Status of Women Committee on May 17th, 2016

[Eva Nassif, Liberal, Vimy, QC]

What role does the Ministry for Women play in regulating training, administration, and monitoring of GBA?

[Dr. Jo Cribb]

As a ministry, we look at all the gender implication statements, but I would signal again that's once something is submitted to a cabinet committee.... In some ways this isn't a useful tool to change that policy, but we can also see where good analysis has been done and where not so good analysis has been done and maybe use that as an indicator about where we should offer our services to our colleagues in the policy community.

We also have what we call a second opinion role that is mandated, which means we have the ability to comment on all cabinet papers before they go to cabinet. And again, we're selective about which papers we comment on. So these are papers that are just about to be promulgated through the cabinet process.

We can use this leverage point to find things where gender implications haven't been well addressed. But obviously because that's right at the end of the process, it can be very difficult to create something, and as we would say, we are most effective when we pick the policies that we are involved in and we're actually on the project team from the very beginning.

I would say to you again that having that ability to have a second opinion on policy advice so we can put our comments and our minister can have gender-based comments within the cabinet process is a very important part of our role, as is requiring departments to do a gender implication statement. That puts the stakes in the ground; it's the institutional framework. I think you've heard my message. I think my advice to you is it's actually about the quality of the thinking that is coming through to you and that you have to do something more to think about how to manage this.

[The Chair, Conservative, Marilyn Gladu]

And that is your time.

Excellent.

I would like to thank all of our witnesses here today.

Thank you.

If you have other information that you want us to receive, you can send it to the clerk. Anything would be helpful. We're beginning to draft our report on Thursday.

Thank you, and we will suspend for a minute while we change up our committee.

[The Chair, Conservative, Marilyn Gladu]

For the remaining fifty minutes, we are pleased to have with us today, from the Department of Health, Cindy Moriarty, who is the executive director for health programs and strategic initiatives from the strategic policy branch. We also have Dr. Cara Tannenbaum, scientific director of the institute of gender and health at the Canadian Institutes of Health Research.

Each of you will have ten minutes for your speech.

We will begin with Ms. Moriarty.

[Cindy Moriarty, Executive Director, Health Programs and Strategic Initiatives, Strategic Policy Branch, Department of Health]

Madam Chair, thank you for the opportunity to present today.

I am pleased to share Health Canada's experience, and I hope the committee finds it useful.

Health Canada has a long history of considering sex and gender as a way of advancing both gender equality and sound science. In the early 1990s, we focused on women's health. In 2000, Health Canada adopted a policy on gender-based analysis, which has since been revised. I'll speak more about the policy in a minute. Also in 2000, the Canadian Institutes of Health Research was established, and with it, the institute of gender and health. The institute is a key partner, and it has had a tremendous influence on our understanding and our approach to this work.

In 2009 we shifted from a focus on women's health to a sex- and gender-based analysis approach. A gender and health unit was created with responsibility for oversight of the health portfolio for sex- and gender-based analysis policy.

Going forward, I'll refer to sex- and gender-based analysis as SGBA, which should shave about two minutes off this presentation.

As you know, Health Canada is part of the health portfolio, which includes the Canadian Food Inspection Agency, the Canadian Institutes of Health Research, and the Public Health Agency of Canada. In 2009, portfolio deputy heads approved the health portfolio's SGBA policy. The policy requires that SGBA be applied to all research, policies, programs, and services in the portfolio.

You'll note that our terminology is a bit different from that of some other departments. We distinguish between sex and gender. Sex refers to biological characteristics, such as body size, shape, hormones, and so on, which distinguish males from females. Gender refers to the array of socially constructed roles, relationships, and relative power and influence that society ascribes to the two sexes, which we tend to think of as masculine and feminine.

For example, if we consider the use of medication, sex is a key consideration in the biochemical response. It may be different in men and women. Gender would be a consideration in how the patient reports the symptoms and how that patient is perceived by the practitioner.

We have established a health portfolio working group to foster a consistent approach and collaboration across the portfolio. This includes agreement on a common goal to embed SGBA as a sustainable practice, and common indicators to measure employee knowledge and use of the policy. We collaborate on employee awareness training and sharing of best practices.

