CHAPTER 2 Overview of Women’s Health Issues
Structure
This chapter is divided into eight sections:
SECTION 1: Chapter Pre-test
SECTION 2: Chapter Objectives
SECTION 3: Sociodemographics
SECTION 4: What Does the Term Women’s Health Mean?
SECTION 5: What Makes Women Healthy or Unhealthy?
SECTION 6: History and Evolution of Women’s Health Issues in North America
SECTION 7: Medical Research Issues in Women’s Health
SECTION 8: Health Care and Women’s Health
SECTION 1: Chapter Pre-Test
1. Historically, the term “women’s health” was:
a) based on the assumption that women were dominated by their sexual functions and their reproductive systems were key to understanding any physical, mental, and moral problems.
b) not a term in use: it is a term coined in the last decade.
c) seen as a continuum, extending throughout the life cycle and is critically and intimately related to the conditions under which women live.
d) the physical health of the body based on medical examinations.
2. In the concept of women’s health, can the terms “sex” and “gender” be used interchangeably?
a) No: “gender” refers to the biological differences between men and women, while “sex” includes attitudes, feelings, behaviours, and activities that society ascribes on a differential basis.
b) No: “sex” refers to the biological differences between men and women, while “gender” includes attitudes, feelings, behaviours, and activities that society ascribes on a differential basis.
c) The term “gender” is not used in the consideration of women’s health since it does not look at biological differences between men and women.
d) Yes: “sex” and “gender” both refer to the combination of biological differences between men and women and the qualities that society ascribes.
3. As of the latest census, the population of Canada was just over:
a) 24 million, almost equally divided between men and women.
b) 36 million, almost equally divided between men and women.
c) 24 million, with 60% men and 40% women.
d) 36 million, with 60% men and 40% women.
4. In the area of women’s health research:
a) drug testing must be done on different ages and races, since this can affect the outcome of treatment.
b) research obtained from trials on men can be generalized to women.
c) the focus has been primarily on heart disease and breast cancer.
d) women can be treated as a homogenous group.
5. One of the problems women have identified in traditional medical care is:
a) differentials of power and authority between the roles of doctors (both male and female) and patients.
b) the establishment of midwifery, as it decreases the medicalization of the childbirth process.
c) the increase in community services that do not follow standard medical practices.
d) the treatment of men and women in a non gender manner.
SECTION 2: Chapter Objectives
At the end of this chapter you should be able to:
1) Cite relevant statistics related to the health of women living in Canada.
2) Define the term “women’s health” and list factors that make women healthy or unhealthy.
3) Describe the role gender plays as a determinant of health.
4) Describe the history and evolution of women’s health issues and research in Canada.
5) List key issues regarding health care delivery and reform in regards to women and explain how women’s health is affecting the education and practice of healthcare practitioners.
SECTION 3: Sociodemographics
Population
As of the latest Canadian census, there were just over 36 million people living in Canada. The population was almost equally divided between men and women. In the group under 65 years of age, there are actually 2% more males than females however for the age group 65 years and older there is a significant over representation of females with 20% more women than their male counterpart. (Statistics Canada, CANSIM)
Life Expectancy
Based on the latest mortality data, women born in 2013 can expect to live to the age of 83.8 while men can expect to live to the age of 79.6. Women who are 65 years old in 2013 would be expected to live to the age of 86.9, while men, to the age of 84.0 (Statistics Canada, CANSIM). Although, women live longer than men do, they are more likely to suffer from long-term activity limitations and chronic conditions such as osteoporosis, arthritis and migraine headaches (Health Canada, 1999). Women are also more often unattached than men in their older years. Therefore, they are often without the built-in care giving that a spouse might provide (McDaniel, 1996).
Education
Educational attainment is known as one of the key components of socioeconomic status. Socio-economic status in general, and education specifically, is often positively associated with health status. The proportion of women aged 25 to 64 with a university degree grew at a faster pace than that of men, more than doubling between 1991 and 2015 from 15% to 35%. In 1991, 14% of women had a college diploma compared to 26% in 2015. (Women in Canada: A Gender-Based Statistical Report, 2016)
Employment
The past several decades have witnessed dramatic growth in the share of women who are part of the paid workforce. In 2014 women accounted for 47% of the employed workforce up from 37% in 1976. (Women in Canada: A Gender-Based Statistical Report, 2016)
There has been particularly sharp growth in the employment rate of women with children in the past quarter century. In 2009, 72.9% of women with children under 16 living at home were part of the mployed workforce. Although the percentage has declined compared with 2008 and 2007, it is still up from 39.1% in 1976. By 2009, 64.4% of women, with children less than 3, were employed, more than double the figure in 1976, when only 27.6% of these women were employed.
