Womens Health: A Model for Health Reform

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Womens Health A Model for Health Reform

• October 25, 2002
• Carolyn Bennett, MD MP

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Health

• Not just the absence of disease

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the health status of any given population is
much more than its health care system. The
determinants of health include a healthy
environment, good housing, education,
satisfactory employment, to name a few
determinants.
Hon. Monique Bégin
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Social Determinants of Health

• Poverty
• Violence
• Previous sexual abuse
• Education
• Family systems
• Environment

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Throughout history, the most salient factor
affecting the health of women has been their
position in society.
Judith Lewis and Judith Bernstein
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Womens health means addressing the needs and
concerns of women both as users and as providers
of health care that is, the term implies
assuring the physical and mental well-being of
women because it (health care) is defined by the
perspectives and experiences of women.
Chicago Mayors Task Force on Womens Health
June 1993
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Taking care of yourself lets you take care of
others
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We are not asking for privileges for women.
All we are saying is that equitable care is not
identical care, particularly where physiological
differences obviously call for specialized
health services. Sustainable progress will be
achieved when women are finally empowered to make
free, informed and responsible choices, and
assert themselves as leaders in their own right
within their societies.Womens health is the
surest road to health for all.
Dr. Hiroshi Nakajima, Director General WHO
Position Paper Preface Fourth
World Conference on Women - Beijing
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Feminist Principles

• Self in relation theory
• Non-hierarchical structures
• Inclusive decision-making

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Self-in-relation theory

• Self-in-relation theory offers us the insight
  that womens health cannot be narrowly confined
  to the study of diseases unique to females, nor
  to specific time periods in womens adult lives.
  Womens health must be viewed within the network
  of relationships and responsibilities in womens
  lives, and understood within the broader
  frameworks of racism and oppression that
  characterize the world in which women conduct
  those relationships and carry out those
  responsibilities.

Lucy M. Candib, M.D.
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Gender Barriers to Care

• Power differential
• Good girl socialization
• Way we think
• Wrong office
• Undervalued

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The System

• Women act as health managers and caregivers for
  themselves, their children and other family
  members
• Within the last two decades, women have been
  present within the medical profession in
  sufficient numbers and force to have an impact,
  but this is only a recent development

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Womens Health Care

• A womans mental and physical health status is
  affected by her life experiences and her
  personal, social, political, and economic
  environment. To respond to womens needs,
  services should be organized and provided in a
  manner that accounts for these determinants of
  health and recognizes her assumed role as provider

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Good governance

• A fair and transparent system that takes people
  seriously.
• Ursula Franklin

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Torontos Womens College Hospital A pioneer in
health care for women.
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Non Quo Sed Quo Modo
It is not what we do but how
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WCH Fight

• 1989 Just KNEW
• Post partum appendectomy
• Ectopic
• Canadians want a say in how their health care is
  delivered.

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This place really is different! Diabetes
education Back education Lumpectomies
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Womens College Hospital
6 principles of Health Care
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Philosophy and Principles of Womens Health

• Broad Definition of Health Care including disease
  prevention and health promotion programs,
  flexible models of care and the provision of care
  appropriate to different stages in a womans life
  cycle

Womens College Hospital
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Philosophy and Principles of Womens Health

• High Quality of Care which is compassionate,
  empathetic, and which acknowledges the choices
  individuals make based on their own unique
  experiences and perceptions

Womens College Hospital
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Philosophy and Principles of Womens Health

• Accessibility of programs through flexible
  schedules, sensitivity to cultural and linguistic
  issues and self-referral to programs as
  appropriate

Womens College Hospital
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Philosophy and Principles of Womens Health

• Empowerment of Women which includes informed,
  participative decision making, community input
  and consumer evaluation of programs

Womens College Hospital
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Philosophy and Principles of Womens Health

• Collaborative Planning demonstrated by provision
  of health care by an interdisciplinary team in
  conjunction with community partnership

Womens College Hospital
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Philosophy and Principles of Womens Health

• Innovative and creative approaches to womens
  health research issues and in response to
  contemporary health issues

Womens College Hospital
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Dont accept imitations!
NIH - Washington, DC - 1993 Turf war - -
Gynaecologists vs. Internists Politics of
aging Young Researcher of Year
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Teaching to promote womens health conference -
London, England

• Bay Centre for Birth Control Decision
• The way women make decisions
• Jean Baker Miller, Toward a New Psychology of
  Women (1986)

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• IMPLICATIONS FOR POLICIES AND PROGRAMS
• This synthesis suggests that a broad population
  health strategy designed to improve the health
  and well-being of women in Canada needs to focus
  on the following

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National Forum on HealthAn Overview of Womens
Health

• 1. Reducing power inequities that lead to social
  inequities and violence. Violence against women
  and poverty caused by inequalities in the
  workforce and the home are without doubt the
  greatest causes of poor health among women.

