Health in All Policies--all talk and little action?

For three decades, Canadian and international researchers have been suggesting that improving population and public health requires attention to a range of determinants and factors and that concerted and coordinated action on the part of non-health ministries and organizations might be necessary to achieve this goal. Suggestions have been made for collaboration and integration by explicitly designing intersectoral actions and interventions and assessing the impact of all policies and programs for their effects on health. While some progress has been made on these goals, it is minor compared to the size of the problem. This article addresses one type of intersectoral action, Health in All Policies (HiAP), and asks questions about why it has not gained a place in governments across Canada. Possible barriers are suggested, such as current structural and political factors that prevent long-range, shared strategies to improve health. Suggestions are made for generating economic and evaluative data on HiAP, developing more sensitive tools for measuring HiAP and adopting explicit "trans-sectoral" approaches to policy-making.

Sex, gender, and secondhand smoke policies: implications for disadvantaged women.

CONTEXT: Although implementation of secondhand smoke policies is increasing, little research has examined the unintended consequences of these policies for disadvantaged women. EVIDENCE ACQUISITION: Macro-, meso-, and micro-level issues connected to secondhand smoke and women are considered to illustrate the range of ways in which sex, gender, and disadvantage affect women's exposure to secondhand smoke. A review of current literature, primarily published between 2000 and 2008, on sex- and gender-based issues related to secondhand smoke exposure and the effects of secondhand smoke policies for various subpopulations of women, including low-income girls and women, nonwhite minority women, and pregnant women, was conducted in 2008. These materials were critically analyzed using a sex and gender analysis, allowing for the drawing of inferences and reflections on the unintended effects of secondhand smoke policies on disadvantaged women. EVIDENCE SYNTHESIS: Smoke-free policies do not always have equal or even desired effects on low-income girls and women. Low-income women are more likely to be exposed to secondhand smoke, may have limited capacity to manage their exposure to secondhand smoke both at home and in the workplace, and may experience heightened stigmatization as a result of secondhand smoke policies. CONCLUSIONS: Various sex- and gender-related factors, such as gendered roles, unequal power differences between men and women, child-caring roles, and unequal earning power, affect exposure and responses to secondhand smoke, women's capacity to control exposure, and their responses to protective policies. In sum, a much more nuanced gender- and diversity-sensitive framework is needed to develop research and tobacco control policies that address these issues.

Tobacco use, women, gender, and chronic obstructive pulmonary disease: are the connections being adequately made?

This article reflects on a multidisciplinary workshop addressing the evidence pertaining to tobacco use, sex, gender, and chronic obstructive pulmonary disease (COPD). In preparation, a literature review was conducted that examined the academic and gray literature on tobacco, COPD, and gender and women, with a view to assessing if and how these literatures spoke to each other. These materials were discussed in a sponsored workshop (Toward a Research Agenda on Gender and Chronic Obstructive Pulmonary Disease) held in Vancouver, Canada, in 2007, engaging a variety of scientists and stakeholders in assessing the issues and emergent questions. The goal of this workshop was to foster the advancement of a research agenda that more tightly links tobacco, COPD, and lung health and that reflects and investigates sex and gender issues, especially in reference to the growing rates of COPD among women. A research agenda for consideration by researchers in the fields of women's health, medicine, tobacco use, COPD, and related fields is offered.