Transcript Women's Health in Nova Scotia

Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
Women’s Health in
Nova Scotia
Prepared for Atlantic Centre of Excellence for
Women’s Health
IWK, Halifax, 27 November, 2003
Five themes
• Practical utility of gender-based analysis
• Interactive nature of health determinants
• Additional women’s health indicators needed
beyond usual population health indictors
• Data improvements and gaps - especially for
diversity analysis
• Purpose = policy link = point to key social
interventions to improve women’s health
Pop. health context: Romanow and
the 3 burning health policy issues
1) How to treat the sick - supply side
2) How to improve the health of
Canadians
3) How to check spiralling health care
costs - demand side
The next Royal Commission......
Practical: High portion of
illness burden is preventable
Excess Risk Factors Account for:
• 40% chronic disease incidence
• 50% chronic disease premature mortality
• 25% direct medical care costs
• 38% total burden of disease (includes
direct and indirect costs)
Why a Gender Perspective
1) Descriptive: Women have distinct health
needs. Causes / outcomes differ by gender
2) Normative: Ensure equal treatment,
overcome biases that impede wellbeing
3) Practical: Blunt, across-board solutions
often miss mark, waste money. Gender
analysis allows policy makers to target
health dollars
Practical: Women’s use
of health services
• Canadian women have higher rates of:
– chronic illness, physician visits
– disability days, activity limitations
– lower functional health status
• In every age group to 75, women more likely
see physicians than men. Overall - 33% more
likely; age 18-54 - 2-3x
E.g., Teenage smoking
• Teen girls higher rates than boys
• Young women have 2x stress cf young men
• Surveys: young women say stress relief and
weight loss = primary reasons for smoking
• Therefore programs, brochures, counselling
targeted to girls more effective than blanket
one-size-fits-all health warnings
1998 Federal Health Minister
• “I have undertaken to fully integrate
gender-based analysis in all of my
Department’s program and policy
development work...”
• “...to enhance the sensitivity of the health
system to women’s health issues...”
• “...more research...on the links between
women’s health and their social and
economic circumstances.”
1) Income: What does it have
to do with women’s health?
• Poverty most reliable predictor of
poor health, premature death, disability:
4x more likely report fair or poor health
• Low income- higher risk smoking,
obesity, physical inactivity, heart risk
• Costly: increased hospitalization:
Women 15-39 = +62%; 40-64 = +92%
…health of single mothers
• Worse health status than married
(NPHS); higher rates chronic illness,
disability days, activity restrictions
• 3x health care practitioner use for
mental, emotional reasons = costly
• Longer-term single mothers have
particularly bad health (Statcan)
Low income children- at risk 31 indicators
• More likely to have low birth weights, poor
health, less nutritious foods
• Higher rates of hyperactivity, delayed
vocabulary development, poorer
employment prospects.
• Less organized sports, but higher injury
rates, and 2x risk of death due to injury than
children who are not poor.
Prevalence of low incomewomen and men -1997 & 2000
Prevalence of low incomewomen and men, Canada 1991-2000
Low-income children
under 18, 1991-2000
Income: Female lone-parent
families - 1997 & 2000
Trend:Low income rates of children:
Single mother families ---1994-2000
Employment of Female Lone
Parents 1976-2001
Low Incomes :
1991-2000
Single mothers without paying jobs
The Economics of
Single-Parenting
• Single mothers with pre-school children
spend 12% income on child care cf 4% in
2-parent families. In one pocket .........
• CPI for child care, restaurant food rises
faster than wages
• Robin Douthitt: “time poverty”. Fulltime single mothers = 75 hour week
2) Equity and health
“What matters in determining mortality
and health in a society is less the
overall wealth of the society and more
how evenly wealth is distributed.
The more equally wealth is
distributed, the better the health
of that society.”
----- British Medical Journal 312, 1998
If Equality->Health, What are Trends?
Average Disposable H’hold Income Ratios, 1980-98
Richest 20% : Poorest 20%
1980
1990
1998
Canada
Newfoundland
Prince Edward Is.
8.2
7.6
7.4
7.1
5.8
6.2
8.5
7.3
6.7
Nova Scotia
7.1
6.2
8.5
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
6.7
7.6
7.8
8.8
8.1
9.1
9.3
6.1
6.9
7.1
6.7
7.3
7.4
7.6
7.0
7.9
8.3
7.6
7.4
10.4
8.0
GINI coefficient 1991-2000
Despite growing educational
parity....