While about 73% of employed women worked full time in 2009, women were, nevertheless, more likely than men to work part time. Of all part time workers in 2009, nearly 7 out of 10 were women. This proportion has changed little over the years. Part-time workers have fewer benefits and are more vulnerable to lay-off. (National Forum on Health, 1997)
The increase in the proportion of women in the workforce has implications for women’s health given that women often have the majority of child rearing and elder care responsibilities. (Statistical report on Health of Canadians, 1999)
According to the Romanow Report, one in five women provide care to someone in the home at an average of 28 hours per week, half of whom are working, many of whom have children, and almost all of whom experience tremendous strain. The report states that caregivers experiencing the strain of care-giving have 63% higher mortality rates. (Romanow, 2002) In addition, according to the Second Report on the Health of Canadians, 1999, 27% of women said care giving affected their own health and 2/3 of women working (ages 25-44) reported job repercussions due to care giving. (Health Canada, 1999)
Income and economic stability are key determinants of health. Low income Canadians are more likely to have poor health status and die earlier than other Canadians. Income has particular relevance for women’s health because women have higher rates of low income than men. This gender wage gap in Canada remains almost as wide as a decade ago. (Colman, 2003)
In addition, poverty and unemployment are associated with adverse lifestyle factors, including poorer nutrition and higher rates of tobacco use, obesity, and physical inactivity. For example, those in the lowest income bracket are two and a half times more likely to smoke than those in the highest income bracket. Wealthier individuals have a lower incidence of high blood pressure and high blood cholesterol, and they live longer (Colman, 2003)
Single mothers consistently report worse health status than mothers in two-parent families. Single mothers score lower on two scales of self-perceived health and “happiness”, and substantially higher on a “distress” scale. They have higher rates of chronic illness, disability days, and activity restrictions, and are three times as likely to consult a health care practitioner for mental and emotional health reasons. (Colman, 2003)
Perceived Health Status
Self-rated health status is a good predictor of measurable health problems, health care utilization, and longevity. Men are slightly more likely than females to rate their health status as excellent or good (63% versus 60%) but the largest differences are generally confined to younger age groups (under 25 years old). (Colman, 2003)
For ages 18-54, women were about 2-3 times as likely as men to have seen a physician in the previous 12 months. Up to age 75, women were more likely to see a physician twice or more in the previous 12 months. Women are also more likely than males to report changes to their health behaviour in the past year (50% versus 44%), and to recognize the need for changes (56% versus 53%). (Statistical Report on the Health of Canadians, 1999)
SECTION 4: What Does the Term Women’s Health Mean?
Historically, understanding of women’s health was based on the assumption that women were dominated by their sexual functions and their reproductive systems were the key to understanding physical, mental, and moral problems.
Currently, women’s health is perceived as a continuum, extending throughout the life cycle. Women’s health is understood to be critically and intimately related to the conditions under which women live.
The Fourth United Nations World Conference on Women (The Beijing Conference) held in 1995 developed a document entitled “A Platform for Action” which was embraced by 189 nations. In this document they adopted the following definition:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women’s health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology.”
(Women’s Health Strategy, 1999)
SECTION 5: What Makes Women Healthy or Unhealthy?
Many factors have been recognized as contributing to the health status of an individual. Health Canada has recognized 12 determinants of health:
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- Income and social status
- Employment
- Education
- Social environments
- Physical environments
- Healthy child development
- Personal health practices and coping skills
- Health services
- Social support networks
- Biology and genetic endowment
- Culture
- Gender
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Sex vs gender
The terms “gender” and “sex” are not interchangeable. However, sex-linked factors and gender-based factors combine to affect health. “Sex” refers to the biological differences between men and women. “Gender” refers to the socially mediated differences as well. According to the National Forum on Health “Gender includes the full range of attitudes, feelings, values, behaviours and activities that society ascribes to the two sexes on a differential basis.”
Determinants of health are highly interactive. Sex (biology) can determine different tendencies for diseases, risk factors, or treatment requirements. Gender has a strong influence on all determinants. Gender can determine differences in exposures to risks, treatment-seeking patterns, or impact of social and economic determinants of health. In any analysis of women’s socioeconomic status, wage gaps, low occupational status, and poverty are common observations.
