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Promoting gender equity in family medicine

May Cohen, MD CCFP FCFP
Professor Emeritus in the Department of Family Medicine at McMaster University in Hamilton, Ont

Sheila Dunn, MD CCFP(EM) FCFP
Associate Professor in the Department of Family and Community Medicine at the University of Toronto and the Research and Program Director at the Bay Centre for Birth Control in Toronto, Ont

Cheryl A. Levitt, MBBCh CCFP FCFP
Professor and immediate Past Chair of the Department of Family Medicine at McMaster University and is Past President of the Ontario College of Family Physicians. All authors participate actively in the Wonca Working Party on Women and Family Medicine, which Dr Levitt chaired from 2001 until July 2007

Correspondence to: Dr Barbara Lent, Department of Family Medicine, University of Western Ontario, 60 Chesley Ave, London ON N5Z 2C1; telephone 519 433–8424; fax 519 433–2244; e-mail blent{at}uwo.ca

With their endorsement of the Hamilton Equity Recommendations¹ (the HER Statement), the College of Family Physicians of Canada (CFPC) and the Ontario College of Family Physicians have joined with their international colleagues in making a commitment to gender^* equity. The HER Statement, which was developed at a unique meeting of the Wonca Working Party on Women and Family Medicine (WWPWFM) attended by 25 women family physicians from 16 countries and all 6 Wonca regions, emphasizes the critical importance of the empowerment of women and provides a framework for how to bring about sustainable gender equity within family medicine. At the same meeting, the group also developed an accompanying statement, 10 Steps to Gender Equity in Health (Table 1²), which underscores the significance of gender as a key determinant of health.

It is widely accepted by international bodies, such as the United Nations and the World Health Organization, that the empowerment of women and the full and equitable participation of women in the workplace, in professions, and throughout society are critical to strengthening civil societies. Kofi Annan, the former Secretary-General of the United Nations, articulated this eloquently:

[S]tudy after study has taught us that there is no tool for development more effective than the empowerment of women. No other policy is as likely to raise economic productivity, or to reduce infant and maternal mortality. No other policy is as sure to improve nutrition and promote health—including the prevention of HIV/AIDS. No other policy is as powerful in increasing the chances of education for the next generation. And I would also venture that no policy is more important in preventing conflict, or in achieving reconciliation after a conflict has ended. But whatever the very real benefits of investing in women, the most important fact remains: Women themselves have the right to live in dignity, in freedom from want and from fear.³

Women and girls frequently do not have the same opportunities to benefit and contribute to society that men and boys do. If they did, we would have much healthier and stronger societies worldwide. Culture, religion, traditions, law, history, and politics all influence the ways in which women do or do not participate in society. These factors also contribute to the differences between men and women, boys and girls, in the kinds of health problems experienced. Gender is a critical issue to address as a key determinant of health and a healthy society. This is not only a problem in developing countries. Every day, Canadian newspapers report stories of family violence, child poverty, and unintended pregnancies, all of which reflect the effects of gender.

Role of the CFPC

As Canadian members of the WWPWFM, we believe that the CFPC and the provincial Colleges can promote gender equity in various ways. Using the 4 principles espoused in the HER Statement as a framework, the following recommendations highlight the ways in which family medicine organizations can promote gender equity and a deeper recognition of gender as a fundamental determinant of health.

1. Enshrine the principle of gender equity within the CFPC’s governance
A review of College bylaws, policies, and regulations would clarify ways to ensure that both men and women are given equitable opportunities to participate in all College activities. Moreover, the College’s new strategic directions should be examined to ensure that they do not affect men and women physicians differently and that they do make a commitment to gender equity.

2. Endeavour to implement gender equity in all activities of the CFPC
At educational and scientific events, organizers could ensure that women and men physicians are well represented as workshop leaders, plenary speakers, and participants. In addition, all committees should ensure that meetings are family-centred and accommodate lifestyle issues and an appropriate balance between professional and personal responsibilities (eg, timing of meetings, provision of child care, allowances for restorative time).

