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Internal WHC Reports

National Planning Forum for Women's Health

Interim Report - December 2003

1. Context of gender mainstreaming and women's health

The Irish government adopted mainstreaming of equality as a strategy to promote equal opportunities in the National Development Plan 2000 to 2006. Mainstreaming has now been adopted across a wide range of Government Departments, programmes and measures, including economic and social infrastructure.

The movement to integrate a gender dimension in all fields of public policy, programmes and measures was confirmed by the United Nations Fourth World Conference held in Beijing in 1995. Major international bodies such as the International Labour Organisation and the European Union have begun the complex process of adopting and implementing the new gender mainstreaming perspective. The World Health Organisation moved to implementation in 2001 with its Madrid Statement on Mainstreaming gender equity in health - the need to move forward. (1)

The Madrid Statement recognised that many governments had not translated their international gender and health commitments into clear policy at national level and it recognised gender mainstreaming as both a political and technical process. The statement laid out four prerequisites for a gender mainstreaming strategy

• Governments should express their political commitment to gender mainstreaming in health policies at all levels of society
• Financial and human resources should be allocated to implement gender-sensitive measures
• Public health policies and programmes should contain a well defined and transparent gender dimension
• Structural capacity should exist in the form of appropriate co-ordinating and implementing bodies formed by all involved sectors

The National Planning Forum for Women's Health was established in 2002 in the period following the publication of the Women's Health Council position paper Promoting Women's Health.(2) The position paper critically reviewed the Plan for Women's Health (1997-99) and made proposals to focus the women's health agenda for the 21st century. The position paper confirmed a number of proposals of the Women's Health Council to seek to establish a framework for significant health gain for women. Central among the proposals, was a new orientation to ensure gender equity in health services and initiatives. This was to be achieved by the proposed development by the Department of Health and Children of criteria, models, structures and procedures for the integration of gender considerations into national and regional policy and practice related to the health of women. This gender mainstreaming approach marked a departure from the development of a national plan specific to women's health.

3. A gender and health strategy

The Women's Health Council convened the Forum in the framework of a proposal to invite all major stakeholders in the health field in Ireland 'to assist it to define the principles and parameters for policy and action in the field of women's health.'(3)

Women's health was identified as an area for action in Ireland's commitments in the Government Report to the United Nations under the 1995 Beijing Platform for Action (4), and is singled out in a separate chapter in the health strategy of 2001 (5). The hosting by the Women's Health Council of a national forum of stakeholders to chart future action is identified as an anti-discrimination measure in Ireland's report to the UN on eliminating discrimination against women (6).

4. The Convening of National Forum Meetings

Three meetings of the National Forum were convened by the Women's Health Council in the course of 2003. In addition two specialised sub-committee meetings were convened to advance technical reflections on mainstreaming strategies. The Forum has a limited time frame of five meetings over an 18-month period.

Chairperson and Facilitator is Ms Rita Burtenshaw. The Forum reports to the Minister through the Women's Health Council.

Some resources have been allocated by the Women's Health Council as secretariat to the Forum.

The meetings of the Forum were attended by:

• Staff of the Women's Health Council
• Women's Health Policy Unit of the Department of Health and Children
• Ten Health Boards (Women's Health Officer/Women's Health Co-ordinator/ Directorate Manager/ Women's Development Officer/Health Promotion Officer/ Director of Acute and Primary Care/Primary Care Manager/Director of Planning and Public Health)
• Community and voluntary sector

5.1 Gender responsive planning of policies, programmes and projects

The Forum endorsed the new orientation to women's health outlined in the Promoting Women's Health Position Paper. A considerable amount of time was devoted at the Forum to exploration of the significance of integrating a gender dimension into policies, programmes and projects at national and regional (Health Board) level. Participants felt the Health Strategy 2001 underplayed the significance of the theme of women's health. Some felt some of the current operation and organisation positioning of Advisory Committees on Women's Health were out of synchronisation with the goal of gender responsive planning in all programmes and policies of, for example, Health Boards. There was an absence of cohesiveness in the outcomes of the various advisory committees' inputs. The absence of cohesiveness can be attributed to the lack of structure to create cohesiveness. The need for sustainable medium to long-term approaches, as compared with current short-term responses was stressed.

