Environmental Scan

Environmental Scan: Evolution of Women’s Health Indicator Use in Canada
 
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Gaps in Canada’s ability to report on women’s health began to receive attention in the mid 1990s. In 1998, the Laboratory Centre for Disease Control at Health Canada noted a lack of data concerning women as a gap in their surveillance.  In response, Health Canada assembled an Advisory Committee on Women’s Health Surveillance to oversee the development of women’s health surveillance in Canada. The recommendations of that committee included integration of sex- and gender-based analysis, expanded capacity for surveillance, and assessment of gaps [1]. The committee was informed by the efforts of women’s health researchers working at the national, provincial, and local levels and their recommendations have helped to point the way for future efforts.

Efforts to improve women’s health surveillance have generally focused on specific areas of interest, including perinatal health, mental health, Aboriginal women’s health, qualitative versus quantitative indicators, and indicator frameworks. This Environmental Scan details each of these areas, beginning with an examination of the report from the Advisory Committee on Women’s Health Surveillance. It then chronologically reviews initiatives and reports on women’s health surveillance and indicators in Canada. Key international projects are also described, because efforts in Canada have been influenced by and have contributed to international initiatives.

To summarize our analysis, tremendous work has been done to improve women’s health surveillance, particularly on specific topics, however significant challenges remain. One paramount challenge is the development of a core set of women’s health indicators, which is needed to form the basis for a comprehensive women’s health surveillance system. This core set will need to be flexible so that it can be applied appropriately at each level of government from local to regional to federal.

This Environmental Scan is presented in chronological order. Throughout the Environmental Scan, links to relevant reports and organizations are included when available. These can also be accessed from the Key Resources tab. Though this review aims to be comprehensive, it may not be exhaustive. Much of the data for this review was drawn from Environmental Scan of Gender and Diversity Sensitive Women’s Health Indicators Initiatives 2000 to 2006, which was a report written by Lissa Donner for Health Canada.

1999

Title: Women’s Health Surveillance: A Plan of Action for Health Canada (1999)
Author: The Advisory Committee on Women’s Health Surveillance
Agency: Health Canada
Coverage: National

The Advisory Committee on Women’s Health was convened in order to identify key issues for women’s health surveillance and to recommend how a national surveillance system might be developed. To do so, the Committee conducted national consultations with experts, researchers, and frontline workers. The findings of the Advisory Committee on Women’s Health Surveillance set the national precedent for focusing on women’s health surveillance, described how such a system could be structured, and detailed priorities for the future. It pointed out that women and men are both biologically different (a sex-based distinction), but also subject to different social contexts that affect their health (a gender-based distinction). The report noted that it is therefore inappropriate to assume that studies on men can be generalized to women, or vice versa, and surveillance systems must be designed to account for the differences between men and women.

The Committee made nine recommendations for the development of effective surveillance of women’s health, which included the inclusion of sex- and gender-based analysis in existing surveillance systems; expansion of surveillance systems to cover musculoskeletal disorders, mental health, and the impact of violence on women’s health; increased reporting on higher risk populations such as First Nations women; a new organizational structure responsible for women’s health surveillance; and the creation of an ongoing priority-setting mechanism for women’s health surveillance. These recommendations established a context in which the development of women’s health surveillance has occurred through the efforts of provincial and national women’s health organizations.

2000

Title: Canadian Perinatal Health Report, 2000
Author: Health Canada
Coverage: National

In 1995, prior to identifying a gap in overall women’s health surveillance, the Laboratory Centre for Disease Control at Health Canada identified gaps in surveillance specifically concerning perinatal health. Based on that recommendation, the Canadian Perinatal Surveillance System (CPSS) was formed in 1995 with the goal of creating a national perinatal surveillance system. The resulting system aims to promote the health of pregnant women, mothers, and infants by identifying health disparities, working to improve health outcomes, and providing a basis for international comparison [2]. CPSS identified 52 indicators of perinatal health, only 24 of which could be included in its first report, Canadian Perinatal Health Report, 2000, due to gaps in data coverage [3]. CPSS is the first national surveillance system to systematically gather data on critical indicators of women’s reproductive health, which partially explains why the evidence base concerning perinatal health in Canada is considered very strong.  New editions of the Canadian Perinatal Health Report were published in 2003 and 2008.

