Transcript of What is Hurting Women's Health? | The Agenda

>> NAM: DESPITE WOMEN REPRESENTING HALF THE POPULATION OF CANADA, THERE REMAIN A LOT F QUESTIONS SURROUNDING THEIR HEALTH NEEDS IS A LACK OF KNOWLEDGE HURTING WOMEN'S HEALTH? AND SHOULD ONTARIO INVEST MORE MONEY INTO RESEARCH? JOINING US TO ANSWER THESE QUESTIONS, WE WELCOME: IN ST ALBERT, ALBERTA, CARMEN WYTON, CHAIR AND FOUNDER OF WOMEN'S HEALTH COALITION OF CANADA. IN THE NATION'S CAPITAL, DOCTOR AMANDA BLACK, PROFESSOR OF, OBSTETRICS AND GYNECOLOGY AT THE UNIVERSITY OF OTTAWA. AND IN ONTARIO'S CAPITAL CITY, CHRISTINE FAUBERT, VICE PRESIDENT OF HEALTH EQUITY & MISSION IMPACT, AT THE HEART AD STROKE FOUNDATION OF CANADA. WELCOME TO YOU ALL. CARMEN, I WANTED TO START WITH YOU. CAN YOU GIVE US AN IDEA, IF YOU WERE TO SAY IT IN A FEW WORDS HOW WOULD YOU DESCRIBE THE CURRENT STATE OF WOMEN'S HEALTHCARE ACROSS CANADA? >> CARMEN: WOMEN'S HEALTHCARE IS, UNFORTUNATELY, DECLINING. IT'S DECLINING IN IMPORTANCE, IT'S DECLINING IN FUNDING, BUT THE NEEDS OF WOMEN ARE INCREASING. AND SO WOMEN ARE BEING LEFT BEHIND AND NOBODY DID IT ON PURPOSE. BUT NOW IT'S ABSOLUTELY THE BET TIME TO CHALLENGE IT AND TO THINK DIFFERENTLY AND TO ENCOURAGE WOMEN TO STAND UP FOR THEMSELVES AS WELL BECAUSE IT'S NOT GOING TO GET BETTER BY ITSELF. >> NAM: WHAT YOU SAID ABOUT WOMEN'S NEEDS INCREASING, I WANTED TO GET INTO SOME STATS FROM YOUR ORGANIZATION ABOUT WHAT IT LOOKS LIKE HERE IN THE PROVINCE OF ONTARIO. BILLING RATES FOR GYNECOLOGICAL PROCEDURES ARE UP TO 50 PERCENT LOWER IN ONTARIO THAN OTHER PROVINCES SUCH AS ALBERTA AND BRITISH COLUMBIA. GYNECOLOGISTS ARE IN SIGNIFICANTLY LESS THAN THEIR SURGICAL COLLEAGUES. OBSTETRICS AND GYNECOLOGY SHARE A SINGLE FUNDING POOL LEADING TO OBSTETRICS BEING PRIORITIZED OVER GYNECOLOGY. WAIT TIMES FOR GYNECOLOGICAL CARE ARE UNACCEPTABLY LONG, WIH SOME CENTRES HAVING WAIT LISTS OF 800 TO 1500 PATIENTS. THE MOST COMPLEX CASES FACED DELAYS OF TWO TO THREE YEARS, LEADING TO SERIOUS HEALTH CONSEQUENCES. GYNECOLOGY REMAINS THE ONLY SPECIALTY THAT HAS SEEN A DECLINE IN SPENDING OVER THE LAST 8 YEARS. CARMEN, AS FOUNDER OF WOMEN'S HEALTH COALITION WHAT PROMPTED YOUR ORGANIZATION TO CREATE THIS STUDY? >> CARMEN: THE WOMEN'S HEALTH COALITION OF CANADA ACTUALLY STARTED IN TORONTO, WHERE I GATHERED WITH WOMEN WHO HAD UTERINE FIBROIDS SO THE COMMON DENOMINATOR AMONG THOSE WOMEN R THE AMOUNT OF TIMES THAT THEY HAD TO WAIT TO BE TAKEN SERIOUSLY TO GET INTO TREATMENT AND IT WAS BECAUSE SO MUCH OF WHAT THEY WOULD CONVEY TO THEIR HEALTHCARE PROFESSIONAL WAS TREATED AS NORMAL AND THEY WERE SENT HOME, OR THEY WERE SENT HOME WITH ANTIDEPRESSANTS. WHEN YOU LOOK AT THE INEQUITIES THAT ARE EMERGING, IT IS BECAUSE WOMEN'S HEALTH IN PRIMARY CARE IS OVERLOOKED AND IS UNDERSERVED AND SO BY THE TIME THEY GET INO THE SPECIALIST SYSTEM, IT'S BEING OVERTAXED AS A RESULT AND SO, THOSE THINGS, THE START OF THE WOMEN'S HEALTH COALITION AD THE INEQUITIES WE ARE SEEING IN ONTARIO AND ACROSS CANADA ARE. IT'S A TREND THAT WE NEED TO BREAK. BUT IT DOES START WITH WOMEN'S HEALTH IN PRIMARY CARE. AS YOU SAID IN YOUR NOTES, OBSTETRICS AND GYNECOLOGY IS A COMBINED SPECIALTY BUT PUT INTO THAT ALSO CLINICAL CARE AND NO