Sex- and Gender-based Analysis+ at the Public Health Agency of Canada

Transcription

1 Sex- and Gender-based Analysis+ at the Public Health Agency of Canada GBA+: Developing the Requisite Expertise for Gender-Based Analysis Plus Conference February 27, 2018

2 Outline 1. SGBA+ at PHAC 2. Strengthen use of evidence 3. Practical examples

3 1. SGBA + at PHAC

4 GBA+: Beyond Sex and Gender

5 Government Commitments to GBA+ In April 2016, SWC/TBS/PCO released the GBA Action Plan ( ). It sets out commitments to: Enhance GBA+ training and capacity Increase accountability, monitoring and reporting GBA+ studied by several Parliamentary Committees Government Responses to the Standing Committees on Status of Women (FEWO) and Public Accounts (PACP) committed to report back in 2017 and 2018 Interim report provided to FEWO and PACP in March Budget 2017 completed and published a gender-based analysis of budgetary measures

6 Key SGBA Developments Health Portfolio SGBA Policy Updated Health Portfolio SGBA Policy Action Plan on Gender Based Analysis (SWC, PCO, TBS) Policy on Results includes SGBA in performance reporting (TBS) Agency Plan to Advance Health Equity Auditor General Report on SGBA Response to Standing Committee Reports (October) Budget 2017 Gender Statement

7 SGBA+ at PHAC Policy statement It is the policy of the Government of Canada s Health Portfolio to use sex and gender-based analysis to develop, implement and evaluate the Health Portfolio s research, legislation, policies, programs and services to address the different needs of women and men Why sex and gender-based analysis plus? In the Health Portfolio we call it sex and gender-based analysis plus (SGBA+) because of the important roles that both sex and gender play in health

8 Why Sex and Gender? Health inequalities exist between men, women, boys and girls For example, life expectancy is different between men and women; signs and symptoms of the same disease are often different in men and women

9 SGBA+ at PHAC Sex and gender are important determinants of health Taking into account sex and gender in PHAC efforts is supported as part of our broader commitment to health equity and reducing the health gap between subgroups of Canadians Integrating sex, gender and other diversity factors increases the reach and impact of our interventions, enabling us to better meet the diverse needs of Canadians SGBA+ implementation focuses on: increasing the organisation s internal capacity by providing targeted training integrating SGBA+ more systematically into surveillance activities, science, policy, programs, and evaluation

10 PHAC strengths and challenges in SGBA+ implementation Application of research and data Strength: capacity for routine collection, analysis and reporting of sexdisaggregated data Challenge: analysts not aware of data that is available or have not identified research/data requirements to support effective SGBA+ Training, tools and resources Strength: tailored training, Agency-specific guide to SGBA+, Agency-wide SGBA+ Network Challenge: limited awareness of SGBA+ and how to access related resources Accountability Strength: review and identification of SGBA+ indicators in program results Challenge: consistent application of SGBA+ in monitoring and reporting on program results

11 2. Strengthen use of evidence

12 A Joint Federal/Provincial/Territorial response: The Pan- Canadian Health Inequalities Reporting Initiative Objective: To strengthen knowledge and action on health inequalities in Canada through improved data infrastructure and reporting Collaborative initiative between federal, provincial, and territorial governments Forum for federal, provincial, and territorial public health coordination and decision-making Federal lead for advancing action on health equity and the social determinants of health Measure and monitor health inequalities à Inform efforts to reduce health inequities à Advance health equity Federal agency for statistical information Non-governmental organization for health and health system information

13 Pan-Canadian Health Inequalities Reporting Initiative: Data Sources and Custodians Canadian Community Health Survey Vital Statistics databases Canadian Cancer Registry Census data National Household Survey Canadian Health Measures Survey Canadian Survey on Disability Survey of Young Canadians Employment Insurance Coverage Survey Early Development Instrument Hospital Mental Health Database Canadian Tuberculosis Reporting System National HIV/AIDS Surveillance System First Nations Regional Health Survey