In addition to standard mortality and morbidity-related indicators of reproductive health, CPSS also monitors a broad range of the social determinants of health [3]. This capacity has improved the understanding of Canadian women’s health and health behaviours leading up to, during and after pregnancy [4]. As these behaviours are highly affected by sex, gender, and diversity, CPSS has provided for some degree of gender-sensitive reporting and data collection within the focused area of perinatal health.

Title: Women’s Health in Atlantic Canada: A Statistical Portrait (2000)
Author: Ronald Colman, GPI Atlantic
Agency: Maritime Centre of Excellence for Women’s Health (now the Atlantic Centre of Excellence for Women’s Health) and the Atlantic Region Policy Forum on Women’s Health and Well Being 
Coverage: Provincial – Atlantic Provinces

Women’s Health in Atlantic Canada adopted a determinants-of-health approach, which includes broadening the concept of health to include health-influencing factors such as socio-economic status and physical environment. Women’s Health in Atlantic Canada applied an SGBA in order to illustrate the value of including gender as a determinant of health. The areas of women’s health selected for illustration in this report included: mental health and psychological well-being; educational attainment and literacy; income distribution and poverty; work and employment; personal lifestyle; preventive health services and social supports. The report illustrated how gender-sensitive surveillance, which takes sex, gender, and diversity into account, goes hand-in-hand with the determinants-of-health approach advocated by Toward a Healthy Future.

This landmark report displayed the insights that can be gained from examining sex-disaggregated data, such as different health patterns and outcomes for men and women in terms of teenage smoking, activity limitations among seniors, and physical activity trends.  It also focused attention on the determinants of health – such as education, social support, and the gender wage gap – a focus that has been mirrored in later reporting on women’s health.

2001

Title: Provincial Profile of Women’s Health: Updated Data on Selected Indicators for Women’s Health in British Columbia (no longer available online)
Author: Women’s Health Bureau, British Columbia Ministry of Health
Coverage: Provincial – British Columbia

Over time, national initiatives to improve data and surveillance on women’s health have been complemented by reports at a provincial level. In the case of the Provincial Profile of Women’s Health, data from health service utilization, the Census of Canada, the regional health authorities and the British Columbia government were disaggregated by sex. The report was commissioned by the Women’s Health Bureau of BC and established a sex-disaggregated baseline against which future women’s health surveillance data could be compared.

A special section of the report was dedicated to the health of First Nations women in BC, which brought attention to their overall poor health status and the need to improve First Nations health and well-being. It also highlighted the need to disaggregate and examine data not just according to sex and gender, but along diversity lines as well. These three interwoven characteristics are critical factors in the health of Canadians and should be monitored accordingly. 

2002

Title: The Plan of Action for Women and Health (2002)
Agency: WHO Centre for Health Development
Coverage: International

The Plan of Action for Women and Health, adopted at the WHO Centre for Health Development’s Third International Meeting on Women and Health (Kobe Meeting), represented the most visible international effort to develop a standard set of the indicators of women’s health. The Plan specifically called for health indicators used by international agencies to be evaluated for gender equity – or the treatment of people in a manner that ensures similar or comparable outcomes between the sexes. This work was undertaken by the La Trobe Consortium in Melbourne, Australia and the results published in 2003 and are discussed below. 

The Plan of Action for Women and Health was an important event because WHO’s focus helped to validate the importance of developing women’s health indicators, and identified the need for a core number of gender-sensitive leading health indicators. The Kobe meeting established an international context that indirectly – and in some cases directly – supported the efforts of Canadian women’s health researchers. Additionally, the Plan identified gender equity as the overarching goal of women’s health surveillance, which helped set the theoretical backing for this powerful concept. 

Title: Hospital Report 2002: Women's Health 
Authors: Christina Porcellato, Donna Stewart, Michael Murray, Ross Baker, Adalstein Brown
Agency: Ontario Hospital Association, Ontario Ministry of Health and Long Term Care, University of Toronto, Canadian Institute for Health Information
Coverage: Provincial - Ontario

The annual Hospital Report, compiled by the Hospital Report Research Collective in Ontario, reports on performance of hospital services by examining health indicators such as readmission rates, clinical utilization, and patient satisfaction. Before 2002, the reports provided minimal focus on issues of sex and gender, but in the 2002 report, sex-specific and gender-sensitive indicators were included for the first time. They have been included in all subsequent reports, indicating the value placed on accounting for the different biological and social context of women’s and men’s health. This process, known as gender mainstreaming, was rare for health surveillance at that time, making the 2002 Hospital Report a critical report in terms of developing sex- and gender-sensitive surveillance in Canada. Examples of the sex-specific and gender-sensitive indicators are rates of caesarean and hysterectomy; female acute myocardial infarction, cholecystectomy and pneumonia; as well as other indicators such as quality of life for caregivers.

