-most research that has been done showed that there was no attention paid to sex/gender relations,
even though they intersect to affect health status, the healthcare system and health policy. A
government strategy that was developed to respond to this shortcoming was gender mainstreaming (GB)
or gender-based analysis (GBA). According to Health Canada (2000) they said that 'GBA will help us
secure the best possible health for the women/ men and girls/boys of Canada' and morever, that 'it
makes for good science and sound evidence by ensuring that biological & social differences between
women/men are brought into the foreground'
-however, GBA has been confronted with serious political and implementation challenges; ambiguities
surrounding the categories of sex and gender persist; differences among women with regard to health
status, experiences of the health care system, health behaviours, and other determinants of health are
not properly identified or responded to. Also, men and their health have not been addressed.
– (look on pg.148 for GBA and how Health Canada feels about it n why its looked upon as helpful)
-GBA seeks to understand how and why inequalities occur in health; however womens and mens needs
often differ and substantive knowledge gaps remain about women's health, in particular regarding
differences among different groups of women. Research is lacking especially for Aboriginal women,
women with disabilites, immigrant women, women of colour, older women, and lesbian women who
require special attention and dedicated resources.
-key factors for successful GBA implementation include political commitment; sensitization to gender
issues among the public; training for decision-makers, implementers, and other officials; adequate
funding; efficient and comprehensive informaiton and data collection systems
-GBA has not been incorporated with policy development, implentation or evaluation; to support this
the government of Canada even says that 'we still face challenges to gender mainstreaming and
institutionalizing the application of gender equality objectives, analyses and processes in the work of
-another impediment to effective GBA is the multi-jurisdictional nature of Canada; even though GBA has
been established as a key federal policy tool, many provincial policies affecting health have been and
continue to be developed without a GBA analysis. Because health intersects with wider social policies,
GBA must be applied across the border in order for board in order for broad societal change to be
-the absence of a systematic application of GBA in health can lead to mistakes in health research and
policy, and can be costly in terms of economic and human costs, including lost opportunities, ill health,
suffering, and overall societal loss
-another drawback is that in GBA, sex and gender are conflated. They both need to be recognized
individually on their own. The variable of sex is important in analysing 'diseases and disablities from
which women suffer because of their sex; dieseases and disabilities for which both men and women
suffer, but which are more prevalent in women or that affect women more severely or that have more
adverse effects on women during pregnancy or from which women are less able to protect themselves.
The variable of gender is important because gender can 'determine different exposures to certain risks,
different treatment seeking patterns, or differential impacts of social and economic determinants ofhealth.
-Health Canada GBA policy says that the GBA framework should intersect with a diversity analysis which
considers factors such as race, ethnicity, level of ability, and sexual orientation. Diversity analysis is a
process of examining ideas, policies, programs, and research to assess their potentially different impact
on specific groups of women and men, and girls and boys; the class or socio-economic status, age, sexual
orientation, gender identity, race, ethnicity, geographic location, education, and physical/mental ability
may differently affect a specific groups' health needs, interests and concerns. However when these
differences are taken into account as an author says, they are treated as constituting add-on dimensions
to the variable of gender, even by women's health researchers. This can marginalize their significant and
it often leads to the essentialization and creation of the 'Other', which perpetuates the privilege that is
experienced by affluent, educated white women.
-Hankivsky proposes a viable alternative, one that would pay sufficient attention to differences and
power relationships would 'diversity mainstreaming'; diversity mainstreaming retains the category of
gender, albeit in a qualified manner and it puts front and centre various forms of oppression and
explores how they interconnect and mutually reinforce one another
-another problem with GBA is that men and their health is not addressed; very little has been paid
attention to the impact of gender on men's health; gender roles can have impact on men's health as well
as women's health for examples the values associated with masculinity, including competitiveness,
material success, and engaging in risk-taking behaviour have health repurcussions
-basically with GBA, it is an essential variable in understanding the health of women, but it is itself
inadequate. Political obstacles remain, which need to be addressed.
Engendering Evidence: Transforming Economic Evaluations
Two important issues at the forefront of Canadian health policy:
o Fiscal considerations
Through evidence-based medicine (EBM) and Evidence-based policy making
(EBP) which lead to less waste in the health sector.
o Gender inequalities
policies should be ‘gender aware’ and ‘diversity inclusive’.
Evidence-based medicine (EBM) Quantitative
The use of the current best evidence in making decisions about the care of individual patients
EBM is based on the idea that scientific medical knowledge exists in some way uncontaminated
by social life and can be applied to humans.
EBM entails deconstructing, stripping away of contexts and controlling for bias while searching
for universal truth.