Transcript Women’s Health Clinic

ADVANCING PRIMARY CARE:
MODELS OF WOMAN-CENTRED
CARE IN CANADA
Madeline Boscoe
National Primary Health Care Conference
May 18, 2004 Winnipeg
Context
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Women are the major users and
providers of care
Contribution of the Women’s Health
Movement
Women are a focus of public health
campaigns – prenatal care, screening
There is opportunity in change
Women’s Movement and the Women’s Health
Movement
 redefining health and relationship with health
care providers
 Redefining health and health issues
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Context
Context
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Many examples: women’s health
collectives, programs, research and
analysis
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Commitment to gender based analysis at
the international, national and regional
levels
Examples
A Framework for
Women Centred Health
Vancouver / Richmond
Health Board June 2001
www.vcn.bc.ca/vrhb/
Women's_Health%20Plan.htm
Consists of 12 elements
The need for respect and safety
2. The importance of empowering
women
3. Involvement and participation of
women
4. Collaborative and inclusive work
environments
1.
Consists of 12 elements
5.
Women’s patterns or preferences in
obtaining health care
6.
Women’s forms of communication and
interaction
7.
The need for information
8.
Women’s decision-making processes
Consists of 12 elements
9.
A gender-inclusive approach to data
10. Gendered
research and evaluation
11. Gender-sensitive
12. Social
training
justice concerns addressed
In application:
- Many examples of programs and service
- Example of Women’s Health Clinic here in
Winnipeg
 Community
health centre model
 based
on the principles of feminism,
equity and diversity, promoting the
health and well-being of women.

to facilitate empowerment, choice
and action.
Approach

Woman-Centered Services
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Develop A Partnership Between The
Woman And Care Provider