The conclusion of a book (“Why are some people healthy and others not?”) produced by The Canadian Institute for Advanced Research (CAIR) in 1994, was that the contribution of medical care to population health is relatively minor. They emphasize that it is the social determinants of health that have a major role in determining why some people are healthy and others not. The major determinants of health defined by CAIR are:
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- Stable and satisfying employment.
- The availability of social support.
- Equitable income distribution.
- A social environment, which provides the individual with a sense of security and control.
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Identifying health in terms of social conditions rather than by access to and use of medical care is not new. The idea that the biological model of disease was inadequate in explaining health has been supported by many proponents over the years. Essentially, the determinants of health are the same for women and men, but practically, the position of women within the occupational and general social structure change the impact of these determinants. A review of the literature has shown that women are over-represented at the bottom and under-represented in the upper reaches along most of the gradients considered important by CAIR.
SECTION 6: History and Evolution of Women’s Health Issues in North America
“In the late 19th century, a woman by definition was disease or disorder.” (Cohen, 1996). Because of her role in reproduction, a woman was regarded as a deviation from the norm represented by the male. Grassroots community groups in the late ’60s and early ‘70s initiated the evolution of our understanding of women’s health. One of the first demands of the contemporary women’s movement was for safe, accessible contraception. In Canada, until 1969, the prescribing of contraceptives by physicians was illegal.
The ‘70s and ‘80s saw an explosion in Canada and the United States of self-help groups, magazines, women’s health centres, community health centres and immigrant women centres.
In 1977, the Food and Drug Administration (FDA) in the United States issued a guideline for clinical drug studies that forced the exclusion of “women with childbearing potential” from early phases of drug study (US Department of Health, Education and Welfare: Food and Drug Administration, 1977). The ban was intended to protect women and future offspring from potential long-term side effects, such as was seen with the drug thalidomide. While the FDA’s guideline only excluded women from the earliest phases of trials, many research sponsors often misinterpreted the restriction and eliminated women from all stages of testing.
Ethical and legal considerations involving women in clinical trials include the concern that female participants may become pregnant, exposing the fetus to potentially harmful substances. While this is a serious issue, it is not seen as being a valid reason for excluding such a large group from the study. In fact, the risk to the fetus can be reduced by close attention to study design (including regular pregnancy testing and education on contraception).
In the last two decades a number of initiatives have been put in place to change research trends throughout North America. These include the development of organizations dealing solely with women’s health along with the creation of new guidelines for research.
The U.S. Public Health Service’s task force on women’s health in 1986 suggested that there be a greater effort towards the inclusion of women in clinical trials. As a result, the National Institute of Health (NIH) designed a policy to encourage inclusion of women in federally funded research. From this, the Office for Research on Women’s Health (ORWH) was established by the NIH in1990 to ensure women’s health research became well represented both within the NIH and the scientific community as a whole.
In 1992, the U.S. Women’s Health Initiative (WHI), a longitudinal study of the causes and effects of disease in women aged 50-79y, was launched. The WHI has focused attention on prevention of heart disease, stroke, breast and colorectal cancers, and osteoporosis. Between 1993 and 1998, the WHI enrolled approximately 160,000 postmenopausal women with the plan to follow them until about 2007.. Three sets of clinical trials were developed with one trial focused on low fat diet,calcium and vitamin D and the other two trials focused on hormone replacement therapy. One particular trial, the combined estrogen plus progesterone trial arm, was halted in 2002 after only 5.2 years as safety concerns were raised. More details of the WHI trial will be provided in Chapter 5 of this learning program.
In 1993, the U.S. FDA retracted the ban on allowing women of childbearing age into clinical trials and issued new guidelines.
In addition, the U.S. National Task Force on AIDS Drug Development recommended in 1995 that women with life-threatening diseases not be excluded from trials, despite potential risk to future offspring.
In 1993, the Canadian Women’s Health Network (CWHN) was officially launched. The CWHN is committed to building links among organizations and individuals who care about women’s health. They strive to:
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- Provide easier access to health information, resources and research.
- Produce user-friendly materials and resources.
- Promote and develop links to information and action networks.
- Provide forums for critical debate.
- Act as a “watchdog” on emerging issues and trends that may affect women’s health.
- Work to change inequitable health policies and practices.
- Encourage community-based participatory research models.
- Promote women’s involvement in health research.
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Since the late 1980s, Canadian governments have played an increasing role in supporting community-based women’s health initiatives and in defining and developing policies that are similar to those seen in the United States. Recent initiatives and outcomes have included:
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- The breast cancer initiative (1992), which included the National Forum on Breast Cancer and enhanced research support.
