IMPLEMENTATION PLAN The Framework has identified a number of strategies directed at achieving broad organisational and cultural change and working in partnership as part of considering the social determinants of health. A number of social and life cycle factors have been identified. Sectors will need to work to achieve these broader "system" strategies. The Framework identifies a number of social factors that have a significant impact on the health of women and result in some groups of women suffering particularly poor health status. SWSAHS is actively involved in partnerships with other government and non-government organisations, eg the Claymore and Miller integration projects, to address issues of social disadvantage that impact on health. As one of the largest employers in the region SWSAHS has taken a proactive role in providing employment strategies for disadvantaged people, eg the Aboriginal Employment Strategy. The Framework has also identified a number of specific health issues that have clear implications for a number of the Area Advisory Committees. The twelve (12) Advisory Committees advise the Area on priorities for health improvement and long term directions for health outcomes and health improvement strategies. The Committees reflect a number of high priority health areas identified by SWSAHS based on the National agenda, the State agenda and the local health needs in the south west of Sydney. While there is not a separate committee for women’s health, all Committees need to incorporate a gender based analysis within an equity framework of health issues, as well as address specific issues. This analysis is part of a comprehensive needs analysis to ensure that different needs, interests and values are identified and are acknowledged in health services development. A summary of some of the key elements of the specific social, lifecycle and health issues identified are as follows: Socio-economic Women from low socio-economic groups suffer significantly more likely to suffer from cardiovascular and lung disease and diabetes Indigenous health Addressing mental and emotional wellbeing, family health and promotion of social supports is crucial to improving indigenous health. Cultural diversity Specific social and health issues include refugee health, social supports, diabetes and cardiovascular disease in particular ethnic groups. Social support Increasing social supports, eg transport, friendship and family networks and public safety will impact on health issues including mental and emotional health, suicide prevention and physical wellbeing. Violence against women Programs aimed at preventing violence and ameliorating its long term effects are a priority. Lesbians and bisexual women Homophobia particularly affects young women placing them at risk of violence, substance abuse, and mental and emotional ill health Young women Stress, eating disorders and body image, smoking, sexuality and relationship issues have been identified. Older women Social isolation and physical disabilities such as osteoporosis and arthritis significantly impact on morbidity for older women. Reproductive health A number of specific health issues for particular ethnic groups and Aboriginal women have been identified, including time of access to antenatal care, prematurity, low birth weight, gestational diabetes and termination services. Breast and cervical screening Older women, Aboriginal and immigrant women are priority groups for increasing recruitment for cervical screening while there is an unacceptable differential between ESB and NESB and Aboriginal women for mammography screening. Disability Women experience more years of disability, handicap and severe handicap. Women are also more likely to provide care to another person because of long term illness, disability or frailty. Mental and emotional health Women are more likely to suffer major depression, agoraphobia, panic disorder and obsessive-compulsive disorder. Women also attempt suicide at a higher rate than men. Gender roles may contribute to depression and anxiety. Children of women with mental illness are also an important consideration. Women and substance abuse Smoking rates in young women are a growing concern. Women affected by substance abuse are at greater risk of physical and sexual assault, poverty, imprisonment, homelessness and social discrimination. There are also specific issues related to women with mental illness and substance abuse. There is also a range if factors that need to be considered for women during pregnancy and postnatally, for children of women affected by