In recent years, the need to enhance the sensitivity of the health system to women's health issues has gained increasing recognition. Also evident has been the need for more research, particularly on the links between women's health and their social and economic circumstances.
These issues are echoed in the Platform for Action, the document adopted by Canada and 188 other nations at the close of the Fourth United Nations World Conference on Women, in September 1995. These messages were delivered clearly in August 1996 by the 300 participants at the bi-national Forum on Women's Health, which was co-hosted by Health Canada and the U.S. Department of Health and Human Services.
In its final report, the National Forum on Health also observed that the health system must pay more attention to the factors which influence women's health and be more responsive to the distinct needs of women.
In response, I am pleased to release Health Canada's Women's Health Strategy. This document is a framework to guide Health Canada in furthering the work it has already undertaken over the years. As part of the Strategy, I have undertaken to fully integrate gender-based analysis in all of my Department's program and policy development work. Two important pillars of the Strategy - funded by Health Canada - are the Canadian Women's Health Network and the five Centres of Excellence for Women's Health. The Strategy invites collaboration with other federal departments, in accordance with the considerable role that social and economic factors play in determining health.
The 1999 Budget signalled a new era of commitment by the federal government to the long term sustainability of Canada's health system. This Strategy is a significant component of our Government's health agenda and a reflection of our resolve to improve the health status of women in Canada.
Health Canada's mission is to help the people of Canada maintain and improve their health. Throughout their lives - as children, in middle adulthood and as seniors - women face life conditions and health issues specific to their biology and social circumstances. The Women's Health Strategy is designed to identify and address these issues by ensuring that in all of Health Canada's areas of responsibility, women and women's health issues will be given full consideration.
This document sets out Health Canada's Women's Health Strategy and the rationale for it. It reviews some of the ways in which the health system has failed to respond adequately to women's health needs and concerns. It highlights issues surrounding causes of death among women, their illnesses and life conditions, quality of life and the social and economic factors that influence their health. Finally, it outlines a broad range of areas where Departmental actions can address these issues. The document refers to a number of concepts and terms central to understanding Health Canada's current approach, the Strategy itself and the analysis which underpins it. A glossary of the main terms appears on page 35.
Canadians are among the healthiest people in the world and the life expectancy of Canadian women is one of the highest. Nonetheless, our health system has not always understood the factors which influence the health status of women nor has it addressed women's issues concerning research, education, leadership and health interventions. Gender bias has affected women as users of the health system and as paid and unpaid health care providers.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology (para. 89).
U.N. Platform for Action
In recent decades, Health Canada, its agencies and the health system as a whole, have made significant contributions to the advancement of women's health in areas such as breast cancer, tobacco use, substance abuse, HIV/AIDS, and reproductive and genetic technologies, to name but a few. In September 1996, Health Canada revised its regulatory guidelines to require that drug companies also include women in clinical trials, in the same proportion as are expected to use the drug. This will help resolve the problem of findings being generalized to women, based on research conducted only on male subjects. The National Health Research Development Program has cited women's health as a priority. These are but a few examples of Health Canada's dedication to women's health.
While these are important accomplishments, much remains to be done. The Department is conscious of the need to build on recent progress and to further a women's health agenda. Thus, it has identified women's health as a priority and has developed a strategy to begin responding to women's health concerns.
This Women's Health Strategy supports the global recognition that the health system should accord women and men equal "treatment," in every sense of the word, and should strive to attain equitable outcomes for both. Canada affirmed this when it adopted the Platform for Action, the concluding document of the Fourth United Nations World Conference on Women, held in Beijing in 1995.
Prior to the Beijing Conference, the U.N. invited countries to develop national action plans to further advance the status of women. In response, the federal government released its Federal Plan for Gender Equality in August 1995. Chapter 3 of the Plan, "Improving the Health and Well-being of Women," discussed issues pertinent to the health situation of women in Canada and committed to the implementation of a women's health strategy.
The Women's Health Strategy provides a framework for Health Canada to meet the health challenges of today and tomorrow for half of Canada's population. It conforms with the Convention on the Elimination of All Forms of Discrimination Against Women; and with the principlesof the Beijing Platform and the Federal Plan: all aspects of women's lives - their health, social conditions, economic and legal status - interact and influence their well-being. While the Strategy focuses primarily on the health system, Health Canada will work with other departments to promote a holistic, multi-sectoral approach to health and social policy development.
