Framework for Girls and Women-centred Health. An Implementation Guide for Vancouver Coastal Health

Transcription

1 Framework for Girls and Women-centred Health An Implementation Guide for Vancouver Coastal Health August 2009

2 This document was developed by Vancouver Coastal Health Women s Health Committee with Robin Barnett, consultant. A Framework for Women-Centred Health (upon which this document is based) was first published by the Vancouver/Richmond Health Board June Website: Contact: PopulationHealth@vch.ca DESIGNed by 2

3 3 a framework for girls and women-centred health Contents 4 Introduction 7 The Framework 8 Tips for Using the Framework 10 Places to Start 12 Glossary

4 Introduction This booklet contains tools to help anyone working to improve the health of girls and women. It centres around the Framework for Girls and Women-Centred Health, a multilevel perspective promoting best practices in planning, evaluation and quality improvement. Along with the Framework, this booklet contains: A snapshot of women s health, using Gender-based Analysis (GBA). Tips on Using the Framework. The Places to Start Checklist, with questions to help assess programs and services. Examples of Best Practices with a focus on innovative, practical ideas. A Glossary with key concepts and terminology, reflecting the contents of Women-Centred Care: A curriculum for health care providers - a companion document to help build upon current practices to create new ways of thinking (about care for girls and women), and new practices and structures within the health system. 1 What is the Framework for Girls and Women-centred Health? In 1998 the Vancouver/Richmond Health Board (precursor to Vancouver Coastal Health) partnered with BC Women s Hospital and Health Centre to improve the health of women in the region. The Framework for Women-Centred Health (2001) was the outcome. The framework makes women-centered approaches to health care a primary focus, and provides a method for assessing and adapting programs and services in order to improve women s health. It is a best practices framework consisting of 12 elements that, taken together, provide entry points to improve responses to the health needs of individual women and specific sub-populations of women. The Framework can also: link with accreditation objectives and indicators; be translated into quality improvement goals; serve as indicators of girls or women-centred health in evaluation. The original Framework document can be obtained by contacting populationhealth@vch.ca Why have a Framework for Girls and Women s Health? Yes, women live longer than men, but that s not the whole story As of 2006, the average life expectancy for women and men living in Vancouver Coastal Health (VCH) was 84.5 years for women (Provincial average: 83.2 years) 82.4 years for men (Provincial average: 78.6 years) 1 Cory, Jill, et.al. Women-Centred Care: A curriculum for health care providers BC Women s Hospital and Health Centre 4

5 5 a framework for girls and women-centred health A comparison of life expectancies prepared for the 2010 Olympics revealed that life expectancy for BC men is increasing at almost twice the rate for BC women. 2 A recent Statistics Canada Study might explain why. 3 It reports that Canadian women are experiencing significant decline in health and quality of life between the ages of 40 and 50, compared to men of the same age. The data indicate that women in their 40s experience more illness linked to emotional stress that lead to a poorer quality of life than their male counterparts. Local data also confirm this trend: The proportion of women in VCH reporting higher levels of stress in their lives increased between 2003 and The greatest increase was seen in Richmond, where the proportion of women reporting high levels of stress increased by 28%. The highest levels of women reporting stress were in North Coast-Garibaldi. 4 % Excellent / Very Good Self-Rated Health Total Population 12 years+ (2005) 80 % Males 70 % Females % % Among Seniors 65 years+ (2005) 60 % Males % Females % % 30 % % 20 % % 10 % 10 % 0 % 0 % Richmond VANCOUVER North Shore/ coast garabaldi Richmond VANCOUVER North Shore/ coast garabaldi Source: The Health of Women and Girls in VCH. August Population Health. Vancouver Coastal Health 2 Life expectancy as a measure of population health: Comparing British Columbia with other Olympic and Paralympic Winter Games host jurisdictions. Summary report. Provincial Health Services Authority. April Orpana, Heather et al. The natural history of health related quality of life: A 10-year cohort study. Statistics Canada Health Reports Vol. 20, No. 1 March The Health of Women and Girls in VCH. Population Health, Vancouver Coastal Health. August 2008

6 Population surveys ask individuals to rate their own physical and mental wellbeing because self-reported health is a widely accepted indicator of general health status. Self-rated health among women over the age of 65 was significantly poorer than that for men. Overall, women were less likely than men to rate their health as either very good or excellent. The lead author of the Statistics Canada study states that we need to look further... to see why their [women s] health and quality of life is decreasing so much. 5 Gender-Based Analysis can reveal differences Looking at life expectancy and self-rated health in this way is an example of genderbased analysis (GBA). It is used to understand the differences between women and men in health status, health care utilization, and health needs. 6 It is also a way to understand the experiences of sub-groups of girls/women and of boys/men. GBA also provides a way to see if or how policies, programs or services might impact girls/women and boys/men differently, and to identify where there are inequities. GBA does not include a how to of strategies to address inequities, however. If GBA is done on a cluster of services, and analysis shows that services are lacking, policy makers would apply a best practices framework to address the problem. Therefore, GBA and best practice frameworks are complementary. Using the Framework in the Coastal Health Services Delivery Area one story Beginning in 2001, the Coastal and Garibaldi region of the Coastal Health Services Delivery Area surveyed women on their health needs and responded to identified priorities as resources allowed. The reports were customized to reflect the needs of diverse populations including Punjabi women in Squamish, and First Nations women in coastal communities. If the results of local consultations had been incorporated in the larger report, women in local communities might not have seen their specific issues reflected. As a result, strong women s health networks were created and still exist today. Leadership for women s health issues emerged from the communities themselves and residents became more directly involved in decision-making about programs and services in their communities. Coastal staff also learned to include women s health as a strategic priority in their program plans, reporting on activities yearly. Initially they were able to have women s health identified as a top priority in the three-year health services delivery plan that was endorsed by the board of directors and submitted to the Ministry of Health. 5 Orpana, Heather et al. The natural history of health related quality of life: A 10-year cohort study. Statistics Canada Health Reports Vol. 20, No. 1 March Manitoba Women s Health Profile. Prairie Women s Health Centre of Excellence

