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Methodological and Methodological and ethical ramifications of ethical ramifications of paying attention to paying attention to gender differences in gender differences in Public Health researchPublic Health researchAnita RiederAnita Rieder
Institute of Social Medicine of the Medical University of Institute of Social Medicine of the Medical University of ViennaVienna
Kitty LawrenceKitty Lawrence
Verein Altern mit ZukunftVerein Altern mit Zukunft
Public HealthPublic Health
Science of preventionScience of prevention of illnesses, lengthening of illnesses, lengthening life and health promotionlife and health promotion
Focus on populationsFocus on populations and not so much on the and not so much on the individual, as well as, integration of social individual, as well as, integration of social responsibilityresponsibility
Public Health assumes, that illnesses and Public Health assumes, that illnesses and health health problems are influenced byproblems are influenced by physical factors, the physical factors, the social and health political environment social and health political environment
Personal health behaviourPersonal health behaviour as a factor having a as a factor having a strong influence on morbidity and Mortalitystrong influence on morbidity and Mortality
Rieder, 2006
Gender Gender specificspecific Medicine Medicine and Public Healthand Public Health
„„Being a woman or a man is a HEALTH Being a woman or a man is a HEALTH DETERMINANT that is as significant as DETERMINANT that is as significant as social origin, economic situation and social origin, economic situation and ethnic origin“ethnic origin“
Strasbourg, April 2005, Expert Committee meeting
Rieder, 2006
Measuring the Global Measuring the Global Gender GapGender Gap
Criteria for MeasurementCriteria for Measurement::– Economic participationEconomic participation – presence of – presence of
women in the workforce in quantitative women in the workforce in quantitative terms, income, statusterms, income, status
– Political EmpowermentPolitical Empowerment – no. years – no. years female head of state, women at ministerial female head of state, women at ministerial level, women with seats in parliamentlevel, women with seats in parliament
– Educational attainment – Educational attainment – primary, primary, secondary tertiary enrolment, literacysecondary tertiary enrolment, literacy
– Health and well-being Health and well-being – life expectancy – life expectancy female vs. male, sex ratiofemale vs. male, sex ratio
World Economic Forum, 2006World Economic Forum, 2006Rieder, 2006
Gender Gap Index 2006Gender Gap Index 2006
RankRank CountryCountry ScoreScore
11 SwedenSweden 0.81330.8133
22 NorwayNorway 0.79940.7994
33 FinlandFinland 0.79580.7958
44 IcelandIceland 0.78130.7813
55 GermanyGermany 0.75240.7524
66 PhilippinePhilippiness
0.75160.7516
77 N. N. ZealandZealand
0.75090.7509
88 DenmarkDenmark 0.74620.7462
99 UKUK 0.73650.7365
1010 IrelandIreland 0.73350.7335
2727 AustriaAustria 0.6990.699
World Economic Forum. The Global Gender Gap.
2006
Gender, Public Health, Gender, Public Health, EthicsEthics Population-based focus: required to Population-based focus: required to
examine ethical implications – examine ethical implications – infringement on individual libertiesinfringement on individual liberties
a framework for public health ethics a framework for public health ethics must not only be a code of restraint to must not only be a code of restraint to fairly and appropriately preserve the fairly and appropriately preserve the negative rights of citizens to non-negative rights of citizens to non-interference, but also to emphasise the interference, but also to emphasise the positive rights of commitment to positive rights of commitment to improve the public’s health and reduce improve the public’s health and reduce certain social inequities certain social inequities
Kass NE. An ethics framework for public health. American Journal of Public Health. 2001;91(11):1776-1782
Inequities between men Inequities between men and women in terms of and women in terms of health, access to public health, access to public health programmes and health programmes and medical treatments have in medical treatments have in part stemmed from the past part stemmed from the past lack of gender lack of gender differentiated research. differentiated research.
NeurologyNeurology
Gender aspects have so far played a minimal Gender aspects have so far played a minimal role in both research and clinical practicerole in both research and clinical practice
Are there differences between men and Are there differences between men and women in terms of brain function?women in terms of brain function?
Influence of pregnancy on course of illness Influence of pregnancy on course of illness e.g. Multiple Sclerosis or Epilepsy – e.g. Multiple Sclerosis or Epilepsy – comprehensivelycomprehensively
New questions arise – gender specific aspects New questions arise – gender specific aspects in older age - neurodegenerative diseases, in older age - neurodegenerative diseases, Stroke – neue FragenStroke – neue Fragen
„ „ No practical guidelines, since assured facts are No practical guidelines, since assured facts are missing“missing“
Gender Medizin: A. Rieder, B. Lohff (Hrsg.), Springer Verlag, 2004
Kapitel 9: C.Schröder, C.Wenzel und K.Weissenborn
Building a competent Building a competent workforce demands workforce demands appropriate training: appropriate training: “Developing a multi-“Developing a multi-disciplinary public health disciplinary public health training is an international training is an international as well as a as well as a national public national public health issue” health issue”
Evans D, Dowling S. J Epidemiol Community Health 2002;56:744-747
““Gender Aspects of Gender Aspects of Medical Education”Medical Education”
EU - research project carried out by the department of history,
ethics, and philosophy of medicine of the Medical University
in HannoverAim: Documentation and evaluation of all European medical curricula with respect to the extent and integration of gender specific teaching offered
It became clear, that across Europe, within the scope of medical education, practically no such teaching models exist Voss et al., Hannover, 2004
Eliminating disparities in health care Eliminating disparities in health care and public health relies on building and public health relies on building a broad and reliable evidence basea broad and reliable evidence base
Seeking out evidence, quantifying it Seeking out evidence, quantifying it and taking the evidence into and taking the evidence into consideration when making consideration when making decisionsdecisions
… …evidence does not make evidence does not make decisions people do!decisions people do!