By integrating women’s health into mainstream performance monitoring – as opposed to being treated as a supplemental concern – the Hospital Report indicated how sex-disaggregated data and analysis of women’s health status, treatment and outcomes can improve overall hospital and health system performance. The hospital report is published annually and has continued to incorporate sex-specific and gender-sensitive indicators due to the understanding that improving gender equity in health does not have to entail a sacrifice of other health services, but in fact can help to enhance and improve them.
 
2003

Title: Comparative Evaluation of Indicators for Gender Equity and Health (2003)
Authors: Vivian Lin, Su Gruszin, Cara Ellickson, John Glover, Kate Silburn, Gai Wilson, Carolyn Poljski
Agency: World Health Organization Kobe Centre
Coverage: International

In response to The Plan of Action for Women and Health (adopted at WHO’s Third International Meeting on Women and Health) the La Trobe Consortium in Melbourne, Australia undertook an unprecedented review of 1095 internationally-used health indicators in order to assess their ability to monitor gender equity in health. Significantly, the Consortium developed a women’s health indicator framework to guide their work. The framework is described in more detail in the Women’s Health Indicator Frameworks section of this document. 

The work of the La Trobe Consortium was the first to undertake an international review of women’s health indicators and the Consortium’s observations have been critical in guiding future efforts. The Consortium identified a number of issues limiting the development and use of women’s health indicators:
Severe deficiencies in administrative data and health system performance in terms of sex and gender, except when a “special” topic-based report is produced. 
A biomedical basis for health indicators, resulting in little to no data concerning the social determinants of health (gender, socioeconomic status, diversity, etc.) or psychosocial concerns.
Lack of engagement between those working on gender equity and those working on health sector reform.
The resulting report recommends that in order to integrate sex-disaggregated and gender-sensitive indicators into mainstream reporting, it is necessary to reduce the indicator list to a shorter, more manageable, cost-effective core set of leading indicators of women’s health. WHO undertook that work and published their findings in 2004 (detailed below).

Title: Women's Health Surveillance Report: A Multidimensional Look at the Health of Canadian Women (2003)
Authors: Health Canada, Canadian Population Health Initiative, Canadian Institute for Health Information
Agency: Health Canada, Canadian Institute for Health Information
Coverage: National 

In 1999, Women’s Health Surveillance: A Plan of Action for Health Canada identified a number of health conditions for which sex and gender information was lacking and where further investigation was needed. The Women’s Health Surveillance Report was Health Canada’s response to this expressed need. The report provides information and descriptive statistics on a broad range of identified determinants of health, measures of health status, and health outcomes for Canadian women. The report drew data from the National Population Health Survey and the General Social Survey in order to assess their capacities to measure women’s health.
The Women’s Health Surveillance Report was groundbreaking because it was one of the first comprehensive Canadian analyses of women’s health issues. By examining sex-disaggregated data from large Canadian surveys, the authors of the report were able to highlight numerous health inequities between women and men, isolate the chronic disease burden for women, and detail the increasingly high levels of poverty among lone mothers and unattached older women [6]. However, while the report was able to identify these critical findings, it was severely hampered by a lack of gender-sensitive data concerning the context of women’s lives. The report called for an expansion of both quantitative and qualitative data on diverse women’s health-related experiences, particularly longitudinal data that would allow for investigation of the links between health behaviours and health outcomes [4]. The Women’s Health Surveillance Report was critical both in terms of its findings and in terms of the gaps in women’s health surveillance that it identified. It brought attention to the need for gender-sensitive, longitudinal, and qualitative data on women’s health.

Title:  A Profile of Women’s Health Indicators in Canada (2003)
Author: Ronald Colman, GPI Atlantic
Agency: Women’s Health Bureau of Health Canada
Coverage: National

While the Women’s Health Surveillance Report used health indicators to examine women’s health issues, A Profile of Women’s Health Indicators in Canada took a different lens on women’s health surveillance by focusing directly on the indicators themselves. The report was commissioned as part of Health Canada’s Women’s Health Indicators Project [7], whose aim was to develop, validate and evaluate a core set of indicators of women’s health. Towards that end, A Profile of Women’s Health Indicators developed a gender-based inventory of health indicators. In selecting the indicators, the report adopted the social determinants of health approach that had been advocated by the La Trobe Consortium and many in the Canadian women’s health field. Accordingly, indicators were drawn from the health field, but also from other Canadian sources such as income, employment, labour force, and the General Social Survey on Victimization. This broad scope allowed the report to examine the capacity of Canadian indicators for reporting the full context of women’s health.

