Gender (and-Sex)-Based Analysis: A Tool for Evidence-based Research in Occupational Health ? Gender (and-Sex)-Based Analysis: A Tool for Evidence-based.

Gender (and-Sex)-Based Analysis: Gender (and-Sex)-Based Analysis: A Tool for Evidence-based A Tool for Evidence-based

Research in Occupational Health ?Research in Occupational Health ?

Sue StreetSue Street

2008 CPHA Conference2008 CPHA ConferenceJune 3, 2008June 3, 2008

OverviewOverview

• Key objectives for today’s presentation

• Occupational Health (OH) as an important component of Public Health (PH)

• Gender disparities in Occupational Health (OH)

• Principles of Gender-based Analysis (GBA) and Gender-and-Sex-based Analysis (GSBA)

• Role of GSBA (and gender-sensitive methods) for developing evidence-based research in OH

Key ObjectivesKey Objectives

1)1) To describe the background of Health Canada’s Gender-Based Analysis (GBA) and Gender-and-Sex-Based Analysis (GSBA)

2)2) To identify the purpose and aims of GBA & GSBA

3)3) To show the value of a gender and diversity analysis for occupational health (OH) research

4)4) To briefly discuss how GSBA can contribute to better evidence in OH research

Occupational Health: An Important Occupational Health: An Important Public Health IssuePublic Health Issue

• Occupational Health (OH):Occupational Health (OH):

- part of the broad spectrum of Public Health (PH)Public Health (PH) in which society collectively attempts to assure the conditions in which people live & work are healthy

- examines how paid work affects health and takes into account the diverse contexts and environments in which work occurs

- multidisciplinary approach to the recognition, treatment, prevention & control of work-related injuries and diseases

Some challenges exist…Some challenges exist…

• An uneasy alliance has existed between OH & PH due to an historical isolation of OH from mainstream PH

• In PH, the need to address health disparities in the population has promoted a renewed focus on the broader social & environmental determinants of health

• OH provides a way of reaching larger segments of the population experiencing health disparities

• To improve the health of working populations, OH & PH must come together to focus on the occupational health and experiences of all workersall workers

Gender Disparities in Occupational Gender Disparities in Occupational Health: Women’s OH IssuesHealth: Women’s OH Issues

• Women comprise ~46% of the paid workforce in North America; much of their work remains gender-divided.

• Women & men often share similar job titles, yet the actual tasks they do and the health effects of that work are different. Overall, less is known about the impact of job duties performed by women.

• Women’s OH issues have received less research attention and women are underrepresented in the scant data available… this is slowly changing but many gaps remain.

Gender and Sex Differences in Gender and Sex Differences in Occupational HealthOccupational Health

• Type of work, job tasks, risk factors, and exposure to risk factors (occupational, physical, emotional and mental risk factors)

• Sexual Division of Labour: women’s work VS men’s work

• Age, race, class, ethnicity, SES, social support

• Mortality and morbidity rates; Injury rates

• Injury onset and symptoms

• Work organization and environmental factors

Gender Disparities in OH Gender Disparities in OH (cont’d)(cont’d)

• Gaps exist in terms of how women’s OH issues have been studied:

– traditional scientific methods have not captured the gender-specific health issues, needs, & voices of women workers and other vulnerable groups

– the work performed by women often de-valued

– OH research has typically focused on men’s jobs/tasks

– norms for OH research, standards & policies based on the “average male worker”“average male worker”

Gender Disparities in OH Gender Disparities in OH (cont’d)(cont’d)

• ““Traditional” OH research has made Traditional” OH research has made important contributions, but has failed to:important contributions, but has failed to:

– recognize the relevance of the sexual division of labour, working conditions, and power structures as sources of health problems over time

– understand that women, like men, have diverse social realities shaped by many factors: work, SES, culture, ethnicity, age, past experiences, class, sexual orientation, educational opportunities, etc.

Health Canada’s Health Canada’s Gender-Based Analysis (GBA)Gender-Based Analysis (GBA)

A process, framework & analytical tool

Systematically integrates a gender perspective into the development of policies, programs, legislation, planning & decision-making processes

Uses gender and sex as organizing principles and for viewing research processes & data

Helps identify/clarify differences between and among women and men, boys and girls

Shows how gender differentially affects health status and outcomes, access to and interaction with the health care system

(Health Canada, Women’s Health Bureau, 2000, 2003)

Health Canada’s GBAHealth Canada’s GBA (cont’d)(cont’d)

• Background:Background:

Gender is relational: GBA focuses on gender relations, gender identity & institutional gender, and how they play out in different settings and environments

Process of evaluation & interpretation that takes into account important differences and key influences experienced by the person or group being studied

