to the creation of the PHAC.
• Utilizing the Canadian International Development Agency (CIDA) model on social audits. An existing contract exists between the voluntary sector and the Government of Canada. This information can be found on the CIDA Web site.

Collaboration

• Building on existing expertise to ensure no duplication of efforts.
• Focussing on coordination and collaboration, as opposed to regulating, with the Canadian Patient Safety Institute, and the Pest Management Regulatory Agency, as well as the Standing Committee on Prescription Drugs (which serves a regulatory function).
• Optimizing and maximizing every opportunity for vertical and horizontal cooperation.
• Making a branch responsible for horizontality. Senior leaders in each branch should report to Horizontality Branch lead. Notion of horizontality should be tied to accountability. For example, horizontal cooperation could be a performance measure for various deliverables.

3. Investments:

Participants urged an Agency to focus on the following priority investments:

Data (Standards, Collection and Access)

• Statistics Canada and CIHI data are very difficult to access and use. Currently, there is a cost associated with accessing and publishing data; therefore, surveillance data on women's health and immigration data by sex differentiation are very difficult to access. These fees and access issues are roadblocks, which are not appropriate, since the data is taxpayers' data.
• A lack of coordination and integration exists with data. This is a clear role for the PHAC. Privacy issues that are emerging around data need to be addressed in a responsible way.
• Each province has different databases with different requirements for data collection. There is no standardization across the country, which creates a huge problem when data are compared.
• Many indicators, aggregated by sex, need to be tracked. For example, how many people are smoking? Who are they? How many people are overweight? Who are they? How many people lost weight?, etc.
• Physicians must help in data collection. Reporting requirements need to be changed from just reporting billing numbers to reporting gender specific statistics.
• The United States has a good model for accessing data, which should be referred to.
• Principles of collaboration and relationship building, sustainable funding, multi-sector, multi-disciplinary approaches must be taken in addressing women's health issues. Violence is a good example of where these principles work.
• Specific data on the makeup of Canadian women are needed. Social determinants data need to be collected. A profile of Canadians based on the determinants of health needs to be completed.
• There is a disconnect between women's stories and women's research. It is possible that there is not a way to capture determinants and write a story. However, it is difficult to fit women's stories into quantitative research methods and various indicators.
• Collection of data for people in different categories of income, education, race, etc. needs to happen. Information on the relationship between race and health does not currently exist.

Research

• Ensure funding is available for research and evaluation for the purpose of examining best practices.
• One per cent of any research budget should be invested into the community to train people on how to work collaboratively with communities, etc.

Funding Environment

• Women's groups have little money and resources, yet the demand from the community to continue the work is tremendous.
• Ensure supports are available for small agencies, school programs, etc., since many groups depend on this money.

4. Public Health Issues:

Participants also raised concerns about specific public health issues, including:

Patient Safety

• Considering the relationship between drug safety, patient safety and public health. Preventative measures must include recognition that over-prescribing drugs contribute to public health problems.

Aging

• Addressing public health needs of an aging population as the majority of the elderly are women. 80 per cent of the population aged 80 years or more are women.
• Stressing importance of health promotion to the elderly, since at aged 65 years, many women have another potential 20 years of life.

Reproductive Health

• Reproductive health - includes reproductive choice and infertility.
• Implications of demography as it relates to access to various reproductive health choices.
• Canada should take a leadership role on Emergency Contraception Pill by including all health human professional roles - not just physicians in this issue. For example, nurses, pharmacists and other health professionals should have a role with the Emergency Contraceptive Pill (ECP), as it should be available in pharmacies.

Primary Care

• Need to expand scope of practice for nurses and broaden the roles of all health professionals so that there is a collaborative approach to women's health and population health.

Determinants of Health

• Gender in policy development in both the non-communicable and communicable disease areas affect women in their roles as health care providers and as caregivers in the home.
• Women often serve as "canaries in the community" by way of representing certain community values and views on advisory groups, boards, etc.
• Homeless issues, mental health issues, issues of the working poor, child poverty, immigrant women's issues all need to be addressed by the PHAC. It is important not to view health promotion solely as the encouragement of healthy behaviour, as with increased physical activity and better nutrition for example.
• Currently, policy statements exist with regard to what needs to happen in mental health.
• Measures for intelligence gathering about vulnerable communities should be developed. The community must be involved in public policy development around the PHAC.

Citizen Engagement

• Current citizen engagement processes must be considered. We must question who sits around the table and recognize that the voice might still not be from the grassroots community. Empowerment is required at the citizen engagement tables to inform and create structures that include marginalised women in leadership, decision-making, etc.
• It is important to honour lessons that have been learned from women's health. Part of it has to do with the consultative process; however, women are tired of being asked, with no action being taken. There is a need for action.

Vulnerable groups

• Must be careful to not become a monolithic organization. For example, violence and sexual health do not represent all women. We must ensure inclusivity of all women.
• Some messaging needs to change. Let young mothers know it is okay to have a family if they want, and that the Canadian social system is willing to assist them in their decisions. It is important to ensure that we have a good social system to support a good health care system. For example, with respect to teenage pregnancies, abortion numbers may rise because of difficulties in accessing affordable day care, or in securing income, etc., which could lead to a decision to have an abortion.
• Increased need for empowerment development within nursing and aboriginal communities. Women of the majority must listen to and assist in compassionate ways when working with women of minority communities. There is a need for their leadership in working with their own communities.
• Mental health and racism are huge issues that the PHAC should work on, and more specifically, the impacts of mental health on people of colour need to be addressed.
• Opportunity exists to become world leaders in terms of how Canada deals with diverse communities in addressing diverse health issues. Alternative, complimentary or traditional medicines need to be respected in terms of how people in different communities look at their health.

5. Chief Public Health Officer (CPHO) and Leadership:

• A strong leader focussed on horizontality, collaboration and relationship building should serve as the CPHO.
• When hiring the CPHO, ensure that addressing women's health and gender issues appear in some questions. Candidates should be asked about their previous experiences, research and knowledge about women's health and gender.