The Agenda with Steve Paikin (Audio) - What is Hurting Women's Health?

Episode Date: May 17, 2025

Women make up half the population in Canada yet there are still major gaps in women's health research. Experts say investments addressing this gap could add years to life and boost the global economy. The Agenda invites Carmen Wyton, Chair and Founder of Women's Health Coalition of Canada; Dr. Amanda Black, Professor of, Obstetrics and Gynecology at The University of Ottawa; and Christine Faubert, Vice President of Health Equity & Mission Impact, at the Heart and Stroke Foundation of Canada to discuss.See omnystudio.com/listener for privacy information.

He was like a father figure to me. Unfortunately, found myself in a very vulnerable position. This is a story about a psychiatrist in Toronto accused of abusing two of his patients, which he denies. It's also a story about a system that is supposed to protect patients. From TVO Podcasts, I'm Krisha Collier, and this is The Oath. Subscribe today wherever you listen. Despite women representing half the population of Canada,

there remain a lot of questions surrounding their health needs. Is the 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 Whiten, Chair and Founder of Women's Health Coalition of Canada, in the nation's capital, Dr. Amanda Black, Professor of Obstetrics and Gynecology

at the University of Ottawa, and in Ontario's capital city, Christine Forbaire, Vice President of Health Equity and Mission Impact at the Heart and Stroke Foundation of Canada. Welcome to you all. Carmen, I wanted to kind of start with you. Can you give us an idea? I mean, if you were to say it in a few words, how would you describe the current state of

women's health care across Canada? Women's health care, unfortunately unfortunately is 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 is absolutely the best 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.

Well, you know what you said about women's needs are 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 common gynecological procedures are up to 50% lower in Ontario than in provinces such as Alberta and British Columbia. Gynecologists earn 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, with some tertiary centers having wait lists of 800 to 1,500 patients.

The most complex cases face delays of two to three years for surgery, leading to serious health consequences. Gynecology remains the only specialty that has seen a decline in spending over the last eight years. Carmen, as founder of Women's Health Coalition, what prompted your organization to create this study? The Women's Health Coalition of Canada actually started in Toronto where I gathered with women

who had uterine fibroids and the common denominator among all those women were the amount, it was the amount of time 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. And so when you look at the inequities that are emerging, it's because women's health in primary care is overlooked and underserved. And so by the time they get into the specialist system, it's being overtaxed as a result. And so those things, the start of the Women's Health Coalition and the inequities we're seeing in Ontario and across Canada, it's a trend that we need to break.

But it does kind of start with women's health in primary care. As you said in your notes, obstetrics and gynecology is a combined specialty, but then put into that also clinical care and no other specialty shows up the way OB-GYN medical and acute care does. Amanda, I wanted to come to you next. Carmen was talking about uterine fibroids. I actually went through an experience of being diagnosed with fibroids and then I kept going into the ER for about a year,

taking up resources from other people because I was in a wait list for two years for surgery. As a gynecologist, does this data align with what you see in your practice? Yeah, 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.

So there are many common gynecologic conditions that could really impact a woman's quality of life and their ability to be full contributing members of society. So things like conditions such as fibroids, certainly heavy menstrual bleeding. So when we look at time lost to work due to issues around the heavy menstrual bleeding, patients with endometriosis who are stuffing

from endometriosis who not only face long delays in diagnosis of endometriosis, but once that diagnosis is made long wait times for access to care. And we know that, for example, women with endometriosis, they report significant effects on quality of life, including their ability to work. So I think it's up to 47% of women with endometriosis report work impairment. And close to 20% of them have missed work in the past because of pain or other symptoms related

to their condition. And that leads to lost productivity and ultimately a greater strain on the health care system and a significant aspect of our workforce not being able to fully participate to their highest potential. And something you said, Amanda, kind of stood out for me is that pain, because I think women are still expected to show up in all aspects of their lives,

no matter what is going on with them. And Carmen, we know historically women's health care has been under-researched and underfunded. Where are we sitting at now? and underfunded. Where are we sitting at now? Well, in terms of underfunding, there was a study done, Sexism in Surgery, and we can do a head-to-head review of men's treatments, men's surgeries, and women's surgeries that are absolutely comparable. And in almost every province, there's going to be greater compensation for men's men's procedures. And so because of that what it means is

that across the whole spectrum of treatment the system is going to favor other specialties. The system is going to favor men's health over women's health. And so that's, that really is the trend we need to turn around. And then on top of that, if women aren't challenging their healthcare provider that the symptoms they're experiencing, whether it's heavy menstrual bleeding or pelvic pain, you know, PCOS is a very complex condition that if women don't really take authority of that health experience and demand more of their system, they are going to sit in law weight lines.