substance abuse. The implementation plan combines some key organisational strategies as well as a number of more specific strategies aimed at the key health issues. Strategies have been developed in relation to the five strategic directions for women’s health and include the objective, strategy, performance indicator, responsibility and target date. The following abbreviations have been used: AET Area Executive Team DCEO Deputy Chief Executive Officer DBS Director, Business Services DDP Director, Division of Planning DFS Director, Financial Services DMCS Director, Medical and Clinical Services DNCS Director, Nursing and Clinical Services DDPH Director, Division of Population Health GMs General Managers   Incorporate a Gender-based Analysis to Health Within an Equity Framework to Further a Shared Sense of Direction and Responsibility Objective: To identify and act on inequalities that arise from belonging to one sex or the other, from unequal relations between the sexes or between women Strategy Performance Indicator Responsibility When 1.1 To undertake gender based analyses within an equity framework as part of planning service or program developments Needs analysis includes gender based analyses within an equity framework Area Advisory Committees, DDP, Ongoing 1.2 To implement the NSW Health Gender Equity Guidelines and checklists (currently in development) as part of policy development, service planning and practice Guidelines implemented Area Advisory Committees, DDP, Following release of Guideline 1.3 Educate and train staff on the impact of gender and other social determinants on women’s health Two training programs conducted per year DNCS June 2001 1.4 To identify and address health inequalities for women <>High priority inequalities identified Specific strategies developed each year to address identified DNCS DCNS June 2001 and annually 1.5 To have well organised, understood and utilised processes of community participation and information sharing Evidence of community participation and consultation Area Board Ongoing   Work in Collaboration with Others to Address the Social Determinants of Health Objective: To work collaboratively with women in the community, other government departments, non-government agencies, advocacy groups, General Practitioners and the private sector to improve the capacity of the health system to maximise health outcomes for women Strategy Performance Indicator Responsibility When 2.1 Continue to improve work opportunities which reduce the negative health consequences of unemployment, especially for Aboriginal, disabled, young and long term unemployed women Area Human Resources Plan includes strategies for long term unemployed DBS Ongoing 2.2 Promote improved health through good management practices, increased level of control, variety of work tasks, appropriate use of skills and flexible work practices Flexible work practices implemented in each Sector DBS, GMs June 2001 2.3 Participate in whole of government initiatives concerning the status of women such as anti-discrimination, anti-violence and Aboriginal Reconciliation initiatives Participation in whole of government initiatives DCEO, GMs Ongoing 2.4 Continue to work in partnership with other government and non-government agencies and members of the local community to improve the social and health status of disadvantaged communities such as the Miller and Claymore projects Improved health status of disadvantaged communities GMs Ongoing 2.5 Consideration of rates of cardiovascular disease, lung disease and diabetes in women, particularly socially disadvantaged women, by relevant Advisory Committees Appropriate strategies included in relevant plans and/or priorities Coronary Heart Disease, Cancer and Diabetes Advisory Committees June 2001 2.6 Promotion of policies and programs to reduce the fear of crime and violence, reduce discrimination, and create safe environments for living Participation in projects DNCS, DDPH Ongoing 2.7 Promotion of the need for high quality, affordable public transport Access considered in all service developments and programs DDP, DDPH Ongoing 2.8 Recognition of skills and resources and opportunities for community development in different communities Prior learning and skill development recognised in Human Resource development DBS June 2001   Advance Research on Women’s Health Experience and Morbidity Objective: To ensure that the health needs of women are adequately researched and the impact of gender examined in health issues Strategy Performance Indicator Responsibility When 3.1 Analysis of data by sex, age and socio-economic