1.1.10 AWHN Conference 6 2010 Federation: Better in than out? A review of the experience of Ireland’s Women’s Health Council 1997/2010 Professor Cecily Kelleher School of Public Health, Physiotherapy and Population Science University College Dublin

1. Better in than out?Better in than out?
A review of the experience ofA review of the experience of
IrelandIreland’’s Womens Women’’s Health Councils Health Council
1997/20101997/2010
Professor Cecily KelleherProfessor Cecily Kelleher
School of Public Health, Physiotherapy andSchool of Public Health, Physiotherapy and
Population SciencePopulation Science
University College DublinUniversity College Dublin

2. AimsAims
Illustrate the legacy of the WHCIllustrate the legacy of the WHC
Review policy making processReview policy making process
Critique the process for the future of womenCritique the process for the future of women’’s healths health
in Ireland and its implications internationallyin Ireland and its implications internationally

3. Ireland in ContextIreland in Context
A popular Tasmanian (alsoA popular Tasmanian (also
Irish!) saying is: "If youIrish!) saying is: "If you
don't like the weather, justdon't like the weather, just
wait 5 minutes".wait 5 minutes".
About 500,000 people liveAbout 500,000 people live
in Tasmania. Compare thatin Tasmania. Compare that
to other locations which areto other locations which are
similar in size: Ireland has asimilar in size: Ireland has a
population of a little over 4population of a little over 4
million, Switzerland 7.5million, Switzerland 7.5
million, and West Virginiamillion, and West Virginia
(USA) just under 2 million.(USA) just under 2 million.

4. Background to WHCBackground to WHC
19931993 –– 22ndnd Commission onCommission on
the Status of Womenthe Status of Women ––
concerned about womenconcerned about women’’ss
health and raised need forhealth and raised need for
policypolicy
19951995 –– public consultationpublic consultation
19971997 –– A Plan for WomenA Plan for Women’’ss
HealthHealth published and WHCpublished and WHC
establishedestablished

5. Kelleher CC.Kelleher CC.
Preface, WomenPreface, Women’’s Studies Review,s Studies Review, VolVol 5.5.
NUIG, 1997.NUIG, 1997.
““Almost invariably, when I raise the subject of womenAlmost invariably, when I raise the subject of women’’s healths health
among health professionals the men groan and ask if surelyamong health professionals the men groan and ask if surely
there has not been enough attention to the subject. After all,there has not been enough attention to the subject. After all,
Men die younger and suffer more from the major killerMen die younger and suffer more from the major killer
diseasesdiseases……..Hidden within the quantitative data, of course, isHidden within the quantitative data, of course, is
the heart of the feminist matterthe heart of the feminist matter..
For while women do live longer than men they have a poorerFor while women do live longer than men they have a poorer
quality of life as they age.., bear the inequalities found in evquality of life as they age.., bear the inequalities found in everyery
society in the world more than men, carry the hidden, unsociety in the world more than men, carry the hidden, un--
prestigious and extensive responsibility for the iceberg ofprestigious and extensive responsibility for the iceberg of
health need in every country and strive throughout to bear andhealth need in every country and strive throughout to bear and
rear new generations of people in a complex and unjustrear new generations of people in a complex and unjust
worldworld……
These are observable facts, not polemic or assertionThese are observable facts, not polemic or assertion””

6. Rationale for WHCRationale for WHC
WomenWomen’’s relativelys relatively
disadvantaged positiondisadvantaged position
Inadequate andInadequate and
inappropriate servicesinappropriate services
Gender stereotypingGender stereotyping
Health issues unique toHealth issues unique to
womenwomen

7. Functions Of WomenFunctions Of Women’’s Healths Health
Council 1997Council 1997--20092009
Statutory Body established inStatutory Body established in
1997:1997:
To advise the Minister forTo advise the Minister for
Health and Children on allHealth and Children on all
matters related to womenmatters related to women’’ss
healthhealth
To assist policyTo assist policy
developmentdevelopment
To develop expertise onTo develop expertise on
womenwomen’’s healths health
To liaise with relevantTo liaise with relevant
international bodiesinternational bodies

8. PrinciplesPrinciples
Equity based on diversityEquity based on diversity
(need to develop flexible and equitable services which(need to develop flexible and equitable services which
respond to the diverse needs and situations ofrespond to the diverse needs and situations of
women)women)
Quality in service provisionQuality in service provision
(of all services to all women throughout their lives)(of all services to all women throughout their lives)
Relevance to womenRelevance to women’’s health needss health needs

9. Process of OperationProcess of Operation
Non executive board of Ministerial appointeesNon executive board of Ministerial appointees
with diverse professional experiencewith diverse professional experience
Team of 5 crossTeam of 5 cross--disciplinary executivedisciplinary executive
SubSub--committee basis with finance, research,committee basis with finance, research,
policy and legislation, community and healthpolicy and legislation, community and health
service delivery groupsservice delivery groups

