Serving women with a wider lens
WCH seeks to change how health care is delivered
Statistics show women below the poverty line tend to live shorter lives and have more health problems, in part due to challenges accessing health care — despite Canada’s universal coverage.
And one in every five women is poor, according to the Canadian Women’s Foundation. For single women, poverty rates are even higher: More than half of single mothers and half of women over 65 who live alone are poor.
The foundation points to the fact that women spend more time doing unpaid work (including child care), while lack of affordable daycare leads many to take on precarious work — jobs that are part time, seasonal or contractual. “Health for women cannot be achieved if all we do is provide health-care services,” says Dr. Danielle Martin, vice-president of medical affairs and health system solutions with Women’s College Hospital (WCH). “As an institution, we need to be pushing for broad social change around the issues that drive health for women.”
Issues such as poverty, which Martin points out can affect women’s health in two ways: It determines their ability to purchase the goods and services they need to be in good health, such as safe housing and nutritious food, but it also affects health through high stress levels, which often drive other factors such as smoking and drinking.
As a research and innovation institution, WCH is running pilot programs that could help redesign how the health-care system addresses social issues that impact women’s health.
“We have researchers involved in looking at virtual-care solutions, such as telephone support for women in rural areas with postpartum depression,” says Martin. “We’re figuring out how to put in place solutions that will help women in the context of their lives.”
When Dr. Sheila Wijayasinghe started her career in Toronto, she realized she was limited in what she could do for patients because of these social determinants.
“If patients can’t afford their medication, I can’t make daycare cheaper for (them), so they aren’t able to earn enough to support themselves and their children,” she says.
As medical director of primary care outreach at WCH, Wijayasinghe is tasked with identifying gaps within GTA communities.
“We look at a wide lens to see which communities aren’t accessing care and how to improve access, particularly for women,” she says.
This can be particularly challenging, because poverty is often hidden. A patient might be working multiple part-time jobs, but is struggling to make ends meet or doesn’t have health coverage through work — so maybe she stops taking her medication when she runs out.
“If we’re not asking our patients what’s limiting and why they’re having trouble accessing care, we’ll never understand,” says Wijayasinghe. Perhaps they can’t afford to pay for transportation or a babysitter — so taking health-care services directly to high-need communities could help provide better access for these women.
Another issue is fear of being judged. A woman might have a substance-abuse problem or mentalhealth issue and has felt judged on previous occasions.
“Because of this fear of judgment, people don’t show up for their appointments,” says Wijayasinghe.
These women may have a history of trauma, so “going back into the health-care system can be scary,” Wijayasinghe says.
“There’s a lot of anxiety because they may have been treated poorly so there’s some apprehension to reconnect.”
Martin stresses these projects aren’t considered “extras.” It’s hoped they’ll influence the way other hospitals and health-care practitioners across the country deal with social determinants that affect women’s health.
“That work is not seen as extracurricular,” says Martin. “That work is viewed as being core to our mission.”