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National Forum on HealthAn Overview of Womens
Health

• 2. Relieving womens double workload. Taxation
  and workplace policies that support caregiving
  and access to high-quality, low-cost child care
  are essential for the improved health of women
  and their families.

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National Forum on HealthAn Overview of Womens
Health

• 3. Ensuring the genuine participation of diverse
  communities of women in all areas of health
  research, planning and service delivery,
  especially in areas related to reproductive
  health. Womens lack of influence in
  decision-making has a negative impact on health.
  Genuine recognition, including remuneration, must
  accompany womens contributions to health policy,
  planning, research and service delivery.

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National Forum on HealthAn Overview of Womens
Health

• 4. Supporting the efforts of Aboriginal women
  and women from minority communities to educate
  themselves, to create networks and to gain
  control over their health.

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National Forum on HealthAn Overview of Womens
Health

• 5. Supporting the development of women
  family-centred health services. This support
  includes increased emphasis on community health
  promotion and disease prevention initiatives as
  well as increased access to client centred
  primary care. Currently, services of value to
  women are being curtailed government spending
  cuts and structural adjustment activities may
  extend and deepen existing gender inequities.

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National Forum on HealthAn Overview of Womens
Health

• 6. Guarding against the over-medicalization of
  womens health. Health services need to view
  womens reproductive functions as natural and
  healthy parts of life. It is also important to
  avoid the medicalization of issues that are
  related to the broader determinants of health.
  Initiatives to stop violence against girls and
  women must use an integrated approach that
  involves all of the key sectors at all levels.

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National Forum on HealthAn Overview of Womens
Health

• 7. Attending to the burden that health system
  reform represents for women. Health system
  reform has the potential to benefit women.
  However, community-based care cannot become a
  euphemism for the conscription of women to
  provide unpaid health care services.

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National Forum on HealthAn Overview of Womens
Health

• 8. Providing increased support for gender and sex
  specific research, female health researchers
  (especially in applied research) and gender
  analyses of research results (in both medicine
  and the broad determinants of health).

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National Forum on HealthAn Overview of Womens
Health

• 9. Supporting women in leadership roles, that is
  decision-making and gate-keeping roles in health
  and health policy.

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1977 . . . Our Bodies Ourselves 1997 . . .
Doctor on Call 2000 . . .Kill or Cure
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1992
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2000
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Trends in Health Care

• Evidence-based practice
• Patient as partner
• Hospital to Community
• Doctors to multidisciplinary
• Multicultural / complementary practices
• Focus on determinants

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Health Care Model

• User Friendly to Women
• Accessible Primary Care
• Birthday Check-Up

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Body Betrayal

• Dx Mere Mortal . Not Bionic

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New Health Care Team

• Patient is captain
• GP is playing coach

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Patient as Partner

• Patient knows body best
• Coach knows the system best

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• Women sometimes need an interpreter when their
  bodies are talking back to them

• Women have to choose a coach that can help with
  it all

• Coach must have a general expertise because of
  womens role as coordinator for family

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3 Important Roles

• Informed Patient
• Advocate
• Citizen

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Good Health Through Good Governance A
Submission to the Commission on the Future of
Health Care in Canada from  The Good Health
Through Good Governance Working Group
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Good Health Through Good Governance A Vision
Statement

• The need to change from a system of illness
  management to a health assurance system
• The potential elements of such a health assurance
  system that integrates health care and public
  health
• A process for bringing about the required
  changes and
• Criteria and mechanisms for a system of
  governance that would sustain the new health
  assurance system.

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Need for Good Governance

• Lack of patient involvement in significant
  decisions in the health care system - leads to
  diminishing confidence and trust.
• Lack of pan-Canadian governance structure - leads
  to duplication and limits opportunities for
  learning.
• Lack of knowledge sharing and innovation and the
  perverse absence of incentives
• Isolated information and feedback systems - leads
  to duplicated procedures, lack of portability of
  health records, and missed opportunities for
  quality improvement.

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Key Elements for Good Health

• System does not need total overhaul, but rather
  key adjustments and a formal recognition of the
  determinants of health.
• Patients are the central reason for the health
  care system - they must be meaningfully engaged
  and treated as partners.
• Health infostructure is a key enabler for
  integration of health care and public health,
  improved data systems and governance.
• Good governance provides connectivity,
  leadership, innovation and accountability across
  the country.