They are going to be waiting for surgery. And their disease or their condition will worsen. And so we have to not be satisfied without any longer. Christine, when Carmen said that the system is going to favor men's health, I saw you nodding. Yes, absolutely. And I think just going back on the research funding, there's definitely a persistent lack of awareness and understanding around women's heart and brain health overall, just even women's health in general. So we know that women have historically been underrepresented in heart and brain health overall, just even women's health in general. So we know that women have historically been underrepresented

in heart and brain health research and just in clinical health research overall. There's a very, I would say like shocking, but stats around the representation of women in clinical trials. We know that over the years, only two thirds, actually two thirds of participants in clinical trials have been men.

So it means that right, a third have been women. So that's a gap. And what it means to it, when women are actually included in clinical trials, it doesn't mean that an 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, you know, what put them at risk, what are the specificities and what type of, you know, diagnosis and treatment are required to really help women achieve health outcomes

that are positive and reaching quality of life. I mean, even something as when we talk about the signs of if you're 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? Yes, absolutely. So we know there's actually shared symptoms both for men and 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 seem a little bit more like anxiety or stress. So they will have, you know, kind of like pain or things happening in terms of their jaw, their upper shoulder, upper back, or even some sort of, you

know, belly ache, 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 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 it's not well known at this point yet. What are those women specific symptoms of a heart attack? When you said that the symptoms could present themselves as anxiety and stress, I think

we're all women. So I think we've all had maybe a situation in our personal lives when you were going through something and it was kind of just shrunken into well it could be anxiety and stress when it could be something more serious. Amanda, how is the medical system in Ontario failing women? Well, I think there are some areas where we are doing well, and certainly in comparison, but I do feel that we have a lot 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 wait times associated with that. So not only the time it takes to 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 that day surgeries that were previously done as inpatient surgeries. But at some point you'd be the mat 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 to be able to

identify even what the issues are, the magnitude of 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 we, you know, 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 have 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 or the systems that we need to be able to really address. data networks or the systems that we need to be able to really address. And I think what I'm seeing that's happening is that because we don't have that, a lot of people are turning to social media for those answers. I want to talk about that, but because you mentioned that, I want to go back to Christine and talk to you a little bit about the work that you all do. How did the Heart and Stroke Foundation start focusing on women-specific research? Yes, well, as I mentioned before, there was such a gap in

terms of knowledge around women's heart and brain health, which is where we're investing our research and doing our work. And I think it was coming from a perspective, too, from an equity perspective. I know Carmen mentioned that earlier, but there's right now, because of those gaps right now, women are not receiving the care that they deserve. And women are dining prematurely and they're not enjoying to the fullest of their life. So there's many, many things to actually do in terms of research.

That was critical for Heart & Stroke because that's a critical thing we do in terms of research. That was critical for heart and stroke because that's a critical thing we do in terms of our mission, our mandate. We've done also a lot of awareness. So these were kind of like the main drivers at the beginning is 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, you know, no, 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, you know, base of knowledge to really drive, you know, how care is provided to clinical practice, you know, care models, treatments,

and to really lead to women's positive outcomes. Carmen, I wanted to go back to something that Amanda was talking about, the fact that we don't have any kind of like data across the country. And so out of frustration, a lot of women, if they can't get an appointment with a gynecologist in order to do that, get 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 to 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? Well, Dr. Blackwood is absolutely right. One of the things that will be 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 into place, I think it was maybe five 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 from, as they go through the various ages and stages of their life. The absence of the framework or 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 rely 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 media so that when people turn to social media, they can actually navigate their way through valid resources. And so, yeah, that's what we need to do and keep them from going stateside. Amanda, could social media be a positive in this situation? Well, absolutely. I think we 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 don't know. I'm looking just at the specific example of pain with IUD insertions or gynecologic procedures. And I think there was a real push from social media for the health care profession to address that.

