Transcript GENDER SENSITIVITY - Men's Health Forum Scotland

GENDER SENSITIVITY
Experience from
Greater Glasgow & Clyde NHS
September 2006
Noreen Shields
Planning & Development Manager – Gender
Corporate Inequalities Team
‘Gender analysis’
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“a gender analysis identifies, analyses and helps to act upon
inequalities that arise from the different roles of women and men or the
unequal power relationships between them and the consequences of
that inequality on their lives, their health and their well-being. Since
these inequalities most often disadvantage women, a gender analysis
highlights women’s problems. However, it also reveals specific health
problems that men face because of the social construction of males
roles.”
WHO, 1998, Gender Policy
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Make more relevant for public & ‘move it on’ – basically men & women
have sometimes same health issues, some different. Our health is
related to how we grow up and feel ‘valued’. Part of this is feeling
valued as a ‘man’ or a ‘woman’ and how we relate to others in our lives.
‘Traditional gendered socialisation’ (gender in culture & power key,
Wilkinson, 2006) can be a key factor in why men & women are
suspicious of each other….lack respect for self & each other / lack
empowerment, which can lead to health and other problems
GGC History - Gender
• 20 years women’s health, 10 years men’s health, last
5 years increased focus gender/relational approach
(Sabo, 1999; White, 2006; Payne, 2006).
• Approaches always saw other aspects of inequality
(e.g. poverty, race, sexuality) as integral
• Evidence of gender bias in medical research &
treatment women & men (Payne, 2006)
GGC History – topic examples
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Women’s Health: ‘From women’ - reproductive health (‘Our bodies
ourselves’); feminism – effects of gender inequality on women and
men; abuse; poverty; mental health; prostitution
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Men’s Health: ‘Men not using services / meeting needs’, Gay men’s
health, sexual health, Men only health problems, masculinity and health
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Gender & Health: aim all processes gender and inequality sensitive
and have some gender specific services where appropriate
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Largely development activity on men & women’s health sought
‘opportunities’ to influence ‘mainstream’ processes. Women’s Health
Policy gave strategic ‘in’. National: Well Man Pilots – largely clinical
focus
GGC Women’s Health Policy
• Women’s Health Policy, 1992 (3rd version 2003)
Why women’s health? 3 inter-related sets
health needs arising from:
• women’s reproductive function;
• sex differences in aetiology, presentation &
management of many health problems;
• gender inequalities in society (e.g. ‘triple role’,
abuse).
GGC new inequality structure
• 9 Transformational Themes: Equality and diversity
integral. Used in personal objectives GGC
• Devolved Structure: Key leadership roles & KSFs in
health ensure equality and diversity in each job
• Corporate Inequalities Team (CIT): Coordinating,
Support & Monitoring function especially regarding
inequality legislation. Leadership - evidence best practice.
Links to performance management, OD, Policy
Development, HR, Finance, and Staff Learning Networks /
Library.
• Single Equality Scheme (RED, DED, GED) – each part
of the system own Action Plan
EXAMPLES – GENDER LEGISLATION TOPICS (1)
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Policy/Strategy: Women’s Health Policy (1996); GBV Strategic
approach; Women & Poverty strategic approach; Sexual Health
Strategy (2000) – Sandyford Initiative; Mental Health Strategy 2001 –
Development work agreed; Alcohol strategy (2002) – Gender Sensitive
Approach Piloted; Maternity services ‘strategy’ (2006)
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Service Change: Mainstream: Gender based violence programme,
Sandyford Initiative, Public Health Midwifery & ROOP, £1 million
Scottish Executive funded “Inequalities Sensitive Practice Initiative”,
Forensic mental health services. Development/pilot work (Mental
health & gender, Addictions, Well Man Pilots, Fathering, Prisons &
Men’s Health).
EXAMPLES – GENDER LEGISLATION TOPICS (2)
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Performance Management: limited experience in identifying gender
sensitive indicators. Abuse indicators will be considered in future.