GBA does not reject evidence; nor does it restrict concepts and methods for evidence-gathering to those associated with qualitative approaches

Evidence is a gender issue; GBA provides different kinds of information about the gaps in health research

Canadian Government’s Commitment toCanadian Government’s Commitment toGBA & Gender EqualityGBA & Gender Equality

Federal Plan for Gender Equality: Status of Women Canada implemented GBA in federal depts (1995)

Health Canada’s Women’s Health Strategy (1999)

Health Canada’s GBA Policy (2000, 2003)

Centres of Excellence for Women’s Health (1996-2008)

Agenda for Gender Equality/WHO Gender mainstreaming (2000)

CIHR - Institute of Gender and Health (2001)

Standing Committee on the Status of Women - Parliamentary Report on GBA (2005)

Revised Federal Gender Equality Strategy - GSBA (2005-2010)

Health Canada’s GBAHealth Canada’s GBA (cont’d)(cont’d)

• Aims:Aims:

GBA provides a gender-sensitive lens for re-thinking how gender, diversity and context are addressed in OH research

Incorporated systematically and takes into account the needs, interests and experiences of bothboth women & men

GBA, similar to an Environmental Impact Analysis, reveals potential impacts and outcomes

BUT… this “equity-promoting” strategy is not without resistance in terms of what it does notdoes not convey or address; limitations discussed later

Gender-and-Sex-Based Analysis (GSBA)Gender-and-Sex-Based Analysis (GSBA)

... An approach to research and evaluation which systematically inquires about biologicalbiological (sex-based) and socioculturalsociocultural (gender-based) differences between women and men, boys and girls, without presuming that any differences exist.

Promotes rigorous sex/gender-sensitive health research which expands understanding of health determinants in both sexes, in order to provide knowledge which can result in improvements in research evidence and health care.

(Spitzer for CIHR, 2005)

Gender-and-Sex-Based AnalysisGender-and-Sex-Based Analysis

SEXSEXthe genetic, biological and physiological characteristics and processes that generally distinguish males and females

GENDERGENDERthe socially constructed roles, relationships, values, attitudes, and forms of power that are commonly attributed to either men or women; includes self-representation

DIVERSITYDIVERSITY analysis overlays GBA

InterrelatedInterrelatedthroughthroughcomplexcomplexpathwayspathways

Gender-and-Sex-Based Analysis Gender-and-Sex-Based Analysis (cont’d)(cont’d)

Meant to be applied within the context of aMeant to be applied within the context of a

diversity framework, that attends to the ways diversity framework, that attends to the ways

in which social determinants interact with sex in which social determinants interact with sex

and gender to contribute to exposures to various and gender to contribute to exposures to various

risk factors, disease courses and outcomes.risk factors, disease courses and outcomes.

(Spitzer for CIHR, 2005)

GSBA: New Questions, New KnowledgeGSBA: New Questions, New Knowledge

• Similar to GBA but this analytic framework explores sex/gender differences & similarities, and their interactions with other health determinants

• Dynamic process rather than a set of prescribed techniques; It can help identify new pathways… gender is more than a variable. Identifies what is not known!

• Contributes to better science, more accurate results & comprehensive evidence:

““GSBA… GSBA… deepens our understanding of how sex and gender deepens our understanding of how sex and gender affect health status and access to health services...”affect health status and access to health services...”

(Health Canada, Report on Planning & Priorities, 2004-05;

Johnson, Greaves & Repta, WHRN, 2007)

New Questions, New Knowledge New Questions, New Knowledge (cont’d)(cont’d)

•• Context matters:Context matters:

► GSBA analyzes diversitydiversity within and between groups of women and men

► Includes age, SES, culture, ethnicity, abilities/ disabilities, sexual orientation, geography; social exclusion/inclusion

•• Across the life spanAcross the life span

•• Often requires the use of mixed & multiple methodologies

•• To help assess how research, policies, programs, and legislation contribute to gender equality and to more equitable health outcomes

Exploring the Value of GSBA Exploring the Value of GSBA for Occupational Healthfor Occupational Health

• GSBA in OH examines:GSBA in OH examines:

The ways in which OH research concerning women’s

paid work has dealt with gender-and-sex-based differences

How gender-sensitive research and sex-disaggregated

data can make visible the historical and current OH issues of importance to both women & men

How to find practical and appropriate methods andstrategies that re-think diversity and gender differences in OH research

GSBA for OH ResearchGSBA for OH Research

• Informed by gender and diversity principles in developing evidence-based research that attends to:

- OH concerns & experiences of women who engage in paid work

- how the work women do & the context of work influences their health

- how ethnicity, race, gender/sex, class, age & SES differences among women & men affect OH

