Women, Income and Health in Manitoba

Q1  Why is health reform a women's health issue?

Health reform is a women's issue for several reasons. Medicare is a universal, publicly funded program and user fees - such as premiums, tray fees, or delisting services - impact those with less income. The Women, Income, and Health in Manitoba study re-confirmed that women are more likely to be poor than men. The poverty rate for adult men in Manitoba is 13.5%, while it is almost 20% for adult women. The poverty rate for senior Manitoba men is 13.6%, while it is 28.3% for senior Manitoba women.

We access the health system more as we age, and the average life expectancy for girls born today is 81.4 years, while it is only 75.7 for Canadian male babies. Women also need greater access to health care services when they are pregnant. User fees can discourage a woman from seeking health care services while pregnant, and thus jeopardize her health and that of her child. Women are also the gatekeepers of family health. Those with limited incomes must often put the needs of their children ahead of their own when accessing health care services.

 

Q2  Why are you releasing this study now?

Health reform is a crucial topic, particularly with the federal commission on medicare being conducted right now and its report due in November. We think it is critical that the provincial and federal governments understand how important it is to preserve medicare as a universal, free service. We already know that prevention is the best way to improve health and reduce health care costs, and that user fees will disproportionately hurt women. Reducing income inequalities and redesigning health care services to meet the needs of low income women is thus a key part of preventative medicine, and any changes to our health care system must consider women's health needs in order to be build a fully effective system.

Changes to the health care system should include the recommendations from the Women, Income and Health in Manitoba study. It shows that income affects health at every step on the economic ladder with the poorest women being sickest, the wealthiest women the healthiest, and middle income women in between. Now is the time to use this knowledge to begin to improve everyone's health, and also ensure that a further deterioration of our health and longevity does not occur.

 

Q3  What international research shows that income is linked to health?

There is a substantial body of research linking income to health, and health researchers and federal and provincial governments have known this for some time. Canada, for example, uses a population health approach, which recognizes income as one of the important determinants of health. (see http://www.phac-aspc.gc.ca/). Our study also points to several national and international studies that show that people's health improves on virtually all measures and in factors that influence health as income and education levels increase.

 

Q4  How does economic inequality affect everyone's health?

Studies across developed nations have looked at the connection between a society's income distribution and its members' health. These found that it is not just poverty that makes people sick; inequality is bad for everyone's health. In societies with greater inequality, even the wealthiest get sick and die sooner.

The Federal/Provincial/Territorial Advisory Committee on Population Health is an advisory committee to a committee of the federal and provincial Deputy Ministers of Health. It reported in 1999, in Toward a Healthy Future: Second Report on the Health of Canadians , that: "There is strong evidence that the health of a given population depends on the equality of income distribution rather than on average income. The greater the disparities between rich and poor, the greater the health consequences."

 

Q5  Why do women living in poverty get sick and die sooner?

There are many ways in which poverty can lead to ill health, including lack of access to affordable housing, transportation, food, and such non-insured benefits as medications. Women and children who are poor are more likely to be socially isolated, which also contributes to ill health. Research is showing that medical care is less important than economic security, social support, and a more equitable distribution of income in ensuring the entire population's well-being.

 

Q6  Are certain groups of women more susceptible to health risks?

Aboriginal women have poorer health than aboriginal men or other Canadian women. They develop chronic conditions earlier and suffer more frequently from heart problems, hypertension, diabetes, arthritis, and rheumatism. They also face formidable barriers in obtaining appropriate health services, including discrimination, distance, and cultural barriers.

Poverty is also an important factor in older women's health. Many factors compound this, including poor housing, higher heating costs, increased isolation, fear for personal safety, and functional impairments.

 

Q7  Why did the Women's Health Clinic (WHC) undertake this study?

Prevention has always been part of the WHC's mandate. As a community clinic, we are concerned with the health of individual women who seek care at our clinic as well as the health of women generally. Women's health is also an important issue for both the provincial and federal governments, and we strongly believe people need to be more aware of the effect income has on individuals' health. Because women are so much more strongly affected, we felt it important that the public should know about this link between poverty and ill health. We commissioned this study to provide us with the background information, and now are asking Manitobans to get involved in this important issue.