OTHER SPECIALTY SHOWS UP THAT THEY DO. >> NAM: AMANDA I WANTED TO COME TO YOU NEXT CARMAN WAS TALKING ABOUT UTERINE FIBROIDS. I ACTUALLY WENT THROUGH AN EXPERIENCE BEING DIAGNOSED WITH FIBROIDS AND I KEPT GOING INTO THE ER FOR ABOUT A YEAR, TAKING UP RESOURCES FOR OTHER PEOPLE, BECAUSE I WAS ON A WAITLIST FOR TWO YEARS FOR SURGERY. AS A GYNECOLOGIST HAS THIS DATA ALIGNED WITH WHAT YOU SEE IN YOUR PRACTICE? >> AMANDA: I THINK THERE ARE A NUMBER OF CONDITIONS THAT AFFECT WOMEN, SPECIFICALLY THAT PROBABLY DON'T RECEIVE THE ATTENTION THAT THEY NEED AS FAR AS RESOURCES, AS FAR AS DIAGNOSIS, AS FAR AS ACCESS TO CARE. THERE ARE MANY COMMON GYNECOLOGIC CONDITIONS THAT COULD REALLY IMPACT A WOMAN'S QUALITY OF LIFE IN THER ABILITY TO BE FULL CONTRIBUTING MEMBERS OF SOCIETY. SINCE LIKE CONDITIONS SUCH AS FIBROIDS CERTAINLY, HEAVY MENSTRUAL BLEEDING SO WHEN WE LOOK AT TIME LOSS TO WORK DUE O ISSUES AROUND HEAVY MENSTRUAL BLEEDING, PATIENTS WITH ENDOMETRIOSIS, NOT ONLY FACING LONG DELAYS WITH DIAGNOSIS WITH ENDOMETRIOSIS BUT WITH DIAGNOSIS IT'S LONG WAIT TIMES FOR ACCESS TO CARE AND WE KNOW THAT FOR EXAMPLE, WITH WOMEN WITH ENDOMETRIOSIS THEY REPORT SIGNIFICANT EFFECTS OF QUALITY OF LIFE INCLUDING THE ABILITY O WORK, SO 70 PERCENT OF WOMEN REPORT IMPAIRMENT AND CLOSE TO 20 PERCENT OF THEM MISSED WORK IN THE PAST BECAUSE OF PAIN, OR OTHER SYMPTOMS RELATED TO THEIR CONDITION AND THAT LEADS TO LOT PRODUCTIVITY AND ULTIMATELY A GREATER STRAIN ON THE HEALTHCARE SYSTEM AND SIGNIFICANT ASPECT OF OUR WORK OF COURSE NOT BEING ABLE TO FULLY PARTICIPATE TO THEIR HIGHEST POTENTIAL. >> NAM: AND SOMETHING YOU SAID, AMANDA STOOD OUT FOR ME WAS THE PAIN. I THINK WOMEN ARE STILL EXPECTED TO SHOW UP IN ALL ASPECTS OF THEIR LIVES NO MATTER WHAT'S GOING ON WITH THEM. AND CARMEN, WE KNOW HISTORICALLY WOMEN'S CARE HAS BEEN UNDER RESEARCHED AND UNDERFUNDED, WHERE ARE WE SITTING AT NOW? >> CARMEN: IN TERMS OF UNDERFUNDING, THERE WAS A STUDY DONE WITH SEXISM IN SURGERY AND WE CAN DO A HEAD-TO-HEAD REVIEW OF MEN'S TREATMENTS, MEN'S SURGERIES, THAT ARE ABSOLUTELY COMPARABLE AND IN ALMOST EVERY PROVINCE, THERE'S GOING TO BE GREATER COMPENSATION FOR MEN'S PROCEDURES AND SO BECAUSE OF THAT, WHAT IT MEANS IS ACROSS THE WHOLE SPECTRUM OF TREATMENT, THE SYSTEM IS GOING TO FAVOUR OTHER SPECIALTIES. THE SYSTEM IS GOING TO FAVOUR MEN'S HEALTH OVER WOMEN'S HEALTH AND SO THAT REALLY IS THE TREND WE NEED TO TURN AROUND AND ON TOP OF THAT, IF WOMEN AREN'T CHALLENGING THEIR HEALTHCARE PROVIDER, THAT THE SYMPTOMS THY ARE EXPERIENCING, PELVIC PAIN, PCOS IS A VERY COMPLEX CONDITION THAT IF THEY DON'T TAKE AUTHORITY OF THAT HEALTHCARE EXPERIENCE AND DEMAND MORE OF THEIR SYSTEM THEY ARE GOING TO SIT IN LONG WHITE LINES, THEY ARE GOING TO BE WAITING FOR SURGERY, AND THEIR CONDITION WILL WORSEN. AND SO WE HAVE TO BE NOT SATISFIED WITH THAT ANY LONGER. >> NAM: CHRISTINE, WHEN CARMEN SAID THAT THE SYSTEM IS GOING O FAVOUR MEN'S HEALTH, I SAW YOU NODDING. >> CHRISTINE: YES, ABSOLUTELY, AND GOING BACK ON THE RESEARCH FUNDING, THERE IS A PERSISTENT LACK OF AWARENESS AND UNDERSTANDING AROUND WOMEN'S HEALTH OVERALL, JUST IN WOMEN'S HEALTH IN GENERAL. WE KNOW THEY ARE UNDERREPRESENTED AND HEALTH RESEARCH AND