Happy gender-based awareness week, and happy anti-homophobia, anti-biphobia, and anti-transphobia day. We picked a good day to come. In any case, this week we're co-hosting a science panel with the Public Health Agency and with the institute of gender and health. Three eminent researchers will share their experience in applying the concepts of sex and gender and the impact this has had on their own research as well as in their fields.

One of the panellists, Dr. Jeff Mogil, who is the head of McGill's pain genetics lab was recently on the CBC's The Current speaking about the importance of testing on female mice as well as male mice. Researchers are learning that even in the animal world it's important to look at both sexes because that will have implications for humans.

At Health Canada, we have taken an incremental approach to implementing sex and gender-based analysis. We started with the intention to build the habit of using comparative analysis first, and then to deepen the competency.

First we had to understand our starting point, so in 2009, we conducted an employee survey to get a baseline on levels of awareness and understanding.

Based on the results, we implemented awareness-raising and training sessions. We now find it more efficient to encourage employees to take the online training offered through the Status of Women Canada, as well as the health research training modules that have been developed by the Institute of Gender and Health. While training is not mandatory, it is strongly encouraged through blitzes with prize incentives.

Other methods include “Did You Know” postings through our broadcast media, and this year we launched a micro-assignment program with the Gender and Health Unit.

From this same survey, we identified Cabinet and Treasury Board documents as our first priority. The survey showed that sex and gender was not always considered in the preparation of Memoranda to Cabinet and Treasury Board submissions. We therefore developed a checklist tool. The Gender and Health Unit played a challenge role.

We found that sex and gender was being introduced too late in the process and that it was a challenge to access sex and gender information relevant to the file. We then made changes to ensure that the Gender and Health Unit was engaged earlier in the process. We strengthened our requirements to seek more qualitative information.

There is still more to do, but we are pleased that this has led to an almost 100% compliance in considering sex and gender in these documents.

More recently we've focused on our science community. Health Canada hosts an annual science forum that brings together about 500 researchers and scientists. This has been a key venue for us to educate and target the researchers and scientists.

Last year we introduced a sex and gender component in the call for abstracts to be presented at that forum. We followed up with the scientists who had included sex and gender to learn more about their initiatives, to play a bit of a challenge function, and to build our evidence base. It's important to know what research is under way and available so that we can make good use of it.

Our research ethics board has integrated a sex and gender requirement into the application and review process. The board has a training package so it can now more routinely ask questions about sex and gender and do so with confidence.

I'd like to just give a flavour and touch on a few other examples.

In 2011 the Canadian Centre on Substance Abuse, which is funded by Health Canada, developed and released Canada's low-risk alcohol drinking guidelines that provides Canadians with information on how to minimize risks for their own and others' drinking. The guidelines include safer drinking tips and recommendations on consumption amounts for men, women, teens, and pregnant women.

In 2013 we revised our regulatory guidelines on clinical trials. We had done this in 1997 to ensure that women were included in equal representation in clinical trials so that we could overcome the errors of results of trials that were done solely on men and generalized to women. What we found after redoing the guidelines was that, while women were included in these clinical trials, the findings weren't necessarily considered or reported in a sex-disaggregated fashion, so in 2013 we did another review to make our expectations explicit.

In 2015 we conducted an SGBA on views and expectations toward end of life and palliative care. We learned that the concept of a good death, at home surrounded by loved ones, was not shared across all sectors. We were looking for sex differences, we were looking for differences with respect to gender roles and caregivers, but what we found in fact is that ethnic background played a more dominant influencing role. This is an example of GBA+ that takes social context and diversity into consideration.

My primary observation on barriers and challenges would be that a rigorous SGBA takes effort and needs to be integrated from the beginning. It requires access to reliable evidence or the capacity to conduct the research at the outset of a policy or program development.

The research community is changing, and while every day more research is available with sex- and gender-specific information, it's not the case in every instance. In the absence of reliable evidence to inform our analysis, we're limited to committing to do so over the life of the file. The institute of gender and health has been a gold mine in that regard in terms of hooking us up with research expertise.

