Transcript Final draft Oral presentation HCSce Forum

Bureau of Women’s
Health and
Gender Analysis
Bureau pour la santé
des femmes et l’analyse
comparative entre les sexes
(BWHGA)
(BSFACS)
Health Canada Science Forum
Ottawa, October 8-9, 2008
Sex and Gender Differences in Extreme Heat Events:
Building a Collaborative Knowledge Base for
Adaptation to Climate Change
1
BWHGA
BSFACS
OVERVIEW
 Introduction
 Research Methodology & Conceptual Framework:
Gender-based Analysis Of Risk Factors
 Gender And Extreme Heat Events: Preliminary Findings
 Lessons Learned: Research And Interventions
 Moving Forward: Next Steps
2
BWHGA
BSFACS
Research Background & Methodology
 Computer-assisted English-language search
 Academic and grey literature
 International and Canadian sources
 Morbidity and mortality data
 Close review of case studies reporting sex and gender data
 Guiding gender-based review questions





How were sex-specific data used?
Who conducts gender-based analysis?
What differences, if any, have been found?
What factors best account for these?
How do sex and gender interact with known risk factors?
3
BWHGA
For women and men in
extreme heat events, how
do sex & gender affect:
BSFACS
Analytic Framework:
Gender-based Analysis
BSFACS
BWHGA
 Exposure?
 Susceptibility?
 Coping & adaptation?
 Intervention?
Gender-based Analysis
SEX
the genetic,
biological and
physiological
characteristics and
processes that
generally
distinguish males
and females
GENDER
Interrelated
through
complex
pathways
Note: DIVERSITY
analysis overlays
GBA
the socially
constructed roles,
relationships,
values, attitudes,
and forms of power
that are commonly
attributed to either
men or women;
includes selfrepresentation
4
BWHGA
BSFACS
Identified Risk Factors for Extreme Heat Events
 Demographic, e.g. age, marital status, income, ethnicity
 Health conditions/behaviours, e.g. dementia, alcohol, CVD obesity,





medications
Sociocultural, e.g. social isolation, dependency, housebound, lack of
knowledge and resources
Occupational and leisure activities, e.g. heat-exposed stressful labour
and sport
Seasonality, e.g. early in heat season
Spatial location, e.g. urban, heat-exposed residences and
neighbourhoods
Institutional capacity, e.g. lack of alerts, emergency planning or
interventions
5
BWHGA
BSFACS
Some Sex/Gender Dimensions Of Known Risk Factors
Activity: Female-dominated workplaces such as bakeries and cleaners; maledominated workplaces such as military, farm, construction. Sports such as
wrestling and military exercises increase men’s risk.
Demographic: Longevity especially increases the effects of health conditions
and extreme heat for women. Lower incomes limit resources and options
(housing, transport), especially for senior women.
Health conditions and behaviours: Conditions related to old age such as
dementia increase risk for women especially. Obesity and alcohol abuse
increase risk for men especially
Socio-cultural: Men’s weaker ties to family increase risk in old age. Women’s
longevity increases late-life dependency; women immigrants’ lower rates
of literacy is isolating. Men’s greater risk tolerance and lower risk
perception increase their risk.
6
BWHGA
BSFACS
Extreme Heat Events And Gender:
Preliminary Findings
1.
2.
Gender-based analysis {GBA} is very rare
-
Only 4 of 70+ publications reviewed addressed gender issues
-
Sex analyzed as a variable but without gender analysis
-
Age-based samples may mask large gender patterns
Little analysis of morbidity using GBA
-
3.
Most analysis based on excess mortality vs. effects on overall health
conditions, access to hospital care, etc.
Little Canadian research with sex-specific data or GBA
7
BWHGA
BSFACS
Preliminary findings (cont’d)
4.
Both women and men are at risk in extreme heat

In 46 discrete data sets, over half (54%) reported excess mortality higher
for women (vs. 46% reporting more excess deaths among men)