Although A Profile of Women’s Health Indicators in Canada and Women’s Health Surveillance Report approached women’s health from different perspectives, their findings and recommendations in terms of women’s health surveillance and indicators expressed common concerns. Both exposed gaps where the available data did not capture the context of women’s lives, such as the lack of data on unpaid housework, family and domestic violence and rates of sexual assault. Other gaps included health determinants and outcomes for diverse populations – such as Aboriginal women, immigrant women and women with disabilities – reinforcing the need to improve data on sex, gender, and diversity in Canadian surveillance systems.  

The findings in A Profile of Women’s Health Indicators in Canada and Women’s Health Surveillance Report served as a catalyst for the development of women’s health indicators as it led to Health Canada initiating a call for external research projects that could develop women’s health indicators to fill the noted gaps [4]. Two projects were funded that address the areas of women’s socio-cultural roles and social inequalities in women’s health: Measuring Health Inequalities among Canadian Women: Developing a Basket of Indicators; and Towards a Better Understanding of Women’s Mental Health and Its Indicators, which are detailed below.

2004

Title: WHO Gender-sensitive Core Set of Leading Health Indicators (2004)
Author: WHO Kobe Centre
Agency: WHO Centre for Health Development 
Coverage: International

Building on the work from the La Trobe Consortium and the Kobe Meeting, the WHO held a meeting in 2004 to finalize a core set of women’s health indicators. The initiative relied on the indicator framework developed by the La Trobe Consortium (more details included in the Women’s Health Indicator Frameworks section of this document) in order to reduce the 1095 reviewed indicators into a final list of 37. These indicators were grouped according to the indicator framework into the topic areas of health status, health determinants, and health system performance. The indicators were selected based on the following criteria: an early alert for emerging health issues and with a predictive capability; highlight current and significant health issues that require and respond to action; cover issues that underlie a range of health problems and would be further elucidated by gender-based analysis; based on sound empirical evidence in relation to health effects; useful for monitoring performance and for evaluation of interventions; feasible to measure; valid and reliable for the general population and for diverse population groups.

As can be seen from the selection criteria, the researchers used a framework as a conceptual background, but also focused on feasibility and measurability to select their indicators in an effort to improve usage. This set of core indicators is meant to be a stand-alone assessment of women’s health, as opposed to many efforts such as the Ontario Hospital Report, which have attempted to integrate women’s health indicators into mainstream reporting and surveillance. Both techniques – women-specific and gender-mainstreaming – can provide valuable insights into the status of Canadian women’s health. 

The core set of women’s health indicators was ground-breaking as it was the first internationally agreed upon set and established the baseline for much future work. To validate the utility of the indicators, the WHO commissioned three pilot studies, one of which occurred in Canada in 2006 and is detailed below.   

2005
Title: Basic Indicators for Gender Equity Analysis in Health (2005)
Agency: Gender, Ethnicity and Health Unit, Pan American Health Organization (PAHO)
Coverage: International 

The work of the Pan American Health Organization (PAHO) was similar to the WHO work in that both established core sets of indicators of women’s health based on theoretical frameworks with gender equity in health as their overarching goal. (PAHO’s indicator framework is described in the Women’s Health Indicator Frameworks section). However, there are a few significant differences between the two. First, the PAHO framework explicitly highlighted systemic and structural discrimination against women as an area of health-related concern, [4] thus placing a greater emphasis on social determinants of health. Second, the PAHO set of indicators was larger, including 105 indicators, and was meant to be a set of options from which countries could select applicable indicators based on their national relevance. Finally, though PAHO’s set of core indicators could stand alone as an assessment of women’s health, incorporating into mainstream reporting and surveillance was a major focus during their development. 

The integration of PAHO’s core set of women’s health indicators into mainstream surveillance and reporting has proven challenging. However, there has been limited success. One of the strengths has been the inclusion of PAHO’s core set within the 2007 report Health in the Americas [4]. Despite the barriers, PAHO’s Basic Indicators for Gender Equity Analysis in Health continues to be a critical component of PAHO’s efforts to support gender equity in the Americas [8].

