Status of Women Committee on May 17th, 2016

[Rachael Thomas, Conservative, Lethbridge, AB]

I think so.

It brings me to another question.

Maybe I'll ask my other question and then come back to my original. Could you comment on that with regards to men and boys in the north?

[Cindy Moriarty]

Could I comment on...?

[Rachael Thomas, Conservative, Lethbridge, AB]

If I understand you correctly, you're saying suicide is more prevalent among boys in the north than it is among boys in the rest of Canada.

[Cindy Moriarty]

I was referring to it in terms of the recent media attention, in terms of the crisis of suicide. This is not only with boys.

[Rachael Thomas, Conservative, Lethbridge, AB]

This isn't a specific study that your department has done.

[Cindy Moriarty]

No, what I was referring to is a study we have that's fairly specific—and there's a risk in extrapolating—and was looking at the concurrence of substance use and abuse with suicide attempts and suicidal ideation. In that study there was information that came forward in terms of the differences between girls and boys; girls and boys in the north; and Inuit youth; and lesbian, gay, bisexual, and transgendered youth. In all cases, among the girls, there was a higher expression of suicidal ideation. There was a higher rate of attempting suicide compared to their counterparts, the mainstream population, and to the boys, but in the case of the boys there is a difference in terms of completion.

I offer that as an example in the sense that we can be driven to looking at who is committing suicide. You have to look at the whole thing in context, and there is something going on with young boys. I don't know what the answer is. I'm not a subject matter expert in that area.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

My original question was more along the lines of, is there a specific gender-based analysis of questions, or a survey that is taken, in order to make sure it is consistently considered through all policy initiatives going forward within your department?

[Cindy Moriarty]

We have some tools and checklists that give some fairly high level questions, and we encourage researchers and policy-makers to look at the data, and have you looked at the data from a sex-disaggregated point of view, and have you considered this kind of research? It's at a high level. It's difficult when you're not the subject matter expert in terms of how deep you can get into the complexity, but it's playing that challenge function in terms of have you considered the differences between men and women, girls and boys, why or why not, have you looked for research out there, why or why not? We help them and point them in that direction.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

I think you've touched on this, but maybe you could into it further, or give me another example. I would be looking for some specific examples with regard to where you see gender issues, which is a phrase we often use. Could you go into that a little within the health department? Where do you see gender issues per se?

[Cindy Moriarty]

Everywhere. Seriously, the mandate of the health department is to look at health outcomes for all Canadians. There isn't a file that doesn't have potential for some personal impact, and that makes it a huge challenge for our departments that are trying to figure out where to focus.

Do you want to give an example?

[Dr. Cara Tannenbaum]

Take drug policy, for instance. It's true that drugs are metabolized differently based on sex. Maybe you didn't see the Health Canada warning about sleeping pills, and that women are recommended to take half the dose. The last time you went to the pharmacist, were you asked, are you a man or a woman, or what dose should I give you? We do it for children, but we don't do it for adults, and yet for certain brands of sleeping pills, the blood level the next morning is 45% higher in women. It's not for that reason we are bad drivers. It's that we were overdosed, so that would be about sex. That's why we say that's the sex-related factor. In drug regulation are we even being transparent about what applies to men and women?

The gender-related factor is why are so many more women taking sleeping pills? I don't know if any of you here are old enough to remember the expression “take a tranq”, or take a tranquillizer. It's women's...it's the gender perception and the gender relation in society that says we need to be cool, calm, collected, always in control, juggling our kids and our jobs, and looking good at the same time. That's the societal institutionalized perception of gender, and so would it make sense that women have more anxiety than men? Probably not, when we look at suicide rates, and yet it's acceptable for women to be taking pills, to ask for more pills for depression and anxiety over men, and that's a gender issue.

I've differentiated around drug policy, for instance, that you need to approach it from a sex and a gender perspective. I don't know if that's a good example for you, but that's how we approach it from a scientific basis.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you, that's helpful. That was a good answer in order to help us wrap our heads around exactly what's going on there, so thank you.

[The Chair, Conservative, Marilyn Gladu]

You have 30 seconds.

[Dr. Cara Tannenbaum]

There's also gender and heart disease.

[Rachael Thomas, Conservative, Lethbridge, AB]

Do you want to talk about that?

[Dr. Cara Tannenbaum]

Yes, I would, just to tell you that Louise Pilote is a Canadian researcher who is funded through the Canadian Institutes of Health Research and she just came up with an analysis that is groundbreaking, world-shaking, amazing. Canada is really a leader.

She was able to give a gender questionnaire to people with early heart attacks. She looked at the Bem Sex Role Inventory, which asks: are you more nurturing or are you more aggressive, so it's kind of feminine versus masculine. She also took into account hours spent on caregiving activities and household chores and those kinds of things. She created a gender index.

In her analysis she was able to consider both sex—are you biologically male or female?—and gender and see which one predicted poorer outcomes after heart disease. It turns out that gender, independent of sex—which is what we've always believed about women—is the predictor.

