Biennial Report of the Minister's Advisory Council on Women's Health

Letter to the Minister

Honourable Penny Priddy
Minister of Health and
Minister Responsible for Seniors
Room 133
Parliament Buildings
Victoria B.C. V8V 1X4

Honourable Penny Priddy:

We are pleased to forward to you the second biennial report from the Minister's Advisory Council on Women's Health. Working together to improve women's health has been an exciting challenge and we look forward to continuing our efforts towards creating positive change for women in British Columbia.

The priorities identified by the Council for study in the immediate future are:

• Regionalization and Women's Health
• Women and Violence
• Women and Mental Health
  

We appreciate your personal commitment to women's health, the support of your office and the assistance of the Ministry staff in enabling us to fulfill our mandate.

Sincerely,

Nancy Hall, Ph.D.
Chair
Minister's Advisory Council on Women's Health

Canadian Cataloguing in Publication Data
	British Columbia. Minister's Advisory Council on Women's Heath. Report of the Minister's Advisory Council on Women's Health, - 1994/1996 - Biennial ISSN 1481-3645 - Report of the Minister's Advisory Council on Women's Health 1. Women's Health Services - British Columbia - Periodicals. I. British Columbia. Ministry of Health and Ministry Responsible for Seniors. II. Title.
RA564.85.B732    362.1'082'0971105    C96-960298-7

Report of the Minister's Advisory Council
on Women's Health 1996-1998

Introduction

The purpose of this report is to communicate to the Minister of Health and the women of British Columbia the mandate and activities of the Minister's Advisory Council on Women's Health during the period June 1996 to June 1998.

Background

Established in September, 1994 following a Provincial Women's Health Conference, the council is made up of 15 members - women from different regions, cultural groups, and communities throughout the province of British Columbia, and government representatives.

Strategic Development of the Council

Given the speed of change in health care administration and the need to facilitate and maintain a well functioning group, members of the Advisory Council agreed to take the time to develop a strategic plan which would provide a framework and direction for our work. We developed guiding principles, a process for our work, as well as action areas and priorities. What follows is the consensus we were able to reach regarding women's health and our role in ensuring health for women in British Columbia.

We have worked hard to ensure that the health needs of women remain a priority by bringing forward the interests and concerns of women in our communities.

Consensus Statement

We have been very pleased to serve as members of the Minister's Advisory Council on Women's Health. It is a great privilege for us to help develop and support the work begun by women throughout the province.

The regionalization of health care administration has increased public participation in health care decision-making as never before. As this regionalization process evolves there is always the potential of great gains and the risk of losses in services to women. We have worked hard to ensure that the health needs of women remain priorities by bringing forward the interests and concerns of women in our communities.

We bring a feminist perspective to our work and have attempted to develop a working style or process that gives each member an equal voice.

Aside from their participation on the Minister's Advisory Council on Women's Health, many members of the Council are also involved in their communities as individual advocates for women's health. In this capacity, they are able to share their experiences from the community at council meetings.

Membership
Cecilia Benoit Marion Crook Erin Dale Nancy Hall, Chair Rita Harder Marcia Hills Maria Hudspith Sally Kimpson Amandah Lea Florence Martin Alicia Mercurio Margaret McPhee Myrna Millar Debbie Pearce Basha Rahn Deborah Schwartz Rita Scott Marla Yaroshuk Simin Tabrizi	Victoria Coquitlam Kamloops Vancouver Delta Victoria Vancouver Victoria Vancouver Nanaimo Vancouver Vancouver Vancouver Vernon Williams Lake South Slocan Terrace Prince Rupert Vancouver

Government and Hospital Representatives
Effie Henry	Ministry of Health and Ministry Responsible for Seniors, Victoria B.C.
Anne Speer	Ministry of Health and Ministry Responsible for Seniors,Victoria B.C.
Sheryl Jackson	Ministry of Women's Equality, Victoria B.C.
Donna Klingspohn	Ministry for Children and Families, Victoria B.C.
Penny Ballem	Children's and Women's Health Centre of B.C., Vancouver B.C.

