Health Portfolio Sex- and Gender-Based Analysis Plus Policy:  Advancing Equity, Diversity and Inclusion    

Policy Statement

The Government of Canada’s Health Portfolio^{Footnote 1} uses Sex- and Gender-Based Analysis Plus (SGBA Plus) to develop, implement, and evaluate the Health Portfolio’s research, surveillance, legislation, policies, regulations, programs, services, and other initiatives^{Footnote 2}. The objective of this policy is to strengthen the integration and application of SGBA Plus in all Health Portfolio activities to advance equity, diversity and inclusion.

SGBA Plus is an analytical process used in the Health Portfolio. It is an intersectional approach to assess how factors such as sex, gender, age, race^{Footnote 3}, ethnicity, socioeconomic status, disability, sexual orientation, cultural background, migration status, and geographic location interact and intersect with each other and broader systems of power.

Conducting this analysis helps us to understand how intersecting identity factors, histories, power relations, distribution of resources and individuals’ lived realities contribute to differences in accessing health-related resources and health outcomes. Applying SGBA Plus enables the Health Portfolio to formulate responsive and inclusive health research, policies, services, programs and other initiatives to promote greater health equity.

Definitions for other key concepts are in Appendix A.

Effective Date

The Health Portfolio SGBA Plus policy came into effect on July 8, 2009. The Health Portfolio monitors its implementation and makes revisions as necessary at least once every five years. Individual organizations may elaborate implementation and monitoring strategies in their action plans and guidance.

Revisions to date:

2021-2022: to emphasize intersectionality by elaborating the "Plus" in SGBA Plus and to provide clearer policy implementation responsibilities

2015-2016: to strengthen the policy and add CFIA as a Health Portfolio member

Application

This policy applies to all Health Portfolio activities.

In applying SGBA Plus, we identify needs and barriers between as well as within different groups that are influenced by the previously mentioned identity factors, social context, and lived experience. In keeping with its commitment to reconciliation, the Health Portfolio acknowledges that SGBA Plus must be applied in a culturally-relevant manner, adhering to the principles respecting the Government of Canada’s relationship with Indigenous Peoples and recognizing First Nations, Inuit and Métis as the self-determining First Peoples of Canada.

The early and ongoing application of SGBA Plus to all Health Portfolio initiatives adheres to Women and Gender Equality Canada’s approach to GBA Plus. It is a valuable process and tool for systematically considering an array of identity factors in the development of policies, programs and initiatives. It can be used across many sectors and functions.

SGBA Plus is also an iterative process throughout the life cycle of an initiative. Applying SGBA Plus early in the development of an initiative ensures that equity, diversity, and inclusion considerations are embedded in the decision-making process. This allows for responsive and inclusive initiatives that meet diverse needs.

Rationale

The 2021-2022 policy revision aligns with the federal government commitment to use Gender-Based Analysis Plus (GBA Plus)^{Footnote 4} in decision-making. The Policy also aligns with federal objectives related to the federal Anti-Racism Strategy and Framework; Clerk of the Privy Council’s Call to Action; and current and evolving related action plans such as those for Disability Inclusion, LGBTQ2, and others.

Evidence demonstrates that biological, economic, and social differences between diverse groups of individuals contribute to differences in health risks, access to health-related resources, health services use, health system interaction, and health outcomes.

This policy supports an evidence-based, intersectional, and culturally relevant approach in the use of SGBA Plus including:

• The recognition that inequities in access to health resources and health outcomes are determined by systems of power and discrimination, including colonialism, systemic racism and economic inequalities;
• The development of sound science and reliable evidence through integration of diversity and Indigenous knowledge considerations in health research design and practices;
• The engagement of diverse stakeholders and partners to understand lived experiences and better address population-specific impacts and needs;
• The collection and analysis of disaggregated data to understand and monitor how diverse identity, social and structural factors, as well as lived experiences, interact to influence health- and safety-related experiences, behaviours and outcomes; and,
• A comprehensive understanding of inequities in access to the determinants of health, health status, experiences of health and illness, health service use, and interaction with the Canadian health (including plant and animal health) and food safety systems.