Priority Populations and programs

Recognition of inequities in power
status – class, racism
Healthy Public Policy
Counseling
•Research- Prairie Center
Information
•Policy Analysis & Development
e.g. – Resource Centre
•Networks/Public Meetings
•Info Packages
• Women, Income and Health
• information requests
•New Reproductive & Genetic
Technological Network
•Newsletter
Circle of Services
•Past abuse
•Stress and self care issues
•Women & Health Reform
•Info Sheets/Kits
e.g. – disordered eating and
weight preoccupation
Empowerment
• Teen program
•Individual (skill
development, knowledge
•Group (self help, action)
•Community
•Phone Triage
Outreach
Liaison/Collaboration
with other services and
sectors
Professional and Community
•Motherhood Stress
Multiple
points of
entry
•Weight Preoccupation
•Growing Older, Healthy Aging
•Menopause, Tobacco and
women
• Well women care
Most appropriate
care provide and
service
Professional
Consultation/Counseling*
• Nurse practitioners
• MDs- on salary
• Midwives
• Dietitian
• Health Educators
• Counseling
Women
encouraged
to access
information
services
Support Groups
& Self Help Groups
• Mothers
• weight/body image
•Catching Our Breath – tobacco
and women
•Endometriosis
•Breast implants
• Reproductive Health program
•Birth Control & Unplanned
Pregnancy
•Pregnancy and Birth- including
Home
•Client Surveys, Program
Evaluations
•Membership in
Women’s Health Clinic
•Participation on
Committees and Board
•Advisory Committee
•Volunteering
System Change
Peer Programs
Medical Care
Input to WHC Programs
• volunteer based
• Birth Control/Unplanned
Pregnancy Program
•Teen Clinic
• Community Education Program
• schools, community
•Reframing health issues
•Demonstration of best
practices & gender
sensitive services
•Research & issue
identification
•Policy analysis &
development
•Community education
•Stakeholder working
groups
•Teen Clinic
• consultations
•Primary Care
Note: The services noted above are intended to
provide examples and are not an exhaustive
listing of WHC services. 2004
Approach
Health Promotion, Prevention And
Healthy Public Policy strategies
 Women only staff and space
 Most Appropriate Caregiver And
Services
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– access through a variety of avenues and
routes of entry
– education, support through groups or
individual counseling, medical treatments,
health screening, advocacy, community
action.
Approach
 Empowerment
– enhance the understanding, selfcare, self-help and self-advocacy
abilities of women
– Structure of the Clinic
 participatory management
 Board and advisory committees
 Client feedback
Approach
 Use
Of Peer Volunteers
– modeling self-help skills, demystifying
medical information
 Community Involvement
- Networks, coalitions
 Innovative
Programs
– new understandings of women’s needs and issues
Staffing: over 40
 Physicians – on salary , medical assists
 Nurse practitioners, dietician
 Health educators, advocacy coordinator
 Counsellors
 Midwives
 Unpaid staff - community education and
BCUP
Healthy Public Policy
Advocacy for System Change
Why is this important for women?
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‘Socio-economic status and other structural
factors (ie. family structure, age and social
support) are more important to women’s health
status than lifestyle factors (ie. smoking, alcohol
consumption and physical activity)’
Gender differences in structural and behavioural determinants of health: an analysis
of the social production of health Virienne Walters and Margaret Denton,
Healthy Public Policy at WHC
Identify critical emerging issues
Outreach and policy advice
Midwifery, regulation of drugs,
gendered research
Intervention at Supreme court on
mandatory treatment of pregnant
women
Healthy Public Policy
Women, Income and
Health
•
Research and outreach
project . Goals:
• improved health service
• Policies the reduce
poverty
• Knowledgeable public
Moving Forward
Primary Care Renewal and Women
1. Inform Indicators and Core Services
discussion
2. Gender Based Analysis
3. Implementation of Models of Women
Centred Care
1. Primary Care Renewal and
Women – Core Services
1. Sex-specific conditions:
1. Reproductive Health service, including
 birth control , unplanned pregnancy and terminations,
 pregnancy, childbirth in home or LDRP
 menstruation, menopause and female infertility,
 screening for cervical cancer.
2. Conditions more prevalent among women,
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breast cancer, thyroid, autoimmune conditions
Sexual assault and violence
disordered eating and body image,
Stress, depression and self-inflicted injuries
Home care
Primary Care Renewal and
Women – Core Services
3. Conditions which appear to be sex-neutral, but not are
not.
 heart disease, tobacco, addictions
4. Effects of women’s gendered roles in our society
influence their health. E.g.
 Care giving responsibilities often cause women to
give higher priority to the health of others,
 the sex-segregation of the labour force, both in
general and within health care in particular;
Primary Care Renewal and
Women – Core Services
 4con’t
 Effect of caregiving on their own
health;
 women have lower average incomes
than men and lower incomes are
associated with poorer health;
 women’s paid work and their working
conditions influence their health.
Primary Care Renewal and
Women – Core Services
5.Gender stereotypes within the health care
system negatively affect women’s health.
These include both stereotypes:
- about women’s use of care and
- about women’s care giving roles.
• Women are often assumed to use
health care services more than men.
• is related to sex-specific care and not to
male stoicism or to women’s predisposition
to seek help.
Primary Care Renewal and
Women – Core Services
• evidence that negative stereotypes about
women lead to women receiving negatively
differential treatment . E.g. 2nd prevention of
heart attacks- physicians assuming symptoms
were psychological in origin
• As well, Health promotion and prevention
programs frequently target women– as vectors
for healthy babies, children, families and
communities.
Primary Care Renewal and
Women – Core Services
6. Over-medicalization of normal aspects of
women’s lives including pregnancy, stress,
childbirth and menopause.
• Pills for prevention
Moving Forward
2. What is Gender Based Analysis
What is Gender?
What is Gender Based Analysis?
a
process or tool
 improves our understanding of
sex and gender as determinants of
health AND
 of their interaction with other
determinants
Resources for Gender Based Analysis
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Exploring Concepts of
Gender and Health,
Health Canada
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Places to Start
- handout from
“A Framework for
Women-Centred Health”
Vancouver Costal Health Authority
Primary Care Renewal and
Women – Core Services
Good primary health care for women must
both incorporate this knowledge and be a
catalyst for change, helping to reduce the
contribution of gender differences to
health inequalities.
Moving Primary Care Forward
Policy Commitment to Gender Based
Analysis
 Inform Indicators and Core Services
discussion
 Implement Models of Care of Women
Centred Care
 Keep Networking and Sharing
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Networking
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CD of resources
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Primary Health Care and Women
listserv—informing policy
development
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Ongoing dialogue
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Canadian Women’s Health Network
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CD-ROM* selected from
– the National Coordinating Group on Health
Care Reform and Women – primary care
– the Centres of Excellence for Women’s
Health and national Working Groups
– Others: Ontario Women’s Health Council,
Health Canada, WHC, Women’s Health in
Women’s Hands, FGM manual
* Note: Documents are on the disc- to search web sites you
must be on line.
Thank you to the Women’s Health Contribution
program , Women’s Health Bureau, Health
Canada , Canadian Women’s Health Network
and the Women’s Health Clinic for support of
this presentation