Our Philosophy of Women's Health

"Health is a resource for everyday life." ^* Women's health encompasses body, mind, and spirit; and is influenced by our biology, and the attitudes and beliefs we hold about ourselves, our health, and our lives. It involves trust in the wisdom of our bodies and a sense of pride in being female. Thus women's health is a measure of our ability to change, realize our potential, respond to conditions within and outside of ourselves, and cope with our lives. All women, whether newly born or preparing to die, have the potential to experience health and well-being.

Women's health is also inextricably connected to the place and to the times in which we live and is affected by social, economic, political, environmental and historical forces. Therefore, women's well-being is both a personal and a collective responsibility.

*From the WHO definition.

The overall mission is to achieve better health for women.

Our Mission

The mandate of the council is to advise the Minister of Health on issues relating to the health needs of women, the development of health care policy and the delivery of women's health services. The overall mission is to achieve better health for women.

Core Strategies for Working to Improve Women's Health

• collaborative relationships
• feminist analysis
• advocacy
• well functioning council
  

Goals

1. Provide an informed perspective on women's health issues through careful information gathering and analysis.
   
2. Provide effective and timely advice to the Minister of Health.
   
3. Advocate on behalf of individuals, groups and identified populations.
   
4. Evaluate our actions as a council and our process in working together.
   

Major Conferences

The Council members agreed that consulting with community women is a critical part of our mandate and endorsed the concept of holding regional meetings on specific topics. In the past year we developed two regional conferences:

1. In October 1997, the Advisory Council worked with the First Nations Women's Group in Prince Rupert, B.C., to develop a mini-conference to discuss and enrich our recommendations regarding Alcohol and Other Drug Problems and B.C. Women . The day long meeting was attended by over 80 women from the northwest and was considered a very successful networking and education event.

2. In March 1998, the Advisory Council worked with the Health Association of B.C. to develop a mini-conference Building Connections for Women's Health, to discuss women's health within the context of the regional health authorities. This meeting in Vancouver was attended by over 50 governors and 100 women representing community women's groups, services and programs, and served to open the dialogue with the HABC about providing education and technical supports to the new governors of the health system. We were pleased that the Honourable Penny Priddy, Minister of Health and Minister Responsible for Seniors, and Honourable Sue Hammell, Minister of Women's Equality, were able to attend and give key note addresses.

Issues of Interest

Our chair and individual members have involved themselves in a variety of issues and processes of importance to women's health. Among them are:

Medicalization of Women's Health

"Medicalization" refers to the tendency to take a life passage such as childbirth or menopause and turn it into a medical problem requiring drugs or surgery, often ignoring the social and psychological aspects of this passage. During 1997, the issue of menopausal health and the management of osteoporosis came to the attention of the advisory council. Osteoporosis is a name given to the progressive demineralization of bones that occurs with normal aging. Osteoporosis as a disease is diagnosed by a statistical comparison of the elderly woman's bone density to that of a premenopausal woman. Fractures have many different causes including, but by no means limited to, osteoporosis.

Evidence-based studies show that the effectiveness of bone densitometry screening in predicting future fractures is poor (Effective Health Care 1994; BCOHTA 1996); yet provincial health ministries are still pressured by doctors and consumer groups to provide access to this technology while population health strategies are neglected.

The advisory council continues to advise the Minister to support a balanced approach to menopausal health and osteoporosis by advising women to pay attention to diet and exercise, to reduce the use of sedative hypnotic drugs such as Ativan, and help frail elderly women maintain their mobility in the community.

Reproductive Health

The majority of British Columbians indicate that reproductive choice is a matter between a woman and her doctor and pregnancy termination is a madatory service in B.C. Yet certain individuals continue to demonstrate publicly and threaten the lives of abortion service providers. Perhaps because of this intimidation, women living outside of the Lower Mainland often have difficulty in accessing abortion services in their health region.

The Advisory Council has been supportive of the efforts of health ministers Joy MacPhail and Penny Priddy to protect the safety of abortion service providers as well as more recently, to improve access to abortion in rural areas of B.C.

New Reproductive Technologies

In contrast to the waning interest in providing abortion services, medical scientists continue to develop new technologies to diagnose fetal abnormalities. The advisory council reviewed a proposal for the expansion of the triple marker screening program to detect neural tube defects with an antenatal blood test and cautioned the minister against expanding a program of screening. Current screening programs lack good quality control data and expansion of the program would be at the expense of other initiatives for women's health.