State parties shall take all appropriate measures to eliminate the discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health services, including those related to family planning.
Article 12, Convention on the Elimination of All Forms of Discrimination Against Women
The Strategy takes up an important challenge advanced in the Platform and the Federal Plan: it promises that Health Canada will integrate gender into all its programs and policies by conducting gender-based analysis (see Glossary).
The overarching goal of the Women's Health Strategy is to improve the health of women in Canada by making the health system more responsive to women and women's health. Four objectives will support this goal:
* See Glossary for definitions of "sex" and "gender" differences. Recognizing the distinct needs and concerns of women and coming to terms with the biases of the health system requires understanding the two dimensions that distinguish women and men: biology and social attributes.
Health Canada's mission is to help Canadians maintain and improve their health by providing leadership, developing policy, conducting or supporting internal and external research, collecting data, undertaking surveillance, acting as a regulatory body, promoting health, preventing disease and providing and funding direct services to First Nations and Inuit. These mandated areas of responsibility are the avenues for implementing the Women's Health Strategy.
The Strategy will be implemented within the context of Health Canada's approach to policy and program development - a population health approach (see Glossary). This approach concerns itself with the entire population or large sub-groups and rests on a body of research demonstrating that a combination of personal, social and economic factors, in addition to health services, plays an important role in achieving and maintaining health.
As part of the population health framework, Health Canada's programs and policies consider three life stages: childhood and adolescence, early to mid-adulthood and later life. Sex and gender considerations will be integrated within each of these life stages. For example, Health Canada's contribution to the National Children's Agenda and to programs for seniors will be informed by these considerations.
The Women's Health Bureau will coordinate the Strategy within Health Canada. It will monitor current and emerging issues and ensure that the Strategy remains relevant over the years. The Bureau will play an especially active role in fulfilling Objective 1 of the Strategy, as part of its mandate to ensure that gender considerations are addressed in all departmental programs and policies. It will initiate projects to enhance its policy development and monitoring function and help Health Canada move closer to achieving gender equality in all its work.
The Bureau supports five Centres of Excellence for Women's Health as well as the Canadian Women's Health Network. The policy development work of the Bureau is being informed by new knowledge generated by the Centres and by other research and health information sources, as outlined in Objective 2 of the Strategy. The Bureau will work with all program and policy sections of the Department to advance measures that will fulfil Objectives 3 and 4.
Women are not a homogeneous group. Disability, race, ethnocultural background and sexual orientation have varying influences on women's health and on their interactions with the health system. The Strategy will be sensitive to these issues of diversity. For example, several of the five federally funded Centres of Excellence for Women's Health are focusing on health issues of concern to immigrant and refugee women, Aboriginal women, women on low incomes and rural women.
Health care systems all across Canada have been undergoing significant reform and restructuring. As documented in the Final Report of the National Forum on Health, while the pattern and pace of change varies, health reform in general is motivated by a mix of fiscal pressure to contain health spending and awareness that the system is in need of significant modernization. Many features characterize our rapidly changing health care environment: reduced dependence on large health care institutions, the devolution of decision making to new regional and community structures, shorter hospital stays and greater reliance on care in the home, alternatives to fee-for-service as methods of compensating physicians, the advent of new classes of health care providers (e.g., midwives and nurse practitioners), increased emphasis on preventive measures, and the drive for efficiency - be it at the clinical or broad health system level.
In infancy and childhood, girls use fewer health services than boys. But once beyond childhood, Canadian women make greater use of a wide array of health services. Changes in our health care system will, therefore, have a significant impact on women. Reform and modernization of the health system will be positive if it means that fewer women will be subjected to unnecessary or ineffective interventions or drugs, that they will have access to better preventive medicine, to midwives and to quality care in their own home. But, if women find that access to important services is limited, or that the net effect of an increased reliance on home care simply means that women assume the greater burden of family caregiving for long-term rehabilitation or chronically ill family members, then the impact of health reform will be less positive.
Rapid changes in electronic technology are influencing the health system at many levels. The development and linking of data banks containing personal health information, the provision of treatment via tele-medicine and the reliance on the Internet for health information are significant trends. These have different implications for women and men, who neither view nor utilize health information similarly nor have equal access to it. As we enter this new world of health information technology, we must ensure that women and men benefit equally.