HEALTH RESEARCH OVERALL. THERE'S THAT I WOULDN'T SAY SHOCKING BUT STATS AROUND THE REPRESENTATION OF WOMEN IN CLINICAL CARE. WE KNOW OVER THE YEARS ONLY TWO THIRDS OF PARTICIPANTS OF CLINICAL TRIALS HAVE BEEN MEN O IT MEANS A THIRD HAVE BEEN WOMEN. THAT IS A GAP AND WHAT IT MEANS ARE THEY ARE INCLUDED IN CLINICAL TRIALS, DOESN'T MEAN N ANALYSIS OF THE RESULTS BY SEX AND GENDER IS CONDUCTED. SO THAT MEANS THAT THE RESEARCH RESULTS, THEY'RE GENERALIZED TO MEN AND WOMEN OVERALL. AND WHEN IN FACT IT ACTUALLY MIGHT REPRESENT MORE MEN THAN WOMEN. SO THERE'S A LOT OF CATCH UP TO DO IN TERMS OF REALLY UNDERSTANDING WOMEN'S HEALTH WOMEN'S HEART AND BRAIN HEALTH WHAT WOULD PUT THEM AT RISK WHAT ARE THE SPECIFICITIES AND WHAT TYPE OF DIAGNOSIS AND TREATMENT ARE REQUIRED TO REALLY HELP WOMEN ACHIEVE HEALTH OUTCOMES THAT ARE POSITIVE AND REACHING QUALITY OF LIFE. >> NAM: EVEN SOMETHING AS WHEN WE TALK ABOUT THE SIGNS OF IF YOU ARE HAVING A HEART ATTACK, I THINK WE THINK OF CERTAIN THINGS. BUT THOSE THINGS ARE RELATED TO MEN. CAN YOU TALK TO US MORE ABOUT THAT, CHRISTINE? >> CHRISTINE: ABSOLUTELY. SO WE KNOW THERE'S ACTUALLY SHARED SYMPTOMS BOTH FOR MEN AD WOMEN. SO THE TYPICAL ONES THAT WE KNOW AROUND CHEST PAIN, THAT KIND OF THING, BUT WE KNOW THAT WOMEN WILL TEND TO ALSO PRESENT WITH DIFFERENT SYMPTOMS. AND UNFORTUNATELY THOSE ARE NOT ALWAYS KNOWN OR SEEN WHEN THEY ACTUALLY PRESENT TO THE EMERGENCY OR WHEN THEY HAVE CONVERSATION WITH THEIR FAMILY DOCTOR. SO WOMEN TEND TO HAVE, FOR EXAMPLE, MORE SYMPTOMS THAT SEM A LITTLE BIT MORE LIKE ANXIETY OR STRESS. SO THEY WILL HAVE KIND OF LIKE PAIN OR THINGS HAPPENING IN TERMS OF THEIR JAW, THEIR UPPER SHOULDER, UPPER BACK, OR EVEN SOME SORT OF BELLYACHE, THAT KIND OF THING. SO OFTENTIMES WHAT HAPPENS IS THAT WOMEN WILL TRY TO DESCRIBE WHAT'S HAPPENING TO THEM, BUT THEN THEY'RE SENT HOME PROBABLY WITH KIND OF LIKE A BASIS AROUND, MAYBE YOU'RE JUST HAVING SOME SORT OF ANXIETY OR DEPRESSION. SO THAT BECOMES REALLY FRUSTRATING. AND UNFORTUNATELY THIS IS JUST BECAUSE, YOU KNOW, IT'S NOT WEL KNOWN AT THIS POINT YET. WHAT ARE THOSE WOMEN'S SPECIFIC SYMPTOMS OF HEART ATTACK. >> NAM: WHEN YOU SAID SYMPTOMS CAN PRESENT THEMSELVES AS ANXIETY AND STRESS I THINK WE ARE ALL WOMEN SO I THINK WE'VE ALL HAD MAYBE A SITUATION IN OR PERSONAL LIVES WHERE YOU WERE GOING THROUGH SOMETHING AND IT WAS JUST SHRUNKEN INTO IT COULD BE ANXIETY OR STRESS WHEN IT COULD BE SOMETHING MORE SERIOU. AMANDA, HOW IS THE MEDICAL SYSTEM IN ONTARIO FAILING WOMEN? >> AMANDA: I THINK THERE ARE SOME AREAS WHERE WE ARE DOING WELL, AND CERTAINLY IN COMPARISON. BUT I DO FEEL THAT WE HAVE A LT OF WORK THAT NEEDS TO BE DONE. WE'RE TALKING FIRST OFF JUST ABOUT ACCESS TO CARE. SO ACCESS BOTH TO PRIMARY CARE WHICH WE KNOW IS AN ISSUE FOR MANY PEOPLE IN ONTARIO, FOR THOUSANDS OF PEOPLE NOT HAVING ACCESS TO A PRIMARY CARE PROVIDER. WE'RE ALSO TALKING ABOUT ACCESS TO GYNECOLOGIC SURGERIES AND THE WAIT TIMES ASSOCIATED WITH THA. SO NOT ONLY THE TIME IT TAKES O SEE A SPECIALIST, BUT THEN THE TIME IT TAKES ONCE YOU SEE THAT SPECIALIST TO ACTUALLY BE SCHEDULED FOR A PROCEDURE. AND KNOWING THAT IN MANY CASES WE'VE INNOVATED AS MUCH AS WE CAN TO TRY TO MOVE CERTAIN THINGS