5.2 Protection of women's health and risk factors

Women are not a homogeneous category or population group. A number of mentions were made at the Forum of the variance in health risk and risk exposure of specific groups of women such as Traveller women, young women, women of non-national origin and women as formal and informal carers of others. While health gain for all women was the goal, this was not incompatible with strategic prioritisation.

5.3 Gender differences in the manifestation of disease

The implications of gender responsive planning were explored in specific core health areas. The gender differences in the risk of disease were starting to become apparent in a number of areas and gender specific responses were a logical follow-up to this evidence. An example was the cardiovascular strategy, which carried different implications for women and men in terms of disease. Here funding on women-and-smoking actions could be identified and potentially ring fenced to mainstream a reduction in women's health risk within the cardiovascular strategy. Demographic changes were discussed which impact on older women who have specific disease-risk exposures. Some risk differences arise from differences in the social and economic contexts of women, compared with men. The need for gender-disaggregated data was frequently alluded to.

5.4 Responses of health systems and services

How the health services respond to women's health through the systems of decision-making, planning, strategy formation and strategy legitimisation attracted extensive discussion and was considered a major discussion topic. There was some uncertainty as to how a specific focus on women's health with positive actions in favour of women, could be joined up with a gender mainstreaming approach integrating a gender dimension into all policies. In the absence of a national women's health plan, a void was experienced in coherent gender planning. While some regional gender planning was taking place, its accountability, review, and its assessment in a national context was not visible. The health service reform process made it imperative to integrate a response to women's health at a number of levels of services and delivery focal points, which would maximise health gain for women. The reform process confirmed the need to integrate a gender dimension into policy-making at a high level and at a policymaking level.

6. Forum discussions on organisational arrangements

6.1 Gender impact assessment

Several discussions named gender impact assessment or equivalent concepts as a new and urgent need in gender mainstreaming strategies in health policy, planning and programmes. Modelled on environmental impact assessment statements, gender impact assessment was regarded as an essential tool to integrate a gender consideration into the variety and range of health service interventions at regional and national level. Technical rather than political, gender impact assessment was viewed as useful to advancing a health gain for women within the national health strategy. Gender impact assessment was viewed as a distinct policy issue with applications at several levels of policymaking: national, regional, local, thematic and sectoral programme areas.

The rationale for gender impact assessment was explored. Gender Impact Assessment is recommended by the European Commission and by the gender equality unit of the National Development Plan for Ireland located at the Department of Justice, Equality and Law Reform. It is regarded as the most appropriate way of estimating or forecasting the likely impact of policy and structural changes on gender balance and gendered outcomes of health policy. In the light of the Health Strategy, gender impact assessment was regarded as a crucial and core methodology for bringing to light the gender implications and ramifications of health policy for both provider and user.

Women are not a homogenous group. Gender impact assessments need to be inclusive of groups of women such as ethnic minority women, Traveller women, and asylum seeking and refugee women.

6.2 Gender Disaggregated Data

The availability of data on sex differences in health risks, health policies and health outcomes was given particular attention as a mode of quantifying the rationale for gender impact assessment. Gender disaggregated data issues fell into four categories:

• Areas of health where no gender disaggregated data is gathered,
• Areas of health policy where data is gathered but not published,
• Areas of policy where the data is both gathered and published on a once off basis,
• Areas of policy where data is gathered and published in a standardised time series.

