Engendering evidence; Transforming Economic Evaluations
2 important issues are currently at the forefront of Canadian health policy; fiscal consideration
and gender inequalities in health, particularly those affecting women. In evolving fiscal culture in
which cost containment and reduced public health expenditures are prevalent.
As result evidence based medicine (EBM) and evidence based policy making (EBP), which claim
to reduce waste are seen as essential to the health sector.
The argument that we make in this chapter is that if evidence based policy is to be sufficient,
effective and specifically beneficially to women’s health, work needs to be done to better
understand the gender and diversity biases inherent in the methods of economic evaluations.
Our goal is not to reject economic evaluations but instead to explore how they can be
Evidence Based Medicine
Evidence based medicine (EBM) is premised on the idea that scientific medical knowledge exists
in some way uncontaminated by social life and it can be applied unproblematically to the human
Its perceived benefits are improved treatment, greater openness in clinical decision making and
better informed patients regarding the potential benefits and harms of different treatments.
Feminists have observed that emotion and intuition have little legitimate place in EBM
And yet intuitive insights are commonplace in general practice,clinical decision making is
entirely a logical and deductive process.
The problem of this gender exclusive research is two fold :it perpetuates the myth that
cardiovascular disease is a man's disease and by applying the findings to the female population
, it leads to faulty understanding and responsiveness to women's Cvd. .
Current approaches to producing evidence reinforce the traditional biases of the biomedical
model .As Rogers (2004) observes,EBM is superimposed upon here t medical
practice(informed by a biochemical framework) repeating Nd reinforcing existing biases against
women both in research and in treatment .
EBM neglects gendered differences in the causes of ill health
Evidence Based Policy
Evidence based policy EBP is qualitative different from EBM ( black, 2001)
It is different because it concerns decisions at the population policy level rather than the
individual clinical level EBP health is Health policy reform, including discussions on health priorities, have been
undertaken without a requisite evidence based
Because evidence based health policy is the prices of finding, appraising and interpreting
reaserch according to an explicit set of decision results and statistical and epidemiological
It is thought to provide the needed information to ensure both scientifically sound and phi
socially prudent decisions
EVP Encourages investment into treatments , programs and policy's that will work
Evidence based health policy,economic evaluations and ethics
Health policy can be defined as those actions of government and other actors in society that
are aimed at improving the health of populations
Rising health care costs an aging population,grieving pressures on the health care system
Limited health resources are all contributing to the increased interest in economic info
Economic evidence derived from full and partial economic evaluations are increasingly seen as
useful and necessary .of these cost effectiveness analysis (CEA) and cost of illness (CPI) studies
dominate current practice .
CEA seeks to maximize some total good through the most efficient use of limited resources .
CEA studies are considered full economic evaluations ,they meAsure both the cost of a specific
treatment and the expected benefits arising from it
Benefits are often
Waisted in terms of QAlys(quality adjusted life years)
CEA studies provide a close up perspective on the cost s and consequences of specific
treatments or health intervention s
They are used widely in a number of areas to compare the effectiveness of alternative forms if
treatment for specific medical conditions.
In contrast to CEA ,COI studies are partial economic evaluation and. Provide a broad macro
perspective on only the current rather than potential costs associatedv
with different categories or causes of I'll health.
They provide a comprehensive summary of the wide costs involved in any health issue.
Can praise political justification do conducting other types of studies .
Despite their growing popularity ,economic evaluations still require improvement
According to hankivsky et al (2004 ) what is included in terms of costs and how costs are
measured and analyzed in terms of their distributional implications reflect an inherently
discriminatory methodology that has profound implications for equity
Recently important work is emerging at the interface of economics ,ethics moral philosophy and
In particular the value choices and ethical assumptions underlying the production of evidence
and more specifically economic evaluations are being interrogated leading to serious questions
about existing methodologies and their practical applications
Applying a gender and diversity lens to economic costing studies
In terms of costing studies ,applying a gender and diversity lens can assist in interrogating what
is measured ,how it is measured and analysed and how the process either reduces or
contributes to health inequities including those associated with gender and it's
Applying a gender and diversity lens also demonstrates that if health care is to become truly
evidence based changes are needed in terms of what is counted as evidence .the methods for
gathering and synthesizing
Evidence will need to be broadened substantially.
In the context of COI studies used faulty and discriminatory approaches .what is counted and
how it is counted dies not yet reflect the municipality of women identities ,interests ,and
The narrow emphasis of costing research on treatment rather than prevention of illness and
The breadth and scope of the current generation of economic costing studies severely limit their
usefulness to policy makers who are interested in understanding n