14 The Health Inequalities Data Tool Data for OVER 70 HEALTH INDICATORS * from 13 national data sources HEALTH STATUS Including indicators for: Life expectancy Mortality & disability Mental illness & suicide Perceived physical & mental health Infectious & chronic diseases HEALTH DETERMINANTS Including indicators for: Health behaviours Physical & social environments Working conditions Access to health care Social protection Social inequities Early childhood development disaggregated by each of 14 SOCIAL AND DEMOGRAPHIC STRATIFIERS meaningful to health equity. # SOCIO- ECONOMIC STATUS 1. Income 2. Education 3. Employment 4. Occupation 5. Material & social deprivation 6. INDIGENOUS PEOPLES First Nations Inuit Métis PLACE OF RESIDENCE 7. Urban/rural 13. SEX: Male or Female POPULATION GROUP 8. Age 9. Immigrant status 10. Sexual orientation 11. Functional health 12. Ethnicity/racial background 14. JURISDICTION: National or Provincial/Territorial * See Annex A for full list of indicators # Where data allow

15 Key contribution: enhanced analytical capacity to support policy and planning Access to data and related reporting products can strengthen action on health inequalities by FPT governments by addressing three types of questions: 1 For a given health issue, where are the greatest inequalities? E.g. Indicators for mental health and illness can help to assess whether inequalities are most pronounced by income, cultural/racial background, Indigenous identity, sexual orientation, age, etc. 2 For which health issue(s) do vulnerable populations experience the greatest inequalities? E.g. Examining inequalities data for Indigenous peoples or children (or visible minority groups, LGBT communities, etc.) can help to direct program and research resources to the health issues for which they experience the most disproportionate risk 3 How can public health research, programs and services better address health inequalities? E.g. Access to data can facilitate health equity integration by: Improving policy, program, and planning decisions Prioritizing science, intervention research, and surveillance investments Supporting program evaluation, including relevance and effectiveness for vulnerable populations Enabling monitoring of progress in reducing health inequalities

16 The Health Inequalities Data Tool (infobase.phac-aspc.gc.ca/health-inequalities) PUBLIC ACCESS Hosted on PHAC s online data platform, Public Health Infobase USER-FRIENDLY Retrieve, visualize, and explore the data by topic and population of interest using easy-tonavigate menus OPEN CONTENT Data and charts can be downloaded for further dissemination MORE INFORMED POLICY AND PROGRAM DECISION-MAKING Disaggregated health data can help policymakers and program officials to: identify those most affected by a health issue, and direct resources at the health issues for which different groups experience the most disproportionate risk

17 HIDT Data: Selection menu Use the National, Provincial and Territorial Data tab to study inequalities between sub-populations

18 HIDT Data: Changing your sex selection To change your sex selection (e.g. totals versus females, or females only, etc.) click or unclick the sex legend items located besides For sex selection, toggle legend items

19 SGBA+ in Applied Research SGBA+ considerations in Science Proposal Review Process SGBA+ considerations in Protocol for Attestation of PHAC Science and Research Activities SGBA+ considerations in PHAC scientific journals

20 SGBA+ is About Equity SGBA+ is an analytical process to address sex-, gender- and diversitybased inequalities in health The determinants of health, which are inclusive of sex and gender, give context to health inequalities Intersectionality combines SGBA+ and the determinants of health to identify pathways to achieve equity in health

21 Grants and Contributions Tool for Health Equity Invitations to Submit a Funding Proposal template includes considerations of gender and diversity issues SOLICITATION TEMPLATE Prompts Program staff to consider health equity in solicitations Consider reach and impact: How will your approach affect different population groups (positively or negatively)? Who might be left out? How will it apply to people with different types/degrees of disadvantage? Solicitation written by Program: Purpose: Health equity dimension: Consideration will be given to seniors populations that have greater need for, or experience barriers to access to, resources related to mental health concerns (e.g. by sex). Proposal written by applicant (example): We will design the training program to ensure we address the diverse needs of older men, women and gender diverse people with mental health illnesses and problems. We will seek guidance to address health literacy needs by completing a plain language review of the documents, geographical needs (e.g. recruit older adult reviewers from both rural and urban settings), culture and gender as well as ensuring the training is available online and accessible to pharmacists across the country.