Policy requirements^{Footnote 5}

Roles and Responsibilities

All Health Portfolio employees help to ensure the sustainable implementation and application of SGBA Plus by:

• building their capacity to apply the intersectional principles of SGBA Plus to all aspects of their work;
• committing to personally learning about racism, reconciliation, accessibility, diversity, equity and inclusion;
• recommending SGBA Plus considerations to managers and executives; and,
• documenting their SGBA Plus process to support recommended options and evidence-based decision-making.

Deputy Heads within their respective organizations are responsible for providing leadership to ensure collaboration and accountability in implementing this policy across the Health Portfolio. This includes:

• ensuring meaningful SGBA Plus implementation within their organization;
• dedicating sufficient and appropriate human and financial resources, including infrastructure and training, to ensure SGBA Plus integration throughout organizational products and processes; and,
• requiring the monitoring of and reporting on the implementation of this policy.

A designated senior department or agency lead(s) (e.g., SGBA Plus/GBA Plus Champion) is responsible for driving:

• SGBA Plus awareness, capacity building, coordination, and implementation into core functions and activities, such as policies, programs, initiatives, monitoring, and reporting, in collaboration with senior management;
• the importance of SGBA Plus in day-to-day work;
• departmental SGBA Plus/GBA Plus focal point/responsibility centre(s); and,
• facilitation and collaboration with other departmental Champions in the Health Portfolio and Federal Government.

Management/supervisors, are drivers of cultural change within their groups, and are responsible for:

• applying SGBA Plus to their organizational mandates;
• ensuring SGBA Plus is embedded in their sector/branch products and processes;
• facilitating opportunities between management and the SGBA Plus/GBA Plus focal point/responsibility centre(s) to strengthen SGBA Plus implementation and address gaps; and,
• supporting the sustainable practice of SGBA Plus.

The SGBA Plus Responsibility Centre for each Health Portfolio organization (e.g., S/GBA Plus team, S/GBA Plus focal point, GBA Plus Responsibility Centre, SGBA Plus Centre of Excellence) is responsible for:

• leading, supporting, and monitoring the implementation and ongoing practice of SGBA Plus;
• providing oversight, direction, and promotion of SGBA Plus across the department/agency;
• providing expertise and support for SGBA Plus implementation;
• collaborating with the Health Portfolio SGBA Plus Working Group to update the policy every 5 years;
• leading or coordinating the challenge function on SGBA Plus quality; and,
• developing strategic partnerships and supporting the SGBA Plus champion/leadership in the department/agency.

Health Canada’s SGBA Plus Centre of Excellence (Strategic Policy Branch) acts as the secretariat to support coordination on SGBA Plus across the Health Portfolio.

Guiding Principles

• Accessibility - In alignment with the Accessible Canada Act, the Health Portfolio is committed to promoting accessibility through SGBA Plus application by systematically considering the barriers faced by diverse groups of individuals, and taking steps to remove them at all levels wherever feasible.
• Anti-Racism – Recognizing that we live in a society shaped by systemic racism, the Health Portfolio emphasizes the need to apply an anti-racist approach at all levels through SGBA Plus, which is an approach for addressing systemic and institutional racism, inherent bias, and discrimination in our work.
• Continuous Improvement - The Health Portfolio is committed to building on its experience and incorporating lessons learned and best practices in order to fully integrate the use of SGBA Plus to advance equity, diversity and inclusion.
• Culturally Relevant Approach - The Health Portfolio takes an approach that acknowledges the unique historical, cultural, political and socio-economic realities of Indigenous Peoples and the need for distinctions-based approaches that account for the distinct lived experiences not only between but within First Nations, Inuit and Métis communities and individuals.
• Equity – SGBA Plus will be used to examine how various intersecting identity, social and structural factors, such as systemic racism and colonization, impact the effectiveness of or are impacted by Health Portfolio activities, and to modify activities where necessary, to ensure that the needs of all groups are addressed and justly accommodated.
• Inclusiveness - The Health Portfolio takes an inclusive approach to ensure that everyone from diverse and marginalized groups can benefit. This includes meaningful engagement of people from diverse backgrounds and with a variety of lived experiences for the design of informed policies, programs and initiatives.
• Integrated Approach – The consideration of diverse, intersecting identity, social and structural factors will remain an integral part of Health Portfolio activities and be fully integrated into organizational processes and practices. This will be done, not by simply adding different factors into the empirical mix but rather the analyses will centre on the relationship between these factors, as well as the broader context, and their overlapping and cumulative effects on health service access and health outcomes for individuals.
• One Health – The scope of this policy applies SGBA Plus in a One Health approach to all health-related issues including zoonotic diseases, antimicrobial resistance, food safety and food security, vector-borne diseases, environmental contamination, and other health threats shared by people, animals, and the environment.
• Respect - The Health Portfolio is founded on a culture of respect, as we work together to develop strong relationships with everyone in order to advance these principles.
• Shared Responsibility - It is the responsibility of senior management to provide the leadership necessary to ensure the implementation of SGBA Plus within their Health Portfolio organizations. At the same time, the successful implementation of SGBA Plus requires the participation of all Health Portfolio staff.