- The Canadian Institutes for Health Research (CIHR)’s 1994 women’s health study report that revealed a lack of research devoted to women’s health.
- The creation of the McMaster Research Centre for the Promotion of Women’s Health in 1994.
- The establishment in 1996 of 5 Centres of Excellence for Women’s Health to help facilitate research and surveys on women’s health. The Centres are based in Halifax, Toronto, Winnipeg and Vancouver.. The Centres do not conduct biomedical* or clinical research, but identify key issues in women’s health and do research on them. They also help define a research agenda for Canada in the field of women’s health. In addition, the Canadian Women’s Health Network will help interpret the research of the Centres.
- The revision by Health Canada of its guidelines for clinical trials in 1996, requiring drug companies to include women in clinical trials in the same proportion as is are expected to use the drug. In addition, the policy requires that women of childbearing age be informed about potential teratogenicity* of the drugs being tested so that they may make educated choices about whether they should participate.
- The creation of the Women’s Health Bureau in 1993 to ensure that women’s health concerns receive appropriate attention and emphasis within Health Canada. Key activities of the Bureau are:
- The Women’s Health Strategy, launched in 1999, which provides a framework for Health Canada for gender-sensitive policy development. Its objectives are:
1. “To ensure that Health Canada policies and programs are responsive to sex and gender differences and to women’s health needs.
2. To increase knowledge and understanding of women’s health and women’s health needs.
3. To support the provision of effective health objectives to women.
4. To promote good health through preventive measures and the reduction of risk factors that most imperil the health of women.” - From the Women’s Health Strategy’s four objectives, flows Health Canada’s commitment to gender-based analysis (GBA). Health Canada’s Gender-based Analysis Policy was issued in 2000 and states that Health Canada is committed to the implementation of GBA throughout the department. GBA is a tool for examining and assessing the links between gender and health and between gender and other health determinants. GBA is designed to promote sound scientific research, and provide relevant health information and evidence, with the goal of enhancing health outcomes and strengthening health care.
- The Women’s Health Contribution Program, established in 1996, which supports community-academic partnerships in the development and dissemination of policy research and information for women’s health.
- The Women’s Health Indicators Project, launched in January 2002, which is a research initiative to develop, validate and evaluate a core set of indicators that takes gender and diversity into account. The aim is to improve the ways in which women’s health is measured and to more accurately monitor changes in women’s health status/outcomes. Its report was released in July 2003 detailing how gender, income, employment, education, and other basic social and economic characteristics have a profound effect on health outcomes.
- The Women’s Health Strategy, launched in 1999, which provides a framework for Health Canada for gender-sensitive policy development. Its objectives are:
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SECTION 7: Medical Research Issues in Women’s Health
Knowledge gaps
Women and men have been treated as gender neutral by the research community. That is, a drug or treatment that had been tested successfully on males was considered sufficiently evaluated for females as well. However, it has become more and more obvious to researchers that treatments and results cannot always be generalized across genders. Women and men differ in physiological ways that result in different responses to identical treatments. In addition, the focus of research in women’s health was primarily on fertility and reproduction. As recently as 30 years ago, coronary heart disease and lung cancer were considered to be “men’s diseases”. Applying research to women does not just require the addition of women to clinical studies, but involves gender-sensitive research methods.
As described in Chapter 3, factors influencing drug response include age, gender, race, distribution of body fat, body size, hormonal environment, enzyme production, and disease state. There have been few studies performed on the topic of gender-specific pharmacokinetics*. Of the studies performed, it has been illustrated that drug elimination can vary drastically at different points in the menstrual cycle. Pregnancy can also lead to different drug effects due to alterations in plasma protein binding. In addition, the use of oral contraceptives or hormone supplements may alter the effects of a drug when taken by women.
The pharmacokinetics of drugs in breast milk is another area of women’s health that needs to be studied further, in order to determine whether a drug is excreted into breast milk and its relative safety to the infant.
Researchers are beginning to turn their attention to conditions recognized as unique or more prevalent to women. This includes menopause, cervical, ovarian and uterine cancers (all unique to women), and also breast cancer, migraine headaches, depression, arthritis, osteoporosis and multiple sclerosis (which are more prevalent in women than in men).
In some diseases symptoms vary cyclically with menstrual cycle phase. These diseases tend to be characterized as being triggered by external factors as well as having relapsing and remitting phases. Examples of diseases with symptoms that can vary with menstrual cycle phase include epilepsy, migraine and asthma.
