Issues Practice

The issue you are working on could be almost anything: wait lists, health care budgets, health human resources, aging populations, chronic or infectious diseases, emergency preparedness, substance use, etc.

TIP: Don’t overthink this exercise. Just quickly list the main points of what you know or believe about the issue. Don’t worry about getting it ‘right’ at this stage.

Can you clearly state why the issue is important? For example, is obesity an important issue because it threatens health, because it taxes health care budgets, because it is becoming more common, because we don’t fully understand it – or all of the above?

Once you’ve decided why an issue is important, ask yourself for whom it is important? For example, does your work lead you to focus on those living with unhealthy weights, on those paying the bills for obesity-related illnesses, on the food industry, on public policies?

Does knowing who cares about this issue affect your understanding of it or what you’ve been asked to do about it? For example, is the issue of obesity important to government because is strains health care budgets? Is it important for industry because the rising incidence of obesity might lead to new regulations on food production, preparation and packaging?

Where are your information and ideas about this issue coming from? Research, popular attitudes, the media, political decisions, government sources, personal experience?

Are your sources of information reliable?

TIP: For more detail on types of evidence and assessing the strengths and limitations of evidence, link to the evidence module.

Tip: If you need a quick refresher on how the core concepts are defined, go here:

Characterize a population using the core concepts of sex, gender, diversity and equity.

Have you thought about how this issue might affect females, males and people who identify as neither or both?

HINT: Remember that sex is biological and is expressed along a continuum.

Think about how sex differences might change your understanding of an issue. For example, we know that, on average, healthy women have a higher percentage of body fat than healthy men. Similarly, we know that women are physiologically more susceptible to HIV transmission than almost all men. Only men who have sex with men as receptive partners are as physically vulnerable to HIV infection as women.

How do gender roles and norms influence how this issue is experienced or understood?

HINT: Remember that gender is social and is expressed along a continuum.

Think about the social norms and expectations associated with the issue. Are they different for women and men, transgendered people, etc.? For example, we know that, in general, women experience greater social pressure than men to be thin, sometimes very thin. As a result, the experiences of overweight and obesity are different for women and men.

Consider how this issue affects people who are visibly different, such as those of different sexes, ages, ethnic or racial identities. Consider how this issue affects people who may be different in ways that are not visible or obvious: for example, differences in sexual orientation and income level or living in rural versus urban settings.

For example, differing standards of beauty across cultures can affect reactions to and experiences of overweight and obesity. Similarly, achieving and maintaining healthy weight may pose different challenges for younger and older people, for people living with disabilities or in rural and remote communities.

TIP: Try using one of these lists of the social determinants of health as a quick guide for thinking about types of diversity and their significance. Click to open lists.

Does the issue have the same impact on or significance for different groups of people? Are these differences unfair – caused by inequity or leading to inequity?

For example, are overweight and obesity associated with stigma and discrimination? Do overweight or obese children and older people suffer similar types and degrees of stigma and discrimination?

TIP: Need a reminder about the definitions of equity and equality? Go here.

If you are already using sex-disaggregated data or data that address the other social determinants of health, your definition of the issue may not change a great deal. But even if you are dealing with an issue that focuses on just one sex, you will still need to consider how gender roles and norms affect the issue and how diverse populations experience the issue. For example, erectile dysfunction happens only to males, but the condition and decisions about how to treat it affect their male and female partners.

Similarly, if you are focusing on how an issue affects one sex or another, you will still need to consider how gender roles and norms affect the issue and how diverse populations experience it. For example, experiences of erectile dysfunction are affected by norms of masculinity, which may vary from one population to another.

If you are new to SGBA, thinking about sex, gender, diversity and equity may alter your understanding of an issue considerably. For example, you might have thought of obesity as the result only of individual choices, but now you might consider the influence of urban planning, food packaging and public policy on the range of choices available to individuals, families and communities.

Keep in mind that you may also not be able to address all of the core concepts if there is no separate evidence for males and females or for transgender people, or if there is inadequate information about diverse populations and characteristics.

If your information is incomplete or limited in some other way, you may still be able to define and work on an issue, but you will need to be clear and precise about what you know and what you don’t know. For example, we have good information about rates of overweight and obesity among First Nations and Inuit peoples, but only for those living on reserve and participating in surveys. We also have limited data for Métis women, men and children. As a result, we can only discuss how this issue affects specific sub-populations of Aboriginal people, rather than all “Aboriginal” people in Canada.

This is an excellent opportunity for reflection. Take a moment to examine your own assumptions or beliefs about an issue as well as those of your colleagues, managers and partners. Did you already have a firm opinion about the issue when you began your work?

Need a quick reminder about types of bias?

At this point, you want to be as thorough and specific as you can about your understanding of the issue.

Ask yourself if there might be other evidence or opinions that suggest a different definition or interpretation. For example, obesity is often blamed on poor eating habits and physical inactivity and solutions generally focusing on encouraging better food choices and more exercise. But some research suggests that there is a link between obesity and food insecurity – not having reliable and predictable access to sufficient amounts of nutritious food. In such cases, unhealthy weights are not simply a product of eating too much and exercising too little. The ‘issue’ is more complicated and responses to it must be more complicated as well.

It’s time to practice iteration. Need a reminder about the meaning of iteration? Click here.

“Iteration” is the practice of reflecting on our knowledge of a particular issue and adjusting our thinking and processes to address gaps, inconsistencies and oversights as well as to accommodate new knowledge or insights. In other words, iteration involves asking what the issue is, who framed it, who is at risk or in need, what evidence is available to shed light on the topic, and what we are doing about the issue.

TIP: Click here for an overview of the SGBA process. (process hand-out)