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Twenty Questions to Save Medicare
Caveat We dont have to have as balanced an
approach as the Romanow workbooks
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Twenty Questions to Save Medicare
Citizen

• If we can have an exemplary health care system
  with 10 of the GDP and 70/30 public/private
  splitwe should
• Get on with it
• Keep squabbling about who pays

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Twenty Questions to Save Medicare
Citizen

• Up until now, weve had a
• Health care system
• Hospital/Doctor insurance plan

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Twenty Questions to Save Medicare
Citizen

• Id rather my tax dollars went to
• Clean air
• More puffers and respirators

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Twenty Questions to Save Medicare
Citizen

• I think that deciding what procedures, drugs etc
  are covered
• Should be decided behind closed doors by
  bureaucrats and providers
• Should be an ongoing dialogue with citizens

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Twenty Questions to Save Medicare
Citizen

• Provinces should be rewarded for
• Gutting the welfare, crime prevention and
  environment budgets and thereby increasing the
  demand for health care
• Creating best practices in accountability,
  transparency and cost effective high quality care

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Twenty Questions to Save Medicare
Citizen

• Which of the following is NOT a principle of the
  Canada Health Act?

• Portability
• Accessibility
• Comprehensive

• High Quality Care
• Publicly Funded
• Universality

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Twenty Questions to Save Medicare
Citizen

• As quality is the answer to the last question.
  Patient safety can be ensured best by
• A system of various regulating bodies organized
  by profession that have no capacity for system
  failure
• Quality assurance mechanism that crosses the
  provincial silos of health care and compares the
  outcomes province to province

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Twenty Questions to Save Medicare
Advocate

• Access to priority care should be given to the
• Sicker
• Richer

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Twenty Questions to Save Medicare
Advocate

• In the last two weeks of life patients should
• Be given dignity and comfort
• Have thousands of dollars spent on further
  testing, procedures and hospitalisation

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Twenty Questions to Save Medicare
Advocate

• I think doctors should be rewarded for
• The number of patients they can push through in a
  day
• Keeping patients well, the results they achieve
  in immunization rates, mammograms, helping
  patients stop smoking

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Twenty Questions to Save Medicare
Advocate

• The most important protection we have against a
  two-tiered system is
• The Canada Health Act
• The confidence Canadians have in the public
  system
• The arguments of the Fraser Institute
• a) and b)

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Twenty Questions to Save Medicare
Advocate

• I would rather
• Train more orthopaedic surgeons
• Spend money on a communication strategy to
  prevent broken hips by asking seniors to remove
  their scatter rugs and not to put their newspaper
  on the floor

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Twenty Questions to Save Medicare
Patient

• Health care means to me
• Best possible repair shop
• Keeping people well, improving their health
  status

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Twenty Questions to Save Medicare
Patient

• My child is vomiting, Id rather
• Get telephone advice from my family doctors
  office or another available health professional
• Spend 4 hours in an emergency department

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Twenty Questions to Save Medicare
Patient

• In Primary Care, only a doctor can

• Do well baby visits
• Give immunizations

• Assess a sexual assault victim
• Im stumped

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Twenty Questions to Save Medicare
Patient

• You have a strep throat, you get to the pharmacy
  and the prescription for a super drug is 68.
  You
• Pay and leave
• Pay but remind yourself to mention it to your
  doctor next time
• Have the pharmacist call your doctor to ask if
  there's been a mistake 'cause Penicillin at 10
  is the drug of choice for strep throat

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Twenty Questions to Save Medicare
Patient

• You have a bladder infection, last one was two
  years ago but you know exactly what it is. You
  take a sample You call the doctor's office and
  they tell you to come in
• You go in, knowing that the doctor doesn't get
  paid unless you do
• You insist that the doctor calls a prescription
  for Bactrim to the pharmacy even if they have to
  charge you for the call and promise to drop by
  today and leave a sample before you begin the
  prescription
• You insist on having a prescription called in,
  agreeing to come in with a sample if the symptoms
  aren't gone in 2 days

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Twenty Questions to Save Medicare
Patient

• You've had six months of heavy painful periods,
  you go to the gynaecologist for your Pap smear
  who advises that a D C would only give
  temporary relief and so at your age you're going
  to need a hysterectomy anyway so why don't we
  just book it
• You agree, you're really fed up with this period
  nonsense anyway
• You ask for a second opinion or call the
  equivalent of a 1-800-so-they-say-you-need-a-hyste
  rectomy number
• You go back and see your GP (where you should
  have had your Pap smear anyway, get an ultrasound
  and tell the GP not to send any more patients to
  this consultant

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Twenty Questions to Save Medicare
Patient

• If a patient arrives at the doctor with a viral
  infection asking for antibiotics, the patient
  should want the doctor to
• Write the script in order to make the patient
  happy and have them leave quickly
• Take the time to explain that antibiotics dont
  work for viruses

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Twenty Questions to Save Medicare
Patient

• Primary Care Reform means
• Organizing family practice into multidisciplinary
  teams that provide 24/7 care
• Integration of the frontline with the pharmacies,
  labs, hospitals and home care providers
• No longer having to go to the doctor for normal
  results and prescription renewals
• A secure electronic medical record that can track
  results and ensure accountability
• All of the above

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It is not the strongest of the species that
survives, not the most intelligent, but the one
most responsive to change. Charles
Darwin