Other important changes on the health landscape include increasing consumer attention to, and use of complementary and alternative health practices and therapies, changing demographics marked by an aging and increasingly pluralistic society, and the globalization of trade with its effect on the health sector. All these societal changes, when viewed through a gender lens, reveal different pictures for women and for men.
Only recently have health policy makers and health service providers acknowledged in a tangible way the extent to which social, economic and cultural factors influence health. Similarly, our health system has been slow to recognize that sex and gender are other significant determinants of health. For many years, a burgeoning women's health movement called attention to biases in the health system. At first, the sense that the system was failing women was intuitive and personal. Over time, awareness grew that shortfalls in the system were more pervasive and required a comprehensive response - including changes in attitude and practice.
The Women's Health Strategy has been developed to :
The Women's Health Strategy underscores the recognition that in questions of health, it matters whether you are a woman or a man. Drawing on some commonly accepted examples, these differences are discussed below, in areas such as: patterns of illness, disease and mortality; the way women and men experience illness; their interactions with the health system; the effects of risk factors on women's and men's well-being and the social, cultural, economic and personal determinants of health, which are significantly affected by gender differences. Shedding more light on these issues and seeking gender-appropriate measures to respond are prime reasons for the Women's Health Strategy.
Women outlive men by six yearsFootnote 1 and the death rate is higher among men than women in all age groups, especially between the ages of 20 and 44, where their likelihood of dying is more than twice that of women.Footnote 2 These differences are mostly attributable to men dying from "external" causes, especially motor vehicle accidents and suicide.
However, there is a reversal in these statistics when it comes to cancer deaths in the age group 20-44: women in the prime of life are dying in greater numbers than men. In projections of cancer-related deaths for 1998, women in the age group 30-39, for instance, have a death rate that is one and a half times that of men. In the age group 40-49, their death rate attributable to cancer is one third higher.Footnote 3 These deaths are primarily due to breast cancer, the causes of which are still largely unknown.
As well, women continue to die from largely preventable conditions such as cervical cancer. Unprecedented numbers are now dying from lung cancer, another preventable disease. In 1994, for the first time, lung cancer surpassed breast cancer as the leading cancer killer of women.Footnote 4 While the incidence of breast cancer is lower among black women, they tend to die from the disease in greater numbers than white women, pointing to the need for attention to diversity.
Mortality is not the only significant health indicator when considering differences between women and men. Despite women's life expectancy of nearly 81 years,Footnote 5 their later life is often characterized by isolation, disability and health problems.
Although living 6.3 years longer than men, women only enjoy 1.5 more disability-free years of life (p. 27).
Report on the Health of Canadians, September 1996
At greater risk are women with low levels of education, low income, and low control over their work environment. These women are more likely to smoke and to be both sedentary and obese. As well, visible minority women are also more at risk, notably South-Asian and Black women.
Women, Heart Disease and Stroke in Canada, Heart and Stroke Foundation of Canada, 1997
The health sector has paid a great deal of attention to the reproductive system of women, and particularly to maternal health concerns. Important successes have been achieved in this area. However, illnesses common to both women and men have not always been understood in terms of their sex and gender-based differences and, therefore, have not been appropriately addressed by the health system.
Diseases of the heart are such an example. Prevention, diagnosis and treatment must reflect an understanding that the symptoms, the course of the illness, the effect of medications and the suitability of certain surgical procedures are different for women and men. As well, historically, in the area of heart research on new medications, women were rarely included as subjects. Cardiovascular disease (heart disease and strokes) is the major cause of death and one of the major causes of disability among women. Women themselves, when asked what illness puts them at greatest risk of death, will usually identify breast cancer,Footnote 6 without realizing that cardiovascular disease carries greater risks. This has implications for health promotion efforts.
In most age groups, women suffer more than men from chronic conditions, particularly migraines, allergies, arthritis and rheumatism. Younger women report more back and limb problems than young men.Footnote 7 Training, program development and health promotion activities must be sensitive to these differences.