Gender wage gap remains
unchanged in Canada
-
Ratio of Female to Male Hourly wages: 1997-2001
1997 1998
1999 2000
2001
Av. hrly 81.5% 81.3% 80.9% 80.5% 80.7%
Median
78.5% 78.1% 79.1% 77.2% 79.8%
hourly
Av. hrly
82.9% 82.5% 82.3% 81.9% 82%
full-time
Av. wkly
69.1% 69.2% 69.4% 69.3% 69.5%
full-time
Wage inequality in Nova Scotia has
remained the same
-
Ratio of Female to Male Hourly wages: 1998-2001
Nova
Scotia
Canada
Nfld /
Labrador
1998
81.3%
78.8%
93.5% 80.4%
81.3%
2001
80.7%
77.0%
94.3% 80.9%
78.7%
PEI
New
Brunswick
Explaining the gender wage
gap
• Convergence of women’s hourly wages
stalled…. despite clear educational gains.
• After controlling for hours worked, educational
attainment, work experience, industry,
occupation, and socio-demographic factors,
StatsCan concluded that: …
• …“roughly one half to three quarters
of the gender wage gap cannot be
explained.” (Drolet, 2001)
Differences among Cdn women:
Nova Scotia cf Canada:
• 1990 = $0.82 disp.income for $1 in Ontario.
1998 = $0.73
Financial Security Nova Scotia
• 1984: 2.1% of national wealth.
• 1999: 1.8% “
“
(3.1% of Canadian Pop.)
Share of national wealth vs.
population
(1984 & 1999)
Wealth gap in Canada:
• Richest 10% own 53% of wealth
• Richest 50% own 94.4%, leaving 5.6% for
poorest 50%
• Poorest ¼ of Canadians own 0.1% (or
one-thousandth of wealth)
• Among poorest 20%, 1/3 fell behind 2+
months in bill, loan, rent, mortgage
= Importance of diversity approach
Within Atlantic Canada:
• Richest 10% own 49% of wealth
• Richest 20% = 2/3
• Richest 40% = 86%
• Poorest 60% have 14% of wealth
• Poorest 10% = “negative” wealth
3) Employment- a key
determinant of women’s health
Issues:
• Both overwork and unemployment
are stressful- (Japanese study)
• Polarization of work hours -increasing
the level of inequality in family earnings.
• Women’s health - function of paid + unpaid
work - gender division of labour in household
• Women doubled employment, BUT still
do nearly two-thirds of household work.
% of Women and Men
Employed Canada 1976-2001
In Atlantic Can. -higher % of
employed are women
Women with young children sharpest increase in employment,
Since 1976:
 women without children have increased
their employment rate by 26%;
 women with youngest child 6-15 by 62%;
 women with youngest child 3-5 by 83%;
 women with youngest child 0-2 by 124%
Employed women with
children
But distribution is uneven Employment and Education
• 75.4% of female university graduates
have a job, cf 79.3% of male graduates.
• But… women with less than grade 9 are
less than half as likely to be employed as
males – 13.6% of women cf 29.4% of men
• Gender analysis not just m/f but
diversity - sub-groups of women - esp.
vulnerable
Women increased professional
status - I.e. strong educational
improvement
75% of Halifax pop.25-29
graduated high school BUT
60% of Halifax pop. 25-54
post-secondary grads BUT
Unemployment rate in Halifax =
7%
BUT.... Unemployment +
underemployment
Youth unemployment 15-24
explains entire gender gap
Job security -and work options
Job security - temp work
Job security – union coverage
(helps explain PEI equity)
High decision latitude at
work - related to lower stress
4) While f-t women work 39 hrs cf 43 - men,
women still do most unpaid housework
Atlantic Canada: f/t employed
women also work almost as many
hours as men
50
45
40
43.1
39.3
44.8
39.1
46.3
40
43.8
43.4
39.1
39.2
35
Male
Female
30
25
20
15
Can
Nfld
PEI
NS
NB
Women still do bulk of
unpaid housework
Employed mothers (f/t) work
average 75-hr week - pd+unpd
Statcan: Women moving to longer work hours:
• 4x likely smoke more, 2x likely drink more
• 40% more likely decrease physical activity
• 80% more likely have unhealthy weight gain
• 2.2x more likely experience major depressive
episodes cf women on standard hours
Stress and health behaviours smoking
More Nova Scotians report high
stress % of pop. 18+, reporting “quite a lot” of
life stress, 2001
Nova Scotia health regions
with “quite a lot” of stress,
2001
Less stressful alternatives
(societal vs individual solutions)
Social supports are important
• Social networks may play as important a
role in protecting health, buffering against
disease, and aiding recovery from illness
as behavioural and lifestyle choices such as
quitting smoking, losing weight, and
exercising.