Accountability

Deputy Heads are responsible for ensuring that Health Portfolio organizations implement the Health Portfolio Sex- and Gender-Based Analysis Plus Policy, as well as the joint review, and revision of the policy as stipulated above.

Reporting

Deputy Heads and their delegates are also accountable for reporting on implementation progress.

Appendix A – Glossary

Terms used throughout the policy are defined below although it is not an exhaustive list. The glossary will be updated as required.

Anti-Racism

Anti-racism refers to a form of action against racial hatred, bias, systemic racism, and the oppression of marginalized groups. Also, anti-racism is an active and conscious effort to work against multidimensional aspects of racism and it is the active dismantling of systems, privileges, and everyday practices that reinforce and normalize the contemporary dimensions of racial dominance of one group over others. (1)

Culture

The term "culture" can be defined in many ways. Broadly described, culture can include economic systems; political ideologies and processes; ways of life and social mores; educational institutions; social programs; the environment, technological systems, recreational practices, customs and traditions; artistic and heritage activities; transportation and communication industries; and religious and spiritual activities. (2)

Culturally Relevant GBA Plus

A culturally relevant Gender-Based Analysis Plus (GBA Plus) considers the historical and current issues faced by Indigenous Peoples, including the impacts that colonization and intergenerational trauma have caused, respectfully acknowledges resiliency with a strengths-based approach, and values Indigenous knowledge and ways of transmitting knowledge. Rather than take a one-size-fits-all, pan-Indigenous approach, a culturally relevant GBA Plus recognizes the different lived experiences not only between but within First Nations, Inuit and Métis communities, including separate experiences with colonization, and that these distinct groups will be impacted differently by policies and programs. Therefore, while the considerations listed represent common elements of an Indigenous culturally relevant approach, different Indigenous organizations each have a unique perspective on how GBA Plus is framed in their communities and are at various stages of developing GBA Plus resources that are specific to their contexts. (5)

Disability

Disability means any impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment—or a functional limitation—whether permanent, temporary or episodic in nature, or evident or not, that, in interaction with a barrier, hinders a person’s full and equal participation in society. (3)

Discrimination

The denial of equal treatment and opportunity to individuals or groups because of personal characteristics and membership in specific groups, with respect to education, accommodation, health care, employment and access to services, goods and facilities. Behaviour that results from distinguishing people on that basis without regard to individual merit, resulting in unequal outcomes for persons perceived as different. Differential treatment that may occur on the basis of race, nationality, religion, ethnic affiliation. (1)

Diversity

Diversity consists of the conditions, expressions and experiences of different groups identified by age, culture, ethnicity, education, gender, disability, sexual orientation, migration status, geographic location, language and religious beliefs (and other factors). (4)