One of the areas of greatest difference between women and men is their respective profiles of mental health disorders. Study after study has reported higher levels of depression among women.Footnote 8,Footnote 9 Young women, in particular, are more apt to have a low self-image.Footnote 10 The rate of psychiatric hospitalization is consistently higher for women.Footnote 11 While men commit suicide more frequently,Footnote 12 women attempt suicide more often but are more likely to fail in their attempts.Footnote 13 All of these observations point to gender-based differences in the way in which women and men experience and cope with stress and life events, and how they signal their distress. Recent findings on the links between stress and decreased efficiency of the immune system add further impetus to the need to address stress in the lives of both women and men, with an appreciation for gender differences.Footnote 14
In accord with previous studies, the NPHS revealed a higher prevalence of depression in women than men: (7.4 versus 3.7% for men in cycle 1(1994) and 5.5% versus 2.8% in cycle 2 (1996). Women were also more likely to experience recurring depressive episodes: nearly three out of four people (72%)...in both 1994/95 and 1996/97 were women.
National Population Health Survey Overview, Statistics Canada
Observations of mental health differences have specific implications for diagnosis and treatment. Many psychological assessment methods, including history taking, have not been constructed to fairly capture and adjust for gender differences and they often apply to women certain norms and definitions of mental health based on male standards.Footnote 15 For example, women are inevitably labelled more anxious and tense than men. The point of reference becomes important in defining what is, and what is not, pathological, and the implications for diagnosis and treatment.
Sexual and reproductive health issues are numerous and differ among women and men. While women with HIV and AIDS can experience many symptoms similar to men's, they are often faced with difficult decisions related to pregnancy and the possibility of mother-to-fetus transmission.
Although not a disease, menopause brings many physiological changes for women and places women at risk of developing cardiovascular disease or osteoporosis. These risks may be influenced by hereditary background but may also be modified by diet, smoking, daily activities and environmental factors, therefore pointing to the need for a comprehensive health strategy for these women.
The Women's Health Strategy recognizes that illness and the threat of death are not the only health-related concerns of women. Quality of life issues are important to them and can predispose them to ill health. A 1992 study by Vivienne WaltersFootnote 16 revealed that 68% of women surveyed said that tiredness was their major complaint. Feeling under stress and experiencing disturbed sleep were other related complaints.
In their adult years, many women carry a double workload. Traditionally, they have been the family members primarily responsible for maintaining the home and caring for children and ill or elderly family members. When they joined the paid labour force, they continued these domestic duties along with employment outside the home. As a result, in the 20-44 age group, the work stress index of women is much higher than that of men.Footnote 17
The media are an influential force in the socialization of women and men. They help create unrealistic expectations about weight and appearance and subtly encourage women to attach undue importance to these. Women and men respond differently to these pressures. Women, especially young women, tend to be more negatively affected by these messages, as evidenced by widespread preoccupation with weight loss,Footnote 18 and more seriously still, by rising rates of anorexia and bulimia.Footnote 19
Natural reproductive processes such as menses, pregnancy, childbirth and menopause may cause pain and discomfort and interfere with life events. When coupled with other sources of stress, they can bring about physical and mental distress unique to women. For many years, women's advocates have stated that women and their health concerns are too often over-medicalized (i.e., over-medicated and their conditions treated as pathological) because the health sector has difficulty distinguishing between natural processes and sickness.
Health risks for women and men derive from a number of factors including active high-risk behaviour, passive behaviour that precludes or undermines health, family history and social and physical environments.
Suicides, motor vehicle accidents and other types of accidents account for more sick days away from work and cause more deaths for men than for women.Footnote 20,Footnote 21 However, women and men do take risks of other kinds such as having unprotected sex which can result in STDs or unwanted pregnancies, or using drugs intravenously.
The reasons behind risk taking and the results which ensue vary according to gender. In regard to sexual behaviour, for instance, popular notions assume sexual assertiveness among males and relative passivity among females. Women are generally regarded as responsible for contraception but may sometimes face barriers in negotiating safer sex with a male partner. This is a factor of relevance, for example, in understanding the transmission of HIV in women. In light of recent statistics indicating that the rate of HIV among women who are tested is increasing,Footnote 22 we must improve our knowledge of the dynamics of women's high-risk behaviours. These behaviours are sometimes gender-specific and are changing as women's social roles and status in society evolve.
The teen pregnancy rate peaked in 1974, declined in the mid-eighties but is creeping up again particularly in the under age 15 group, where it has gone from 3.9 per 1,000 in 1987 to 5.1 in 1993 (p. 18).
Reproductive Health: Pregnancies and Rates, Canada 1974-93, Table 14B, Statistics Canada, 1996
As well, women face different risks due to factors tied to their biological and social characteristics: for instance, the prevalence of osteoporosis among older women, coupled with the loss of agility and balance, result in a high number of fractures in women, often leading to severe disability or death.