OUT OF MAIN OPERATING ROOMS INTO OUTPATIENT FACILITIES, TRYING TO DO THINGS WITH DAY SURGERIES THAT WERE PREVIOUSLY DONE AS INPATIENT SURGERIES, BUT AT SOME POINT YU REACH A MAX. AND I THINK THERE NEEDS TO BE THAT RECOGNITION THAT THESE ARE CONDITIONS THAT AFFECT A SIGNIFICANT PROPORTION OF THE POPULATION. AND WE WANT TO BE ABLE TO GET THESE PEOPLE BACK INTO THEIR LIVES AND BE PRODUCTIVE MEMBERS OF SOCIETY. I THINK ONE OF THE CHALLENGES THAT WE HAVE IS THAT WE DON'T HAVE RELIABLE STANDARDIZED DATA TO LOOK AT HOW WE CAN HELP IMPROVE OUR HEALTH OUTCOMES. SO THERE'S NO NATIONAL FRAMEWORK OR EVEN A PROVINCIAL FRAMEWORK FOR COLLECTING OR SHARING CONSISTENT DATA ABOUT A NUMBER OF WOMEN HEALTH ISSUES INCLUDING PREGNANCY OUTCOMES MATERNAL MORBIDITY AND MORTALITY, OR SOME OF THE MORE COMMON GYNECOLOGIC CONDITIONS THAT WE SEE SUCH AS ENDOMETRIOSIS, FIBROIDS, PELVIC PAIN, EVEN PMS TYPE SYMPTOMS OR MENOPAUSE SYMPTOMS. SO HOW WE'RE FAILING IN THAT IS THAT WE'RE NOT INVESTING IN THE STRUCTURES THAT WE NEED OR THE SYSTEMS THAT WE NEED IN PLACE O BE ABLE TO IDENTIFY EVEN WHAT THE ISSUES ARE, THE MAGNITUDE F THE PROBLEM, AND SO THAT WE CAN GO ABOUT ADDRESSING THIS APPROPRIATELY AND MAKING SURE THAT WE'VE GOT THE RESOURCES ADEQUATELY ALLOCATED. SO I THINK WHERE WE'RE FAILING IS ACCESS TO CARE, WAIT TIMES PEOPLE NOW HAVING TO GO OUTSIDE OF THE PROVINCE OR OUTSIDE OF THE COUNTRY TO ACCESS CARE, BUT ALSO JUST NOT REALLY HAVING A GOOD UNDERSTANDING OF WHAT THE PROBLEM IS BECAUSE WE HAVEN'T INVESTED IN THE DATA NETWORKS R THE SYSTEMS THAT WE NEED TO BE ABLE TO REALLY ADDRESS. >> NAM: AND WHAT I THINK I'M SAYING IS HAPPENING IS BECAUSE WE DON'T HAVE THAT, A LOT OF PEOPLE ARE TURNING TO SOCIAL MEDIA FOR THOSE ANSWERS. I WANT TO TALK ABOUT THAT. BECAUSE HE MENTIONED DATA, I WANT TO GO BACK TO CHRISTINE AD TALK TO YOU ABOUT THE WORK YOU DO. HOW DID THE HEART AND STROKE FOUNDATION START FOCUSING ON WOMEN'S SPECIFIC RESEARCH? >> AMANDA: >> CHRISTINE: AS I MENTIONED BEFORE THERE WAS SUCH A GAP IN TERMS OF KNOWLEDGE AROUND WOMEN'S HEART AND BRAIN HEALTH, WHICH IS WHERE WE ARE INVESTING OUR RESEARCH AND DOING OUR WOR. AND I THINK IT WAS COMING FROM AN EQUITY PERSPECTIVE. I KNOW CARMEN MENTIONED THAT EARLIER, BUT BECAUSE OF THOSE GAPS RIGHT NOW, WOMEN ARE NOT RECEIVING THE CARE THAT THEY DESERVE AND WOMEN ARE DYING PREMATURELY AND THEY'RE NOT ENJOYING TO THE FULLEST THEIR LIVES. SO THERE'S MANY, MANY THINGS TO ACTUALLY DO IN TERMS OF RESEARCH THAT WAS CRITICAL FOR HEART AND STROKE, BECAUSE THAT'S A CRITICAL THING WE DO IN TERMS F OUR MISSION, OUR MANDATE. WE'VE DONE ALSO A LOT OF AWARENESS. SO THESE WERE KIND OF LIKE THE MAIN DRIVERS AT THE BEGINNING S JUST HELPING PEOPLE UNDERSTAND THAT WOMEN'S HEART AND BRAIN HEALTH, IT'S ACTUALLY, IT'S NOT JUST SOMETHING THAT HAPPENS TO MEN. SO HEART DISEASE IS OFTENTIMES ASSOCIATED WITH MEN. SO JUST RAISING AWARENESS AROUND THIS ACTUALLY IMPACTS WOMEN AS WELL. SO THAT'S A CRITICAL THING THAT EVERYBODY NEEDS TO UNDERSTAND AND TO BE AWARE OF. AND THEN JUST BUILDING THAT ALL BASE OF KNOWLEDGE TO REALLY DRIVE OUR CARE IS PROVIDED. SO CLINICAL PRACTICE, CARE MODELS, TREATMENTS, AND TO REALLY LEAD TO WOMEN'S POSITIVE OUTCOMES. >> NAM: CARMEN, I WANTED TO GO BACK TO SOMETHING AMANDA WAS TALKING ABOUT, THE FACT THAT WE DON'T HAVE ANY KIND OF DATA ACROSS THE COUNTRY. AND SO OUT OF FRUSTRATION, A LT OF WOMEN, IF THEY CAN'T GET AN APPOINTMENT WITH A GYNECOLOGIST IN ORDER TO DO AN APPOINTMENT WITH A GYNECOLOGIST, YOU NEED A FAMILY DOCTOR. WE KNOW THERE'S A FAMILY DOCTOR SHORTAGE IN THIS COUNTRY. SO WHEN YOU CAN'T HAVE ACCESS O THAT, YOU TURN TO SOCIAL MEDIA. SOCIAL MEDIA IS NOT ALWAYS THE PLACE THAT HAS THE BEST INFO BUT SOMETIMES THAT'S WHERE PEOPLE CAN FIND A COMMUNITY AND MAYBE INFORMATION THAT THEY'RE IN DESPERATE NEED OF. SO HOW DO WE AVOID THAT MOVING FORWARD? >> CARMEN: DOCTOR BLACK IS ABSOLUTELY RIGHT. ONE OF THE THINGS THAT IS CORE TO THE FUTURE OF WOMEN'S HEALTH IS CANADA, THE GOVERNMENT OF CANADA PRIORITIZING A WOMEN'S HEALTH FRAMEWORK. AND IF YOU PUT IT INTO THE PERSPECTIVE OF THE DIABETES FRAMEWORK THAT THEY BROUGHT INO PLACE, I THINK IT WAS MAYBE FIE YEARS AGO, IT'S A VERY SIMILAR TYPE APPROACH. IT'S A VERY LARGE POPULATION WITH COMPLEX, UNIQUE NEEDS. IN THE CASE OF WOMEN'S HEALTH IT CHANGES AS THEY GO THROUGH THE VARIOUS AGES AND STAGES OF THEIR LIFE. THE ABSENCE OF THE FRAMEWORK, R RATHER THE INSTALLATION OF THE FRAMEWORK COULD DRIVE SOME OF THOSE AWARENESS FACTORS. YOU'LL NEVER GET RID OF SOCIAL MEDIA, BUT THERE NEEDS TO BE A BETTER NETWORK OF QUALIFIED RESOURCES THAT PATIENTS CAN REY ON. AND THAT WOULD BE THE ADVANTAGE OF A FRAMEWORK THAT WAS FEDERALLY ENABLED AND THEN INSTITUTED ACROSS PROVINCES IN CANADA. AND SO THE WOMEN'S HEALTH COALITION IS COMMITTED TO WORKING ON THAT WITH EVERY PROVINCE, MAKING SURE WE HAVE QUALIFIED RESOURCES, AND THEN LET'S TRACK THEM IN SOCIAL MEDA SO THAT WHEN PEOPLE TURN TO SOCIAL MEDIA, THEY CAN ACTUALLY NAVIGATE THEIR WAY THROUGH VALD RESOURCES. AND SO, YEAH, THAT'S WHAT WE NEED TO DO AND KEEP THEM FROM GOING STATESIDE. >> NAM: AMANDA, COULD SOCIAL MEDIA BE A POSITIVE IN THE SITUATION? >> AMANDA: ABSOLUTELY I THINK E HAVE TO LOOK AT BOTH SIDES. SO THERE'S THE POSITIVE AND THE NEGATIVE ASPECTS OF SOCIAL MEDIA. AND CERTAINLY WE HAVE SEEN WAYS IN WHICH WOMEN HAVE USED SOCIAL MEDIA TO ADVOCATE FOR THEIR OWN HEALTH. SO I'M LOOKING JUST AT THIS SPECIFIC EXAMPLE OF PAIN WITH IUD INSERTIONS OR GYNECOLOGIC PROCEDURES. AND I THINK THERE WAS A REAL PUSH FROM SOCIAL MEDIA FOR THE HEALTHCARE PROFESSION TO ADDRESS THAT. AND I THINK WE HAVE NOW DONE THAT. AND THAT'S THAT PUSH FROM WOMEN THEMSELVES. AND I THINK THAT SOCIAL WILL ACTUALLY HELPS BREED POLITICAL WILL OR WILL AT THE LEVEL OF THE POLICYMAKERS. SO ABSOLUTELY, I THINK THERE AE POSITIVES TO THAT. SIMILARLY, AS CARMEN MENTIONED WE NEED TO MAKE SURE WE COMBAT DISINFORMATION THAT'S OUT THERE AND ENSURE THAT PEOPLE DO HAVE ACCESS TO THE BEST POSSIBLE INFORMATION THAT THEY HAVE WHEN THEY'RE MAKING DECISIONS ABOUT THEIR HEALTH OR JUST EXPLORING WHAT THEY MIGHT BE WORRIED ABOT WHEN IT COMES TO HEALTH. AND THE SOCIETY OF OBSTETRICIANS AND GYNECOLOGISTS HAS A NUMBER OF EXCELLENT WEBSITES ON MENOPAUSE, ENDOMETRIOSIS, HPV, PREGNANCY, OFTEN IN COLLABORATION WITH OTHER ORGANIZATIONS IN CANADA. AND THOSE PROVIDE REALLY GOOD INFORMATIVE EVIDENCE-BASED INFORMATION THAT HOPEFULLY WILL ADDRESS THE CONCERNS