22 Health Equity Lens for Evaluation Evaluation Core Issue Question to determine if a health equity dimension is present Is a Health Equity Dimension Present? Relevance Continued Need: Does the public health issue in question differ systematically between populations in terms of incidence, prevalence, impact and/or intervention capacity? Priorities: Do declarations of government priorities related to the relevant public health issue recognize that a health equity dimension exists? Priorities: Do declarations of Agency priorities related to the relevant public health issue recognize that a health equity dimension exists? YES / NO YES / NO YES / NO Role: Are there policy and program authorities that establish the federal public health role and responsibilities related to health equity? YES / NO Performance Outcomes: Is there evidence that the program is expected to address health equity (e.g. based on program design)? Outcomes: Did achievement of outcomes impact health equity? YES / NO YES / NO

23 3. Practical examples

24 Scope the Sex and Gender Issues A partial view Traumatic Brain Injury (TBI) Men are up to three times more likely than women to sustain a traumatic brain injury. Sport and physical activity Sport has traditionally been the domain of males. Consequently, females face numerous overt and covert barriers that limit their access to and participation in physical activity and sport. A more comprehensive view and female athletes may be more likely (in comparable sports) than male athletes to be concussed and to have poorer outcomes. Only 8% of girls met the recommendations of the Canadian Physical Activity Guidelines compared to 14 % of boys. Only 2% of girls aged are getting enough physical activity. Yet, nearly all parents report their kids are very physically active. Implication Prevention efforts need to consider the unique risks of women and men / boys and girls. A group physical activity only for girls could create a supportive and cooperative environment for participants in which they learn it is okay to make mistakes, that the group is there to support them, and that they can depend on others.

25 Intersectionality and TBI What do the evidence say about TBI and how this issue affects boys, girls, men, women and gender diverse group differently? Who is most affected? Is data disaggregated and analyzed by sex, gender and other diversity factors? Why are these groups most affected? Sex Religion Income Gender

26 TBI: SGBA + Women who have sustained a TBI report experiencing more headaches and dizziness than men Evidence is still mixed in terms of exactly how and why women s and men s experiences tend to differ following a TBI, but researchers have speculated that physiological factors, including differences in size and reproductive hormones, may affect injury severity and recovery Social factors also affect experiences and outcomes after TBI. Among older adults who have sustained a TBI, women are much more likely than men to move to a long-term care facility, rather than a home setting Some women have also reported foregoing personal care or rehabilitative treatments in order to fulfil domestic obligations despite experiencing significant physical and mental symptoms.

27 Brain Injury: Concussion What is a concussion? A concussion is a brain injury that cannot be seen on routine x-rays, CT scans, or MRIs. It affects the way a child may think and remember things, and can cause a variety of symptoms What causes a concussion? Any blow to the head, face or neck, or a blow to the body which causes a sudden jarring of the head may cause a concussion (e.g. a ball to the head, being checked into the boards in hockey) Key message A child does not need to be knocked out (lose consciousness) to have had a concussion

28 Concussion: Harmonised Guidelines (2017)

29 Sentinel surveillance of concussions and other TBI ( ) (numbers are crude estimates based on population proportion using Ontario & Alberta data) 5-9 years old vs years old Boys Girls Boys Girls

30 Concussion: SGBA+ Female athletes may be more likely than male athletes to sustain a concussion There are theories related to the size and strength of neck musculature, which are generally smaller and weaker in females, which may increase the forces experienced during contact and participation Women or girls may report more symptoms at the time of a concussive injury because they are generally more expressive or because there are fewer cultural prohibitions against complaining or being unable to tough it out as compared to men or boys

31 Moving forward: SGBA+ at PHAC on concussion Will increase SGBA+ considerations in its program design and delivery on concussion awareness Will make necessary revisions to Grants and Contributions templates (Invitations to Submit a Funding Proposal) to include consideration of gender and diversity issues

32 Opportunities for enhanced SGBA+ implementation at PHAC Build SGBA+ awareness and capacity (e.g. tailored training for PHAC executives, managers, and analysts) Strengthen SGBA+ in application in key initiatives: Dementia Family violence prevention Suicide prevention HIV and Hepatitis C community-based funding Sex-disaggregated surveillance data for immunization Apply SGBA+ in performance measurement and reporting

33 Lessons learned Strengthen application of data (e.g. disaggregated data) Take a planned and coordinated approach with built in hooks or prompts for key functions (e.g. community program funding applications, research proposals, surveillance plans) Monitor & evaluate the results

34 Using SGBA+ contributes to More rigorous science More effective programs and interventions that contribute to health equity Better and innovative policies, programs and interventions for girls, boys, women, men and gender diverse groups of Canada

35 Thank you! Gerry Gallagher SGBA+ Champion Executive Director, Centre for Chronic Disease Prevention and Health Equity Marie DesMeules Director, Social Determinants of Health Division (SDOH) Miga Chultem Manager, Health Equity Integration Unit, SDOH