Gender-based violence is another risk factor that women face, and has wide-ranging consequences for their health and the health system. A 1993 Statistics Canada study revealed that half of Canadian women are victims of physical or sexual assault as defined by the Criminal Code at least once beyond age 16, and are most at risk from their male partners. Dating violence, violence or sexual harassment in the workplace and by professionals in the health system and sexual assault have all been documented in recent studies, as has the enormous cost of violence to the health system.Footnote 23
9% of females and 6% of males aged 12-14 are beginning smokers.
1996/97 NPHS Highlights, Smoking Behaviour of Canadians, Health Canada
One of the most tragic forms of high-risk behaviour for women is cigarette smoking, as evidenced in current statistics on lung cancer mortality rates for women. The rate at which adolescent girls are taking up smoking is particularly alarming.Footnote 24 This wave of new smokers bodes poorly for the health of tomorrow's women. It implies that greater knowledge and effort are required to successfully reach teens of both sexes. A better understanding of gender-based differences and effective interventions are critical to the success of these efforts.
The circumstances of some women's lives reduce their access or motivation to take preventive measures to safeguard their health. Invasive cervical cancer is commonly found in those women who have never been screened or who are not screened regularly. The 1996/97 National Population Health Survey reports that Pap smear rates varied by socioeconomic status. Lifetime rates for women aged 18 and older ranged from 75% of those in the lowest household income group to 90% for those in the highest. Aboriginal women are over-represented in cervical cancer statistics and are a group for which special measures must be taken to improve use of known preventive measures.
Physical inactivity is also a problem. Women of all ages do not engage sufficiently in physical activity, despite its many positive effects on health. The health system must learn how to encourage healthy behaviours in women by developing approaches that take into account their values, lifestyles and roles.
Environmental and occupational risks are increasingly significant for women. Their occupations tend to expose them to lengthy periods of inactivity, especially in a sitting position, and to repetitive strain injury. As well, women may react differently than men to environmental contaminants. Current concern about the relationship of environmental toxins to breast cancer is an example.
Health Canada and the provincial and territorial governments have committed to a health determinants approach. This approach recognizes that many factors in addition to health care determine the health status of an individual.
The 12 health determinants which Health Canada has identified are:
In 1996, children in female lone-parent families were five times more likely to be in a low-income situation than those in two-parent families (60.8% of female lone-parent families had low income versus 11.8% for two-parent families). Statistics Canada, 1997
These determinants are highly interactive. Income, employment and education, for instance, are inter-related and have implications for other determinants such as environments, child development and personal health practices.
Gender has a strong influence on all determinants. For example, wage gaps, low occupational status and poverty are common observations in any analysis of women's socio-economic status.
The lives of women seniors are more likely to be marked by poverty as a result of interruptions or non-participation in the paid labour force, or of low wages and few benefits.Footnote 25
Medicare provides universal access to physicians and hospital services. However, because women, as a group, are less likely to be employed full-time, they are less likely to have access to uninsured services such as drugs.
In 1993, the majority (56%) of senior women living alone or with unrelated persons, had low incomes. This compared with 38% of unattached senior men (p. 85). Women in Canada, Third Edition, Statistics Canada, 1996
The health system, not unlike society at large, tends to type-cast women and men based on longstanding traditional roles and attitudes. This has affected women both as users of the health care system and as caregivers, and has occurred in four ways:
43% of Canadian women have changed doctors because they were dissatisfied with the way they were being treated. Four of the six most frequent reasons were related to the "doctor's attitude". Women's College Hospital Health Survey, March 1995
The Women's Health Strategy will seek to address these biases and inequities by encouraging a focus beyond maternity; by promoting greater participation of women in decision making; by shedding more light on the biological and social differences that explain when and why women and men ought not to be treated similarly, and proposing improvements; and by encouraging more comparable or similar treatment when warranted.
It should be noted that both women and men can be negatively affected by the health system. The implementation of the Women's Health Strategy does not minimize the difficulties that men may experience, or negate the fact that they too have health concerns specific to their biological and social circumstances.
The next section of the document highlights the main components of the Women's Health Strategy. The Strategy, in its totality, responds to health status issues that most critically affect women, to the limited role of women in decision making and to research and education gaps. It proposes processes and methodologies for ensuring that these areas become sensitive to the sex- and gender-specific needs of women.