10. Evolution of ApproachEvolution of Approach
Social determinants of health rather thanSocial determinants of health rather than
diseasedisease--specific reductionist modelspecific reductionist model
Shift away from pure focus on reproductiveShift away from pure focus on reproductive
healthhealth
Gender Mainstreaming rather than womenGender Mainstreaming rather than women’’ss
health per sehealth per se

11. ExamplesExamples
Health DeterminantsHealth Determinants
Patterns of HealthPatterns of Health
conditionsconditions
Health Policy andHealth Policy and
Services provisionServices provision

12. Social DeterminantsSocial Determinants
One of the first advocates in Ireland on womenOne of the first advocates in Ireland on women’’ss
health and disadvantagehealth and disadvantage
Various reports on Gender Based ViolenceVarious reports on Gender Based Violence
GBV and HealthGBV and Health
GBV and Minority Ethnic WomenGBV and Minority Ethnic Women
FGMFGM

13. Research ReportsResearch Reports

14. Understanding GBVUnderstanding GBV
The ecological frameworkThe ecological framework
Level 4:
Society
Level 3:
Community
Level 2:
Family
Level 1:
Individual
(Perpetrator)

15. Research DocumentsResearch Documents

16. Women, Debt andWomen, Debt and
HealthHealth
Joint exploratory research project of theJoint exploratory research project of the
WomenWomen’’s Health Council and MABSs Health Council and MABS ndlndl
October 10October 10thth
20072007

17. Origins and Aims of theOrigins and Aims of the
researchresearch
Main aims of the project :Main aims of the project :
explore if female MABS clients discussexplore if female MABS clients discuss
health during their money advice andhealth during their money advice and
budgeting consultations;budgeting consultations;
investigate if the women identified linksinvestigate if the women identified links
between their debt/financial difficulties andbetween their debt/financial difficulties and
their health; andtheir health; and
document the types of health issues thatdocument the types of health issues that
arose.arose.

18. Client income sourcesClient income sources

19. Debt issues by average weekly net incomeDebt issues by average weekly net income

20. Emotional health problems mentionedEmotional health problems mentioned

21. Physical health problems mentionedPhysical health problems mentioned

22. ServicesServices
Guide to genderGuide to gender--sensitive servicessensitive services
HSE Gender Mainstreaming Working GroupHSE Gender Mainstreaming Working Group –– 1 year project1 year project
Women and Substance misuseWomen and Substance misuse
Perspectives on Provision of Counselling for womenPerspectives on Provision of Counselling for women
Women and mental health: Promoting a gendered approach toWomen and mental health: Promoting a gendered approach to
policy and service provisionpolicy and service provision

23. Cardiovascular DiseaseCardiovascular Disease
First ever report onFirst ever report on
CVD and women inCVD and women in
IrelandIreland
Explicit exploration ofExplicit exploration of
LifecourseLifecourse andand
DisadvantageDisadvantage
Led to Best PracticeLed to Best Practice
Guidelines for GPsGuidelines for GPs
Led to Best PracticeLed to Best Practice
Guidelines for A&EGuidelines for A&E

24. The Cardiovascular Risk Factor Profile of Grandparents and itsThe Cardiovascular Risk Factor Profile of Grandparents and its
Contribution to Infant BirthContribution to Infant Birth--weight in the Lifeweight in the Life--ways Crossways Cross--generationgeneration
Cohort StudyCohort Study
Kelleher CC et al., Prevention and Control 2005; 1(1): 54.Kelleher CC et al., Prevention and Control 2005; 1(1): 54.
Birth weight :Birth weight :
Range: 840Range: 840 –– 5360 grams5360 grams
Mean: 3491 grams (S.D. 584.4)Mean: 3491 grams (S.D. 584.4)
What predicts baby birth weight ?What predicts baby birth weight ?
MotherMother::
Age, smoking status,Age, smoking status,
education, GMS, maritaleducation, GMS, marital
status, BMIstatus, BMI
Maternal GrandmotherMaternal Grandmother::
BMI, Maternal GrandBMI, Maternal Grand--
Parent EducationParent Education