And I think we have now done that. And that's that push from, from women themselves. And I think that that social will actually helps breed political will or will at the level of the policymakers. So, absolutely, I think there are 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 about 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, really good, informative, evidence-based information that hopefully will address

the concerns that people have without some, 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. Well, speaking of disinformation, we are going to play a little myth-busting in a moment. But for people who might have 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?

Well, I think for everybody who's not familiar with that, so Bill C-64 was introduced last February and received royal assent last October. And that's the national framework for pharma care with the first essential medicines that are being covered on that being diabetes medication and contraception. And that is a huge step forward as far as women's equity

in this country. When we look at the rates of unintended pregnancy in Canada, up to 40% of pregnancies were 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 that sometimes people argue, well, can we afford to do that? Our argument is always, well, you can't afford not to do it because the cost of unintended pregnancy alone,

just the direct cost, is $320 million per year, not factoring in the longer downstreams effect for the society and the individual and the children themselves. So I think this is a it's a huge step forward. Cost modeling is showing 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 huge step forward. Now what we need to do, we're at the point where it's perceived royal assent. Some provinces and one of the

territories have signed on, but we need to encourage our provincial governments, including our provincial governor in Ontario, to sign on to bilateral agreements so that we can ensure that access is not dependent on where you live or your income. It is a it's a 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. Christina, are you nodding? Christine, I saw you nodding. Yes, absolutely. Yes. And I was just talking to our team in Ontario,

I think, thinking about just just building on a medication piece. 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 due to the cost. You know, their overall drugs, gaps in terms of drug coverage will 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. 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 cases? There's one core response to that trend that we don't want to see, and that is switching wholly to HPD primary screening. And we are beginning to do that in Canada. We're really not doing it fast enough.

There's still some provinces that say they're 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. In the last five minutes, I wanted to go over some of the disinformation that we're 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. 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 being one of the most effective methods of pregnancy prevention, it would not be high on the list simply because women can have variations in their cycles for a variety of reasons. They may have other coexisting medical conditions.

So natural family planning is possible to be using, but I would not consider that as an effective method of contraception for a lot of women. Also STDs, right, or STIs? It doesn't protect you from that. 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. And Christine, only, this is just a myth, it's not me saying it, but this is only unhealthy older men have to worry about heart disease. Oh so absolutely not and this is interesting and this is I think what drove all of our work, you know, for a few years now. It's interesting because nearly 40 percent, what we know from a study we did in 2021, is that nearly 40 percent of people in Canada, they do not realize that heart disease and stroke are the leading cause of premature death in women.

And we know that there's a number of conditions including heart failure, stroke, and others that are actually more prevalent among women. So that's definitely something to raise more awareness among women, but also just people in Canada overall, including healthcare professionals. And Carmen, all women experience painful periods? 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? We have about 90 seconds left.

I would like to give you all 30 seconds. It's come to, I guess, where we are right now. Women have to advocate for themselves. And it can be intimidating because doctors are authority figures. What can women watching do to advocate for themselves in the healthcare system as we have it right now? I'll start with you, Amanda. Well, I would say we would want people to start with recognizing

the importance of maintaining the sexual and reproductive rights that we have in Canada and Ontario. And I think there are a lot of things that we think are 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 be vocal about the need for access to sexual and reproductive health services,

so including contraception sexual 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 very quickly and we need to be very vocal about the importance in our country and in our province of maintaining those rights. And Christine? I would say, I think the importance of just recognizing that a lot of our heart conditions and stroke

can be prevented for women and for 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, you know, reproductive years, when they had pregnancies, around menopause, you know, post menopause. So what heart and stroke is trying to do is really to help equip women with more knowledge and again, you know, knowledge that's evidence-based to really understand what their unique risks are, and then what can they 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 and Stroke website, to really help women advocate for themselves and just have the right resources and tools in their conversations with their health care providers. And 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 providers. 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 be other auctions available to them. 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 be willing to just sit back and let their health happen to them. I think they need to step up, talk to people, and go to the, 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. Thank you all so much for your time. I think it's conversations like this that can spark awareness this because that is what will make the system change. Thank you all so much for your time. I think it's conversations like this that can spark awareness and lead it to action and help a lot of women across this country. We appreciate your time. Thank you.

Thank you. Thank you for having us.