ADVANCING PRIMARY CARE: MODELS OF WOMAN-CENTRED CARE IN CANADA Madeline Boscoe National Primary Health Care Conference May 18, 2004 Winnipeg

ADVANCING PRIMARY CARE: ADVANCING PRIMARY CARE: MODELS OF WOMAN-MODELS OF WOMAN-

CENTRED CARE IN CANADACENTRED CARE IN CANADA

Madeline BoscoeMadeline Boscoe

National Primary Health Care National Primary Health Care ConferenceConference

May 18, 2004 WinnipegMay 18, 2004 Winnipeg

ContextContext

Women are the major users and Women are the major users and providers of careproviders of care

Contribution of the Women’s Contribution of the Women’s Health Movement Health Movement

Women are a focus of public Women are a focus of public health campaigns – prenatal care, health campaigns – prenatal care, screeningscreening

There is opportunity in change There is opportunity in change

Women’s Movement and the Women’s Women’s Movement and the Women’s Health Movement Health Movement

redefining health and relationship with redefining health and relationship with health care providers health care providers

Redefining health and health issuesRedefining health and health issues

ContextContext

ContextContext

Many examples: women’s health Many examples: women’s health collectives, programs, research and collectives, programs, research and analysisanalysis

Commitment to gender based Commitment to gender based analysis at the international, national analysis at the international, national and regional levelsand regional levels

Examples Examples

A Framework forA Framework for

Women Centred Women Centred HealthHealth

Vancouver / Richmond Vancouver / Richmond Health Board June 2001Health Board June 2001

www.vcn.bc.ca/vrhb/

Women's_Health%20Plan.htmWomen's_Health%20Plan.htm

Consists of 12 elementsConsists of 12 elements

1.1. The need for respect and safety The need for respect and safety

2.2. The importance of empowering The importance of empowering women women

3.3. Involvement and participation Involvement and participation of women of women

4.4. Collaborative and inclusive work Collaborative and inclusive work environments environments


5.5. Women’s patterns or preferences Women’s patterns or preferences

in obtaining health care in obtaining health care

6.6. Women’s forms of communication and Women’s forms of communication and interaction interaction

7.7. The need for informationThe need for information

8.8. Women’s decision-making processes Women’s decision-making processes


9.9. A gender-inclusive approach to dataA gender-inclusive approach to data

10.10.Gendered research and evaluation Gendered research and evaluation

11.11.Gender-sensitive trainingGender-sensitive training

12.12.Social justice concerns addressedSocial justice concerns addressed

In application:In application:- Many examples of programs and Many examples of programs and

serviceservice- Example of Women’s Health Clinic Example of Women’s Health Clinic

here in Winnipeghere in Winnipeg

Community health centre model Community health centre model

based on the principles of based on the principles of feminism, equity and diversity, feminism, equity and diversity, promoting the health and well-promoting the health and well-being of women. being of women.

to facilitate empowerment, to facilitate empowerment, choice and actionchoice and action..

ApproachApproach

Woman-Centered ServicesWoman-Centered Services

Develop A Partnership Between Develop A Partnership Between

The Woman And Care ProviderThe Woman And Care Provider

Priority Populations and programsPriority Populations and programs

Recognition of inequities in power Recognition of inequities in power

status – class, racismstatus – class, racism

Healthy Public Policy

•Research- Prairie Center

•Policy Analysis & Development

•Networks/Public Meetings

• Women, Income and Health

•Women & Health Reform

•New Reproductive & Genetic Technological Network

Counseling

e.g. – disordered eating and weight preoccupation

•Past abuse

•Stress and self care issues

• Teen program

• Mothers

• weight/body image

•Catching Our Breath – tobacco and women

•Endometriosis

•Breast implants

Peer Programs

• volunteer based

• Birth Control/Unplanned Pregnancy Program

•Teen Clinic

• Community Education Program

• schools, community

Medical Care

• Reproductive Health program

•Birth Control & Unplanned Pregnancy

•Pregnancy and Birth- including Home

•Teen Clinic

• consultations

•Primary Care

Professional Consultation/Counseling*• Nurse practitioners• MDs- on salary• Midwives• Dietitian• Health Educators• Counseling

•Motherhood Stress

•Weight Preoccupation

•Growing Older, Healthy Aging

•Menopause, Tobacco and women

• Well women care

Information

Liaison/Collaboration with other services and sectors

e.g. – Resource Centre

•Info Packages

• information requests

•Info Sheets/Kits

•Newsletter

•Phone Triage

Most appropriate care provide and service

Multiple points of entry

Women encouraged to access information services

Empowerment•Individual (skill development, knowledge•Group (self help, action)•Community

Input to WHC Programs•Client Surveys, Program Evaluations•Membership in Women’s Health Clinic•Participation on Committees and Board•Advisory Committee•Volunteering