“Balance Scorecard” may be considered
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Human Resource management: evidence of good practice around
inequalities / gender. Aim influence further (recruitment strategy, family
friendly policies, career advancement, SWISS)
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Procurement: Limited experience (e.g. purchased service
specifications being gender sensitive)
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Involvement: Single Equality Scheme consultation – meaningful /
ongoing link to PFPI. Provide info / raise issues / challenging
assumptions sensitively. Staff involvement / ownership (Action Plans &
Staff Networks aid)
GENDER SENSITIVITY –
KEY ELEMENTS IN PRACTICE
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Understanding impact of gender socialisation and gender in culture on
individuals / groups
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Responding to effects of gender socialisation
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Tangible aspects: accessibility, empowering relationships with staff,
workers reflect on own gender socialisation etc, choice of worker,
abuse response, poverty – gendered nature and “hidden debt”,
sexuality – ask & respond, engage people on relationships – how
gendered, gender in ‘meaningful activity’, childcare for men & women,
environment, need to consider “starting points”
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If don’t consider gender, won’t address problem systematically / factors
in underlying health problem / prevent longer term problems
GENDER SENSITIVITY –
POSSIBILITIES WITH CLIENTS
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‘Before coming here I assumed I was simply a violent and aggressive person, a
maniac. I now realise that I’m not and that I was just dealing with having been
abused. I now see myself as a completely different person thanks to Thrive. In
the past, I only had 2 mental states – OK & extreme rage. I now experience a
wider range of emotions, some good, some bad but I’m really glad I’m
experiencing them.’ (Man at service for male survivors of sexual abuse)
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‘Even on the first visit X could pinpoint what I thought was just the one thing that
was bothering me, she could pinpoint a whole lot of other things that was
coming back so that started to make my mind open up to what was really wrong
and the second time around she helped me and my husband because he was
ill.’ (Woman who attended WMHP Demo Project)
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‘I know she is depressed and she has lost her mum an all that but is it not her
job to take the wean to nursery.’ (Man & woman using addiction services)
GENDER LEGISLATION - MEASURES
• Proportionality & relevance: national & local priorities
of key relevance (e.g. mental health, abuse). ‘Hidden
/ ‘silenced’ groups’ (e.g. service review for mothers
with learning disabilities)
• Effectiveness: structure & ‘facilitation’ in place. Each
part of structure Action Plan
• Involvement: aim in consultation decode for public /
ask qs relevant to them. Statutory & non-statutory
staff
• Transparency: decision trail documented
Barriers / challenges…
• Gender & Health: not a ‘public discourse’ in UK – Academia but
abuse an ‘in’; or in media although men’s & women’s health &
relationships – gender implicit
• Lack of national strategy examples apart from abuse
• NHS discourse on masculinity very limited. Also many staff –
gender equates with women
• Inequalities seen as ‘additional work’ / optional extra / ‘politically
correct’
• Challenge not ‘lose’ clients where ‘gender blind gave degree of
comfort / colluded’ (DOH conversation)
GENDER SENSITIVITY –
GGC KEY LEARNING
• Need gender sensitive & some gender specific
services
• Need to allay fears that gender sensitivity means
“specialist” services
• Staff need to be involved in ideas & support to make
mistakes
• Can be personally challenging
• Work on abuse within gender frame can be good
starting point
• Whole system approach
References
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CRE, DRC, EOC (2006) Public Sector Duty: Three Commissions joint
position paper. London: CRE, DRC, EOC
Payne S (2006) The Health of Men & Women. Cambridge: Polity
Press
Mackenzie M, Shields N, MacDonald B (2006) Evaluation of Women’s
Health Demonstration Project. Glasgow: GGCNHS
FMR Research Ltd (2006) Evaluation of Thrive Counselling Service.
Glasgow: FMR Research Ltd
Sabo D (1999) Understanding men’s health: a gender and relational
approach. Boston: Elseveir
Wilkinson R (2005) Gender and race: ‘kicking down’. Chapter in
‘What makes rich societies sick’
Contact Details
• Corporate Inequalities Team, Greater Glasgow and Clyde NHS
Board, Dalian House, 350 St Vincent Street, Glasgow, G2 3 YU.
• Email: [email protected] (Head of Health
Improvement & Inequalities)
• [email protected] (Lead for Gender & Sexual
Orientation)
• Tel: 0141 201 4967