– See: Mustard, J.F., & Frank, J. (1991).The
Determinants of Health. (CIAR Publ. No. 5).
Social Supports: NS low in Atlantic
region - those reporting high levels,
over age 12, 2001
Key Social SupportsVolunteerism and Family
• Health Canada uses volunteerism as a
key indicator of a “supportive social
environment” that can enhance health.
• All four Atlantic provinces = highest
rates of volunteer work in the country.
• More women than men volunteer
Volunteerism: Atlantic
Provinces lead (formal rate)
But volunteerism has
declined --here and nationally
Volunteerism rests on narrower
base: Fewer volunteers - longer
hours
• NS lost 30,000 volunteers 19972000
• Work hours of remaining
volunteers up 32%
• So volunteer service hours
increased 18% despite loss of
volunteers - burnout danger
Family violence = key
indicator of women’s health
• CIHI, Statcan identify crime as “nonmedical determinant of health.” But
women’s health analysis requires
special indicators - family violence,
like unpaid work, is key indicator.
• Family identified as key pillar of social
support - determinant of health. But
family violence may undermine social
support, health
Family=high % of all violence
• Spousal violence = 18% of all violence
reported to police.
• Women = 85% of all reported spousal abuse
= 6x rate for men
• Nearly 1/3 of all reported female victims of
violence in Canada attacked by spouse
• Unreported - much higher = 8% all women
with partner attacked past 5 years.
Importance of diversity approach.
E.g 1: Aboriginal women’s health
• Life expectancy = 76.2 cf 81 (non-Abor.)
• Higher rates hypertension, cervical
cancer, circulatory & respiratory diseases
• Diabetes = 3x non-Abor. Fem = 2x male
• HIV/AIDS = 2x non-Abor. 50% female
Abor AIDS cases = IV drug use cf 17%
• 9% Aboriginal mothers under 18 cf 1%
Aboriginal women’s health
• 3x mortality due to violence. 25-44 = 5x
• Alcohol-related accidents = 3x
• Fetal alcohol syndrome. Over 50% view
alcohol abuse as problem in community
• 3x suicide rate cf non-Aborig. women
Eg2: Regional disparities require
special attention / intervention
E.g Cape Breton….
• High unemployment and low-income rates,
• Much higher incidence of chronic illness,
disability, and premature death than Halifax
• Highest age-standardized mortality rate in
Maritimes
• Highest death rate from circulatory disease,
heart disease in Maritimes – 30% above
national average
Of 21 Atlantic health districts,
Cape Breton has highest rates of:
• Cancer death (231.8 per 100,000) – 25%
higher than the national average, lung cancer
• Deaths due to bronchitis, emphysema, and
asthma (9.2 per 100,000) –50%+ higher than
the national average
• High blood pressure– 21.7%, (24.3% women
19% men = 72% higher than the Canadian
rate. The next highest rates are in southsouthwest Nova Scotia
Cape Breton = highest:
• Arthritis and rheumatism: 31% of women,
23% of men
• Activity limitation (34%), followed by
Colchester, Cumberland, and East Hants
counties (30.1%)
Life expectancy: 72.8 years for men, and 79.4
for women. (Canada: 75.4 years - men and
81.2 years -women
Disability-free life
expectancy
• Cape Bretoners have an average
disability-free life expectancy of only
61.8 years, seven fewer than the
national average, and the lowest of all
the 139 health regions in Canada.
• This means that Cape Bretoners can
expect to live considerably more years
with a disability than other Canadians.
Potential years of life lost
• highest number of potential years of life lost
due to both cancer and circulatory diseases.
• Cape Bretoners lose 2,261.9 potential years of
life per 100,000 population due to cancer –
41% higher than the national average of
1,603.7,
• and they lose 1,684 potential years of life per
100,000 population due to circulatory diseases
– 65% higher than the national average of
1,020.7.
Women have generally
healthier behaviours: NS:
• Women healthier diets. 5+ servings
fruit/veg/day:
F = 38.1%; M = 26.8%
• Daily smokers:
F = 21.2%; M = 25.8%
• Physically Active: F = 23.4%; M = 18.5%
• Overwt (BMI 27+): F = 33.8%, M = 44.1%
Obesity (BMI 30+): F = 19,3%, M = 22.7%
• Heavy drinking: F = 15.4%, M = 36.6%
BUT...