While Health Canada makes a point of looking at sex and gender, it's been our experience that there's much more progress on the sex aspect than there has been on gender, which is much nuanced and complex.

On best practices I would offer the following comments. Having a policy sets a tone, but it's not sufficient on its own. Supporting continued guidance is needed to embed the practice, for example through a dedicated resource such as the gender and health unit.

Monitoring and measurement tools are critical. Putting in place a performance measurement framework, especially at the portfolio level, was not easy, and it took considerable expertise.

Taking an incremental approach has been effective for Health Canada, and the requirement for an annual report from the deputy minister level adds impetus to the collection and sharing of evidence and success stories.

A lesson learned for us has been that SGBA is not a one-time task. It's an analytical strategic competency that works best when applied continuously over the life of a project or file. It's not enough to “do it” if at some point in time, typically at the beginning or the outset of a policy or file, the results really need to be applied in the decisions to have effect.

In conclusion, I would offer that, while we're confident we've made good progress, we know that we have much more to do. We look forward to continued collaboration with our partners and to meeting these challenges.

I would be happy to answer any questions.

Thank you.

[The Chair, Conservative, Marilyn Gladu]

Thank you.

We'll go over to Dr. Tannenbaum.

You have 10 minutes.

[Dr. Cara Tannenbaum, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research]

Thank you, Madame Chair.

I would like to thank the committee for inviting me to discuss the issue of sex- and gender-based analysis and to speak to you on how the Canadian Institutes of Health Research is supporting the integration of sex and gender in its research and its programs.

The Canadian Institutes of Health Research, or CIHR, is the Government of Canada agency responsible for supporting health research excellence in universities, hospitals and research centres across Canada.

To achieve its mandate, CIHR supports research through a unique interdisciplinary structure made up of 13 institutes. The mission of CIHR's Institute of Gender and Health, of which I am currently the Scientific Director, is to foster research excellence regarding the influence of gender and sex on the health of women, men and gender-diverse people throughout life, and to apply these research findings to identify and address pressing health challenges.

It's pretty well established that sex- and gender-based factors affect health practices, outcomes, and access to health care, yet these important factors—as my colleague showed you—are often not taken into consideration. For example, the majority of basic science research is conducted on male-only animals; women continue to be under-represented in clinical trials; and, issues such as depression and suicide have been poorly studied and poorly addressed in men and boys here in Canada.

As a physician, treating patients gives me first-hand experience of how research excellence can lead to better health for men, women, boys, girls, and gender-diverse people. Daily I am reminded that to truly transform the health outcomes of Canadians, we need more scientific discoveries, treatments, and effective translations of the evidence that account for sex and gender in meaningful ways. To me, this idea is at the core of personalized medicine. After all, what trait is more personal to each of us than the sex we were born with or the gender we identify with?

CIHR has made important progress towards addressing these health and research gaps. For example, as of December 2010, after the SGBA policy came into effect, all researchers applying for CIHR funding, regardless of discipline, are asked to consider how sex and gender are accounted for in their study.

I heard a question about baseline measurement before. At baseline, what proportion of CIHR applicants do you think said “yes, we think of it”? Any takers?

It was 10%. Ten per cent of CIHR applicants reported that they had incorporated sex and gender into their research design. By last year, that number had increased to 50%. The main barrier, it seemed, for conducting SGBA was a lack of knowledge, a lack of skills, and the confidence to actually conduct the analysis and incorporate it into their research.

What did we do about this? We developed our interactive online training modules, which were launched this week, to promote competency among the researchers and also among the peer reviewers, the people who evaluate and decide if people get funded, on whether sex and gender are appropriately integrated into the research study. The launch of these modules has been highly anticipated and positively received, and I could, if you'd like, show you evidence of effectiveness in the first 300 users.

Even before the official launch this week, the National Institutes of Health in the U.S. shared the link to our modules with their 11,000 followers on Twitter. For this reason, as well as our role at the gender advisory board of the European Union, Canada is becoming an international leader in the science, implementation, and evaluation of SGBA.

When researchers understand the importance of sex and gender and apply a sex-and-gender lens to their research, Canadians benefit. That's why CIHR works to translate research findings into evidence-based practices, programs, and policies.

