Applying GBA+

Description: Dr. Cara Tannenbaum demonstrates the importance of establishing why certain data discrepancies exist in GBA+. She explores the complexities of these discrepancies and shares examples of how to develop a policy using GBA+.

Date: June 9, 2020

Duration: 00:05:49

Resolution: 1080p


[An image of the GBA+ logo appears with the words "Gender-Based Analysis Plus".]

[A background with colourful bars appears with the title "Applying GBA+". The sub-title "Ask the WHY" appears on the screen and then fades out.]

[DR. CARA TANNENBAUM seated in her office, speaks to the camera. A colourful GBA+ symbol appears at the bottom left corner of the frame and her name (Dr. Cara Tannenbaum) and job title (Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research [CIHR]) appear to the right of the GBA+ symbol.]

The reason that we do GBA+, is to be able to look at the data for different populations of individuals. To see where there's inequities, to see how one group is doing, how another group is doing. To see if there's differences. But that's only the first step. What's more important is to ask the why.

[The words "ASK THE WHY" appear in large bold letters to the right of DR. CARA TANNENBAUM.]

What is the mechanism?

[The words "What is the mechanism?" appear on the screen below the words "ASK THE WHY".]

How can we explain that there's differences?

[The words "How can we explain that there's differences?" also appear on screen below the words "What is the mechanism?".]

And once we get the answer to why there's differences, then we'll be able to come up with personalized, tailored, more thoughtful recommendations for policy;

[A fullscreen visual of a young woman in an office, smiling and typing on her computer.]

[A fullscreen visual of a father playing with his two young children on the carpeted floor.]

so that we know that all our efforts haven't been in vain

[A fullscreen visual of a young construction worker smiling while crossing his arms, standing in front of a group of other construction workers.]

and that maybe one-size-fits-all does not apply to the subject area.

[A full screen visual panning across various workers sitting in front of laptops, talking and smiling with their headsets.]

And by taking that extra time to understand the "why," and thoughtfully come up with our solution, then our policies will be of greater benefit to everybody.

[A background with colourful bars appears on the screen with the sub-title "Complexities" before wiping away to reveal DR. CARA TANNENBAUM.]

In the 21st century, we're embracing complexity. We realize that two individuals are not the same. We're talking about personalized medicine now or precision health where, based on your genetic makeup, based on your race,

[Colourful bars appear and transition to a full screen visual of a doctor showing a young woman her ultrasound.]

based on your sex, based on your age, based on your gender,

[A full screen visual of a young male patient, badly injured and lying on a hospital bed, being tended to by a nurse and doctor.]

we should be able to tailor therapy to give you the best treatment

[A full screen visual of an elderly patient sleeping in a hospital bed, and then there is a sull screen visual of a child sleeping in a hospital bed.]

[Colourful bars appear and transition back to DR. CARA TANNENBAUM.]

at the right time, at the right dose, for the right condition, so that your individual treatment will benefit you. I've given you a medical example,

[Colourful bars appear and transition to an overhead view of Parliament Hill and the Ottawa River.]

but this applies at every single departmental level in government for every policy and for every sector in Canada.

[A background with colourful bars appears with the sub-title "Unpacking the WHY of GBA+".]

Pharmaceutical policy, sex and gender-based analysis plus, how would I approach this?

First, I'd look at the sex or biological factors that have to do with drugs, and we know that drugs are processed differently and metabolize differently than men and women.

[The words "Use the data to look at the sex and biological factors" appear to the right of DR. CARA TANNENBAUM.]

Let me tell you four or five reasons why. First of all, women tend to be smaller than men.

So the same dose of a drug has a greater effect in a smaller body than in a bigger body. Because women are smaller, their kidneys are smaller.

[A 2014 graphic titled "How Canadians Compare" and the sub-title, "Height of the average Canadian" appears. A male and female silhouette on screen, where the male is indicated as 178.1 cm (5'10") and the female as 163.9 cm (5'4"). Listed underneath is the source: NDC Risk Factor Collaboration.]