Title: Bringing Women and Gender into Healthy Canadians: A Federal Report on Comparable Health Indicators 2004
Authors: Kay Willson, Beth Jackson
Agency: National Coordinating Group on Health Care Reform and Women, British Columbia Centre of Excellence for Women’s Health
Coverage: National

Gender mainstreaming, or the inclusion of sex- and gender-sensitive indicators into mainstream surveillance, is a reoccurring theme both in Canada and internationally. It reflects an understanding that what is measured is to some degree what counts, and that proper measuring of women’s health is critical to improving gender equity, women’s health, and consequently, overall population health. In this pursuit, the National Coordinating Group on Health Care Reform and Women and the British Columbia Centre of Excellence for Women’s Health hosted a workshop at which women’s health researchers and policy advisors analyzed the federal report titled Healthy Canadians: A Federal Report on Comparable Health Indicators 2004 [8]. The group’s report presented recommendations to improve Healthy Canadians through improved selection of health indicators, illustrated concerns with Healthy Canadians through several examples, and provided examples of additional indicators of importance to women’s health. Their recommendations mirror many of the comments of other initiatives – that surveillance and reporting can better represent women’s health by: using gender-sensitive indicators that are selected based on a comprehensive conceptual framework; expanding indicator coverage to include measures of diversity and the social determinants of health; and selecting indicators that are linked to targets to improve health and reduce health inequities.  

Title: Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-based Analysis for Manitoba’s Regional Health Authorities (2005)
Authors: Randy Fransoo, Patricia Martens, The Need to Know Team, Elaine Burland, Heather Prior, Charles Burchill, Dan Chateau, Randy Walld
Agency: The Manitoba Centre for Health Policy
Coverage: Provincial – Manitoba

Noting a lack of sex-disaggregated data on health and health care at Manitoba’s Regional Health Authority (RHA) level, a collaboration of policy, practice, and research experts created this atlas-style report to examine some key issues affecting men’s and women’s health. It contains an overview of male/female differences in health status, health service use, and quality of care. The report’s adherence to a strictly medical perspective helped to isolate some of the statistically quantifiable differences between men and women and couch them in a format familiar to medical practitioners and hospital administrators. By doing so, the report made clear the value of examining sex-disaggregated data – illuminating the efficiencies, quality issues, and services that could be improved by tailoring programs to the different needs of men and women. Additionally, by providing a sex-disaggregated analysis, this reported provided a basis from which gender-sensitive analysis could be conducted.  
 
2006 

Title: Towards a Better Understanding of Women’s Mental Health and Its Indicators (2006)
Author: Cara Tannenbaum
Agency: Centre de recherché de l’Institut universitaire de gériatrie de Montréal
Coverage: National

The findings of A Profile of Women’s Health Indicators in Canada (2003) prompted Health Canada to issue a call for external research projects that could develop women’s health indicators to fill the gaps the report had noted. Towards a Better Understanding of Women’s Mental Health and Its Indicators was funded out of that call in order to fill in the gap of appropriate reporting on the mental health of men and women. At the time of the project’s initiation, there was a lack of adequate health indicators to measure and monitor mental health for women and men in Canada [9]. Using health services utilization data from Quebec and data from the Canadian Community Health Survey (CCHS) Cycle 1.2, the project sought to understand the causes of distress among women to inform a preventative approach to women’s mental health. 

The report outlined gendered differences in expressions of distress, treatment patterns for mental health symptoms, and health-care seeking among men and women [11]. A number of recommendations for the improvement of women’s mental health indicators in the CCHS stemmed from this project, including three new indicators for inclusion. The first was to improve data collection among minority and immigrant populations in further mental health studies, and the second was to include broader determinants of mental health and revise measures of mental health distress, symptoms and disorders. The third recommendation was to make clear why certain questions were included and excluded in the CCHS.

As can be seen from these recommendations, investigating the influences of sex and gender can lead to the identification of gendered health risks, symptoms, and experiences that in turn can lead to tailored, more effective health services. However, in order for these results to be seen, sex- and gender-sensitive indicators need to be integrated into mainstream surveillance.  