- gender as more than a dichotomy

Bringing GSBA into Health Research:Bringing GSBA into Health Research:Starting points…Starting points…

1.) 1.) Revisit an original study by applying GSBA, re-analyzing Revisit an original study by applying GSBA, re-analyzing data, or performing a secondary analysisdata, or performing a secondary analysis

(with no changes made to the original research design since data are already collected)

2.) 2.) Augment existing research with GSBAAugment existing research with GSBA

(which calls for minor additions to the research design)

3.) 3.) Incorporate a GSBA from the beginningIncorporate a GSBA from the beginning

(i.e., use a sex and gender perspective throughout the research project)

New Initiatives, Good PracticesNew Initiatives, Good Practices

• Sex, Gender and Women’s Occupational Health: The Sex, Gender and Women’s Occupational Health: The Importance of Considering MechanismImportance of Considering Mechanism (Messing & Stellman, 2006)

-- Examines inventories of OH research to identify trends in the approaches used to study women’s OH

-- GSBA applied to studies of: (i) mercury exposure (ii) WMSDs

• GBA, Women’s Health Surveillance and Women’s GBA, Women’s Health Surveillance and Women’s Health IndicatorsHealth Indicators (Austin, Tudiver, et al., 2007)

-- Examines some ways GBA/GSBA can be applied to health surveillance systems & the development of gender-sensitive health indicators; tracking injury trends over time and across populations.

New Initiatives, Good Practices New Initiatives, Good Practices (cont’d)(cont’d)

• Gender Equality, Work and Health: A Review of the Gender Equality, Work and Health: A Review of the EvidenceEvidence (Messing & Ostlin, WHO, 2006)

-- Examines the need to strengthen and put in place more & better programs/practices (GSBA) to ensure women’s OHS issues at work, while improving their access to economic and social equality

-- Documents the relationship between gender inequality, health, work and safety problems; reviews gender issues in OH research

• Workplace Injury or “part of the job”?: Towards a Workplace Injury or “part of the job”?: Towards a gendered understanding of injuries and complaints gendered understanding of injuries and complaints among young workersamong young workers (Breslin, et al., Soc. Sci. Med., 64: 2007)

-- Explores young workers’ understandings and experiences of OH risks, and their gendered nature

GSBA: Barriers & ChallengesGSBA: Barriers & Challenges

BarriersBarriers

Policy and tools do not guarantee accurate or consistent use

Complexities, pressures of policy-making implementation

Working in “silos”

Lack of clear business case for GSBA: seen as ‘add on’

Resistance (e.g. challenges mainstream paradigms)

Limited accountability

ChallengesChallenges

GSBA is limited even with mandate, legislation and/or accountability frameworks

Systematic reviews in OH have limited gender/sex/ diversity data to draw on

Data may be collected but not analyzed

Need for capacity building, took, knowledge transfer and education about gender and sex-analysis applied to research

GSBA: Facilitating FactorsGSBA: Facilitating Factors

Facilitating FactorsFacilitating Factors

Presence of ‘champions’ in key places – the higher the better!

Demonstrated value added and relevance to Public Health priorities (shared by OH)

Collaborative projects within and across sectors

Opportunity for accountability and evidence-based decision-making

Public engagement/pressure

Key MessagesKey Messages

• Gender and Sex are dynamic, multidimensional concepts

• Gender-and-Sex-Based Analysis (SGBA) can:

-- enhance the quality of evidence about Occupational Health

-- contribute to research, programs, policies, and clinical practice that address upstream determinants of individual & population health in the workplace

• Gender-specific analyses and sex-disaggregated data are necessary because women’s & men’s lives and their workplace experiences are significantly different

• GSBA must be mandated in OHS policy and consistently applied in OH research and practice

• Collaborations across disciplines/sectors are crucial to address the complex OH issues in public health

References of InterestReferences of Interest

• Messing, K., & Ostlin, P. (2006). Gender Equality, Work and Health: A Review of the Evidence. Geneva: WHO.

• CIHR (2006). Gender and Sex-Based Analysis in Health Research: A Guide for CIHR Peer Review Committees. Accessed on May 15, 2008: http://www.cihr-irsc.gc.ca/e/32019

• Johnson, J., Greaves, L., & Repta, R. (2007). Better Science with Sex and Gender: A Primer for Health Research. Vancouver, BC: WHRN.

• Spitzer, D.L. (2005). Gender and Health Disparities. Ottawa, ON: CIHR.

• Messing, K., & Stellman, J. (2006). Sex, Gender and Women’s Occupational Health: The Importance of Considering Mechanism. Env. Res.,102.

Questions ???Questions ???

Thank you!Thank you!