status, Aboriginality and ethnicity Demographic analysis undertaken in all services planning and development Area Advisory Committees, DDP Ongoing 3.2 Establishment of a women’s health research interest group to facilitate partnerships with research organisations and develop understanding of women’s health Partnerships established DNCS June 2001 3.3 Promotion of the inclusion of women as subjects and in the design and implementation of epidemiological and clinical research Strategies developed for consideration by Ethics Committee DNCS June 2001 3.4 Promotion of innovative research focussing on: Impact of gender on health; Interaction between gender and other social determinants of health; and Non reproductive aspects of women’s health Number of research activities within SWSAHS 20% of innovative grants funding from the National Women’s Health Program component of the PHOFA allocated to the 3 research areas DNCS June 2002 and ongoing   Develop and Apply an Appropriate Health Outcomes Approach to Women’s Health Objective: To identify a range of indicators, including social, economic and biological, in order to measure the improvement of the health of women, and in particular, disadvantaged women Strategy Performance Indicator Responsibility When 4.1 Review and incorporate as appropriate NSW Health priority health outcomes for women when available (currently in development) in local policy and planning Outcomes included in relevant planning processes Area Advisory Committees, DDP June 2001 4.2 Development of appropriate indicators for measuring women’s health outcomes in consultation with Area Advisory Committees, NGOs and the community A range of indicators developed including: Health Status: eg, mortality, morbidity, wellness, quality of life Risk/Protective Factors: eg, behavioural, environmental, genetic, social, medical, policies Equity Indicators: eg, access, location, gender, demographic, socio-economic Capacity: eg, service availability, infrastructure, program sustainability, staff training. Area Advisory Committees, DDP June 2002 4.3 Development of training and skills for staff involved in program or service development to enable evaluation of the health outcome of programs or services Training and skills developed DNCS June 2002 4.4 Continued monitoring of agreed national and state targets/outcomes in key priority areas including breast and cervical screening, injury, cardiovascular disease, diabetes, mental health and physical activity Targets/outcomes achieved Epidemiology Unit Ongoing   Focus on Women Most in Need Objective: To address the specific health needs of women in SWSAHS with a focus on those who are most in need Strategy Performance Indicator Responsibility When 5.1 Reproductive health Development of programs for Aboriginal women, young women and specific ethnic and other groups identified as most at risk in the antenatal and postnatal period Provision of locally accessible and affordable termination services Development of support and health services for women with dependant children with flexibility for women with most need   Time of commencement of antenatal care by Aboriginal women and ethnic groups Rates of pregnancy related conditions eg low birth weight, prematurity, smoking and gestational diabetes Services available   Implementation of Families First program   GMs     GMs       DDP   GMs   Ongoing     Ongoing       Ongoing   June 2002 5.2 Breast and cervical screening Achievement of cervical screening targets for older women, Aboriginal and immigrant women Achievement of screening rates for all women in SWSAHS with particular priority for Aboriginal and non English speaking women   SWSAHS Cervical Screening Strategic Plan implemented and rates increased BreastScreen targets achieved   DNCS, DPH   Inter-Area Management Committee and BreastScreen Western   Ongoing   Ongoing 5.3 Disability Involvement and consultation with women with disabilities in planning of services Needs analysis in Sector Disability Plans identify priority areas for action for women with disabilities including Aboriginal women and older women. Development of programs that support and address the needs of women in their role as carers     Evidence of consultations in development of plans Sector Disability Plans include specific strategies and programs for priority areas Support programs and services for carers developed   DDP; GMs   >GMs.       