2007

Title: A field test of the gender-sensitive core set of leading health indicators in Manitoba, Canada (2007)
Authors:  Margaret Haworth-Brockmann, Lissa Donner, Harpa Isfeld
Agency: Prairie Women’s Health Centre of Excellence
Coverage: Provincial – Manitoba

After developing Gender-Sensitive Core Set of Leading Health Indicators, the WHO funded three field tests, in Canada, Tanzania, and China. The Prairie Women’s Health Centre of Excellence (PWHCE) in Manitoba conducted the Canadian field test, with the goal of assessing the feasibility of using the core set in a province of Canada. Of the 37 indicators tested, the authors found that the majority of the indicators (23) could be tested without modification using provincial health utilization data or national survey data or both. The PWHCE provided recommendations to enhance ten of these 23 indicators for greater usability. Out of the 37 indicators, one indicator could be tested with some modification to the definition, and 12 could not be tested due to a lack of data collection and 1 due to lack of applicability of the indicator. The PWHCE also suggested additional indicators for inclusion in the core set including: proportion of women and men living in suitable housing; proportion of women and men using prescription drugs; and proportion of women and men with cardiovascular disease.
Aside from assessing the feasibility of the core set of indicators, the PWHCE was also able to comment on the overall ability of the core set to summarize women’s health in Canada. Building on Sex Differences in Health Status, Health Care Use, and Quality of Care, the PWHCE noted that in order for the core set of indicators to properly capture the experiences of Manitoba women, resulting data would need to be not only sex-disaggregated, but also account for diversity. The report noted that Manitoba women have different geographical, ethnic, and socioeconomic background, therefore indicator analysis must examine the health implications of these differences. This observation reflects much of the Canadian focus on women’s health indicators – that implementing a set of women’s health indicators is not sufficient unless those indicators are gender-sensitive and capture the diversity among groups of women. The full report on the field test can be requested through the PWHCE website.

2008
Title: Closing the gap in a generation (2008)
Agency: WHO Commission on Social Determinants of Health
Coverage: International

Closing the gap in a generation represents the culmination of WHO’s investigations into health inequities based on gender, race, and/or socioeconomic status. The report argues that in order to make significant improvements to the health system, it is necessary to look beyond physical and mental illness in order to understand true population health. Though the recognition of the importance of the social determinants had grown significantly in previous years, Closing the gap was significant in the primacy it placed on them as well as the measureable targets it set. Notably for women’s health, Closing the gap recognizes gender as a critical structural determinant of health. This focus is reflected in the topics in the report, which include both a separate chapter on achieving gender equity as well as an integration of gender-sensitive indicators and issues throughout the rest of the report. Examples of gender-sensitive goals include supporting gender pay equity, providing resources for parents who remain at home, and ensuring equitable distribution of social resources. As such, Closing the gap displays the value of both considering women’s health as a stand-alone concern, as well as integrating it into the construction of other health-related issues.

Critically, Closing the gap in a generation reemphasized the WHO’s commitment to the overarching goal of equity in health. As the report states, “Health and health equity may not be the aim of all social policies but they will be a fundamental result” [12]. This goal is supported, shared, and reinforced by women’s health indicators and surveillance – a connection that can be seen explicitly in recent WHO documents such as Women and Health: Today’s Evidence, Tomorrow’s Agenda (discussed in this document).

Title: A Profile of Women’s Health in Manitoba (2008)
Authors: Lissa Donner, Margaret Haworth-Brockman, Harpa Isfeld, Caitlin Forsey
Agency: Prairie Women’s Health Centre of Excellence
Coverage: Provincial - Manitoba

Building on the feasibility study of the WHO core set of women’s health indicators, the Prairie Women’s Health Centre of Excellence (PWHCE) reviewed over 140 women’s health indicators using a variety of sources of Manitoban data. Whereas the feasibility study approached a core set of indicators of women’s health, the Profile of Women’s Health applied a sex- and gender-based analysis to mainstream data sources in Manitoba in order to gain a comprehensive picture of women’s health.  A gender lens was applied in the examination of health status, health services use, socio-economic influences, health system performance and lifestyle choices to better portray these indicators in the context of women’s lives. 

A Profile of Women’s Health in Manitoba contributed to the understanding of the ways in which gender influences women’s health as well as the interplay of gender with social and clinical factors to produce health outcomes. The report was one of the first to provide an in-depth, provincial analysis and the local-level results contain profound implications for service delivery, policy and research.

Title: Finding Data on Women: A Guide to Major Sources At Statistics Canada (2008)
Author: Marcia Almey 
Agency: Statistics Canada
Coverage: National 

This document outlined the extent and scope of women’s and men’s data available at Statistics Canada. It included a discussion on the various formats of data available (e.g., periodicals, print, electronic versions), a summary of the major social data sources, discussion of types of data and how they could be used and finally, current initiatives and research on social data at Statistics Canada. This report is a useful resource for locating nationally collected data on women.  