The Women's Health Strategy is an integrated framework for addressing major women's health issues. It consolidates Health Canada's current and new initiatives. The Strategy has seven main attributes: it is balanced, respectful of diversity, egalitarian, evidence-based, coherent, multi-sectoral and incremental.
The goal of the Women's Health Strategy is to improve the health of women in Canada by enhancing the responsiveness of the health system to women and women's health.
To meet its goal, the Strategy is organized around four main objectives which are intended to bring about changes to the way Health Canada discharges its major responsibilities: its leadership, networking and coordination roles; policy development; research, surveillance and data collection activities; regulatory functions; direct service delivery; and its work to promote health and prevent disease.
Balance will be respected in that the Strategy will focus on all age groups; on bio-medical and social aspects of health; on policy and program elements; on individual and population health issues; and on women as users of health care as well as caregivers, paid and unpaid.
Diversity among women and the fact that they are not a homogeneous group is recognized. Health Canada is sensitive to ethnocultural heritage, sexual orientation, level of ability and demographic characteristics that alter women's experience of health and their interactions with the health system.
The Strategy is premised on an egalitarian relationship between the user and the provider of services and recognizes women and men as equal partners in the development of policy, research and services.
The Strategy will be evidence-based, informed by concerns identified by women and the health system and by data and research findings which shed light on the differences between women's and men's health concerns.
Strategies developed for women and analysis of issues in one area must connect with strategies and analysis in others; each can benefit from the other, thus ensuring that the Strategy is coherent.
The Strategy will be multi-sectoral, recognizing that social and economic factors play an important part in securing and maintaining health and that the involvement of partners from many areas in both the governmental and non-governmental sectors is essential.
Finally, the Strategy will be incremental. It will adapt to emerging issues and new knowledge.
The Strategy is primarily focused on Health Canada's policies and programs and on pursuing activities within Canada. However, Health Canada will, from time to time, work in partnership with other countries and international organizations, on matters of common interest that advance the women's health agenda at home and globally.
The following pages set out the four objectives of the Strategy and identify some of the key activities that will be undertaken to fulfil them.
The federal government is committed ... to ensuring that all future legislation and policies include, where appropriate, an analysis of the potential for different impacts on women and men (p. 17). Setting the Stage for the Next Century: The Federal Plan for Gender Equality, 1995
Once attained, Objective 1 would result in the Department having fully integrated gender into its day-to-day operations. It represents Health Canada's commitment to doing business in a way that is sensitive to women's health needs and concerns. To support this process, a number of steps will be taken:
The Women's Health Strategy will be evidence-based. Health Canada plays a significant role in the collection and analysis of data and the support of a number of research programs and activities. The Strategy will make this research more relevant to women's health concerns. Findings will be widely shared, in simple and straightforward language. Objective 2 will be supported by the following:
Health Canada has a role to play in supporting groups and jurisdictions that have direct responsibility for the delivery of health services. The Department is responsible for interpreting and enforcing the Canada Health Act whose principles constitute the framework for Canada's publicly financed health care system. In addition to strengthening knowledge, as outlined in Objective 2, the federal government provides leadership and support for the development of public awareness, health practices and educational aids. It also delivers or funds health services for First Nations and Inuit. The Women's Health Strategy will encourage and promote a wide range of activities in these areas:
Health Canada has a responsibility to reach individuals before they adopt health-threatening lifestyles and to assist them in avoiding high-risk situations, behaviours and products that lead to health conditions or disease. To fulfil this Objective, Health Canada's Women's Health Strategy has identified a number of measures:
The development of Health Canada's Strategy for Women's Health was guided by statistical data, issues identified and documented in the literature as well as in briefs presented by women's and health organizations. The initiative will continue to be refined and further developed on the basis of the recommendations emanating from the workshops of the Canada-U.S.A. Women's Health Forum, from emerging trends and new knowledge and from consultations which are organized from time to time by Health Canada.
In June 2000, the United Nations General Assembly will hold a special session on Women's Equality, to review progress by member states in the implementation of the 1995 Beijing Platform for Action. The purpose of the meeting is also to propose a vision for the years to come. Health Canada's strategy for advancing women's health will contribute to Canada's vision.