If you have a certain gender identity or gender role, then that's going to make you access help either more quickly or more slowly, or follow the recommendations. I don't know if you've seen the American Medical Association's blurb on the woman who is having chest symptoms. She calls 911, and they say, “We're going to be there immediately” and she says, “Give me 10 minutes; the kitchen is a mess”. That's gender.

[The Chair, Conservative, Marilyn Gladu]

All right. Thank you.

We will now go to Ms. Malcolmson for seven minutes.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Thank you, Chair.

I'm trying to find some ways to talk about how outcomes might be different at a public spending level or at a health level if we did GBA well.

A number of us around the table met with representatives from an ovarian cancer lobby a couple of weeks ago. I was kind of stunned at some of their numbers. For ovarian cancer the fatality rate is terrible. There is no vaccine. There is no screening. There have been no major treatment breakthroughs since the early nineties, and no improvement in outcomes because there has been such a poor research investment.

They gave us numbers from the 2013 Canada research survey. In that year, investments in ovarian cancer were $13.8 million; for breast cancer it was $74 million; and for prostate cancer it was $36.5 million. That's just one example of something that looks really out of whack.

I'm curious. Do you have any experience with that file? Can you talk with us a little bit about how, if we had a more robust gender lens at the time of budget decisions and policy decisions and if we did this better, that kind of outcome might improve?

[Cindy Moriarty]

I can't speak specifically on this one. That would be a Public Health Agency matter, not a Health Canada one specifically, so I wouldn't have enough knowledge.

Using that as an example to extrapolate though, for sure if we looked at those kinds of issues and did a better job, we would have better outcomes, whether those were tied to the budget or just generally as health outcomes. For sure that work needs to be done.

If we looked at something like that, if we were doing a sex- and gender-based analysis, we would be looking not just at the rates but at what it is, what's contributing to those rates, and what's going on there, as well as at how the reporting is being done, and then we would go from there. I can't really speak more specifically to ovarian cancer.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

I'm not trying to make any guesses about how we might be able to change the outcomes for the women affected, but what happens at a decision-making level around who is digging into the research, and who is making recommendations around allocating budgets in certain areas? Could better federal GBA get at any of those issues, or is something more fundamental at play when we see such discrepancies, especially in this case, for a disease that only women are ever going to encounter?

[Cindy Moriarty]

Doing better sex- and gender-based analysis is certainly never going to hurt, but I think you're sort of touching on a bigger question in terms of the decision-making. Because we are public servants, our job is to give that good advice based on evidence, to do our best research, and to put the best options forward. In terms of the decisions and the budget, for example, those are parliamentary decisions.

I don't want to overstep, but there is a need to ask the right questions and to be looking for things at that level as well in the decision-making and then in the follow-up.

Do you want to add to that? I don't want to take all the time.

[Dr. Cara Tannenbaum]

Two things come to mind. One is how the evidence is being translated into health care. For instance, we just did a review of clinical practice guidelines for health care clinicians. Clinical practice guidelines are recommendations based on evidence. We just reviewed about 118 of them put out by the Canadian Medical Association. Maybe two-thirds actually looked at sex and gender issues, but very few had recommendations about how you should treat men and women. In the Netherlands, they had a public campaign that was launched a few months ago saying, “Treat me like a lady”. Some people may not like the word “lady”, but the point is, does your doctor, nurse, physio, naturopath, or whatever truly know the difference based on evidence, how you could be treated differently?

Men have breasts. One in ten cases of breast cancer occurs in men. Men don't have ovaries. That is an interesting point. Every man will die with prostate cancer, because with time you develop it. It is not aggressive. Ovarian cancer is still relatively rare compared to those. Are the decisions being made on a population basis? What are the arguments that are being made? There is certainly what we call ring-fenced funding, which is when Parliament says, for instance, we need more spending for dementia. We could respond only to what is being allocated to us, whether it is in the open competition or whether there is some strategic initiative.

Does that answer your question better?

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

We are certainly trying to get at the political lens here—what advice comes to Parliament.

[Dr. Cara Tannenbaum]

From a gender-based perspective, it is pretty new that women talk about their breasts. Men feel comfortable talking about their prostate. Anything below the belt, they are happy talking about. Sorry, that came out wrong. Ovaries are sensitive. It is about fertility; it is about being a woman. That is maybe where the gender issues come in, in terms of the fundraising, the discussions, and things like that. Ovaries are hard to feel; breasts are kind of out there. Just from a medical perspective, you can't feel if someone has ovarian cancer if you were to examine them.

A gender-based analysis would consider all those things that maybe didn't seem scientific, that I just mentioned, which might shed light on the problem and a possible solution.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

My riding, Nanaimo—Ladysmith on Vancouver Island, has a lot of health care delivery and hospitals that are concentrated in the region, and a particularly old population. Health care issues are really at the fore. We also have one of the highest poverty rates in the province. I am concerned that we don't have an increase in health care spending.

I am curious about the kind of political decisions that might get fed through a gender lens that might, if not made...if we are not funding health care well.... Can you talk a bit about how women might be disproportionally affected if we don't do that test around[Inaudible—Editor]?