Because their kidneys are smaller, it takes them longer to excrete the drug and the drug tends to accumulate in their body. This part's kind of sad, but it also turns out that women have a lot more fat tissue than men.

[A graphic appears on the screen to symbolize the average mean percentage of body fat between men and women. A bar graph appears with the female symbol inside a green bar and the male symbol inside an orange bar. The green bar is significantly higher than the orange bar. Underneath the words, "Average Mean Percentage Body Fat by Sex" appear.]

Even if they exercise the same and they're the same age and everything, it's just the way our bodies are designed. And what a lot of people don't know is that a lot of medication tends to linger or accumulate in fat tissue.

[The graphic fades out and DR. CARA TANNENBAUM appears on screen.]

It's just kind of warm and fuzzy and it stays there a little bit longer. So now, we have the drugs being eliminated more slowly and kind of being accumulated in the body.

[A graphic of the male and female symbols appear; the words "2x Side Effects" appear shortly after next to the female symbol, and the female symbol increases in size while the male symbol decreases in size.]

So it turns out that statistics tell us that women have twice as many side effects from most medications than men. That's how the body and the drug interact.

There is another way that the drug and the body interact,

[An animation graphic appears on the screen of opiods falling onto brain receptors attached to a brain. The text on screen indicates the following: "Opioid", "Opioid receptor on brain", and "Opioid fit exactly on receptor".]

and that's: if once the drug has attached to the receptor in the body, does it produce a greater effect? Talking about opioids, it turns out—that when the opioid drug attaches to the receptor in the brain

[The graphic fades out and DR. CARA TANNENBAUM appears on screen.]

that controls pain and euphoria, and all those things that happen when you take an opioid—that if

[A colourful animated graphic appears representing a menstrual cycle, surrounded by 28 days . The title of the graphic is "Days of the Average Menstrual Cycle". From days 1 to 5, it says "menstruation (3-7 days)" and then at day 14 it says "ovulation".]

a woman is in a certain phase in her menstrual cycle and has more or less estrogen in her body at a given time, that might potentiate

[The graphic fades out and DR. CARA TANNENBAUM appears on screen.]

or increase the effect of the opioid on that woman. So it's not only what the body does to the drug

[Animated graphic of an arm outstretched receiving a pill from a prescription bottle.]

but what the drug does to the body that might have to do with sex or biological factors.

[A background with colourful bars appears with the sub-title "Example of developing policy using GBA+" before fading out and DR. CARA TANNENBAUM appears on screen.]

Now imagine that I were tasked with putting together the drug formulary and which drugs should actually be on this formulary.

A lot of factors are going to come into consideration:

[The word "FACTORS" appears at the top of the screen, followed by the following images: a dollar sign symbol, a group of people, and a paper report.]

we'll have to look at the price of the drug; we'll have to look at who's using it; we'll have to look at the different medical conditions. And here I'll give a shout-out

[The graphic fades out and DR. CARA TANNENBAUM appears on screen.]

to some of the work that's been funded by the Institute of Gender and Health.

That I would expect somebody working on this file to go

[A graphic representing the Drug Atlas report appeares on the screen, and a male and female silhouette appear on either side. The Drug Atlas is divided into two and disappears behind each silhouette. Pills fall down from the top of the screen, divide into two groups and move towards the male and female silhouettes, and then disappear behind each silhouette.]

pull out the Drug Atlas that's been published, which disaggregates this information according to male and female use of the drug.

So we have information in Canada showing what proportion of sleeping pills are taken by males or females

[The graphic fades out and DR. CARA TANNENBAUM appears on screen.]

in what age group, and how many of them are currently covered, and how many of them are not currently covered, and which ones are most commonly used. And yet, there also has to be a qualitative assessment of that. What may or may not be included in the pharmacare discussion today is about the appropriateness of choosing one drug over the other. So sex, gender, medication; I think it all interacts and there could be some severe unintended consequences if you don't think about sex and gender when you're making pharmaceutical policy.

[DR. CARA TANNENBAUM fades out and the Government of Canada logo appears.]



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