Ethnicity

Ethnicity is a broader term than race. The term is used to categorize groups of people according to their cultural expression and identification. Commonalities such as racial, national, tribal, religious, linguistic, or cultural origin may be used to describe someone’s ethnicity. (1)

Gender

Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender has traditionally been conceptualized as a binary (girl/woman and boy/man) yet there is considerable diversity in how individuals and groups understand, experience, and express it. (6)

Gender-Based Analysis Plus (GBA Plus)

GBA Plus is a Government of Canada Priority, and is required for government decision-making and evaluation processes. GBA Plus is an analytical tool to support the development of responsive and inclusive initiatives, including policies, programs, and other initiatives. The term "GBA Plus" is used throughout the Government of Canada, while the Health Portfolio uses the term "SGBA Plus". (4)

Geographic location

Geographic location in Canada is often broken up into discrete provinces and territories, or into groupings of provinces and territories that compose geographical regions. Urban and rural/remote geographic location is frequently used to measure inequality, as there is a good evidence associating this construct with inequitable health care access, quality and outcomes (CIHI).

Additionally, when considering the effect of geographic location on health, it is also important to consider Indigenous communities and in particular First Nations reserves. (1)

Health equity

Health equity refers to the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically. (7)

Inclusion

Inclusion is defined as the practice of ensuring that all individuals are valued and respected for their contributions and equally supported. (8)

Intersectio
nality

Intersectionality is an approach to analyzing social relations and structures in a given society which recognizes that every person’s identity consists of multiple overlapping factors. The term was first coined in 1989 by scholar and civil rights activist Kimberlé Crenshaw to explain how race interacts with gender and other factors to produce barriers for Black women^{Footnote 6}.

Today, intersectionality is understood more broadly as a framework for understanding how people may experience systemic privilege and oppression based on their intersecting identities, depending on how they are valued by social institutions. (2)

Sex

Sex refers to a set of biological attributes in humans and animals. It is primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex can be categorized as male, female, or intersex, as there is variation in the biological attributes that comprise sex and how those attributes are expressed. (6)

Race

Race is a social construct and is not grounded in biology: racial categorization schemes were invented by Western scientists to support worldviews that considered some groups of people as superior and some as inferior. This is a concern in the health sciences, because beliefs about race-based biological differences can influence how health care providers perceive their patients and make diagnostic or treatment decisions. However, the racialization of certain groups is a very real social phenomenon, and as such, it is necessary to pay attention to race as an identity factor because it has an impact on how people access and receive care and other federal programs and services.

While we recognize that racial categorizations are not biological, the impacts of racial identity need to be measured and assessed along with other identity factors as a determinant of health. (9)

Sex- and Gender-Based Analysis

SGBA Plus is an analytical process used in the Health Portfolio. It is an intersectional approach to assess how factors such as sex, gender, age, race, ethnicity, socioeconomic status, disability, sexual orientation, cultural background, migration status, and geographic location interact and intersect with each other and broader systems of power.

Conducting this analysis helps us to understand how intersecting identity factors, histories, power relations, distribution of resources and individuals’ lived realities contribute to differences in accessing health-related resources and health outcomes. Applying SGBA analysis enables the Health Portfolio to formulate responsive and inclusive health research, policies, services, programs and other initiatives to promote greater health equity.

Sexual Orientation

A term used to describe a person’s emotional, romantic, or sexual attraction. (1)

Systemic Racism

Systemic racism consists of organizational culture, policies, directives, practices or procedures that exclude, displace or marginalize some racialized groups or create unfair barriers for them to access valuable benefits and opportunities. This is often the result of institutional biases in organizational culture, policies, directives, practices, and procedures that may appear neutral but have the effect of privileging some groups and disadvantaging others. (1)

