GBA+ Policy Recommendations and Considerations
Description: Using an example, Dr. Cara Tannenbaum outlines how to develop a policy brief. She offers various policy recommendations and important GBA+ policy considerations.
Date: June 9, 2020
[An image of the GBA+ logo appears with the words "Gender-Based Analysis Plus".]
[A background with colourful bars appears with the title "GBA+ Policy Recommendations and Considerations" appears on the screen. These words fade out and the sub-title "Developing a Policy" appears.]
[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.]
So, if I were going to write a policy brief on pharmaceutical policy. You have to approach this from several different perspectives.
[A background with colourful bars appears with the words "Look at the Data".]
First, let's look at the data like we did.
[On the left of the screen, a graphic appears of a blue silhouette of a man's head encircled with the male symbol. On the right of the screen a pink silhouette of a woman's head appears encircled with the female symbol.]
The data showed us that medications affect men and women differently. My first question would be: well is Health Canada actually looking at that data when new drugs are being submitted for approval to Canada? Are we actually asking the drug companies: did you test these medications? Do they have the same positive effect? Do they have the same possibility of side effects and frequency of side effects in men and women? In fact, should we have that information publicly available?
[The homepage of the Health Canada website appears filling the entire screen. The screen blurs and a pill bottle spilling appears.]
If I just got a prescription from my doctor, should I be able to go to the Health Canada website, in the interest of openness and transparency, and see, okay, this new drug that's being prescribed to me, was it tested in males and females? Is there a different side-effect profile?
[The graphic of the pill bottle remains and pills spill out. A male symbol appears on the bottom left and the female symbol appears on the bottom right .The graphics of the pill bottle and symbols fade away and question marks scatter the screen. Question marks fade and colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
Do I feel, if I'm Asian or if I'm Indigenous or if I'm a new immigrant or if I'm a black Canadian, can I look at who this drug got tested on and know that I was well represented in the experiments and in the trials, so that it would be safe for me to take?
One policy recommendation would be openness and transparency around the population and the information that went into establishing the safety and effectiveness of that drug, so that Canadians can make informed choices.
[The words "Policy Recommendations" appear on screen with then a bullet point appears below with the words "Openness and transparency" . Colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
Another policy recommendation might be, in our deep-dive sex and gender- based analysis plus, to look at the "why" and try to address that.
[The words "Policy Recommendations" and the bullet point with the words "Openness and transparency" reappear on screen and a second bullet point item on the list appears "Look at the WHY". Colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
Let's go back to the opioids. Why are men dying more from opioids? Well, if I go into the why, it turns out that there are a lot of myths out there that are very gender related. I was working with Veterans Affairs at one point and I found out that there was this rumour or social media meme that, Methadone treatment affects libido.
[Text appears on the screen "Myth: Methadone treatment affects libido." Colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
If you went on methadone treatment to try to get you off opioids, it would kill your libido; that methadone decreased testosterone levels and that men would have a higher chance of having erectile dysfunction and sexual issues because of the methadone.
That's true and not true. The truth is that all opioids decrease testosterone levels and decrease libido in men. It's just when you're on the opioids you don't realize that, but when you try to get off of them, you actually feel better and you attribute it to the methadone.
How do we get more men to go into opioid-reduction programs?
[The words "Policy Recommendations" and the two bullet points: "Openness and transparency" and "Look at the WHY" reappear on screen and a third item on the list appears "Get rid of gendered myths". Colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
Get rid of some of those gendered myths, increase communication, maybe, about the sex-hormone effects on opioids and opioids on sex hormones, and make sure that information is publicly available about the side effects and harms of these medications.
If we were talking about drug formularies, I would want to look at the frequency of use of these medications cross-sectionally with income. Which are the populations who would, I would guess, have their medication patterns change the most because of pharmacare? Are those, for instance, the older women who didn't have the drug coverage and maybe weren't able to pay for their medications? And are the medications that we're putting on the list appropriate?
[Blank screen appears with three circles, in each circle a word appears, "Sex", "Age", and "Race." Images of different types of pills appear in the circles under the words. Colourful bars appear and wipe away text to reveal DR. CARA TANNENBAUM.]
Should we maybe have different lists based on different sex, age, racial groups, depending on which medications work better for some people than other people? This would be a personalized approach to pharmacare. You might say; "Whoa, that's too complicated! Pharmacare is complicated enough as it is." But I say, if we're going to do it, let's do it right and let's make sure that we apply SGBA plus analysis to it.
[A background with colourful bars appears on the screen with the words "Important Policy Considerations."]
We've been talking mostly about prescription drugs but there are over-the-counter drugs that people take.
[A fullscreen image of an older man talking to a pharmacist appears. The pharmacist is holding a prescription bottle. Colourful bars appear and wipe away image to reveal DR. CARA TANNENBAUM.]
But there's also the non-prescription or pill drugs. There's cannabis, right?
[The report cover of a Government of Canada report appears on screen with the words: "A Framework for the Legalization and Regulation of Cannabis in Canada: The Final Report of the Task Force on Cannabis Legalization and Regulation." Underneath the words are triangle frames with cannabis leaves inside.]
Marijuana now legal in Canada. What's a sex and gender-based analysis on marijuana? There 's lots of things that you could think about. The most obvious sex-related factor is the propensity to get pregnant.
[An image appears on the screen of a silhouette of a pregnant woman. The silhouette slides left and a graphic of a marijuana leaf appears. Colourful bars appear and wipe away the image to reveal DR. CARA TANNENBAUM.]
And do we actually know what the effect of marijuana is going to be on the fetus?
Do we need to start having recommended limits that are different on cannabis? Do we need to start having recommended limits that are different on opioids? Did you know that there's some medication now where we do recommend different doses of the same medication for males and females?
If we don't have policies in place in Canada that ask the questions:
[The words "Policy Recommendation" appear on screen. Above the words a green box appears that reads "Do sex and gender affect approval in Canada?" To the right a blue box appears with the text "Is marketing being done properly?" Below a pink box appears with the words "Are we making recommendations?" To the left a gold box appears that reads "Is the public aware?"]
Do sex and gender affect pharmaceutical approval in Canada?
Is the marketing being done properly?
Are we making the recommendations
and does the public know that they shouldn't be taking medications that might be safe in one person and not safe in them?
Then we're not helping Canadians with their health.
[DR. CARA TANNENBAUM cuts out and a background with colourful bars appears and then disappears, and the Government of Canada logo appears.]