7 7 a framework for girls and women-centred health Social class, income, social status and food security Social support networks, extended families, single parenting caregiving Healthy child development, Adolescence, Midlife, Aging, Disabilities Education, language skills, literacy Aboriginal status, ethnicity & race, immigrant or refugee status Gendersensitive and diversities training Multiple gender roles across cultures and life course, sexual orientation Health services, links with communities, traditional and complementary therapies Patterns or preferences in obtaining care. Access to care Employment & working conditions including childcare Sex (biology) and genetics Resilency, effects of gender -based trauma & violence across the life course Geographic location, physical environment, housing, safe communities Social environments, media images, sexual coercion, discrimination 1 Barnett, R. et. al. Voices From the Front Lines: Models of Women-centred Care in Manitoba and Saskatchewan Prairie Women s Health Centre of Excellence. Winnipeg.

8 Coast Garibaldi used the Framework as a guide to revise public health nursing protocols for postpartum depression, child health clinics, prenatal classes, response to violence against women, and its sexual assault policy. This assured women s health the visibility it needed not to get lost within larger plans. One goal has been to use the Framework as a tool when implementing any new public health program. In 2008 a project applied the Framework to youth clinics: youth teams identified areas where they were doing well and areas for improvement in terms of girls and womencentred service delivery. TIPS for USING THE FRAMEWORK Everything begins with girls and women and their communities. While it may seem easier to have a checklist to use, the backgrounds and needs of girls and women vary between populations and within diverse populations. Consider the diversity of girls and women in your communities. Each set of circumstances potentially raises a different set of responses. It is in the details of individual and community lives that the solutions for health and health care are revealed. Listen and dialogue with girls and women in their communities. Consider the diversity of girls and women in your communities: Professional women Lesbian and bisexual women Transgender people Girls & young women Older women Women with disabilities Women of colour Immigrant and refugee women Survivors of trauma and abuse First Nations women Rural women Homeless women Pregnant women Single mothers What are strengths? What are areas of concern? Use a caring, non-judgmental, and respectful approach to learn the details about girls and women s lives. The objective is to arrive at solutions to health collaboratively. Even small steps can make a difference. 8

9 a framework for girls and women-centred health The flower Framework allows you to see the best practices elements integrated with determinants of health and the four-quadrant First Nations medicine wheel. Additional factors have been added to the determinants to help make them more reflective of girls and women s lives. Try to apply the concepts from the determinants of health to the context of girls and women s lives to uncover their impact on individual girls and women or a community s mental, physical, emotional or spiritual health and/or health care. Imagine if each concentric circle could spin around the centre. You could spin the determinants of health or the best practices elements. You can use any element as an entry point. Wherever you start, you can see all the determinants relating to or intersecting with that practice element. What is already being done from a girls or women-centred perspective? What needs to be addressed? For example: links with community support research knowledge of gender differences in symptoms or treatment a medical problem that needs to be reframed as a safety issue The Framework becomes a proposal for action. Together with girls and women or communities you can figure out what to do even for complex situations where many determinants intersect. Use the best practice examples to trigger local solutions to program or service planning. 9

10 Places to Start Questions to Consider Doing well Somewhat Unsure Action and who are your partners? Framework Element Action Has your service considered ways to make programs physically and emotionally safe for women and girls? Respect & safety Do you support women and girls in ways that allow them a sense of control over their lives and care? Empowerment Are women and girls from diverse communities involved in program planning? Are they partners in their own care? Involvement & participation Does your work environment support you to support women and girls empowering themselves? Collaborative work environment Are you aware of different women s preferences in obtaining care? Can all women access services? Do you encourage or provide ways for women and girls to meet together and support each other? Patterns or preferences in obtaining care/access to care Communication & interaction Do you ask women if information is presented in ways that they find accessible? Need for information Do you support women making decisions about health differently than how you would make them yourself? Decisionmaking processes Does your service collect data that distinguish between groups of women and between men and women? Genderinclusive approach to data Are you aware of current research that shows how health issues are different among groups of women, as well as different between women and men? Gendered research & evaluation Do you measure all women s experiences by one standard of race, ethnicity, sexual orientation, abilities, income level and age? Gender sensitive and diversities training Does your service or agency acknowledge inequities among girls and women and support providing equality of opportunity and health outcomes for them? Social justice 10