Title: Measuring Health Inequities among Canadian Women: Developing a Basket of Indicators (2008)
Author: Arlene S. Bierman
Agency: St. Michael’s Hospital, University of Toronto
Coverage: National 

The Measuring Health Inequities in Canadian Women project aimed to address the lack of attention to women’s health in mainstream monitoring of health status and health care, particularly for groups of women experiencing significant health inequities. The goal of the project was to develop a women’s health indicator framework that could serve as a tool to bring policymakers, providers, and the public together to achieve consensus on priorities and to select a core set of women's health indicators. Through a review of existing frameworks and key literature, the project developed a Women’s Health Indicator Framework, which is dynamic in nature and reflects the intersection of gender, and the social determinants of health. Further description of the framework can be found in the Women’s Health Indicator Frameworks section of this document. Using this framework, researchers identified key women’s health indicators and analyzed them using Canadian Community Health Survey data.

The findings documented in Measuring Health Inequities in Canadian Women identified gender and socioeconomic health inequities that need to be addressed and provided recommendations for the development of new women’s health indicators for reporting and monitoring. Based on the report’s recommendations, federal, provincial and local officials can select indicators from a core list based on their needs and priorities. The author of the report concluded that gender and equity analysis should be incorporated into all health indicator reporting and a core set of these indicators should be used as a tool for driving change, linked to clear objectives and strategies for improvement.  

2009 

Title: Women and Health: Today’s Evidence Tomorrow’s Agenda (2009)
Agency: World Health Organization
Coverage: International 

Women and Health: Today’s Evidence Tomorrow’s Agenda builds on the framing of health equity as an overarching goal of policy (as expressed by Closing the gap in a generation) by providing an international examination of key women’s health issues.  The report documented a number of health disparities existing between men and women, but particularly focused on differences in health status and health care of girls and women across different settings.  The report also acknowledged that chronic diseases, injuries and mental ill-health are significant contributors to women’s morbidity and mortality.  Providing healthy environments for young women and promoting healthy behaviours were identified as important strategies for improving women’s health.  

Women and Health reported that while health inequities, social determinants of health, and surveillance were all considered critical to a well functioning health system, coverage of women-specific and gender-sensitive indicators was spotty at best. While the report used what data was available to form illustrative examples of the critical issues affecting the health of girls, adolescents, adult women,  and older women’s health, it also identifies areas where new data need to be generated, available data compiled and analyzed, and research undertaken to fill critical gaps in the evidence base.   

Ongoing

Title: Project for an Ontario Women’s Health Evidence-Based Report (POWER)
Authors: Susan K Shiller, Arlene S. Bierman
Agency: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital and Institute for Clinical Evaluative Sciences
Coverage: Provincial - Ontario

The POWER project is one of the key ongoing initiatives on women’s health indicators in Canada. It is a partnership between the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital and the Institute of Clinical Evaluative Sciences involving a collaboration of over 60 researchers from diverse backgrounds. Its goals are to examine gender differences on a comprehensive set of evidence-based indicators as well as differences among women associated with socioeconomic status, ethnicity, and geography.

Throughout this multi-year project, the POWER team will be producing the POWER Report (A Project for an Ontario Women’s Health Evidence-Based Report), which examines current health information to uncover the differences between men and women and between various groups of women. The POWER report provides in-depth look at numerous health domains representing the leading causes of morbidity and mortality among women including: burden of illness, cancer, depression, cardiovascular disease and access to health care. Additional chapters are forthcoming. The POWER Report is informed by the dynamic Gender and Equity Health Indicator Framework, that was adapted from the CIHI framework and recognizes that sex, gender and non-medical determinants of health are fundamental in shaping women’s health. Further description of the framework can be found in the Women’s Health Indicator Frameworks section.

The chapters on health domains provide an in-depth analysis of women’s health data, and include a strong diversity component, highlighting the health of specific subpopulations in Ontario. The online format of the report makes it highly accessible to policy makers, providers and consumers, and the report itself will inform steps forward to improve health and decrease health inequities among women in Ontario and across Canada.