But female smoking rates
declined later and slower
Teen Smoking rates by Gender
age 15-19,
1996 vs. 2001
45%
40%
40%
35%
30%
24%
25%
24%
21%
20%
15%
10%
5%
0%
1996
2001
Male
Female
Health behaviours vary
regionally: NS high rates m/f:
e.g.: % Overwt (BMI 27+), pop. 20-64, 2001
And within regions: eg Obesity
(BMI=>30), NS regions, aged 20-64, 2001
Cape Breton, W. Nfld = low
mammogram screening, high
breast cancer death rate
The physical environment is an
important determinant of health
- Health Canada
“At certain levels of exposure, contaminants in our
air, water, food and soil can cause a variety of
adverse health effects, including cancer, birth
defects, respiratory illness and gastrointestinal
ailments.
Factors relating to housing, indoor air quality, and
the design of communities and transportation
systems can significantly influence our physical
and psychological well-being.”
NS: 2nd-hand smoke exposure on most
days in the last month, regions, 2001 2001
Access to Health care
• Women use more health care services than
men, thus are disproportionately affected
by barriers.
• Atlantic Canadians have greater difficulties
accessing care than most other Canadians.
• The barriers result from less availability of
key health care services in rural areas,
rather than from longer waiting times.
In Sum:
• Women have distinct health issues....
that have social and economic roots
• Diversity approach –special needs of
Aboriginals, disabled, minorities, recent
immigrants, disadvantaged regions, etc.
• 3 interventions that can improve
women’s health, save health costs:
1) reduce time-overwork stress
2) eliminate gender wage gap
3) reduce poverty of single parents
Can it be
done?...1900s/1980s...
Improving women’s health
today will benefit future
generations of Nova Scotians
SOME ADDITIONAL
SLIDES – NOT PART OF
PRESENTATION
• The slides that follow were not part
of the presentation – and include a
few additional details on
behavioural determinants of health
Women have generally
healthier behaviours
• Women healthier diets. 5+ servings
fruit/veg/day: F = 43%; M = 32%
• Daily smokers: F = 19%; M = 24%
• Overweight (BMI = 27+): F = 28%, M =
36% Obesity (BMI = 30+):
F = 14%, M
= 16%
• Heavy drinking: F = 11%, M = 28%
BUT...
Behavioural pathways – Atlantic
Canadians eat less fruits and
vegetables
% less than 5 servings of fruit
and veg. per day, Nova Scotia,
2001
Alcohol consumption:
% consuming 5+ drinks 12+ times/year
(2001)
Nova Scotia: % consuming
5+ drinks 12+ times a year,
(2001)
Tobacco:
% of pop. who are
current smokers 1985 and 2001
But female smoking rates
declined later and slower
Smoking: % who are daily
smokers (age 12 and over, 2001)
Nova Scotia- % of daily smokers
by health district, 2001
More women physically
inactive
Physically active or inactive.
% of pop. (2000)
Nova Scotia % Physically active:
by health district (2000)
% Overweightaged 20-64,
2001
Nova Scotia: % of overweight men and
women: (BMI=>27), aged 20-64, 2001
Obesity: increasing, NS men
highest
BMI=30+, 1994/95- 2000
Mammogram: Women, 50-69, routine
screening within last two years, 2001
Mammogram: Women, 50-69, routine
screening within last two years, 2001
Cape Breton = lowest
mammogram screening,
highest breast cancer rate
Pap smear test
% of women 18-59 years, 2001
Pap smear test
% of women 18-59 years, 2001
The physical environment is an
important determinant of health
- Health Canada
“At certain levels of exposure, contaminants in our
air, water, food and soil can cause a variety of
adverse health effects, including cancer, birth
defects, respiratory illness and gastrointestinal
ailments.
Factors relating to housing, indoor air quality, and
the design of communities and transportation
systems can significantly influence our physical
and psychological well-being.”
Second hand smoke: exposure on most
days in the last month, 2001
Access to Health care
• Women use more health care services than men,
thus are disproportionately affected by barriers.
• Atlantic Canadians have greater difficulties
accessing care than most other Canadians.
• The barriers result from less availability of key
health care services in rural areas, rather than
from longer waiting times.
• Atlantic Canadians are generally highly satisfied
with the quality of the health care services they
receive.
In Sum:
• Women have distinct health issues....
that have social and economic roots
• 3 interventions that can improve
women’s health, save health costs:
1) reduce time-overwork
stress
2) eliminate gender
wage gap
3) reduce single
parent poverty
• Can it be done?......1900s/1980s.......
Improving women’s health
today will benefit future
generations of Nova
Scotians