Canada’s commitment to Women’s Health Research
Currently, Canada is a solid foundation for a range of expertise in women’s health research.
There are:
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- over 500 self-identified, multi-disciplinary women’s health researchers in Canada.
- over 25 women’s health, health-related centres, organizations, and government departments in Canada.
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In addition to the many research initiatives mentioned in section 6 of this chapter, examples of other research units that are sensitive to women’s concerns include:
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- The Centre for Research in Women’s Health, a joint project of Sunnybrook and Women’s College Health Sciences Centre and the University of Toronto
- The McMaster Research Centre for the Promotion of Women’s Health at McMaster University in Hamilton, Ontario
- The Women’s Health Research Institute established by BC Women’s Hospital + Health Centre
- Several clinical research chairs in women’s health
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SECTION 8: Health Care and Women’s Health
Women as Patients, People of Influence and Providers
Through many efforts, Canadian women of many regions and backgrounds have questioned some of the approaches to how health services are delivered and many accepted assumptions of “quality care”. Women have identified, among others:
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- Differentials of power and authority between the roles of doctors (both male and female) and patients
- Limited communication between patient and caregiver due to time constraints on most medical encounters
- Lack of sufficient information to make informed treatment decisions
- Fragmented care, resulting in a patient who requires coordinated care feeling that she is not treated as a person but only certain body parts
- How the nature and structure of the workplace and other environments can affect health
- Added barriers for women from diverse cultures and sexual orientation, and survivors of abuse
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Women have organized and supported many creative models of community-based health services. Many of these rely on government funding, and much volunteer labour:
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- Community health centres offering primary care, health promotion and social services
- Battered women’s shelters
- Community kitchens
- Women’s centres providing health information, parenting support, and nutrition programs
- Reproductive health projects for women in immigrant and refugee communities
- Health promotion resources and programs geared to women’s needs
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Such community-based services contribute to a woman’s sense of well-being by treating her as a whole person and empowering her to ask questions and make informed decisions. An additional benefit is that being involved in patient support groups, such as for breast cancer, is shown to improve quality of life and significantly increases length of survival in women.
Women’s Health and Health Care Providers
“In Faculties of Health Sciences and Medicine, students are increasingly paying attention to gender as a determinant of health and attending to issues of gender and power in the professional-patient relationship.” (Cohen, 1996) Increasing numbers of women entering medicine and positions of influence have been vital to these efforts.
Guidelines have been developed regarding the doctor-patient relationship. In addition, information gathered in 1992 on women’s expectations of physicians is being translated into health sciences curricula.
A women’s health curriculum was developed and published by Crombie et al. in Canadian Family Physician on behalf of a joint working group in 1990. The Working Group recommended that medical residency programs cover women’s health issues like: mental health, impact of roles and relationships, concerns of special groups, violence, occupational health, and conditions more common or specific to women.
It appears that health professional education in Canada attempts to teach future practitioners to care for the whole person, rather than teaching about women or others as separate groups. The trend is for providers to be educated to be sensitive to patients in terms of ethnicity, race, religion, age, lifestyle choices, or living conditions.
As of 2017, 41% per cent of physicians in Canada and 40 per cent in Ontario were female. The Association of Faculties of Medicine of Canada reported the percentage of female graduates from accredited Canadian medical schools have exceeded their male counterparts since 2001. This shift in the mix of male and female physicians has also had an impact on physician practice, with more female physicians choosing general and family practice compared to medical specialities. (Romanow, 2002)
Reading List
Federal, Provincial and Territorial Advisory Committee on Population Health. Statistical Report on the Health of Canadians. Ottawa: Health Canada; 1999.
Federal, Provincial and Territorial Advisory Committee on Population Health. Toward a Healthy Future: Second Report on the Health of Canadians. Ottawa: Health Canada; 1999.
National Forum on Health. An Overview of Women’s Health. In: Canada Health Action: Building on the Legacy, Volume II. Ottawa: National Forum on Health, 1997.
Health Canada. Women’s Health Strategy. March 1999. Cited 10/19/99 and 11/04/2003. Available from: http://www.hc.-sc.gc.ca/datapcb/datawhb/womenstrat.html
Canadian Women’s Health Network. Cited 1/14/00. Available from: http://www.cwhn.ca/about.html
Colman R. A profile of Women’s Health Indicators in Canada, July 2003, GPI Atlantic, prepared for the Women’s Health Bureau, Health Canada.