 

Q8  How does this fit into the WHC's mandate?

The WHC is a community health centre that provides women-focused health services with an emphasis on health education and prevention. It encourages women to learn all they can about what contributes to their health so they can make informed decisions. It also brings together agencies and individuals for education and action on issues that impact on women's health, which is what it did with the advisory committee for this awareness project.

 

Q9  What do you want policy-makers to do?

This awareness campaign aims to help decision makers, both inside and beyond the health care sector, to consider the health consequences of their decisions and how these can assist low-income women's health. There is a list of action ideas in the "Backgrounder", brochure, and report, but there are many policy-makers who could be involved in this progress. Municipal politicians should consider the impact on women's health when setting public recreation fees and transit fares. The CRTC should consider how lack of phone service can lead to social isolation and contribute to ill health when setting local phone rates. The health sector and regional health authorities could talk to low-income women in their communities, and the organizations that work with them, about their health needs and use that information to change the way in which they deliver and evaluate services.

 

Q10  What alternative models have you presented in your study?

The Women, Income, and Health in Manitoba study has offered Manitoba health care organizations interested in developing health services that take income and women's health into account three models. These are the Women's Health Clinic Model of Care, the Vancouver/Richmond Health Board's A Framework for Women-Centred Health, and the Commonwealth Secretariat of England's Models of good practice relevant to women and health. All three models offer ideas for improving health services to better meet the needs of low-income women.

 

Q11  What are Manitoba agencies and RHAs doing to improve women's health services as well as services for women living on low incomes?

A wide range of public health programs and services are offered throughout Manitoba by a variety of agencies offering community health programs as well as many regional health authorities (RHAs). Those noted here are a few examples of special initiatives and public health programs to improve women's services.

The North Point Douglas Project for Women in Winnipeg was started in 2000 as part of the Community Empowerment Project for Women by Women sponsored by the Social Planning Council of Winnipeg. Funded by the federal and provincial governments, its goals are to empower women by promoting their emotional, mental and physical health, promote a safe and healthy community, and achieve sustainability for a North Point Douglas Women's Resource Centre. Though still based in Norquay School, its aim is to soon relocate to a building across from the school where it can begin to expand its programs. It already offers a community telephone, computer with internet access, resource directory, clothing depot, book and toy lending library, and sewing machines, and the women are working on developing a housing registry for suitable housing in the area. It also currently offers a wide range of programs, including crafts, afternoon videos, and writing for women. Once relocated, it plans to have a community kitchen where a nutritionist will be available to teach healthier eating and meal preparation, and it can work to develop the only laundromat in the area.

For more information, please contact:

• Sandy Dzedzora, Project Coordinator, at (204) 947-0321.

South Westman RHA began a women's health pilot program two years ago to provide educational and clinical support to women in Boissevain and Melita. The on-going program now has several components:

• it holds a monthly luncheon for about 50 women in each town. Women buy their own lunches, but have chosen a wide range of speakers and topics, including depression, breast health, cancer, exercise, empowerment, cardiovascular disease, herbal remedies, healthy eating and dieting, pap tests, and "ask the doctor" questions
• it organizes babysitters every second month for the Moms and Tots programs in each town so the moms can attend discussions on such topics as relationships, raising children, and breast health;
• it holds two lunch-time educational sessions per month in each high school, where teen girls bring their own lunch but have speakers and sessions on skin care and beauty, smoking, self-esteem, eating awareness, relationships and contraception, and giving babies up for adoption;
• it operates a clinic two afternoons a month in each town for physicals, pap tests, breast exams, and other women's health issues so women may access it for their health care or augment their care from another doctor.

 

For more information, please contact:

• Dr. Mairi Burnett, Boissevain, Bus: (204) 534-3777.

