MEDICARE AND GENDER: Let's Tackle Health Care Reform as If Women Mattered
Armstrong, Pat, CCPA Monitor
In looking forward, we need to make health care the objective rather than the problem. And instead of seeing expenditures on health care as the primary issue, we should look at the contributions health care makes, not only to the overall economy and corporations, but also to employment and communities. To do so in ways that are equitable and effective, and thus efficient, we need to recognize that gender matters and understand the ways gender matters in health and care.
Women account for 80% of the health care labour force and provide the overwhelming majority of the unpaid personal care. They also comprise the majority of those who use the health care system, in part because they have the babies and because they live longer than men, and in part because of the ways they are treated as workers and patients in health care. Women are also the majority of those who take others for care, although they are a minority of those making the major decisions about health services and about the other factors that shape our health.
Integrating gender into our care strategies thus means beginning with a focus on women and ensuring that they are not missing from the plans for care. It means recognizing differences among women as well. This understanding must be fundamental to research, policy, and practices.
Attending to women's health goes far beyond boobs and babies to understanding that the lives of women and men, boys and girls are shaped and experienced in different and usually unequal ways. In planning for timely access to care for hips and knees, for example, we need more research into why women are twice as likely as men to need new hips and into how we can ensure that they get access to care in proportion to their need, taking their responsibilities for unpaid care into account. Only then can we work to reduce the need for new hips and organize services in ways that allocate care where it is needed most and that are appropriate to these needs.
We must start by asking what services are required and where, for which women and men, and why. For example, we know from research by the Aboriginal Women's Health and Healing Research Group that AIDS cases are almost three times higher among Aboriginal women than among non-Aboriginal women. First Nations and Inuit women have a diabetes rate nearly five times that of other women, with higher relative rates than men. We need to investigate the factors contributing to these differences and inequities, examining the daily conditions of their lives, as well as ideas about these women and their bodies, and the ways they are treated in care.
This means establishing not only what services have to be provided to them but also what kinds of services are available and where they are located-all critical to understanding questions of timely access, efficiency, and equity. Without culturally appropriate services near where they live and without services provided in ways that address causes, relationships and confidentiality, women cannot receive timely, effective access and they, along with the entire health care system, will pay more in the long run. In short, we should begin long before these women reach the health service and evaluate the services with different criteria in mind.
Attending to women's health care work means reexamining the structures and relations in health care work and integrating a gender analysis into our plans for care services. Let me give you some examples.
First, consider the concern over nursing shortages and the aging labour force. It is no accident that the bulk of the nursing labour force is, for the first time, over age 50. This never happened before because we made many nurses quit when they were young. Initially, they were forced to leave when they got married. Later, married women could stay, but they had to leave when they became pregnant. Older nurses tended to be single women who worked as supervisors and often lived in a residence that provided them -with food and clean clothes. …