System Change•Reframing health issues•Demonstration of best practices & gender sensitive services•Research & issue identification•Policy analysis & development•Community education•Stakeholder working groups

Note: The services noted above are intended to provide examples and are not an exhaustive listing of WHC services. 2004

Outreach

Professional and Community

Support Groups & Self Help Groups

Circle of Services

ApproachApproach

Health Promotion, Prevention And Health Promotion, Prevention And Healthy Public Policy strategies Healthy Public Policy strategies

Women only staff and spaceWomen only staff and space Most Appropriate Caregiver And Most Appropriate Caregiver And

ServicesServices– access through a variety of avenues access through a variety of avenues

and routes of entryand routes of entry– education, support through groups or education, support through groups or

individual counseling, medical individual counseling, medical treatments, health screening, treatments, health screening, advocacy, community action.advocacy, community action.

ApproachApproach

EmpowermentEmpowerment– enhance the understanding, enhance the understanding,

self-care, self-help and self-self-care, self-help and self-advocacy abilities of womenadvocacy abilities of women

– Structure of the ClinicStructure of the Clinic participatory management participatory management Board and advisory committeesBoard and advisory committees Client feedbackClient feedback

ApproachApproach

Use Of Peer VolunteersUse Of Peer Volunteers– modeling self-help skills, modeling self-help skills,

demystifying medical informationdemystifying medical information Community InvolvementCommunity Involvement

- Networks, coalitions- Networks, coalitions

Innovative ProgramsInnovative Programs – new understandings of women’s needs and new understandings of women’s needs and

issuesissues

Staffing: over 40Staffing: over 40 Physicians – on salary , medical assists Physicians – on salary , medical assists Nurse practitioners, dietician Nurse practitioners, dietician Health educators, advocacy coordinatorHealth educators, advocacy coordinator CounsellorsCounsellors Midwives Midwives Unpaid staff - community education and Unpaid staff - community education and

BCUPBCUP

Healthy Public Policy Healthy Public Policy

Advocacy for System Change Advocacy for System Change

Why is this important for women?Why is this important for women?

‘‘Socio-economic status and other structural Socio-economic status and other structural factors (ie. family structure, age and social factors (ie. family structure, age and social support) are more important to women’s support) are more important to women’s health status than lifestyle factors (ie. health status than lifestyle factors (ie. smoking, alcohol consumption and physical smoking, alcohol consumption and physical activityactivity)’ )’

Gender differences in structural and behavioural determinants of health: an Gender differences in structural and behavioural determinants of health: an analysis of the social production of health Virienne Walters and Margaret analysis of the social production of health Virienne Walters and Margaret Denton, Denton,

Healthy Public Policy at Healthy Public Policy at WHCWHC

Identify critical emerging Identify critical emerging issuesissues

Outreach and policy adviceOutreach and policy adviceMidwifery, regulation of Midwifery, regulation of

drugs, gendered researchdrugs, gendered research Intervention at Supreme Intervention at Supreme

court on mandatory court on mandatory treatment of pregnant womentreatment of pregnant women

Healthy Public Policy Healthy Public Policy

Women, Income and Women, Income and HealthHealth

• Research and Research and outreach project . outreach project . Goals: Goals: • improved health improved health

serviceservice• Policies the reduce Policies the reduce

poverty poverty • Knowledgeable publicKnowledgeable public

Moving ForwardMoving Forward

Primary Care Renewal and WomenPrimary Care Renewal and Women

1.1. Inform Indicators and Core Services Inform Indicators and Core Services discussion discussion

2.2. Gender Based AnalysisGender Based Analysis

3.3. Implementation of Models of Implementation of Models of Women Centred Care Women Centred Care

1. Primary Care Renewal 1. Primary Care Renewal and Women – Core Servicesand Women – Core Services

1.1. Sex-specific conditions: Sex-specific conditions: 1.1. Reproductive Health service, includingReproductive Health service, including birth control , unplanned pregnancy and terminations, birth control , unplanned pregnancy and terminations, pregnancy, childbirth in home or LDRPpregnancy, childbirth in home or LDRP menstruation, menopause and female infertility, menstruation, menopause and female infertility, screening for cervical cancer. screening for cervical cancer.