As the recommendations from the federal Royal Commission on New Reproductive and Genetic Technologies are yet to be implemented in B.C., the Advisory Council will continue to monitor this aspect of care.

Midwifery

Since 1994, the advisory council has worked to support the development of the necessary legislation and agreements to implement midwifery in B.C. As of March 1998, 32 midwives are legally practicing in B.C. supported by full public funding from the Ministry of Health. While the practice of midwifery has become a debated issue, in a year where doctors were renegotiating their fee schedule, the advisory council has always stood by midwifery as a choice for birthing women that emphasizes support for the normal birthing process and birth in the location of the woman's choice.

Breast Health

In 1995, the advisory council reviewed the current system of prevention, care, rehabilitation and research of breast health that was in place for B.C. women. Two new initiatives were developed consequent to Advisory Council and other lobbying:

• The Breast Program and Clinic at B.C. Women's where women with a positive mammogram can obtain an accurate diagnosis of health or cancer within one week. In addition, the clinic offers an innovative breast health teaching program for rural physicians.
• Support for the Screening Mammography Program of B.C. to develop a more active recruitment process for women over the age of 50 as this is the age group where two-thirds of the cancers occur and screening participation rates were lower in this group than among women under 40 years. This recruitment of post-menopausal women was also supported by a prevention care television media campaign.

Advisory council members Myrna Millar, Erin Dale, and Penny Ballem participated in the Breast Health TeleForum held by B.C. Women's Foundation in May 1998.

Aboriginal Women's Health

The advisory council has attempted to facilitate strength building among aboriginal women by partnering with the First Nations Women's Group in Prince Rupert in October 1997, to discuss women's health and the need for women-centred care. We also featured aboriginal women's health at our meeting with the provincial health authorities in March 1998.

Major Areas of Activity

In October 1997, at a joint meeting of outgoing and incoming Council members held in Prince Rupert the group identified three strategic priorities for future action. The council will also address any ongoing issues raised by the health minister, the Women's Health Bureau or community women. The strategic priorities identified for 1998-2000 were:

• Regionalization and Women's Health
• Women and Violence
• Women and Mental Health

The council members also agreed to take on the work of implementing the recommendations from the paper Alcohol and Other Drug Problems and B.C. Women .

Regionalization

Regionalization and the accompanying decentralization of health services has occupied the advisory council's agenda for much of the past four years. The challenge has been to ensure that the health needs of populations that are less well served such as women, multi-cultural and refugee groups, aboriginals, persons with disabilities, and children and elders are addressed within the new structure.

The advisory council supported the minister's wishes to see qualified women as governors of the newly established regional health authorities. It is recognized that women-centred care would not become a reality unless women were appointed to the boards and councils on an equal basis with men.

We are currently exploring with the Health Association of B.C. ways of bringing education about women's health issues such as mental health, violence and addictions to regional health authority governors and staff throughout the province. A series of one day workshops will be given at regional health authority meetings throughout the province in the spring and fall 1999.

Women and Violence in the Health System

Six out of every 10 women in B.C. experience some form of violence from men after the age of 16, the highest rate of recorded incidents in Canada. In their lifetime, one in two B.C. women is a victim of sexual assault, one in three of spousal assault, and one in five of other types of physical assault, but support for action on violence against women within the health sector has been limited.

Funding has been provided by the Ministry of Health for the Sexual Assault Nurse Examiner Program at B.C. Women's that trains nurses to counsel and conduct forensic exams of women who present to hospital emergency rooms after being assaulted. In 1998, the decision was made to extend funding to B.C. Women's to provide training for health workers on responding to domestic violence and sexual assault in the health regions.

In March 1997, the advisory council together with the Ministry of Women's Equality, decided to develop a policy paper summarizing the health impacts of violence and outlining best practice situations around the province. This report will identify innovative, women-friendly health sector strategies concerning violence against women. Best practices in B.C. and elsewhere will be highlighted as well as suggestions for innovation in prevention, early intervention and treatment. The report will be released in fall 1998 at a one day conference in Kamloops on 'Towards an Agenda for Change. Strengthening the Response of the Health System to Violence Against Women.'

Women and Mental Health

The advisory council has been active in three areas related to mental health.

