ADVANCING PRIMARY CARE: MODELS OF WOMAN-CENTRED CARE IN CANADA

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

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Context

• Women are the major users and providers of care
• Contribution of the Womens Health Movement
• Women are a focus of public health campaigns
  prenatal care, screening
• There is opportunity in change

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• Womens Movement and the Womens Health Movement
  
• redefining health and relationship with health
  care providers
• Redefining health and health issues

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Context
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Context

• Many examples womens health collectives,
  programs, research and analysis
• Commitment to gender based analysis at the
  international, national and regional levels

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Examples

• A Framework for
• Women Centred Health
• Vancouver / Richmond Health Board June 2001
• www.vcn.bc.ca/vrhb/
• Women's_Health20Plan.htm

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Consists of 12 elements

• The need for respect and safety
• The importance of empowering women
• Involvement and participation of women
• Collaborative and inclusive work environments

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Consists of 12 elements

• Womens patterns or preferences in obtaining
  health care
• Womens forms of communication and interaction
• The need for information
• Womens decision-making processes

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Consists of 12 elements

• A gender-inclusive approach to data
• Gendered research and evaluation
• Gender-sensitive training
• Social justice concerns addressed

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• In application
• Many examples of programs and service
• Example of Womens Health Clinic here in Winnipeg

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• 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.

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Approach

• Woman-Centered Services
• Develop A Partnership Between The Woman And Care
  Provider
• Priority Populations and programs
• Recognition of inequities in power status
  class, racism

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Healthy Public Policy
Counseling

• Research- Prairie Center
• Policy Analysis Development
• Networks/Public Meetings
• Women, Income and Health
• Women Health Reform
• New Reproductive Genetic Technological Network

Information

• e.g. disordered eating and weight preoccupation
  
• Past abuse
• Stress and self care issues
• Teen program

• e.g. Resource Centre
• Info Packages
• information requests
• Info Sheets/Kits
• Newsletter
• Phone Triage

Circle of Services
Empowerment

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

Liaison/Collaboration with other services and
sectors
Support Groups
Input to WHC Programs
Outreach Professional and Community
Self Help Groups
Multiple points of entry

• Client Surveys, Program Evaluations
• Membership in Womens Health Clinic
• Participation on Committees and Board
• Advisory Committee
• Volunteering

• Mothers
• weight/body image
• Catching Our Breath tobacco and women
• Endometriosis
• Breast implants

• Motherhood Stress
• Weight Preoccupation
• Growing Older, Healthy Aging
• Menopause, Tobacco and women
• Well women care

Women encouraged to access information services
Most appropriate care provide and service
System Change

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

Peer Programs
Professional Consultation/Counseling
Medical Care

• volunteer based
• Birth Control/Unplanned Pregnancy Program
• Teen Clinic
• Community Education Program
• schools, community

• Nurse practitioners
• MDs- on salary
• Midwives
• Dietitian
• Health Educators
• Counseling

• Reproductive Health program
• Birth Control Unplanned Pregnancy
• Pregnancy and Birth- including Home
• 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
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Approach

• Health Promotion, Prevention And Healthy Public
  Policy strategies
• Women only staff and space
• Most Appropriate Caregiver And Services
• access through a variety of avenues and routes
  of entry
• education, support through groups or individual
  counseling, medical treatments, health screening,
  advocacy, community action.

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Approach

• Empowerment
• enhance the understanding, self-care, self-help
  and self-advocacy abilities of women
• Structure of the Clinic
• participatory management
• Board and advisory committees
• Client feedback

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Approach

• Use Of Peer Volunteers
• modeling self-help skills, demystifying medical
  information
• Community Involvement
• - Networks, coalitions
• Innovative Programs
• new understandings of womens needs and issues

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• Staffing over 40
• Physicians on salary , medical assists
• Nurse practitioners, dietician
• Health educators, advocacy coordinator
• Counsellors
• Midwives
• Unpaid staff - community education and BCUP

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Healthy Public Policy

• Advocacy for System Change
• Why is this important for women?
• Socio-economic status and other structural
  factors (ie. family structure, age and social
  support) are more important to womens 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,

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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

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Healthy Public Policy

• Women, Income and Health
• Research and outreach project . Goals
• improved health service
• Policies the reduce poverty
• Knowledgeable public

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Moving Forward

• Primary Care Renewal and Women
• Inform Indicators and Core Services discussion
• Gender Based Analysis
• Implementation of Models of Women Centred Care

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1. Primary Care Renewal and Women Core Services

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

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Primary Care Renewal and Women Core Services

• Conditions which appear to be sex-neutral, but
  not are not.
• heart disease, tobacco, addictions
• Effects of womens 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

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Primary Care Renewal and Women Core Services

• 4

• cont
• Effect of caregiving on their own health
• women have lower average incomes than men and
  lower incomes are associated with poorer health
• womens paid work and their working conditions
  influence their health.

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Primary Care Renewal and Women Core Services

• Gender stereotypes within the health care system
  negatively affect womens health.
• These include both stereotypes
• - about womens use of care and
• - about womens 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 womens predisposition to seek
  help.

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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.

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Primary Care Renewal and Women Core Services

• Over-medicalization of normal aspects of womens
  lives including pregnancy, stress, childbirth and
  menopause.
• Pills for prevention

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Moving Forward

• 2. What is Gender Based Analysis
• What is Gender?

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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

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Resources for Gender Based Analysis

• Exploring Concepts of Gender and Health, Health
  Canada
• Places to Start
• handout from
• A Framework for Women-Centred Health
• Vancouver Costal Health Authority

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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.

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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

• CD of resources
• Primary Health Care and Women listservinforming
  policy development
• Ongoing dialogue
• Canadian Womens 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 Womens Health and
  national Working Groups
• Others Ontario Womens Health Council, Health
  Canada, WHC, Womens Health in Womens Hands, FGM
  manual
• Note Documents are on the disc- to search web
  sites you must be on line.

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• Thank you to the Womens Health Contribution
  program , Womens Health Bureau, Health Canada ,
  Canadian Womens Health Network and the Womens
  Health Clinic for support of this presentation