Title: The Source
Agency: British Columbia Centre of Excellence for Women’s Health
Coverage: National

Since 2006, the British Columbia Centre of Excellence (BCCEWH) has partnered with women’s health organizations from across Canada in order to develop a pan-Canadian resource for women’s health surveillance. The Source provides an SGBA, data sources, and reports on over 70 indicators of women’s health, which are organized according to the WHO framework. The Source contains descriptions of sex-specific, gender-sensitive, and qualitative indicators, including analysis of each in terms of sex, gender, and diversity. The Source is built on the understanding that improving access to the evidence base for women’s health will better inform the care provided to women and girls across Canada. 

Title: BC Perinatal Health Program
Agency: Provincial Health Services Authority
Coverage: Provincial – BC

The BC Perinatal Health Program (BCPHP) has a province-wide mandate to support a high-quality perinatal care program in BC. As part of that effort, the BCPHP maintains the BC Perinatal Database Registry, a comprehensive, province-wide perinatal database collected for the purpose of evaluating perinatal outcomes, care processes and resources, ultimately improving maternal, fetal, and newborn care. Since 2001, the registry has contained data on over 99% of all births in BC. The health indicator data collected by the BCPHP is used as the basis for an annual report, which provides evidence on issues pertaining to the care, treatment and outcomes of mothers and newborns in BC [13]. The annual reports can be accessed on their website. 

The efforts of the BCPHP feed and mirror those of the Canadian Perinatal Surveillance System, which is detailed earlier in this section. Both work to develop surveillance capacity and quality in a specific area of women’s health – perinatal health. While indicators used are generally sex-specific, as only women experience pregnancy and childbirth, both surveillance systems recognize the importance of understanding the context of women’s lives on their health through reporting on social determinants of health.

Title: Women in Canada: A Gender-based Statistical Report 
Agency: Statistics Canada
Coverage: National

Women in Canada, the 5th edition of which was released in 2006, provides a statistical summary of the demographic and cultural characteristics of Canadian women. Although the report is only partially concerned with health statistics, it is indicative of the growing understanding that the experiences of Canadian men and women are different and warrant specific attention.  The report included indicators on a range of socioeconomic, demographic and health data and maintained that sex and gender were major determinants of health and wellbeing [4]. The report also acknowledged that women from different backgrounds have diverse experiences, and included separate chapters addressing the experiences of Aboriginal women, immigrant women, senior women, women of visible minority and women with disabilities. 

References
[1] Advisory Committee on Women’s Health Surveillance. Women’s Health Surveillance: A Plan of Action for Health Canada. Ottawa: Health Canada; 1999.
[2] Pelletier L. Internal Evaluation Team. The Canadian Perinatal Surveillance System: 10 Years Later. Ottawa: Public Health Association of Canada; 2005.
[3] Health Canada. Canadian Perinatal Health Report 2000. Ottawa: Minister of Public Works and Government Services Canada; 2000.
[4] Austin A, Tudiver S, Chultem M, Kantiebo M. Gender-based analysis, women’s health surveillance and women’s health indicators- working together to promote equity in health in Canada. International Journal for Public Health 2007; 52: S41-S48.
[5] Federal, Provincial and Territorial Advisory Committee on Population Health. Toward a Healthy Future: Second Report on the Health of Canadians. Ottawa: Health Canada; 1999.
[6] Hankivsky O, The Canadian Women’s Health Network. Women’s Health in Canada: Beijing and Beyond. Ottawa: The Canadian Women’s Health Network; 2005.
[7] Women’s Health Indicators Project. Health Canada website. Accessed on Feb 4, 2010 from www.hc-sc.gc.ca/hl-vs/women-femmes/indicators-indicateurs-eng.php
[8] Jara L. Integrating a gender perspective into health statistics: an ongoing process in Central America. Int J Public Health 2007; 52:S35–S40.
[9] Title: Towards a Better Understanding of Women's Mental Health and Its Indicators. Health Canada Website. Access on Mar 18, 2010 from www.hc-sc.gc.ca/sr-sr/finance/hprp-prpms/results-resultats/2006-tannenbaum-eng.php
[10] Health Canada. Healthy Canadians: A Federal Report on Comparable Health Indicators 2004. Ottawa; 2004.
[11] Donner L.  Environmental Scan of Gender and Diversity Sensitive Women’s Health Indicators Initiatives 2000 to 2006; 2007.
[12] CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization; 2008: p. 1.
[13] British Columbia Perinatal Health Program. British Columbia Perinatal Database Registry Annual Report 2007. Vancouver, BC; 2007.