Highly Ranked, Yet Still Unfair: Addressing Women’s Health (In)equities in Ontario

Unpacking Equity is a collaboration between the Public Policy and Governance Review and the Gender, Diversity and Public Policy Initiative (GDPP) at the Munk School of Global Affairs and Public Policy. This series aims to explain equity-related policy issues and break down complicated topics involving equity, diversity and inclusion. Policy professionals can gain a better understanding of these complex issues in order to incorporate an equity lens into their practice. To learn more, please get in touch with the GDPP.

By Kristi Kodama

The universal healthcare system that we have today has continuously been a source of national pride for Canadians, especially when compared to our southern neighbours. Yet for a healthcare system that is commonly believed to represent equality and equity, Canada’s is found wanting. A report by The Commonwealth Fund found that Canada ranked third-last in a group of 11 other developed nations in terms of healthcare equity. Canada remains behind countries such as the United Kingdom, the Netherlands, Sweden and Switzerland.

Ontario is the most populated province in Canada, with its healthcare system challenged to serve over 13 million residents of diverse backgrounds and projected to rise to nearly 18.5 million by 2041. Ontario is considered to be the second-healthiest province in Canada by the Conference Board of Canada. Statistics Canada reports that the province boasts the second-longest life expectancy, behind British Columbia. These reports create a commonly-held perception that Ontario’s healthcare system is doing quite well in its services to the public.

Ontario’s high rankings and vast spending do not translate to health equity in the province. Many health inequalities and health disparities between segments of the population are determined by socio-economic factors that can be improved. Government policies and programs perpetuate conditions which create health inequalities and inequity. The Canadian government defines health equity as “the absence of unfair systems and policies that cause health inequalities ….[and] seeks to reduce inequalities and to increase access to opportunities and conditions conducive to health for all.” This involves everyone being afforded the opportunity to improve their health and access quality healthcare.

One of the ways in which women experience healthcare inequity is with regards to prescription drugs. Despite some drugs affecting men and women differently, there has been a long history of researchers and doctors excluding women from drug trials prior to 1990. This is a global concern, and Ontario is not exempt: media reports citing Women’s College Hospital point out that even though women are more likely to die of heart disease, many cardiovascular drugs available have been largely tested on men. Researchers have previously defended the argument that there are too many complications that arise in including women, such as changing menstrual cycles and pregnancy concerns that make drug trials difficult. When women are included in drug trials, medical research may not explicitly report how medications affected men and women differently. This prevents the research from being usable for further research or by consideration of doctors when prescribing medications to their women patients. These barriers and unequal treatment could potentially be remedied if more emphasis is placed on women’s experiences in new and ongoing research and drug trials.

Gender inequity also extends to in-person healthcare services. Researchers at the University of Maryland found that although women generally report higher levels, longer duration and more frequent incidences of pain, medical personnel are less likely to take their pain seriously as though they would for men. Women’s College Hospital in Toronto reports that women experiencing chronic pain are more likely to be sent to therapists, rather than pain management clinics. 

Transgender women are often subject to misgendering and transphobia by healthcare professionals and may even be expected to educate medical staff on transgender-specific healthcare concerns. Trans and gender-diverse people often face additional barriers that intersect with other identities, such as race, disability and socioeconomic status. This remains a problem in Ontario, as well as the rest of Canada.   

A report recently completed in collaboration with health community groups, the University of Toronto and Planned Parenthood of Toronto, with funding support from the Province of Ontario, found that women, especially women of colour, can be deterred by racism, homophobia, and other offensive treatments and stereotypes in healthcare settings. A lack of available language interpretation services and disability accommodations are also barriers to accessing healthcare. To mitigate these barriers and promote equity, the report recommended healthcare service improvements in the form of more women healthcare professionals, diverse staff, service in multiple languages, and general “respect for race, gender, culture and other aspects of identity” to better communicate with and serve patients. These recommendations could be considered for other hospitals and healthcare clinics to adopt to promote greater equity in providing accessible healthcare services.

Women can experience greater health equity by the continued improvement of government programs and policies that directly address their health concerns. The Canadian Institutes for Health Research promote integrated healthcare “delivered in a way that is person- and population-centred, and responsive to economic, social, language, cultural, and gender differences.” Tools exist such as The Ontario Women’s Health Framework, which was developed by a collaboration between the province, women, health advocates and experts, community groups and health organizations. The framework highlights the involvement of women in determining their own health priorities and health services to improve the overall quality of healthcare in Ontario. Women’s College Institute is a leader in Canadian research specifically on the health of women. In practice, hospitals are already demonstrating gender-sensitive healthcare. For example, since 2017, Women’s College Hospital has collaborated with Young Women’s Canadian Association (YWCA)  Toronto to provide primary healthcare for marginalized women and their children within their local community.

As a country, we place a high value on individualized healthcare, and with this value comes the expectation that health services adapt to and provide care to each and every person. This expectation can be realized, but only if health inequities continue to be addressed, so that every individual can truly have the opportunity to achieve their best health outcomes.  

Kristi Kodama is a 2020 Master of Public Policy Candidate at the University of Toronto’s Munk School of Global Affairs and Public Policy. She holds a Bachelor of Arts in History and Political Science from the University of Guelph. Her interests include policies related to accessibility and equity in healthcare, education and transportation.