25. LifewaysLifeways: Three Year follow: Three Year follow--up inup in
General PracticeGeneral Practice

26. WHC research on MenopauseWHC research on Menopause
WomenWomen’’s experiences and understandingss experiences and understandings
of menopauseof menopause
(1(1stst
major qualitative study in Ireland, documentingmajor qualitative study in Ireland, documenting
how women feel about this time in their lives)how women feel about this time in their lives)
Menopause information and servicesMenopause information and services
available to women in Irelandavailable to women in Ireland
(Survey that examined current menopause(Survey that examined current menopause
information & servicesinformation & services for women in Ireland)for women in Ireland)
Public attitudes to the menopause:Public attitudes to the menopause:
Omnibus surveyOmnibus survey
(Nationally representative survey gathered(Nationally representative survey gathered
information on symptoms, information seeking andinformation on symptoms, information seeking and
awareness levels of menopause in Ireland)awareness levels of menopause in Ireland)
Managing Menopause: A review of the bioManaging Menopause: A review of the bio--
medicalmedical evidenceevidence

27. AA LifecourseLifecourse approachapproach

28. CancerCancer
First National report on womenFirst National report on women
and cancer with National Cancerand cancer with National Cancer
registry (NCRI)registry (NCRI)
FollowFollow--up Study to investigateup Study to investigate
low level of cancer treatment inlow level of cancer treatment in
older womenolder women
Review of clinical practice andReview of clinical practice and
factsheet developmentfactsheet development ((Breast,Breast,
ovarian, uterine and cervical cancers)ovarian, uterine and cervical cancers)
Evaluation of Effectiveness ofEvaluation of Effectiveness of
Irish Cervical ScreeningIrish Cervical Screening
ProgrammeProgramme

29. Incidence rates in women in Ireland compared to otherIncidence rates in women in Ireland compared to other
western European countries, all cancerswestern European countries, all cancers
375
338
333
326
321
316
306
291
289
286
247
236
0 50 100 150 200 250 300 350 400
Denmark
Sweden
IRELAND
Netherlands
Belgium
United Kingdom
Finland
Germany
France
Italy
Portugal
Spain
age-standardised rate per 100,000
years included:
Ireland - 1994-2001;
other countries -
1998

30. Mortality rates in women in Ireland compared to otherMortality rates in women in Ireland compared to other
western European countries, all cancerswestern European countries, all cancers
years included:
Ireland - 1994-
2001;
other countries -
1998
198
174
168
160
153
151
138
133
128
126
118
112
0 40 80 120 160 200
Denmark
IRELAND
United Kingdom
Netherlands
Belgium
Germany
Sweden
Italy
France
Finland
Portugal
Spain
age-standardised rate per 100,000

31. Trends in incidence rates during 1994Trends in incidence rates during 1994--
20012001
Rising incidenceRising incidence annual changeannual change
breast (invasive)breast (invasive) +2%+2%
nonnon--HodgkinHodgkin’’s lymphomas lymphoma +2%+2%
lunglung +1.8%+1.8%
uterusuterus +1.6%+1.6%
melanoma of the skinmelanoma of the skin +1%+1%
in situin situ breast cancerbreast cancer +10%+10%
in situin situ cervical cancercervical cancer +5%+5%
Falling incidenceFalling incidence
stomachstomach --1%1%
Stable incidenceStable incidence
colorectalcolorectal ovaryovary
pancreaspancreas cervixcervix

32. Compliance with European Code AgainstCompliance with European Code Against
Cancer in IrelandCancer in Ireland
* Based on data from Surveys of Lifestyle, Attitudes and Nutrition (SLAN) in 1998 and
2002
2002200219981998
76%76%76%76%moderate alcohol consumptionmoderate alcohol consumption
64%64%52%52%5 fruit and vegetable servings per5 fruit and vegetable servings per
dayday
24%24%27%27%daily exercisedaily exercise
88%88%91%91%BMI < 30kg/m2BMI < 30kg/m2
74%74%69%69%nonnon--smokersmoker
% of women meeting ECAC% of women meeting ECAC
recommendations*recommendations*

33. Influencing General PolicyInfluencing General Policy
FormationFormation
National WomenNational Women’’ss
StrategyStrategy
Crisis PregnancyCrisis Pregnancy
AgencyAgency
A Vision for ChangeA Vision for Change --
mental healthmental health
Patient Safety andPatient Safety and
Quality AssuranceQuality Assurance
Nurse PrescribingNurse Prescribing
LegislationLegislation

34. Engagement of PolicymakersEngagement of Policymakers

35. All Ireland Traveller Health StudyAll Ireland Traveller Health Study--
OurOur GeelsGeels 20072007--20102010
CensusCensus health survey of 10,000health survey of 10,000
families North and South 2008/9,families North and South 2008/9,
completed and now beingcompleted and now being
analysed for reportanalysed for report
Vital statisticsVital statistics analysis 20 yearsanalysis 20 years
on, in progresson, in progress
Qualitative consultationQualitative consultation withwith
Travellers, being analysedTravellers, being analysed
Health Service ProvidersHealth Service Providers’’
surveysurvey, Spring 2010, Spring 2010