North Eastman RHA:

• has hired a primary health care nurse in Lac du Bonnet and a primary health care nurse practitioner in Beausejour and Oak Bank to help address the shortage of female doctors in the region so women may access female health practitioners, if they choose;
• is supporting Mrs. Lucci's, a family resource centre in Lac du Bonnet that provides health education programs, particularly for single moms who wish to learn work skills in its second-hand store. It supports Wings of Power, a family resource centre providing similar programs in Pine Falls, where there is a larger aboriginal population;
• has a public health nurse and wellness facilitator facilitate a young parents support group in Lac du Bonnet. It meets monthly to provide low-income families, particularly those the public health nurse has deemed at risk, with a family meal and health education session. The group usually attracts up to 20 people. The women chose the topics, which have included breast health, cervical screening, parenting issues, and child health.
• has public health nurses involved in the increasing numbers of Moms and Tots programs and providing reproductive health education and birth control disbursement in the high schools.
• started a North Eastman Regional Women's Wellness Network. Last year, it developed breast health education packages for the region's doctors and nurses. It also contained the information needed for follow-up, both in the region and beyond. The Network donated Dr. Susan Love's Breast Book to the Beausejour and Lac du Bonnet libraries, and all breast cancer support groups and clinic in the region. On March 15, it is sponsoring a women's wellness day for stay-at-home moms. They will have free day care and a lunch, and address mental health parenting and health issues.
• provided education sessions on breast examination, cervical health, and even prostate health on two Hutterite colonies.

 

For more information, please contact:

• Vicki Landry, Primary Health Care Nurse, RHA, Bus: (204) 345-1218, or
  
• Karen Kost, Mrs. Lucci's, Lac du Bonnet, Bus: (204) 345-9909.

Marquette RHA offers programs that assist women and their families. It:

• offers individual consultation with a public health nurse through prenatal classes, postnatal home visits, and well baby clinics. Through this process, timely infant screening can flag development concerns to provide early intervention by the Early Childhood Development team;
• offers a reproductive health program that provides contraception and information for low-income moms and teens. A key component of this program is the reproductive health educational session held as part of senior high life awareness days across the region;
• is involved as a partner in starting their second literacy program, which helps women with basic literacy skills and upgrading toward their GED;
• is a key partner in providing information and programming assistance with various community models that exist in its region. Some examples include the numerous "Moms' Morning Out" groups, Minnedosa Gym and Tot recreation program, parent teacher councils, and parent child resource centres. Program support includes pre- and post-natal nutrition and health, along with a variety of topics women request themselves;
• provides women, through the Healthy Baby Program offered in up to ten communities, with the opportunity to experience food preparation and learn nutrition information for themselves and their families;
• provides a community outreach program, including partnership with a multi-disciplinary team, for up to 50 families in Baby 1st visitor program.

 

For more information, please contact:
• Pat Cockburn, Vice President Programs and Services, Bus: 204-759-4507;
• Pat Martin, Public Health Program Director, Bus: (204) 476-2341.

 

Q12  How can Manitobans support the move to improve women's health?

We are asking Manitobans to get involved - to take these issues to their community and religious groups, parent councils, MPs, MLAs, and municipal councillors. This program's coordinator, Gail Watson, is available to speak to groups, and there are also brochures and posters available, as noted below. Manitoba health service providers could help by strategizing how they can make their services more accessible to low income women, and the WHC can provide further ideas to aid them. Policy makers outside the health system - in such areas as banking, transportation, communications, social services, housing, the private sector, and government - could begin to develop and implement their policies with a view to how they can help improve the health of low-income women.

 

Q13  How can I get more information about this subject?

Project coordinator Gail Watson is available to speak to groups;

Check www.womenshealthclinic.org for the executive summary, report, news release, backgrounder, question and answer, and brochure; or

Contact the Women's Health Clinic in Winnipeg:
Gail Watson, Project Co-ordinator, (204) 947-2422, x 134;
Barbara Wiktorowicz, Executive Director, (204) 947-1517 x102; or
Madeline Boscoe, Advocacy Co-ordinator, (204) 947-2422 x 122.

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