1.  The 1998 Mental Health Plan

The Advisory Council played an important role in recommending that the draft Mental Health Plan change from a gender neutral document to a plan that recognizes the unique mental health needs of women. The health care system tends to use the male experience as the norm and providers ignore the fact that relative to men, women are more likely to be living in poverty, more likely to experience violence in a relationship and more likely to have family care-giving responsibilities that create unique vulnerabilities and access problems. This recognition in turn necessitates a gender specific response where healing and recovery can take place in a safe location and that links between service providers in mental health, transition houses, consumer organizations and service providers in alcohol and drug treatment need to be strengthened.

2.  Trauma Services to Persons with Mental Illness

In 1994, in response to the Ombudsman's report Are You Listening?, a trauma services unit was established at Riverview Hospital to serve as a provincial resource to treat patients and educate providers in methods to address a history of trauma in patients with mental illness. Despite our efforts to the contrary, this unit has been disbanded in the downsizing of Riverview. The advisory council will look for future action in this area to support this important health need. We also will take forward concerns from community women about violence and trauma resulting from their experiences with the medical/psychiatric system.

3.  Mental Health Services for Parenting Women

The advisory council was asked to review a proposal to expand the present Reproductive Psychiatry Program at St. Paul's Hospital and B.C. Women's Hospital. While we questioned the naming of the women's specialty in psychiatry to "Reproductive Psychiatry," we are also eager that service systems recognize and respond to the unique needs of women who are either pregnant or parenting and experiencing mental illness. We will continue to work in this area in the coming year and also support a collaborative research project with the B.C. Centre of Excellence in Women's Health that is examining women's unique mental health needs.

Women and Addiction

1.  Systemic Change

Council members identified a woman-centred analysis as a significant strategy in supporting action regarding women with needs related to addiction. We were concerned about the growing evidence of criticism against marginalized women with substance misuse problems and a service system that was not as responsive as it could be in addressing these needs.

We were also concerned about changes in the addictions field in B.C. These included:

• Move of the responsibility for Alcohol and Drug Services from the Ministry of Health to the new Ministry for Children and Families.
• A policy environment that puts the needs of the child against those of the woman by removing to care children of women with addictions.

In January 1997, the advisory council developed a policy analysis of the needs in respect to women experiencing problems with alcohol and other drugs. Consultant Nancy Poole worked with a subcommittee of the council to develop an analysis.

We presented our report on November 1997, and asked that the minister appoint an interministry working group to work to ensure that the following are addressed:

• Problems identified in the report with the current system of care from the perspective of its ability to provide women-centred care and a continuum of alcohol and drug related services from primary prevention through early and brief interventions to specialized treatment.

The 1998/99 budget had some enhancements in support of women-centred detoxification and withdrawal services but we are still concerned about the lack of focus on prevention and early intervention priorities.

Note: Copies of this paper, entitled Alcohol and Other Drug Problems and B.C. Women are available through the Women's Health Bureau, Ministry of Health, at 5-1, 1515 Blanshard Street, Victoria, B.C., V8W 3C8.

2.   Women and Tobacco

As lung cancer has recently overtaken breast cancer as the primary cancer from which women die and more young women are starting to smoke than young men, the advisory council undertook various actions to support a woman-centred approach to smoking reduction and cessation. We assisted former health minister Joy MacPhail in introducing a special Women and Tobacco Initiative so that women-centred approaches could be delivered in the regions. Advisory council member Deborah Swartz, developed such an approach to smoking cessation that has been published by the Women's Health Clinic in Winnipeg and is currently being implemented throughout B.C. as one of the Women and Tobacco projects. We are supportive of continuing Ministry of Health action in this area.

Acknowledgements

We are most appreciative of the support of the Women's Health Bureau staff and are proud of the cooperative working relationship that has developed between the Minister's Advisory Council on Women's Health and the Women's Health Bureau.

Our second two-year term as the Minister's Advisory Council on Women's Health has been an exciting opportunity to explore issues of importance to women's health. We wish to thank the people who shared their expertise and made presentations to help us with our learning process.

Special thanks to: Honourable Joy MacPhail, previous Minister of Health, and our new minister, the Honourable Penny Priddy, who have both been very responsive to our suggestions and concerns.

Above all, we would like to thank the women of British Columbia for providing us with information and highlighting issues for us to work on as a council - we are grateful for this opportunity to advise the Minister of Health on issues that are important to you.

Last Revised: July 21, 2005