Rethinking Women and Healthy Living in Canada Margaret Haworth-Brockman, Executive Director Prairie Women’s Health Centre of Excellence Gender, Diversity and Health Workshop February 11, 2013 This work was financially supported by Health Canada.

Outline How we came to do this project What the project includes Our methods Some examples of our findings Where to from here

Shifts & Silver Linings New emphasis on Healthy Living for our work Opportunity to build on expertise in SGBA (to more open audiences?): discourse analysis and practical applications At PWHCE we had experience: Profile of Women’s Health in Manitoba Guidelines for practical applications of GBA for PAHO Collaboration on Rising to the Challenge, beyond GBA 101 Recent work on Gender and Health Statistics commissioned by the WHO

Rethinking Women and Healthy Living in Canada Collaboration by three Centres of Excellence for Women’s Health National-level project A reconstruction and critique of the healthy living discourse SGBA of healthy living topics Exploration of a few healthy living strategies Promising practices Taking the position that there are important inequalities between and among women that have implications for their opportunities for health, and that sex and gender are key determinants of health, we have undertaken a sex and gender-based analysis of healthy living in Canada. Our work involved an analysis of the healthy living discourse, the examination of nine areas of healthy living practice and research, namely: physical activity, sedentary behaviour, body weights, ‘eating well’ (incl. sodium), food insecurity, tobacco, alcohol, sexual behaviour, and injury (incl. violence), and a review of selected healthy living strategies from 4 provinces – ON, BC, PEI and Manitoba.

Integrated Pan-Canadian Healthy Living Strategy of 2005 Goals are to improve overall health outcomes and reduce health disparities. Does not offer sex-specific targets nor make provisions to address the determinants of health—which include sex and gender—in measurement, reporting or formulation of policies and programs. Policy Context: Integrated Pan-Canadian Healthy Living Strategy released in 2005. The Strategy identifed reducing health disparities and improving overall health outcomes as its two goals. Notably, the strategy did not include sex-specific goals or offer gendered considerations, and did not make any provisions to address the determinants of health--which include sex and gender--in measurement and reporting or in the formulation of policies and programs. Only in the discussion of the consultations with First Nations Women’s organizations did issues of gender arise and it should be said that the Native Women’s Association of Canada actually made three important recommendations during the consultation: Domestic, racialized and sexualized violence must be taken into consideration. Realities of Aboriginal women’s lives need to be considered. Must support women-centered activities and sports.

Healthy Living Discourse Some contradictions: Individual vs. social responsibility for health Individual vs. collective and systemic solutions for chronic diseases Leading to: Transformation of risk and probability for populations into “certain danger” for individuals Focus on physical health rather than mental health Blame for certain types of illnesses Limited attention to context of healthy living and sex, gender, diversity as well as the determinants of health To contextualize our data analysis and review of interventions, we started by reading and examining the discourse of healthy living that frames and positions the Pan-Canadian Healthy Living Strategy. The discourse of healthy living reflects neoliberal approach to the economy that favours freedom of the market and a minimal role for the state. More specifically, the HL discourse is characterized by a tendency to embrace an individual rather than a social view of health and hence to propose individual rather than collective or structural solutions for health problems, including chronic diseases. This is accompanied by the almost magical transformation of statistical, probabilistic models of risk into virtually certain danger for individuals, a focus on physical rather than mental health, a tendency to blame people when they become ill. The healthy living discourse is also largely blind to the impact of sex, gender and diversity on health and the opportunities for health, despite the emergence of a discourse focusing on equity. A lack of awareness of sex, gender and diversity within the healthy living discourse leads to one-size-fits-all policy recommendations and programs that do not necessarily meet the needs of their participants nor reach out to those most in need of support.

A Profile of Women and Healthy Living in Canada

Healthy Living Topics Each snapshot includes current rates, sex-specific details, gendered influences, risk factors, critique of measures, and policy implications. Women in Canada, 15 years and older - mostly

Health Indicator Framework Figure 2. Organizing framework for gender-sensitive indicators. Adapted, with permission from the authors, from Moussavi et al. {{2736 Moussavi, S. in press;}}.

National-Level Data Sources Canadian Community Health Survey, including: CCHS-Nutrition Module, Cycle 2.2, 2004; CCHS, Cycle 3.1, 2005; and annuals 2007-2008 and 2009-2010. Canadian Health Measures Survey, Cycle 1, 2007- 2009 Canadian Tobacco Use Monitoring Survey, Annual 2010 Canadian Alcohol and Drug Use Monitoring Survey, 2010 National Trauma Registry, Comprehensive Dataset (NTR-CDS) General Social Survey-Victimization Cycle 2009 Association of Workers Compensation Boards of Canada, National Work Injury Statistics Program (AWCBC - NWISP) Census of Agriculture, 2001 and 2006 Public Health Agency of Canada, Sexually Transmitted Infections Surveillance Data

Analytical Process Definition of issues & measures Gathering Information—review of data & add gender contexts, meaning, experience Analytical Inquiry—asking challenging questions Implications & Lessons to build gender sensitive strategies Attend to gender in each step of the analytical process. 11 11

SGBA of Healthy Living Strategies Sex- and gender-informed discussion on healthy living strategies in Canada at various levels of government. Review of strategy documents plus consultations with policy makers about how gender has been considered in their healthy living strategies. Detailed examination of strategies in Prince Edward Island, Ontario, Manitoba and British Columbia

Gender-Sensitive Practices, Policies and Programs in Healthy Living Scoping review of research on gender-sensitive promising practices in healthy living. Selected examples of promising practices, policies and programs related to our ten healthy living topics. Recommendations for future directions to advance healthy living in Canada for women.

Some Quick Results Women with higher incomes are more likely to take part in physical activity, but are also more likely to drink heavily Aboriginal women less likely to drink heavily We know very little about sexual behaviour for women over the age of 49 or those not considered “high risk” All women show excessive sedentary behaviour Tobacco smoking rates are largely declining, except among young women and women who use smoking as a coping behaviour Older women find food labels complicated, and they don’t necessarily prefer cooking programs Occupational injury data may under-represent women’s injuries in certain sectors

Conclusions A gender lens on healthy living can shift our understanding of, and responses to, the needs of women in Canada. Responses to healthy living for women in Canada might look different if they incorporate sex, gender, diversity and equity. A sex and gender lens can allow the Pan-Canadian Healthy Living Strategy and provincial strategies to address the inequities that prevent healthy living for women. Looking at healthy living through a gender lens might: shift our understanding of, and responses to, the needs of women in Canada. Using a sex and gender lens would facilitate the Pan-Canadian Healthy Living Strategy and provincial strategies to address the unequal distribution of risk factors and barriers to healthy living for women. Responses to the issue of healthy living among women in Canada might look different if they incorporated sex, gender, diversity and equity.

The Source www.womenshealthdata.ca More Information The Source www.womenshealthdata.ca Fact Sheets

Questions or comments: Acknowledgements Co-authors: Ann Pederson, Barbara Clow, Harpa Isfeld, Anna Liwander and Linda Snyder This project was made possible through a contribution from Health Canada Thank you! Questions or comments: m.haworth-brockman@uwinnipeg.ca apederson@cw.bc.ca b.clow@dal.ca