11 a framework for girls and women-centred health Places to Start Examples of Practices to meet the needs of Girls and Women Framework Element A Speak Out Board How about a bulletin board in a waiting area turned into a place where women and girls can leave notes for other women. One clinic in Vancouver has a Hearts Board where women can leave notes of comfort and support for other women. Build safety in programs where both women and men attend. Many women do not disclose the violence in their lives until they feel safe. By providing women-only options in programming or monitoring co-educational groups to ensure women have an equal voice, a climate can be created where women feel safe. A Somali women s group conducted focus groups in their community and prepared a report in their own language. When translated into English, cultural information was added to the report which clarified findings for the English reader. Use peer coaches or buddies to assist girls and women to build knowledge and skills and have a voice. Planning a new program or evaluating a project? Include women and/or girls on the committee. Send them all copies of the Framework. See if they want to use it in planning without any preconceived agenda. Set up mechanisms within team structures to deal with inherent differences among people and roles. Include girls and women from different communities in the team. Change the time of support groups or some services to enable women who have children in care or school to attend, and finish in time to pick up their children. Working in a school? How about finding a way to initiate a girls group where girls can talk about what s happening in their lives. Some women may require an advocate, interpreter, community worker or intermediary to get information. Exchanging stories with someone from their own community may be an important learning method. Listen to girls and women discuss the context of decisions, rather than oblige simple either/or choices. Allow women to decide how much they want to discuss. Women falling through the cracks? Keep statistics on the women and men being turned away or referred to other agencies. Are there more women? Where are they going? Use websites to keep up with new research. Keep handy the handouts from the Women-Centred Care Curriculum about the 10 sex and 10 gender differences that make a difference to health. Learn about a population you are unfamiliar with. Take a workshop. Read and talk with people. Want to share what you re learning? Try to get together with your co-workers or compile a list of diverse services that you could refer women to. Share it with others. Staff at one health centre felt some women were not getting to services. They set up a drop-in in one area to ask residents what they would like. Solutions included extending hours and services in multiple sites. Respect and safety Empowerment Involvement and participation Collaborative work environment Patterns or preferences in obtaining care / access to care Communication and interaction Need for information Decision-making processes Gender-inclusive approach to data Gendered research and evaluation Gender sensitive and diversities training Social justice 11

12 Glossary Best practices A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result so that there is no need to reinvent the wheel. Diversity Diversity includes age, class, different abilities, education, ethnicity, family, gender, marital/relationship status, race, religion, work experience, geographic size and location, and sexual orientation. Ethnicities Ethnicities is commonly used to reference populations, groups or categories that are characterized by a shared nationality, culture, or language. As an identity, it is primarily a construct of self-definition and self-concept measured by how connected a person feels to a specific ethnic group. 7 Empowerment Empowerment is a process where someone or a group acquires the power to think and act freely, exercise choice, and fulfill their potential. Four factors that contribute to women s empowerment: A core sense of self The ability to take action based on that sense of self A sense of control over one s life Being connected with others. 8 Gender Refers to differences between men/boys and women/girls and people of different sexual orientation created by social and cultural norms rather than biology. Therefore they are socially constructed. 9 Gender-based analysis A way to examine the differences and disparities in the roles that girls/women and boys/men play, the power imbalances in their relations, their needs, constraints and opportunities and the impact of these differences on their lives or health. 10 Gender-and violence A pattern of abuse that is an enduring, traumatic, and complex experience which isolates and controls women, whether or not it includes physical or sexual violence. 11 Gender equity Gender equity is fairness and justice in the distribution of benefits and responsibilities between girls/ women, boys/men and people of different sexual orientation. The concept recognizes that there is a social and political context of inequality, and that imbalances of power and needs should be rectified. 12 Gender equality Gender equality is the absence of discrimination on the basis of a person s sex or sexual orientation in opportunities, and the allocation of resources, benefits or access to services. Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Race Commonly describes biological or physical characteristics in contrast to ethnicities. Despite this popular view, there are no biological criteria for dividing races into distinct categories. Sex Fixed biological characteristics of a person that indicate male, female or intersex (displaying characteristics of both sexes). Women-centred care Women/ girls know their own bodies and realities and practitioners listen to them describe their needs in their own way and in their own voice. All girls and women receive evidence-based care that respects their social, economic, physical and cultural realities Hankivsky, O., & Cormier, R.. Intersectionality: Moving Women s Health Research and Policy Forward. Vancouver: Women s Health Research Network Laurene E. Sheilds, Women s Experiences of the Meaning of Empowerment, California: Qualitative Health Research. Sage Publications., 1995, pp Cory, Jill, et. al. Women-Centred Care: A curriculum for health care providers. BC Women s Hospital & Health Centre Ibid. 11 Jill Cory and Lynda Dechief. SHE Framework: Safety and Health Enhancement for Women Experiencing Abuse. Woman Abuse Response Program. BC Women s Hospital. 12 Cory, J. et. al. op.cit. 13 Ibid.