GMs   June 2001   June 2001     June 2002 5.4 Mental and emotional health Consideration of issues for women in relation to suicide prevention and attempted suicide Consideration of other factors contributing to women’s mental and emotional health and how these can be addressed in service planning and development Continued development of post natal depression services Development of counselling services for domestic violence in Fairfield, Bankstown, Liverpool and Wingecarribee Sectors   Plans reflect needs of women in relation to these issues Factors identified     Improved identification and access to referral services Implementation of Families First Strategy   Counselling services established   Mental Health Advisory Committee Mental Health Advisory Committee, DNCS GMs, Mental Health Advisory Committee         GMs, Mental Health Advisory Committee   June 2001   June 2001   June 2001         June 2001 5.5 Women and substance abuse Inclusion in the SWSAHS Drug and Alcohol Plan of strategies related to: particular needs of women during pregnancy and postnatally (such as hospital liaison officers, referral to methadone and other support services; development of partnerships between drug and alcohol services and other health services relating to provision of play groups for women and children attending methadone programs, outreach services for immunisation; safe detoxification services and proclaimed places for women; and housing support. That rates of smoking in young women are considered in the development of the Tobacco Prevention Plan     Plan includes strategies   Specific strategies to target young women are included   Drug and Alcohol Advisory Committee   DPH   June 2000   June 2000   APPENDIX 1: MAIN LANGUAGES & COUNTRY OF BIRTH SWSAHS Bankstown: Australia & NES Country of birth females 11+ (NES >500 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 32 47 22 13 3 117 Non – ATSI Australia 1952 4221 1659 1423 773 10,028 Vietnam 429 2313 764 535 177 4218 Lebanon 295 2257 985 726 159 4422 Greece 24 211 325 655 65 1280 Italy 6 153 236 628 209 1232 China 62 443 159 263 135 1062 FYR Macedonia 30 282 248 235 36 827 Poland 29 66 64 196 245 600 Bankstown: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 1000 speakers) Arabic 7741 Vietnamese 3763 Greek 2975 Italian 1925 Cantonese 1748 Macedonian 1276 Camden: Australia & NES Country of birth females 11+ (NES>50 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 32 47 22 13 3 117 Non - ATSI Australia 1952 4221 1659 1423 773 10028 Italy 0 33 45 69 25 172 Germany 3 17 35 32 16 103 Malta 3 19 34 35 3 94 Philippines 12 37 21 12 0 82 China 12 25 18 15 3 73 Lebanon 9 27 12 10 0 58 Camden: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 50 speakers) Italian 303 Maltese 87 Cantonese 85 Croatian 80 Arabic 76 Spanish 63 Campbelltown: Australia & NES Country of birth females 11+(NES>400 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 321 466 136 66 12 1001 Non - ATSI Australia 9081 16153 6679 4497 1672 38082 Philippines 186 455 315 127 43 1126 Fiji 71 294 87 58 0 510 Chile 59 198 101 109 6 473 Lebanon 44 230 109 60 5 448 Germany 13 75 141 141 37 407 St Africa 84 159 111 92 19 465 India 37 174 93 70 28 412 W. Samoa 47 227 88 33 15 410 Campbelltown: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 350 speakers) Spanish 1198 Arabic 1081 Tagalog 848 Samoan 546 Lao 451 Cantonese 440 Hindi 430 Croatian 359 Fairfield: Australia & NES Country of birth females 11+ (NES>1000 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 125 180 63 50 10 428 Non – ATSI Australia 7486 9958 2892 3751 1716 25803 Vietnam 1505 6573 2223 1491 378 12170 Cambodia 416 1777 558 450 124 3325 Italy 21 391 591 1360 481 2844 China 139 807 359 536 388 2229 Iraq 264 1000 479 423 79 2245 Former Yugoslavia nfd 95 500 440 465 107 1606 Laos 132 820 272 179 67 1470 Philippines 216 487 428 171 69 1371 Chile 166 512 328 251 42 1298 Croatia 31 288 343 438 91 1191 Uruguay 46 343 275 338 66 1068 Fairfield: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 1000 speakers) Vietnamese 9673 Italian 4549 Cantonese 4314 Spanish 4263 Assyrian 2696 Arabic 2451 Khmer 2291 Serbian 2091 Croatian 1879 Mandarin 1573 Lao 1180 Tagalog 1100 Liverpool: Australia & NES Country of birth females 11+ (NES>500 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 179 336 88 86 4 693 Non – ATSI Australia 5240 12084 3435 4364 1357 26480 Italy 9 239 356 699 348 1651 Vietnam 191 776 260 140 41 1400 Fiji 190 610 163 126 16 1105 Lebanon 123 537 195 116 20 991 Philippines 144 451 230 107 40 972 Former Yugoslavia nfd 56 279 164 184 59 742 China 67 281 142 118 36 644 India 52 329 84 60 20 545 Chile 77 260 120 93 15 565 Poland 68 172 134 108 71 553 Liverpool: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 500 speakers) Italian 