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omen are different from men. Vive la difference! Although the difference is not news to most of us, it is still being discovered in healthcare. Often, healthcare has been dispensed as if 'one size fits all'. Health Canada's Women's Health Strategy "underscores the recognition that in questions of health, it matters whether you are a woman or a man".

As patients, women need healthcare tailored to women's bodies and mindful of women's social roles. There are some conditions that affect more women than men, such as arthritis, osteoporosis, and eating disorders. There are some conditions that affect women differently than they affect men. Heart attacks and AIDS are two of many serious conditions that doctors sometimes overlook in women, because the signs and symptoms look different than they do in men. And there are some conditions that only affect women, such as pregnancy, childbirth and menopause. But too often, reproductive health is what 'women's health' is seen to be. Women's health is much more than this.

Understanding women's health means understanding how gender, not just biology, affects us.

Gender goes beyond biology. Babies are born girls or boys. That's biology. When parents dress girls in pink and boys in blue, that's gender. Other examples of "gender" include social roles, personality traits, attitudes, behaviours, values, and relative access to power and influence.

Biologically, women tend to have stronger immune systems, which protects them against infection, but makes them more vulnerable to auto-immune conditions such as rheumatoid arthritis and lupus. Women are twice as likely as men to contract a sexually transmitted disease during unprotected intercourse with an infected partner, and 20 times more likely to contract HIV. And there are many other ways that sex-whether one is male or female-makes a difference to one's health, as noted by the Society for Women's Health Research.

But health is also affected by social expectations, such as family roles and occupations. Because women usually earn less than men, women are more vulnerable to poverty. Because women's family role is to take care of other family members, and they are often financially dependent on men, they are likely to stay in violent relationships even after they get injured. These, and other effects of gender on health, are noted by Canadian researcher Karen Grant in 10 Gender Differences that Make a Difference to Women's Health.

Menopause is an example of how a biological activity has been overlaid with gender expectations. When menopause was regarded as strictly a biological imperative, it seemed not much could be done to relieve the symptoms or delay the aging process. Recognition of the role that gender expectations played (keeping women from exercising, for instance) suggested new approaches for treatment. Modern healthcare recognizes a variety of methods - from exercise and diet to medication - that can help women sail smoothly through menopause and remain vigorous in their later years.

Heart disease is usually seen as a threat to men, yet it is the number one killer of women too. The symptoms of a heart attack in women are somewhat unusual compared to those in men. Sometimes women with heart disease are not taken seriously, and do not receive the appropriate tests and treatment.

Understanding how heart attacks differ in men and women will help doctors and patients recognize heart attacks and risk indicators, and recommend more effective treatments for women. "Gender-based analysis" (see sidebar) is a tool that can improve health care by looking at how conditions such heart disease, differ according to one's gender and sex.

			What is Gender-based Analysis?
			GBA is a tool for analyzing policy. The Federal government has mandated since 1995 that all government policy and legislation undergo GBA, where applicable. In the case of healthcare policy, GBA helps us look at how well current practices deal with the effects of gender on health and healthcare. Where women are concerned, GBA asks questions such as: What factors affect women's health? Do women have equal access to healthcare? Do we receive appropriate care when we do get access? For instance, more women than men seek medical help with handling stress. Women usually do at least twenty hours of unpaid work at home, in addition to the hours in the paid workforce. Many women also juggle volunteer work or caregiving work for older or disabled family members, as well. "As a result," the Women's Health Strategy states, "in the 20-44 age group, the work stress index of women is much higher than that of men." Women are the main healthcare providers and consumers, in Canada and elsewhere. Women are overly represented among the poor, are the principal care providers and managers of family health, are the majority of health care workers, and are still found mostly in secondary or support roles in the workplace. All these factors are part of women's gender roles in society, and affect women's experiences with the healthcare system. Applying GBA analysis to healthcare policies will improve patient outcomes and help keep workers in the healthcare workforce.

An estimated 60,000 Canadians, mostly women, suffer from either bulimia, anorexia or both eating disorders, says the Peterborough Women's Health Centre Eating disorders are often clearly linked to female social roles and standards of attractiveness. According to the Body Image and Eating Disorders Resource Centre, "The latest report from Statistics Canada states that 40% of grade 3 girls are dissatisfied with their bodies. This increases to 80% by the time they hit grade 8." To counteract girls' anxieties about their bodies, the Peterborough Centre suggests focusing on their other abilities and skills, emphasizing physical activity, and setting a good example by not dwelling on anyone's body size or weight.

Violence is another major factor in women's health. According to Health Canada, "The measurable health-related costs of violence against women in Canada exceed $1.5 billion a year," including lost time at work, medical treatment and dental repair, long-term counselling, and use of crisis centres and shelters. Nine out of ten persons injured by a spouse or partner, are women.

Women also face other health issues as the major caregivers to their families, for both their children and their aging parents. "Women provide more than 80% of the paid and unpaid health care in this country," as the Women's Health Clinic stated in a brief to The Standing Senate Committee on Social Affairs, Science and Technology. As unpaid caregivers, women who care for seniors give an average of 28 hours a week to their care.

Mothers of children with severe disabilities give an average of fifty to sixty hours a week. The stresses of unpaid homecare can include: lack of social life, lack of sleep, increased anxiety, and higher rates of illness.

In recent years, it has been recognized that many factors interact and contribute to a person's health. Gender is a key factor in the twelve determinants of health identified by Health Canada.

Gender interacts with several of the other determinants, as the Women's Health Strategy notes, "wage gaps, low occupational status and poverty are common observations in any analysis of women's socio-economic status." The National Forum on Health reported that women from Aboriginal communities are at especially high risk for illness and shorter lifespans than the rest of the population. They are less likely to finish high school, or to be employed; and their poverty rates are higher (33 percent) than other women (17 percent). Racism and poverty are also key factors for women in visible minority groups. Their unemployment rates are higher, and 28 percent have incomes below the poverty cut-off.

With this knowledge that gender affects health and healthcare, policy makers have an important tool for analyzing and improving healthcare applications. This tool, called gender-based analysis, recognizes that women and men have different health concerns, due not only to biology, but to gender. And when medical knowledge takes gender into account as a critical health factor, the result is better healthcare, and better health, for everyone.