1. Gendering Institutions: Women and Access to Health Jan Angus, RN, PhD Associate Professor Canadian Institutes of Health Research New Investigator

2. Gender Analysis – an ecological view Multiple dimensions of gender: 1.Individual (feminine or masculine comportment) 2.Interpersonal (interactions, activities) 3.Contextual (social, material conditions) 4.Institutional (discourses and arrangements within large social structures)

3. Institutions (from Smith, 2005)  Functional complexes or clusters of activity (corporations, health care, education, etc)  Multiple sites and tasks coordinated by language or textually based discourse  Institutional discourses or policies may:  Create barriers or marginalizing conditions  Build on or reinforce gender normativity  Individuals may be caught within institutional intersections or overlaps

4. Everyday Context Opportunities, barriers and resources for health and self care Employment & Income Domestic Tasks & Family Care Self Care Domestic Time CommitmentsWorkplace Time Commitments

5. Pathways to Breast Cancer Diagnosis* SA: So, well, coming here it is not so easy because we were not settled, we did not have a home yet, so it was difficult for us and then I put aside my health because I had a check up last June I: And that was back in [country of origin]? SA: Yeah, we arrive in [city] and we were kind of busy because of looking for a school for the children and orientation of all the places…so it was busy and we are adjusting to the cold weather because we are not used to it. So back in August I found something hard here, but a small one. And then as I said we were kind of adjusting and we didn’t have health insurance because we just arrived so I just put it aside… But come January and I told [husband] that I’m alarmed because it’s a different one and then he tells me that I’m not permanent in my job too… * Funded by Social Sciences and Humanities Research Council

6. Another Pathways Example… M: It was a Thursday night, I discovered the lump because I felt a sharp pain under my arm and I thought, “What’s that?” And I felt under my arm and I didn’t feel anything…but when I put my hand there [closer to breast] I felt the lump. Now I usually check in the shower, so I was totally flabbergasted…So I went into work Friday morning and I waited till my doctor’s office opened which was around 9:30, and I phoned and I made an appointment for that day. And I told my boss “I found a lump and I’m leaving”… M: I was off work for the first surgery, and when I came back…! So it’s like “What’s wrong with you guys, like I’m getting mixed signals here. First of all for months you were telling me I was gonna do this job, and now you go and hire someone else?” So that was a little bit stressful. I didn’t want to be stressed out having to compete with this girl, so I said I’d rather stay off [on sick leave during chemotherapy].

7. Institutional Context of Health Care Everyday Context Opportunities, barriers and resources for health and self care Employment & Income Domestic Tasks & Family Care Health & Self Care Domestic Time CommitmentsWorkplace Time Commitments “Plugging in to the system” Working with The Health Care System

8. From “Gateways to Cancer Screening for Women with Mobility Disabilities”*  Participants reported multiple barriers to mammography, cervical screening and colorectal screening:  Providers did not suggest screening or refer  Participants were deterred by previous negative experience with health care  Lack of available information about providers with specialized knowledge, accessible technology and on-site attendants  Coordination required to arrange transportation services, attendant care, and screening appointments * Community Project Funded by Canadian Cancer Society

9. A Gateways Example “When I got to [the hospital] they took me to the dressing room. They gave me a gown and I told them I couldn’t use this change room. They said ‘There is no accessible change room’. They told me I can use the examining room [to change]. I sat in the chair [provided for use with mammography technology], but I said I wanted to stay in my chair, my chair was high enough. But I still had to sit in the sideways one.”

10. Conclusions  Institutional overlaps create conflicts among women’s multiple sites of responsibility and activity  Input from stakeholders at all phases of policy or procedure development – especially reassessment – to identify barriers and required resources  Strategic health messaging with inclusive images and specific information to support self advocacy in access to care  Examine how policies and procedures interact with uninsured costs of health care, built environments, equipment, transportation