The Intersections Between Women's Health And Poverty:
A Policy Paper for the Prairie Women's Health Centre of Excellence
The population health model encourages health analysts to consider both
bio-medical and socio-economic determinants of health in the implementation
of policies and practices. Over the last few decades, studies have connected
socio-economic factors and health inequalities. New research also acknowledges
that women's health is a by-product of gender-based differences resulting
from social and economic inequities as well as biologically based sex
Regrettably, in much of the literature, the connections between women's
health and women's poverty are often overlooked. Poverty is often addressed
as a gender-neutral problem. The failure to connect income inequality,
health and gender is problematic due to the pervasiveness and depth
of poverty among women in Canada. Overlooking this factor at the research
stage makes certain that the gendered nature of poverty remains unaccounted
for in policies and programs. According to Beaudry and Reichert:
If we are to define poverty as more than simply the lack
of income, but a systemic deprivation of healthy human development as
part of the human community, then poverty can be an extension of all
the life experiences. As well, women, who have endured these histories
have accepted (not willingly) the transfer of their own decision making
to the state.
The Prairie Women's Health Centre of Excellence (PWHCE) has addressed
the paucity of information on the health issues faced by poor women
by supporting a number of research studies. This paper is a review of
research papers supported by the PWHCE and is a synthesis of the policy
recommendations arising from the research. These are combined with the
results and recommendations from two other, external papers written
at the same time, one in Saskatchewan and one in Manitoba.
The documents emphasize that multi-faceted, comprehensive strategies
are required to address the health issues women face, arising from living
in poverty. The narratives emerging from the research provide valuable
insights into women's experiences with parenting, working and living
in poverty. Donner et al's paper provides important quantitative data
to broaden the understandings of the full scope of the problems. The
recommendations for action are based on the voices and observations
of the women themselves.
Summaries of Reports
The five recent reports reviewed from the PWHCE and the two external
reports delineate the scope of women's poverty and the ways that low
incomes impede well-being.
Sharing Our Stories on Promoting Health and Community Healing:
An Aboriginal Women's Health Project by Connie Deiter
and Linda Otway traces the history of health policies for First Nations
people in Canada. The chronic disempowerment experienced by many Aboriginal
people suggests that the adoption of health practices will only be realized
through long-term healing and the gradual re-acquisition of basic life
skills. The report goes on to summarize 98 interviews with Aboriginal
women from Saskatchewan and Manitoba, including five Elders. The women
interviewed connected their health status with governing policies and
procedures. Poverty is identified as a major contributor to the health
issues of Aboriginal women. Among its many recommendations, the report
calls upon governments to recognize and accept Aboriginal concepts of
health and healing.
Sexual Violence and Dislocation as Social Risk Factors Involved
in the Acquisition of HIV Among Women in Manitoba by Iris
McKeown, M.D., Sharon Reid, Shelly Turner and Pam Orr explores factors
leading to the over-representation of Aboriginal women in the incidence
and prevalence of HIV infections in Canada. The researchers investigate
women's movement and dislocation from rural and remote communities to
urban centres. In a study designed by the participants themselves, the
women reveal that health decisions for low-income women usually involve
giving up one detrimental behaviour for another that affords moderately
enhanced well-being. Thus health promotion models that promote individual
choice making and responsibility must be cautiously applied when women
in fact have profoundly limited "choices" to make.
"We Did it Together": Low-Income Mothers Working Toward
a Healthier Community by Kathryn Green emphasizes the
limitations of health policies that encourage skill and knowledge development
without addressing the social context of poor women's lives. The project
brought together low-income mothers to discuss ways to make their communities
and social environments safer for women and children. The women call
for adequate financial support in a number of ways to enable all families
to meet their basic needs. Other recommendations request the implementation
of policies that promote parenting as important and essential and providing
parents with further supports such as respite care and further financial
Left in the Cold: Women's Health and the Demise of Social
Housing Policies by Darlene Rude and Kathleen Thompson
is a comprehensive overview of the diminishing availability of adequate
housing for low-income Canadians due to federal and provincial withdrawal
of funding and responsibilities. The report includes a literature review
and review of policy trends in Canada over the last decade, including
an analysis of housing and health policies in Regina, Saskatchewan and
Winnipeg, Manitoba. The authors interviewed thirteen women who provided
first-hand accounts of their housing difficulties. The report calls
for the development of a gender-sensitive housing strategy that can
address the shortage of adequate and affordable housing for women, particularly
women raising young children, and women with disabilities or other health
Mothers' Health and Access to Recreation Activities for
Children in Low Income Families by Shirley Forsyth explores
the intersections between children's ability to participate in recreation
activities and their mother's health. Forsyth found that increases in
recreation fees present challenges for low-income families who cannot
cover the costs of children's involvement in activities. In Winnipeg,
Manitoba families were affected disproportionately by recent increases
in community and municipal fee hikes. The study verifies the cost-savings
that result from even minor investments in population health related
strategies. The other two key reports are summarized briefly and the
findings and implications from the work are interwoven through the policy
Women, Income and Health in Manitoba: An Overview and Ideas
for Action by Lissa Donner et al. provides statistics
on poverty among women in Manitoba and the connections that are made
to women's health status. One of the paper's particular strengths is
the attention it pays to poverty among Aboriginal women and the resulting
health concerns. Donner et al. identify strategies aimed at improving
women's incomes, and consequently, their health. The paper makes a persuasive
argument that policy initiatives on population health must consistently
Women, Health and Poverty: Review and Looking Forward
by Jayne Melville Whyte evaluates the success of initiatives aimed at
addressing women's poverty and their well-being. Whyte also visited
seven communities that sponsored projects on women's poverty with funding
form Health Canada. The women Whyte interviewed provide key insights
into the experience of poverty. One of Whyte's most troubling conclusions
is that women's poverty is almost invisible to policy makers and program
designers: "Poverty has not been seen as a women's issue - not by government
and sometimes, not by women's groups, not even by anti-poverty groups".
