In order to develop or evaluate policies, programs and research, we need to understand what we know and don’t know about an issue or population. We can begin by summarizing the evidence we’ve collected, looking for emerging themes and checking for gaps.
Next we need to assess whether or not our evidence addresses the core concepts of sex, gender, diversity and equity. We should check, for instance, if we have statistics by sex and other relevant determinants of health, such as income, ethnicity, education, and ability. For example, one of the case studies in Rising to the Challenge demonstrates an SGBA of wait times for total joint arthroplasty (TJA) – hip and knee replacement surgery. The researchers began by asking if women and men wait the same length of time for hip and knee replacement surgery. When they went to gather evidence, they discovered that provincial and territorial government statistics were not broken down by sex or other determinants of health. As it result, it was possible to learn how many joint replacement surgeries were being conducted, where they were happening, and how long people were waiting for them, but it was not possible to tell who was getting hip or knee replacement surgery (by sex or age) or who was on the wait list for surgery. In other words, they couldn’t tell if equal numbers of women and men were waiting for surgery or waiting for the same amount of time.
We should also check that diverse groups of people were included or represented in the research. This kind of basic synthesis allows us to look for differences and similarities among populations and to figure out who is privileged in the data and who is missing from it. For example, many surveys in Canada do not collect or include information about people living in the northern territories: Yukon, Northwest Territories and Nunavut. As a result, people living in southern regions are more privileged in the data and, consequently, in the development of policies and programs.
Once we have completed this basic synthesis, we need to ask more challenging questions, particularly about how issues affect or are experienced similarly or differently by diverse groups. In other words, we need to think about the context of people’s lives, including the roles of gender, diversity and equity.
Let’s consider the issue of unpaid caregiving. We know that most of those providing unpaid care to family and friends are women. The statistics tell us this much. But what that statistics do not tell us is how often women are pressed into caregiving by personal and social beliefs that women are nurturing by nature and therefore ideally suited to the work of caring for others. Similarly, we may need to dig deeply in the research to understand the contexts in which women and men provide care. As this cartoon suggests, caregivers often have many additional responsibilities and the combined burden can take a toll on their health as well as their social and economic well-being. If we hope to create effective and equitable policies and programs, we need to think beyond the actual provision of care to the other demands and needs in the lives of diverse groups of caregivers.
Having determined what we know and don’t know from our research, we are in a better position to provide informed, reliable advice for the development or evaluation of policies and programs. Recognizing the strengths and limitations of our evidence is critical. We can never create perfect policies or programs that meet everyone’s needs all of the time, but we can be precise about which populations are likely to benefit from a specific policy or program and which are not. Understanding who is missing can help to pinpoint key areas for new or more research. It can also support efforts to anticipate and prevent any potential harms arising from policies or programs, such as increasing health inequities.
Image source: Used with permission of Women and Health Care Reform