Women’s Health in Canada: Critical Perspectives on Theory and Policy edited by Marina Morrow, Olena Hankivsky, Colleen Varcoe, 2007
Women in Canada: A Gender-based Statistical Report (89-503-X)
Romanow RJ. Building on values: The future of health care in Canada. Commision on the future of health care in Canada. Final report 2002.
Baird, Karen L. The New NIH and FDA Medical Research Policies: Targeting Gender, Promoting Justice. Journal of Health Politics, Policy and Law. Vol. 24, No. 3, June 1999: pg. 531-565.
Merkatz, Ruth B. Inclusion of Women in Clinical Trials: A Historical Overview of Scientific, Ethical, and Legal Issues. JOGNN. Volume 27, Number 1, January/February 1998: pg. 78-84.
Key Facts About the Centres of Excellence for Women’s Health Program (CEWHP). www.cwhn.ca/cewhp-pcesf/key_facts.html. Accessed on October 19, 1999.
Pre-Test Answers
1. a)
2. b)
3. b)
4. a)
5. a)
Chapter 2 Test
1.
The program launched in 1993 to provide easier access to health information and research, produce user-friendly materials and resources, to promote and develop links to information and action Networks, and to promote women’s involvement in health research is called:
a) the Canadian Women’s Health Network.
b) the Centres of Excellence for Women’s Health.
c) the McMaster Research Centre for the Promotion of Women’s Health.
d) the Women’s Health Strategy.
2.
The increase in the proportion of women in the workforce has implications for women’s health
a) due to an increase in the number of work-related injuries.
b) given that women are often still burdened with the majority of child-rearing responsibilities and elder care.
c) since women are less likely than men to seek out a physician’s advice relating to illness.
d) since women are more susceptible to common viruses than their male counterparts.
3.
In terms of self-rated health status,
a) in younger age groups, men are slightly more likely than women to rate their health status as excellent or good.
b) in younger age groups, women are slightly more likely than men to rate their health status as excellent or good.
c) men are much more likely than women to rate their health status as excellent or good.
d) women are much more likely than men to rate their health status as excellent or good.
4.
Which statement is true regarding health behaviours?
a) Although women are more likely than men to recognize changes in their health behaviour, men are more likely to report changes.
b) Men are more likely than women to report changes to their health behaviour in the past year and recognize the need for changes.
c) Women and men are equally likely to report changes to their health behaviour in the past year and to recognize the need for changes.
d) Women are more likely than men to report changes to their health behaviours in the past year and to recognize the need for changes.
5.
Many factors have been recognized as contributing to the health status of an individual. Health Canada:
a) has recognized 12 determinants of health, including age, race, and gender.
b) has recognized 12 determinants of health, including education, culture, and gender.
c) has recognized 18 determinants of health, including education, age, and culture.
d) has recognized 18 determinants of health, including income, social environment and gender.
6.
Which activity was not initiated by the Women’s Health Bureau?
a) The Women’s Health Strategy
b) The Women’s Health Contribution Program
c) The McMaster Research Centre
d) The Women’s Health Indicators Project
e) The Development of Gender-Based Analysis
7.
Health Canada’s initiatives into women’s health include:
a) a breast cancer initiative and the establishment of the Office for Research on Women’s Health in 1990.
b) a breast cancer initiative, joint Canada-US initiatives, and the development of a women’s health research agenda which includes the Centres for Excellence for Women’s Health.
c) the development of a women’s health research agenda and the publishing of the Outreach Notebook for the NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research.
d) the Women’s Health Initiative, a breast cancer initiative, and the establishment in 1994 of the Office of Women’s Health.
8.
It appears that health professional education in Canada attempts to teach future practitioners:
a) that there is no need for separate attention to be spent on women’s health.
b) to care for the whole person.
c) to limit communication between patient and doctor.
d) to treat patients as the sum of his or her body parts.
Chapter 2 Test Answers
1.
a) the Canadian Women’s Health Network.
2.
b) given that women are often still burdened with the majority of child-rearing responsibilities and elder care.
3.
a) in younger age groups, men are slightly more likely than women to rate their health status as excellent or good.
4.
d) Women are more likely than men to report changes to their health behaviour in the past year and recognize the need for changes.
5.
b) has recognized 12 determinants of health, including education, culture and gender.
6.
c) The McMaster Research Centre
7.
b) a breast cancer initiative, joint Canada-US initiatives, and the development of a women’s health research agenda which includes the Centres for Excellence for Women’s Health.
8.
b) to care for the whole person.