KeywordKeyword“Gender”“Gender”
An important basis for An important basis for Public Health Strategies Public Health Strategies areare
Target group specificTarget group specific
health reportshealth reports
Rieder, 2006
Women‘s Health Women‘s Health ReportReportMen‘s Health ReportMen‘s Health Report Women‘s health reports - pioneers Women‘s health reports - pioneers
in the compilation of gender specific in the compilation of gender specific health reportshealth reports
Austrian women‘s health report Austrian women‘s health report served as a model and paved the served as a model and paved the way for men‘s health reportway for men‘s health report
Rieder, 2006
Gender und Public Gender und Public HealthHealth
Compilation and analysis of Compilation and analysis of health datahealth data
Identification of gender Identification of gender differences and assessing the differences and assessing the relevance in the health systemrelevance in the health system
Creating conceptsCreating concepts Transfer to practiceTransfer to practice
Rieder, 2006
for.....for.....
effective health care satisfying effective health care satisfying both demands and needs -both demands and needs -
preventive and curativepreventive and curative increasing health and life increasing health and life
expectancy as well as quality expectancy as well as quality of lifeof life
Rieder, 2006
Men’s Health Report Men’s Health Report of the city of Vienna 1999of the city of Vienna 1999
1st comprehensive international 1st comprehensive international scientific report on men’s healthscientific report on men’s health
Foundation for the definition of the main Foundation for the definition of the main focus points for men’s health carefocus points for men’s health care
Basis for the identification of priorities in Basis for the identification of priorities in public health care and in preventionpublic health care and in prevention
Basis for health political discussionsBasis for health political discussions
Schmeiser-Rieder et al, 1999, MA-L (Hrsg)), Schmeiser-Rieder et al, 1999, MA-L (Hrsg)), Rieder et al, Lancet 2001, Schmeiser-Rieder et al, Rieder et al, Lancet 2001, Schmeiser-Rieder et al,
WHO-Health Report on the Aging Male, 2000WHO-Health Report on the Aging Male, 2000Rieder, 2006
Implementation of the Women‘s Health Report 2005
Fields of activity and measures
Prevention and reduction of morbidity and mortality (e.g. CVD, breast cancer, lung cancer etc.)
Taking into account social situation woman-specific socialisation and health
Taking into account women‘s individual lifecycle needs
Support of women‘s health promotion and prevention
Taking into account gender differences in measures to ensure quality in health care
Women‘s HealthReport
Target groups
Areas of action
Politics
Scientific Management:Univ.-Prof. Dr. Beate Wimmer-PuchingerWomens Health Commissioner
Rieder, 2006
From research to From research to practicepractice
The Vienna Women‘s Health The Vienna Women‘s Health ProgrammeProgramme
Univ.-Prof. Dr.Univ.-Prof. Dr.Beate Wimmer-Puchinger Beate Wimmer-Puchinger Executive Officer for Women‘s HealthExecutive Officer for Women‘s HealthWomen‘s Health Program ViennaWomen‘s Health Program ViennaVienna Social FundVienna Social Fund
Rieder, 2006 Rieder, 2006
„„A Heart for A Heart for Vienna“Vienna“
Vienna Health Promotion Program Vienna Health Promotion Program 20002000City of Vienna, Fonds Soziales WienCity of Vienna, Fonds Soziales Wien
Purpose:Purpose: Reduce prevalence of Reduce prevalence of
cardiovascular risk factorscardiovascular risk factors through optimisation of life through optimisation of life
style factorsstyle factorsRieder, 2006
Rieder, 2006
Aspects to consider when incorporating gender into public health
Gender Medicine Gender Medicine The Public Health The Public Health
PerspectivePerspective
Key issueKey issueWhat do we want to What do we want to
achieve? achieve?
TTargets and objectives?argets and objectives?EExpected outcome?xpected outcome?IImpact on political decision mpact on political decision making?making?IImpact on society?mpact on society? Rieder, 2006
Gender-Specific Gender-Specific MedicineMedicine ““Much is still unknown and there is ample Much is still unknown and there is ample
scope for research”scope for research” ““Current best models of care will benefit Current best models of care will benefit
from findings revealed by gender – based from findings revealed by gender – based research”research”
““Our major challenge will be to determine Our major challenge will be to determine the relative contributions to gender-the relative contributions to gender-specific health of biological and social specific health of biological and social factors”factors”
““Research findings have the potential to Research findings have the potential to bring about policy changes……. “bring about policy changes……. “
Correa-de Araujo, et al, JAMA, 292:2921-2922, 2004
Rieder, 2006
Gender Gender SpecificSpecific MedicineMedicinehas a major has a major responsibility to meet responsibility to meet the societal needs and the societal needs and to contribute to the to contribute to the societal value of health societal value of health research…research…
Rieder, 2006