THAT PEOPLE HAVE WITHOUT SOME OR QUESTIONS THAT THEY HAVE WITHOUT WORRYING ABOUT SOME OTHER MAYBE ULTERIOR MOTIVES THAT THERE MAY BE AS PART OF A SOCIAL MEDIA PLATFORM OR OTHER WEBSITES. >> NAM: SPEAKING OF DISINFORMATION WE ARE GOING TO PLAY A LITTLE MYTH BUSTING IN A MOMENT. BUT FOR PEOPLE WHO MIGHT'VE MISSED IT, WOMEN BEFORE WERE GETTING IUDS WITHOUT ANY PAIN MANAGEMENT. AND NOW, IT'S KIND OF CHANGED. BUT AMANDA, YOU HELPED TO GET BILL C-64, THE PHARMA CARE ACT PASSED LAST FALL. WHY IS THIS A STEP IN THE RIGHT DIRECTION? >> AMANDA: FOR THOSE WHO ARE UNFAMILIAR IT WAS INTRODUCED LAST FEBRUARY AND RECEIVED ROYAL ASSENT LAST OCTOBER AND THAT'S A NATIONAL FRAMEWORK FOR PHARMA CARE AND FOR ESSENTIAL MEDICINES THAT ARE BEING COVERED UNDER THAT BEING DIABETES MEDICINE AD CONTRACEPTION. AND THAT'S A HUGE STEP FORWARD, AS FAR AS WOMEN'S EQUITY IN THIS COUNTRY. WHEN WE LOOK AT THE RATES OF UNINTENDED PREGNANCY IN CANADA IT'S UP TO 40% OF PREGNANCIES ARE UNINTENDED, MANY OF THOSE BECAUSE PEOPLE CAN'T ACCESS CONTRACEPTION OR MAYBE THEY CAN'T ACCESS THE CONTRACEPTIVE OF THEIR CHOICE BECAUSE COST IS A BARRIER. AND THE COST THAT SOMETIMES PEOPLE ARGUE, WELL, CAN WE AFFORD TO DO THAT? OUR ARGUMENT IS YOU CAN'T AFFORD NOT TO DO IT BECAUSE THE COST F UNINTENDED REGNANT SEA ALONE, THE DIRECT COST IS $320 MILLION PER YEAR, NOT FACTORING THE LOG DOWNSTREAM EFFECT FOR THE SOCIETY AND THE INDIVIDUAL AND THE CHILDREN THEMSELVES. SO I THINK IT'S A HUGE STEP FORWARD. COST MODELING HAS SHOWN A SIGNIFICANT COST SAVINGS ASSOCIATED WITH THAT, BOTH WHEN WE LOOK AT COST MODELING IN BC COST MODELING NATIONALLY AND COST MODELING IN OTHER COUNTRIES. SO IT'S A HUGE STEP FORWARD. NOW, WHAT WE NEED TO DO, WE'RE AT THE POINT WHERE IT'S RECEIVED ROYAL ASSENT. SOME PROVINCES AND ONE OF THE TERRITORIES HAVE SIGNED ON, BUT WE NEED TO ENCOURAGE OUR PROVINCIAL GOVERNMENTS INCLUDING OUR PROVINCIAL GOVERNMENT IN ONTARIO TO SIGN N TO BILATERAL AGREEMENTS SO THAT WE CAN ENSURE THAT ACCESS IS NT DEPENDENT ON WHERE YOU LIVE OR YOUR INCOME. IT'S SOMETHING THAT ALL CANADIANS HAVE ACCESS TO AND THAT ENSURES THAT WE HAVE EQUITABLE PROVISION OF CONTRACEPTION IN CANADA, WHICH WILL PROVIDE WOMEN WITH MORE OPPORTUNITIES. >> NAM: CHRISTINE, I SAW YOU NODDING. >> CHRISTINE: YES, ABSOLUTELY. YES. AND I WAS JUST TALKING TO OUR TEAM IN ONTARIO. JUST THINKING ON BILLING ON MEDICATION. WE KNOW THAT IN ONTARIO, NEARLY ONE IN FIVE WOMEN IN ONTARIO DO NOT HAVE ACCESS OR DO NOT HAVE ANY DRUG INSURANCE PLAN. AND THEY'RE ALSO MORE LIKELY THAN MEN TO ACTUALLY SKIP FILLING THEIR PRESCRIPTION BECAUSE OF THE COST, THE OVERALL DRUGS AND GAPS IN TERMS OF DRUG COVERAGE DISPROPORTIONATELY AFFECT WOMEN COMPARED TO MEN, ESPECIALLY WOMEN FROM LOW INCOME. SO I THINK, YEAH, ABSOLUTELY THERE'S LOTS OF GAPS ON THAT FRONT AND THAT NEEDS TO BE ADDRESSED. >> NAM: WE CAN'T HAVE THIS CONVERSATION WITHOUT TALKING ABOUT CERVICAL CANCER. ACCORDING TO THE GOVERNMENT OF CANADA AND CANADIAN CANCER SOCIETY CERVICAL CANCER INCIDENCE HAS INCREASED IN RECENT YEARS AND IS CITED AS THE FASTEST INCREASING CANCER AMONGST WOMEN. CARMEN, WHAT ARE SOME WAYS IN WHICH WE CAN REDUCE THESE CASE? >> CARMEN: THERE'S ONE CORE RESPONSE TO THAT TREND THAT