The difficulty in making the 'business case' for application of gender policies in the health services in the absence of gender disaggregated data was noted by Forum members. Therefore it was recommended that the collection of disaggregated data should proceed in a strategically prioritised manner. This would group the data under four headings (see section 5 earlier):

• Planning policies and programmes
• Risk and disease exposure
• Manifestation of disease
• Responses of health systems and services

6.3 Performance Indicators

Performance indicators were viewed as crucial in delivering a more responsive and effective health service to the entirety of populations served. Paradoxically, in the absence of gender disaggregated data, performance indicators are difficult to construct. Performance indicators combine sets of data to form social indicators, which should be based on a wide consensus to attract the maximum usage of the indicators. In the absence of explorations of a consensus, a number of tested social indicators from other jurisdictions could be obtained.

The Forum recommended that a 'process' indicator should be immediately adopted which would test or provide indications of structures for taking gender considerations into account. Examples are the presence of an advisory implementation committee on women's health and other similar test questions.

Forum participants expected performance indicators for gender to be present, or in development, at this significant moment of health service restructuring and publications of health service reviews. There was no evidence to stakeholders to confirm that such a development process was occurring, despite Ireland's commitment to gender mainstreaming.

7. Conclusions

• There is a need for the Department of Health and Children to state its commitment to the process of incorporating gender considerations into all health policies, programmes, actions and measures and to outline the budget to be attached to this work. There is a need to move forward on gender through, for example, the use of guidelines.
• The National Planning Forum for Women's Health has been a useful, albeit limited-life, expression of commitment to a new orientation in women's health policy.
• This new orientation towards integrating a gender dimension into all health policies, programmes and actions, has raised new questions about the role of specific women/men oriented actions, for the participating stakeholders, and practitioners at regional level in particular.
• There is no policy or resources available for mainstreaming.
• The Forum concluded that it was important to incorporate a gender dimension into policy planning at the earliest stages, and not at a later stage when structures and process have been embedded.
• The inclusion of a gender dimension in health planning and delivery takes place alongside positive actions or women-only actions, as a part of a twin-track approach to mainstreaming gender considerations across health policy.
• Forum participants believe that the timing on this new orientation in gender policy is vital, given the health service reform process underway and the absence of a visible gender dimension within that process.
• The Forum participants believed that there were new and difficult implications of adopting a 'gender mainstreaming' orientation as outlined in the WHC 2002 document: Promoting Women's Health. Nevertheless, this is a positive goal that will significantly contribute to women and men's health gain in the long term.
• The Forum identified a number of technical considerations and need for new support or co-ordinating structures, in order for the new orientation to work effectively.
• The Forum insisted on the importance of gender impact assessment, gendered performance indicators and gender-disaggregated data to advance the increased consideration of gender in health policy. This was integrally linked to the need for Performance Indicators in the gender and health field. However, it is not possible to have Performance Indicators without gender disaggregated data being available as a first step in the gender impact assessment process.
• The Forum stressed that its recommendations should strengthen current health systems and not duplicate them.
• The Forum welcomed the opportunity to continue its work under the auspices of the Women's Health Council with two further meetings and to submitting a Final Report of its work in early 2004.

References

1. Madrid Seminar on Gender Mainstreaming Health Policies in Europe on 14th September 2001. See also Strategic Action Plan for the Health of Women in Europe, endorsed at a WHO meeting in Copenhagen, 5-7 February 2001.
2. Women's Health Council (2002). Promoting women's health - a population investment for Ireland's future, a position paper of the Women's Health Council, Dublin, June.
3. Women's Health Council (2002) Promoting Women's Health - a population investment for Ireland's future, Dublin, p.39.
4. Department of Justice, Equality and Law Reform (2002), Ireland - Report to the United Nations on the National Plan for Women 2002 on the implementation of the Beijing Platform for Action, Stationery Office, Dublin.
5. Department of Health and Children (2001). Quality and Fairness: a Health System for You - Health Strategy, Stationery Office, Dublin, p.152.
6. Department of Justice, Equality and Law Reform (2003) Ireland's Fourth and Fifth Reports under the UN Convention on the Elimination of all Forms of Discrimination against Women, Stationery Office, Dublin, p.90.