For example, a few months ago, we were invited to a CIHR “Best Brains Exchange” in Halifax, Nova Scotia, which I facilitated, on the topic of keeping older adults healthy and engaged in their community, socially and economically. Researchers from across Canada came together with policy-makers to share best available evidence on innovative, evidence-based, sex- and gender-responsive interventions to help inform the Nova Scotia government's seniors' framework and action plan.

We call these researchers who provide evidence our “sex and gender champions”. Later I could talk a little bit about how we're operationalizing that.

The researchers shared best practices for improving not just the health and prosperity of older adults; we also addressed gender equity issues. I'm not sure how many of you are familiar with what the World Health Organization calls “gender transformative” policies and programs as opposed to “gender unequal” or “gender blind” approaches. Gender transformation is currently the gold standard, we hope, to apply SGBA to health policies and programs here in Canada.

As a leading contributor to the health portfolio's sex- and gender-based analysis policy and to the tri-agency policy statement on equity, CIHR is undertaking a thorough review of its operations to inform an SGBA implementation plan and support performance measurement in this area. Through these activities, CIHR will be able to report against its multilateral commitments to Status of Women Canada, the tri-agency working group on equity, and the health portfolio's SGBA policy under a single lens.

CIHR also works with its sister granting agencies, as well as the Social Sciences and Humanities Research Council and the Natural Sciences and Engineering Research Council, to plan and host gender summit 2017, which will be held in November in Montreal. You're all invited.

In closing, Madam Chair, let me assure you that CIHR is committed to ensuring the research it funds benefits women and men equally, and to applying sex- and gender-based analysis to its programs, processes and policies.

Again, I wish to thank you for the opportunity to speak on this important issue.

I will be pleased to answer any of your questions.

[The Chair, Conservative, Marilyn Gladu]

Excellent. Wonderful. Thank you both.

We'll start our seven-minute round of questioning with my Liberal colleague Ms. Vandenbeld.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you very much.

When we had Status of Women Canada here, they told us that some of the best examples come from Health Canada. I think from your presentation, with regard to a lot of the barriers we heard from other agencies, and the challenges, it looks like you're addressing them in very innovative ways. I just want to commend you for that.

I'm interested in the notion of the sex- and gender-based analysis. I'm assuming that this is SGBA+ because of some of the examples you gave. Is the reason for this being peculiar to Health Canada because of the biological nature of a lot of the files you have, or is this something that might be applicable to other departments? In particular, I noted you said that on the sex part it's much easier and much more applied than on the gender side. I wonder if you could tell us a little bit about the reasons for that.

[Cindy Moriarty]

First of all, thank you. I think success is all relative, but I'm glad to take that one home.

To start with the latter, in terms of the consideration of sex being easier, it's because we can get sex-disaggregated data on almost anything. It's not always reported that way, and if it's a new and emerging issue sometimes we have to do a little digging or generate new research, but relatively speaking, we can usually tell males from females. I'll spare you the commentary on the fact that even that is not completely binary.

For gender, it is much more nuanced. That's where the plus comes in. It's about context and roles and relationships. That just takes much more of a finer touch. I think we still have a ways to go there. We've been able to tackle it in some files but not in others.

Why sex and gender? Frankly, I think it was a couple of things. One was that as a science department with a science portfolio, it was really important—critical, obviously—for us to get the science right, because that has tremendous impact, as Dr. Tannenbaum said, in terms of health outcomes and impacts. So there is a science to it. We were looking at it as more than a social construct. Reflecting back, looking at it as sex and gender versus gender-based analysis allowed us to produce some good marketing in terms of getting over some of the barriers with regard to resistance: “Here come those crazy feminists again.”

I mean, I grew up in the early eighties. Feminist analysis got translated into gender-based analysis, and now in the health sector we're looking at sex- and gender-based analysis. So it was really about positioning it for us, and to use it in training and marketing as an evidenced-based tool and an evidence-based process as well as a gender equality mechanism or method.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Do you think that might be applicable in other departments or other science-based departments?

[Cindy Moriarty]

It could be. I think in the literature, even internally, we notice that the terminology around sex and gender can be used interchangeably. It's something we tend to be a bit fussy about, so I think for sure in other science research departments....