Methodology makes a difference
•
US researchers study all heat-related deaths & find men at most risk
•
International researchers study heat waves & find women at most risk

Context and cultural differences in society and in gender relations also
matter, e.g. care giving patterns, emergency preparedness, population
diversity, gender norms
8
BWHGA
BSFACS
Preliminary findings (cont’d)
5. Sex/gender interact in complex ways with other risk
factors: Age
9
BSFACS
BWHGA
Preliminary findings (cont’d)
Sex/gender interact in complex ways with other risk
factors: Ethnicity/race
Hyperthermia Mortality by Race and Sex
Missouri, 2000-2007
Source: Missouri Department of Health and Senior
Services, accessed September 19, 2008 from:
http://www.dhss.mo.gov/Hyperthermia/hyper3.pdf
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Men
Women
Black
White
10
BWHGA
BSFACS
Preliminary findings (cont’d)
6. Extreme heat morbidity is gendered, too

Provisional analysis of Manitobans hospitalized with hyperthermia, 1992-2007

More men (133) than women ( 87) were hospitalized with hyperthermia over
15 years (N= 220)


What put these men at increased risk?
What factors protected women?
Source: Manitoba Health, 2008. Note: Age and sex are tracked for cross-tabulation.
11
BWHGA
BSFACS
Lessons Learned
 Many methodological issues remain, e.g.

Lack of consistency in data collection for heat related mortality and
morbidity

Lack of consistency by jurisdiction

Sex/gender not systematically defined & addressed in biomedical
research on heat health

Lack of qualitative, contextual analysis
12
BWHGA
BSFACS
 Research needed to inform policy & emergency management, e.g.

How do sex & gender relate to heat risk factors other than age-related health
conditions?

How do sex & gender affect exposures, susceptibilities, coping and adaptive
capacities for women and men through the life course?

What specific factors are protective for women and for men in extreme heat? In
what geographic and social-cultural contexts?

How will national and regional trends in Canada affect women and men, boys and
girls in a warming environment?

How do sex/gender differences in the impacts of extreme heat events interact with
the practical considerations of developing heat messaging and other protective
measures?

In the Canadian context especially, what are the primary practical opportunities for
action to protect women and men from the effects of extreme heat?
13
BWHGA
BSFACS
Moving Forward:
Key Messages And Recommendations
 Context matters. Extreme heat mortality is not a simple function of
any single risk factor.
 Sex and gender considerations provide important contextual
information that can help to more effectively assess risks, plan
interventions and direct resources.
 More multidisciplinary research (both qualitative and quantitative)
is needed to identify and target high- risk populations of women
and men.
 Sex- and gender-sensitive research findings can enhance heat
alert and other preparedness strategies to ensure appropriate
interventions.
14
BWHGA
BSFACS
Thanks to the team of authors and reviewers
Authors:
Bureau of Women’s Health and Gender Analysis/RAPB/Health Canada:
Mireille Kantiebo, Sari Tudiver, Jennifer Payne, and Cindy Moriarty
Elaine Enarson - Consulting
Margaret Haworth-Brockman, Prairie Women’s Health Centre of Excellence
Madeline Boscoe, Canadian Women’s Health Network
Reviewers:
Climate Change and Health Office/ /HECSB/Health Canada:
Anna Yusa, Stephen Dolan, and Ugis Bickis
David Dougherty, Health Policy Research Division/SPB/Health Canada
15
BWHGA
BSFACS
If you have any further questions or comments, please contact:
Mireille Kantiebo ([email protected])
Elaine Enarson ([email protected])
We gratefully acknowledge the support of our partners in this work, including the Climate Change
and Health Office of Health Canada, Health Policy Research Division, Prairie Women’s Health
Centre of Excellence, Canadian Women’s Health Network, and the US Centers for Disease Control
Additional resources:
Climate Change and Health Office at Health Canada
www.healthcanada.gc.ca/cc
Gender and Disaster Network
http://gdnonline.org
Gender and Climate Change
http://www.gencc.interconnection.org/
16