2682 Arabic 1903 Spanish 1714 Vietnamese 1315 Hindi 940 Greek 939 Tagalog 791 Cantonese 754 Croatian 635 Serbian 692 Polish 595 Wingecarribee: Australia & NES Country of birth females 11+ (NES>50 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 31 56 16 18 0 121 Non - ATSI Australia 2242 3879 1959 2690 1391 12161 Germany 3 13 41 54 20 131 Netherlands 0 15 32 34 20 101 Wingecarribee: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 50 speakers) German 100 Italian 79 Netherlandic 56 Wollondilly: Australia & NES Country of birth females 11+ (NES>50 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 35 78 29 17 3 162 Non - ATSI Australia 2175 4122 1903 1611 613 10350 Germany 6 21 37 38 22 124 Netherlands 0 16 35 28 10 89 Italy 0 14 21 30 9 74 Estonia 0 0 0 14 70 84 Wollondilly: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 50 speakers) Italian 130 German 87 Estonian 82 Maltese 72 Croatian 59 Netherlandic 50 SWSAHS: Australia & NES Country of birth females 11+ (NES>2000 females) Country 11-19 20-39 40-49 50-69 70+ Total ATSI Australia 810 1311 419 297 42 2879 Non - ATSI Australia 35689 63586 23565 26736 13022 162598    Vietnam 2170 9846 3312 2195 596 18119 Lebanon 535 3616 1504 1062 212 6929 Italy 39 905 1322 2917 1104 6287 China 300 1672 750 1014 599 4335 Philippines 643 1706 1146 493 169 4157 Cambodia 481 2084 692 537 149 3943 Former Yugoslavia nfd 172 954 732 848 211 2917 Fiji 421 1473 479 317 37 2727 Iraq 324 1200 553 471 89 2637 Chile 323 1067 598 493 73 2554 Germany 66 270 570 877 394 2177 Croatia 44 537 596 806 156 2139 Laos 225 1305 408 262 103 2303 Poland 196 457 435 555 568 2211 SWSAHS: Main Languages other than English spoken at home females 11+ Language Number of speakers 11+ (Groups with > 1000 speakers) Vietnamese 15085 Arabic 13311 Italian 10231 Spanish 7880 Cantonese 7408 Greek 5143 Croatian 3399 Tagalog 3182 Serbian 3165 Assyrian 3029 Khmer 2831 Macedonian 2657 Mandarin 2509 Polish 2337 Hindi 2153 Lao 2023 German 1841 Maltese 1791 Samoan 1259 French 1092 Turkish 1077 GLOSSARY Gender Refers to women’s and men’s roles and responsibilities that are socially determined. Gender is related to how we are perceived and expected to think and act as women and men because of the way society is organised, not because of our biological differences Sex Genetic/physiological or biological characteristics of a person that indicate whether one is female of male Mainstreaming Gender Integration of gender concerns into the analyses, formulation and monitoring of policies, programs and projects, with the objective of ensuring that these reduce inequalities between women and men Gender analysis A methodology for assessing and redressing gender bias in policies, program design, management, implementation and review. The basic elements of gender analysis are: a) To identify differences and inequalities between men and women relating to who has access to work, resources, responsibilities and decision-making power: Which Men? Which Women? b) To assess differences in women’s and men’s opportunities needs, incentives, and rewards c) To assess whether the institutions involved in policy making and program implementation have the capacity to advance gender equality objectives d) Identify and remove obstacles and resistance in initiatives to achieve gender equality and equity Gender Equality Absence of discrimination on the basis of a person’s sex in opportunities and the allocation of resources or benefits or in access to services Gender Equity Refers to fairness and justice in the distribution of benefits and responsibilities between women and men. The concept recognises that women and men have different needs and power and that these differences should be identified and addressed in a manner that rectifies the imbalance between the sexes Intervention Strategies carried out by individuals, organisation, the community and government to maintain or attain health Health Outcomes This is a change in the health of a defined population related to an intervention REFERENCES Acheson D. (1998): Independent Inquiry into Inequalities in Health. UK, The Stationary Office Adelson P, Frommer M, Weisberg E. (1996): "Termination of pregnancy in NSW, 1990" A&NZ Journal of Public Health Vol 20:1; p.64-68 Adamson L. (1997): A Picture of Wellness: The History of the Bankstown Older Women’s Wellness Centre. Sydney, Older Women’s Network [AIHW] Australian Institute of Health and Welfare. (1999): 1998 National Drug Strategy Household Survey: First results. Canberra, AIHW. Alcorso C and Schofield T. 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