WE DON'T WANT TO SEE AND THAT IS SWITCHING WHOLLY TO HPV PRIMARY SCREENING. AND WE ARE BEGINNING TO DO THAT IN CANADA. WE ARE REALLY NOT DOING IT FAST ENOUGH. THERE'S SOME PROVINCES THAT ARE SAYING THEY ARE TRANSITIONING, SOME HAVE TRANSITIONED TO SELF SAMPLING. BUT THEY'RE NOT DOING THE OTHER STUFF THAT NEEDS TO HAPPEN IN BETWEEN. SELF-SAMPLING IS A CHOICE FOR SURE, BUT IT'S NOT THE ONLY OPTION OR ALWAYS THE BEST OPTION. SO WE HAVE TO SWITCH TO HPV PRIMARY SCREENING SO THAT CERVICAL CANCER DOESN'T EVEN HAPPEN. AND THAT REALLY WOULD ALLOW US TO ELIMINATE UP TO 90% OF THE CURRENT CERVICAL CANCER RATES COULD BE ELIMINATED IF WE FOCUSED ON HPV SCREENING INSTEAD OF, YOU KNOW, WAITING FOR A WOMAN TO PRESENT TO HER GYNECOLOGIST WITH ADVANCED DISEASE. AND SO CERVICAL CANCER IS PREVENTABLE AND WE NEED TO EMBRACE THAT AND WE NEED TO FOCUS ON HPV. >> NAM: IN THE LAST 5 MINUTES I WANTED TO GO OVER SOME OF THE DISINFORMATION WE ARE HEARING A LOT ONLINE. AMANDA, I WANTED TO START WITH YOU. IF YOU CAN TELL US IF THIS IS TRUE OR FALSE, NATURALLY TRACKING YOUR CYCLE IS THE SAFEST FORM OF BIRTH CONTROL. >> AMANDA: SO I WOULD SAY THAT THAT IS NOT TRUE. SOME PEOPLE MAY OPT TO USE NATURAL FAMILY PLANNING METHODS INCLUDING CYCLE TRACKING AS A WAY OF MONITORING THEIR FERTILITY. BUT AS FAR AS, YOU KNOW, BEING ONE OF THE MOST EFFECTIVE METHODS OF PREGNANCY PREVENTION IT WOULD NOT BE HIGH ON THE LIT SIMPLY BECAUSE WOMEN CAN HAVE VARIATIONS IN THEIR CYCLES FORA VARIETY OF REASONS. THEY MAY HAVE OTHER COEXISTING MEDICAL CONDITIONS. SO NATURAL FAMILY PLANNING IS POSSIBLE TO BE USING, BUT I WOULD NOT CONSIDER IT AS AN EFFECTIVE METHOD OF CONTRACEPTION FOR A LOT OF WOMEN. >> NAM: ALSO STDS OR STI'S, RIGHT? IT DOESN'T PROTECT YOU FROM THAT? >> AMANDA: NO, SO NONE OF THE METHODS OF CONTRACEPTION OTHER THAN THE CONDOMS WOULD PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS. AND SINCE THE CONDOMS PROTECT AGAINST MANY, BUT NOT ALL STIS. >> NAM: AND CHRISTINE, THIS IS JUST A MYTH, IT'S NOT ME SAYING IT BUT IT'S ONLY UNHEALTHY OLDER MEN THAT HAVE TO WORRY ABOUT HEART DISEASE? >> SPEAKER: >> CHRISTINE: FALSE. ABSOLUTELY NOT. THIS IS INTERESTING, AND THIS S WHAT DROVE OUR WORK FOR A FEW YEARS NOW. WE, IT'S INTERESTING BECAUSE NEARLY 40%, WHAT WE KNOW FROM A STUDY WE DID IN 2021 IS THAT NEARLY 40% OF PEOPLE IN CANADA THEY DO NOT REALIZE THAT HEART DISEASE AND STROKE ARE THE LEADING CAUSE OF PREMATURE DEAH IN WOMEN. AND WE KNOW THAT THERE'S A NUMBER OF CONDITIONS, INCLUDING YOU KNOW, HEART FAILURE, STROKE AND OTHERS THAT ARE ACTUALLY MORE PREVALENT AMONG WOMEN. SO THAT'S, YEAH, DEFINITELY SOMETHING TO RAISE MORE AWARENESS AMONG, YOU KNOW WOMEN, BUT ALSO JUST PEOPLE IN CANADA OVERALL, INCLUDING HEALTH PROFESSIONALS. >> NAM: AND CARMEN, ALL WOMEN EXPERIENCE PAINFUL PERIODS. >> CARMEN: THAT WOULD NOT BE TRUE. BUT MANY WOMEN, ONE OUT OF THREE WOMEN WILL EXPERIENCE SUCH SEVERE MENSTRUAL PAIN AND MENSTRUAL BLEEDING THAT IT ACTUALLY BECOMES LIFE DISRUPTING. IT KEEPS THEM FROM SOCIAL ENGAGEMENTS, KEEPS THEM FROM FAMILY EVENTS. SO YEAH, ONE OUT OF THREE WOMEN WILL EXPERIENCE SEVERE PAIN AND QUALITY OF LIFE DISRUPTION. SO PARTLY TRUE. HOW'S THAT? >> NAM: 90 SECONDS LEFT, I WOULD LIKE