3. Promulgate the pivotal role of gender as a key determinant of health
The College’s principles of family medicine emphasize that "family physicians are skilled clinicians" and "resource[s] to a defined community." As leaders in promoting health in our communities, family physicians must incorporate into their clinical and professional work consideration of sex and gender as 2 critical interrelated determinants of health. In this context, sex refers to biological factors, while gender is a social construct that reflects the values, attitudes, and behaviour of men and women in society. Gender itself is not only a critical determinant of health; it also interacts with the other determinants of health, such as poverty, education, ethnic origin, and housing, to influence pathogenesis, management, and prognosis of illness. The College and its chapters should ensure that educational programs at the undergraduate, postgraduate, and continuing professional development levels incorporate these concepts. Canadian family physicians have participated in the development of several excellent educational resources—see the Training Manual on Gender Mainstreaming in Health (www.mwia.net/gmanual.pdf), developed by the Medical Women’s International Association, and the Gender and Health Collaborative Curriculum Project (www.genderandhealth.ca), developed by the Gender Issues Committee and the Committee on Undergraduate Education of the Council of Ontario Faculties of Medicine.

4. Promote the equitable inclusion and advancement of women family physicians in the CFPC and in academic medicine in Canada
With the ever increasing numbers of women in the profession, and the number of women who have held leadership positions in the College and in academia, many Canadians believe that gender equality has been achieved in family medicine. Women physicians’ organizational leadership and academic progress and advancement, however, is slower than their numbers would suggest,^4,5 reflecting personal, institutional, and societal barriers to women physicians’ full participation in family medicine and in the CFPC. Women students and residents face barriers as well.⁶ Addressing these barriers by providing appropriate supports and mentoring programs, and by making institutional changes that will benefit all physicians, will help the College and its affiliates attain equity.

A leader for change

With the high respect it has earned internationally, the CFPC has the opportunity to make a real difference. We can carefully assess the challenges posed by the changing physician work force and ensure equitable participation of women and men. To build an organizational and professional culture that understands and incorporates gender equity into all its activities will require knowledge, reflection, and firm commitment. Promoting equity might challenge our assumptions about what family medicine should look like. Our vision for family medicine reflects the principles of social justice. Family medicine will be a discipline where men and women can participate equally as physicians in practice, academia, and organized medicine and where our College advances the health of all Canadians by addressing gender inequities in health.

Footnotes

^* Gender is used throughout this article to mean a social construct that reflects the roles, expectations, behaviours, and values of men and women in contrast to biological differences related to sex.

Equity is not the same as equality. Equality speaks to sameness, the same numbers, identical rights. Equity is the principle and practice of fair allocation of resources, programs, and decision making to both women and men, and includes the redressing of identified imbalances in the benefits available.

Competing interests

None declared

The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

References

1. Lent B. Wonca Working Party on Women and Family Medicine. Gender equity. Canadian contribution to international initiative. Can Fam Physician 2007;53:488-90.[Free Full Text]
2. Wonca Working Party on Women and Family Medicine. Wonca’s 10 steps to gender equity in health. Hamilton, ON: Wonca Working Party on Women and Family Medicine; 2006. Available from: http://www.womenandfamilymedicine.com/wwpwfm-statements/10_steps_gender_equity_02-07-2007.pdf. Accessed 2007 July 23.
3. Annan K. Message of the Secretary General. New York, NY: United Nations; 2005. Available from: www.un.org/events/women/iwd/2005/message.html. Accessed 2007 July 23.
4. Hamel M, Ingelfinger J, Phimister E, Solomon C. Women in academic medicine—progress and challenges. N Engl J Med 2006;355(3):310-2.[Free Full Text]
5. Levitt C, Candib L, Lent B, Howard M. Working Party releases first in a series: women in organizational medicine. Wonca News 2006;32(3):6-8.
6. Lent B, Levitt C, Candib L, Howard M. Women in training. Wonca News 2007;32(6):14-5.

Related articles in CFP:

Promouvoir l’équité entre les sexes en médecine familiale

Barbara Lent, May Cohen, Sheila Dunn, and Cheryl A. Levitt
CFP 2007 53: 1426-1428. [Full Text]  

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