Glossary References

1. Women and Gender Equality Canada. Gender Based Analysis Plus Step-by-Step Guide Compendium. Available at: GCpedia Gender-Based Analysis Plus Step-by-Step Guide Compendium. Accessed 09/10, 2021.
2. Women and Gender Equality. Gender-Based Analysis Plus Step-by-Step Guide. Available at: GCpedia Gender-Based Analysis Plus Step-by-Step Guide. Accessed 09/13, 2021.
3. Accessible Canada Act. Available at: Justice Laws Website Accessible Canada Act. Accessed 09/10, 2021.
4. Women and Gender Equality Canada. Introduction to GBA+ Glossary. 2018; Available at: Women and Gender Equality Canada Introduction to GBA+ Glossary. Accessed 09/10, 2021
5. Native Women’s Association of Canada. A Culturally Relevant Gender-Based Analysis (CRGBA) Starter Kit. 2020. Available at: Native Women’s Association of Canada A Culturally Relevant GBA Starter Kit 2020. Accessed 06/10, 2021.
6. Canadian Institutes of Health Research Institute of Gender and Health. Definitions of Sex and Gender. 2015; Available at: Canadian Institutes of Health Research Definitions of Sex and Gender. Accessed 03/18, 2021
7. Public Health Agency of Canada. Pan-Canadian Health Inequalities Reporting Initiative: Key Health Inequalities in Canada - A National Portrait. 2018; 180210.
8. Canada Research Chairs. Frequently asked questions on the program’s equity, diversity and inclusion practices. Available at: Canada Research Chairs Frequently asked questions. Accessed 09/13, 2021.
9. Appiah, Kwame Anthony and Gutmann, Amy. Color Conscious: The Political Morality of Race, Princeton: Princeton University Press, 1998. Available at: De Gruyter, Colour Conscious: The Politics of Morality of Race.

Appendix B - Historical GBA+ Timeline (1981-2021)

1981 – 1995 : The Government of Canada commits to gender equality as per constitutional guarantees and international agreements^{Footnote 7}. In 1995, the Federal Plan for Gender Equality, Canada’s commitment to the Beijing Platform for Action^{Footnote 8} promotes gender equality through the implementation of gender-based analysis across federal departments and agencies.

2000 – 2003 : The Health Canada Gender-Based Analysis Policy and Implementation Strategy advances equality through the use and implementation of gender-based analysis.

2006 : Canadian Institutes of Health Research’s Guidelines for Gender and Sex-Based Analysis in Health Research aims at integrating gender and sex-based analysis throughout the full context of Canadian Institutes of Health Research’s peer review process.

2007 : Central Agencies reinforce their expectation that gender-based analysis be applied to initiatives prior to Cabinet and Treasury Board considerations (e.g. Privy Council Office’s Memorandum to Cabinet Information Requirements and Treasury Board Secretariat’s Guide to Preparing Treasury Board Submissions).

2009 : The revised Health Portfolio Sex and Gender-Based Analysis Policy comes into effect. The term "sex and gender-based analysis" is adopted to emphasize the importance of sex or biological differences in the health sector.

2012 : Status of Women Canada updates the term “gender-based analysis” to "Gender-based Analysis Plus" (GBA+). This approach emphasizes the consideration of other identity factors such as age, race, education, language, geographic location, culture and income.

2015 : The Health Portfolio enhances its Sex and Gender-Based Analysis Policy and welcomes the CFIA as its newest member.

2016 : In response to the OAG’s report in April 2016, Central Agencies and Status of Women Canada release the GBA+ Action Plan (2016-2020) to support GBA+ implementation, identify barriers, build GBA+ capacity, and strengthen monitoring, accountability and reporting.

2017 : The government creates new GBA+ requirements for Cabinet and regulatory initiatives, strengthens networks and enhances training for officials, and moves to support GBA+ by reinforcing greater diversity and inclusion in the public service.

2018 : Gender equality becomes a central focus of the 2018 Budget, with the Gender Results Framework tracking Canada’s performance towards greater equality and the creation of the Department for Women and Gender Equality (WAGE).

2021 : Budget 2021 introduced a Quality of Life Framework to promote holistic thinking on the determinants of quality of life in 5 domains, Prosperity, Health, Environment, Society, and Good Governance. In 2021, WAGE launched GBA Plus with new guidance and tools for a deeper focus on the identity factors and systemic issues of inequality, such as social factors, power relations, structures and systems.