2.2. Conditions more prevalent among women,Conditions more prevalent among women, breast cancer, thyroid, autoimmune conditionsbreast cancer, thyroid, autoimmune conditions Sexual assault and violenceSexual assault and violence disordered eating and body image, disordered eating and body image, Stress, depression and self-inflicted injuries Stress, depression and self-inflicted injuries Home careHome care

Primary Care Renewal and Primary Care Renewal and Women – Core ServicesWomen – Core Services

3.3. Conditions which appear to be sex-neutral, but Conditions which appear to be sex-neutral, but not are not.not are not. heart disease, tobacco, addictionsheart disease, tobacco, addictions

4.4. Effects of women’s gendered roles in our society Effects of women’s gendered roles in our society influence their health. E.g.influence their health. E.g. Care giving responsibilities often cause women Care giving responsibilities often cause women

to give higher priority to the health of others,to give higher priority to the health of others,

the sex-segregation of the labour force, both in the sex-segregation of the labour force, both in general and within health care in particular;general and within health care in particular;


con’tcon’t Effect of caregiving on their own Effect of caregiving on their own

health; health;

women have lower average incomes women have lower average incomes than men and lower incomes are than men and lower incomes are associated with poorer health;associated with poorer health;

women’s paid work and their women’s paid work and their working conditions influence their working conditions influence their health.health.

44


5.5.Gender stereotypes within the health care Gender stereotypes within the health care system negatively affect women’s health. system negatively affect women’s health. These include both stereotypes: These include both stereotypes:

- about women’s use of care and- about women’s use of care and - about women’s care giving roles.- about women’s care giving roles.

• Women are often assumed to use Women are often assumed to use health care services more than men. health care services more than men.

• is related to sex-specific care and not to is related to sex-specific care and not to male stoicism or to women’s predisposition male stoicism or to women’s predisposition to seek help. to seek help.


• evidence that negative stereotypes about evidence that negative stereotypes about women lead to women receiving women lead to women receiving negatively differential treatment . E.g. 2negatively differential treatment . E.g. 2ndnd prevention of heart attacks- physicians prevention of heart attacks- physicians assuming symptoms were psychological in assuming symptoms were psychological in originorigin

• As well, Health promotion and prevention As well, Health promotion and prevention programs frequently target women– as programs frequently target women– as vectors for healthy babies, children, vectors for healthy babies, children, families and communities. families and communities.


6.6. Over-medicalization of normal Over-medicalization of normal aspects of women’s lives including aspects of women’s lives including pregnancy, stress, childbirth and pregnancy, stress, childbirth and menopause. menopause. • Pills for preventionPills for prevention

Moving ForwardMoving Forward

2. What is Gender Based Analysis2. What is Gender Based Analysis

What is Gender?What is Gender?

What is Gender Based What is Gender Based Analysis?Analysis?

a process or tool a process or tool improves our understanding improves our understanding

of sex and gender as of sex and gender as determinants of health AND determinants of health AND

of their interaction with other of their interaction with other determinantsdeterminants

Resources for Gender Based Resources for Gender Based AnalysisAnalysis

Exploring Concepts Exploring Concepts of Gender and of Gender and HealthHealth, , Health CanadaHealth Canada

Places to Start Places to Start - handout from handout from “ “A Framework for A Framework for

Women-Centred Women-Centred Health” Health”

Vancouver Costal Health Vancouver Costal Health AuthorityAuthority


Good primary health care for women Good primary health care for women must both incorporate this must both incorporate this knowledge and be a catalyst for knowledge and be a catalyst for change, helping to reduce the change, helping to reduce the contribution of gender differences to contribution of gender differences to health inequalities.health inequalities.

Moving Primary Care Moving Primary Care ForwardForward

Policy Commitment to Gender Based Policy Commitment to Gender Based Analysis Analysis

Inform Indicators and Core Services Inform Indicators and Core Services discussiondiscussion

Implement Models of Care of Women Implement Models of Care of Women Centred Care Centred Care

Keep Networking and Sharing Keep Networking and Sharing

Networking Networking

CD of resourcesCD of resources

Primary Health Care and Women Primary Health Care and Women listserv—informing policy listserv—informing policy developmentdevelopment

Ongoing dialogueOngoing dialogue

Canadian Women’s Health Canadian Women’s Health NetworkNetwork

CD-ROM* selected from CD-ROM* selected from – the National Coordinating Group on Health the National Coordinating Group on Health

Care Reform and Women – primary careCare Reform and Women – primary care– the Centres of Excellence for Women’s the Centres of Excellence for Women’s

Health and national Working GroupsHealth and national Working Groups– Others: Ontario Women’s Health Council, Others: Ontario Women’s Health Council,

Health Canada, WHC, Women’s Health in Health Canada, WHC, Women’s Health in Women’s Hands, FGM manualWomen’s Hands, FGM manual

* * Note: Documents are on the disc- to search web sites you must Note: Documents are on the disc- to search web sites you must

be on linebe on line..

Thank you to the Women’s Health Thank you to the Women’s Health Contribution program , Women’s Health Contribution program , Women’s Health Bureau, Health Canada , Canadian Women’s Bureau, Health Canada , Canadian Women’s Health Network and the Women’s Health Health Network and the Women’s Health Clinic for support of this presentationClinic for support of this presentation