Unit9_genderandhealth_Student copy 1.pptx

GENDER AND HEALTH Unit 9 HTH SCI 1RR3 Land Acknowledgement McMaster University recognizes and acknowledges that it is located on the traditional territories of the Mississauga and Haudenosaunee nations, and within the lands protected by the “Dish with One Spoon” wampum agreement. That wampum uses...

GENDER AND HEALTH Unit 9 HTH SCI 1RR3 Land Acknowledgement McMaster University recognizes and acknowledges that it is located on the traditional territories of the Mississauga and Haudenosaunee nations, and within the lands protected by the “Dish with One Spoon” wampum agreement. That wampum uses the symbolism of a dish to represent the territory, and one spoon to represent that the people are to share the resources of the land and only take what AGENDA 1.Sex vs Gender 2.Gender and Health 3.Mainstreaming Gender (GBA+) 4.Gender Diversity 5.Intersectionality 6.Next Week Small Group Discussion ● Before we begin today’s topic let’s take a moment to reflect on our own positionality. How does our own identify, experience, social position affect how we approach and care for patients and/or their families. ● What bias (both subconscious and conscious) might we hold personally as well as our society as a whole? ● What can we do to challenge our SEX V.S. GENDER 1: DEFINITIONS SEX = biology (e.g. XX; XY) SEX = biology (e.g. XX; XY) GENDER = socially constructed roles (typically assigned at birth) Terminology ● Sex = male/female ● Gender – much more diverse – man, men, he, him, woman, women, she, her, they, them SEX & HEALTH https://healthydebate.ca/personal-health-navigator/women-react-differently-men- 2: GENDER & HEALTH Gender Bias Many of our objective and subjective screening tests are “one size fits all” • Women tend to utilize healthcare services more than men • Q: Perceived as less masculine to access care? • Women have higher rates of depression but men have higher rates of suicide • Q: Missing depression symptoms in men? Over diagnosing in women? GENDER INEQUALITY Versus INEQUITY INEQUALITY Sex-based differences: woman having a MI presenting with upper back pain/fatigue versus “elephant on my chest” INEQUITY (Unfair): Woman gets sent home with no MI work-up Note: highlights the inextricable link between sex (biological reasons for different presentations) and gender (women seen as “hysterical”) in health WHO Conceptual Framework Revisited Note upstream location of gender Distributio n Gende r and interaction with other SDoH – particularly class and race Power Sex Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health: Social determinants of health discussion paper 2. Geneva, Switzerland: World Health Organization Press. REMINDER GENDER & INCOME WOMEN & CHILDREN “In 2018, the child poverty rate was 5.8% for those living in couple families, compared with 26.2% for those in female lone-parent families.” SOURCE Statistics Canada. (2020). Canadian Income Survey, 2018. https://www150.statcan.gc.ca/n1/en/daily-quotidien/200224/dq200224a-eng Males Female s Albert Sask B.C. Ont Que Man N.S. PEI a 35.99 31.92 31.7 31.43 28.71 27.96 26.81 24.33 3 29.67 27.04 25.8 27.60 25.85 24.72 24.30 24.18 3 • Wage gap declining BUT still significant • Men hourly wages on average $31.05 and women on average $26.92 • Canada ranks 23rd out of 27 with 18.5% gap between men and women in OECD nations Source : Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 16: Gender) Closing the Gender-Based Gap • Elimination of gender-based discrimination is needed through policy creation and enforcement 1. 2. 3. 4. 5. pay equity reducing extreme forms of poverty and social exclusion national affordable childcare programs, improve access to employment insurance policies that make it easier for workplaces to achieve collective agreements through unionization. Source : Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2nd ed.). Ontar University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 16: Gender) REMINDER GENDER & WORK GENDER-BASED INEQUITY: • non-racialized women earn 69 cents for every dollar nonracialized men earn RACE-BASED INEQUITY: • racialized men earn 76 cents for every dollar non-racialized men earn • racialized women earn 85 cents for every dollar nonracialized women earn GENDER-BASED + RACE-BASED INEQUITY (intersectionality): • racialized women earn 58 cents for every dollar nonSheila Block and Grace-Edward Galabuzi. (December, 2018). Persistent Inequality: Ontario’s Colour-coded Labour Market https://www.policyalternatives.ca/sites/default/files/uploads/publications/Ontario%20Office/2018/12/Persistent%20inequality.pdf REMINDER GENDER & EDUCATION Women with Bachelor’s degree earn ~ 63% more than women with a high school diploma https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2017036-eng.htm Men with Bachelor’s degree earn ~ 45% more than men with a high school diploma GENDER & FOOD INSECURITY REMINDER Prevalence of chronic conditions among Canadian adults (18-64 years) of age, Mood or anxiety by household food insecurity status and sex, 2007 – 08 disorder Hypertension Heart Disease Women Diabetes mellitus Bowel Disorders Back Problems Men Arthritis Asthma 0 5 10 15 20 25 30 % adults reporting condition 35 40 45 50 Severe food insecurity Moderate food insecurity Marginal food insecurity Food secure Severe food insecurity Moderate food insecurity 3: MAINSTREAMING GENDER (GBA+) WOMEN’S HEALTH MOVEMENT 1970 1971 Time Magazine (2011): “One of the best 100 nonfiction books (in English) since the founding of Time in 1923.” 