36. Constitutional Questions:Constitutional Questions:
2525thth Amendment to the Constitution (Protection of HumanAmendment to the Constitution (Protection of Human
Life in Pregnancy) Bill, 2001Life in Pregnancy) Bill, 2001
Legal OpinionLegal Opinion
Literature review onLiterature review on
evidence baseevidence base
SubSub--committee assessmentscommittee assessments
Plenary all day meeting toPlenary all day meeting to
reach positionreach position
Corporate StatementCorporate Statement
submitted to Ministersubmitted to Minister
Statement placed onStatement placed on
CouncilCouncil’’s website and ins website and in
annual report 2002annual report 2002

37. 1010--point Submission on Abortionpoint Submission on Abortion
Legislation WHC annual ReportLegislation WHC annual Report
20022002
Addressed Specific issues arising fromAddressed Specific issues arising from
proposed amendment onlyproposed amendment only
Welcome for Crisis Pregnancy AgencyWelcome for Crisis Pregnancy Agency
Proposed Legislation at odds with WHOProposed Legislation at odds with WHO
definition of Health indefinition of Health in DOHCDOHC’’ss policypolicy
documentsdocuments
Suicide in Pregnancy literature in IrelandSuicide in Pregnancy literature in Ireland
inadequateinadequate

38. International PolicyInternational Policy
Gender advisor in ECHIMGender advisor in ECHIM
(European Commission Health(European Commission Health
Indicators project)Indicators project)
National Advisor during the EUNational Advisor during the EU
Austrian Presidency in 2006Austrian Presidency in 2006
Expert advisor on the Council ofExpert advisor on the Council of
Europe Committee on InequalitiesEurope Committee on Inequalities
in Healthin Health –– Gender DifferencesGender Differences
Gender advisor to WHO and pilotGender advisor to WHO and pilot
case study participationcase study participation

39. Lessons LearntLessons Learnt
Takes time for evidenceTakes time for evidence
to translate into changesto translate into changes
in practicein practice
Evidence is only oneEvidence is only one
element to policyelement to policy
makingmaking
Collaboration with keyCollaboration with key
stakeholders is keystakeholders is key
Persistence is necessaryPersistence is necessary

40. FollowFollow--upup
20032003 –– Health Reform ProgrammeHealth Reform Programme --
recommendation to streamline WHC intorecommendation to streamline WHC into
Department of Health & ChildrenDepartment of Health & Children
20082008 –– Rationalisation of state agenciesRationalisation of state agencies
programmeprogramme -- announcement of dissolutionannouncement of dissolution
September 2009September 2009 –– WHC dissolved and itsWHC dissolved and its
functions subsumed into DOHCfunctions subsumed into DOHC

41. The FutureThe Future
New Unit within Department of Health andNew Unit within Department of Health and
Children associated with Social InclusionChildren associated with Social Inclusion
programmeprogramme
More direct engagement with policy makingMore direct engagement with policy making
A dual strategy for womenA dual strategy for women’’s healths health
Gender mainstreamingGender mainstreaming
WomenWomen’’s health issuess health issues

42. Better out than in?Better out than in?
Positives and NegativesPositives and Negatives
Solid Research OutputSolid Research Output
Translation into policyTranslation into policy
of key reportsof key reports
Examples ofExamples of
International InfluenceInternational Influence
IndependentIndependent
contribution to publiccontribution to public
policy debatepolicy debate
No formal ties to policyNo formal ties to policy
making processmaking process
Confusion aboutConfusion about
statutory as opposed tostatutory as opposed to
NGO remitNGO remit
Continuing challengesContinuing challenges
InternationallyInternationally

43. ConclusionsConclusions
WHC contribution over 10 yearsWHC contribution over 10 years
Increased evidence baseIncreased evidence base
Major policy shiftsMajor policy shifts –– gendergender
Work programme presented a paradox, theWork programme presented a paradox, the
more holistic our philosophy the moremore holistic our philosophy the more
apparently topic specific and reductionistapparently topic specific and reductionist
the work programmethe work programme
Potential for embedding genderPotential for embedding gender
mainstreaming into policy makingmainstreaming into policy making

44. AcknowledgementsAcknowledgements
GeraldineGeraldine LuddyLuddy, formerly chief executive, now, formerly chief executive, now
Principal Officer, Department of Health and ChildrenPrincipal Officer, Department of Health and Children
All staff of executive 1997All staff of executive 1997--2010, particularly2010, particularly
AlessandraAlessandra FantiniFantini,, AoifeAoife OO’’Brien, Caroline GreeneBrien, Caroline Greene
and Lauraand Laura WynessWyness
Collaborating Agencies mentioned in thisCollaborating Agencies mentioned in this
presentationpresentation
All Board members, WHC 1997All Board members, WHC 1997--20092009
Health Research Board of IrelandHealth Research Board of Ireland
Research team at UCDResearch team at UCD