TO GIVE YOU ALL 30 SECOND. IT'S COME TO, I GUESS, WHERE WE ARE RIGHT NOW. WOMEN HAVE TO ADVOCATE FOR THEMSELVES AND IT CAN BE INTIMIDATING BECAUSE DOCTORS AE AUTHORITY FIGURES. WHAT CAN WOMEN WATCHING DO TO ADVOCATE FOR THEMSELVES IN THE HEALTHCARE SYSTEM AS WE HAVE IT RIGHT NOW? AMANDA? >> AMANDA: WHAT I WOULD SAY IS WE WANT PEOPLE TO START RECOGNIZING THE IMPORTANCE OF MAINTAINING THE SEXUAL REPRODUCTIVE RIGHTS THAT WE HAE IN CANADA AND ONTARIO. AND I THINK THERE ARE A LOT OF THINGS THAT WE THINK ARE A GIVEN, AND WE JUST HAVE COME TO EXPECT IT, BUT WE'VE SEEN THAT THAT'S NOT NECESSARILY THE CASE AND THOSE RIGHTS CAN SOMETIMES BE ROLLED BACK. SO ENCOURAGING WOMEN TO STILL E VOCAL ABOUT THE NEED FOR ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH SERVICES. SO INCLUDING CONTRACEPTION, INCLUDING ABORTION SERVICES, INCLUDING GYNECOLOGIC CARE, I THINK THAT THAT'S REALLY REALLY IMPORTANT BECAUSE AGAIN AS WE'RE SEEING, IT'S VERY THINGS COULD ROLL BACKWARDS VEY QUICKLY AND WE NEED TO BE VERY VOCAL ABOUT THE IMPORTANCE IN OUR COUNTRY AND IN OUR PROVINCE AT MAINTAINING THOSE RIGHTS. >> NAM: CHRISTINE? >> CHRISTINE: I WOULD SAY I THINK THE IMPORTANCE OF JUST RECOGNIZING A LOT OF OUR HEART CONDITIONS AND STROKE CAN BE PREVENTED FOR WOMEN AND MEN AS WELL. BUT I GUESS HELPING WOMEN UNDERSTAND WHAT THEIR UNIQUE RISKS ARE FOR HEART DISEASE AND STROKE. AND WE KNOW THAT WOMEN HAVE SPECIFIC RISKS, ESPECIALLY WHEN WE LOOK AT THEIR LIFE STAGES AROUND REPRODUCTIVE YEARS, WHEN THEY HAD PREGNANCIES, AROUND MENOPAUSE, POST-MENOPAUSE. SO WHAT HEART AND STROKE IS TRYING TO DO IS REALLY TO HELP EQUIP WOMEN WITH MORE KNOWLEDGE. AND AGAIN, KNOWLEDGE THAT'S EVIDENCE-BASED TO REALLY UNDERSTAND WHAT THEIR UNIQUE RISKS ARE AND THEN WHAT CAN THY DO IN TERMS OF TAKING ACTION TO REALLY REDUCE OR PREVENT OR TO MANAGE THEIR RISK. AND SO ONE THING WE DO IS WE HAVE A CAMPAIGN RIGHT NOW. WE'VE BUILT SOME RESOURCES ON OUR WOMEN'S HUB ON OUR HEART AD STROKE WEBSITE TO REALLY HELP WOMEN ADVOCATE FOR THEMSELVES AND JUST HAVE THE RIGHT RESOURCES AND TOOLS IN THEIR CONVERSATIONS WITH THEIR HEALTHCARE PROVIDERS. >> NAM: CARMEN? >> CARMEN: WOMEN NEED TO BE ENCOURAGED TO TAKE AUTHORITY OF THEIR HEALTH JOURNEY AND WITH EVERYTHING THAT THAT MEANS. AND THAT MEANS SEEKING OUT INFORMATION ON HEALTH PROVIDER. THE CONVENTIONAL SYSTEM THAT'S ALWAYS BEEN AROUND ISN'T THE ONLY THING AVAILABLE. I KNOW THAT OUR PUBLIC HEALTH SYSTEM IS STRAINED, BUT THERE ARE PRIVATE HEALTH SYSTEMS THAT ARE EMERGING THAT CAN HELP COVER A GAP. AND SO IF WOMEN DO HAVE ACCESS TO HEALTH BENEFITS, THERE MAY E OTHER OPTIONS AVAILABLE TO THE. THEY CAN GO TO SITES LIKE THE HEART AND STROKE FOUNDATION WHERE THERE'S GOOD INFORMATION TO HELP THEM NAVIGATE THE SYSTEM. BUT I THINK WOMEN HAVE TO NOT E WILLING TO JUST SIT BACK AND LT THEIR HEALTH HAPPEN TO THEM. I THINK THEY NEED TO STEP UP, TALK TO PEOPLE AND FIND THE RESOURCES ON THEIR OWN AND ACT ON THEM. THEY'VE GOT TO OWN THIS BECAUSE THAT IS WHAT WILL MAKE THE SYSTEM CHANGE. >> NAM: THANK YOU ALL SO MUCH FOR YOUR TIME, IT'S CONVERSATIONS LIKE THIS THAT CN SPARK AWARENESS AND LEAD TO ACTION AND HELP A LOT OF WOMEN ACROSS THIS COUNTRY. WE APPRECIATE YOUR TIME. THANK YOU.