1973 201 1 https://www.ourbodiesourselves.org/our-story/ Women strived to “take back” their bodies from male-dominated healthcare systems The 17 Sustainable Development Goals address: • • • health & well being for all (Goal 3) gender equality (Goal 5) reduction of inequality within & among countries (Goal 10) (United Nations Development Programme, 2015) Gender, Health & Sustainable Development Goals • Mainstreaming gender requires policies and practices: Examples: Universal health coverage; monitoring of health inequities re: income, gender, age, race, ethnicity, migratory status, disabilities, and where people live. • There is a need to improve coverage of health services by removing barriers… Mager, V. (2015). Gender, health and the Sustainable Development Goals. Bulletin of the World Health Organization 93 (743). https://www.who.int/bulletin/volumes/93/11/15-165027.pdf Mainstreaming Gender Q: How might this impact what we learn as healthcare providers? https://www.theglobeandmail.com/business/technology/science/a rticle-female-health-scientists-face-large-gender-gap-in-access-to -federal/ Mainstreaming Gender REQUIRED MEDIA FILE: https://www.youtube.com/watch?v=WZvNcflKBDs MAINSTREAMING GENDER http://www.cihr-irsc.gc.ca/e/50003.html LANGUAGE MATTERS GENDER IDENTITY – internal awareness of gender GENDER EXPRESSION – social expression of gender https://www.rainbowhealthontario.ca/ TransHealthGuide/intro-terms.html TRANS – incongruence with assigned gender (umbrella term for not Cis) CIS – non-trans NON-BINARY – does not identify exclusively with one gender TWO-SPIRIT – Indigenous term referring to having both a masculine and feminine spirit GENDER NON-CONFORMING – expression of gender that transcends masculine/feminine stereotypes Reminder: Sexuality and– discomfort Gender are concepts! GENDER DYSPHORIA withdifferent the Gender Identity and Gender Expression ● Under the Ontario Human Rights Code, discrimination and harassment because of gender identity or gender expression is against the law. Everyone should be able to have the same opportunities and benefits, and be treated with equal dignity and respect including transgender, transsexual and intersex persons, cross-dressers, and other people whose gender identity or expression is, or is seen to be, different from their birth sex. ● In 2012 “gender identity” and “gender expression” were added as grounds of discrimination in the Ontario Human Rights Code. https://www.ohrc.on.ca/en/ code_grounds/gender_identity TRANS AND GENDER DIVERSE HEALTH CARE https://www.rainbowhealthontario.ca/TransHealthGuide/ Implications of Discrimination & Transphobia Current Transphobic Climate in North America ● 2021 has seen a record number of anti-trans legislation passed in the US targeting trans youth ○ Athletics ○ Criminalization of gender-affirming care for trans kids ○ Texas- Recent directive to Child and Family protective services (ACLU, 2022) ○ Quebec- Bill 2- amendment to province’s family An Inclusive Approach to Care ● Make it a standard practice to ask all patients what name they would like to be called and what pronouns they use ● Refrain from making assumptions about a person’s sexual orientation or gender identity based on appearance ● Uses gender-inclusive language when discussing: ○ Pronouns, names ○ Significant others/partners/family members ○ Body parts ○ Medical terminology (Centre of Excellence for Transgender An Inclusive Approach to Care ● Recognize that patients may not disclose their gender identity and/or sexual orientation for a number of reasons: ○ To prevent experiencing discrimination/structural violence ○ To avoid receiving poor quality care ● Be intentional in promoting inclusive and effective communication: ○ Don’t operate in a ‘don’t ask/don’t tell’ capacity- normalize disclosure as a standard part of care ○ Actively resist informational/institutional forms of erasure to promote disclosure ● Create inclusive forms, documents, educational resources, policies, practices and procedures (Centre of Excellence for Transgender 5: INTERSECTIONALITY Advancing gender equality in ” Canada isn’t just about closing “ gaps between men and women https://www.canadianwomen.org/the-facts/intersectional-feminism/ ” REQUIRED MEDIA FILE: Kimberle Crenshaw. (2016). The Urgency of Intersectionality. Ted Talk. (16 minutes) *see syllabus INTERSECTIONALITY AND HEALTH https://www.utoronto.ca/news/u-t-physician-pushes-paptests-immigrant-women-and-those-living-low-incomeneighbourhoods “A woman living in a high-income neighbourhood in Toronto is about four times more likely to have up-todate screening than a recent immigrant of South Asian descent who is over 50 and doesn't have a general Q: Why do you think this might be? practitioner.” THE INTERSECTIONS: Single Mom https://projects.thespec.io/codered10/ THE INTERSECTIONS: Single Mom + Low Income https://projects.thespec.io/codered10/ THE INTERSECTIONS: Single Mom + Low Income + Core Housing Need https://projects.thespec.io/codered10/ THE INTERSECTIONS: Indigenous Women ALSO CONSIDER… • Gender and location (urban vs. rural/isolated) • Gender and age (youth and older adults) SOURCE Intersectionality, CoVid 19 and Health Care Workers Intersections of Gender (Discussion with Bukola Salami) ● 1.4 million health care workers in Canada (from Canadian Institute of Health Information (excludes PSWs) ● 23% nursing staff immigrants, 90% female (Stats Canada) ● Stated nursing is like cappuccino, white on top, more brown underneath ● Practical nurses more likely immigrants and people of colour ● PhD and management positions, less and less immigrant populations ● PSWs- approx. 80% of COVID stats are in LTC and PSWs provide bulk of care ● About 250,000 PSWs, HC aides, orderlies with 1/3 of them Critical Thinking Question ● What happens if you do not take an intersectional approach when discussing gender in health studies? Systemic Barriers ● Policymaking has a silo nature e.g. health, immigration, education do not collaborate or talk together ● Immigrants fall through the gaps within these systems ● Power Inequities in HC system ● Differences in social locations of those who control resources and workers CRITICAL THINKING QUESTION 2. What kinds of social policies are required to reduce gender-related inequities? Thank you for participating