I can't really comment in depth in terms of the work of other departments that are sort of more socially engaged, but I think it's important to at least be clear on what it is we're looking at.

[Anita Vandenbeld, Liberal, Ottawa West—Nepean, ON]

Thank you.

I'm sharing my time with Ms. Ludwig.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Thank you very much for your presentations.

In terms of the research, what I'm gathering is that you were looking at the sex or gender and looking at the variables of marital status, race, ethnicity, income, education, and health. Did you take in the geographical location in Canada?

[Cindy Moriarty]

We should. We don't always do that consistently, but absolutely.

At Health Canada and at a lot of departments, when we come out with statements they tend to be about all Canadians or all people living in Canada. For me, looking at this is getting at the question: which Canadians are we talking about? Are we talking about women in the north, men in the east, youth, etc.? It should look at all of that.

[Dr. Cara Tannenbaum]

It was a great question.

We just released a course on that called sex and gender in secondary data analysis. There are algorithms, not only by postal code but also for ethnicity based on name and where you're living, so that intersectional approach is something that the Canadian Institutes of Health Research is now promoting as a gold standard for researchers within government as well as health researchers in the social sciences and elsewhere.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Great.

On that, Dr. Tannenbaum, are you working with the social science departments at any university in terms of looking at the data collection methods so that when they are being compared they are reliable?

[Dr. Cara Tannenbaum]

You raise an excellent point.

The answer to the first part of your question is, yes, we're multidisciplinary. The institute of gender and health takes a bio-psychosocial approach to everything including animal research where, actually, the research assistant's sex can influence the way the animals respond to pain. There's even literature out there saying that animals have gender, which is fascinating but not the topic today.

Whether we're working with universities and social scientists to look at how the questions are asked, I'd say half our researchers are social scientists. I'm thinking particularly of Greta Bauer and Elizabeth Saewyc, who are particularly looking at the questions around gender, gender identity, and what came out of the transgender youth survey.

I don't know if you all responded to the census, but I wrote my own comment, and I'm sure you saw not just to tick off male and female, which is particularly relevant to the bill tabled today. We're suggesting probably a two-step approach, for instance, about the sex that you were assigned at birth versus what gender you currently identify with.

The second part of your question regards systemic bias in questionnaires. Many of the depression questionnaires that are used ask, “Are you crying more often?” Well, men, aren't going to answer that. Men actually have a lot more physical symptoms. They may feel more anger and be more irritable, so there is bias in the data collection methods, absolutely.

Our second course, called sex and gender in primary data collection with humans, addresses those issues that you very wisely raised.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

I just have one quick question; it might be a long answer.

Some of the research that you've done has identified that in cardiovascular disease, it tends to appear about 10 years later in women than men. There are higher rates now of young girls smoking and, looking at the death rate for suicides, it's at least four times higher for men.

Did you do any comparison based on gender identification?

[Dr. Cara Tannenbaum]

It's a great question.

[The Chair, Conservative, Marilyn Gladu]

I'm sorry.

We'll have to wait for the answer. That's your time. I'm sorry.

[Dr. Cara Tannenbaum]

It's a fascinating answer. You should really ask it again.

[The Chair, Conservative, Marilyn Gladu]

Sure.

We'll go over to my Conservative colleague Ms. Harder.

You have seven minutes.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you very much.

I'm going to start with the Department of Health. I have a few questions for you.

First off, when addressing health issues that affect both male and female individuals, how does the health department use gender-based analysis to determine the impact on each gender? What are your procedures in place?

[Cindy Moriarty]

We would do the sex- and gender-based analysis in terms of identifying what the population at risk is and what the differences are. With suicide, to pick up on that one as an example, we know that boys are committing suicide more, but in fact, girls express suicidal ideation and have more attempts than boys do. We would collect that kind of data, and then it's up to whoever is the policy lead to ask what that tells us and what we look at.

Sometimes it's about making sure that there's an equitable approach within the policy. Sometimes it's because there's a crisis, like in the case of particularly boys in the north committing suicide. We need to understand what's going on there that's different from suicide among youth generally. For sure, we would look at that. I don't know if that answered your question.