Women's Health Indicators

Introduction to Women's Health Indicators
 
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Having a comprehensive picture of the health of a population is critical to guiding health research, policy and programs. Such a picture is created by collecting data on a range of health measures – health indicators – that can be pooled together and analyzed to describe, compare and monitor patterns of mortality (deaths), morbidity (illness, disease), wellness, and health-affecting factors (personal behaviours, resources such as housing and systemic influences such as the availability of care).  To understand women’s health, this information must be available and should be analyzed by sex and by gender. Sex- and gender-based analysis (SGBA) is recognized internationally and by the Canadian government as a critical component of sound health planning. According to Government of Canada policy, SGBA is used “to ensure that the initiatives and activities of the Health Portfolio lead to sound science, ensure gender equality and are effective and efficient” [1].

This section of The Source has been developed to introduce the concepts and context of work done in the area of women’s health indicators in Canada. This introduction includes an overview of what is meant by women’s health indicators and the rationale behind their use. This material is followed by a brief introduction to indicator frameworks, which are explained more fully in the following pages.

What Are Women’s Health Indicators?

A women’s health indicator measures health status in a population of women. In Canada, as in other countries, women’s health indicators are intended to measure how sex and gender affect the health of women and girls, to understand in what ways women’s health differs from men’s but also to understand specific influences within and among sub-populations of women.

Sex refers to the biological characteristics that distinguish males and females. Sex differences include physical and physiological differences such as body shape and size, proportion of fat to muscle, and hormones. Health-related data are often recorded by sex, (male or female), although they are not always reported by sex. Looking at sex-disaggregated data is the first step towards understanding the effect of being male or female in any specific health condition. Data that are both reported and recorded by sex allow the user to make comparisons between males and females. Indicators may also be women-specific, in that they measure conditions that occur only among women, such as maternal smoking, maternal mortality or ovarian cancer rates.

Gender refers to the socially constructed roles and relationships, personality traits, attitudes, relative power, and other characteristics that are ascribed to men and women by society.  Gender-sensitive indicators allow us to identify, examine, and monitor gender-related in changes in society over time [2]. They should also allow for comparisons of diversity between groups of women, men, boys, or girls [3], which implies that they should measure other characteristics such as age, location of residence, ethnic background, sexual orientation, religious tradition, and a host of other variations among people.

Including measurements of sex, gender, and diversity in health indicators allows SGBA to pursue the overall goal of equity, or the treatment of people in a manner that ensures similar or comparable outcomes. This is distinct from equality, which requires that people in similar circumstances be treated in similar ways. Policies and services that aim to achieve equity are often different from one group to another because they are tailored to the individual needs of different groups of people.

Click here or on the Environmental Scan tab to read about historical and current efforts to expand and refine women’s health indicator use and comprehensiveness.

Why Women’s Health Indicators?

An ideal set of women’s health indicators…
1.    Drive change: A good indicator is one that suggests directions for action. Linking indicators with priorities and strategies for change is critical to improving women’s health [4].
2.    Make visible what is currently invisible: Data on women’s health indicators provide the basis for SGBA to illuminate differences between men and women and/or among groups of women in terms of determinants of health, access to health services, and health outcomes.
3.    Enable comparison: Women’s health indicators provide standard measures that can be compared by community, region, province, and/or country.
4.    Monitor progress: Collecting and comparing indicators over time enables us to see if women’s health has improved or worsened, as well as to identify key trends in disease or health.
5.    Measure the impact of policies, programs or projects: Women’s health indicators help expand our knowledge of the impact of policies and programs on women’s health [5].
6.    Point to more effective, targeted interventions: Women’s health indicators may help improve the focus and effectiveness of existing or emerging interventions, by identifying the specific needs of women and subgroups of women.
7.    Support gender equity: Understanding how health outcomes are impacted by sex, gender, and diversity can help tailor policies and services to achieve gender equity.

Unfortunately, in Canada surveys, surveillance systems, and other health related data often do not record or report statistical data by sex, gender, ethnicity, Aboriginal status, geographic region, socio-economic status or other variables that allow us to conduct SGBA and better understand the health of specific populations [6]. In some cases these details are recorded by not reported, and become lost through aggregation to population-level reporting. In other cases, the data collection mechanisms are missing altogether. Recognizing this gap, women’s health researchers and policy makers have worked diligently over the past two decades to improve representation of sex and gender in health surveillance and thus our ability to conduct SGBA. However, despite recent advances, significant gaps still exist in our ability to monitor, report on, and understand women’s health.

Health Indicator Frameworks

When international researchers began investigating women’s health indicators, they attempted to capture all aspects of health and illness by developing extensive lists of indicators, some with more than one thousand.  This approach produced an overwhelming amount of data to be collected, analyzed, and reported; and many of the indicators measured very similar health characteristics.

Since then, women’s health analysts have been developing theoretical frameworks to narrow the number of indicators necessary to capture the complexities of health status and influences in a manageable way. The original lists of indicators have evolved into frameworks which posit relationships among the indicators and a comprehensive model of women’s health. Additionally, researchers have begun to investigate how qualitative information, which asks why or how health outcomes occur, can complement and enhance standard quantitative indicators, which measure whether something occurs or the degree to which it occurs. An analysis of current indicator frameworks can be found in the Frameworks section of this document.

The Source

This document pulls together related pages from The Source, a web-based tool to assist researchers, policy makers, health planners, and students identify sources of health data for women and girls. The Source is organized according to a number of critical indicators of women’s health and provides a sex-and gender-based analysis of these indicators. The indicators and topics are grouped according to the categories Health Status, Health Determinants, and Health Services. This organization is based on the model used by the World Health Organization and the Public Health Agency of Canada. 

References

[1] Health Portfolio Sex and Gender-Based Analysis Policy. Health Canada website. Access on April 15, 2010 from www.hc-sc.gc.ca/hl-vs/pubs/women-femmes/sgba-policy-politique-ags-eng.php

[2] Beck T, (1999). Using Gender-Sensitive Indicators: A Reference Manual for Goverments and Other Stakeholders. London: Commonwealth Secretariat.

[3] United Nations Development Fund for Women (UNIFEM), (2000). Progress of the World’s Women 2000; UNIFEM Biennial Report. New York: United National Development Fund for Women.

[4] Clark J., and Bierman A. (2009).  The Power Study Framework, Chapter 2. Accessed on December 7, 2009 from www.powerstudy.ca/webfm_send/50

[5] Aguilar L. Gender Indicators. Accessed on December 7, 2009 from www.genderandenvironment.org/admin/admin_biblioteca/documentos/Gender%20Indicators.pdf

[6] Austin S, 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. Int J Public Health 2007; 52: S41-S48.