Bulletin Index/

What Counts in Health Research?

1. What Counts and Who’s Counted in Women’s Health Research?

2. A Full Measure: Women's Occupational Status and Health

3. Towards Gender-sensitive Health Indicators

Who's Counted in Health Research?

4. Silent Measures: Disability in the Canadian Biotechnology Strategy

5. The Challenges of Studying the Health of Women Working in Call Centres

6. Research as a Spiritual Contract: An Aboriginal Women's Health Project

Making Research Count

7. Gender-Based Analysis: Beyond the Red Queen Syndrome

8. How to Make Research Count

Towards Gender-sensitive Health Indicators

A new inventory provides summary tables of women’s health indicators compiled from Canadian and international databases. The inventory also describes features of gendersensitive indicators that could, if applied, provide a more adequate system of health surveillance for Canadian women. Indicators are important instruments in the measurement and evaluation of women’s health and are defined as "a flag, marker or sign that points to a condition you want to measure."[3] An indicator can be a number, a fact, an opinion or a perception about a specific condition or situation.[4]

To construct the inventory, we reviewed databases of academic literature and documents from research groups and government dated from 1995-2000. All documents were critically reviewed for indicators of health/women’s health, conceptual frameworks and determinants of health that apply to women’s health. "Classic" documents, such as the Lalonde Report[5], were consulted regardless of release date, as were articles prior to 1995 when they were cited by more than five references.

Our inventory is organized into four large indicator domains: the determinants of health, basic population characteristics, health status and health consequences. (By determinant, we mean the genetic, social, economic, lifestyle and environmental factors that are influential independently or in combination with one another. These are drawn from Health Canada’s Women’s Health Strategy.)[6]

By evaluating the quality and limits of indicators and determinants and the data resulting from their use in specific literature, the inventory exposes neglected areas. Significantly, although indicators arise from a wide range of conceptual frameworks, gender and culture have the least number of indicators with respect to health. Also, although one in six Canadians is an immigrant,[7] the migration experience is not currently considered as a determinant of health. It is important that any indicator used to measure the health of women includes features that consider individuality, diversity, and differences from men, especially in the context of migration.

Sex and Gender
At their foundation, all indicators should entail gender analysis[8] and have a solid comprehension of the difference between sex (biological distinctions between women and men)[9] and gender (socially attributed identity constructed by relations of power that dictate the choices and chances available to women and men, girls and boys).[10] In order to move beyond explanations of women’s health that reduce women to their reproductive capacities, the study of gender relations is also crucial. Gender relations refers to the often, but not always, asymmetrical relations of power based on sex differences that are crucial in accounting for gender differences in health.

Gender-sensitive Indicators
Gender-sensitive indicators measure gender-related changes in society over time. These indicators should provide evidence of the status of women relative to some agreed normative standard or explicit reference group (e.g., relative to men of the same population or to women in other communities or countries).[11] For example, a gender-sensitive indicator of social empowerment would be defined as one that measures the desired autonomy of women/men over fertility decisions (e.g., number of children, number of abortions, etc.).[12] Also, both quantitative and qualitative methods are needed for women’s health because they are complementary, equally effective for monitoring and evaluation, and because they can cross-validate and highlight each other’s shortcomings.

For all health indicators, there must be consensus as to what degree of imperfection will be allowed in their definition. This is generally regulated by testing to make sure that the indicator is valid (measures what it is supposed to measure), and reliable (measures in a consistent manner), but these must be conceived from a gender perspective to assure the quality of an indicator for women’s health.

Selecting Gender-sensitive Indicators
The following criteria are suggested as important markers in national level gender-sensitive indicators or indicator systems:[13]

1. Comparison to a norm: For example, the situation of men in the same country or that of women in another country, in order to focus on questions of gender equality and equity rather than on the status of women, a term which tends to have definitional discrepancies.
   
   
2. Disaggregation of data by sex. Where possible, data should also be disaggregated by age, socioeconomic status, country of origin (or birth country, including the length of time spent in said country), geographical coverage (e.g., Canadian indicators should include data from all provinces and territories, including isolated areas and Native Reserves, in order to have an appropriate geographical coverage and attend to disparities), as well as ethnic and racial group.
   
   
3. Scope of availability: Indicators should not only be reflective of the entire country but also be available for the entire country.
   
   
4. Reliability: The extent that data can be free of bias or error (e.g., reporting errors, issues of recall when asking people to re-visit childhood or traumatic experiences, tendency to under-report alcohol or tobacco consumption, etc.). The user should know how the indicators were constructed.
   
   
5. Measurability: For less precise concepts, such as women’s empowerment, proxy indicators should be used (e.g., greater choice for women in accessing health care).
   
   
6. Where composite indices are devised, value assumptions of selection and weighting must be made explicit.
   
   
7. Time frames: Gender-sensitive indicators should be reliable enough to use as a time series and the time span of indicators should be stated clearly.
   
   
8. International comparability: Indicators should be collected using internationally accepted definitions in order to allow for international comparison.
   
   
9. Participation: Indicators should be used and developed in a participatory process with stakeholders. It is important that women themselves are involved in identifying health needs and priorities and their relevant indicators.

This inventory contributed to discussions held by the Population and Public Health Branch of Health Canada on indicators to include in a Surveillance Report Card on Canadian Women’s Health.

For a copy of An Inventory of Conceptual Frameworks and Women’s Health Indicators (2001) contact:
Centre d’excellence pour la santé des femmes Centre d’excellence pour la santé des femmes – Consortium Université de Montréal
To obtain copies of CESAF publications, contact:
Canadian Women’s Health Network
Suite 203, 419 Graham Avenue, Winnipeg, MB Canada R3C 0M3
Tel: (204) 942-5500, Fax. (204) 989-2355,
Information Line (toll free): 1-888-818-9172, TTY (toll free): 1-866-694-6367
Web site: www.cwhn.ca   E-mail: cwhn@cwhn.ca

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