Statistics Canada, Catalogue no.91-209-XPE, Report on the Demographic Situation in Canada 1997: Current Demographic Analysis, June 1998
Kathryn Wilkins, "Causes of Death", Canadian Social Trends, Statistics Canada, Summer 1996.
National Cancer Institute of Canada and Statistics Canada, Catalogue no. 82F000088-XPE, Canadian Cancer Statistics, 1998, Table 10.
Ibid; p. 65.
Statistics Canada, Catalogue no.91-209-XPE, loc. cit., p. 77.
Vivienne Walters, Rhonda Lenton, and Marie Mckeary, Women's Health in the Context of Women's Lives, Health Canada, 1995, p. 5.
Health Canada, Report on the Health of Canadians: Technical Appendix, p. 297. (Source: Statistics Canada, National Population Health Survey, 1994-95).
Karen Pugliese, "Women and Mental Health: Two Traditions of Feminist Research". Women and Health, Vol. 19, Nos. 2/3, 1992, p. 44.
Statistics Canada data indicate that in all age groups, the prevalence of depression is higher for girls and women than for boys and men. (Source: National Population Health Survey, Statistics Canada Website: http://www.statcan.ca).
Canadian Advisory Council on the Status of Women, We're Here, Listen to Us! A Survey of Young Women in Canada, March 1992, pp. 14,15 and 89.
Health Canada, Report on the Health of Canadians Technical Appendix, loc. cit., p. 294 (based on Health Indicators, Statistics Canada, 1994).
Health Canada, Report on the Health of Canadians, Technical Appendix, loc. cit., p. 327.
Health Canada, Working Together for Women's Health, A Framework for Women's Mental Health, 1993, p. 30.
M. Irwin,"Stress-Induced Immune Suppression. Role of the Autonomic Nervous System", Annals of New York Academy of Science, 697: 203-18, 1993.
I. Broverman, D. Broverman, P. Clarkson, P. Rosinkrantz, and S. Vogel, "Sex-Role Stereotypes and Clinical Judgments of Mental Health", Journal of Consulting and Clinical Psychology, 34, 1970, pp. 1-7 (as cited in Anne Oakley, Essays on Women, Medicine and Health, Edinburgh University Press, 1993, p. 25).
Vivienne Walters et al., Women's Health in the Context of Women's Lives, loc. cit., p. 5.
Health Canada, Report on the Health of Canadians. Technical Appendix, loc. cit., p. 316 (Source: National Population Health Survey, 1994-95).
The National Population Health Survey 1994-95 states that among 12-14 year-olds, 27% of girls and 14% of boys reported trying to lose weight.
According to the National Eating Disorder Information Centre (1995), in Canada, 80-90% of women experience body image dissatisfaction and 66% have "experimented" with bulimia. It is particularly disturbing to note that more than one half of 4th grade girls consider themselves to be overweight and that many are dieting (9 year-olds: 50%; 10 year-olds: 80%), UNB Faculty of Nursing, February 4, 1996.
Kathryn Wilkins, loc. cit., p. 15.
Karen Messing, Women's Occupational Health: A Critical Review and Discussion of Current Issues, Paper commissioned for the Canada-U.S.A. Women's Health Forum, August 1996, p. 7, para. 34.
HIV and AIDS in Canada, Surveillance Report to June 30, 1998, LCDC, November 1998, p. 1.
D. Kinnon and L. Hanvey, Health Aspects of Violence Against Women, Paper commissioned for the Canada-U.S.A. Women's Health Forum, August 1996.
Health Canada, 1994, Youth Smoking Survey, 1996, Factsheet #1, p. 1.
Statistics Canada, Women In Canada, A Statistical Report. Third Edition, 1995, p. 84.
UNICEF, The Progress of Nations, 1996, pp. 8, 9.
OECD, OECD Health System: Fact and Trends, 1993.
Health Canada, What Women are Saying: Women's Health Issues in Canada. Summary of Findings of Focus Groups with Canadian Women on Women's Health Issues, 1996.
Jennie Popay et al., "Gender Inequalities in Health: Social Position, Affective Disorders and Minor Physical Morbidity", Social Science and Medicine, vol. 36, No. 1, 1993, p. 31.
Robert G. Evans, Morris L. Barer and Theodore R. Marmor, Why Are Some People Healthy and Others Not?, Aldine de Gruyter, New York, 1994, p. 322