From this Policy Analysis five key themes emerge:
- The continued importance of gender-based analysis. The research
confirms that health policies and programs continue to downplay the
importance of socio-economic factors in women's health. The research
documents the problems that low-income women face in parenting, in
"choosing" healthy behaviours and in accessing services that incorporate
their multiple roles as survivors, mothers and caregivers. Health
promotion strategies are ineffective if they are based on the assumption
that "all women are engaging in risk behaviours by choice".
- The importance of defining and implementing population health approaches.
All of the studies point to the need to define and put into operation
the population health approach in ways that would more adequately
address the parameters of women's poverty. In the case of social housing,
for instance, governments endorse population health ideals while implementing
policies that undermine its ideals. In Sharing Our Stories, one woman
points out, "It makes me mad when I see hospitals closing, and doctors
leaving, yet, they can build onto the casino."
- The need for further research clearly linking health and poverty.
Researchers' attempts to link well-being to economics are compromised
by the interplay between a number of factors that are individually
capable of affecting health. Poverty can be difficult to isolate from
issues of race, social isolation, low self-esteem. The studies do
connect poverty with health conditions, particularly stress and mental
health concerns. Largely, however, the causal relationships between
women's poverty and all types of illness and disease remain invisible
and unexplored. Women's health researchers must also work to provide
the epidemiological data policy makers demand.
- The importance of women's stories of their lives and their health.
Notwithstanding the above, the voices of the women in the reports
provide real evidence of the challenges that low-income women confront.
Their voices are descriptive and evocative. Policy models that promote
personal responsibility for health without reflecting on the barriers
that some individuals and communities face are inadequate. The women
who were part of Sexual Violence and Dislocation, for instance, shared
their past histories which led to their crucial choices in dismal
circumstances. This points to the difficulties in developing effective
health policies without extensive and careful consultation with women
- The need to promote positive images of poor women, children and
families. Living in poverty presents numerous challenges and risks,
particularly for those women who are also mothers. Figuring out how
to get enough food for the month when you're using grocery money to
pay the rent, you have mall kids and no care; keeping your kids happy
and out of trouble when you live in a dangerous neighbourhood and
can't pay for recreation; moving a couple of times a year in the hope
of finding somewhere decent to live - challenges like these fill the
days of parents in poverty. One way to end "poor bashing" is to provide
women in poverty with opportunities to celebrate their strengths and
resourcefulness, while at the same time working towards equity and
equality. Society must examine the ways that consumerism shapes values
To create a coherent message for future work addressing poverty as a
determinant of women's health, the recommendations from the studies
cited in this report were analyzed and a set of twelve consolidated
recommendations were formed.
- Expand thinking and commit to further action on the determinants
- Develop comprehensive strategies for women's equality.
- Support the creation of healthy communities.
- Treat women's poverty seriously. Address children's poverty as
a common outcome of women's poverty.
- Commit to developing and implementing a plan to reduce and eliminate
- Develop research agendas, policies and programs on women's health
and women's poverty in partnership with poor women.
- Foster and develop supportive networks for poor women.
- Ensure safe and affordable housing is available for poor women
and their families.
- Commit to improving the health and well-being of Aboriginal women.
- Develop education programs for women at risk.
- Require appropriate training for service providers.
- Recognize non-mainstream professionals, particularly Aboriginal
Elders and traditional healers.
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The successful implementation of the population health approach
depends upon the adoption of a gender lens. The links between poverty
and health, coupled with the fact that women comprise the majority of
Canada poor, confirm that addressing women's poverty within the context
of women's health will enhance the likelihood that reform strategies
will exert a positive influence on health status.